Mental Health First Aid Initiative

The Mental Health First Aid Initiative is designed to fill a mental health void in our Military Health System. This void is comparable to the one that existed in physical health care prior to the implementation of CPR or BLS. Mental Health First Aid (MHFA) is a program that leads to certification after completing the 12-hour course. It prepares people with or without health care experience to be first responders to someone experiencing mental health problems. The course demystifies mental health problems including when and how to help in specific situations and when you should not attempt to do so. Participants learn how to assist with specific situations that involve diverting crisis and assisting, but only until professional help is procured. They are also carefully schooled in what scenarios require calling to authorities as their only contribution to a situation.

The main steps taught: Assess for risk of suicide or harm. Listen non-judgmentally. Give reassurance and information. Encourage appropriate professional help. Encourage self-help and other support strategies.

Exercises cover a multitude of scenarios such as: how to respond to someone who is having a discussion with someone who is not there, how to help a stranger experiencing a panic attack, what to do if a friend is expressing hopelessness, how to help a family member who is distressed over a chronic illness and a multitude of other situations as well as those brought up by participants. The students learn that when someone might be suicidal, it is best to ask direct questions and that using the word "suicide" will not make things worse. They also learn to never leave a suicidal person alone and to get that person professional help as soon as possible. Students learn to ask; "Are you thinking of killing yourself?" "Have you made a plan?" "Have you thought about how you would do it?" If they answer yes to all of the questions, the students learn what to do next.

Knowledge reduces stigma; students learn that mentally ill people are much more likely to be victims than perpetrators of violence, but they are also shown how to stay safe in uncertain situations. Additionally covered are more common problems, including anxiety and substance abuse. Students learn how best to support someone who is in treatment by learning about care options and medications. This includes side effects that sometimes cause patients to discontinue medication or treatment. They learn how to talk about these decisions and how to tactfully support returning to treatment. In many cases where a tragedy happened, there were early warning signs. This course prepares students to identify them.

Emphasis is on understanding and compassion. Just as in CPR, treatment is left to the professionals. This fact is constantly repeated so that the participants understand that the course does not give them any skills to treat mental problems, only how to guide someone as a friend, to treatment with professionals and how to support someone once they are actively in treatment. The National Council for Community Behavioral Healthcare, a non-profit, and their partners the Maryland Department of Health and Mental Hygiene and the Missouri Department of Mental Health, sponsor MHFA. The course relies on a curriculum developed and tested in Australia. Since 2008, over 50,000 people in 48 states have taken the course. The state of Arizona started offering this course after the shooting of US Representative Gabrielle Gifford.

This initiative would initially support the readiness of our troops and medical force by actively seeking out and certifying in MHFA, family members of those diagnosed and treated on an outpatient basis for a mental illness. This would aid in compliance with treatment, medications, and decrease tension in the home. Many service members have little support while in treatment. Their family members do not understand what the loved one is experiencing and only know that they are now “mentally ill”. Many service members who have attended our Intensive Outpatient Mental Health program have lost their families during the time they were in treatment due to their spouses fear and misunderstanding. Education of the family at the level of MHFA would help to alleviate fear and increase understanding and the compassion needed to survive a mental illness. This could later be expanded to service members’ supervisors and the military police for the same reasons; to demystify what is really happening to the service member and give them tools to use understand and support the person in mental health crisis. In the hospital setting, non-clinical hospital workers, support staff and security officers would also be appropriate candidates for MHFA. Just like in CPR, the more first responders available, the better outcomes for those rescued. The program also has a great additional benefit for those who earn their certification. This is something of a trickledown effect, giving them greater compassion and understanding that many feel lead to having better relationships with their family, friends, neighbors and co-workers.

The cost of the program is contingent on the number of participants. The course manuals including shipping and handling to our Military Treatment Facility in Hawaii is $20 each. The suggested number of participants per class is 10 to 25. We already have a certified MHFA Trainer so the start up costs would be only that for the books. If an additional staff person received the basic MHFA training, they could function as an assistant, as long as the class sizes were small. If we were to have larger classes the need for an additional certified MHFA Trainer would be needed as will be the case if we expand the pilot. At that time, there would be the cost of sending additional mental health clinicians to receive MHFA Trainer certification or higher credentialing. The savings brought about by implementing the Mental Health Initiative can be counted in dollars and in lives. There would be dollars saved by diverting readmissions to the inpatient psychiatric unit a lower level of care, prior to a crisis; to an outpatient provider or a support group instead. Dollars saved by having fewer admissions through the ER for overdoses or other suicide attempts. Dollars saved by service members who avoid divorce and having to pay child support for children wives are afraid to let them be with unsupervised because of “PTDS”. Then there are the lives saved because someone asked the right questions and diverted a crisis that would have lead to suicide or the deaths of others. There will also be the many service members who will receive the care they need with the understanding and caring support of their family, supervisors and peers, and return to full duty. This will be without stigma and loss of self-esteem. This best-case scenario would not take any more than a classroom with a monitor, a white board or chalkboard, a $20 manual, a few pens and paper, 12 hours of time and an instructor with students eager to learn how to help.

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