We all know what first aid is. Many of us even have first aid kits that we’ve purchased or put together ourselves. We pull them out when we have a minor injury and grab the bandages or whatever we need. But what about first aid for the mind? It’s not a kit you can pick up at the pharmacy, but there is mental health first aid that you can learn. Find out more about it in this episode.
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About Our Guest
Michael Cox is a licensed professional counselor in the state of Texas and is the co-founder and therapist in private practice at Whole Life Priorities. Cox is also a level II restoration therapist and a master trainer for Mental Health First Aid. He has more than 20 years of experience working with adolescents and their families, individuals and couples. Prior to entering the counseling and mental health field, Cox was a vocational minister.
MENTAL HEALTH FIRST AID SHOW TRANSCRIPT
Editor’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.
Narrator 1: Welcome to the Psych Central show, where each episode presents an in-depth look at issues from the field of psychology and mental health – with host Gabe Howard and co-host Vincent M. Wales.
Gabe Howard: Hello, everybody, and welcome to this week’s episode of the Psych Central Show podcast. My name is Gabe Howard and with me as always is Vincent M. Wales, and we are here today with Michael Cox who is a licensed professional counselor in the state of Texas and is a co-founder and therapist in private practice at Whole Life Priorities. But we’re here to talk to him today because he is a master trainer for Mental Health First Aid. Michael welcome to the show.
Michael Cox: Oh thank you.
Vincent M. Wales: We’re glad to have you.
Gabe Howard: We are excited to have you on the show because we’ve heard a lot in the last few years about mental health first aid. It’s everywhere. We’ve read tons of good stuff, tons of questionable stuff. There is a lot of conversation about what mental health first aid is and who it’s helping and what it does. And we’re basically counting on you to answer all of it. So can you explain to us exactly what is mental health first aid?
Vincent M. Wales: No pressure.
Gabe Howard: No pressure.
Michael Cox: No pressure. The first thing the easiest thing is, if you looking for a plug is MentalHealthFirstAid.org is the plug but mental health first aid or Mental Health First Aid USA is probably going to give you a whole lot more information. I want to give you however briefly the history. Mental Health First Aid started in Australia in 2001, came to the United States in 2008. And what we now call our adult curriculum and in 2012 we started a pilot youth mental health first aid where it’s for adults that work with youth. There is now a teen Mental Health First Aid for teens ages or grades ten through twelve and the basics of first aid is to be able to help individuals who are non clinicians. Individuals who are not trained in the mental health field to know how to help an individual who may be just having a mental health problem. So something that interrupts their day to day life or in a mental health crisis. So very simply let’s use CPR First Aid but for mental health. Just know what to do. Build some confidence around individuals to know what to do if their friends, families, or someone the community is experiencing mental health problems and then know how to get them to the appropriate help if needed.
Vincent M. Wales: Well that sounds like a good thing.
Gabe Howard: Yeah. That sounds incredible. Now in the interest of full disclosure, I have taken both curriculums. I’ve taken Mental Health First Aid youth which is sort of designed so that adults can work with young people, it’s not designed to educate young people on how to spot a mental health crisis, but rather for adults to help out young folks. And then the Mental Health First Aid adult curriculum is for adults to help out other adults. So I’ve taken them both, and they’re both very good classes in my opinion. I think that they’re in some ways, speaking as somebody who lives with bipolar disorder, I don’t think that they go deep enough. Because it’s mental health, it’s not mental illness. It’s looking for that spark. And in other ways I think that there’s just so much missing information when it comes to mental health, mental illness, and psychology that eight hours isn’t enough. So can you talk a little bit about what somebody walking out of the eight hour class is really trained or educated to do specifically.
