How to spot the signs that a friend is in crisis during lockdown, and how to support them from afar

• During the pandemic, many people are experiencing severe stress, depression, and anxiety.
• We can socialize virtually, but it's not always easy to get to the root of real mental health issues over the phone.
• Resident Talkspace therapist Rachel O'Neill offers some tips on how to recognize the signs of a friend in crisis, and how to help from afar.
• "What a person in crisis is looking for is someone to hear what they're saying," said O'Neill.

In the months and years to come, some sociologists warn, we will be looking at a "grief tsunami."

People around the world will be mourning unexpected deaths of loved-ones, deaths they weren't able to memorialize with a funeral. Many of us will be struggling with the knock-on effects of being socially isolated for so long, or lacking support for mental health, eating disorders, or alcohol use disorders. Many will have lost their jobs.

These days we are fortunate to have means of connecting with each other and supporting each other as best we can over the phone or video chat. But, often, it's hard to get to the root of how a person is struggling in one scheduled virtual conversation.

So, how can we recognize the signs of friends in crisis, and what can we do to help?

Rachel O'Neill, a resident therapist at the mobile therapy site Talkspace, has some ideas.

Has their behavior changed, and is it more than a blip?

During such a seismic event as this pandemic, we all go through ups and downs. But if the downs last for a very long time, that could be a sign that they are struggling.

Check in with your friends to recognize whether they're acting or living differently, and whether it's continuing for a long time, O'Neill said. For example:

• If somebody really outgoing no longer cares about socializing, that's a red flag.
• If people aren't adequately taking care of themselves, not getting enough sleep or eating erratically, those can also be signs of crisis.
• If someone is hopeless or constantly talking about feeling stressed out, those tend to be warning signs too.

You don't have to talk about what's bothering them

Recognize that your friend is going through something and ask them how you can be helpful, and don't assume they want to talk about it.

"We all have this ability to cope and once that's been taken away, we may find yourself in crisis," said O'Neill. "Distractions are okay, but we don't want to use them forever because eventually they stop working, but in the short term asking do you want to just watch Netflix together like, or jump on a call and just hang out can get them out of the crisis."

Just showing your friends that you care and are available for them can be helpful, even if you aren't discussing the cause of their emotional spiral. Friends might actually appreciate having a break from talking or thinking about whatever is bothering them.

"Figure out what it is that might be helpful for them to talk about," said O'Neill. "Sometimes the person doesn't need to talk about what's causing the crisis or do a deep dive into it, it can be more about talking about things that might help ground them to get back into their routine, or ways to feel normal."

If it looks a pattern of behavior is emerging, it's time to recommend help

Having a single very bad, hopeless, dark day is normal, but having a string of them for weeks in a row is a sign that help may be needed.

"We all have good mental health days, we have bad mental health days, and that's okay," said O'Neill. "If it feels like there's this pervasive pattern of them just really struggling every day, then I think that's a good invitation to maybe talk with them about other sources of support, especially professional help."

What to say if you feel you need to establish healthy boundaries

If you feel like your friend is leaning on you for more help than you're able to give, O'Neill offers this script:

"I'm so invested in your wellbeing that it's hard for me to not just want to jump in and solve your problems for you, but that's not going to help you, so the next best thing is helping you find somebody that might be able to help you work through this."

Setting that boundary is crucial, both for you and the other person's well being, because "there's only so much that you can give and there's only so much of someone else's pain that we can take on before it starts to really impact us, too," said O'Neill.

Expressing your concern directly can be helpful

"If you're open and honest and you express what it is that you're concerned about that can be a good step," said O'Neill. "You can say I noticed that it's really been a struggle for you to find motivation or to care for yourself and I'm worried about you and I'd like to help you get connected with someone to talk to. How does that sound?"

It's important that they don't feel like you're taking control away from them, especially given people in crises are often feeling a lack of control. So being transparent with your concerns and how you'd like to help can be useful.

Don't minimize their trauma

And when talking about the crisis, we often have an urge to minimize what's happening to make people feel like it isn't such a big deal. But O'Neill says doing that could be a mistake, and it is better to acknowledge that what has happened is tough than to try to diminish it.

"What a person in crisis is looking for is someone to hear what they're saying," said O'Neill. "One of the most beneficial things you could do if somebody in your life is experiencing a crisis is to listen to what they're experiencing, and be there to provide whatever type of support they're asking you to provide."