Safeguarding and Recognising When Distress Needs Immediate Help: Guidance for People with Chronic Illness

Executive Summary

People living with chronic illness are at increased risk of emotional distress, anxiety, depression, and feelings of isolation. At times, this distress becomes severe and can escalate into crisis or risk of self-harm or suicide. This whitepaper outlines the essential principles of safeguarding, how to spot when distress requires immediate help, and the best ways to get support in the UK—across the NHS, charities, and online services. It is written as a practical guide for patients, families, health professionals, and carers.

Introduction: Why Safeguarding Matters in Chronic Illness

Chronic illnesses can alter every part of a person’s life—relationships, independence, employment, hopes, and daily routines. While strong support can be a buffer, the ongoing burden of symptoms, stigma, and uncertainty increases the risk of mental health crisis for some. In rare instances, individuals may feel life is no longer worth living or may harm themselves accidentally or deliberately.

Safeguarding, as defined by the UK Government and NHS, is the process of protecting people who may be at risk of harm due to illness, disability, or circumstance (NHS Safeguarding). Recognising distress and knowing how to respond quickly can save lives.

Understanding Distress: When is Help Needed?

Emotional distress in chronic illness is common. It can manifest as:

Low mood, relentless sadness, or hopelessness
Anxiety, panic attacks, or feeling overwhelmed
Withdrawal from friends, family, or support activities
Loss of interest in usual pleasures
Poor self-care (not taking medication, refusing appointments)
Thoughts of not wanting to go on—or of harming oneself

When distress is severe, persistent, or includes risk to safety, immediate support is essential.

Safeguarding Principles in the UK

Safeguarding means:

Protecting children and vulnerable adults from harm (abuse, neglect, self-neglect, and exploitation)
Acting promptly if someone is at risk of serious emotional or physical harm
Sharing information appropriately (with consent, or without if there’s urgent risk)

The Care Act 2014 and NHS policies set out clear duties for clinicians and for all adults to raise concerns without fear of blame.

See: NHS Safeguarding Information

Red Flags for At-Risk Distress

Watch for:

Direct or indirect talk about wanting to die (“I can’t do this anymore.” “My family would be better off.”)
Evidence of deliberate self-harm (cuts, burns, overdoses)
Withdrawn, agitated, or reckless behaviour
Sudden changes in mood, routine, or engagement
Giving away possessions, saying goodbye, or preparing for absence
Neglect of basic needs despite reminders or offers of help

If someone mentions suicidal or self-harm thoughts, always take it seriously.

How to Talk about Distress and Suicidal Feelings

Approach kindly and without judgement: “You seem down lately—want to talk?”
Avoid minimising the problem (“You’ll be fine”, “Other people have it worse”)
Use open questions (“How long have you been feeling this way?” “What kinds of thoughts are you having?”)
Listen actively—don’t rush to offer fixes.
If risk is present, ask directly: “Are you having thoughts of ending your life?”
- This does not increase risk—it reduces isolation and gets people help.
Reassure them that they are not alone and that help is possible.

See: NHS How to Support Someone in Crisis

What to Do: Step-by-Step if You or Someone You Know is Struggling

Assess immediate risk: If life is in danger, call 999 or go to the nearest A&E.
If urgent support is needed (but not an emergency):
- Contact NHS 111.
- Call a mental health crisis team (details often in care plans or on NHS websites).
- Use a specialist helpline like Samaritans (116 123) or text SHOUT to 85258.
Speak to a GP or existing care team: Same-day appointments should be requested for crisis.
Remove dangerous items if possible.
Stay with the person or ensure they are with someone trustworthy until help arrives.
Record what’s happened and who you have spoken to for follow-up.

Safeguarding for Children and Vulnerable Adults with Chronic Illness

Children or people lacking capacity require extra vigilance.

Watch for sudden changes in mood, behaviour, attendance, or academic/work performance.
If you suspect abuse, neglect, or immediate risk, contact local social services or NSPCC (for children).
For looked after children (LAC) and those with complex needs, extra safeguarding procedures will be in place through health and local authority teams.