Michael Cox: Yeah. When someone walks out of class the first thing that, you know, the biggest goal of mental health first aid is that education and awareness. So the first thing is just to give a very basic understanding of what a mental health problem is. When an individual is experiencing a mental health problem, what does that look like? So it’s bringing that stigma down, reduction of that stigma and helping people be a little bit more aware of signs and symptoms and so to know what is what a person might display and I might be going on in an individual’s life and it could be you said a mental health crisis earlier and it could be in a crisis situation or just in a day to day life. And so not everybody with a mental health problem they’re necessary to the point of an actual crisis an individual walking out that class will be able to know when there’s something that happens disrupting an individual’s life for a long period of time say about two weeks. To know something’s happening, something’s going on. They may not. They’re not going to be able to diagnose and I’m not going to be able to come out with an actual diagnosis of what that problem is but get a very general understanding of what the problem is. On the adult curriculum they go into a lot more detail with those specific disorders just to get a little bit more understanding. As you can imagine for adults, most adults, if they’re experiencing a mental health problem are pretty much going to be in the throes of it. And so what is presented in adults can be different than in youth and so in our adult curriculum individuals are able to walk away with a little bit more understanding of what are depression, anxiety, psychosis, suicide awareness, and just some basics around suicide. And then once I see someone experiencing these problems disrupting their life I know what to do. There’s a little more confidence and being able to respond. So if you just simply faced something like CPR First Aid you know we don’t go in and give you the tools to do heart surgery or reset a bone but know what to do initially. So someone else that has more training than you to be able to help, that kind of stabilizing. And so Mental Health First Aid does that. And we do it in those different modules as you said. You have an adult to adult, adult to youth, and that’s a youth program. And then now our newest one is teen with teenagers in high school 10th grade to 12th grade. And so just building a confidence and an awareness around what to do if someone experiences a mental health problem and or a crisis and how to definitely respond and how to get them to the help that is necessary.
Gabe Howard: One of the things that I think we should probably clarify is that you know so many people think that mental health first aid is designed to help people respond to people who are mentally ill. It’s like well this is a way the society can interact with the mentally ill, help the mentally ill, stop the mentally ill, prevent the mentally ill, etc., etc. You know obviously I think it’s very very important if I myself am in a crisis because of bipolar disorder I want somebody to help me. But it’s called Mental Health First Aid for a reason. Because there’s a world of difference between mental health and mental illness. Can you talk about that for a moment?
Michael Cox: In the training we kind of purposely use the words like mental health problem to kind of give this kind of a broad overview and we use that for a couple of purposes. One, for your average mental health first aider they are not going to get the skills and techniques to know how to diagnose and so we don’t want someone walking away thinking like they’ve got that tool but we’re just talking about something that’s disrupting an individual’s life. And so, for a first aider, if I’m engaged with someone I can tell that something’s happening that’s outside of their norm that maybe outside of what they’re experiencing and going through. And may maybe interrupting their ability to go to work. Their ability to engage in their daily activities or ability to have satisfying relationships. So something’s going on, something’s happening and I can figure out how do I engage as a first aider here? And then help that individual or aid individual and if needed professional help is needed. We try to connect that individual to professional help. The opposite end of that is an individual who actually has an actual diagnosis. And so an individual who’s been to trained professional and has been through the process of assessment and has an actual diagnosis with an actual mental illness. And so, you still can utilize Mental Health First Aid in those situations. The first aider is not going to walk away with the ability to make that diagnosis and so we learn or try to teach folks what their role is in those individuals lives. And we use the general term mental health problem, just to help community individuals know, they don’t really have to worry about it or try to focus on the diagnosis itself. It is just simply noticing someone experiencing the problem or crisis. And what do I do in the situation to help them out? The distinction is mental health problem, we use that as a general term when it comes to identifying with something disrupting an individual’s life. And then we look at actual diagnoses, for an example of depression, or anxiety disorders. We look at what those are, what the criteria for those are, and what an individual might be experiencing in those. And just for general education for the community to understand those and get a better understanding. And what how to respond in a specific situation. Each participant walks away with a manual that goes in to much more detail on some of those disorders, and more specifically on what the role of a first aider might be in the lives of individuals experiencing specific illnesses or disorders.
Vincent M. Wales: Thank you. I have a question about one of the, I guess you call them, modules. You have the adult and you have the youth and you mentioned a teen one now. Is that one similar to the adult one in that it’s for adults to recognize the symptoms in teens? Or is it for teens to also be involved in that end of it?
