Someone Is Struggling#

You've noticed something is wrong with someone you care about. They're withdrawing, drinking more, not themselves. You want to say something but you're afraid of making it worse. This skill gives you the exact words, the things to avoid, and the steps that actually help — based on Mental Health First Aid, QPR (Question Persuade Refer), and crisis intervention training.

Sources & Verification#

• QPR method: QPR Institute, QPR Gatekeeper Training for Suicide Prevention, qprinstitute.com — evidence-based gatekeeper training used by SAMHSA
• Mental Health First Aid: National Council for Mental Wellbeing, mentalhealthfirstaid.org — peer-reviewed curriculum adapted from Australian model
• Asking about suicide does not increase risk: Dazzi, T. et al., "Does asking about suicide and self-harm increase the risk? A systematic review," Psychological Medicine, 2014 ( DOI: 10.1017/S0033291714001299)
• Connectedness as protective factor: CDC, "Suicide Prevention Resource for Action," 2022 ( cdc.gov/suicide/resources)
• 988 Suicide & Crisis Lifeline: 988lifeline.org — verified active as of March 2026
• Crisis Text Line: text HOME to 741741, crisistextline.org

When to Use#

• User is worried about a friend, partner, or family member
• Someone they know seems depressed, withdrawn, or hopeless
• They suspect someone is drinking too much or using substances
• They're afraid someone might be thinking about suicide
• They want to help but don't know what to say
• Someone made a comment that scared them ("I can't do this anymore")

Instructions#

Step 1: Assess what you're seeing#

Help the user identify what's going on. Ask them to describe the behaviors they've noticed, then map to the appropriate level:

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WHAT ARE YOU SEEING?

LEVEL 1 — STRUGGLING (changes in behavior):
[] Withdrawing from people or activities they used to enjoy
[] Sleeping much more or much less than usual
[] Irritable, short-tempered, or emotionally flat
[] Neglecting responsibilities, hygiene, or appearance
[] Drinking or using more than they used to
[] Saying things like "what's the point" or "I'm fine" when they're not

LEVEL 2 — IN CRISIS (immediate concern):
[] Talking about being a burden ("you'd be better off without me")
[] Giving away possessions
[] Saying goodbye or making final arrangements
[] Sudden calm after a period of severe depression
[] Expressing hopelessness ("nothing is going to change")
[] Increased reckless behavior (driving fast, binge drinking, picking fights)

IF LEVEL 2 — Go directly to Step 4 (crisis intervention).

Step 2: Start the conversation#

The hardest part is opening your mouth. These scripts work because they're specific and non-judgmental.

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OPENING LINES (pick one that fits):

DIRECT:
"Hey, I've noticed [specific behavior] and I'm worried about you.
Can we talk?"

GENTLE:
"I care about you and something feels different lately.
I'm not judging — I just want to check in."

IF THEY SAY "I'M FINE":
"You might be fine. But if you're not, I want you to know
I'm here. You don't have to talk now, but the door is open."

IF THEY GET DEFENSIVE:
"I'm not trying to fix you or tell you what to do.
I just noticed [specific thing] and I'd feel worse saying nothing."

IF THEY OPEN UP:
Don't immediately problem-solve. Just listen.
"That sounds really hard. How long has it been like this?"
"What does a bad day look like for you?"

Step 3: What to do and what NOT to do#

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DO:
-> Name the specific behavior you noticed (not "you seem off")
-> Listen more than you talk
-> Validate: "That makes sense given what you're going through"
-> Ask what they need: "Do you want advice or do you just need
   someone to listen?"
-> Follow up. One conversation isn't enough. Check in again in
   2-3 days. And again after that.
-> Be honest about your limits: "I'm not a therapist, but I can
   help you find one"

DO NOT:
-> Say "just think positive" or "other people have it worse"
-> Try to relate by making it about your own experience
-> Promise to keep secrets about self-harm or suicidal thoughts
-> Give ultimatums ("get help or I'm done")
-> Try to be their therapist
-> Minimize: "I'm sure it'll get better"
-> Wait for them to come to you — they won't

Step 4: If you think they might be suicidal#

You will not plant the idea by asking. Research is clear on this — asking about suicide does NOT increase risk. Not asking does.

