I have become aware that mental health first aid is being taught. Is this something we should seek out and learn?

Izzy, I don't think we're thinking the same thing. Mental Health First Aid isn't really about the will to survive or mental toughness, if I'm thinking the same thing as dweste.

MHFA is like learning how to identify and assess mental health issues that could become crises, like suicide, depression, substance abuse, etc. You learn how to listen to them and talk to them and learn appropriate resources they could turn to or even ways for you to help them, if things aren't too dire. Just like basic first aid, you're not the doctor, but you help the person survive until more definitive help can be brought to bear.

I think it's a valuable skillset for anyone. There is a lot of mental health issues out there, especially in the prison systems, but budget cuts are releasing many of them into the general population. Many returning vets face mental health challenges, including suicide. The economy and unemployment situation that has dragged on for years is pushing many to the breaking point.

Just last week, we had one of the worst mass shootings in Orange County history when a guy angry about child custody walks into the hair salon where his ex-wife works and shoots nine, killing eight. Some would argue that "Well, all those people should've been armed" but how much more desirable and efficient would it have been if someone could've identified the stress he was under and diffused that anger long before he decided to grab a gun and go on a murder spree.

Although I know people who have gone through programs like grief counseling or working on a suicide hotline, I don't know anyone who has taken something really called Mental Health First Aid, so I'm not sure what the curriculum is like.

I think law enforcement should have more training like this. People with mental issues don't talk or react the way you expect, and that often gets them shot, unfortunately. Like I said, there's a lot of mental health challenges out there nowadays.

I heard at least one NPR interview of someone directing a nationwide MHFA training effort particularly geared to the workplace. There is some internet stuff on the MHFA nemomic[sp] which as I recall was ALGEE.

The answer to your question is fairly obvious. Mental issues are jsut as profound as the ABCs and other aspects of pysical illness.

I had to look it up. One site defined it: "Mental Health First Aid is a groundbreaking public education program that helps the public identify, understand, and respond to signs of mental illnesses and substance use disorders."

What might be more practical would be a course in dealing with the results of a widescale disaster, where everyone seems to need help. After all, you and the people around you will probably be the first responders, possibly for some time. There is a good chance that no one will be themselves, but it's probably not a good time to end up escalating the problems by telling panicked, distraught people to 'snap out of it'.

We would most likely be dealing with acquaintances, neighbors, family, co-workers and strangers during and immediately after the incident.

An article titled Prioritizing “Psychological” Consequence...Scale Disasters (8 pages) (mostly from a medical standpoint) indicates they have "categorized ... 5 key antecedents or 'psychological triggers' that have been shown to be associated with emotional, behavioral and cognitive reactions during large-scale emergencies:"

1. Restricted Movement - isolation, shelter-in-place, decontamination, quarantine, increased social distance, and evacuation.

2. Limited Resources - limited resources and supplies can decrease a person’s sense of safety.

3. Trauma Exposure - intense or prolonged direct exposure (actual witnessing or images of people who are injured or ill) can cause psychological consequences.

4. Limited Information - actual or perceived lack of appropriate information about risks, possible consequences, what to do or where to go for help, conflicting information-- all can lead to psychological reactions (fear, anxiety, frustration, hostility).

5. Perceived Personal or Family Risk - fear and concern about safety of self, and the safety and well-being of family and loved ones, but the perception of risk may also cause people to become fearful, anxious, angry, or hostile, particularly if they believe the risk is being imposed intentionally.

Another article: Acute Psychological Impact of Disaster & Large-Scale Trauma

For children: FEMA: Helping Children Cope with Disaster

And when that is all taken care of, then you can find someone who can help YOU.

Sue

Very nice, Sue.

Frankly, I believe there are two types of people post-disaster.

Type 1: O woe is me, whatever can I do, sob sob, my stuff is gone, where is the government to help me??

Type 2: Lived through another one. Let's start to clean up, salvage what we can. Just stuff. Glad no one was hurt.

Mental health professionals need to work with Type 1s. Should they try to help Type 2, they would be put to work doing something useful.

I don't disagree with Sue's information. Just glad I am not one of the Type 1s sitting on my butt crying about stuff.

