Early signs of mental illness: How to identify and respond to them

Understanding the early signs of mental illness can alert you that a friend, family member or co-worker is struggling. Just like knowing CPR can save lives during an emergency, knowing signs of mental illness can enable early intervention that improves quality of life and potentially prevents self-harm.

"Early intervention makes it easier to get in front of almost any health condition, including mental illness," says Dr. Chris Rogers, medical director of child and adolescent services at the Medical Center of Aurora and associate program director of the HealthONE psychiatry residency program.

Dr. Rogers' specialty is working with kids and teens, but mental health struggles have been on the rise in people of all ages, even before the start of the COVID-19 pandemic. "So many people are struggling right now," Dr. Rogers says. "The chief factor is feeling alone. People don't always know how to get help; they don't always think their struggles are worth getting help for."

When parents, family members, friends or teachers recognize that someone is struggling and reach out with a simple question like, "Are you OK?" it can help connect that person to the care they need.

How to recognize early signs of mental illness

"Any real change — a sudden or abrupt departure from usual behavior — should be on your radar," says Dr. Rogers. For example, if someone who's normally social suddenly wants to be alone most of the time, or if someone who's usually physically active wants to watch TV all day, that's a good reason to check in with them.

The early signs of mental illness can vary at different ages or stages of life, Dr. Rogers says. With small children, an early sign of stress may be suddenly having accidents or wetting the bed after being potty-trained. Older children may experience night terrors or frequent nightmares.

"Teenagers are a little trickier," Dr. Rogers admits. This is when self-harm becomes more of a possibility. Kids who are cutting themselves may hide the wounds and scars by suddenly wearing long sleeves or pants. He also points out that older adults are often hit hard by loneliness, depression and mental illness but may be less likely to ask for help.

Other early signs of mental illness — including depression, anxiety, substance use or other disorders — can include:

• Not sleeping or sleeping too much
• Changes in eating patterns, including eating too much or loss of appetite, even for favorite foods
• Mood changes, such as irritability or lack of emotional response
• Lack of energy
• Withdrawal from usually enjoyed activities
• Unexplained pain or symptoms, such as headaches or stomachaches
• Excessive worry
• Feelings of guilt
• Difficulties adjusting to changes in schedules or situations, even a reluctance to try new foods or meet new people
• Drug or alcohol use

Some of these signs are completely normal during times of stress and will go away or decrease after some time. But if a change in behavior persists for more than a few days, or appears to a greater degree than usual, that's an indicator someone may be struggling with their mental health and could use some support.

What to do if someone you know is struggling

"It's often easier to tell that someone is struggling than to know what to do about it," Dr. Rogers says. Broaching the conversation about mental health or asking questions about whether someone is considering self-harm can feel daunting.

Dr. Rogers says that ideally, you have a relationship with the person where you're used to talking about emotions, feelings and mental health issues, such as depression and suicide. "These should be topics that people are comfortable talking about," he says. "If you've already started that conversation, it's not as awkward to bring up the topic."

Normalize seeking help and open conversations

In conversations about mental health, Dr. Rogers suggests normalizing the idea of seeking help by mentioning times when talking to a friend or seeking therapy helped you deal with a difficult issue. "It's so much easier to open up to someone who they don't see as perfect or who has been open about what it was like to get help," he says.

Parents, especially, express fears that talking to their children about suicide will plant the idea in their heads. But studies show that when parents talk openly and proactively about mental health and suicide, it actually helps protect kids. The same is true of drug use.

Getting comfortable with talking to a therapist or mental health professional about life goals and normal life stresses can make it easier to get help in times of crisis. "I encourage everyone to think about having mental health checkups," he says. You can do this by talking to your primary care provider or going directly to a mental health professional who participates in your insurance. If you don't have insurance, most counties have community mental health centers that offer low-cost or free services.

Show your support

"If you think someone you know may be struggling, the best thing to do is to try to connect with them and offer support," Dr. Rogers says. If someone has been spending a lot of time alone, ask them to go for a walk or to join you for coffee. If they're going through a stressful time, let them know they can talk to you. Or, you can offer to find a therapist for them or help them make an appointment with their doctor.

Across the nation, dialing or texting 988 will connect you to the Suicide & Crisis Lifeline, a network of over 200 crisis centers that are available 24/7. Trained counselors will listen, provide support and connect with resources as necessary.

Speaking up — and knowing the early signs of mental illness — can save and improve lives.

Find information about mental health resources from our broader health network, HCA Healthcare.