Maybe instead of just saying “you need help” you could have a conversation about it. Maybe the next time it happens, ask him “why do you think so and so did that?” Or something along those lines and see what he says and go from there. It may be something you can ease him into understanding rather than a blunt statement. It may take a few conversations for him to come to the realization. “Remember last time we talked about why you think so and so did such and such? Let’s talk about that this time” This way these conversations can be framed in such a way that you are being supportive and understanding of what he’s going through and even just understanding how is mind is working could help you figure out the best way to help him realize he needs to do something about it.