Content warning: mentions of multiple mental health conditions, including suicide; mention of police/ law enforcement; mention of substance use, including Naloxone/Narcan; mention of opioids
A few months ago I attended Mental Health First Aid (MHFA) training through my employer. It was an important and potentially transformative experience, and given the theme of this month’s issue, I wanted to take the opportunity to share a little bit about that training, why you may want to sign up, and the positive effects that I have seen as someone now trained in MHFA.
The primary reasons that I decided to attend MHFA training were: 1) I have been certified in traditional first aid for many years, and this seemed a necessary addition (you do not have to have undergone traditional first aid training to participate in MHFA); and 2) I’m aware of the continued need for mental health care in all of my communities, and I wanted tools to address that need. The training I attended was a full day event, or about 7.5 hours of training. There are many different providers for this training and that time may vary, but the material presented likely requires at least that many hours. If you’re considering signing up, know that it is a bit of a time commitment (thought I would argue well worth it).
Mental Health First Aid in the United States is provided by The National Council for Mental Wellbeing. According to the MHFA website, the training is, “a course that teaches you how to identify, understand, and respond to signs of mental illnesses and substance use disorders. The training gives you the skills you need to reach out and provide initial help and support to someone who may be developing a mental health or substance use problem or experiencing a crisis.” I would agree with this description, with a few aspects highlighted that I did not anticipate before participating. The primary conversation that I wasn’t specifically expecting, but sincerely needed, was training on how to approach someone about suicidal ideation. And tangentially, another unexpected benefit of the training was developing a small community within the training group where we now have contacts and resources in these situations via each other. Knowing I have access to that group has been very helpful, and we have had many meaningful, important conversations since our training that has continued our education of the topics covered the day of.
The history of Mental Health First Aid begins in 2001 in Australia. MHFA was founded to create a “skills-based training course that teaches participants about mental health and substance-use issues.” There are specific training courses for different target groups including veterans, children, the elderly, and the workplace (there are several more which can be found on their website). MHFA USA is now its own entity, but there are MHFA available around the world for those of you not in the United States. One of the reasons it will matter to take a geographically specific MHFA training is that the resources provided will vary widely by location, as will the most urgent needs of your community. The scope of MHFA continues to expand as needs change and more research is performed. The certification that you receive from training will be active for three years from that date (similar to traditional first aid certification).
During the training, I was provided with an MHFA manual, a MHFA participant processing guide, and a collection of state and nation specific resources to take home with me. A brief overview of the topics covered during training included an introduction to MHFA, first aid for mental health issues, and first aid for crises. The introduction covered mental health in the United States, MHFA definitions, and self-care for the mental health first aider. First aid for mental health issues covered depression, anxiety, trauma, trauma-related and stressor-related disorders, bipolar disorder, psychosis, eating disorders, substance use disorder, nonsuicidal self-injury, and suicide (some of this terminology is considered outdated, but is listed as such in the official course material). The third section on MHFA for crises was focused on the same subjects, but at the moment of crisis rather than as a general response to those conditions.
One specific conversation that I want to mention may be particular to the training I received, as I cannot promise that other facilitators would treat this issue with the same consideration and respect. We had multiple discussions about the decision to call 911 during a mental health emergency and, more specifically, when to involve the police (911 will facilitate either medical intervention or law enforcement intervention as needed, and you also have the ability to contact your local law enforcement directly through other channels). The facilitators for my group acknowledged the significant safety concerns for both the reporter/caller and the person experiencing the crisis when the police become involved. We were told that if there is a weapon involved, the police must be called, and if medical intervention is necessary 911 must be called. In both of those situations, it would be our responsibility as a MHFA trained individual to make that decision and allow those with advanced training in either medicine or in disarming to handle a crisis at that level. However, it’s important to me to acknowledge here what a significant concern that is in these situations, either not wanting to involve the police for safety concerns, or not knowing any other resources available besides law enforcement. In the United States, 988 is the National Crisis Hotline, intended for use in the event of mental health crises or suicidal intervention. You can call or text that number, but there is no guarantee they will not involve law enforcement even without you asking. Essentially, I am saying that during my training they recognised the risk associated with involving law enforcement and I appreciated that consideration. It’s a judgement call we each have to make in those situations (whether we are trained to respond professionally or if we are simply witnessing a crisis nearby), but I felt affirmed knowing the risk was acknowledged by those who do this work professionally.
Opioid safety was also discussed at length during MHFA training. In the United States, opioid use/over use is a frequent occurrence and it’s expected that even the general population will interface with the opioid crisis. We learned about Narcan (a medication approved to rapidly reverse opioid overdose), how to administer it, how to get it from your local pharmacy (in some places it is over the counter, check with harmreduction.org for availability near you), and where it is most critical to have it available. In many states, Naloxone (what most people know as Narcan) training is also provided during general first aid training, but I thought it was important to mention for anyone considering MHFA training. Access to Naloxone saves lives, as the window for use is very short and our current healthcare system cannot adequately respond to all overdoses. More often, non medical personnel are using Naloxone before transferring a patient to emergency services, and having the training to do so safely and appropriately will likely be relevant for many readers of this article.
Overall, I want to recommend Mental Health First Aid training to anyone with the interest in mental health and the ability to set aside a day to take the course. Knowing what to do, both for ourselves and others, in a mental health crisis can literally save a life, in much the same way as traditional first aid. Check out the sources listed for more information, and look after yourselves and each other. I believe that we keep ourselves safe, that building community is the best way to ensure a healthy environment (physical and mental) for as many people as possible. If my training in MHFA can help even one person (it already has) then to me, it is well worth it.
- Mental Health First Aid USA. 2020. Mental Health First Aid USA for Adults Assisting Adults. Washington, DC: National Council for Behavioral Health.