The levels of mental health distress can be understood on a spectrum. At the lower end is mild distress, which might manifest as feeling irritable, having trouble sleeping for a night or two or experiencing brief periods of sadness. This level of distress is often a normal reaction to life's challenges and is usually manageable with self-care and time.

Moderate distress involves more pronounced symptoms, such as persistent anxiety, changes in appetite, social withdrawal or difficulty concentrating. At this stage, it can start to significantly affect work, school and relationships, and professional help may be beneficial.

Finally, severe distress is characterized by intense, debilitating symptoms that make it difficult to perform basic daily tasks. This can include, but is not limited to, panic attacks, severe depression with suicidal thoughts or psychosis. This level of distress often requires immediate professional intervention and support. Understanding these different levels is crucial for knowing when to seek help for oneself or others.

As members of a caring community, we all play a role in fostering a culture of well-being. A critical part of this is learning to recognize when someone might be struggling with their mental health. It's not about diagnosing, but about noticing changes and connecting people with the support they need.

Mental health exists on a spectrum, and it's normal for students to experience stress and sadness. The key is to look for a noticeable shift from their typical self — a pattern of behavior or a collection of signs that persists for days or weeks and impacts their ability to function. Trust your instincts; if you feel something is wrong, it’s worth paying attention to. Below are common signs of distress, categorized to help you identify potential concerns.

Signs of Potential Mental Health Difficulties

These signs can indicate that a student is struggling with issues like depression, anxiety, an eating disorder, substance misuse or other mental health challenges. A person may show signs from one or multiple categories.

Academic and Behavioral Changes

• Significant Decline in Academic Performance: A noticeable drop in grades, missed assignments or poor test performance that is out of character.
• Poor Attendance: Frequently skipping classes, labs, or mandatory meetings.
• Loss of Interest: Apathy or disinterest in activities, hobbies or relationships they once enjoyed.
• Social Withdrawal and Isolation: Pulling away from friends, family and social events; spending an unusual amount of time alone.
• Changes in Energy Levels: Persistent fatigue and lethargy, or, conversely, hyperactivity, agitation and restlessness.
• Increase in Reckless or Impulsive Behaviors: Engaging in actions with a high potential for negative consequences, such as reckless driving, unsafe sex or excessive spending.
• Increased Substance Use: More frequent or heavy use of alcohol or other drugs, leading to consequences like blacking out, vomiting or academic/social problems.

Emotional and Social Changes

• Extreme or Prolonged Mood Swings: Rapid or dramatic shifts in mood (e.g., from euphoric to deeply sad) that seem disproportionate to the situation.
• Increased Irritability or Aggression: A short temper, frequent arguments or disruptive or threatening behavior.
• Persistent Sadness or Frequent Crying: Displaying overwhelming sadness, hopelessness or crying spells with little or no apparent cause.
• Overwhelming Anxiety or Worry: Expressing constant, excessive worry, or exhibiting physical signs of anxiety like panic attacks, trembling or shortness of breath.

Physical Changes

• Drastic Changes in Sleep Patterns: Consistently oversleeping and struggling to get out of bed (hypersomnia) or the inability to sleep (insomnia).
• Significant Weight or Appetite Changes: Dramatic weight loss or gain; a preoccupation with food, weight, calories or body image.
• Decline in Personal Hygiene: A noticeable change in personal grooming, such as not showering, wearing dirty clothes or a generally disheveled appearance.
• Unexplained Physical Ailments: Frequent complaints of headaches, stomachaches or other physical pains that do not have a clear medical cause.
• Evidence of Self-Harm: Unexplained cuts, scratches or burns, often on the arms or legs, which may be hidden by clothing.

Concerning Communication or Thought Patterns

• Confused or Disorganized Thinking: Bizarre speech, illogical thoughts or seeming to lose touch with reality (e.g., paranoia, strange beliefs).
• Expressions of Hopelessness or Worthlessness: Talking about feeling trapped, being a burden to others or that things will never get better.
• Overwhelming Guilt or Shame: Expressing intense feelings of guilt or self-blame over past events.

Urgent Warning Signs of Potential Suicide

While the signs above are serious, the following indicators suggest an immediate and critical risk of suicide. If you observe any of these signs, it is vital to take immediate action.

• Direct or Indirect Talk About Suicide: Any mention of wanting to die, killing themselves or "not being around anymore." This can happen in person, online, in texts or in academic work. Examples include, but are not limited to, "I can't see a way out," "Everyone would be better off without me," or "If I'm not here tomorrow ...".
• Actively Seeking Means: Researching methods to end one's life online, or trying to acquire pills, weapons or other lethal means.
• Making a Plan or Preparations: This can include actions like writing a suicide note, giving away cherished possessions or making arrangements for pets or belongings.
• Expressing a Sense of Being a Burden: Stating that their friends, family or the world would be better off without them.
• A Sudden and Unexplained Sense of Calm: After a long period of deep depression, a sudden shift to being calm or happy can be a major red flag. This may indicate they have made the decision to end their life and feel a sense of relief.
• Saying Goodbye: Visiting or calling people to say goodbye in a way that feels final.

