Experts wish more people spotted the signs earlier: feeling overwhelmed, not feeling “like yourself,” shifts in sleep, behavior and mood.
The United States has a mental health problem, data from the U.S. Centers for Disease Control and Prevention show. More young people, especially girls, are reporting poor mental health. And while the national suicide rate fell slightly in 2024, it did so from one of its highest levels ever reported.
Mental health crises can happen abruptly or build to a tipping point over time. They can be fueled by a sudden loss or traumatic event, personal or societal upheaval, underlying health conditions, or any combination of factors.
Whatever the cause, experts say the best thing to do is to spark a conversation as early as possible and connect to a broader support system.
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EDITOR’S NOTE: This story includes discussion of suicide. If you or someone you know needs help, the national suicide and crisis lifeline in the U.S. is available by calling or texting 988.
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Recognize the signs of a crisis
Mental health professionals say what constitutes a crisis varies from person to person. But there are some key signals that could indicate someone is struggling, and they can be subtle at first.
“My crisis might not be your crisis, but what we do know is that — however people define crisis — there is a change in how they’re feeling, a change in how they’re behaving,” said Dr. Theresa Miskimen Rivera, president of the American Psychiatric Association.
Crises can start as someone feeling depression or anxiety but not quite being able to pinpoint the cause, Miskimen Rivera said.
Other signs can include:
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— Not enjoying or engaging in things they used to like.
— Engaging less socially.
— Sleep irregularities.
— Decreased hygiene.
— Increasing use of alcohol or drugs.
— Extreme mood swings.
— Talking about being a burden on others.
— Feeling hopeless, wanting to die or kill themselves, having no reason to live.
If you see these changes, it’s time for a conversation, experts say.
Prepare for the conversation
Crisis intervention experts recommend taking a moment to do some research and prepare before jumping into a conversation with someone in crisis.
Tips and resources can be found on the websites of organizations including the National Alliance on Mental Illness, The Trevor Project, the American Psychological Association and 988, the U.S. mental health crisis hotline. You can also call, text or chat with 988 to get guidance on how to start a conversation.
“We get more than 10 million calls, chats and texts a year, and a lot those are actually people just looking for resources for someone in their life that’s struggling,” said Tia Dole, who oversees the lifeline.
How to have the conversation
Alex Boyd, director of crisis intervention at The Trevor Project, which runs a suicide prevention hotline for LGBTQ+ youth, breaks the initial conversation into four parts:
— Start with an open-ended question that acknowledges the shift in behavior. For example: “I noticed you haven’t been showing up to (the space we share) recently. I want to check in. What’s going on?”
— Express your care and concern for the person.
— Ask what the crisis looks like for them. “What’s been going on for you that has led you to (name the change in behavior)? What’s changed for you? What are you concerned about?”
— Acknowledge it is a tough time and ask directly: Are you having thoughts of suicide or self-harm? At this point, you should also think about other support and resources for the person. Your job is to support them, not treat them. Ask them: What would feel helpful right now?
Speak openly about suicide
It’s a common myth that asking someone about whether they are contemplating suicide can put the thought in their mind, experts said.
It may seem awkward or scary, but it’s very important to ask people directly if they have plans to harm or kill themselves and if they intend to act on them.
If they have a plan, Boyd recommends saying something like: “What would lead you to actually take that step? Because that sounds scary. I don’t want that to happen. What would lead you to feel more escalated to act on the plan?”
If someone is in immediate danger of harming themselves or others, seek professional help immediately. Ideally, you can do this in collaboration with the person in crisis, with the goal of giving them agency and build their confidence to ask for help, Boyd said.
Calling 988 or another helpline can connect you to available crisis intervention teams or other specialized resources.
Phoning 911 or going to an emergency room are options, experts say, though not all emergency medical service personnel or dispatchers are trained in mental health intervention.
Starting the conversation is only the beginning
Mental health crises are complex, experts say, and it is critical to understand cultural stigmas and other barriers that might be at play in starting a conversation.
For some, jumping right in with diagnostic words like “depression” and “anxiety” can cause the person to shut down, Dole said. Others might not say anything the first time you try to have a conversation, but come back days or weeks later to talk.
Dole recommends using “parallel activities” to take the pressure off the conversation. Creating space for a conversation about mental health while taking a walk or during a car ride can allow someone to open up without forcing eye contact or formality, she said.
It’s important to validate and normalize the person’s experience without minimizing it, experts said. Don’t write anything off as “just a phase.” Sharing your own experience can be helpful to a degree, but make sure not to make the conversation all about yourself.
True healing can take years
Your loved one may also need support as they navigate years of care and the complexities of the mental health care system. Their options may be limited based on whether they have insurance, where they live or their personal identity. They may have to try several therapists before they find the best fit.
“Getting help — the traditional, clinical help — is really hard,” Dole said. “It takes perseverance to find a clinician.”
She encouraged people to also consider leaning on other, nonmedical resources, including faith-based organizations, community centers and schools.
Above all, don’t let the news that a loved one is struggling taint your view of them.
“Being suicidal or having a mental health crisis does not diminish who they are as your loved one,” Dole said. “They’re still them.”
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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.
