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View HCA Virginia's recommendations to start conversations about mental wellness including dealing with discrimination, misconceptions and social consequences.

Conversations about mental health may reduce the history of shame and secrecy associated with mental illness, encourage individuals to seek help if they are struggling with mental health issues, and encourage people whose friends or family members are struggling to connect them to help.

Mental health issues affect nearly every family. However, as communities, we have struggled to have open and honest conversations about these issues. Discomfort, fears of social consequences, and misconceptions, in addition to discrimination have contributed to keeping individuals silent. Conversations allow our communities to learn more about mental illness, and contribute to decision making related to steps to improve mental health in families, schools, and communities. Mental illness IS treatable, and most individuals CAN and DO recover and lead happy, productive, and full lives.

What is Mental Illness?

A mental illness is a condition that affects a person’s thinking, feeling, behavior, or mood. Common examples are Depression, Anxiety, Bipolar Disorder, Attention Deficit Hyperactivity Disorder (ADHD), Eating Disorders, amongst others. A Mental illness is not the result of one event. Research suggests multiple, often overlapping causes. Genetics, environment, and lifestyle choices significantly influence whether or not someone develops a mental health condition. Traumatic life events, and even a stressful job or home life can also make some individuals more susceptible. Basic brain structure and biochemical processes may also play a role.

Mental illness IS treatable. To start, nutrition, exercise, self-care, and lifestyle changes can have a positive effect on mental health and wellness. In other cases, mental illness can be managed through psychotherapy and/or medication.

Signs of Mental Illness

Below are some possible indicators of mental illness. Most usually persist over several weeks.

  • Noticeable change in work or school performance
  • Inability to cope with problems and daily life activities
  • Noticeable changes in sleeping and/or eating habits (too much or too little)
  • Psychosomatic or many physical complaints (i.e. headaches and stomach aches)
  • Risky sexual behavior
  • Extended period of negative mood
  • Abuse of alcohol and/or drugs
  • Change in hygiene, lack of personal self-care
  • Preoccupation with food, weight, exercise and/or body image
  • Persistent nightmares
  • Frequent outbursts of anger, aggression
  • Aggressive actions towards others; opposition to authority, truancy, theft, or vandalism
  • Paranoid or irrational thoughts, feelings; and behaviors
  • Threats of self-harm or harm to others
  • No-suicidal self-injury or other self-destructive behavior (cutting, burning, hair pulling, etc.)
  • Thoughts of or preoccupation with death or suicide

Prevalence, facts, and figures

There are many perspectives about mental illness, its causes, and how to best treat and respond to these conditions. The following information is intended to provide some basic facts about mental health and mental illness to help individuals and communities begin the conversation.

Mental Health Statistics

  • Over 19% of U.S. adults experience mental illness. This represents 1 in 5 adults.
  • Nearly 5% of U.S. adults experience “serious mental illness.” This represents 1 in 25 adults.
  • Over 16% of U.S. youth aged 6-17 experienced a mental health disorder.
  • Nearly 4% of U.S. adults experience a co-occurring substance use disorder and mental illness.
  • Only about 40% of U.S. adults with mental illness receive treatment and about 60% of those with serious mental illness receive treatment.
  • Only about half of U.S. youth aged 6-17 with a mental health disorder receive treatment.
  • The average delay between onset of mental illness symptoms and treatment is around 11 years!
  • Nearly 20% of U.S. adults with mental illness also experience a substance use disorder.
  • High school students with significant symptoms of depression are more than twice as likely to drop out compared to their peers.
  • The rate of unemployment is higher among U.S. adults who have mental illness (nearly 6%) compared to those who do not (3.6%)
  • More than 8 million people in the U.S. provide care to an adult with a mental or emotional health issue.
  • Caregivers of adults with mental or emotional health issues spend an average of 32 hours per week providing unpaid care.
  • Mental illness and substance use disorders are involved in 1 out of every 8 emergency department visits by a U.S. adult.

Suicide Statistics

  • Suicide is the 2nd leading cause of death among people aged 10-34 in the U.S.
  • Suicide is the 10th leading cause of death in the U.S.
  • The overall suicide rate in the U.S. has increased by 31% since 2001.
  • 46% of people who die by suicide had a diagnosed mental health condition.
  • Lesbian, gay and bisexual youth are 4 times more likely to attempt suicide than straight youth.
  • Transgender adults are nearly 12 times more likely to attempt suicide than the general population.

