Responding to Distressed People (FS1805, Sept. 2016)

Sometimes you need help. Sometimes you are help. This flow chart outlines the process of responding to distressed people.

Deb Gebeke

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You want to help. As a friend, professional, family or community member, you may encounter people in distress. This information will help you know what to look for, recognize warning signs and take a course of action.

A person is experiencing distress.

Signs of Distress Include:

  • Nervousness, agitation or irritability
  • Infrequent class/work attendance
  • Excessive crying, sleeping
  • Changes in routine behavior
  • Changes in personal or work relationships
  • Deterioration of hygiene
  • Undue aggressive or abrasive behavior
  • Bursts of anger and blaming
  • Fearfulness
  • Avoidance or withdrawal
  • Frequent alcohol and/or drug use, smoking
  • Frequent gambling

Express your concerns to the distressed person. Point out your observations and ask about his/her situation.

  • I heard you say your meeting with the banker was a disaster. Can you tell me about it?
  • I’ve noticed you haven’t come to coffee for a long time and I’m concerned about you.
  • I’ve seen you angry a lot lately and noticed you were harsh with the kids. How can I help?
  • I noticed you came to work late again and you look like you haven’t slept. I’m concerned.

Are you worried about the person’s safety or do you see possible warning signs?

Warning Signs Include:

  • Has prolonged periods of distress/overload
  • Talks about or threatens suicide
  • Makes statements such as “I want this all to end” or “I can’t go on anymore”
  • Exhibits significant confusion, isolation
  • Shows behavior that is bizarre, alarming and/or dangerous
  • Makes statements about hurting or killing others
  • Has marked change in behavior, mood and/or hygiene
  • Appears depressed (frequent crying, insomnia, oversleeping, weight loss/gain, loss of pleasure)
  • Appears/reports hopelessness or helplessness
  • Engages in self-harm

Click Here if YES

Click Here if NO

Yes, I am worried about the person's safety and I see possible signs

  • Directly ask about your concerns and/or warning signs. (Have you thought about hurting yourself or others?)
  • Directly ask about suicide and/or homicide as it relates to the displayed warning sign(s). (Do you have a plan?)

Do you believe danger is imminent? Are you worried this person might harm him/herself or others?

Click here if Yes, imminent danger is clearly present

Click here if Unclear about whether imminent danger is present

Click here if No imminent danger is present

Yes, imminent danger is clearly present


  • Person found unconscious or unresponsive
  • Person tells you he/she has ingested pills beyond the recommended dose
  • Person is threatening immediate danger to him/herself (e.g., threatening to hurt others, ingest pills, shoot him/herself)
  • Person attempts to cause physical harm to someone else (or to people in general)
  • Your gut tells you this is serious

Immediately call 911

  • Stay with the person until help arrives unless you do not feel safe. Talk to him/her and gather any information possible.
  • If the person becomes violent or has a gun, leave and call 911.

If this happens in a work setting, contact your supervisor and inform him/her of the situation.

Write down

  • Relevant details about the situation (who, what, when, where)
  • Any background information you have about the person’s difficulties
  • A number where you can be reached

Unclear about whether imminent danger is present


  • Person reports a history of concerning behavior (e.g., drinking, drugs, cutting, gambling) and now states a desire to engage in this behavior again
  • Person is found intoxicated or appears to be under the influence of substances
  • Person makes statements suggestive of suicidal/homicidal thinking that are not overtly indicative of imminent danger (e.g., “I don’t know if I can keep going.”)
  • Person appears agitated/emotionally distraught and does not respond to your attempts to calm him/her
  • Person experiences a sudden stressful event (e.g., death, breakup, divorce) and seems emotionally unstable/inconsolable, or the person’s response appears unusual
  • Uncontrollable crying over a minor setback, or conversely, no reaction over a major loss.

Stay with the person. Call the National Suicide Prevention Lifeline and ask for help in making a plan of action. Help the person move forward in the next step of the plan. If the person leaves and you are concerned for his/her safety or others, call 911.

Ask the person for permission to call a family member for extra support.

If this happens at work, contact your supervisor and inform him/her of the situation.

No imminent danger is present


  • You observe a person crying or furious after getting off the phone, and she/he reports being sad or worried about the market and the loss in farm income in recent weeks, but you see no other warning signs.
  • You observe a co-worker or family member who is dealing with a major illness in the family and is struggling to manage, but you see no other warning signs.
  • You observe any number of life difficulties happening to someone but no signs of imminent danger or failure to cope in a safe manner.

As much as you are comfortable, listen and provide support, but do not become the counselor/therapist. Reflect the feelings you hear behind the words. Ask clarifying questions and make plans to check in again.

Discuss counseling services and/or other resources that might be helpful and address any concerns the person might have about these resources. If you need assistance in determining appropriate resources or about how to refer, call 211.

Note: If at any point you believe the person’s “Imminent Danger” status has changed, return to the “Imminent Danger” steps outlined in this decision-making tree.

Adapted from “Dealing with Distressed Students,” a publication by the NDSU Counseling Center and NDSU Behavioral Health Intervention Team, 2016

Resources for depression and/or suicide risk:

Call 211: Statewide 24-hour helpline, health and human services information and referral.

Refer to a local health-care provider or local mental health professional. If you meet resistance, suggest and accompany the person to a professional you know. Some examples might be: clergy members, medically trained personnel, hospital emergency room personnel, law enforcement agencies/personnel, school counselors.

National Suicide Prevention Lifeline: 1-800-273-8255 (TALK)24-hour crisis intervention if you or someone you know are having suicidal thoughts.

APRIL 2016

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