Warning signs that you, your friend or

your student might be struggling with

their mental health

Looking out for

yourself

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lmost every person will have periods with worse mental health at some
point or another of their life. Most say being sad is inevitable, a part of
life. But being sad is not the same as having mental health issues, even
if they can be related. According to the American Psychiatric Association, a
mental illness (many of which are temporary!) is a health condition involving
changes in emotion, thinking and behaviour that cause significant distress
and/ or impede somebodies normal functioning in society.

The major difference between a mental illness and a physical illness is the fact
most psychiatric disorders have more many more psychological effects than
physiological.

If you experience a decline in your mental health, the best way to improve it
will start with reaching out. Afterwards, the steps will vary as you might need
to change your routine, get therapy, medical attention, medication or even call
a hotline. Regardless, the first step will be detecting you have an issue in the
first place. If you have more than a few of these symptoms you need to
consider help:

Physical signs (which can also be signs of medical problems):

- Loosing appetite: A general sign of distress, mood disorders (like

depression), excessive stress or grief. This is alarming if the loss extends for

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over a week. If you loose your appetite, try to eat something regardless of
satiety to avoid physical health issues like deficiencies in minerals.

- Too much appetite or emotional eating. Food might serve as a coping

mechanism or distraction. In addition, engaging on passive comfort activities
makes it easier to notice and act on smaller hunger queues.

- Heart and chest “tightness”, which might be specially pronounced when

stressed and is alarming if sustained for more than a day.

- Not sleeping enough (insomnia). This includes problems with falling asleep,
repeatedly waking up in the middle of the night and waking up unusually
early by accident. What it doesn’t include is a purposeful choice to stay
awake studying or with your phone.

- Sleeping too much (hipersomnia).

- Increased instances of unexplained muscle pain, not related to exercise,
period pain, sleeping posture or migraines.

- Changes in movement patterns (like having a restless leg or unusually slow

movements).

- Low energy
- Immunodeficiencies (as stress can cause a healthy person to be more
susceptible to the flu and other minor infections).

Note: All of these can be symptoms of other medical conditions so regardless

of whether you have psychological symptoms or not, contact your doctor or
comment this to them the next time you see them.

Social Changes:

- You want to isolate. This is a very bad idea in most cases as it is likely to
make your mental health worse and removes positive distractions as well as
possible help.

- You argue a lot more. Irritability and mood changes are the culprit.
- Emotional outbursts on which you suddenly cry, express extreme joy, anger
or a variety of mixed emotions.

- Lowering grades
- Difficulty concentrating

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- Procrastination. This might be tied to stress, a bad study plan, anxiety, lack
of motivation or a number of other things. Its a bad coping mechanism for
those issues so it can be simultaneously a cause for worsening problems
and a symptom of other issues.

- Substance use.

• If you are reading this you probably know you the social, legal and medical
reasons why you aren’t allowed to consume drugs (the only legal
exceptions being tobacco, cannabis and alcohol in private and in small
quantities if you are over 18). However, (chronic and extreme) consumption
is discouraged also for mental-health reasons. Alcoholism and hard-drug
addiction are common habits of people with disorders like BPD (borderline
personality disorder), BD (bipolar disorder), mayor depressive disorder or
PTSD to have badly developed control over consumption. Its also
guaranteed to cause a steep decline on your mental health if you become
dependent.

• If you do find yourself being unable to stop the chronic consumption of

drugs (legal or not), reach out for personal and professional help as soon as
possible as early intervention prevents relapse. To find a close resource
center in Spain visit: https://pnsd.sanidad.gob.es/ciudadanos/
queHacerConsumo/queHacer/tratamiento.htm

Psychological Changes:‰

- Difficulty with describing yourself (or other sudden confusion around your
identity).

- Bad self image which might manifest as sudden irrational beliefs about your
character (ex: suddenly thinking you are annoying even if nobody has
communicated that in any way, not even with body language) or issues with
your body.