In CERT training, we did receive some information on the psychological effects of disasters. The instructors that night were people who volunteer as...I forget what they called themselves, but get called out to accident and crime scenes to console traumatized victims and witnesses. Mostly like a primer on grief counseling actually.

Which was fine given the time we had. But a more comprehensive curriculum like mental health first aid sounds very useful both for everyday and disaster use. I mean, we use first aid even for the little "ouchies" as we do for the big "ouchies".

I'm going off on a different tangent here, but looking at that list of "5 key antecedents or 'psychological triggers' that have been shown to be associated with emotional, behavioral and cognitive reactions," I think all five conditions apply to incarcerated people and those people endure those stressors for years and years. Is it any wonder that the prison-industrial complex is the biggest buyer of psych meds?

My limited experience suggests that the "two-type-of-people" analysis is fun in comedy routines, but does not seem to make sense for long in the real world. People are so varied and different.

I also think that people really do get scared, go into shock, feel grief, and generally get messy and could use a hand from time to time. And next time it might be you!

In the simpler things, yes. But if you've just dragged out the bodies of your children, and your wife was handed back to you in chunks, please don't tell me you're going to be "a lumberjack and I'm okay"!

There's that saying about there will always be people better off than you, and those who are worse off than you. Where you are on that scale will probably determine how much help you need. And the ones who think they will NEVER need emotional/psychological help may be the ones who crash the hardest when they do crash.




Both legal and illegal!

Sue

Although it may generally be true that you can put people in two camps in response to some sudden and major event, I agree that longer-term, there are all sorts of different ways and timelines that people react and recover. That's why something like MHFA is not just for the minutes and hours immediately after some event since the worst emotional/psychological crises may not appear until much later.

And for non-disaster crises related to mental illness, substance abuse, etc. those can spring up anytime.

And I'll just throw this out since it just happened to pop into my head just now. I remember reading not long ago that in general, the mentally ill tend to be no more violent towards others than "normal" people. However, their odd behavior or lack of expected responses may lead surrounding people to act or talk in ways that provoke them to violence. So, it's important to be able to identify these situations and know the appropriate way to handle them otherwise "bad things happen".

A recent police scandal here in Fullerton, CA is when a schizophrenic guy had trouble complying with officers' orders and was beaten and killed even though audio and video show that he was no immediate threat to anyone. The officers will stand trial for murder and manslaughter. Could MHFA-type training turned this situation into something totally different? Perhaps. The Memphis Police Department's Crisis Intervention Team program seems to be the model for training officers to deal with the mentally ill and other people in emotional crises in a safe and humane manner, so it can be done. I remember watching a segment about CIT on...maybe 60 Minutes?--a long time ago and being very impressed. There's no reason why civilians shouldn't also get similar training since we're usually the people who initially have to deal with people in crises.

Most people, when thinking about survival situations, tend to associate "mentally ill" with violent, crazy people. In reality, many of the mentally ill suffer from a whole array of disorders, many of which are not violent at all. In such cases we don't need to worry about ourselves as much as about them. The software problem diminishes the survival chances of these patients. Imagine a clinically depressed man in a disaster. It would be even more of a challenge for him to get through it, on top of the emotional hammering that he gets every second. If we have the energy to help others, we may be able to help such people by identifying them and by giving them hope. Instead of thinking, "Man, this guy is just a demoralization machine and he doesn't want to do anything to help himself," try and realize it's his illness talking. Light cases may need a bit of understanding, sympathy, and encouragement. Sever cases may need really direct intervention.

I hate having to say this, because all the police officers I know personally are outstanding men who entered their profession out of a sincere desire to protect the citizenry, but as for the Fullerton police scandal, I do not think MHFA training would have made a difference. All reports indicate that the police officers deliberately beat the man to death, disgracing their uniform. Why? Because he was a vagrant that nobody cared about, or at least not until he got on Youtube. This seems like an issue separate from what we're talking about. If we want to make it relevant: maybe MHFA could help the officers' colleagues figure out that they need some therapy before they can serve and protect us civilians.