Substance abuse

Substance abuse takes a tremendous toll on communities. Mental and substance use conditions often co-occur. In other words, individuals with substance use conditions often have a mental health condition at the same time, and persons with mental health problems often abuse substances or experience addiction at the same time. The following includes statistics on substance abuse and co-occurring mental and substance use disorders:

  • In 2011, an estimated 20.6 million persons (8.0 percent of the population aged 12 or older) were classified with substance dependence or abuse in the past year.
  • 19.3 million persons (7.5 percent of the population aged 12 or older) needed treatment for an illicit drug or alcohol use problem but did not receive treatment.
  • Approximately eight million adults have co-occurring disorders.
  • Only 6.9 percent of individuals receive treatment for both conditions while 56.6 percent receive no treatment at all.
  • Co-occurring mental and substance use disorder rates are high among people who experience homelessness.
  • One study reported a 23 percent lifetime prevalence rate of co-occurring disorders for individuals who experience homelessness, and these people may face complex physical, social, and psychological challenges to recovery.
  • With treatment, emergency room visits, hospital stays, and periods of incarceration are significantly reduced.
  • Likewise, high-risk and harmful substance use is decreased. Stable housing along with supportive services provides a higher quality, self-directed, and satisfying life in the community.

Source: SAMHSA Community Conversations About Mental Health

Terms to know

Mental Health is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively, and is able to contribute to his or her community. In this positive sense, mental health is the foundation for individual well-being and the effective functioning of a community.

Mental Illness is defined as “collectively all diagnosable mental disorders” or “health conditions that are characterized by alterations in thinking, mood, or behavior (or some combination thereof) associated with distress and/or impaired functioning.” Under these definitions, substance use might be classified as either a mental health problem or a mental illness, depending on its intensity, duration, and effects.

Mental Health Promotion consists of interventions to enhance the ability to achieve developmentally appropriate tasks and a positive sense of self-esteem, mastery, wellbeing, and social inclusion and to strengthen the ability to cope with adversity. This ability to cope is referred to as resilience.

Mental Health Treatment is the provision of specific intervention techniques by a professional for conditions identified in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). These interventions should have proven effectiveness, the ability to produce measurable changes in behaviors and symptoms, and should be person- and family-centered and culturally and linguistically appropriate. Prevention is a step or set of steps along a continuum to promote individual, family, and community health; prevent mental and substance use disorders; support resilience, and recovery, and prevent relapse.

Recovery is a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential. People with mental illnesses can and do recover from these conditions, and hope plays an essential part in overcoming the internal and external challenges, barriers, and obstacles. Controlling or managing symptoms is part of this process. Reducing or eliminating substance use is critical for recovery from addiction.

Substance Abuse is defined as the use of alcohol or drugs despite negative consequences.

Substance Use is defined as the consumption of low or infrequent doses of alcohol and other drugs, sometimes called experimental, casual, or social use.

Trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or threatening and that has lasting adverse effects on the individual’s functioning and physical, social, emotional, or spiritual well-being.

Types of mental health problems

People can experience different types of mental health problems. Some can occur for a short time, and some occur over an on-going period of time. Just as other health conditions, these are real and diagnosable health conditions that affect and are affected by functioning of the brain, an organ of the body just like the kidney, liver, or heart. Mental health problems can affect your thinking, mood, and behavior. Common types can include:

Anxiety Disorders - People with anxiety disorders respond to certain objects or situations with fear and dread. Anxiety disorders can include obsessive-compulsive disorder, panic disorders, phobias, and Post-Traumatic Stress Disorder (PTSD).

Attention-Deficit Hyperactivity Disorder - Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood disorders and can continue through adolescence and adulthood. Symptoms include difficulty staying focused and paying attention, difficulty controlling behavior, and hyperactivity (overactivity).

Eating Disorders - Eating disorders involve extreme emotions, attitudes, and behaviors involving weight and food. Eating disorders can include anorexia, bulimia, and binge eating.