- Feelings of inadequacy
- Excessive and paranoid fears that weren’t as intense before.
- Feelings of guilt
- Apathy and anhedonia. This means loosing the capacity to be interested by
your work and hobbies and not caring (about your activities, routines,
yourself) or not feeling anything strongly anymore.

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- Disassociation (not feeling like yourself) or derealisation which is not feeling
like your experiences are “real” or you are in control of them (depending of
the person this feels like your life is a movie you are watching, a dream, that
its too slow or is detached from reality)

- Disorganised thinking
- Sensorial sensitivities (overly annoyed by noises, smells or touch)
- Finding it hard to maintain hygiene /other basic habits
- Finding it hard to get out of bed
- Intrusive or impulsive thoughts. These are repetitive unwanted thoughts that
appear without warning, over a period of time. They can be disturbing or
even distressing, specially if they lead to impulsive actions.

- Thinking a lot about death or other forms of distressing and undesired

existential crisis.

- Obsessive and repetitive thoughts

- Desire to restrict food, overwork on the gym, loose weight dramatically or
more generally feeling distress over your size and body image (when its
normal for body types to change in teenage-hood).

- Thoughts of suicide.

• This can be passive (ex: thinking how others would cope with your death,
imagining how it might be, having internal arguments about if you desire it
or not… etc) or active (making specific plans to do it).

• If you ever have these thoughts, REACH OUT. You deserve to be alive and
overcome whatever makes you consider this. If you have hurt yourself, call
112 and go to hospital immediately. If you are in danger and considering it,
call 024 (Spain’s hotline for suicide prevention). If your thoughts are
infrequent and passive, talk with your doctor, therapist and family.

• Don’t be afraid to talk about it with others as whatever distress they feel by
listening to you vent is a fraction of what they would feel if they lost you.
We want you to stay. Only be weary to not relay of friends exclusively.

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SIGNS IN YOUR FRIENDS
Ideally, you shouldn’t have to know this. You are not the responsable for
helping anyone to manage life. However, friends can be the first ones in line to
detect if there is something wrong. Being one of the people the affected
interacts with the most means you also have a lot of power. Whether your
effect is neutral, positive or negative depends on how you perceive and
respond to other’s mental health.

No matter what your friend’s issue is, the best thing you can do for their
mental health is the following:

- Listen to them.
- Let them know you care and support them, treating them not only with
respect but kindness and empathy too.

- Encourage them to get professional/ more effective help if they need it.

This should be done to any friend, whether they have a history of mental
health issues or not. But if they have had past issues, it’s specially
important!

For more info on why mental health conditions are so common at this
point of life see: https://www.who.int/news-room/fact-sheets/detail/
adolescent-mental-
health#:~:text=Adolescence%20is%20a%20unique%20and,vulnerable%20
to%20mental%20health%20problems.

Signs you should talk with them about what is going on:

- They isolate themselves (which does not mean that they are changing social
groups and go with other people).

- They don’t care about their grades anymore / don’t pay attention in class
anymore. This might be a sign of stress, apathy or a serious loss of
motivation if they cared in the past.

- They spend a lot of time expressing how much they care about grades (in an
excessive, anxious way that suggests they base their value on them).

- They seem more anxious than usual around others; avoiding social
gatherings and big groups.

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- Mood swings, specially those on which they seem more aggressive than
usual to others or more frustrated with themselves. Aggression, apathy and
self-hate are very common symptoms of depression in men while extreme
guilt and problems with self-image are slightly more common in depressed
women.

- They tell you about conflicts in their homes (an unstable home life is highly
correlated with declines in mental health) or relationships (for more
information on abusive relationships visit: https://www.safehorizon.org/safe-
horizon-in-the-news/abusive-relationship-signs/ or https://
www.safehorizon.org/safe-horizon-in-the-news/abusive-relationship-signs/ )

Subsection: Self-Harm

Non suicidal self injury or harm is one of the most prevalent and ineffective
ways of coping with a mental disorder or hardship. Somewhat like
consumption of drugs, the practise leads to more problems than it solves
because the person doesn’t develop new skills to manage emotions with and
instead gets trapped in a cycle of punishment, brief relief, hatred and craving.