Michael Cox: I’m really excited about this. Well, it’s in the pilot stage. We have eight high schools or youth communities across the country. They currently are our pilot sites that are piloting this brand new curriculum. And so the National Council for Behavioral Health. partnered with Lady Gaga’s Born This Way Foundation to bring this to the United States and so this curriculum also started or originated in Australia. But the format is completely different, it is for adults. Adults will be teaching the course, but they are teaching teenagers from 10th grade to 12th grade, or 15 to 18, and they are being trained to be first aiders so very similar to the adult curriculum and then the youth adults working with teenagers. This is for teenagers. For their peers to know exactly how to help when they’re in certain types of situations. And the biggest premise of that is to be able to recognize signs or symptoms, but also to know how to get that young person to a trusted adult. It is not helping teenagers take on the problems or diagnose or any of those things. It’s simply like the other two curriculum. When something’s going on, something’s happening, I recognize something going on with my friend, how do I intervene if necessary and how do I get them to a trusted adult?
Vincent M. Wales: Excellent. I was hoping you’d say that.
Michael Cox: Yeah. It’s great. I got the privilege of being one of the National trainers to help develop an instructor training. I will say the curriculum is amazing. I work with teenagers on a regular basis and constantly hear them trying to help their peers in many new and different ways. But they’re really just not feeling equipped. And so this really does give them a chance. The format right now is developed and meant to be taught in schools. It will be part of the curriculum and so they can either do five 45 minute sessions or they can do three 75 minute sessions. And they are taught within the school settings. It can be done outside of the school, but it’s been set up right now that a majority of our pilot spots are in schools.
Gabe Howard: We’re going to step away to hear from our sponsor and we’ll be right back.
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Vincent M. Wales: Welcome back. We’re discussing mental health first aid with Michael Cox.
Gabe Howard: So you’ve said that the primary purpose of Mental Health First Aid is kind of a see something do something kind of model. Just like in regular first aid. You know, rather than, “Oh, you broke your leg. We don’t know what to do, so we’re going to just leave you here.” We know that in mental health a lot of people notice that something’s wrong. Their friend seems off or their friend is depressed or their friend is just not acting normal or the same with a co-worker or a stranger. But they don’t know what to do and therefore they do nothing, or they get angry and they actually make the problem worse.
Michael Cox: Mm-hmm, right.
Gabe Howard: What are some examples that you give? If I’m a person in the workplace and I think that my co-worker is acting odd? What would be like step number one? Is there a way to assess?
Michael Cox: Yes. And first they’d have an action plan. And the action plan is ALGEE. Not the green stuff that grows in the water, but in ALGEE. The A stands for Assess for risk of suicide or harm. L is Listen non-judgmentally. The G is Give reassurance and information. The first E is Encourage appropriate professional help. And then the last E is Encourage self-help and other support strategies. And so just as you would with CPR first aid, when we notice something happening, so we go take that scenario that you just gave in a workplace. That is assessing for the risk of suicide or harm, you’re kind of always in that process. That’s our analogy. It is not necessarily a linear path to follow each step. It can happen in many different ways depending on the circumstance and the situation and your relationship with that individual. But the first thing you’ve going to assess and recognize is something has changed. So this is different from what my colleague typically presents. And so, if they are coming to work late, where they used to come in right on time oftentimes early, or they come into disheveled, they’re not taking care of themselves. That they look black or down and this is happening over a consistent long period of time, maybe a couple of weeks. And that’s the very first thing we want to do. We want to see a shift change in what their presentation is from what is typically. And then as part of that process, you think about listening. The very first thing to do is recognize that, right, I want to do that assessment. But then when I speak about approaching that individual, I want to consider that individual’s privacy and confidentiality. And so I’m going to corner them, I want to do it in a way that’s not gonna embarrass them. That I’m not going to point them out yet also so that they know that I care. And we’re going to talk about my observations so you don’t want to go up and accuse someone or point someone out necessarily. Just talking about what is it that I’ve observed that is shifted in their presentation and behavior, and asking if things are OK. And give them opportunity to respond accordingly. And oftentimes people are pretty relieved when someone has noticed something in their life and then they have the freedom as an adult to say, “Hey I’m good. Things are OK.” But we’re just making an observation and deciding from that observation and how we listen to that individual we determine what’s the next step. Right? And so it may be to an appropriate professional. Oftentimes in a workplace, an individual, that they may have EAP, or an employee assistant program. And so it may be connecting them to a professional that if they needed it they have access to that or it just simply may be, “Hey, can we support you? Maybe go grab some coffee? Or you have some physical needs, that we can address that, we can try to help.” So it may be that they need to connect with a professional or they just need maybe some community support. And looking at what that looks like for that individual. So if you were following that action plan, you would have that individual looking through that process either with a [unintelligible] or colleague.
