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First Aid for an Emotional Crisis

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If you spot someone without a pulse, you call 911 and begin chest compressions.

But what do you do if the person is in the midst of a mental health emergency?

It may be time for Mental Health First Aid, an initiative to train lay people on mental health basics now expanding in New Mexico.

Each 12-hour Mental Health First Aid certification class covers common mental health problems like anxiety, depression and schizophrenia, and offers practical ways to recognize and respond to a crisis until professional help arrives.

“We often train people to learn CPR or Heimlich or first aid but we’re just as likely to come into contact with someone suffering from an emotional crisis,” says Dr. Jana Spalding, a Mental Health First Aid trainer.

About 1 in 4 Americans will face a mental health issue this year, says Spalding, vice president for consumer and family affairs with OptumHealth New Mexico, which manages Medicaid-paid behavioral health and substance abuse services in the state.

Without training, the right response may not be obvious, she says. For example, a person having a panic attack may not be able to move or may be extremely restless or have dizziness and tightness in his or her chest.

Participants learn to assess for harm and risk of suicide and when to call 911. With role-plays, they learn to listen without judgment and offer reassurance. The class is also designed to reduce stigma surrounding mental illness.

Participants run the gamut from firefighters and state workers to teachers and barbers. Anyone who works with the public or has family with mental illness can benefit, she says.

Untrained people worry they will make a crisis worse by saying the wrong thing.

“When we see someone in distress, we get into distress,” Spalding says. “(The course) gives you enough information so you don’t have to be in panic mode.”

Since taking the class in September, Kathleen Fincher uses her training every day. A service coordinator at Rio Vista Apartments, an Albuquerque housing complex, she helps residents connect to services like transportation or food stamps.

She often interacts with people with problems ranging from post-tramautic stress disorder to schizophrenia.

When she learned about the mental health first aid course, she knew she could benefit. Although Fincher has had extensive training on mental illness, the course’s emphasis on real-life scenarios appealed to her. Residents need to feel comfortable asking for help and she wanted to feel confident providing it.

When one resident tried to harm himself, her training kicked in right away. Fincher reassured his friend, called 911 and asked for a crisis intervention team and helped the man get long-term help.

Staying calm is key. Like the confidence that comes from first aid training, she now trusts herself to react well in a mental health crisis.

“I know that I’m doing the right thing now – that helps me remain calm,” she says. “I don’t second-guess myself.”

Mental illness is like any other illness her residents might face on a daily basis.

“Just the support and understanding that we can offer from this training is more beneficial to them than anything,” she says.

The goal is for people taking the course to become aware of mental health problems, not become experts.

“We are not, by any means, saying we’re going to become your psychiatrist because we took this training,” she says.

Mental health first aid was developed in Australia in 2001 in response to surveys that showed high rates of mental health problems and a poor understanding of symptoms, causes and treatments.

After taking the course, a 2004 study of Australian government workers reported more confidence in providing help, greater likelihood of advising people to seek professional help and a reduction in stigma. Participants’ mental health also improved, according to the study, published in the journal BMC Psychiatry.

The National Council for Community Behavioral Healthcare, a nonprofit that represents 2,000 organizations that care for people with mental illness, brought the concept to the U.S. in 2008 and manages the program with the Maryland Department of Health and Mental Hygiene and the Missouri Department of Mental Health.

So far, 60,000 people have been trained in 43 states and Washington, D.C. There are 2,100 trainers, says Meena Dayak, council vice president of marketing and communications.

In 2010, the New Mexico Behavioral Health Collaborative began courses in New Mexico. Initial costs of about $93,000 were paid with a grant from the Substance Abuse and Mental Health Services Administration, says Suzanne Pearlman, co-chair of the Mental Health First Aid Task Force in New Mexico. OptumHealth, which has offered free and Spanish-language trainings since last year, is also partnering with the collaborative.

So far, about 2,700 people have been trained in New Mexico. Over the next three years, the goal is for the program to become as common as first aid, Pearlman says.

Mental health first aid is particularly relevant here, says Linda Roebuck Homer, CEO of the New Mexico Behavioral Health Collaborative. New Mexico, like Australia, has a large rural population and a shortage of trained mental health providers.

When it comes to mental health, early intervention is key, she says. If enough people are trained, the hope is that they connect people to help in their own community.

If someone who lives in a rural area is experiencing intense anxiety, one option is driving to an Albuquerque emergency room. Instead, connecting to local support can be gentler, less intrusive and less costly, Homer says.

When enough people are trained to understand and respond to mental health problems, it may help prevent a crisis before it starts.

“It’s really a crisis diversion,” Homer says.

Pearlman, who took the class in 2010 and is now a trainer, has also used her skills. When a friend in crisis called, Pearlman knew how to diffuse the situation and connect the friend to support and resources. Before the training, she would have been a “deer in the headlights,” she says.

Reducing stigma around mental illness is a powerful piece of the course.

“It really brought humanity to the issue,” she says. “Everyone just felt so much more relaxed and comfortable talking about it.”

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