DB

Well, this is just speculation. None of us knows what went through anyone's head. But from what I have read, the officer was angry that the victim (who is schizophrenic) did not comply with his orders as he was sitting on a bus stop bench. At that point, the officer held his fists in front of the victim's face and angrily said, "Now see my fists? They are getting ready to F*** you up!" Then the beat down started.

Who knows, maybe this officer would've done the same thing with a white, elderly guy who didn't comply because his hearing was bad, or a clean cut tough guy who was stubborn and just wanted to ignore the officer, but it seems to me that the lack of compliance and the indignation that the officer apparently felt is what triggered him and not necessarily the homeless part. However, if an officer understands that someone who has some degree of cognitive impairment may not respond to commands or may not really understand what the commands are, hopefully would not get angry enough to do something like that if he recognizes that in someone. So, that's the context in which I am wondering if MHFA might've made a difference.

Again, just speculation, but that was what I thought about that case. We have a pretty defiant, don't-tell-me-what-to-do(-or-I'll-sue!, or-I'll-cap-your-a**!) culture nowadays and I'm sure there are many people in general, not just police, who get really angry about that at times. Now we get so easily angered that we often times fail to consider legitimate reasons why people don't do what we want/expect them to do.

Some people seem to put themselves into situations because of the 'perks':

Child molesters make a point of putting them where children are: Scouts, clubs, schools, etc.

Politicians put themselves where they can have power.

And you know that some cops put themselves in that job for the power they can wield over people. You know the police departments know that, and try to keep them out or weed them out, but sociopaths and psychopaths can be good actors and excellent manipulators. After all, they've been practicing all their lives.

Sue

They get a better bang for their buck climbing the corporate ladder and becoming CEO's.

This topic is important, but it is also a huge area in which we lack the proper terms for describing what we're dealing with. I am absolutely no expert on any medical issue including mental health care, but I try to learn more about what I think is important.

Here's some reflections on "self medication" mental healt care and first aid:


My quick taste of unemployment (9 months) started as a cool volintarily "in between jobs" experience (fun, challenging and educating experience as a proactive job hunter) and ended with symptoms that really should have triggered the "depression" diagnosis. At that point, I literaly crawled back to my old job to build myself up. I always had my old job as a lifeline, and no substantial financial worries. Lots of unemployed don't.

More than 10 years later and after a case of burnout syndrome in close family I am finally able to learn something: Your self esteem is important, and you should actively build it, expand it and make it stronger. Allow bad times (such as unemployment) to erode your sense of self esteem and you unleash all kind of trouble. Your self esteem is not about your job, your status or financial situation. Your self esteem is all about what you think about yourself, how you value yourself.


I sincerely believe that a robust mental health is important to help you live a good life in good times and keep you floating through bad times. We all have collected different kind of emotional luggage and wreckage through the years. Each of us have to find the tools to deal with that.

Mentally speaking, you are able to control far much more about yourself than you ever can imagine. You can convince yourself to change religion, political opinion or a bunch of other stuff. I think you also can also willingly chose to have the attitude that enables you to come through though times. And you have the power to control how you think about yourself and build your self esteem.


What about mental first aid for others?

You tell me - I want to know...

For dealing with people that clearly are out of it I highly recommend the book "Verbal Judo: The Gentle Art of Persuasion." by George Thompson. His book was written for police officers, but the same techniques are applicable for any situation, including not letting domestic disputes escalate into a shouting match.

An important aspect in this book is empathy: You really try to understand what the other person wants and why he's upset. Having someone who actually is willing to LISTEN is a great thing in itself. It also provides valuable info if there's other actions that could help (quite often, listening IS the solution).


There's all kind of info available about how people react in a disaster - Susan posted some links that I think are quite relevant.

I think it is highly valuable to learn something about how the body physically and mentally reacts to an extreme stress situation. My best read on this subject has been "On Combat: The Psychology and Physiology of Deadly Conflict in War and Peace" by Dave Grossman. If I should sum that book up in a mental first aid perspective it would be that people who have witnessed traumatic situations need someone who can listen to them (pain shared is pain divided) and then tell them that their reactions are perfectly normal.