Vincent M. Wales: Got it. Thank you so much. This sounds, well, great, frankly.
Michael Cox: This program was not created for trained professionals although there are many professionals that take the course. But I think that’s the big deal is that the goal is just to better equip people with a level of confidence, reduce stigma, and build awareness around the reality that people experience mental health problems. Because, you know, they’re not professionals, or professionals aren’t always available. They’re not always around and they’re not always needed. This gives society and people another way to deal with that. It’s not an all inclusive program. We cover some very specific, very basic, topics and disorders and things like that. But there are so many programs that are out there that go in more in depth in each and every one of those, especially around suicide. There are some trainings that are out there that are all equipped and all prepared just for suicide. Mental Health First Aid just touches a portion of that. And so it is just a very general basic community class, a community level course to give and build our awareness and reduce the stigma.
Gabe Howard: I completely agree and I think that whenever you’re discussing mental health or mental illness you’re gonna get people that are uneasy or uncomfortable. You know, people that are like, “No, no, no. Mental illness and mental health only happens to weak people and we don’t want to talk about it. You’re babying people.” And then we have people on the other side that say, “Yu’re infantilizing the mentally ill. We’re fine and can do whatever we want. We don’t need a class.” And everything in between. One of the things that I really liked about the class, you kind of touched on a little bit, you said that there was a small discussion about suicide. And you’re right, in an eight hour day, there’s lots of different topics, it’s not the most prevalent. But one of the exercises in there that I believe in very very strongly is that everybody takes one or two minutes to ask the question, and you do not allow an answer. Are you feeling suicidal? Are you planning on killing yourself? And the curriculum states you’re not supposed to say, “Are you planning on hurting yourself?” Because the person who is suicidal, isn’t planning on hurting themselves. Hurt is pain and you live through that. They’re planning something more than that. The number of people in the room that just asking it, you know, as an exercise, you could see the uncomfortable feelings were palpable. And these are people that got themselves up, signed up for a class, came to the class, and are now participating in the class. And just saying, “Are you suicidal?” made them visibly uncomfortable. So you can only imagine how they’re going to do if they actually feel that somebody is a danger to themselves. Can you talk about that little portion and why that’s so valuable?
Michael Cox: Yeah, great question. In the general community, there is still a misconception or even a fictional belief around. If I asked someone about suicide or if I talk about suicide, I’m going to plant that idea in that individual. Fortunately, we know that there’s plenty of research out there that tells us that this isn’t true. Being very direct, when we talk about being direct and asking that specific question because we’re looking for a very specific answer. So the comparison that you use when it comes to the difference between asking about hurting myself as opposed to killing myself, that someone is thinking about that eventuality, that final decision of taking their lives and ending their life. That’s different from hurt. And so if I was to ask someone who’s thinking about killing themselves and ending their lives, and I say, “Are you thinking about hurting yourself?” That person can be very honest with me and say no. Because their goal or outcome isn’t to harm, it’s to die. And so we talk about being very specific with that and many people are uncomfortable with asking that question. For so many that come to our classes this is the very first time they’ve ever had to utter those words. And so we ask folks to practice because it’s a little bit to do with the muscle memory. To utter the words just for the first time gives a person a level of confidence that saying at least I have said the words. That doesn’t mean they’re gonna be completely comfortable or even comfortable doing it if they are in that situation. But they at least ask the question and have gotten the words out of their mouth, so that if they’re in that situation again it’s not stumbling over those. And we talk about being visibly confident. We use the example oftentimes of the duck on water. There’s nothing on the top of the water. They’re just kind of sailing or gliding appearing along. They’re good and all things are competent. If you look under the water they’ve got their feet just pedaling really really bad to try to move smoothly across the water. So we talk about appearing like that duck on top of the water because it becomes a level of comfort and maybe reassurance for that individual that you’re talking to that may be at that place. There’s a level of confidence we ask people to get in asking that question. And so asking someone directly in the class gives you a chance to at least try for the first time. Just so it’s not the only time that they’ve actually asked that question and they have a level of competence to do so.
