What I learned from Mental Health First Aid training
And some jolly useful resources
I’m a pretty empathetic person. I’m a trained coach, I’ve also received coaching, therapy - individual and group. I even created guidance to deal with mental health crises when I worked at Mencap. I’ve experienced significant anxiety issues for many years and have dealt, surprisingly successfully (to me at least,) with several crisis situations in various contexts. So it didn’t surprise me that the things I would do naturally if I was concerned about someone were the right things. I’m sure most of you reading this would be the same.
Of course I did learn some new things from the course, but mainly it brought all my experiences and knowledge together and put it all into a context that’s practical and usable.
What do I do right
I trust my instincts if someone is upset. I remember that it’s the change in behaviour I’m looking for in someone’s behaviour. Stress doesn’t equal a problem, necessarily. I’d approach them and ask if they’re OK, I’d stay with them until they calmed down.
I’d speak calmly and quietly. I’d listen and suspend judgement (I say ‘suspend’ because we naturally judge and I think it’s healthier to acknowledge this and just put a pin in it instead.) I’d simply say, “That sounds awful.” in response to what someone might share with me. We all know not to jump in with silver linings, but to have something at the ready to say is really helpful. I learned this from a film where a slightly eccentric older person says those exact words to a teenager who is distraught, essentially due to boy trouble. I remember being so taken aback whilst I waited for her wise words and then realised that those were her wise words, ‘That sounds awful,’ followed by silence.
I wouldn’t automatically hug someone though I’d want to. I would ask. Something I learned by being a natural hugger. I’d reassure someone that there is help available and would suggest some of the many resources that are available, some of which I’ve put links to below. All great so far.
What I’d do now in addition
I’d now ask someone, “How can I help?” or, “What do you need?” I’d find out whether they’ve experienced this before (a panic attack, depression, etc.) and what helped last time. In the past I would have probably assumed - despite my best intentions - that I’d know what help someone may need in that moment. That somehow ‘being upset’ makes someone more helpless and unable to access their natural resources. Even though I know from experience, that people always have access to their own resources - it’s just so easy to forget in a different context. I would also introduce myself if I didn’t know someone, something that wouldn’t have occurred to me before.
I’d be more confident if I did approach someone now, having learned that this will of course help the person. In the past I was probably a bit hesitant, which probably makes someone feel the same way about sharing how they feel. I’d be more confident in naming what my concern is, which can help to separate it from the person. For example, “You look upset.” “You seem withdrawn lately,” “You seem panicked.”
Behaviour not diagnosis
I’d remember to focus on the behaviour and the person, and not try and diagnose them. When I worked for Mencap I was obsessed at first with understanding all the disorders, conditions, spectrums etc. so that I knew what I was doing. But eventually, someone wise said to me that I just needed to deal with what and who was in front of me. It was all about confidence of course, and at the beginning I really wasn’t. But I learned to do just that and stop worrying about whether someone was Autistic, had a Learning difficulty, a mental health illness or all of the above and it really helped. So I’d remember this now with mental health too. Just work with that person, in that moment, with whatever they’re experiencing.
Panic attacks are not pleasant but they’re not dangerous. This reminded me of a ‘scared of flying’ tape I used to listen to. ‘Turbulence is uncomfortable, not dangerous’ the re-assuring pilot used to say. Of course, if in doubt about whether or not someone is having a heart attack, the feeling of which often accompanies a panic attack, call 999. As an avid panic attack sufferer I’d probably have told them to focus on breathing out, not in, as I had been advised for years. When you panic, your breath is shallow and if you try and breathe in without breathing out properly - especially a deep breath - you feel like you can’t breathe at all which then makes things worse. So now, I’d re-assure them that they were safe, first and foremost. It’s more important to learn this than to develop coping strategies that may stop working. For that very reason, MHFA England no longer advocate paper bags as people rarely walk around with a paper bag.
I learned that people who are thinking of suicide or trying to attempt suicide are not wanting to die. They just want their pain to stop. That gave me such pause. I’d never thought of it that way. Understanding this means that there are other options to ending pain. It’s a different conversation to talk about choices rather than just saying, “Don’t do it!” This shifted something in me in terms of calling 999/take someone to A&E in an emergency, I can see now why this makes more sense. You’re not stopping someone from something they might want to do, you’re stopping them from harming themselves as a remedy instead of getting help.
If someone is talking about suicide - I’d listen to them and let them talk about their plans. I did learn this when I did Samaritan’s training but it’s easy to forget over time. If someone explains it, it’s now ‘out there’ and they may just see it with a different perspective. Someone talking about their plans doesn’t mean they’re in imminent danger to themselves, but of course, if they are, I’d call 999.
I think in general I’d feel much more confident now in approaching someone who seemed extremely upset and who might be behaving in a way that made me feel nervous. I remember once seeing a lady approach a man on the tube who was shouting and screaming at anyone and everyone. Most people were giving him a wide berth and she approached him and started talking to him. I remember thinking, ‘what on earth would I say, and to what end?’
I now realise that the person in crisis is likely to be far more scared than those around them and that asking if they need some help is a perfectly valid thing to do. Applying the same listening rules around naming of behaviour, asking what they need and being empathetic as I would for anyone. There are of course some additional things to consider and apply and that’s what the training is for.
As with any situation, if I felt there was danger, from any perspective, I’d call the police and ask for a plain clothed police officer to come. I’d make sure the person and myself were safe, looking for exits, removing people from dangerous objects and situations.
If someone was unable to communicate, I’d check for a medical bracelet or health response plan, just in case they had one. To be fair, I may well ask this, if I remembered, of anyone in a crisis situation. The idea with the health response plan is that people who know they may get to crisis point have a description of what they’d like people to do. S
Do the training
I honestly believe everyone - Mental Health first aider or not - would benefit from this training as we all need to improve our ‘mental health literacy’ - the mission of MHFA England. It’ll give you confidence in some strategies that can help you to help everyone from a stranger, to a neighbour to a friend.
Read this - whether you’re a line manager or not
Line manager’s resource - available on MHFA England’s website
There’s also loads of other resources but this is really great and worth a read. https://mhfastorage.blob.core.windows.net/mhfastoragecontainer/bbaee8ce4864ea11a811000d3ab82d69/Line%20Managers%20Resource%20Screen.pdf?sv=2015-07-08&sr=b&sig=FIZls%2BSTBdwo1Q%2FffLojPDecvRmaGCf8XeTh6OPJrV8%3D&se=2022-02-04T09%3A52%3A55Z&sp=r
Resources from MHFA
As I say, there are tonnes of great resources from MHFA. Mind also has alot of great resources. I referred to them alot when I was at Mencap.
The costs of mental ill health to UK business
The cost of mental ill health to UK business is huge: estimates suggest that around 70 million working days are lost every year because of mental health, costing Britain between £70bn and £100bn. The cost of ‘presenteeism’ - people who come to work but are unproductive because they are unwell - could be higher still. MHFA England