I think you would struggle to find someone, especially nowadays, who would not want to step in to help someone experiencing a mental health crisis.

We are, as a society, much more aware and understanding of mental health problems and we are much more willing to offer support to help those who are struggling.

But how do we spot a mental health crisis?

Despite being much better informed about mental health, there persists the potentially dangerous idea that mental health crises are easy to spot.

When asked to picture a person experiencing a mental health crisis, we may imagine someone:

• crying profusely
• reacting to auditory, visual, or other hallucinations
• self-harming or having visible self-harm injuries
• making a suicide attempt

This wouldn’t be entirely wrong, as these signs may well be present in a mental health crisis.

However, mental health crises are not always this striking. There are often much more subtle (and unfortunately, overlooked) signs that someone is in distress.

Mental health is complex; there are as many ways to experience a mental health crisis as there are people in the world.

Nevertheless, there are some similarities or common trends that, if noticed, can give us an important heads-up that maybe this person might need some help.

So what should we look out for?

Changes in body language

If someone has started frequently displaying body language that suggests they are feeling anxious or stressed, this may be a sign that they are struggling with their mental health.

Make sure you don’t joke about their leg-bouncing, nail-biting, or hair-pulling, even if you usually share banter with this person. Joking about it can add another layer of stress, as they may worry about disguising these habits for fear of being mocked.

Gently (and privately) mention that you’ve noticed it and wondered if they had something on their mind.

Avoiding social events or cancelling at the last minute

Some people just don’t enjoy social events and that is totally fine. However, if this person has gone from being outgoing and sociable to withdrawing from and avoiding social settings, this may indicate that their mental health is affecting their ability to socialise.

Again, it’s important not to joke about this, and definitely don’t put pressure on them to attend an event – especially in front of other people.

Instead, try mentioning that you’ve missed them at recent gatherings and ask them if they are struggling to attend. It may be linked to their mental health, as self-isolation is common in those experiencing mental health crisis.

However, it is important not to make assumptions. It may be that they are experiencing financial difficulties or maybe they can’t get childcare. Listen compassionately, offer support or signpost them to the appropriate help.

Frequent absences from work or school

This is a tricky one because there can be so many reasons for absences and again it’s important not to make assumptions and not to make the person feel guilty or embarrassed about their absences.

Nevertheless, as I mentioned previously, self-isolation is common in mental health crises, and as this progresses, it can seep into work or school attendance, as well as social events.

If you want to have a conversation about this, make sure that you make it abundantly clear that they are not in trouble and you are not reprimanding them for their absences. Remain non-judgemental and ask if there is anything with which you can support them.

Missing deadlines or declining grades

When experiencing a mental health crisis, it can be incredibly difficult, if not impossible, to manage your workload or coursework.

Symptoms related to mental health crises, such as severe fatigue, problems with concentration, feeling overwhelmed, suicidal ideation, and so on, can all create barriers to meeting deadlines or producing work that they previously managed.

Increased or excessive use of alcohol or drugs

This one may not be easy to notice. When I was experiencing a mental health crisis and was drinking heavily, I did so at home where no one else would see.

However, if someone has started regularly mentioning how hungover they feel, it might be worth privately broaching the subject and asking if everything is alright.

It’s important not to pass judgement on their alcohol or drug use – this will only serve to alienate them and discourage them from accepting help. Remain neutral, offer support, and if appropriate, signpost them to professional help.

Dishevelled appearance or declining personal hygiene

When at my lowest, my personal hygiene went out the window. I simply didn’t have the energy or the motivation to shower every day, brush my hair, put on clean clothes, or brush my teeth. This was out of character for me. Prior to my mental health crisis, I was always well-kempt and appropriately dressed.

If you notice that they start to regularly appear uncharacteristically dishevelled or their personal hygiene starts to suffer, it may be time for a chat.

Do not specifically point out that you think they look a mess! This could be incredibly embarrassing for them and cause them to retreat further. Instead, keep the conversation broad and give them ample opportunity to talk about what is going on with them.

Self-deprecating or negative comments about themselves

Some people – myself included – are, and always have been, very self-deprecating. It’s just part of my humour!

But, if someone has started doggedly making negative “jokes” about themselves or criticising themselves, this may suggest that they are struggling.

Mental health crises can involve a lot of self-criticism and feelings of worthlessness, which may display itself as self-deprecation. At this point, it’s not just a joke anymore.

Alongside finding out if they need some support with their mental health, try to offer genuine, meaningful encouragement or compliments. When someone’s brain is overwhelming them with self-criticism, it’s important to highlight and bring to their attention the all the wonderful things about them that they might not currently be able to see for themselves.

Making offhand comments about disappearing or wanting to die

Mental health crises can lead to the lowest of low places: feeling suicidal. However whilst this may result in a visible, public suicide attempt, more often than not, it is hidden away from the outside world.

While (thankfully) some people feel able to tell someone that they are suicidal, this is not the case across the board. There can be a lot of shame and embarrassment around admitting that we are having suicidal thoughts.

Little offhand comments may slip out, such as “I wish I could just disappear” or “They’d be better off if I was just gone”.

It is absolutely crucial not to ignore these comments or brush them off as ‘just a figure of speech’..

Take them seriously. Act immediately. Help them to get the support they need.

Now, all of this is not to say that noticing one of these signs definitely means that someone is experiencing mental distress.

They could just be having a one-off bad day or it could even just be part of their personality – for example, as I said earlier, not everyone enjoys social gatherings and they may prefer spending time with their family at home.

However, if you notice these signs persistently and it seems out-of-character for that person, it can’t hurt to have a casual, private chat with them just to check-in.

If it turns out to be nothing, that’s great!

You’ve put your mind at ease and you’ve shown your friend/family member/colleague/classmate (etc) that you care about them and that you’re available if they need help in the future.

But if it’s something, you just might be able to help someone who really needs it.

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Can you think of any other important signs of a mental health crisis to look out for?

Feel free to share them in the comments below.

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