Mental Health Warning Signs
and Getting Help in Sri Lanka

Mental health problems are common, treatable and nothing to be ashamed of, yet many people wait months or years before seeking help, often because of stigma or not knowing where to turn. Worldwide, about 322 million people have depression and 470 million have an anxiety disorder, and in high-income countries only about one in three people with depression receive treatment. Recognising the warning signs early, in yourself or someone you care about, makes a real difference: treatment works better when started sooner. Warning signs include persistent low mood or worry, loss of interest, changes in sleep or appetite, withdrawing from people, difficulty coping with daily life, and increased use of alcohol or drugs. Some signs need urgent attention, such as talking about wanting to die or feeling like a burden. It's a common fear that asking someone about suicide might "put the idea in their head", but a review of 13 studies found no evidence that asking increases suicidal thoughts, and talking openly may reduce them. Prevention works: Sri Lanka's suicide rate fell by about 70% between 1995 and 2015, saving an estimated 93,000 lives, largely through public health action. Sri Lanka has free and confidential support, including the National Institute of Mental Health helpline (1926), CCCline (1333, available 24 hours a day in Sinhala, Tamil and English) and Sri Lanka Sumithrayo. This guide explains the warning signs, how to help someone who's struggling, and where to get help.

Key numbers

Why early help matters

Mental health conditions such as depression and anxiety tend to improve faster, and are less likely to return, when treated early. Left untreated, they can affect work, relationships, sleep and physical health, including raising the risk of heart disease, diabetes and dementia (see Depression and Physical Health and Anxiety and Physical Health). Seeking help early is a sign of strength and good sense, just like seeing a doctor for chest pain.

Warning signs to watch for

Everyone has bad days. Warning signs are changes that last two weeks or more, or that affect your ability to cope with daily life.

Mood and emotions

• Feeling sad, empty, hopeless or irritable most of the day
• Losing interest or pleasure in things you used to enjoy
• Constant worry, fear or panic
• Feeling numb, guilty or worthless

Thinking

• Difficulty concentrating, remembering or making decisions
• Persistent negative thoughts about yourself or the future
• Racing thoughts, or unusual beliefs or experiences that others don't share

Behaviour

• Withdrawing from family, friends and activities
• Struggling to manage work, study or household tasks
• Drinking more alcohol or using drugs to cope
• Neglecting appearance, hygiene or responsibilities

Body

• Sleeping much more or much less than usual
• Changes in appetite or weight
• Constant tiredness or low energy
• Unexplained aches, pains or stomach problems

In older adults, mental health problems often appear as tiredness, poor sleep, physical complaints, memory problems or loss of interest, rather than obvious sadness.

Urgent warning signs. Seek help immediately if you or someone else:

• Talks about wanting to die or not wanting to be alive
• Talks about feeling hopeless, trapped or a burden to others
• Is giving away possessions or saying goodbye
• Shows sudden calmness after a period of severe distress
• Has hurt themselves or is at risk of doing so
• Is confused, hearing voices or behaving very differently from usual

In these situations, don't leave the person alone if they're at immediate risk. Call 1990 for an ambulance, go to the nearest hospital emergency department, or call 1926 or 1333 for urgent guidance.

How to help someone who's struggling

You don't need to be an expert to make a difference. A simple approach:

• 1. Reach out. Choose a quiet, private moment and say what you've noticed: "You haven't seemed yourself lately. How are you really doing?"
• 2. Listen without judging. Let them talk. Avoid rushing to give advice or saying "just think positive".
• 3. Ask directly about suicide if you're worried. For example: "Sometimes when people feel this bad, they think about ending their life. Have you had thoughts like that?" A 2014 review of 13 studies found no evidence that asking about suicide increases suicidal thoughts, and the authors suggested that talking about it openly may reduce them.
• 4. Offer support and information. Reassure them that these problems are common and treatable.
• 5. Encourage professional help. Offer to help them make an appointment, call a helpline together, or go with them.
• 6. Stay in touch. Check in regularly. Recovery takes time.
• 7. Look after yourself. Supporting someone can be draining; seek support for yourself too.

If someone is at risk, help keep them safe: stay with them, remove access to anything they could use to harm themselves, such as stored medicines and agricultural chemicals, and get urgent help.

Where to get help in Sri Lanka

Start with a doctor. Your family doctor or any government hospital outpatient department can assess you, check for physical causes, start treatment and refer you to a psychiatrist, psychologist or counsellor. Many government hospitals have psychiatry clinics, and government health services are free (see Therapy and Counselling).

Helplines and support services

Numbers and hours can change; check the organisation's website if a line doesn't connect. Sumithrayo also has branches across the country, including Colombo, Kandy, Galle, Jaffna, Kurunegala, Negombo and others.

Prevention works. Sri Lanka has one of the world's most striking examples of suicide prevention. The suicide rate peaked at 57 per 100,000 people in 1995 and fell by about 70% to around 17 per 100,000, saving an estimated 93,000 lives between 1995 and 2015. Researchers attribute much of this to national restrictions on highly toxic pesticides, along with improvements in medical care. It's a powerful reminder that suicide is preventable, both through public policy and through individual care and connection.

Recommendations by scenario

Practical notes

Save the key numbers in your phone now: 1990, 1926 and 1333, and share them with family members. If you notice warning signs in yourself, talk to someone you trust and see a doctor; you don't need to wait until things are severe. If you're worried about someone else, reaching out with a simple "Are you okay?" can be the first step to them getting help. Our Longevity Doctors include mental wellbeing in every assessment, can screen for depression and anxiety, and can help you access the right care, starting with the free longevity assessment.