Families of someone with post-traumatic stress disorder learn to live with a certain amount of turbulence. Rough nights, bad anniversaries, a week when your husband barely talks or your daughter cannot leave the house. Over time you get good at riding it out. The danger is that you also get used to it, and the moment when things have moved past rough and into serious can slip by unnoticed.

This page is for parents, spouses, partners and adult children in the St. Louis area and across Missouri who love someone with PTSD. It lays out the signs that mean it is time to push for more help, the signs that mean it is time to act today, and how to prepare so that you are not deciding everything in the middle of a crisis.

Signs it is time to push for more care

These are not emergencies, but they are signals that your loved one needs more than what is happening now. Consider a firmer conversation about treatment, or a call to their existing clinician with their permission, if you notice:

• Nightmares, flashbacks or panic becoming more frequent or more intense.
• Avoidance growing until it shrinks their world: skipping work, dropping friends, not leaving the house.
• Drinking or drug use climbing, especially to sleep or to get through the day.
• Anger outbursts becoming more frequent or harder to come down from.
• Depression settling in: hopelessness, no interest in anything, sleeping all day, saying they are a burden.
• Stopping a medication or dropping out of therapy without a plan.

The backbone of PTSD treatment is therapy designed for trauma; EMDR, prolonged exposure and cognitive processing therapy are three names you may hear. Veterans can start at the VA, whose Coaching Into Care program talks with family members about how to raise the subject.

Signs it cannot wait

Some warning signs mean you should act now, today, without waiting for an appointment:

• Talking about wanting to die, or about killing themselves.
• Looking for a way to do it, such as searching online or getting hold of a weapon or pills.
• Saying goodbye, giving away belongings, or tying up affairs.
• Talking about feeling trapped, unbearable pain, or being a burden.
• A sudden calm after a long stretch of distress, which can sometimes mean a decision has been made.
• Threatening to hurt someone else, or losing touch with what is real.

If you see these, ask directly: "Are you thinking about suicide?" Asking does not plant the idea. It opens the door. Stay with them, remove access to firearms and stockpiled medications if you can do so safely, and get help on the line.

Building a plan before you need it

The calmest time to plan for a crisis is when there is not one. If your loved one is willing, sit down together and write a simple safety plan. Many clinicians use one with patients, and you can ask theirs for a template. It usually includes:

• Personal warning signs that a hard stretch is starting.
• Things that help them calm down on their own.
• People and places that offer distraction or support.
• Names and numbers of people to call, including their clinicians.
• Steps to make the home safer, such as storing firearms away from the home during hard periods or locking up medications.

Keep a copy where you can find it at two in the morning, maybe taped inside a kitchen cabinet. Put key numbers in your phone now, and make sure another relative knows where the plan lives.

Talking with their clinicians

Privacy rules mean your loved one's therapist or doctor usually cannot tell you much without written permission. That does not stop you from sharing what you see. You can call or write to a clinician and describe what worries you; they can listen even if they cannot reply with details. Better still, ask your loved one during a calm stretch whether they would sign a release so that you can be part of the conversation. Many people say yes when it is framed as teamwork rather than supervision.

When depression is part of the picture

Depression and PTSD often show up together, and the depression can be the part that drives the most danger. If your loved one seems stuck in hopelessness, it is worth getting that looked at alongside their trauma care. Around St. Louis, Brain Recovery Centers holds free 30-minute consultations for adults at its two clinics, Chesterfield and South County, always in person. That visit can assess depression traveling with PTSD. It is not crisis care, and trauma therapy, the VA and your loved one's own clinicians keep leading the PTSD side.

Caring for the caregiver

Watching for warning signs is draining work. Make sure someone is watching out for you too: a friend, a support group, a counselor of your own. You will make clearer decisions in a crisis if you have not been running on fumes for months.

Where to call

Immediate danger means 911. For a suicidal crisis, reach 988, the national Suicide and Crisis Lifeline, where trained crisis staff answer by phone or by text at any hour, weekends and holidays included. For a veteran, dialing 988 and then pressing 1 connects to the Veterans Crisis Line. You can call 988 yourself as a worried family member to talk through what to do next. You do not have to carry this moment alone.

This page is meant as general education for families, not as medical advice.