When Corrina left home for college, she was the bright, pretty cheerleader and volunteer.  I met her a few years later while I was researching mental illness among youth, and Corrina was in crisis. She nearly died in a hot car before being rescued and hospitalized involuntarily. She had received a terrifying diagnosis of psychosis. What happened, and how did everyone — her parents, school, friends and Corrina — miss the warning signs?

Today — during National Mental Wellness Month — we know the earlier people experiencing psychotic episodes seek help, the better the outcome can be. It’s good to be vigilant of at-risk friends and loved ones in need and understand the signs of serious mental illness.  In my new book, I share the stories of 47 young people who had experienced an emergency hospitalization for a psychotic break. They didn’t want this to happen to others, so they shared things they thought we should know.

First, some people are at a higher risk of developing psychosis. Many who develop psychosis as young adults had “adverse childhood experiences, such as” the death of a parent, sexual abuse, and even growing up with darker skin in a lighter-skinned neighborhood. These events don’t cause psychosis, but they can make a person more vulnerable to developing psychosis later. The more crisis experiences, the more risk.

Second, psychosis is triggered by stress and often starts during times of intense pressure. Young adulthood is when a person is expected (in many cultures) to prove themselves as independent adults. Corrina’s symptoms started when she was 24 after trying and failing to make it in college. She had gone back to school and was caring for a sick parent. It was too much for her, especially given her vulnerabilities.

Third, for most people, the onset is not sudden but gradual. In a viral TED Talk, psychologist Eleanor Longden described how her auditory hallucinations started with first-person observations, like “she is opening the door.” Over time, they then turned into multiple, negative persecutory voices that were simultaneously awful and her “only perceived companions.”

Fourth, the more one pays attention to psychosis, the more personalized it becomes and the more attention it pays to you. This can lead to self-shame as some people wonder if they actively “pushed themselves over the edge” once the psychosis stops.

These experiences are naturally distracting and often lead to social withdrawal as the afflicted attempt to cope with their worsening psychosis and preserve their sanity. It’s just too much to have the voices, do everyday life, and try to match up different realities. Corrina’s voices cast her as an angel and her family as demon imposters sent from “beyond the veil” to kill her. Imagine dealing with such voices while trying to function in class, at work, or enjoying a party with friends.

Finally, as everything gets worse, some start engaging in odd behaviors because they are distracted by their voices. Some people forget to take a shower, or take care of their hygiene, or eat, or are told by the voices not to do these things. Grades drop. Insomnia sets in. Social media posts get weird. Many seek relief from readily available substances that their peers tell them can help them calm down (cannabis) or study (Adderall) — both of which can make psychosis worse.

So, what can we do? If you see a young person struggling with social withdrawal, talking to themselves, interacting with things you cannot see or hear, losing sleep, neglecting hygiene, and attempting self-care with substance misuse, reach out and ask if they need support. Check their social media accounts. Ask their friends. Talk to their parents. Someone will know what’s going on, and the sooner they get help, the better.

Next, show them, their parents or their teachers this column and ask if there is any way this is happening to them. If you are the parent, ask your child.

Tell them not to be afraid but to ask their doctor or make an urgent appointment with student health. If they don’t want to go to a clinic, they can try a Hearing Voices group: people who meet up to learn more about what it means to hear voices and how to manage them.

Some people who hear voices never see the police or the hospital or become dangerous to themselves or others. That’s usually because they found support early on to help them manage the experience. We need to work together to make sure positive outcomes become the norm.