When professional help is needed

After extraordinary events, strong feelings and physical reactions are common: poor sleep, nightmares, irritability, crying, intrusive images. For many people they become weaker with time, rest and support from others. This is not an illness but an understandable reaction to something hard to understand.

Some of those affected, however, need more support. Psychological first-aid guides roughly distinguish two cases: acute danger, where you must act at once, and persistent distress, where timely professional help makes sense. Knowing these two thresholds makes it easier to act at the right moment.

The IASC guidelines describe help in emergencies like a pyramid: at the bottom are basic services and safety, above them support from family and community, above that focused support, and at the top specialised treatment for a smaller share of people. Every level matters, and nobody needs to be ashamed of needing a higher one.

You must act immediately if someone talks about suicide or self-harm, threatens or endangers others, is very confused, sees or hears things that are not there, or loses control completely. Then call the local emergency number (112 in the EU) or a local crisis line and stay with the person. If you would put yourself in danger, keep your distance and leave the rest to the emergency services.

If you are worried, ask calmly and directly: “Are you thinking of harming yourself?” Many people fear that this question might give someone the idea in the first place. Suicide-prevention guidance rather describes the opposite: the open question shows you are serious and can bring relief. Listen, don't judge, and get help together.

Do not leave a person at acute risk alone. As far as you can without danger to yourself, remove dangerous objects or medication from their reach until help arrives. Talk of suicide is never “just talk”; always take it seriously.

Not every kind of distress is an emergency, but some should not simply be sat out. Timely professional help makes sense if strong anxiety, low mood, sleeplessness, nightmares or intrusive memories do not ease over weeks or even get worse.

A second important sign is when daily life no longer works: someone can no longer look after themselves or their children, stops going to work, withdraws completely or increasingly uses alcohol, medication or drugs to somehow cope. Then waiting “until it gets better by itself” is not a good idea.

This text makes no diagnosis and prescribes no treatment. It is only meant to help you recognise when it is time to involve professionals. Whether and which treatment makes sense is decided by those affected together with doctors or psychotherapists.

Good first points of contact are the family doctor, local crisis lines or crisis services, psychotherapy and psychiatric services, pastoral care and the psychosocial services of relief organisations after disasters. Many countries have phone or chat helplines that can be reached at night as well. Which numbers apply to you differs by country and region – which is why deliberately no specific numbers are given here.

Look up local services in calm times and write them down: crisis line, family doctor's practice, trusted people. Put the list with your emergency documents and save the numbers in your phone. In a crisis there is often no time, energy or signal to search.

Bear in mind that professionals are not immediately available everywhere during a major crisis. Then family, friends, neighbours and helpers on the spot are all the more important – until professional support can be reached. In acute danger, though, the rule is always: call the emergency number.

For many people the first call is the hardest step. You can help by looking up the number, being there during the call or going along to the appointment. Take load off in daily life, for example with shopping or childcare, and stay in touch even if the person withdraws. But don't push anyone to talk about what they have experienced.

Helpers – whether professionals or neighbours – can themselves be heavily affected after an emergency. Anyone who has seen a lot of suffering may and should accept support too. That is a sign of responsibility, not weakness.

Mind your own limits. You don't have to carry everything alone or take on the role of a therapist. Your job is to be there, to take things seriously and to smooth the way to professionals.