Most likely, we already check in on our friends and family on a regular basis. However, if you notice any of the following listed below, you might consider checking in on them more often and offering a different level of support. Reaching out right away could make a difference.

Reach out more if you notice any of the following:

• Excessive worrying or fear
• Feeling excessively sad or low
• Confused thinking or problems concentrating and learning
• Extreme mood changes, including uncontrollable “highs” or feelings of euphoria
• Prolonged or strong feelings of irritability or anger
• Avoiding friends and social activities
• Difficulties understanding or relating to other people
• Changes in sleeping habits or feeling tired and low energy
• Changes in eating habits such as increased hunger or lack of appetite
• Changes in sex drive
• Difficulty perceiving reality (delusions or hallucinations, in which a person experiences and senses things that don’t exist in objective reality)
• Inability to perceive changes in one’s own feelings, behavior or personality (”lack of insight” or anosognosia – pronounced uh-no-sog-NOH-zee-uh)
• Overuse of substances like alcohol or drugs
• Multiple physical ailments without obvious causes (such as headaches, stomachaches or vague and ongoing “aches and pains”)
• Thinking about suicide
• Inability to carry out daily activities or handle daily problems and stress
• An intense fear of weight gain or concern with appearance

It is important to recognize that emotional struggles can happen to anyone. It is not exclusive to a certain race, ethnicity, sex, age, education level, or financial status. It can be difficult to know what to do or say.

Offering support isn’t about having all the answers or solving someone’s problems. It’s about caring, listening, and helping them connect to additional support and resources if necessary. It is about being there for the person and letting them know they are important and significant to you. It’s about letting them know they are not alone.

The following are some tips to help get you started. These are simple actions that anyone can do to offer support. Do not underestimate the power of kindness and being present for someone.

First, determine the right time and place. Sometimes this is easier said than done. Ideally, you want to find a time that works for both of you and provides enough time for a conversation that won’t feel rushed. Try to find a safe location where the person will feel comfortable talking.

Check in. Start by asking, “How have you been?” or “How’s it going?” If their response is “Fine” or “Good” or “OK,” then follow up by sharing what you’ve noticed and that you’re concerned about them. More often than not, the person will appreciate that you care and are checking in. Sometimes, though, a person may respond angrily, become defensive, or simply state that they don’t want to talk about it. Whatever the case, remain calm and respectful, don’t argue or judge, and let them know you’re there for them if they ever want to talk.

Listen. Listen. Listen. It’s okay if you don’t know exactly what to say. Sitting with someone and listening and being present with them is a great way to offer support. When someone is not present, it is noticed. So, be sure to listen without any distractions and give the person your full, undivided attention. Put your phone on silent mode, and keep it out of sight. Also, remember to listen with respect, empathy, and an open mind. Listen without judging their thoughts, feelings, or perspective. And, every so often, summarize what they have said to make sure you’re understanding. This also demonstrates that you really care and are truly listening.

Avoid minimizing. Don’t make comments like “You’re fine” or “Cheer up” or “It could be worse.” Instead of helping, these comments minimize what the person is going through and could lead to feelings of shame or embarrassment.

Avoid giving advice. Unless the person specifically asks for your advice, don’t give it. Keep listening and asking open-ended questions. Maybe ask them what they think might help. Ask something like, “Have you been through something like this before? What helped then?”

Ask, “”How can I help?” Don’t assume you know what would be helpful to someone who is struggling. It’s always better to ask, “How can I help?” If they’re unsure or respond with “Nothing, I’m fine,” offer a few suggestions for things you are willing to do. Don’t be pushy though. Maybe offer things like running a few errands for them or cooking them a meal.

Practice random acts of kindness. Sometimes doing something for them, such as bringing them a meal or helping around the house, is what they need. It can be hard for people to ask for help when they need it.

Stay connected. Checking in with a quick text/call saying you are thinking about them lets them know they are not alone. Remind them that you’re still there for them. Continue doing this every couple of days or weekly.

Be inclusive. Keep including them in social activities. Also, understand if they initially commit but later decide not to come. Be supportive by not making them feel guilty, and let them know you will check in on them later. Keep inviting them to events, even if they consistently decline.

Know when to seek professional help. Sometimes the support you can offer won’t be enough. If you notice that your friend or loved one continues to struggle after weeks or months, they may be showing signs of a mental health condition and likely need professional help. Don’t be afraid to encourage them to seek help from a mental health professional, and offer to help them find a provider if needed. If someone you care about is in immediate danger of taking suicidal action, seek help by calling 911 or going to the closest emergency room. Trained crisis counselors are available 24/7 by texting MHA to 741741, calling or texting 988, or chatting at 988lifeline.org.

