Anyone can take a first aid class to learn how to perform CPR or splint a broken bone. But how should you respond to someone not in a physical health crisis, but a mental health crisis?
Mental health professionals in New Hampshire are promoting a course in mental health first aid. The goal is to train the general public to recognize the signs of mental illness - and encourage them to intervene.
For 20 years, Charlie fought bruising battles with mental illness. When he was at his lowest point, here’s how he describes his life.
"It was just horrible because everything was just to the extreme," says Charlie. "Your emotions were at the top of the peak. You’d get angry, then you’d be scared to death, paranoid, hiding in your house, afraid to go outside, thinking people want to harm you. It was just total, 24-7, nonstop chaos. It was just torment, pure torment."
This emotional rollercoaster made Charlie’ behavior erratic. (NHPR is not using his last name, by the way, to protect his identity.) One night about 15 years ago, the police came to Charlie’s house in response to a neighbor’s call about a domestic disturbance.
"I don’t really remember too much from the incident because my ex said I was hit in the head with a flash light, dragged outside and beaten. I couldn’t tell you what happened," says Charlie.
Police later testified Charlie became aggressive and resisted arrest, at which point they physically restrained him, and then he passed out. Witnesses testified police beat him into a coma.
After the arrest, Charlie does remember what happened: he went to prison for four years. When his sentence was complete, he was still suffering from psychosis, so he went to New Hampshire Hospital for treatment.
During that hospital stay, doctors finally linked Charlie’s unpredictable behavior to a car accident when he was just six years old. He was diagnosed with a Traumatic Brain Injury, and the hospital got him on meds that gave him his life back.
Dr. Robert Murray, Charlie’s psychiatrist, says for years Charlie’s life hinged not only on his mental illness, but on other people’s inability to recognize his mental illness.
"Do we steer [a] person toward mental health treatment and good services, or not? I mean in his case that really didn’t happen for him early on," says Dr. Murray.
One in four Americans suffer from a diagnosable mental illness, and fewer than half of those people seek treatment in a given year. Most do not have major psychotic episodes like Charlie, but relatively simpler problems like anxiety or depression.
And just like with a stroke or heart attack, the sooner someone with a mental health problem gets help, the better.
In a classroom on the campus of the Sullivan County Jail in Claremont, 20 people recently sat down for an eight-hour course in mental health first aid. The class originated in Australia and, through the D.C.-based National Council for Behavioral Health, about 350,000 Americans have taken it.
"Mental health first aid doesn’t teach people how to be therapists or counselors, but rather provides you with some general tools and basic awareness," instructor Heather Prebish tells the classroom.
It’s a bit like Psych 101: students learn the basics about depression, anxiety, substance abuse and psychosis. Then they learn how to speak to someone who is struggling mentally. For a loved one you suspect is depressed, you may encourage exercise or seeking counseling.
Suellen Griffin is the President and CEO of West Central Behavioral Health in Lebanon, one of the state’s ten mental health facilities making a unified push to train people across the state.
"People who take the course say that there’s really two things that they walk away with," says Griffin. "One, that they’re more empathetic. And secondly, the stigma related to mental health or mental illness is something that some of them bring to the class, and they walk away with a very different understanding."
Griffin says, in part, the class makes such a difference because most of the students have little to no knowledge of mental illness.
Ross Cunningham, Superintendent of the Sullivan County Jail, estimates 50 to 60 percent of the jail’s population suffer from mental illness - that’s two or three times the rate of mental illness in the general public.
"Jails have become kind of the quasi mental health centers throughout the country," says Cunningham. "My staff, for example, on third shift have to field a person coming in the back gate, and they could be coming off detox, they could be coming off a struggle of being arrested."
If guards can’t recognize those symptoms, Cunningham says, they may only respond once an inmate lashes out. But he also says jails will continue to be inundated if society shies away from helping people with mentally illness.
There are about 30 people across the state trained to teach mental health first aid. It’s hard to predict exactly what an eight-hour class can do for New Hampshire. But an ongoing study in Philadelphia shows promising results. In the first months after taking this class, 63 percent of trainees intervened to help someone. People who took the class also said it made them less fearful and more confident to approach a person they suspect is suffering.
Of course, that won’t stop people from becoming depressed any more than first aid stops someone from being hit by a car. But it may get people to respond as readily to one, as they do to the other.