Always Send Mail Through the Post Office: A-S-M-T-P-O Mental Health Check-In You Can See
- Donald St Pierre, MSN, RN-BC
- Nov 8, 2025
- 5 min read
Mental illnesses are health conditions that change how a person feels, thinks, and acts. They can affect mood, thoughts, and behavior in a big way (American Psychiatric Association, 2024).
Most of the time, serious mental illness doesn’t appear out of nowhere. Friends and family often notice that “something is not quite right” with a person’s thinking, feelings, or behavior before things get really bad (Psychiatry.org; NAMI).
NurseMob uses the phrase:
Always Send Mail Through the Post Office
to help people remember A-S-M-T-P-O – six areas you can look at when you’re worried about someone’s mental health:
Appearance
Speech
Memory & Mood
Thoughts
Perception
Orientation
This is not for you to diagnose anyone. It’s a simple way to notice changes and know when it might be time to reach out for help.
A – Appearance: How Someone Looks on the Outside
Things to notice:
Big changes in hygiene – not bathing, not brushing teeth, hair very unkempt
Clothes that are very dirty, or not right for the weather (heavy coat in summer, shorts in winter)
Looking much more tired or “run down” than usual
Groups like NAMI and Mayo Clinic say that not caring about appearance or hygiene, or looking unusually worn out, can be early warning signs of a mental health condition (NAMI; Mayo Clinic).
“If someone used to dress and clean up every day, but now looks like they stopped caring for a long time, that can be a sign they’re not okay inside.”
S – Speech: How Someone Talks
Listen for changes like:
Talking much faster than usual, jumping from topic to topic
Talking much slower, with long pauses
Saying things that are very negative, hopeless, or clearly untrue
Changes in speech and the way someone talks about themselves or the world can be a sign of mental illness, especially when combined with other changes (WebMD; Verywell Health).
“If the way someone talks suddenly feels very different from their normal—super fast, super slow, or very mixed-up—that’s something to pay attention to.”
M – Memory & Mood
Memory
Watch for:
A lot of forgetting – even recent events
Seeming confused about simple things
Trouble following basic conversations
Confused thinking, trouble concentrating, and memory problems can show up in mental health conditions and should be taken seriously if they keep going (Verywell Health; NAMI).
Mood
Notice:
Feeling very sad or “low” most of the time
Extreme mood swings – very “up” then very “down”
A lot of irritability or anger that is new or much worse
Health organizations say strong, long-lasting changes in mood—like ongoing sadness, anger, or fear—are common warning signs of mental illness (NAMI; Mayo Clinic; NAMI “Know the Warning Signs”).
“If someone’s feelings are way different than usual, and stay that way for a while, their brain might need help.”
T – Thoughts: What and How Someone Is Thinking
Things to look for in what they say:
Saying they are worthless or “better off dead”
Strong fears or beliefs that others are out to get them
Ideas that clearly don’t match reality
And in how they talk:
Thoughts that seem very jumbled
Jumping from one idea to another so fast it doesn’t make sense
Confused thinking, unusual beliefs, and talk of self-harm are well-known warning signs in many serious mental health conditions (Psychiatry.org; NAMI; BetterMind).
“If their ideas don’t really make sense, or they say scary things about themselves, that’s a sign they need support.”
P – Perception: How Someone Sees, Hears, and Feels the World
Perception is how the brain understands sights, sounds, and feelings.
Warning signs:
Saying they hear voices when no one is there
Saying they see things others cannot see
Feeling like the world isn’t real or their body feels strange
Hearing or seeing things that others don’t (hallucinations) can happen in serious mental health conditions and should always be taken seriously (Verywell Mind; Verywell Health; AAHA/NAMI).
“If someone’s brain is telling them things are there that other people can’t hear or see, they need help, not judgment.”
O – Orientation: Knowing Person, Place, and Time
Orientation means knowing:
Who you are
Where you are
What day or time it is
Be concerned if someone:
Gets lost in places they usually know
Doesn’t know where they are
Is very mixed up about the day or year
Confusion and trouble knowing where you are or what is happening can be signs of serious mental or physical problems and should not be ignored (Mayo Clinic; Hesperian Health Guides).
“If someone keeps getting lost or doesn’t know what’s going on around them, it’s a big sign their brain needs help.”
How to Use A-S-M-T-P-O as a Regular Person
Remember: this tool is for noticing, not diagnosing.
If you see big changes in several of these areas that:
Last weeks or longer,
Are very different from the person’s usual self, and
Make school, work, or home life much harder,
then it’s time to:
Talk kindly to the person.
“I’ve noticed some changes and I care about you. How are you feeling?”
Encourage professional help.
Suggest talking to a doctor, counselor, or mental health clinic.
NAMI and other groups say that recognizing warning signs early is one of the best ways to get help sooner and have better outcomes.
Act quickly in an emergency.
If someone talks about suicide, hurting others, or seems completely disconnected from reality, call your local emergency number or a crisis line (for example, 988 in the U.S.), or go to the nearest emergency department (NAMI; Verywell Health).
Tee Shirt: Education You Can Wear (A-S-M-T-P-O)
Mental health conditions affect about 1 in 5 adults each year, and many teens and children as well (NIMH, 2022; Verywell Health, 2025).
Most families are never taught how to recognize the signs. Your A-S-M-T-P-O design turns this into something people can see and remember:
A mail carrier image that makes the phrase “Always Send Mail Through the Post Office” easy to recall
Simple labels:
Appearance
Speech
Memory & mood
Thoughts
Perception
Orientation
Every time someone wears or sees this shirt, they get a gentle reminder:
“If someone’s appearance, speech, memory, mood, thoughts, perception, or orientation change a lot and stay that way, it might be time to get help.”
That’s education you can wear—quietly teaching mental health awareness in homes, schools, workplaces, and communities.
References
American Psychiatric Association. (2024). What is mental illness?
Hesperian Health Guides. (2024). Noticing signs of mental illness.
Mayo Clinic. (2024). Mental illness: Symptoms and causes.
National Alliance on Mental Illness (NAMI). (2024). Warning signs and symptoms and related “Know the warning signs” materials.
National Institute of Mental Health. (2022). Mental illness statistics.
Psychiatry.org. (2024). Warning signs of mental illness.
Verywell Health. (2025). 20 warning signs of untreated mental illness.
Verywell Health. (2024). What are hallucinations and what causes them?
Verywell Mind. (2024). Hallucinations: Symptoms, types, causes, treatment.
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