It's the most wonderful time of the year. Time to spread joy and Christmas cheer.

But what if the holidays are really a struggle for you?

We talked with Dr. Kimberly Kjome, a psychiatrist at Seton Shoal Creek Hospital, about why the holidays can be so difficult, warning signs and what to do about it.

This time of year is particularly hard for a number of reasons:

• It feels like everyone around you is happy, which can make it even more apparent that you are not.

• You feel guilty that you're feeling down when everything, from the Christmas music in the stores to the decorations in homes, is bright and cheery.

• Being around family can be stressful, and this is the time of year when families are more likely to visit.

• Holiday giving and parties can put a financial strain on families. It's hard to have to say you can't afford the celebration or the gifts.

• Students have final exams and the stress that comes with those.

• This is also a time when we think about who isn't here. If it's the first year or even the 15th year since someone has passed, the holidays can be a difficult time because the memories are everywhere.

• The time between sunrise and sunset is the shortest of the year. Literally, there are more dark times than in summer.

• It's socially acceptable to drink alcohol, which can intensify feelings and make pre-existing depression worse.

It's an emergency if you feel like you don't want to live anymore and you've already thought about how you would die. Call 911 or, in Austin, call 512-472-HELP.

If you feel like you're in crisis but it's not quite an emergency, let someone you love know. It's not a burden. Kjome says that often families will tell patients that they want to know what's going on and that they want to know if they are struggling.

If you're the family member or friend, be open to having a conversation and not feeling resentful. Don't say things like "suck it up" or "things are going to get better." Don't dismiss their emotions. Validate their feelings and have a compassionate conversation with them.

Also be aware of what your limits are. You might not feel equipped to help as much as they need it. You can help make the call to 512-472-HELP or 911 if you feel it's a crisis.

"If they can't make that decision themselves, the decision needs to be made for them," Kjome says.

Dell Seton Medical Center has a psychiatric emergency room for adults, and Dell Children's Medical Center of Central Texas has one for children. Usually, Kjome says, patients are seen within five to 10 minutes, and a medical professional will help determine if they need to be hospitalized or if they need intensive outpatient therapy or a follow-up appointment with a psychiatrist.

What insurance pays for varies based on your plan, more so with mental health than physical health. Knowing ahead of time what it will pay for and what it won't can be helpful, but you don't have to have insurance to be seen at a psychiatric emergency room. If you have no insurance, you still have options. Integral Care has a mental health urgent care clinic and clinics for ongoing care that provide reduced-cost care as well as low-cost medications.

National Alliance of Mental Illness Austin also has a list of resources for Travis County and surrounding counties, as well as national resources. It also has a checklist for when to call 911 and a Mental Health Crisis Planning sheet.

Here is a list of warning signs of a mental health crisis from NAMI Austin:

Inability to cope with daily tasks

• Doesn’t bathe, brush teeth, comb/brush hair

• Refuses to eat or eats too much

• Sleeps all day, refuses to get out of bed

• Can’t sleep/sleeps very short periods of time

Rapid mood swings

• Increased energy level

• Unable to stay still, pacing

• Suddenly depressed, withdrawn

• Suddenly happy/calm after period of depression

Increased agitation

• Makes verbal threats

• Violent, out-of-control behavior

• Destroys property

• Culturally inappropriate language

Displays abusive behavior

• Hurts others

• Cutting, burning or other self-injuring behavior

• Abuses alcohol or drugs

Loses touch with reality (psychosis)

• Unable to recognize family or friends

• Has increasingly strange ideas

• Is confused or disorganized

• Thinks they are someone they are not

• Does not understand what people are saying

• Hears voices

• Sees things that are not there

Isolation from school, work, family, friends,

• Decreased interest in usual recreational activities

• Changes in friendships

• Stops going to school or work

Unexplained physical symptoms

• Facial expressions look different

• Increase in headaches, stomach aches

• Complains they don’t feel well

Kjome says there is some good news. More people are thinking about and talking about mental health with the rise of the opioid crisis and this year's rash of celebrity deaths by suicide.

This year, she says, was a turning point in the way we viewed mental health.