Responding to people under pressure under the big sky.
How to recognize warning signs of those in distress and figure out a course of action.
Sometimes you need help, sometimes you are the one that can help.
- Nervousness, agitation or irritability
- Infrequent work attendance
- Changes in routine behavior
- Changes in personal or work relationships
- Deterioration of hygiene
- Undue aggressive or abrasive behavior
- Burst of anger and blaming
- Avoidance or withdrawal
- Frequent alcohol and/or drug use, smoking
- Frequent gambling
- Excessive crying, sleeping
- 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.
- 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 depresses (frequent crying, insomnia, oversleeping, weight loss/gain, loss of pleasure)
- Appears/reports hopelessness or helplessness
- Engages in self-harm
- 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?)
Proceed to either "Yes, imminent danger is clearly present." or 'Unclear about whether imminent danger is present" options in the descision tree below.
Yes, imminent danger is clearly present.
Unclear about whether imminent danger is present.
No imminent danger is present.
- Person found to be 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.
- 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
- Person reports a history of concerning behavior (e.g. drinking, drugs, gambling, self-harm) 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 thining 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, divorce, job loss) 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 Montana and National Suicide Preventionl Lifeline, 1-800-273-8255, 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 support.
If this happens at work, contact your supervisor and inform him/her of the situation.
- You observe a person furious or crying 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 a person to get help, call 211 from anywhere in Montana, or the Montana Warm Line 877-688-3377.
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.
For anxiety, depression, suicide risk, and/or prescription opioid misuse:
- Call 211: Montana 24-hour helpline, health and human services information and referral. Visit www.montana211.org for information on appropriate resources.
- Montana Suicide Prevention Lifeline: 1-800-273-8255 (TALK)
24-hour crisis intervention if you or someone you know are having suicidal thoughts.
- CRISIS TEXT LINE: Text the word 'HOME' to 74141 from anywhere in the U.S.
- Prescription opioid misuse treatment facilities exist throughout Montana. For more information on the nearest facility or where to drop off unused prescription opioids, please visit: http://health.msuextension.org/opioid_misuse.html
- Refer to a local health-care provider or local mental health professional. If you meet resistance, suggest and accopmany the person to a professional. iSome examples might be clergy members, medically-trained prefessionals, hospital emergency room personnel, law enforcement agencies/personnel, school counselors, and your local Extension office.
For more information, visit http://www.msuextension.org/wellness/
Adapted from "Responding to Distressed People," a publication of NDSU Extension, 2016.
Revised and adapted by Michelle Grocke, MSU Extension Health and Wellness Specialist, and Alice Burchak, MSU Extension Agent, Toole County.
Publication funded by the Substance Abuse and Mental health Services Administration