Mental Health First Aid: How to Stop the Bleeding When the Wound Is Emotional

Michael Allora had a feeling he might be able to help when the call came into the fire station. A middle-aged man was distraught and threatening suicide. His marriage was ending and he was struggling with alcohol abuse. The police officers on the scene were trying to “gain compliance,” but the man wasn’t up for following orders.

Talking it out

“If the man was not compliant,” Allora said, “the situation would eventually escalate and he may very well end up in handcuffs.”

Luckily, Allora -- the deputy chief of the Clifton, New Jersey, fire department -- was trained in Mental Health First Aid. It’s a program that teaches a five-step action plan people can use with a person who’s in crisis. Rather than insisting that the man comply with orders, Allora tried to understand what the man needed.

“The family members [including his soon-to-be-ex-wife] that had called 911 for help were trying to be helpful by being involved, which in this case was actually agitating the situation,” Allora said. “So what I did first and foremost was to remove the family members, which was helpful.”

Allora let the police officers stay in the room but asked them to give him the time he needed to talk to the man about what he was going through. The police officers were standing, but Allora got down to the man’s level.

“He was not debating the fact that he was having a crisis,” Allora said. “He did not want to go back to the hospital because his previous experiences had been negative. But what we found out, through a tremendous amount of conversation, was that it wasn’t only the hospital that was negative, it was how he was treated from the time of the 911 call to the time that he got to the hospital.”

Having Allora act as an ally instead of an enforcer made all the difference. Finally, Allora found the key that opened the door.

“He wanted to have a cigarette,” Allora said. “And the police officers refused to allow him to smoke a cigarette… Once he was able to get a cigarette, he literally walked right out to the ambulance.”

Do you know the signs?

Knowing how to identify the signs of a mental health crisis, how to defuse it, and how to help the person get the help they need is especially important for emergency responders like Allora. But 60 percent of the people who get trained in Mental Health First Aid are just regular people.

More than 600,000 people in the U.S. have been trained in Mental Health First Aid, including First Lady Michelle Obama. Trainings are usually free, supported by taxpayers to the tune of $15 million a year. The Mental Health First Aid Act would raise that to $20 million, but the bill has been introduced in the past three sessions of Congress and hasn’t gone anywhere.

Most people know how to handle routine first aid emergencies – how to clean and cover a wound, for example, maybe even how to do CPR – but they may not know how to respond when a friend is having a panic attack, or withdrawing.

"I don't want to lose you."

Tousha Paxton-Barnes returned from active duty in Afghanistan and tried to pick up her normal life in Amarillo, Texas. But she was overcome with depression, anxiety, and post-traumatic stress. The military values of strength and resilience made it difficult for her to ask for help or even admit she needed it.

An average of 22 veterans die every day from suicide – more than die in the line of duty. Paxton-Barnes was considering becoming one of them.

She was saved by a close friend who recognized that she was in trouble. “I was isolating myself,” said Paxton-Barnes. “I was avoiding talking. I was losing weight.”

Her friend came to her house and said, “I don’t want to lose you.” And she took her by the arm and helped her find the myriad services she needed – not just mental health counseling but financial assistance and employment services.

Paxton-Barnes, herself now trained in Mental Health First Aid, provides peer-to-peer support for other veterans.

"We sometimes forget how hard it is to be an adolescent"

Teachers and school administrators also benefit tremendously from Mental Health First Aid education. Suicide is the leading cause of death for youth between the ages of 10 and 24. “As adults, we sometimes forget how hard it is to be an adolescent,” said Alyssa Fruchtenicht, a school-based mental health coordinator and Mental Health First Aid instructor. “When we see a kid who is absolutely miserable at school, we might think that they chose to be that way or maybe it’s just a part of adolescence. But in fact, they might be in the midst of a mental health crisis.”

She said an intervention as simple as a teacher asking, “How can I be helpful?” can be a powerful lifeline. “It conveys a recognition of pain and distress and a level of sympathy, rather than judgment,” said Fruchtenicht. “It doesn’t mean that the teacher can fix whatever is wrong, but it means that the teacher will help connect that young person with the care they need.”

Photo: Deputy Fire Chief Michael Allora of Clifton, New Jersey, at a Mental Health First Aid instructors' gathering. ALGEE the Koala is the movement's mascot. ALGEE stands for the five stages of Mental Health FIrst Aid: Assessing risk, Listening without judgment, Giving reassurance, Encouraging professional help, and Encouraging self-help. Photo from the Mental Health Association in New Jersey via Twitter