Adolescence is a time of significant physical, emotional, and social change. While this period of development is a crucial one, it makes teenagers particularly vulnerable to mental health difficulties. Approximately one in seven 10-19-year-olds worldwide experiences a mental health disorder. Some of the most common mental health conditions that emerge in adolescence are emotional disorders, behavioral disorders, eating disorders, psychosis, and suicide and self-harm. Unfortunately, the World Health Organization (WHO) notes that many of these mental health conditions go unrecognized and untreated in today’s youth.
Peer support can play a crucial role in early identification and encouraging teens to access mental health care. Teenagers often spend more time with their friends than they do with their families, and so being able to recognize mental health warning signs in friends can make a massive difference.1,2
As mental health symptoms can vary from person to person, however, that isn’t always easy. To help young people look out for each other, here are four common signs a friend is struggling with mental health:
1. Low Self-Esteem and Comparing Themselves to Others
If you notice that your friend is constantly comparing themselves to others, this can be a sign of a mental health issue. When adolescents set unreasonably high standards for themselves, they tend to experience increased rates of anxiety, depression, and other psychiatric conditions. For example, if your friend is talking about being uncomfortable in their body or disliking their shape or figure, this can be a sign of an eating disorder.3
Mission Prep Healthcare specializes in mental health treatment for teens aged 12-17, offering residential and outpatient programs for anxiety, depression, trauma, and mood disorders. Our therapies include CBT, DBT, EMDR, and TMS, tailored to each adolescent’s needs.
With a structured, supportive environment, we integrate academic support and family involvement to promote lasting recovery. Our goal is to help teens build resilience and regain confidence in their future.
2. Increased Feelings of Sadness and Depression
One of the main signs of depression in a friend is if they frequently experience a low mood. You may notice that your friend looks sad more often than not, which can be more noticeable if they begin to open up about these feelings in more detail. They may voice concerns that life is meaningless or hopeless, or that nothing brings them joy anymore. These are important warning signs because they can indicate that a friend is dealing with major depressive disorder (MDD). You should be particularly concerned if these thoughts and feelings become more severe, because they can be a warning sign for teen suicide.4
3. Chronic Fatigue or Difficulty Sleeping
Sometimes, recognizing mental health struggles in friends involves noticing small changes in their behavior. For example, if your friend has been much more tired than usual, or they are talking about having problems sleeping, this can be a sign of anxiety or depression.
Anxiety and sleep are closely connected. One common symptom of anxiety is rumination, or focusing on negative information. If your friend is constantly replaying mistakes or worrying about what might go wrong, it can lead to sleep problems.
Sleeping too much is also linked to depression in teenagers.5 While sleep patterns may change during adolescence due to hormones or busy social or school lives, sudden or unexplained sleep problems are potential signs of depression in a friend to be aware of.
4. Withdrawing from Friends
Pulling away from friends and isolating are common burnout and emotional exhaustion signs. If you notice that your friend is spending a lot of time alone, turning down plans, or becoming extremely overwhelmed in social situations, you may be recognizing mental health struggles. Social withdrawal and isolation are two changes in behavior linked to mental health. These can be signs of anxiety, depression, or other mental health concerns, so they shouldn’t be ignored.3–6
These aren’t the only signs, but they’re a starting point for how to tell if a friend is dealing with mental health issues. In some cases, there may be other reasons for changes in mood and behavior. If you’re worried, the next step is knowing how to help, without overstepping boundaries or impacting your own well-being.
What to Do When a Friend Is Struggling Mentally
Knowing what to say to a friend struggling with mental health can be difficult enough, let alone knowing what to do. If you’re worried about your friend, your first instinct may be to fix the problem. But with mental health concerns, there’s not always an easy fix.
Providing emotional support without fixing is the key to helping your friend through this difficult time. In addition, prioritizing your own health and wellness is equally important because you can’t help anyone if you’re running on empty.
Mental Health First Aid (MHFA) is an evidence-based training program that provides a framework for this. The program’s teen Mental Health First Aid Action Plan (tMHFA) teaches you how to identify a friend’s mental health struggle, offer initial support, and direct your friend to a trusted adult or professional.7 Below is a breakdown of how the plan works.
