Does my family member need mental health help? A 4-minute checklist for families

This checklist is for families who are worried about an adult relative: a son or daughter, a spouse, a parent or a sibling. It helps you put what you have noticed in order, so that you can decide on a next step.

The questions ask about changes over the past month that families often notice first:

• pulling away from family and friends, and big changes in sleep or self-care;
• seeming very sad or hopeless;
• unusual suspicion, talking to themselves, or hearing voices or seeing things others don't¹;
• spells of unusually high energy, fast talk or heavy spending²;
• using more alcohol, drugs or sleeping pills than before;
• problems with study, work or at home, and refusing help.

The last two questions are about safety: talk of death or suicide, self-harm, aggression, or you feeling unsafe at home.

Questions 1 to 10 each score 0 for “No”, 1 for “Not sure” and 2 for “Yes”, so the total runs from 0 to 20. “Not sure” counts a little, because families often see only part of the picture.

A “Yes” to any of these three questions leads to the third result whatever the total:

• unusual suspicion without reason (question 5);
• talking to themselves, or hearing voices or seeing things others don't (question 6);
• spells of unusually high energy (question 7).

These can be signs of psychosis or mania, which are best assessed by a psychiatrist soon¹².

Questions 11 and 12 are about safety and are not added to the total. A “Yes” or “Not sure” to either one opens a panel with urgent help at once. You can still finish the checklist and see your result.

Your result describes what you have noticed, not who your family member is. This checklist cannot diagnose your family member: only an assessment by a qualified professional can do that.

• Few warning signs right now: keep talking with your family member, and check again if things change.
• Some signs worth a professional opinion: several of the changes you noticed are worth discussing with a psychiatrist. A first consultation can include the family.
• Many warning signs — please seek help soon: the signs suggest your family member may be seriously unwell, or include signs a psychiatrist should assess soon.

These changes can have different causes, so an assessment is the way to find out what is going on. If a psychiatrist advises admission and supervised treatment in hospital, admission: a guide for families explains how it works.

• Choose a calm moment to talk. Say what you have noticed and why you are worried, without blame, for example: “You haven't been sleeping, and I'm worried about you.” Listen more than you speak.
• Write down the changes: when they started, what has changed in sleep, eating and daily life, and anything said about death or harm. Notes help the professional you see, so you do not have to rely on memory.
• Offer to help arrange an appointment and to go along. It can be easier to start with something your family member agrees is a problem, such as poor sleep or stress.
• If they refuse help, stay in touch, keep the door open and get advice for yourself. See what to do when someone refuses treatment and how to support someone you love.
• Respect their privacy. Adults have a right to confidentiality, but it has limits when someone's life is at risk.
• Look after yourself too. Caring for someone who is unwell is hard: rest, share the load and get support for yourself³. Our caregiver stress check can help you see how you are coping.

Arrange an assessment soon if your family member hears voices, is very suspicious, barely sleeps or eats, or is using drugs. A qualified professional, such as a BMDC-registered psychiatrist or a clinical psychologist, can advise you. Care is available in private practice and at public hospitals.

While you wait for help:

• if your family member might harm themselves, do not leave them alone, and move medicines, pesticides and sharp objects out of reach;
• if you feel unsafe, move away from the situation and get to a safe place first. Your safety comes first.

Suicides are preventable, and help is available⁴.

The team at Dr. MR Siddique Psychiatry Centre wrote this checklist for families. It is not a validated test. It helps you organise what you have noticed, but it cannot diagnose your family member; only an assessment by a qualified professional can do that. The questions are in our own words; they are not copied or translated from any published questionnaire.

Please do not use it to label anyone. The sources below explain the signs mentioned on this page. Some are written for readers in the UK or Australia, but the signs they describe are the same everywhere.