What to Do If You're Concerned

• Talk to the Person Directly: If you feel comfortable and safe, talk to them in private. Express your concern using "I" statements, such as, "I've noticed you haven't been in class lately, and I'm worried about you."
• Listen Without Judgment: Allow them to share as much or as little as they want. You don't need to have the answers; just being present and listening is a powerful form of support.
• Share Your Concern and Connect Them to Help: Encourage them to speak with a professional. Fill out a CMU CARES referral form to connect them with Student Support Resources. You can offer to walk them to Counseling and Psychological Services (CaPS) or help them call them for support. 
• In an Emergency: If you believe a student is in immediate danger of harming themselves or others, do not leave them alone, and utilize the crisis resources below under Crisis Resources to seek support.

CaPS and Student Affairs provides trainings for the CMU community (students, staff and faculty) that aim at increasing understanding and preparedness when confronting someone who is experiencing distress or thinking of suicide. 

• Mental Health First Aid is an evidence-based, international education program proven to be effective in teaching adults how to identify, understand and respond to signs of mental health and substance abuse challenges among adults. You will build skills you need to reach out and provide initial support to those who are struggling. You will also learn how to connect them to the appropriate support. 
• Pathways for Suicide Prevention Training, originally designed by Syracuse University, is specifically intended for a college/university community. It focuses on enhancing a person’s knowledge, awareness and skills concerning college student suicide. Emphasis is placed on developing empathic listening skills, communication skills and the ability to ask students compassionately and directly about their suicidal thoughts. This training employs a multicultural framework and seeks to enhance understanding of and ability to respond to students from numerous intersecting identities.
• Supporting Student Well-Being: Faculty Professional Development in Recognizing and Assisting Students in Distress is a 90-minute faculty-designed, professional development opportunity that is meant to serve as a broad overview of how best to aid students at Carnegie Mellon University. Following this session, faculty should be able to:

1. Articulate key findings about the CMU student mental health experience,
2. Describe the vital role of faculty in supporting students,
3. Identify the appropriate methods to assist students,
4. Describe the available support resources on campus.

• Counseling and Psychological Services
  Counseling and Psychological Services addresses the mental health needs of students on campus. All services are confidential. 
• TimelyCare
  CaPS partners with TimelyCare to offer additional mental health support to students. Using your Andrew ID, CMU students can access this service for free. Services include counseling, well-being videos, health coaching and TalkNow, which is an on-demand service for students in need of support. 
• Student Support Resources
  The office of Student Support Resources offers an additional level of support to students who are in need of advocacy and guidance in navigating well-being concerns.
• Wellness and Meaning Making Programs
  The office of Wellness and Meaning Making Programs comprises wellness initiatives and religious and spiritual life. They offer a wide array of workshops, personal development opportunities, community-connection events and services to support students' holistic health.
• Lean on Me 
  Lean on Me is an anonymous peer support student organization at CMU that offers support to students through text. 
• Plaidvocates
  The Plaidvocates is a peer health and wellness advocacy program for student-athletes that supports the well-being of CMU’s varsity athletics community.
• Peer Health Advocates
  Peer Health Advocates (PHAs) are a team of NASPA-Certified Peer Educators through University Health Services (UHS) supporting and encouraging holistic student health and well-being across campus through culturally responsive programming, projects and one-on-one meetings. 

For an expanded list of other community resources by topic, explore the many resources on the Community Health and Well-Being Resources webpage.

• American Association of Suicidology
• Suicide Prevention Resource Center
• JED Foundation 
• American Foundation for Suicide Prevention 
• Substance Abuse and Mental Health Service Administration (SAMHSA)

Twice during the academic year, all Carnegie Mellon students, faculty and staff receive an e-mail from Community Health and Well-Being (CHWB) with a description of resources available to the campus community. Additionally, Counseling and Psychological services shares resources monthly in its distribution list e-mail and with the University Advisor distribution list e-mail.

The resources on this webpage are shared during First-Year Orientation and Graduate Student Orientation events by the various offices under Community Health and Well-Being. Also, the information from this webpage is communicated during Counseling and Psychological Services outreach events throughout the year. Finally, Counseling and Psychological Services (CaPS) Instagram account regularly posts information about how to seek help, support a friend, identify concerning signs in a peer, etc.

To address a campus crisis, including the death of a CMU community member, the Office of the Vice President for Student Affairs and Dean of Students has established a comprehensive response plan. This plan is designed to provide timely resources, support and communication to the campus community. The office will also coordinate with relevant campus and local partners to ensure a tailored response that addresses the community's needs.