The warning signs of mental illness often come early in life. Fifty percent of cases of mental illness begin by age 14, and three-quarters begin by age 24.

Looking for warning signs will help you, your loved one and his or her treatment providers get a head start on managing the illness. Generally speaking, it’s hard for the people with the illness to fully recognize the warning signs. So often his friends and family will start to see problems first.  Here are some typical signs:

• Increased irritability.
• More noticeable tension, anxiousness or worries.
• Increased sleep disturbances (such as hearing your loved one being up all night and sleeping through the day OR  not sleeping for more than 24 hours)
• Depression.
• Social withdrawal in more extreme forms, such as refusing to leave his or her room even to eat, spending most of the time alone.
• Deterioration of school or job performance.
• Concentration problems (taking longer to do tasks, have trouble finding tasks, having trouble following a conversation or a TV show).
• Decreasing or stopping medication or treatment (such as, refusing to go to the doctor or the case manager appointment, skipping the vocational program).
• Eating less or eating more.
• Excessively high or low energy.
• Lost interest in doing things.
• Poor hygiene or lost interest in the way he or she looks.
• Saying that he or she is afraid that he or she is “going crazy.” 
• Becoming excessive in religious practices.
• Feeling bothered by thoughts that he or she can’t get rid of.
• Mistrustfulness or suspiciousness.
• Showing emotions that do not fit the situation.
• Vague speech.
• Speech that doesn’t make sense.
• Making up words.
• Inappropriate responses … laughing or smiling when talking of a sad event, making irrational statements.
• Unusual idea or beliefs.
• Feeling completely overwhelmed. 
• Leaving bizarre voice mail messages, outgoing messages or writings.
• A blank vacant facial expression.
• Rapidly changing mood … from happy to sad to angry for no apparent reason.

Warning Signs of Mental Illness in Children

• Severe and recurring depression … feeling very sad or withdrawn for more than two weeks.
• Explosive, destructive or lengthy rages, especially after the age of four.
• Extreme sadness or lack of interest in play.
• Severe separation anxiety.
• Talk of wanting to die or kill themselves or others.
• Dangerous behaviors, such as trying to jump from a fast moving car or a roof.
• Grandiose belief in own abilities that defy the laws of logic (possessing ability to fly).
• Sexualized behavior unusual for the child’s age.
• Impulsive aggression.
• Delusional beliefs and hallucinations.
• Extreme hostility.
• Extreme or persistent irritability.
• Telling teachers how to teach the class, bossing adults around.
• Creativity that seems driven or compulsive.
• Excessive involvement in multiple projects and activities.
• Compulsive craving for certain objects or food.
• Hearing voices telling them to take harmful action.
• Racing thoughts, pressure to keep talking.
• Sleep disturbances, including gory nightmares or not sleeping very much.
• Drawings or stories with extremely graphic violence.

Trust Your Instincts

If the person is a family member … a child or husband … and their behavior seems unusual to you, trust your instincts.

If your teenager is not engaging in activities or with friends and is chronically disconnected, angry and sad, the behavior is abnormal and needs intervention.

Many teenagers have episodes of sadness, anxiety, frustration and feelings of being overwhelmed.  The episodes should not last more than a few days at most.  If the feelings are continual and your teen is chronically anxious, speak to your child about your concerns and consult your family doctor.

Don’t ignore. Don’t accept other people saying it’s just a stage. Trust your instincts that something is wrong.

Mental illness is a difficult phrase: It implies that this kind of illness is different from all other kinds of illness. It’s not. It’s a brain-based illness, for the most part. I use the phrase because it is widely understood, not because it is appropriate.

Mental illness is common, and it’s generally episodic. Things get better and then things get worse and then things get better again. 

Illness or Individuality?

There are plenty of people who are very shy, or believe in government conspiracies, or are sure that they talked to the dead, or heard directly from God.  Does that mean they are mentally ill?  Not necessarily.

To one degree or another, many people hold views that are unusual or eccentric. To qualify as mental illness, the behavior must do these things:

1. The symptoms must interfere with the person’s ability to have social relationships, go to school or hold down a job, or take care of himself.
2. The most severe symptoms must last for at least a month, unless the period is cut short with successful treatment.
3. The symptoms are not explained by drug abuse, the side effects of another medication or the impact of another illness.

Is Mental Illness Really Common, Though?

Yes. It may not seem common because it is so often hidden. Here are the facts from NAMI and the World Health Organization:

• About 1 in 5 adults in the U.S. – 43.8 million or 18.5% experience a mental illness in any given year.
• About 1 in 25 adults in the U.S. – 9.8 million or 4% – experiences a serious mental illness in any given year that substantially interferes with or limited one or more major life activities.
• About 1 in 5 children aged 13-18 (21.4%) experiences a severe mental disorder at some point.  For children aged 8-15, the estimate is 13%.
• 1.1% of adults in the U.S. are on the schizophrenia spectrum.
• 2.6% of adults in the U.S. have bipolar disorder.
• 6.9% of adults in the U.S. – 16 million – had at least one major depressive episode in the past year.
• 18.1% of U.S. adults have an anxiety disorder such as posttraumatic stress disorder, obsessive-compulsive disorder and specific phobias.
• About the 20.2 million adults with a substance use disorder, 50.5% – 10.2 million adults – have a co-occurring mental illness.
• About 26% of homeless adults staying in shelters have a serious mental illness.
• About 20% of state prisoners and 21% of local jail prisoners have a recent history of mental illness.
• 70% of youth in juvenile justice systems have at least one mental health conditions and at least 20% have a major mental illness.
• More than 90 percent of children who commit suicide have a mental illness.
• Only 41% of adults with a mental health condition received medical services for it.
• Only half of the children with mental health conditions get help.
• African Americans and Hispanic American use mental health services at about half the rate as Caucasian Americans.  Asian Americans get services at about one-third the rate.
• Percentage of people with mental illness that Jesus cared enough about to die for:  100%