Noticing signs of mental illness

---

HealthWiki > Promoting Community Mental Health > Chapter 3: Serious mental illness > Noticing signs of mental illness

---

In this chapter:

 

In this chapter:

• Chapter 3: Serious mental illness
• Noticing signs of mental illness

Being aware of the signs of serious mental illness can help you respond if someone needs help. The more that people get the good, respectful treatment they need, the better the condition will be managed. As is true for all of us, isolation and added stress make things worse. Finding ways to maintain connectedness for the person going through serious mental health difficulties is essential.

Warning signs

Signs of serious mental illness can be similar to those of common and less severe mental health challenges (for example, see “Depression”). It is less worrisome when a person’s behavior changes only for a short time or has a clear explanation—such as difficulty sleeping when under extra stress, or feeling deep sadness following the death of a loved one. But if changes alarm you, or if they continue or get worse over time, it could be more serious. Even when people do not talk about what is going on, you may notice changes in how they act, things they say, or just that they seem “off.” Signs include:

• Seeming especially down or showing persistent sadness for two weeks or more.
• Feeling tired all the time or without energy to carry out daily activities.
• Avoiding interactions with people, cutting off relationships, or suddenly spending a lot of time alone.
• Saying they feel lonely, without purpose, overwhelmed, ashamed, or hopeless.
• Outbursts of anger or extreme irritability. In children, frequent or extreme emotional outbursts.
• Changes in eating habits, loss of weight, not taking care of themselves as they usually do.
• Difficulty sleeping or having nightmares.
• Using more alcohol or drugs than usual.
• Frequent headaches, stomachaches, or unexplained aches and pains.
• Changes in school or work performance, difficulty concentrating.
• Avoiding or missing school, work, or other usual activities.
• A notable backsliding in skills for children. For example, a child who used the toilet now has frequent accidents, a child who showed independence becomes very clingy, or a child who was talking no longer uses words.
• Drastic changes in mood, behavior, or personality.
• Hurting oneself or talking about it. Saying they want to escape or wish they were dead.

Signs are different for each person and not everyone with one or two of these signs needs medical help. But showing multiple signs or signs that continue over time is a reason to talk to the person and be aware of what might be going on with them. If a person is thinking about or mentions suicide, take them seriously. Speak with them directly about this and connect them to help (see the list of hotlines and other help lines).

Severe depression

Depression is considered severe based on how long the person has had it and how much it interferes with their functioning. The most important thing for someone struggling with severe depression is for them stay connected, to not feel alone. Make it clear that you are comfortable being with people who are feeling low, that you are interested in their experience, and that they are not a burden when they share their situation with you. Ask what help and support they have now, and what they have found helpful in the past. Ask specifically about medications—are they starting, restarting, or changing medications, either prescribed or self-treating. Using medicines does not always affect depression as hoped, as quickly as hoped, or in a predictable way. To better manage, people taking medicine for depression may benefit from an ongoing relationship with a mental health provider, or at least from checking in about their medications.

A common experience with depression is feeling unable to do anything at all, including something that might lessen the depression, such as exercise or group activities. This can become a vicious cycle. A support group where people share experiences and provide moral support to one another can help break the cycle and make a big difference.

Mania

Mania means being very keyed-up. A person who is manic may feel extremely happy, talk fast, move fast, not sleep, start big projects, make rash decisions, drive too fast, or spend a lot of money.

A person in a manic state can be so caught up in the experience that it is almost impossible to interrupt them when speaking, slow them down, or get them to reflect on their actions. They may believe they are super-important or on a special mission. Mania usually feels good, so people don’t want it to end, but it can cause people to do harmful things.

If you see someone becoming manic, stay calm and work to stay connected with them. Listening techniques may be helpful. If the person is about to do something important—like quit their job or make a major purchase, without much thought or consideration of the longer-term consequences —don’t argue about whether the idea is good or bad. Instead, encourage them to delay and take some time to think it over. Get in touch with people who know the person well and share your observations about their behavior, preferably with the person present and involved in the conversation. If the person knows they have bipolar disorder or another condition related to mania, perhaps they can check with their health care providers about medications. If this is a new experience for them, perhaps you can help them get an evaluation.

People who have had mania in the past can learn to identify their early warning signs, such as difficulty sleeping, racing thoughts, or a hard time focusing. They can arrange for support when they notice these signs developing and limit the negative effects of their mania.

Post-traumatic stress disorder (PTSD)

PTSD is a severe response to trauma following one or a series of terrible events or situations. Instead of the person feeling better over time, their emotional and physical reactions continue and are severe enough that it becomes hard for them to function. Signs of PTSD can include a person reliving the traumatic experiences in their mind (flashbacks) while awake or at night, interrupting sleep. Other signs are feeling numb or hopeless, severe levels of anxiety, being very watchful and always on alert for danger, and overreacting when startled. When responses intensify or continue for months or years and limit people in their everyday lives, PTSD is one way to describe this set of effects of long-term trauma.

While these are common and expected reactions to surviving or witnessing violence or other traumatic situations, finding the right kind of support after the event can help someone heal without developing the difficult and debilitating symptoms of PTSD. Helping someone feel emotionally safe is important as well as not pushing them to talk if they don’t want to. Make sure they have control over as many decisions as possible.

