Immense value resides within advanced life support training courses. While these courses are traditionally reserved for health professionals, more people are turning to advanced life support training to improve their career outlook and save lives. According to the International Liaison Committee on Resuscitation (ILCOR), cardiac arrest statistics appear to be increasing. More than 475,000 Americans die from cardiac arrest annually. Cardiac arrest causes more deaths than breast cancer, influenza, pneumonia, firearms, house fires, HIV, prostate cancer, and colorectal cancer combined.
Participants in a First Aid course learn how to respond to someone suffering trauma, such as injuries sustained in a car accident or a fall.
This life-saving skills training program includes cardiopulmonary resuscitation (CPR) and use of an automated external defibrillator (AED). The life-saving benefits of First Aid have triggered a change in perception surrounding how people respond to traumas or emergencies. Unfortunately, traditional First Aid overlooked a critical component of providing care—mental health—and Mental Health First Aid was borne.
With stigma of mental health illnesses still alive, ignoring or failing to recognize the signs of a crisis can lead to tragic outcomes. Health care professionals and those working in fields with a high prevalence of mental health illness need to understand the similarities and differences between traditional First Aid and Mental Health First Aid.
What Is Traditional First Aid
First Aid is a life-saving program that teaches students how to provide immediate, short-term care to those in need. Traditional First Aid includes the treatment of allergic reactions, minor wounds, stabilization of severe injuries until professional help arrives, and more. This may include applying a tourniquet, administering epinephrine from a First Aid kit, stabilizing the spine temporarily, applying bandages or tape, and using chemical cold packs. The goal of First Aid is simple; remove a person from a dangerous situation, if possible, and help them until emergency medical services arrive.
First Aid increases chances of survival for those suffering life-threatening injuries, which is why Occupational Safety and Health Administration (OSHA) requires industries with a higher risk of employee injury employee First Aid-trained workers. Ultimately, traditional First Aid is about responding to basic medical emergencies, but as awareness of mental health illnesses has grown, more people are looking for ways to help those suffering a different type of emergency, such as a mental health crisis. Responding to emergencies is the key similarity between traditional First Aid and First Aid for those experiencing mental health issues.
What Is Mental Health First Aid
First Aid for mental health is about communication and helping someone overcome a mental health emergency or crisis, not a physical, medical emergency. In the U.S., reports the National Alliance on Mental illness (NAMI), approximately one in five adults suffers from mental illness each year. Approximately one in 25 adults experiences a serious mental illness that inhibits the ability to perform basic daily activities. At the same time, one in five adolescents between the ages of 13 and 18 experiences a severe mental illness at some point.
The situation only grows grimmer from that point. According to CDC.gov, the rate of suicide rose 30 percent between 1999 and 2016. In fact, approximately 45,000 people lost their lives due to suicide in 2016, making it the leading cause of death for the whole population on average. The key to forcing suicide rates down lies in increasing public awareness and reducing the stigma associated with mental health, but it is also important to understand that anyone can help those experiencing a mental health emergency. This is where Mental Health First Aid comes into play.
The Steps to Providing First Aid to Those in Mental Health Distress
Those suffering a mental health crisis or emergency may or may not ask for help. The nature of mental illness and its attached stigma may make those with a mental health illness feel unable to reach out or obtain help. In some cases, they may simply be unaware of available resources or how to get help. Therefore, the onus falls to those in a position to intervene. This includes knowing how to respond, and Mental Health First Aid utilizes a five-step plan to enable intervention.
A mnemonic exists for the five-step plan—ALGEE.
- Assess for suicide risk or risk of self-injurious behavior.
- Listen nonjudgmentally.
- Give reassurance and information.
- Encourage professional help.
- Encourage self-help.
Each of these steps empowers everyday individuals, as well as those working in fields with a high risk of mental health illness, including health care, the justice system, substance abuse treatment centers, mental health facilities, and schools, to help. Of course, providing help goes back to understanding how to apply each step.
1. Assess—Know How to Recognize When Someone Needs Help
Identifying those experiences mental crises remains a sensitive topic. Moreover, substance abuse, regardless of the type of substance, is a mental health illness, and those suffering withdrawal symptoms have an increased risk of depression and mental health crises. In fact, 25 percent of those with a severe mental illness also have a co-occurring substance use disorder, asserts DrugAbuse.Gov.
Meanwhile, more than half of those living with a substance use disorder have a co-occurring mental health disorder. This dangerous dance increases the risk for a mental health crisis. Depending on the age group, the prevalence increases. For instance, those transitioning to young adulthood, between the ages of 18 and 25, endure a period of higher vulnerability to mental health issues and an increased risk of suicide.
It is important to know the signs of a mental health crisis. Unfortunately, those experiencing mental illness or crises may not necessarily exhibit obvious warning signs. When a person reaches a breaking point, warning signs begin to emerge. According to NAMI, the warning signs of a mental health crisis include the following:
- Difficulty or inability to perform basic daily tasks, including personal hygiene and maintaining personal responsibilities.
- Severe changes in mood and energy levels, such as unexplained excitement or withdrawal from emotion and once-enjoyed activities.
- Increased irritability and agitation.
- Abusive behaviors, including physical, verbal, and self-injurious behaviors, as well as substance use.
- Psychosis, which refers to the loss of ability to recognize family and friends, confusion, unusual and strange ideas, or even hallucinations.
- Paranoia, including unusual suspicion and mistrust of people.
In addition to recognizing the signs of a mental health crisis, it is important to understand the warning signs of suicide, including:
- Failed romantic relationships.
- Self-deprecating statements, such as “it isn’t worth it” or “nothing else matters anymore.”
- Increased alcohol or drug use.
- A sense of hopelessness or helplessness.
- “Tying up loose ends.”
