So how do you know when it is time to refer to a more formal kind of care?

Common indicators it may be time to refer include:

  • Despite an earnest desire to change/improve, the person seems unable to do so.
  • You have exhausted your knowledge/experience in helping with the specific struggle.
  • The time required to provide the level of support needed exceeds what you have to offer.
  • The person seems hesitant to share the details of their struggle with you.
  • The closeness of your relationship with the person makes it difficult to be objective.
  • Prolonged depression suggested by a sad demeanor, apathy, weight loss, (appearance of lack of sleep) tearfulness
  • Nervousness, agitation, excessive worry; irritability, aggressiveness, non-stop talking
  • Bizarre, strange behavior or speech
  • Violent outbursts
  • Extreme dependency, including spending much of his or her time visiting
  • Marked changes in personal hygiene
  • Signs of alcohol or drug abuse
  • Binging or purging of food
  • Withdrawal from friends or social isolation
  • Physical or sexual assault
  • Self-harm (cutting, burning, picking, disordered eating)
  • Talk of suicide, either directly or indirectly, such as, “I won’t be around to take that exam anyway,” or “I’m not worried about getting a job; I won’t need one.”
  • Crisis – death, significant loss, betrayal (affair)

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