When Someone Says They’re Not Okay: Recognising Emotional Distress and Starting the Conversation
Sometimes the signs that someone is struggling are obvious.
Other times, they are hidden behind a smile, a busy work schedule or a simple response of, “I’m fine.”
Emotional distress can affect anyone, regardless of age, background or circumstances. And while not every difficult period means someone is experiencing a mental health crisis, recognising meaningful changes and knowing how to respond can make an important difference.
For World Suicide Prevention Day on 10 September, the message for 2026 is particularly simple: Start the Conversation.
Mental health struggles are not always easy to see
We often expect emotional distress to look like visible sadness.
But people cope in different ways.
Someone who is struggling may still go to work, attend social events, laugh with friends and appear completely normal from the outside.
Instead, family and friends may notice smaller changes over time.
These could include:
- Withdrawing from friends or family
- Losing interest in activities they previously enjoyed
- Becoming unusually quiet or isolated
- Significant changes in sleeping habits
- Changes in appetite
- Difficulty concentrating
- Becoming unusually irritable or angry
- Increased use of alcohol or other substances
- Neglecting normal responsibilities
- Expressing hopelessness or feeling like a burden
One sign on its own does not necessarily mean someone is experiencing a serious mental health problem.
What matters is often a noticeable change from their usual behaviour, particularly when several changes occur together.
Pay attention to what people say
Sometimes people communicate distress indirectly.
Statements such as:
“I can’t do this anymore.”
“Nothing is going to get better.”
“Everyone would be better without me.”
“I just want everything to stop.”
“I don’t see the point anymore.”
should not simply be dismissed as attention-seeking or dramatic.
They may be signs that someone is feeling overwhelmed, hopeless or unable to see another way through their situation.
It is okay to take those words seriously.
Starting the conversation does not have to be complicated
Many people hesitate to talk to someone they are worried about because they are afraid of saying the wrong thing.
You do not need to have the perfect words.
A simple conversation can begin with:
“I’ve noticed you haven’t seemed like yourself lately. Are you okay?”
“You seem to be going through a lot. Do you want to talk?”
“I’m worried about you. How are you really doing?”
Then listen.
Try not to immediately solve the problem or tell the person why they should not feel the way they do.
Sometimes being heard without judgement is the first step towards seeking further help.
It is okay to ask directly about suicide
People sometimes worry that asking someone whether they are thinking about suicide will put the idea into their head.
Evidence does not support this belief.
If you are genuinely concerned, asking directly and calmly can give someone permission to speak openly about what they are experiencing.
You might ask:
“Are you thinking about hurting yourself?”
or
“Have you been thinking about suicide?”
If the answer is yes, remain calm and take the response seriously.
You do not need to manage the situation by yourself.
Help the person connect with professional or emergency support.
Don’t minimise what someone is experiencing
When we care about someone, our natural instinct may be to reassure them quickly.
But phrases such as:
“Other people have it worse.”
“You have so much to be grateful for.”
“Just think positively.”
“Cheer up.”
may leave the person feeling even more misunderstood.
Instead, try responses such as:
“That sounds really difficult.”
“I’m glad you told me.”
“You don’t have to deal with this alone.”
“Let’s find someone who can help.”
The goal is not to convince someone that their problems do not exist.
It is to help them feel supported while finding a safer way through them.
What can contribute to emotional distress?
There is rarely one single reason someone reaches a point of emotional crisis.
Several factors may occur together, including:
- Depression or other mental health conditions
- Relationship difficulties
- Bereavement
- Financial stress
- Unemployment
- Trauma or abuse
- Chronic illness
- Social isolation
- Substance use
- Family conflict
- Academic or workplace pressures
WHO reporting from Eswatini has highlighted several vulnerable groups, including adolescents and young adults, people experiencing abuse or trauma, individuals with untreated mental illness, people with substance-use problems and those facing isolation, unemployment, financial difficulties or relationship stress.
Mental distress is therefore not something that should be reduced to someone simply being “weak” or unable to cope.
Men may be less likely to talk about emotional distress
In many communities, men grow up hearing messages such as:
“Be strong.”
“Don’t cry.”
“Deal with it.”
These expectations can make it harder to acknowledge emotional pain or ask for help.
A person may instead express distress through anger, withdrawal, risk-taking, substance use or sudden behavioural changes.
Creating space for men to talk openly about stress, relationships, finances and emotional health without ridicule or judgement is an important part of prevention.
Young people need adults who listen
Teenagers and young adults can also experience significant emotional distress.
Changes in friendships, school pressure, bullying, relationship problems, family conflict and uncertainty about the future can feel overwhelming.
Parents and caregivers should pay attention to persistent changes in behaviour, mood, sleep, school performance or social interaction.
If a young person says they are struggling, take them seriously.
You do not need to agree with how serious a problem appears from an adult perspective to understand that it may feel extremely serious to them.
When should professional help be considered?
Consider encouraging someone to speak to a healthcare professional when emotional difficulties:
- Persist for several weeks
- Interfere with work, school or daily responsibilities
- Affect sleep or appetite significantly
- Lead to withdrawal or isolation
- Result in increased alcohol or substance use
- Cause ongoing hopelessness
- Affect relationships
- Include thoughts of self-harm or suicide
Mental healthcare can include counselling, psychological therapy, medication when clinically appropriate and support for underlying problems.
Seeking professional help does not require someone to wait until they have reached a crisis.
What if someone may be in immediate danger?
If someone says they intend to harm themselves, has an immediate plan to do so or you believe their life may be in danger, treat the situation as a medical emergency.
Stay with them if it is safe for you to do so and seek urgent professional assistance.
In Eswatini, the Government lists:
- Ambulance / medical emergency: 977
- Police: 999
- Women & Child Protection: 951
- Child Helpline: 116
You can also take the person to the emergency department of the nearest hospital.
For people affected by abuse or gender-based violence, the SWAGAA 951 toll-free helpline also provides confidential support, counselling and emergency referrals.
Looking after yourself matters too
Supporting someone experiencing significant emotional distress can be difficult.
You may feel frightened, responsible or unsure whether you are doing enough.
Remember that you are not expected to become someone’s therapist.
You can listen, encourage them to seek professional help and remain supportive while recognising that trained healthcare professionals may need to become involved.
If supporting someone is beginning to affect your own mental health, you are allowed to seek support too.
A conversation can be more important than you realise
WHO’s theme for World Suicide Prevention Day from 2024–2026 is Changing the Narrative on Suicide.
The aim is to move away from silence, stigma and misunderstanding towards openness, empathy and support.
That does not mean every conversation will immediately solve someone’s problems.
But asking someone how they are doing — and genuinely listening to the answer — can create an opportunity for them to speak.
And sometimes that conversation is the beginning of getting help.
Speak to a TruMD Eswatini healthcare professional
If you are experiencing persistent anxiety, low mood, overwhelming stress or other emotional difficulties, TruMD Eswatini gives you convenient access to qualified healthcare professionals.
You can discuss what you have been experiencing confidentially and receive guidance on appropriate next steps.
If you are concerned about a family member or someone close to you, a healthcare professional can also help you understand how to respond and where additional mental health support may be needed.
If someone is in immediate danger or at risk of harming themselves, however, do not wait for a routine online consultation — seek emergency assistance immediately.
Mental health conversations matter.
Sometimes the most important question you can ask someone is simply:
“How are you really doing?”
