When self-help is not enough: signs, first steps and finding care

The exercises on this site are small, everyday tools. They can help you settle during a hard moment, but they are not treatment, and no health body the editors read suggests that self-help takes the place of care when problems are serious or persistent. Knowing when to move from one to the other is a skill of its own.

This page gathers what the US National Institute of Mental Health (NIMH), the NHS and a federal treatment locator say about signs to look for, what a first conversation can involve, and where to look for care. It cannot assess your situation.

If you are in danger or in crisis

In an emergency, call your local emergency number. That is 911 in the United States and 999 in the United Kingdom. The NIMH says that in life-threatening situations people should call 911 or go to the nearest emergency room. The NHS says to call 999 or go to A&E if someone's life is at risk or if you do not feel you can keep yourself or someone else safe. It adds that a mental health emergency should be taken as seriously as a physical one.

In the United States, the NIMH says that if you are suicidal or in emotional distress you can call or text 988, or start a chat online, to reach the 988 Suicide and Crisis Lifeline, which it describes as 24-hour, confidential support. In the United Kingdom, the NHS lists 111 for urgent advice (choose the mental health option) and says that Samaritans can be reached free on 116 123. Elsewhere, use your own national emergency number.

Signs that it may be time to talk to someone

The NIMH offers a simple way to think about it. For mild symptoms lasting less than two weeks, while you can still care for yourself and others, it suggests regular exercise, healthy eating, seven to nine hours of sleep, time with loved ones, and meditation or breathing exercises. It then says that if these activities do not help or symptoms worsen, you should talk to a health care provider.

For more severe symptoms lasting two weeks or more, the NIMH says to seek professional help. Its examples include feeling sad, tearful or hopeless, feeling worthless or guilty, losing interest in things you usually enjoy, difficulty concentrating, trouble completing tasks, and changes in appetite, weight or sleep.

The NHS gives a practical test for anxiety, fear and panic. It advises seeing a GP if you are struggling to cope, if the things you are trying yourself are not helping, or if you would prefer a referral to talking therapies. The NHS also says anxiety can be a main symptom of several health conditions, so it advises against self-diagnosing. For how ordinary stress differs from something longer lasting, see stress and anxiety: what is the difference. Persistent sleep trouble is covered in sleep, stress and winding down.

Where self-help stops

Breathing and grounding exercises, such as the paced breathing timer and the 5-4-3-2-1 grounding walkthrough, are things to do in the moment. The NIMH lists breathing exercises and meditation among activities that may help with mild symptoms. For more persistent difficulties it says treatment usually includes therapy, medication or both, and mindfulness: risks and limits explains why popular practices should not stand in for care.

What a first conversation can look like

The NIMH recommends starting with a primary care provider if you do not know where to begin. It says this person can perform an initial mental health screening and refer you to a mental health professional such as a social worker, psychologist or psychiatrist. It encourages people to raise their concerns even if the provider does not ask.

The NIMH suggests preparing ahead. Write down your questions, list every medication, vitamin and supplement you take, and review your family mental health history. It advises being honest and specific: describe your symptoms, when they started, how severe they are, how often they happen, and any major stressors or recent life changes. It notes that discussions with a provider are private and cannot be shared without your permission. You can also ask about other options if a suggested treatment does not feel right, because there is no one-size-fits-all treatment.

In England, the NHS says adults aged 18 or over (16 or over in some areas) can refer themselves to NHS talking therapies without seeing a GP first.

How to look for care

The NIMH lists several routes. A primary care provider can refer you. In the United States, federal resources include the Substance Abuse and Mental Health Services Administration (SAMHSA) treatment locator. Other routes include professional organisations with provider directories, state and county health departments, your insurer, a school or college health centre, and an employee assistance programme at work. The NIMH notes that it is a research agency and cannot provide referrals.

FindTreatment.gov, run by SAMHSA, describes itself as a confidential and anonymous resource for people seeking treatment for mental and substance use disorders in the United States and its territories. Its home page also lists a National Helpline, 1-800-662-HELP (4357), for treatment referral and information, available 24 hours a day.

The NIMH suggests questions to ask a possible provider: what experience they have treating your issue, how they usually treat it, how long treatment may last, whether they accept your insurance, and how much it will cost. It says treatment works best with a good relationship with your professional, and that you should not stop treatment without talking to your provider. If you want to try something like mindfulness for anxiety alongside care, mention it to your provider.

The short version

Self-help can support you through ordinary stress, but if symptoms last, worsen or interfere with daily life, health bodies advise talking to a doctor or mental health professional. Start with a primary care provider or a GP, prepare notes for the visit, and use official locators to find care. In an emergency, call your local emergency number.