When I’m in a depression state, I know I should reach out for help , but often, I don’t.
My mind tells me it isn’t worth the effort. Thoughts like:
“No one will care.”
“Even if they do care, they can’t do anything for me.”
“I’m wasting their time. I’m not that important.”
When my anxiety-brain is active, the thoughts might sound like:
“I don’t want to freak anyone out.”
“I’m nervous, but I don’t have a good reason, so I must be crazy.”
A NLM study on masked depression shows that people with depression and anxiety often hide their symptoms very well. This makes it important for practitioners to recognize the signs of distress even when someone is trying to appear okay.
We’ll talk more about depression and anxiety later in this course. For now, remember that most people experiencing mental distress do not directly say “I need help.” Practitioners rely on warning signs to know when supportive action is needed.
External Warning Signs of Mental Distress
People will have the occasional bad day, and that’s fine, but several bad days in a row might indicate something is wrong. Below are several observable patterns that suggest someone may be struggling.
- Body posture — Slouching, stiff shoulders, fidgeting, avoiding eye contact when they normally wouldn’t.
- Physical appearance — Looking less groomed or put-together than usual.
- Attentiveness — Difficulty focusing, following a conversation, or recalling details.
- Tardiness — Showing up late more often, missing meetings, or forgetting appointments.
- Exhaustion — Appearing worn down, moving slowly, or describing poor sleep.
- Communication changes — Speaking quietly, speaking so quickly it’s hard to follow, or shifting tone.
- Irritability — Snapping at others, frustration, or low tolerance for stress; irritability is often a sign of distress.
- Shame-based language — Statements like “You’re going to be mad at me,” “You’re going to hate me,” or “I know I’m failing.”
Internal Warning Signs
Clients will not always verbalize these, but they may hint at them during conversations. Internal indicators include:
- Feeling overwhelmed by small tasks
- Having difficulty making decisions
- Feeling disconnected from others
- Loss of enjoyment in things they used to like
- Persistent negative self-talk (“I’m worthless,” “I’m failing,” “I don’t belong here”)
- Feeling like a burden
- Feeling stuck, numb, or emotionally flat
- Increased fear of judgment or criticism
- Physical symptoms like headaches, stomach issues, and muscle tension
Practitioners may pick up on these through tone, pacing, hesitations, or context clues.
People in distress often experience shame or confusion that prevents them from asking for help. Your ability to recognize early warning signs can support them before the situation escalates.
Reflection Exercise: Dee
Take a moment to pause and consider the scenario below. You can reflect quietly, write a few notes, or skip this section if now isn’t the right time.
Dee is a Deaf woman in her 40s who has been out of work for two years. Recently, you’ve noticed that Dee has begun arriving late to appointments. Where she once dressed professionally, she now appears more casual. Her posture seems more slumped than usual. Her signing is smaller and less animated, and she appears tired.
- What might these changes suggest about how Dee is currently experiencing distress or exhaustion?
- What factors would be important to consider when deciding whether, how, or when to acknowledge these changes?
- How might you approach this situation in a way that respects Dee’s autonomy, communication needs, and context?
Remember to notice what you’re thinking and learning. Take a break if you need one.
When you’re ready, continue to the Module 1 Summary and Reflection.
Disability and Mental Distress 