Learn more: NSPCC Safeguarding

NHS Pathways and Emergency Support

Emergency services: Call 999 for life-threatening situations.
NHS 111: For urgent but not life-threatening crises.
Local Crisis Team: Mental Health Crisis Teams operate in most NHS Trusts nationwide.
A&E/Mental Health Assessment: All hospitals provide support for psychological emergencies.

Many chronic illness clinics have a named specialist nurse or psychologist for crisis—ask your team in advance who to contact.

The Role of Families, Friends, and Carers

Learn the signs: Attend NHS mental health first aid or safeguarding training if offered.
Keep communication open: Check in with loved ones regularly, especially during health flares.
Be prepared: Know crisis contacts and keep a list visible at home.
Look after yourself: Supporting someone in crisis is challenging. Access support from Carers UK and other resources.

Psychological Services: Access and Pathways

NHS Talking Therapies for psychological distress: self-referral available in England (search here)
CAMHS/Paediatric support: for young people in distress, referral via GP, school, or paediatrician
Hospital Liaison Psychiatry: present in most acute hospital trusts; they see inpatients and those attending A&E
Charity and voluntary sector: rapid counselling and peer support through organisations like Mind
Long-term support plans: should involve regular reassessment and be adaptable to crises

Crisis Helplines and Specialist Charities

Samaritans: 116 123 (free, 24/7), https://www.samaritans.org/
SHOUT Crisis Text Line: Text SHOUT to 85258 (free, nationwide)
Mind Infoline: 0300 123 3393, https://www.mind.org.uk/information-support/helplines/
Papyrus (young people, suicide prevention): 0800 068 4141, https://www.papyrus-uk.org/
NSPCC (children): 0808 800 5000, https://www.nspcc.org.uk/
Carers UK: https://www.carersuk.org/

Case Examples: Timely Help and Recovery

1. Pauline, 44, Lupus and Depression:
When Pauline’s symptoms flared, she stopped taking medication and told her family she wished she “could go to sleep and not wake up”. Her partner called NHS 111; she received a rapid mental health assessment, and a safe care plan was created with her GP, lupus nurse, and psychologist.

2. Jamie, 18, Type 1 Diabetes:
After multiple A&E visits for hypoglycaemia, Jamie admitted self-harming and refusing insulin due to distress about lifelong illness. A hospital liaison psychiatrist coordinated a school, GP, and family meeting; Jamie accessed CAMHS crisis support and peer mentoring via Diabetes UK.

Legal and Ethical Considerations: Safeguarding Adults and Children

Adults with capacity: Their wishes are paramount, but imminent risk allows sharing information for safety.
Lack of capacity: Best interests principle under the Mental Capacity Act 2005.
Children: Welfare is paramount (Children Act 1989/2004). Practitioners are legally required to act on concerns.
Confidentiality: May be suspended if there is immediate risk of harm.
Record keeping is vital for follow-up and further safeguarding.

Learn more:
NHS Safeguarding Legislation

FAQs on Distress, Safeguarding, and Resources

Isn’t talking about suicide dangerous?
No; asking about suicidal feelings may provide relief and prevents isolation.

Can I call for help if someone refuses?
If you believe someone is at risk of immediate harm, call for help regardless of their wishes.

What if I don’t know what to say?
Simply listening and staying with someone is powerful; you do not have to fix their feelings.

How can I support my own wellbeing as a carer?
Use dedicated carer support lines and peer groups (via Carers UK) and take respite when available.

Conclusion

Distress, crisis, and risk are not failings—they are signals that help is needed, rapidly and without judgement. The UK offers a wealth of NHS, professional, and voluntary sector support for anyone living with chronic illness—and for their families—who may reach emotional breaking point. Safeguarding saves lives; together, we can recognise trouble early, seek immediate support, and foster long-term wellbeing.