The following information comes from the Substance Abuse and Mental Health Services Administration (SAMHSA)

If a friend or family member is showing signs of a mental health problem or reaching out to you for help, offer support by:

• Finding out if the person is getting the care that they need and want—if not, connect them to help.
• Expressing your concern and support.
• Reminding your friend or family member that help is available and that mental health problems can be treated.
• Asking questions, listening to ideas, and being responsive when the topic of mental health problems come up.
• Reassuring your friend or family member that you care about them.
• Offering to help your friend or family member with everyday tasks.
• Including your friend or family member in your plans—continue to invite them without being overbearing, even if your friend or family member resists your invitations.
• Educating other people so they understand the facts about mental health problems and do not discriminate.
• Treating people with mental health problems with respect, compassion, and empathy.

Do you need help starting a conversation about mental health? Try leading with these questions and make sure to actively listen to your friend or family member’s response:

• I’ve been worried about you. Can we talk about what you are experiencing? If not, who are you comfortable talking to?
• What can I do to help you to talk about issues with your parents or someone else who is responsible and cares about you?
• What else can I help you with?
• I am someone who cares and wants to listen. What do you want me to know about how you are feeling?
• Who or what has helped you deal with similar issues in the past?
• Sometimes talking to someone who has dealt with a similar experience helps. Do you know of others who have experienced these types of problems who you can talk with?
• It seems like you are going through a difficult time. How can I help you to find help?
• How can I help you find more information about mental health problems?
• I’m concerned about your safety. Have you thought about harming yourself or others?

When talking about mental health problems:

• Know how to connect people to help (https://www.samhsa.gov/find-help)
• Communicate in a straightforward manner
• Speak at a level appropriate to a person’s age and development level (preschool children need fewer details as compared to teenagers)
• Discuss the topic when and where the person feels safe and comfortable
• Watch for reactions during the discussion and slow down or back up if the person becomes confused or looks upset

Tips for Being a Support to Others

• Steps to Support is a guide for what to do and say when someone you know is going through a hard time.
  Visit  stepstosupport.com/.
• The Mental Health Coalition is a coalition of the leading mental health organizations, brands, and individuals who have joined forces to end the stigma surrounding mental health and to change the way people talk about, and care for, mental illness. Visit  thementalhealthcoalition.org/get-involved.
• Seize the Awkward helps provide young people with the inspiration and resources they need to help them reach out to their friends and start conversations about mental health. This toolkit will help you share the tools that Seize the Awkward provides within your communities and networks.
  Learn more at  seizetheawkward.org/.
• Emotional Support Human is an initiative of the Horizon Foundation in Howard County Maryland. The initiative is working to normalize conversation around mental health and reinforce the idea that we can all be a pillar in a time of need. Learn more at  supporthuman.org.

Mental Health and Mental Illness

• Explore the “Learning Centers” at MyConnectionNEW.org to expand your understanding of a variety of mental health conditions:  Learning Center
• Explore “Mental Illness, Recovery, And The Science Behind It” at Mental Health America’s website:  mhanational.org/science. Visit the section “Mental Health Information” to learn about the signs and symptoms of mental illness, facts, statistics, and the latest news on mental illness:  mhanational.org/MentalHealthInfo.
• Learn more about mental disorders, treatments and therapies in the “Mental Health Information” section of the National Institute of Mental Health website:  nimh.nih.gov/health
• “Looking After Others” and “Looking After Yourself” are resources on the Centre for Clinical Intervention (Australia) website which contain a wealth of information on a variety of mental health conditions as well as tools to help develop coping strategies for living well with these conditions:  cci.health.wa.gov.au/Resources/Looking-After-Others

Training opportunities to expand my support skills

• Mental Health First Aid is a skills-based training course that teaches participants how to identify, understand, and respond to someone experiencing a mental health and/or substance-use issue. To learn more and to find a course near you, visit  mentalhealthfirstaid.org.
• QPR trains participants in the 3 simple steps anyone can learn to help save a life from suicide – Question, Persuade, Refer. To find out more about QPR training opportunities, go to Prevent Suicide Fox Cities at  preventsuicidefoxcities.org or the QPR Institute at  qprinstitute.com/.
• Emotional CPR (eCPR) is a community education program that teaches people how to support another person experiencing an emotional crisis. It is a hope-based public health approach to build strong, resilient, cooperative communities. To learn more about eCPR and eCPR training visit Ebb & Flow Connections at  ebbandflowcooperative.com/ecpr.
• National Alliance on Mental Illness (NAMI) Fox Valley offers a wide variety of classes and presentations that provide vital information about mental health, mental illness, treatment, and resources. To learn more about NAMI Fox Valley’s mental health education opportunities visit  namifoxvalley.org/.