When is it time?

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)