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QPR METHOD (Question, Persuade, Refer):

QUESTION — Ask directly:
"Are you thinking about hurting yourself?"
"Are you thinking about suicide?"
Say the word. Don't dance around it.

If YES:
-> Stay calm. Do not panic or act shocked.
-> "Thank you for telling me. You're not alone in this."
-> "Do you have a plan?" (This helps assess immediacy)
-> Do NOT leave them alone if the risk seems immediate.

PERSUADE — Connect them to help:
"Will you call 988 with me right now?"
"Can I take you to the ER?"
"Can we call your therapist together?"

REFER — Hand off to professionals:
-> 988 Suicide & Crisis Lifeline: call or text 988
-> Crisis Text Line: text HOME to 741741
-> If immediate danger: call 911
-> For veterans: Veterans Crisis Line 988, press 1

Step 5: Help them get professional support#

If they're willing to get help, reduce every barrier you can.

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MAKE IT EASY:

-> "Can I help you find a therapist? Let's look together right now."
-> "I'll drive you to the appointment."
-> "Want me to sit in the waiting room?"

AFFORDABLE OPTIONS:
-> Open Path Collective (openpathcollective.org): $30-$80/session
-> NAMI Helpline: 1-800-950-NAMI (free peer support)
-> SAMHSA Helpline: 1-800-662-4357 (substance abuse, free, 24/7)
-> Community mental health centers (sliding scale fees)
-> Employer EAP: usually 3-8 free confidential sessions
-> University training clinics: $5-$30/session

Step 6: Take care of yourself#

Supporting someone in crisis takes a toll. You matter too.

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FOR THE SUPPORTER:
-> You are not responsible for saving them.
   You are responsible for showing up and connecting them to help.
-> Set boundaries. You can care without being on call 24/7.
-> Talk to someone yourself — a therapist, a friend, NAMI's
   family support groups.
-> If they refuse help, that is not your failure.
   You can't force recovery. You can only keep the door open.

If This Fails#

If your efforts to help aren't working or the situation escalates:

1. They refuse to talk? Don't force it. Say "The door is open whenever you're ready" and follow up in a few days. Persistence without pressure is the goal — most people don't open up on the first attempt.
2. They opened up but refuse professional help? You cannot make someone get help. What you can do: keep showing up, normalize therapy ("I see a therapist too" if true), and reduce barriers ("I'll make the call with you"). Plant the seed and water it.
3. You're in over your head? If you're losing sleep, feeling responsible for their life, or it's affecting your own mental health, talk to someone yourself. NAMI's family support groups (nami.org/support) are free and designed for exactly this situation.
4. The situation involves substances? Substance abuse changes the playbook. Contact SAMHSA's helpline (1-800-662-4357, free, 24/7) for guidance on how to approach someone with a substance use problem. Al-Anon (al-anon.org) supports families and friends specifically.
5. They're in immediate danger? If someone has a plan, access to means, or is actively self-harming: call 911 or take them to the nearest ER. This is not a betrayal — it is an emergency response. You can repair the relationship later. You cannot repair a death.
6. You tried everything and nothing changed? Some people are not ready. That is not your failure. Document what you did (for your own peace of mind), maintain the relationship as best you can, and keep crisis numbers accessible: 988 (call or text), Crisis Text Line (text HOME to 741741).

Rules#

• If there is ANY mention of suicidal ideation, provide 988 and crisis resources immediately — before anything else
• Never promise confidentiality about self-harm or suicide
• This skill is about the SUPPORTER, not the person in crisis. Help the user help their person.
• Do not diagnose. Help them recognize patterns, not label conditions.
• Always acknowledge that this is hard for the supporter too

Tips#

• The single most protective factor against suicide is connectedness. Your conversation might literally save a life.
• People rarely ask for help directly. The cry for help usually sounds like withdrawal, irritability, or "I'm tired."
• Following up matters more than the first conversation. A text that says "thinking about you" three days later shows it wasn't performative.
• If someone is abusing alcohol or substances, SAMHSA's helpline (1-800-662-4357) is the best first call. It's free, confidential, and available 24/7 in English and Spanish.