Supporting someone with PTSD often involves talk therapy, peer and other social support, integrative therapies, and the many traditional cultural strategies that help someone ground themselves and reset their body and mind. Talk therapies that help can include those focused on what is felt in the body (somatic experiencing), thoughts while paying attention to a back-and-forth movement or sound (EMDR), and new skills to help deal with the traumatic memories (different types of trauma-focused cognitive behavioral therapy/CBT). Psychiatric drugs work for some people, and recent research shows that psychedelic drugs (including MDMA, LSD, and others), given under trained guidance, can help some people with PTSD.

Psychosis

Psychosis means losing touch with the reality shared by most people. People with psychosis may not be able to make decisions or act as they normally would because the world they are experiencing has changed. They may have hallucinations: hearing voices or sounds that others do not, or seeing, feeling, tasting, or smelling things that are not there. Psychosis can also cause delusions, such as a false belief that they are being persecuted, on a special mission, or being controlled by outside forces. Psychosis can dramatically change thinking, emotions, and behaviors and will disrupt a person’s life, making it difficult to initiate or maintain relationships, care for themselves or others, work, or carry out other usual activities. Psychosis is very distressing to experience. It is also very hard to watch someone you know go through it.

Common signs of psychosis:

• Changes in emotion and motivation. These can include depression, anxiety, irritability, being suspicious, acting without emotion or showing emotions that are out of place, changes in appetite, and changes in energy.
• Changes in thinking and perception. These can include difficulties with concentration or paying attention, the feeling that they or others around them have changed or are acting very differently, a change in or absence of the senses (smell, sound, or color).
• Changes in behavior. These can include severe problems getting enough sleep, social withdrawal or isolation, and difficulty carrying out regular activities related to work, family, and other common settings.

How to communicate with a person experiencing psychosis

It can be hard to communicate with a person experiencing psychosis because the two of you are not experiencing the same reality. They may not be aware that you find their behavior unusual. With a person showing signs of psychosis:

Use caution and remain calm. While keeping yourself safe, do what you can to help them feel safe talking with you. Do not stand too close or over them. Do not touch them without permission. Speak calmly and carefully, using common, ordinary language. (See “Your safety matters,” and other communication tips.)

Ask what they believe is happening. Use listening techniques and take care not to show judgment or tell them what to do. Ask if they are experiencing something that troubles them, if they notice changes in how they are feeling, or what they are thinking about.

Don’t argue. If they are speaking with you about a hallucination or delusion, do not argue with them about it or deny that it is happening. Acknowledge that what they are experiencing is real to them without confirming or denying what they are seeing or feeling. You can say: “I accept that you hear someone giving you those instructions.”

Seek help. Try to get in touch with people who know and are trusted by the person. Share what you saw the person doing or saying, preferably with the person present and involved in the conversation. If the person has a condition like schizophrenia that can involve psychosis, ask the person which friends and family may know about their experiences with medications or have permission to talk to their health care provider. If this is a new experience for them, perhaps you can help them get an evaluation and care. Avoid involving the police, especially when there is no emergency.

Chapter 4 is about helping people in crisis. It includes information about mental health crisis programs that can provide alternatives to involving the police.

Peer mental health support: People who have been there

Integrating peer support into mental health care is remarkably successful. People facing mental health challenges are more likely to trust, listen to, and learn from another person who has faced those same challenges. Because they have “been there” themselves and are committed to not holding power over the person, peer support workers have proven better at connecting with people who often feel isolated and distant from traditional professionals.

In the US, several peer support programs highlight the unique empathy from someone with lived experiences with mental illness, offering a type of mental health care that is culturally and socially relevant and accessible.

Project LETS is a US grassroots organization led by and for folks with lived experience of madness, disability, and trauma, and people who are neurodivergent (meaning their minds work in ways that others think unusual, despite this being very common). The project’s Peer Mental Health Advocates work one-on-one with people unable or unwilling to access professional help, as well as people who do have a therapist or psychiatrist but are in need of more support.

The Wildflower Alliance has for decades promoted, given trainings for, and been a provider of peer support. Its Western Massachusetts community centers welcome people—without appointments or paperwork—to be with others, participate in community activities, find a support group, or talk one-on-one. Wildflower’s Afiya Peer Respite House also provides up to a week of housing (a private bedroom) on short notice when a person needs a place to step away from their living situation with access to peer support 24 hours a day. Online support groups and community discussion through the social platform Discord also provide peer support. These spaces let people share openly whatever is going on for them without having to fear judgment, unwanted advice, or coercion.

The Wildflower Alliance, Project LETS, and other peer support networks recognize that for many people, experiences with severe mental health challenges are not so simple as being sick or being recovered. For some people, peer support has proven to be a powerful alternative to traditional medical approaches.

Our core values include giving people choices, making the process collaborative rather than telling people what to do, and making the peer relationships mutual and equal.

Our peer-run respite house strives to provide a space in which each person can find the balance and support needed to turn a difficult time into a learning and growth opportunity.

This page was updated:18 Apr 2025