Dec. 25 -- GRAND FORKS -- Although the holidays can bring joy and togetherness, the season is not always a happy time of year for everyone, mental health experts say.

The sense of grief over the death of a loved one may intensify, as the absence is felt more deeply. And heightened stress, loneliness or despair can be overwhelming.

Recognizing the importance of mental health awareness and suicide prevention, health care experts emphasize the need to watch for warning signs in friends and loved ones.

Equally important, they say, is knowing what to do if these signs are evident.

"Nobody thinks it's going to happen to them -- until it does," said Melissa Markegard, suicide prevention administrator for the North Dakota Department of Health and Human Services. "Warning signs are often missed or dismissed until it's too late. That's why it's vital to stay vigilant, have open conversations, and reach out for help. Call or text 988 -- don't wait."

Call data from FirstLink, the agency that answers the 988 Suicide and Crisis Lifeline for North Dakota, has received nearly 8,000 calls, texts and chats in 2024, Markegard said. "Nearly 2,000 of those were dialed in October."

For those dealing with depression, the holiday may make those feelings more intense, said Kevan Greene, a psychotherapist and licensed clinical social worker with Altru Health System.

"Sometimes the holidays can be a tipping point, and can push people to extremes," he said. "It's so important that we keep our eyes and ears open, because extremes can show up at holiday time."

It may be the grief and loss that envelops a person facing the first Christmas after a loved one has died, the loneliness felt by empty-nesters whose last child has left home, or the loss of a job.

Greene recommends watching for signs of "excessive drinking, even if it's social or isolated drinking," and returning to or adopting new unhealthy habits.

Alcoholism is a "big risk factor" in declining mental health during the holidays, he said.

"I would discourage having alcohol at family holiday get-togethers, as I have seen in my practice that this substance can tarnish many well-intended holiday celebrations. And I think people will be surprised at the overall acceptance of it by the majority of family members, as this sends a message of peace and safety, and that this is a priority of the host."

Also, be alert to signs of isolating and not wanting to be around others, he said. Canceling plans or engagements may be signs of deteriorating mental health, because social gatherings "may be more of a different time for them."

Greene stresses the importance of including people in your activities. "It shows them they are cared for and loved. It also gives us the opportunity to check up on them. The more involved they are and the more we have them with us, we can catch signs of depression, because the rates do go up during the holidays."

If you know of a lonely widow or widower, "give holiday cookies or make a nice call," Greene said. "Show and tell them that you care."

Also, "offer a listening ear to hear how they're experiencing the holidays," he said. Their circumstances may have changed and this may not be as joyous a time as it used to be.

There are lots of opportunities to "grab onto more community things," he said. Seek out faith-based or other activities that promote "a feeling of community."

The holidays offer "a golden opportunity to even enhance that relationship" with a friend or loved one, he said. "Reach out to them" and share your concerns. Be willing to listen and encourage them to seek help if they want to talk to someone else.

The holidays also are "a great time to forgive one another for any grievances, grudges or misunderstandings we may have with others," Greene said. "We try to overcomplicate things and want to hear an apology from someone, or we may feel that we may not have the right words to say, but just asking someone over to celebrate with you is a big step and the spirit of the holiday and family togetherness typically are the main ingredients to instill love and joy back into relationships and family that may have been lacking for some time."

Checking on and including friends and family after the holidays "is equally important to help maintain togetherness and feelings of inclusion," he said, "as the holidays can be a great motivator for improvement of ourselves and the relationships we have."

Many people who experience suicidal thoughts exhibit warning signs that can be identified and addressed, according to the state Department of Health and Human Services. Recognizing these signs and responding promptly can prevent a crisis.

Risk factors include:

* Mental health conditions, such as depression or anxiety

* Substance use or abuse

* Family dysfunction, trauma or relationship conflicts

* Access to lethal means like firearms or medications

* Significant life changes, including job loss or the death of a loved one

Warning signs include:

* Talking about wanting to die or expressing feelings of hopelessness

* Behavioral changes, such as withdrawing from social activities, giving away possessions, or fixating on death

* Sudden mood shifts, especially calmness after a period of turmoil

* Sharing alarming messages or posts on social media

The state Department of Health and Human Services recommends taking immediate steps to make a life-saving difference. They include:

* Ask directly: Don't shy away from asking, "Are you thinking about suicide?"

* Listen without judgment: Show compassion and avoid minimizing their feelings.

* Provide reassurance: Emphasize that they're not alone and that help is available.

* Secure dangerous items: Remove potential means of self-harm, such as weapons or pills.

* Contact help: Call or text 988 for guidance from a trained crisis counselor.

For those struggling with stress or emotions during the holidays, small steps can promote mental well-being. They include:

* Stay connected: Reach out to friends or family, even for brief check-ins.

* Set boundaries: It's OK to decline additional responsibilities.

* Take breaks: Dedicate time to activities that recharge you, like walking or journaling.

* Acknowledge your feelings: Allow yourself to experience and process emotions without judgment.

"Help is always just a call away," Markegard said. "Reaching out to the 988 Suicide and Crisis Lifeline can be the first step toward hope and healing. You don't have to go through it alone."

. In-person support is available through mobile crisis teams located statewide to provide immediate assistance, and can be accessed through 988 or 911.

Specialty care, for those with developmental disabilities, is provided through the CARES Crisis Response Team, accessed through 988.

If you or someone you know is in a mental health crisis, call or text 988. Help is free, confidential and available 24/7.