Many people have taken a CPR or a first-aid course, but not all that many have had a chance to put those lifesaving skills to use. Most people will never encounter a stranger having a heart attack in the grocery store, said Alissa LeRoux Smith, community health manager for Fairview Southdale Hospital in Edina, but with one in five Americans diagnosed with a mental illness, many will one day witness a person in the throes of a mental health crisis.
“A mental health crisis is far more common than a lot of people realize,” Smith said. “Your chances of encountering somebody struggling with a serious mental health issue are much higher than your chances of encountering somebody who’s having a heart attack.” While CPR and first-aid trainings remain essential, she said: “What’s really needed is people trained to know how to react in a mental health crisis. Not enough of us know what to do in these types of situations.”
For Fairview, this concern became apparent last year when the health system conducted its annual community needs assessment.
“One of the top needs in our service area was discovered to be social and emotional well-being,” Smith explained. “This includes the need for more information and resources on mental health.”
In response, Fairview decided to conduct a series of adult mental health first-aid trainings based on a program created in Australia in 2001 and brought to the United States in 2008 by the National Council for Behavioral Healthcare.
“The purpose of the training is to teach people how to recognize warning signs and risk factors for mental health disorders,” Smith said, “and to teach participants how to feel comfortable offering help to someone experiencing a mental health crisis.”
In the year since Fairview Southdale began offering the courses, the hospital has conducted six sessions and has certified 123 people. So far, most participants have been medical workers, many from Fairview. The health system wanted to make the one-day, eight-hour training available to more people the community, so they applied for a grant from the Fairview Foundation. The grant was approved, and the next two sessions of the mental health first-aid class, which can cost as much as $1,500, will now be offered at no cost to participants.
“We want to teach this course to as many people as possible,” Smith said. “We don’t want a cost barrier. We know this training is important, but it is also hard to come by. We are the only hospital offering the course in the state. NAMI offers courses, but there are only about 40 certified instructors in Minnesota.”
What do participants learn?
Mental health first-aid courses are conducted much like traditional first-aid or CPR courses — with a dose of public education thrown in, Smith said. The idea is to normalize mental illness, to explain that a mental health crisis is the same as a physical health crisis and that people in the midst of one deserve immediate care and assistance.
A mental health crisis can take many forms, Smith said. There are situations, she said, including “Suicidal ideation, a panic attack or an episode of psychosis” that can be life-hreatening, or at least life-limiting. Because of the societal stigma surrounding mental illness, some people are afraid to ask for help until their condition reaches a crisis stage. Graduates of a mental health first-aid course are trained to identify a person in crisis, to offer help — and to connect them to places that can provide emergency assistance.
A large percentage of class time is devoted to an overview of mental illnesses, symptoms and treatments.
“A lot of the training is Mental Health 101,” Smith said. “We go through the major mental illnesses, we talk about stereotypes, and we work to raise empathy for people with these disorders.”
One exercise that helps participants gain empathy for people with mental illness is the “auditory hallucinations” exercise. In the exercise, Smith said, “A participant and an instructor have a conversation. A second volunteer plays a hallucination by whispering into the participant’s ear. The participant tries to keep up their conversation with the instructor, but by having a volunteer whispering into their ear, they see how difficult it can be to live with voices. This exercise builds empathy. Participants learn how hard it is to concentrate on what another person is saying when there are voices in your head. They see just how it would be to maintain relationships or carry out everyday life.”
Participants also learn a five-step action plan designed for working with people in mental health crisis known as ALGEE. It stands for:
Assess the risk of suicide or harm,
Encourage appropriate professional help and
Encourage self-help or other support strategies.
“We go through each of those steps with different disorders,” Smith said.
Because a mental health crisis is different from an acute physical health crisis, where a person may be bleeding or unconscious, a large part of mental health first-aid training is devoted to showing participants how to link people in mental health crisis with places that specialize in mental health treatment. In that way, mental health first-aid responders become connectors, listening ears and helpful hands that can guide those in crisis to the care they need.
“A big part of the training is talking about local resources,” Smith said. “A lot of people with mental illness don’t know what resources are out there. They don’t know about crisis lines. They don’t know whom to call, where to go. We are teaching people how to connect people in crisis to those services.”
Sometimes a person certified in mental health first aid may have an opportunity to help a stranger in distress, Smith said, but more likely they will be called upon to assist family members, friends or acquaintances.
“One example we use in class is say you have a coworker who might be showing signs of depression, like withdrawing or not performing their duties or showing up late for work,” Smith said. “Typically you’d probably ignore it. But if you’d taken a course in mental health first aid, you would know how to reach out to that person with help or resources. That might make the difference between someone self harming — or even attempting suicide.”
Health beyond the heart
For years, Donna Blaul, Heart Center nurse manager at Fairview-Southdale Hospital, has focused on caring for people’s cardiac health. But what she often saw was that her patients’ hearts weren’t the only part of their bodies in crisis. Many also suffered from common mental illnesses like anxiety, depression or bipolar disorder, and while she knew how to treat their physical bodies, she wasn’t sure how to help them cope with their mental and emotional states.
“As nurses, we are really focused on labs and vitals and assessments of the patients in terms of their physical needs,” Blaul said. “We are trained clinically, so if your heart rate increases or if you start spiking a fever, we start thinking along the lines of sepsis or what physical ailments are alerting us to changing conditions of patients. When it comes to patients who have mental illness, we tend to be judgmental. Society sees it more as a defect or something ‘weird.’ We don’t know how to react.”
Blaul knew that mental illness wasn’t “weird,” and she wanted to understand it better so she could offer assistance to her patients in mental health crisis. She heard about the mental health first aid training course at work and signed up.
“I thought that that was an area that I need more education in as a nurse,” she recalled. “One of the things I really appreciated about this class was it helped me view mental illness as a disease, like cardiac disease or diabetes. It helped me open my eyes to what people with mental illness are going through and how we can help them find treatment and assistance.”
The training helped Blaul look at life in her hospital from a different perspective.
“They had some really powerful eye-openers,” she said. “The trainers asked, ‘When people are hospitalized in a mental health unit, how many get sent flowers or cards? How many flowers and cards are sent to the cardiac unit?’ That really made me think. Mental illness is just another illness, but it doesn’t always get treated that way.”
Fairview Southdale’s adult mental health first-aid course, which will be offered free of charge on Aug. 21 and Oct. 16, is open to participants over age 18.
The course is “appropriate for anybody who wants to increase their mental health literacy,” Smith said. “I would not recommend it for a Ph.D. psychologist. It’s more of a public-education level of information designed for people with limited-to-no knowledge of mental health. It is great for employers, for health and human services staff, for members of the faith community. It would also be good for public safety staff and volunteers, business leaders and community members.”
Registration for the Aug. 21 class is still open but limited to 30 participants. Registration is also open for the Oct. 16 class. To register by phone, contact Tiffany Utke at 612-706-4566.