This is also a sadly common coping mechanism in teens between the ages of
12 and 17 although anyone can fall susceptible to it’s trap. People who do this
know it isn’t a normal or healthy thing to do and likely feel guilt over it. If your
friend self-harms you might realise that:

- They have unexplained bruises, cuts or burns. They might repeatedly use
excuses to deny they are self-made due to fear of criticism or a desire to not
“upset you”.

- Hiding: The most common method is wearing long sleeves or pants even
when its hot or not appropriate. They might wear makeup over scars or put
their hand over a zone whenever forced to wear less concealing clothes.
Alternatively, they might avoid swimming class or any other situation where
they might be caught.

- They make jokes about it. They might not have confirmed it but make small
comments that suggest they do. This is often part of coping with the act
itself by making a tragic and disordered practise less serious. Never
normalise this humor if the people involved aren’t in remission.

- A small percentage of people who self-harm engage in less direct activities

like unsafe sex, exercising to the point of injury, purposefully getting in
accidents or getting into fights they know they will get hurt in. If they act in a

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 way that will purposefully cause them physical pain, its unhealthy and its
self-harm.

- They find small ways to self-harm when they are stressed, even in public. Do
they hit their leg, foot or arm when something goes wrong? Do they dig in
their nails when things are overwhelming? Punch things to relieve anger?
These can be forms of stimming or ties, they might not even cause a lot of
pain. But even if they aren’t necessarily self-injury (as they are very
impulsive), people who do these things show they have issues processing
strong emotions; a common trait in people who self-harm.

What to do: Ask them about it and why they do that. Although it will change
over time, the reason for their actions is key for stopping them. For example, if
they use pain to manage and exprese internal pain, a good plan might be to
express the pain though mediums like art, writing or talking with a professional
while if they do it as a way to relieve stress, exercise or screaming therapy
might address it better. Few people self-harm for attention or because of their
friend’s influence but those cases must be taken seriously and treated by a
professional. Never dismiss something so serious, as light or situational self-
injury can morph into a habit and a serious addiction.

Always encourage them to get help and stop. And no matter what, follow their
case, asking them over a period of time to show support if a relapse occurs.

If they can’t reduce their dependance of the method and its a danger on their
life, tell someone who can help them, whether that is a teacher they actually
trust, their sibling or (if they are understanding and willing to help) their parent.

Subsection: Eating disorders

Suspecting a friend has an eating disorder will be different than suspecting any
other psychological disorder. Eating disorders like binge eating disorder or
EDNOS (eating disorder not otherwise specified) will likely have symptoms that
you can’t see as clearly since binges or emotional eating are often done at
home, hidden from others.

In the case of more restrictive, deadly and common EDs like Anorexia or
Bulimia, the person is likely aware that they are doing something dangerous.
For this reason, they might lie to hide it and not care about how this form of
self-harm is ruining their lives. Signs you should talk with them and contact
help are:

- They talk a lot about their bodies and weight in a very critical way.

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 • Comments like “look how fat I am”, “I will run this afternoon to burn this, I
feel so guilty” or “eating that will make me gross” are indicators.

• This also includes comments on which they are comparing themselves to

others, for better (“I wish I looked like them, they are so small”) or worse
(“No wonder they look like that, I would never eat that”).

- They make references to being able to make themselves puke / vomit, feel
they need to exercise excessively to “punish their eating” and have bruises
on their hand (common as a result of purging in severe bulimia). Its specially
suspicious if they always go to the bathroom immediately after eating, every
day.

- They avoid and fear eating in public or being perceived as unhealthy

- They are barely eating at lunch or highly restricting what they do eat (for
example, freaking out over any sauces being added or only eating the low-
calorie fruits and vegetables). They might skip a meal saying they had a big
breakfast (a lie) or when going out refuse to have a baked good yet accept a
0-calorie sports drink. This restriction of food is critically not because of
texture, taste or actual fullness.

