Top Ten Indicators to Refer to a
Mental Health Professional
The person you are concerned about:
-
Is exhibiting a decline in his/her ability to experience pleasure
and/or an increase in being sad, hopeless and helpless
- You may notice that the person is not as upbeat
as usual.
- He/she may talk much more frequently about how
awful life/the world is and that nothing can be done about it.
- The person may make comments about “why bother”
or “what’s the use”
- There will be a decline in talking about things
that are enjoyable.
- He/she may stop doing things they like to do (examples:
going to the movies, visiting with friends, participating in athletic
events or being a spectator of sporting events)
- The person begins to talk about being unable to
do anything that forwards their dreams or desires
-
Has intrusive thoughts or is unable to concentrate or focus
- You may notice that the person is not able to focus
on their goals or the topic of conversation.
- The person is unable to complete their action steps
and isn’t aware of what got in the way.
- You notice that the person begins talking about
unpleasant events during the course of talking about themselves
and their goals.
- The person tells you that unpleasant thoughts keep
popping into their minds at inopportune moments or when they are
thinking about or doing other things and that they can’t seem to
get away from these thoughts.
- The person tells you about recurring scary dreams
that they didn’t have before.
- The person reports that they have so many thoughts
swirling in their heads and that they can’t get them to slow down.
-
Is unable to get to sleep or awakens during the night and is unable
to get back to sleep or sleeps excessively
- The person comes to their sessions tired and exhausted.
- The person begins talking about not being able
to get to sleep or how he/she just wants to sleep all the time.
- The person may report to you how he/she gets to
sleep and then wakes up and can’t get back to sleep.
- The person tells you how they need to take naps
during the day, something they have not done before.
- The person reports that they fell asleep at an
inopportune time or place.
-
Has a change in appetite: decrease in appetite or increase in appetite
- The person reports that he/she isn’t hungry and
just doesn’t want to eat.
- The person reports that he/she is eating all the
time, usually sweets or junk food, whether or not they are hungry.
- The person says they don’t get any enjoyment from
eating when they did in the past.
- The person reports that they are not sitting down
to eat with friends or family when they did in the past.
-
Is feeling guilty because others have suffered or died
- The person reports that they feel guilty because
they are alive or have not been injured.
- The person states that they don’t understand why
they are still here/alive when others have had to suffer/die
- The person doesn’t want to move forward with their
goals because they don’t deserve to have the life they choose, especially
when other people have had to suffer/die.
- The person questions their right to have a fulfilling
life/career in the face of all that has happened
- The person expresses the belief that he/she is
unworthy of having a satisfying life.
-
Has feelings of despair or hopelessness
- According to the person nothing in life is OK.
- The person moves into excessive negative thinking.
- The person says that they can’t make a difference
or that whatever they do doesn’t matter.
- The person has the attitude of "Why bother?"
-
Is being hyper alert and/or excessively tired
- The person reports that they can’t relax.
- The person states that they are jumping at the
slightest noise.
- The person reports that it feels like they always
have to be on guard.
- The person states that they are listening for any
little sound that is out of the ordinary.
- The person reports that they have no energy.
- The person states that they can’t do their usual
chores because they are so tired.
- The person states that it takes too much energy
to do things they normally did in the past.
-
Has increased irritability or outbursts of anger
- The person becomes increasingly belligerent or
argumentative with you or other people.
- The person reports that everyone or everything
annoys them.
- The person starts making comments about how miserable
everyone and everything is.
- The person reports that other people in their life
are telling them how miserable/angry they have become.
- The person reports getting into arguments with
people.
- The person states that they get so upset they don’t
know what to do with themselves.
- The person reports that they feel like a “pressure
cooker” or are “ready to burst.”
- The person increasingly tells you about wanting
to do or doing things that would harm themselves or others (examples:
wanting to put their fist through a window; wanting to punch someone;
wanting to hit someone/something with their car).
-
Has impulsive and risk-taking behavior
- The person reports doing things, such as going
on a buying spree, without thinking about the consequences of their
behavior.
- The person tells you that something came to their
mind so they went and did it without thinking about the outcome.
- The person reports an increase in doing things
that could be detrimental to themselves or others (examples: increase
in promiscuous sexual behavior; increase in alcohol/drug consumption;
deciding to get married after knowing someone an unusually short
period of time).
-
Has thoughts of death and/or suicide
- The person begins talking a lot about death, not
just a fear of dying.
- The person alludes to the fact that dying would
be appropriate for them.
- The person makes comments that to die right now
would be OK with them.
- The person becomes fascinated with what dying would
be like.
- The person talks about ways to die.
- The person talks about going to a better place
and how wonderful it would be and seems to be carried away by the
thought.
- The person tells you they know how they would kill
themselves if they wanted to/had the chance.
- The person alludes to having a plan or way they
would die/go to a better place/leave the planet/leave the situation/get
out of here.
- Whereas previously the person was engaging, personable
and warm and now they present to you as cold, distant and aloof
tell them what you are observing and ask them what has changed for
them. This is often a signal that they have disengaged from living
and are silently thinking or planning to suicide.
- Some questions you might ask the person if you
are unclear about what is going on with them or their intentions:
"Are you wanting to die?" "How would you die if you decided to?"
"Are you planning on dying?" "When are you planning on dying?"
- If you have any inclination or indication that
the person is planning on dying or committing suicide, refer them
immediately to an emergency room or call 911.
- Tell the person that you care about them, are
concerned for them, that you are taking what they say seriously
and that they must get help immediately.
- If the person balks at what you are saying,
gets belligerent or even more distant AND you become even more
concerned about them, you may need to tell them you will break
confidentiality because of your concern for their well-being
and that you will call 911 (You can call your local 911 and
give them the address and phone number of the person, even if
it is in another state, and they can contact the person’s local
911 dispatcher).
If
is important to note that the appearance of any one of these
indicators, except for #10 which must be referred and followed up on
immediately, does not indicate the immediate need for a referral to a
psychotherapist or community mental health agency; everyone can
experience a very brief episode of any of the indicators. However, if
you see that several indicators are emerging and that the person is not
presenting as whole, competent and capable then it is time for a
referral to a mental health professional.
Prepared by: Lynn F. Meinke, MA, RN, CLC, CSLC
Life Coach
Chair: Life-Personal Coach Committee of ICF
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