Mental Health First Aid:
An Approach for Helping Others in Need
2014 Women’s Veterans Conference
Matt Koren & Tina Zimmerman
Purpose of Today’s Session
• Overview of Mental Health First Aid
• Provide Examples of the Curriculum
– Signs & Symptoms
– Assessing for Risk of Suicide or Harm
• How to Request a Training in Your Area
• Resources
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The Invisible Wounds of War
“Many are struggling with the ‘invisible wounds’ of
this war, including traumatic brain injury, posttraumatic stress, depression, and anxiety. Any
attempt to characterize these individuals as
somehow weaker than others is simply
misguided…We remain committed to raising
awareness, helping individuals increase their
resiliency while ensuring they have access to the
right support services and resources.”
General Peter Chiarelli
Former Vice Chief of Staff
U.S. Army
SUB 7
Disability Weights Exercise
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What Is Mental Health First Aid?
• Help offered to a person developing
a mental health problem or
experiencing a mental health crisis
• Given until appropriate treatment and
support are received or until the crisis
resolves
• Not a substitute for counseling, medical
care, peer support or treatment
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MHFA Overview
• Originated in Australia
• Currently in 20 countries
• Partnership with Maryland and Missouri
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State Governments
Adult MHFA course available in both
Spanish and English
Youth MHFA is designed to teach adults
how to help an adolescent (age 12-18)
who is experiencing a mental health or
addictions challenge or is in crisis
In SAMHSA’s National Registry of
Evidence-based Programs and Practices
In US, 180,000 First Aiders trained by
4,200 Instructors
In PA 8,935 trained with 279 trainers
What You Learn
• Overview of mental health problems
– Depressive/Mood disorders
– Anxiety disorders
– Disorders in which psychosis occurs
– Substance use disorders
– Traumatic Brain Injury
• Signs & Symptoms/Risk Factors
• Mental Health First Aid for crisis and noncrisis situations using ALGEE
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Why Mental Health First Aid?
• Mental health problems are common
• Stigma is associated with mental
health problems
• Professional help is not always on hand
• Many people with mental health
problems delay, or do not seek help
• Many people…
– are not well informed about MH problems
– do not know how to respond
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U.S. Adults with a Mental Disorder in
Any One Year
Type of Mental Disorder
% (1Year)
Anxiety disorder
19.1.
Major depressive disorder
6.8.
Substance use disorder
6.3.
Bipolar disorder
2.8.
Eating disorders
2.1.
Schizophrenia
0.45.
Any mental disorder
19.6
Only 41% of people with a mental illness use mental health services in any given year; Median delay in
getting treatment was 10 years; Lifetime prevalence nearly 50%
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MHFA ACTION PLAN
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Assess for risk of suicide or harm
Listen nonjudgmentally
Give reassurance and information
Encourage appropriate professional help
Encourage self-help and other support
strategies
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Where MHFA Can Help
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The Curriculum
• Mental Health Disorders versus
Mental Health Problems
• MHFA addresses both
• Teach about most prevalent illnesses
• Crisis Situation
– Assess for Risk of Suicide or Harm
– Safety
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Signs & Symptoms: Thoughts
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Frequent self-criticism or self-blame
Pessimism
Difficulty concentrating or remembering
Indecisiveness or confusion
Rigid thinking
Racing thoughts
Tendency to believe others see one in a negative light
Altered sense of self
Delusions or hallucinations
Odd ideas; lack of insight
Suspiciousness
Thoughts of death and suicide
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Signs & Symptoms: Emotions
• Depressed mood and/or mood swings
• Unrealistic or excessive anxiety or
guilt
• Excessive irritability or anger
• Lack of inhibition
• Lack of emotion or emotional
response
• Helplessness or hopelessness
• Oversensitivity to comments/criticism
• Low self-esteem
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Signs & Symptoms: Behaviors
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Crying spells
Withdrawal from others
Neglect of responsibilities
Loss of interest in personal appearance
Loss of motivation
Slow movement
Use of drugs and alcohol
Changes in energy level
Obsessive or compulsive behavior
Avoidance or fearful behavior
Showing distress
Talking rapidly
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Signs & Symptoms: Physical
• Cardiovascular: pounding heart, chest pain, rapid
heartbeat, blushing
• Respiratory: fast breathing, shortness of breath
• Neurological: dizziness, headache, sweating, tingling,
numbness
• Gastrointestinal: choking, dry mouth, stomach pains,
nausea, vomiting, diarrhea
• Musculoskeletal: muscle aches and pains, restlessness,
tremors and shaking, inability to relax
• Changes in normal patterns: overeating or not eating at
all, sleeping much more or much less
• Appearance: Change in hygiene, unkempt, eyes
bloodshot or glassy, weight gain or loss
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Assess for Risk of Suicide or Harm
Suicide Risk Assessment
• Gender
• Age
• Chronic physical illness
• Mental illness
• Use of alcohol or other substances
• Less social support
• Previous attempt
• Organized plan
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Warning Signs of Suicide
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Threatening to hurt or kill oneself
Seeking access to means
Talking or writing about death, dying, or suicide
Feeling hopeless
Feeling worthless or a lack of purpose
Acting recklessly or engaging in risky activities
Feeling trapped
Increasing alcohol or drug use
Withdrawing from family, friends, or society
Demonstrating rage and anger or seeking
revenge
• Appearing agitated
• Having a dramatic change in mood
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Veteran Specific Risks
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Frequent deployments
Deployments to hostile environments
Exposure to extreme stress
Assault while in the service
Length of deployments
Service related injury
Questions to Ask
Ask the person directly whether he or she
is suicidal:
• “Are you having thoughts of suicide?”
• “Are you thinking about killing yourself?”
Ask the person whether he or she has a
plan:
• “Have you decided how (or when)you are going to kill
yourself?”
• “Have you collected the things you need to carry out
your plan?”
Check For Two Other Risks
• Has the person been using alcohol or other drugs?
• Has he or she made a suicide attempt in the past?
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How to Talk with a Person
Who Is Suicidal
Build Rapport
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Respect the individual and their experience
Maintain neutrality/avoid assumptions
Discuss your observations with the person
Recognize potential barriers to accepting help
Brainstorm some questions that might help build
rapport with a Service Member, Veteran or family
• Appear confident, as this can be reassuring
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Keeping the Person Safe
Avoid
• Leaving an actively suicidal person alone
• Using guilt and threats to try to prevent suicide
– You will go to hell
– You will ruin other people’s lives if you die by suicide
• Agreeing to keep their plan a secret
Address the following:
• Have someone stay present
• Provide a safety contact number
• Help the person identify past supports
• Involve them in decision making
• Call law enforcement if the person has a weapon
or is behaving aggressively
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Wrap up
• Military service can have both negative
and positive effects on an individual and
family, but by nature this is a resilient
population with significant strengths.
• There are more resources now than ever
before to help and support Service
Members, Veterans and their families.
• You have the potential to connect people
in need to resources that can help them.
Finding Trainings in Your Area
• SW PA Collaborative
– http://www.ahci.org/html/mhfa/
• Mental Health First Aid website
– http://www.mentalhealthfirstaid.org/find_mhfa.php
Matt Koren
Tina Zimmerman
412-325-1100, ext.
7774
mkoren@ahci.org
412-325-1100, ext.
7764
tzimmerman@ahci.org
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