- They lose weight very dramatically which might lead to visible symptoms
such as hair-loss/ hair weakening, always being cold, pale skin, sudden
itches, heart palpitations, passing out when exercising, sleeping a lot / being
tired all the time, complaining of stomach aches, suddenly having a bad
memory or losing physical strength.

- They change behaviours to deal with body dysmorphia like wearing baggy
clothes all the time, looking excessively at themselves or avoiding mirrors,
not seating down to avoid the seeing their thigh bulkiness or constantly
adjusting their clothes.

- They are hungry and suppressing it with an unhealthy use of chewing gum,
excessive consumption of water or unnecessary cleaning their teeth.

- They seem to know a lot about calories, BMI and body fat percentage;
usually fearing high calories in food and increasing their number in a metric.

- These behaviours aren’t directed by a doctor (who you should talk to before
entering a diet!) and are not due to health concerns.

NOTE: Anyone of any gender can have an eating disorder. They can also occur
in people of any weight, from those who were already thin to those who restrict
unhealthily while being overweight.

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GENERALLY, REACH OUT FOR ADULT HELP IF:

- They admit they need help but don’t know where to start.

- Helping them is hurting you or triggering YOU.

- They self harm and don’t intend on stopping.

- They are skipping meals regularly and hiding it from adults / doctors.
- They show suicidal behaviours. (In this case, always talk with them, asking
will generally not increase their ideation)-

This includes not just suicidal jokes but other warning behaviours like:
giving out valued things, saying phrases like “I can’t keep going” or “you
would be better without me”. If they act with sudden calmness or more
impulsive behaviour. They try to put their business in order or say
goodbye. If they tell you explicitly their plan.

MAKE SURE YOU ARE OK: In order to help others, you need to be ok yourself.
If what they say makes you more likely to engage in negative behaviours or
copy their issues, ask them to relay more on other people, not just you. If you
do lend a hand, make your priority to keep up with your own self-care: drink
water, meditate, talk with a therapist yourself, relax, eat enough.

You are the one that can help their mental health the most, but its never your
responsibility or fault. If someone uses suicide as leverage to get something
from you, that’s abusive and your plan of action should be to immediately refer
them to professional help (call their therapist, counsellor, family or a hospital)
and leave their proximity.

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Warning signs in a student
As a teacher, it is to some limited extent your responsibility to help your
student. Your plan of action may vary because of the law, the situation and the
resources your school has. The first course of action will for the most part be
talking with the person you are worried about:

- Their grades drop from their past average. When addressing that case, don’t
focus on that or present this as the main problem, but ask them what the
problem is. It might be that they have an issue with the specific material
being taught, have recently felt the effects of a lifelong issue like ADHD or
dislexia or a new issue with their mental health.

- They can’t pay attention / space out in class

- They seem to no longer spend time with their friends. This isn’t by nature a
bad thing but it can also be a sign of isolation.

- They deliver projects late. The most likely reason for this is procrastination
and lack of motivation, which you should try to meet with empathy. Talk with
them or bring them to other specialists so they can find the underlaying
issue. If they just lack motivation for your subject, this is less alarming and
more normal.

- They come to class with worse hygiene. In small kids this might signify
parental abuse or even be correlated with physical trauma/ sexual abuse,
specially if paired with a fear of being touched. In teenagers, its a common
sign of depression to feel unable to do hygiene-related self-care.

- They have bruises, cuts, swelling or show malnutrition. Any of these is

serious enough to be addressed as they can indicate self-harm in a student
or abuse.

• Talk with them first, don’t immediately contact their parents as that can
be highly dangerous for the minor.

• If they are unresponsive to you, contact a fellow teacher they have more
of a connection with or a school psychologist.

• Once you know the origins of the injuries, contact the appropriate
authority or the (now confirmed as safe) parents.

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