- Purchasing a weapon or hoarding medications.
- Preoccupation with death.
One other warning sign is more of a risk factor than an actual sign of an impending suicide attempt. Those with a history of suicide attempts or self-injurious behaviors, as well as with a history of suicide attempts among friends or family, have an increased risk of suicide.
2. Listen Nonjudgmentally—Be Open and Willing to Understand How a Person Feels
Listening nonjudgmentally can be one of the hardest aspects of helping someone in a mental health crisis. Listening has many layers, and how you present yourself will affect the conversation. Someone in a crisis may have a flight of ideas, jumping from topic to topic without reason, and maintaining a calm, open body posture is crucial to encouraging someone to speak about his or her feelings.
- Maintain appropriate eye contact, listening to every word and idea. However, do not stare endlessly. A delicate threshold exists between maintaining eye contact and becoming an intimidating presence.
- Be mindful of your nonverbal communication. Hand gestures, sudden movements, and posture will influence the conversation. Try to maintain an open, understanding level of empathy through nonverbal cues. This may include avoiding crossing your arm, showing true compassion in your facial expressions, and more.
- Never jump to conclusions. This is the most important part of listening nonjudgmentally. Jumping to conclusions will only exacerbate the issue.
The subsequent steps in providing assistance do not necessarily occur in exact order. It may be necessary to repeat subsequent steps throughout the conversation or change the order. However, remembering the steps in order will help direct the conversation to provide meaningful help to those in need.
3. Give Reassurance—Offer Emotional Support and Direction
Someone experiencing a mental health crisis may be overwhelmed, sad, uncertain, anxious, agitated, annoyed, or exhibiting any other emotion. This is where you will show emotion regarding the situation. Offer reassurance that you will help. This may include offering to contact a family member or other friends. Offer practical help, such as providing a ride to see friends or family or even running minor errands. Offer to check in on the person in need often, every day if you can. Make sure the person in crisis understands you care about his or her life and health.
The other side of giving reassurance is about offering information. Information might include where to get assistance for mental health needs, such as a community-based center or mental health treatment centers. In a way, this step leads to the next.
4. Encourage Professional Help—Discuss Professionals Capable of Helping the Person “Get Through This”
After offering information and your reassurances, it is time to encourage the person to get professional help. Professional help may include primary care physicians, social workers, psychiatrists, certified peer specialists, grief counselors, and more. Depending on the type of mental illness, if known, it may be necessary to encourage treatment for substance abuse, or you may consider helping the person locate available resources in your area. Ultimately, you help the person find a way out of the darkness and despair.
5. Encourage Self-Help—Show Support for Self-Help Behaviors, Including Exercise and More
The final planned step of First Aid for those suffering mental health crisises is about encouraging self-help. Self-help refers to activities and actions taken by the person experiencing the crisis to regain control. During this step, you may encourage supportive activities, such as exercising, preparing and cooking a meal, participating in group events, such as yoga sessions, attending group therapy, or developing a hobby.
What About Someone Engaging in Self-Injurious Behaviors or Threatening Suicide
Providing help to those in a mental health crisis will mean knowing what to do when someone appears to be on the verge of self-injurious behavior or is otherwise considering suicide. From the first step in providing First Aid to those with mental health needs, you should look for the warning signs of suicide. Starting the conversation is essential to providing help. Begin by explaining how you recognized these signs before asking about plans or thoughts of suicide, such as the following:
“I’ve noticed that you have been having trouble sleeping and haven’t been interacting with many people anymore. I was wondering if you have been thinking about hurting yourself or suicide?”
The conversation could go in several directions from here. The person may deny it, or they may affirm your suspicions. They may even try to circumnavigate the question. It may be necessary to ask additional questions to further understand if someone is considering suicide. These include:
- “Do you have a plan?”
- “Do you know when you would do it?”
- “How would you do it?”
- “How long have you felt this way, and when was the last time you thought about suicide?”
If the answer to the direct question or any subsequent question is yes, time is of the essence. Suicidal thoughts or actions, including self-injurious behaviors, represent a medical emergency. Get professional help as soon as possible by following these steps:
- Call a therapist, psychiatrist or other health care professional that has been working to help the person in crisis.
- Remove potential means of suicide, such as weapons or medications. Obviously, do not attempt to remove a weapon that the person is actively threatening to use and possesses without relying on other types of training, such as Satori Alternatives to Managing Aggression (SAMA) to remove sharp objects or knives.
- Depending on the current situation, contact emergency medical services. However, you must not leave the person alone. Report the incident to professionals as soon as possible. Furthermore, offer to contact help for the person in need. If the situation becomes violent or you are incapable of having a discussion, do not waste time. Call 911.
Alternatively, it may be prudent to ask the person to speak with a counselor at a suicide prevention line.
For instance, call the National Suicide Prevention Line, and ask the person in crisis to “give it a try.” It is important to carefully consider another’s actions and demeanor as the situation could escalate. However, following the ALGEE mnemonic should help de-escalate the situation.
THE NATIONAL SUICIDE PREVENTION LINE CAN BE REACHED ANYTIME AT 1-800-273-8255.
Know How to Respond to Medical and Mental Emergencies With the Right Training
Although First Aid for mental health emergencies is different from traditional First Aid, they have a common goal; help those in need of immediate assistance until professional help is available. In addition, those with mental health emergencies may be capable of overcoming the emergency on their own, provided they are not in a current crisis, such as experiencing thoughts of suicide. By understanding the differences in these types of emergency care—providing emotional, mental support and help versus physical, medical help—you can save a life.
Have you ever been present when someone was in a mental health crisis or emergency, or have you completed a past First Aid for mental health training program? If so, share your thoughts along with this article to social media, and remember to enroll in your applicable life-saving skills’ courses today.