Mental Health First Aid
I've been interested in watching the concept of mental health "first aid"—developed in Australia—move through the mental health community. The Australian website, www.mhfa.com.au, explains that it is a "12-hour course...designed to give members of the public some skills to help someone developing a mental health problem or in a mental health crisis situation. The philosophy behind the course is that mental health crises, such as suicidal and self-harming actions, may be avoided through early intervention with people developing mental disorders. If crises do arise, then members of the public can take action to reduce the harms that could result."
The course trains people to use the "ALGEE" approach ...a play off the word "algae"—evidently more common to people in Australia than here in landlocked Illinois, where I'm writing this blog!
1. Assess Risk of Suicide or Harm
2. Listen Nonjudgmentally
3. Give Reassurance and Information
4. Encourage Person to Get Appropriate Professional Help
5. Encourage Self-Help Strategies
There are many vocal members of the American consumer community who have great concerns about putting mental health first aid to use here in the U.S. For example, there's some concern that this program was created without the input of consumers. While I've seen evidence that consumers were part of creating the guidelines for helping someone with depression or suicidal thoughts (and consumers have been part of the program's evauation), it does appear that we were not a part of this program's inception.
There's also some concern that this approach—a "first aid" approach—would be used as "treatment," instead of as a temporary stopgap until people could access a full range of treatment options: talk therapy, WRAP, medication...whatever full treatment might entail for them. Would implementing "first aid" push mental health care down the slippery slope into a band-aid approach to treatment and further erode our access to care?
There's concern that the "first aid" approach simply channels people into the broken mental health care system—i.e., will the five ALGEE steps just end up getting people into our bad system, where they become lost and no one does anything more for them? Actually, real recovery takes a lot of time and is often NOT found through our broken system.
There's also concern that mental health "first aid" would move us away from recovery, toward nothing more than a crisis management mode. A lot of hard work goes into full recovery. Addressing just the mental health crisis—and not mental health recovery—could shortchange the real work that needs to be done (and funded) for real recovery to occur.
On the other hand, the National Council for Community Behavioral Healthcare rightly notes that "[t]he root of most stigmas is generally fear. The stigma surrounding mental illnesses in America is no different: fear of not understanding the problem, fear of doing or saying the "wrong" thing, and fear of not knowing what to do when someone needs help." The Council goes on to state that "Mental Health First Aid is the help provided to a person developing a mental health problem or experiencing a mental health crisis until appropriate professional treatment is received or until the crisis resolves. It gives primary care providers, educators, businesses, and others in the public a tool and a resource to help overcome the fear."
Many of us who have lost a loved one from suicide wish we'd known what to do or say before, and during, the crisis. Perhaps this training could help? Family members and friends often wonder how to help—perhaps this is a tool they could use?
The National Council says it "will bring Mental Health First Aid to the United States by training our member organizations—community-based providers of mental health and addiction services—to lead and manage certification programs in their communities. As provider organizations already connected with other health care groups, community leaders, advocates and families, National Council members are uniquely positioned to educate their communities, promote the certification program and to provide effective, culturally-relevant training across broad audiences. The National Council will launch the certification program in May 2008 in 10 locations across the country."
DBSA has shared its concerns about the concept of mental health first aid with the National Council. They have embraced the notion of working with our organization and other consumers to ensure that the program they teach is reworked to reflect consumer values and is appropriately positioned within a recovery context.
What do you think of mental health first aid? Where do you sit on this particular fence?