Responding to Distressed People

(FS1805, Revised June 2022)

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

Lead Author
Lead Author:
Sean Brotherson, Professor & Extension Family Science Specialist
Other Authors

Deb Gebeke (Former Author)

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Publication Sections

Sometimes you need help. Sometimes you are help.

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 figure out a course of action.

Experiencing distress

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

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.

Safety and warning signs

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 (low mood, crying, sleep problems, weight loss/gain, fatigue)
  • 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?)

Do you believe danger is imminent?

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, 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 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, 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 or text the local or National Suicide Prevention Lifeline (either 9-8-8 or 1-800-273-8255), and ask for help in making a plan of action. 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 or friend for 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.


Resources for depression, anxiety, suicide risk or addiction/substance misuse:

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

❏ National Suicide Prevention Lifeline: Call 9-8-8 or call/text 1-800-273-8255 (TALK) 24-hour crisis support if you or someone you know needs suicide or mental health-related crisis support. 

❏ Crisis Text Line: Text the word HOME to 741741 from anywhere in the U.S. to connect
with a trained crisis counselor, anytime. 

❏ Help is Here: For resources related to alcohol, substance or opioid misuse in North Dakota, visit the Recovery Reinvented website  or the Help is Here website from ND Behavioral Health.

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

❏ ND Regional Human Service Centers: Counseling services available statewide. 

❏ In an emergency, call 911.

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

Made possible with support from the North Dakota Farm and Ranch Stress Assistance Center project, with funding from USDA-NIFA.

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