Spotting the signs

You're looking for change, not symptoms

People expect mental illness to announce itself, and it very rarely does. There's no moment where someone becomes visibly unwell. What there is, almost always, is a slow drift away from how that person normally is — and because it's gradual, the people closest to them adjust to it without noticing.

That's why family and friends spot things that professionals can't. I only ever meet someone at one moment in time. You have twenty years of knowing what normal looks like for them. That knowledge is the diagnostic instrument, and it's a good one.

Where change tends to show first

Withdrawal

Cancelling more than they used to. Replying to messages days late, or not at all. Being in the house but not in the room. This is usually the earliest sign and the most consistently ignored, because it's easy to read as being busy, or rude, or just growing apart.

Sleep

In either direction, and it matters more than almost anything else. Awake at four in the morning, repeatedly. Or sleeping twelve hours and still exhausted. Disrupted sleep both signals and worsens nearly every mental health problem there is, so it's worth taking seriously in its own right.

Function

The practical business of a life quietly stopping: post unopened, bills unpaid, work slipping, meals skipped or becoming erratic, appointments missed. Ask what they've stopped doing, rather than how they feel — people find the first question far easier to answer honestly.

Self-care and appearance

Washing less. Wearing the same clothes for days. A noticeable change in weight in either direction. Someone who has always been particular about how they look becoming indifferent to it is a significant change, not a lapse.

What they say, and how

Flatness. Irritability that's out of character. Speech that's much faster or much slower than usual. Thoughts that are hard to follow. And the phrases that sound like passing remarks and aren't: everyone would be better off without me, I'm just a burden, what's the point.

What it looks like in different people

Teenagers

The hard part is that ordinary adolescence looks similar — withdrawal, moodiness, new sleep patterns. Look for duration and breadth. Two bad weeks is adolescence. Three months of dropping every friendship, every interest and every routine at once is not. A sharp fall in school performance in a child who was doing fine is one of the clearest signals available, and it's the one most often treated as a motivation problem.

Men, particularly middle-aged men

Depression in men often doesn't look like sadness. It looks like anger, irritability, working relentlessly, drinking more, and a flat refusal to discuss it. Men are far less likely to present to a GP and far more likely to die by suicide. If the man in your life has become someone short-tempered you no longer quite recognise, that is worth taking as seriously as tears would be.

Older people

Depression in older adults is routinely mistaken for ageing, or for dementia, by everybody including clinicians. Confusion, memory complaints and withdrawal can all be depression, and depression is treatable. It's worth insisting the question is asked.

Signs that need action today, not next week

• Any talk of suicide, however casual it sounds, however much they laugh it off.
• Saying goodbye oddly, giving away things that matter to them, or putting affairs in order for no reason.
• Beliefs that are fixed and clearly not true, or hearing or seeing things others don't — particularly if the voices are hostile or instructing.
• Not sleeping at all for days, alongside rapid speech, grand plans and reckless spending or risk-taking.
• Being unable to keep themselves safe, or to manage the basics of eating and drinking.

If any of those apply, go to help right now. Nobody who works in mental health will think you overreacted.

The myth worth killing

A lot of people don't ask the direct question because they believe asking about suicide might put the idea in someone's head. It doesn't. The research on this is consistent and it has been for a long time. Asking plainly — "are you thinking about ending your life?" — tends to bring relief, because the person has usually been carrying it alone and waiting for somebody to make it sayable.

The question that costs lives is the one nobody asks.

If you've noticed something

Noticing is the hard part and you've done it. What to do next — how to open the conversation, what to say, what not to say, and what to do if they refuse help — is on the for families and carers page.