15.7 — Measuring It, and the Red Lines

Why measure

Your memory of how the last month went is unreliable (2.4), and it is biased by how you feel today (2.5).

Which means you cannot tell whether anything is working without a number.

And there is a second reason. Improvement is gradual, so it is invisible from inside. People frequently conclude that nothing has changed while a score shows a substantial move, and that conclusion is what makes them stop.

The two scales worth knowing

Both are short, free, used routinely in clinical practice, and available online.

The PHQ-9, for depression. Nine questions covering the core symptoms, scored over the last two weeks. Takes two minutes.

The GAD-7, for anxiety. Seven questions, same format.

Both produce a score band — none, mild, moderate, moderately severe, severe. What matters more than the band is the direction over time.

How to use them properly.

Same day each fortnight. Not when you feel bad, which selects for the worst days.

Record the number and the date. A single score is nearly meaningless; a trend over three months is real information.

And note the context — what was happening that fortnight.

Two cautions. These are screening tools, not diagnoses. A high score means see somebody, not that you have the condition. And they can be gamed by yourself without noticing — people minimise, particularly on the questions they find shameful.

One specific point about the PHQ-9: question nine asks about thoughts of being better off dead or of hurting yourself. Any positive answer to that question is a reason to speak to somebody, regardless of the total score.

What else to track

Sleep hours (6.8). Frequently the leading indicator, moving before mood does.

A one-to-ten daily rating, taking five seconds (4.5).

And one behavioural measure specific to your problem. Number of days exercised. Number of social contacts. Number of times you avoided the thing. Behaviour is harder to misremember than mood.

The red lines

These mean stop self-directing and get a person. Not eventually — now.

Thoughts of ending your life. Any, at any level. 14.8, and Tele-MANAS on 14416.

Thoughts of harming somebody else.

Anything you would call psychosis — hearing or seeing things others do not, beliefs that others find alarming, thinking that has become disorganised (14.5).

A manic or hypomanic episode — several days of markedly reduced need for sleep with high energy, fast thinking and unusual behaviour (14.5).

Not eating, restricting, purging, or a body weight that is falling (14.7).

Substance use you cannot control, and any physical dependence on alcohol or benzodiazepines, where stopping alone can be dangerous (8.4).

Self-harm that is recurring or escalating.

Being unable to function — not working, not washing, not leaving the house, for weeks.

Anybody being harmed in your household, including you (Part 13).

And a trauma history that is intruding, where meditation or journalling is producing flashbacks (7.9, 14.4).

The softer signals

Less urgent and still reasons to get help.

Three months of self-directed work with no movement in the numbers.

The same theme in every session (15.6), unresolved.

Getting worse rather than better.

Other people are worried, and more than one of them.

You are avoiding the sessions — which is usually avoidance of the material rather than lack of time.

And it is affecting somebody else — your children, your partner, your work.

The threshold is lower than you think

Two things worth saying plainly.

You do not have to be in crisis to get help. The average delay between symptoms starting and treatment is measured in years for several conditions, and outcomes are better with earlier treatment.

And the question "is this bad enough?" is itself a reasonable reason to go. Nobody is turned away for insufficient severity. The cost of an unnecessary appointment is an hour; the cost of a delayed necessary one is measured in years.

What to say when you go

People freeze at this. Three sentences are enough.

"I've been feeling [low / anxious / not myself] for about [time].""It's affecting [sleep / work / my relationships].""I'd like to know what my options are."

That is a complete presentation. You do not need to have diagnosed yourself, prepared a history, or justified being there.

And if you have been tracking, bring the numbers. A GP looking at three months of PHQ-9 scores gets more in ten seconds than from twenty minutes of description.

In India, where to start

Your GP or physician. A reasonable and underused first stop, and they can refer.

Tele-MANAS — 14416. Free, 24 hours, multiple languages, government-run. The lowest-barrier option available and a legitimate first call, not only for emergencies.

KIRAN — 1800-599-0019. Free, 24 hours.

A psychiatrist for medication and for anything in the red lines. A clinical psychologist for structured therapy.

District mental health programmes exist in many districts and offer services at low or no cost.

And 112 for an emergency.

What to do

Take a PHQ-9 and a GAD-7 today and write the numbers down. Repeat in two weeks. This costs four minutes and it is the only way you will know whether anything is working.

Read the red lines and be honest about whether any apply. If one does, the answer is a person, and the self-directed work continues alongside rather than instead.

Save 14416 in your phone.

And if you have been wondering for more than a month whether to get help, that is long enough. Book it.

Next: 15.8 closes Part 15 with how to choose somebody and what a good one looks like.