Co-Occurring Mental and Substance Use Disorders - Mental illnesses and substance use disorders often occur together. Sometimes one disorder can be a contributing factor to or can exacerbate the other. Sometimes they simply occur at the same time.

Mood Disorders - These disorders involve persistent feelings of sadness or periods of feeling overly happy, or fluctuating between extreme happiness and extreme sadness. Mood disorders can include depression, bipolar disorder, Seasonal Affective Disorder (SAD), and compulsion to self-harm.

Personality Disorders - People with personality disorders have extreme and inflexible personality traits that are distressing to the person and/or cause problems in work, school, or social relationships. Personality disorders can include antisocial personality disorder and borderline personality disorder.

Psychotic Disorders - People with psychotic disorders hear, see, and believe things that are not real or true. An example of a psychotic disorder is schizophrenia.

Substance Use Disorders - Substance use disorders involve the dependence on or abuse of alcohol and/or drugs, including the nonmedical use of prescription drugs.

Suicidal Behavior - Suicide is a serious problem that causes immeasurable pain, suffering, and loss to individuals, families and communities nationwide. Millions of people consider, plan, or attempt suicide each year; many die as a result.

Source: SAMHSA Community Conversations About Mental Health

How to ask for help

Reaching out for help, while seeming simple, is not. Reaching out for help is a big step, and one that shows courage, not weakness. Your parents, siblings, family, teachers and counselors, primary care physician, in-person and online therapists, community mental health programs and clinics, employee assistance programs, student counseling centers, local community service boards, and national helplines are all options.

If you are comfortable, consider telling a family member, trusted adult, or friend that you need additional support. If you are in a crisis situation and have thoughts of hurting yourself or others, take action IMMEDIATELY. Cal 911, or a crisis hotline like the National Suicide Prevention Lifeline, or visit the nearest emergency room. Your safety is the #1 priority.

Below are some additional suggestions for starting the conversation (by text, email, or in-person) if necessary:

  • “I’m (anxious/depressed/suicidal). I’m not sure what to ask for, but I don’t want to be alone right now.”
  • “I’m going through a tough time and I feel like you’re someone I can trust. Are you free to talk?”
  • “I’m struggling with my mental health and what I’ve been trying isn’t working. Can we meet and try to come up with a better plan?”
  • “I don’t feel safe by myself right now. Can you come over or stay on the phone with me until I calm down?”
  • “I’m in a bad place but I’m not ready to talk about it. Can you help me distract myself?”
  • “Can you check back with me later just to make sure I’m alright?”
  • “I’m having a hard time taking care of myself. I need extra support. Can you help?”
  • “I’m struggling right now and I’m afraid I’m reaching my limit. Can I give you a call tonight?”
  • “I’m suicidal. I need help right now.

If you are struggling with your mental health, remember that it is never too soon or too late to let someone know.

Having a conversation

If you think that someone that you care about is struggling with mental illness or mental health issues, it can be very difficult to initiate a conversation with them about what’s going on. If a direct discussion is too difficult, consider texting or emailing to start. Plan to have some time to work through this with this person, so make sure that you are able to have an in-depth discussion and you won’t have to cut things short. Planning for 30-60 minutes should be sufficient. Consider using the prompts below to help you frame exactly what is happening, or what you’ve been observing that has caused you to initiate this discussion.

  • “For the past (day, week, month, year, etc.).”
  • “It seems like you have been feeling (sad, angry, anxious, agitated, overwhelmed, stressed, etc.).”
  • “You seem to be struggling with your (job stress, job loss, death of loved one, recent health diagnosis, relationship, finances, etc.).”
  • “I’ve noticed your (changes in appetite, weight loss/gain, decrease/increase in energy, alcohol or drug use, guilt, paranoia, lack of sleep/too much sleep, anger, isolation, self-injury, talk of suicide, etc.).
  • “Talking to you about this makes me feel (nervous, anxious, hopeful, embarrassed, etc.).”
  • “I’m telling you this because (I’m worried about you, its impacting our friendship/relationship, I don’t know if anyone else has said anything, etc.).”
  • “I would like to help you (talk to a therapist/doctor, talk to a teacher/guidance counselor, what to do, create a plan, etc.).”
  • “What can I do?”