Teen Mental Health First Aid Action Plan (tMHFA)
Once you’ve identified that someone is struggling, the next step is figuring out how to start a mental health conversation with a friend. It might seem overwhelming, but simply approaching your friend and asking them how they are is a great first step. Stay calm, be respectful, and ask if there is anything you can do to help.7
The next step in the action plan is to listen. Being a supportive friend during mental health struggles means listening to your friend without judging or trying to fix everything. However, knowing when to get an adult involved is also important. After listening, ask them which adult they would feel comfortable talking to.7
If your friend is resistant to getting an adult involved and you’re still worried about their well-being and safety, you may need to tell someone yourself. This can be scary, especially if you are worried about damaging your friendship, but the most important thing is keeping you and your friend safe.7
Setting Healthy Boundaries While Helping a Friend
Research shows that supporting a friend with mental illness without healthy boundaries can take a serious toll. Some people reported feeling stressed and emotionally drained. Others found themselves compromising their own lives and well-being to support their friend. This can lead to stress-related mental health struggles of your own.7,8
One example of boundary setting for mental health is reminding yourself that you are not responsible for your friend’s decisions. You can follow the steps outlined in tMHFA, but that doesn’t mean your friend will take your advice or follow through on promises. If they continue to share troubling information about their mental health, it is important to know when to seek outside help.7,8
Supporting a friend with mental illness can impact your life in many ways. Helping your friend through a difficult time can make you feel good and capable, but you also need to look after your own mental health. This is why setting healthy boundaries while helping a friend with their mental health is crucial.7,8
Mission Prep: Supporting Teenagers with Mental Health Concerns
If you’re seeking mental health support for yourself, a friend, or your child, Mission Prep offers multiple treatment options. Our outpatient therapy, residential treatment centers, and intensive outpatient programs (IOP) for teens are designed to address a variety of mental health concerns.
Our programs are effective in treating adolescent depression, anxiety, eating disorders, and other mood or behavioral disorders. Our clinical team understands the unique pressures teenagers face and creates treatment plans tailored to each individual’s needs.
Call us today to speak to a member of our team about your current situation and receive recommendations for quality care. It is never too early to reach out for help for yourself or someone you care about.
References
- World Health Organization. (2025, September 1). Mental health of adolescents. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health
- Subasinghe, A., Morgan, A., Paxton, S. J., & Hart, L. M. (2025). Adolescents’ online and in-person help-giving experiences towards a peer with a mental health problem: A qualitative study. Advances in Mental Health, 1–18. https://doi.org/10.1080/18387357.2025.2565346
- Salminen-Tuomaala, M., Nissinen, K., & Haasio, A. (2023). Detecting signs of mental health problems in secondary school-aged youth. Clinical Nursing Studies, 11(1), 28. https://doi.org/10.5430/cns.v11n1p28
- Keyes, K. M., Kreski, N. T., & Patrick, M. E. (2024). Depressive symptoms in adolescence and young adulthood. JAMA Network Open, 7(8), e2427748. https://doi.org/10.1001/jamanetworkopen.2024.27748
- Bowker, J. C., Gurbacki, J. N., Richard, C. L., & Rubin, K. H. (2023). Anxious-withdrawal and sleep problems during adolescence: The moderating role of peer difficulties. Behavioral Sciences, 13(9), 740. https://doi.org/10.3390/bs13090740
- Martínez-Líbano, J., Coronado Reyno, C., Iturra Lara, R., & Barahona-Fuentes, G. (2025). Psychometric properties of the Emotional Exhaustion Scale for Children and Adolescents (EES-CA). Adolescents, 5(2), 20. https://doi.org/10.3390/adolescents5020020
- Kapil, R. (2019, July 2). How you can help a friend in crisis. Mental Health First Aid. https://mentalhealthfirstaid.org/news/how-you-can-help-a-friend-in-crisis/
- Byrom, N. C. (2019). Supporting a friend, housemate or partner with mental health difficulties: The student experience. Early Intervention in Psychiatry, 13(2), 202–207. https://doi.org/10.1111/eip.12462