Vincent M. Wales: Thanks for that. We’re getting close to the end of the show so I want to wrap up with one final question for. When it comes right down to it, do you think that this program makes people safer?
Michael Cox: I do. I think it makes them safer. And I think it makes people safer because we are equipping the general community with the tools they need to be able to notice the signs the symptoms. The risk factors that are there, and to hopefully have a level of competence of how to approach someone and provide the aid that they can or get them to the professionals that they need to. And then even more so probably, even greater than that, is the level of stigma reduction that’s happening, where people are more aware of what mental illnesses is and are able to be more competent in approaching someone and not scared, as you said in the beginning of the program. Now they’re not afraid or not increasing the stigma around it, but having a better ability to cope and therefore able to reach out to individuals to see that things are going on and may be more confident in approaching them.
Vincent M. Wales: Fantastic. Thank you.
Gabe Howard: Thank you so much for being here. I myself, as somebody living with bipolar disorder, got a lot out of the class. I especially liked the part in youth mental health first aid where they reminded all of the adults that, you know, youth have a lot going on. And you know, for the listeners, Michael was my trainer. That’s how we initially connected. And you were like OK, so you know you got a 16 or 17 year old who breaks up with his first boyfriend or girlfriend. The love is lost, it’s all over. The class was much pretty like, “Who cares? This is no big deal. Sixteen year old breaks up with their date.”.
Vincent M. Wales: That happens to everybody.
Gabe Howard: Yeah, we’re paying mortgages here. We got jobs and then and then you know you were like OK you let us go for a couple of seconds and then you were basically like, “OK. And that’s how you felt when you were 16 too, right?” Well then all of a sudden we got angry. We’re like, “No. This was the most important thing in the world when it happened to us!” And because you’re right, adults have this tendency to minimize every single experience that happens to a young person because we feel like hey we survived. So can you. And that is very damaging and detrimental. So that alone is worth the price of admission. Just to realize that you know young people go through stuff and it’s the first time they’ve gone through it. So there’s a lot more than just that. That was just an incredible piece. To take us out of here, tell us again what ALGEE means and we will head on out. Thank you so much, Michael, for being here we really do appreciate it.
Michael Cox: My pleasure. So ALGEE, the A stands for Assess for risk of suicide or harm. The L is Listen and be nonjudgmental. The G is Give reassurance and information. The first E is Encourage appropriate professional help. And the final E is Encourage self-help and other support strategies.
Gabe Howard: That is really awesome. Thank you, Michael, so much. Again mental health first aid is offered by the National Council. That Web site is in the show notes, but, Michael, can you give it to us one more time?
Michael Cox: Yes. The place for Mental Health First Aid is MentalHealthFirstAid.org.
Gabe Howard: Very, very cool. All right. Thank you, Michael, for being here and thank you everyone else for tuning in. Remember you can get one week of free, convenient, affordable, private online counseling anytime anywhere simply by visiting BetterHelp.com/PsychCentral. We’ll see everybody next week.
About The Psych Central Show Podcast Hosts
Gabe Howard is an award-winning writer and speaker who lives with bipolar and anxiety disorders. He is also one of the co-hosts of the popular show, A Bipolar, a Schizophrenic, and a Podcast. As a speaker, he travels nationally and is available to make your event stand out. To work with Gabe, please visit his website, gabehoward.com.
Vincent M. Wales is a former suicide prevention counselor who lives with persistent depressive disorder. He is also the author of several award-winning novels and creator of the costumed hero, Dynamistress. Visit his websites at www.vincentmwales.com and www.dynamistress.com.