It is estimated that one in every four people are variously affected each year with some mental health concern. The National Institute of Mental Health has documented that only one-third of them get treatment. Whether these individuals seek out treatment or back into it under pressure, the number of people who believe that mental health is a component of overall health is even lower.
Treatment is warranted when mental illness strikes. It could be as simple as acknowledgement (vs. denial) and getting involved in exercise, support groups, hobbies, anything that noticeably lessens the burden and eases the mind. If the illness is debilitating, ongoing medication or short-term hospitalization might be needed. Study and application of effective behavioral strategies and therapy are middle-ground treatments that can bring needed understanding, relief and coping mechanisms for symptom flare-ups or deeper issues.
The people behind Mental Health First Aid (MHFA), a relatively new program in this country, hope to educate laypeople about mental health concerns. Their focus is relatively simple: training people how to spot acute mental health symptoms in friends, neighbors and colleagues and guide them to treatment. Mental health advocacy also is rolled up in this equation.
My work as vocational coordinator at a psychosocial rehab agency years ago involved finding meaningful work for folks with mental health diagnoses. But due to necessity I had to be an advocate, first, for mental illness. Whether minor depression or schizophrenia, if you are talking to employers, you quickly realize that mental illness needs to be destigmatized in order for any progress to be made.
MHFA’s goal of guiding people to treatment also involves identifying the difference between functional and temporarily nonfunctional states. If only this continuum of real distress could be better understood by a broad public, acute mental health care in this country could be vastly improved, advocacy could be championed, and people would begin to see that true health is more than just physical.
Mental Health First Aid had its beginnings in Australia in 2001. A professor, Tony Jorm, and nurse, Betty Kitchener, created it in affiliation with the University of Melbourne. Studies soon documented its effectiveness in saving lives and improving the mental health of the layperson giving the care and guidance. According to MHFA program material, “just as CPR training helps a layperson without medical training assist an individual following a heart attack, Mental Health First Aid training helps a layperson assist someone experiencing a mental health crisis.”
So successful was this Australian pilot program that other countries followed suit, including the U.S. in 2008, and communities are now offering the training course. Hospital, nursing home and school personnel initially took part. (One might think professionals in these arenas might not need the training, but mental illness often is out of the scope of those who deal with physical illness and trauma.) It’s envisioned that someday the training will be as common as that for cardiopulmonary rehabilitation (CPR).
Typically a 12-hour course over two days, it includes identification of risk factors and “warning signs of mental health problems.” An overview of treatment options is given, including individual information on depression, anxiety, psychosis, substance abuse, and even eating disorders and self-injury.
Integral to MHFA is a five-step action plan regarding skills needed for situation assessment, implementation of appropriate interventions, and connecting the person in distress to available resources on a spectrum of professional, peer, social and self-help. Part of the training reinforces nonjudgmental listening, as well as reassuringly imparting information about available resources in the gentlest, yet most effective manner.
An excellent video of a MHFA role-play can be found on the national website. Two individuals are seen acting out dialogue as if neighbors talking on a porch. The man raps on the door of a woman who he feels has not been doing well. He asks nonthreatening questions in a soothing, helpful manner, and asks her to come out on the porch to talk to him. His words seem comforting and he acknowledges that her feelings (which seem to be paranoiac) must be very scary. He suggests a call to the crisis team, to come and simply talk to her. He says, tellingly, “If I were this upset, wouldn’t you want to help me?” The role-play comes to a good conclusion and the actors reflect, for the camera audience, on what went well.
Mike Gruber is just one of many professionals teaching MHFA in Allegheny County, Penn. Quoting a Pittsburgh City Paper reporter in a recent article, Gruber feels that what is the experiential approach of MHFA makes it “more effective at reducing stigma than would a public-awareness campaign.”
The National Council for Community Behavioral Healthcare is asking for the public to sign, on their website, letters of support for MHFA legislation. (Staffer Meena Dayak is available to answer related questions.) H.R. 274 would authorize $20 million for the program in 2014. One of three templates to congressional leaders mentions that MHFA was endorsed as a best practice for state and local governments, and this is indeed the direction that the National Council would like to gain momentum in, according to the organization, striving for training across as many local communities as possible in the U.S.