The college years many not always be the happiest of times.

For reasons still being studied by scientists, the first symptoms of chronic mental illnesses — such as anxiety disorders, bipolar disorder, depression, and eating disorders — tend to emerge during the teen and young adult years (ages 16 to 24).

If you are a college student, you will likely have friends dealing with mental health challenges. But college students experiencing the first symptoms of a mental illness can be reluctant to seek help. Without help, however, a struggling student can face academic difficulties and even risk having to leave school before graduation.

Studies have found that college students will often talk to their friends before seeking any professional help. It can be frightening or overwhelming to have a friend confide serious troubles, but with the right guidance, you can help her through these challenges.

Here’s what you can do to support a friend in crisis or through a diagnosis.

Supporting a Friend in a Crisis

Suicide is the second leading cause of death on college campuses (the leading cause is accidents).

If your friend is making an explicit threat to take her own life or someone else’s, treat the situation seriously — it’s an emergency.

Call 911 or campus emergency services right away. Or, take your friend to the nearest hospital emergency room and stay with her until help can be obtained.

You can also advise your friend to call the National Suicide Prevention Hotline – 1-800-273-8255 or an on-campus crisis hotline if your university offers it.

# How to Know if Your Friend Is Suicidal

Any mentions of suicide, a wish to die, the prospect of people being better off without her, or exasperation about not being able to take it anymore are all signs that you should pay attention to.

Other signs of suicidal ideation include saying goodbyes, giving away personal possessions, glamorizing death, raging at the world — “You’ll be sorry when I am gone" — or posting ominous messages on social media.

Remember that a person often does not want to die, but just wants the pain she is feeling to stop. As a friend, demonstrate that you want help her in that process.

# How to Talk to a Suicidal Friend

Start a conversation by articulating your concern in a caring way: “You haven’t seemed yourself lately," or, “We’ve missed you at practice," or, “I’m concerned that you haven’t been outside your dorm room in days."

Afterward, you can ask to hear more about what your friend is going through with questions such as, “Do you want to talk about it?" and, “What can I do to help?"

Your friend may resist your offer or reassure you that everything is OK, but trust your instincts — persist in showing that you are there for her. Offer to walk with her to the campus counseling center, or sit with her until she feels ready to talk.

Ask the direct question, “Are you thinking about suicide?"or, “Do you have a plan to take your own life?"

Using the word “suicide" will not increase the chances that your friend will become suicidal. It’s better that you ask so you can fully understand how pressing the need to find help is.

When you are talking to your friend, do not minimize what she is feeling. Even if you don’t think that you would react to what she is going through in the same way, her pain is no less legitimate. “Just snap out of it" or “This will pass" are not helpful statements. Instead, practice empathy. Even if you can’t imagine what it’s like to experience what your friend is going through, you can acknowledge how difficult it must be to feel pain or heartbreak of any kind.

Don’t promise secrecy — you, the friend, are not a trained counselor. You may need to talk to a trusted adult — such as resident advisor, dean, or mental health professional — to get your friend the right help she needs.

Supporting a Friend with a Mental Illness

If your friend is showing signs of a mental illness, it means she is at the start of a journey on a long and often difficult road. Having your support through her diagnosis and treatment will help her in this challenging process.

# Signs of Emerging Mental Illness

You may spot some changes in your friend. Keep an eye out for the following signs:

• Feeling sad, withdrawn, anxious, fearful, and/or depressed for more than two weeks (for example, missing many classes, staying in her room, withdrawing from all friends and social activities)

• Serious out-of-control, risk-taking, or impulsive behaviors (such as extremely reckless driving)

• Mood swings, from low to high, or from high to low, that persist and make it difficult for her to function

• Irrational behavior, such as hallucinations, paranoia, or false beliefs

• Persistent aggressive or angry behavior

• Dramatic changes in eating or sleeping habits — too little or too much of either

• Increased abuse of substances, such as alcohol or drugs (which can be forms of self-medication)

# How to Encourage Your Friend to Seek Help

If your friend is not in imminent danger of harming herself or others, but shows signs of possible onset of mental illness, your first step is to encourage her to seek treatment.

Offer to connect your friend with campus mental health resources. If they are not available, or if there is a long waiting time for an initial counseling intake appointment (as there often is), help your friend find off-campus mental health resources.

It may not be easy to find a psychiatrist (a mental health professional who can prescribe medication) or psychologist (a mental health professional who offers talk therapy) — particularly one who accepts your friend’s insurance or is within an easy distance from college. Don’t be discouraged! Persist in finding help, and if she agrees, go with your friend to the first appointment or offer to drive her there.

# How to Support Your Friend Through Treatment

Encourage your friend to stick with a treatment plan. The sooner she gets help, the more likely it is she will get better. Remind your friend that a mental illness is just another form of a physical illness; it can respond to treatment. And that treatment for mental illness — often including a combination of therapy and medication — can return her to stability and regular functioning.

Mental illness treatment doesn’t promise instantaneous results. It takes time for medications to become effective. Medications may change, and therapy will be ongoing. Your newly-diagnosed friend may worry that with a mental Illness, she will be isolated or treated differently by her friend group. So as a friend, be sure to include her in your plans, check in regularly, and offer to listen. Help her stay on her treatment plan, even if improved mental health comes more slowly (or quickly) than expected.

As a friend, you are just that: a friend. Trust your instincts. If you think your friend is in need, she probably is.

Talk, listen, support, and encourage.

Further Reading on Noodle:

How to Identify a Mental Health-Friendly College

How to Take Care of Your Mental Health in College

Four Tips to Help You Stay Focused While Battling Depression

Additional Resources:

The National Alliance on Mental Illness (NAMI)

The Jed Foundation

Active Minds