Health can mean something different to everyone. It can mean running 5ks, managing a chronic condition at home, or just having the energy to get up in the morning and take care of family.

More recently, another vital dimension of health has entered the public discussion: mental health.

Symptoms of mental illness often appear slowly, making them initially difficult to spot. In fact, it’s common for someone to experience symptoms for years before they come to the attention of a medical professional. Often, as someone begins to show signs of mental illness, it’s the people around them – partners, friends, parents, teachers, co-workers – who first notice differences in emotions or behavior.

It’s important to know that many people struggle with their mental health. In fact, the 2015 National Survey on Drug Use and Health estimated that there were some 43.4 million adults in the United States living with mental illness. That’s about 18 percent of the adult population, or nearly 1 in 5 adult Americans facing an often-invisible struggle. If you add substance use disorders to the list, the numbers increase further. So, chances are that one of your friends, relatives or colleagues is suffering from a mental health issue.

How can we help friends, loved ones, or community members who appear to be struggling? First, know the signs. For example, if someone who has been previously social begins to lose interest in being around others, this could be a sign of an internal struggle.

Similarly, when we are mentally healthy we’re generally able to take care of our basic needs – buying groceries, taking out the trash, paying the bills – and hygiene. If these things are slipping, it could be another sign someone needs help.

The list goes on: excessive fear or worry, mood changes, sleep or appetite changes, changes in school or work performance, and talking about death or suicide.

While some of these symptoms could be signs that someone is simply going through a tough time – or they just have the winter blues! – do not be afraid to reach out. A good place to suggest they start is with their primary care physician, who can refer them to a mental health professional. If you are concerned for someone’s safety, local crisis services are available 24 hours a day.

If you have questions or thoughts about a topic you’d like to cover in this space, I’d love to hear from you. Get in touch by emailing AskEileen@UVMHealth.org.

Eileen Whalen, MHA, RN, is a former trauma nurse who now leads The University of Vermont Medical Center. She currently serves as co-chair of the RiseVT board, and co-chair of the Chittenden County Opioid Alliance board.