CHE TRINITY HEALTH
By JULIE MINDA
With an estimated 1 in 4 in the U.S. suffering from mental disorders, chances are good that people who are active in their community — teachers, church workers, volunteers, first responders, camp counselors, social workers — will interact with someone with mental health needs.
But many people are not equipped to recognize mental illness in others, nor do many know how to respond to someone needing mental health help.
Pittsburgh Mercy Health System is offering a mental health first aid course so that laypeople can understand the signs and symptoms of mental illness and addiction and respond quickly and effectively.
"It's like using basic first aid," but for mental health, said Mark Rogalsky, unit manager of prevention services for Pittsburgh Mercy. "Like if someone is having a panic attack, it's about (a responder) getting them to relax, to focus. It's about seeing what's going on and then getting people help.
"It's not about saving the day; it's a brief intervention" to stabilize a situation and assist people in getting the professional help they need, he said.
In touch with the public
Pittsburgh Mercy has been offering the two-day, eight-hour course since December 2012 using curriculum from Mental Health First Aid USA, an organization that is implementing in the U.S. a course developed in Australia by a mental health professor and a health education nurse. The course is free to Pittsburgh Mercy's staff, with costs covered by various grants the program has received, including a grant from McAuley Ministries. Community participants in Allegheny County, Pa., pay a small fee based on the size and type of organization or business and the number of people trained. Pittsburgh Mercy offers services for people with mental illness, intellectual disabilities and substance abuse disorders and for people who are homeless, abused and vulnerable.
Rogalsky said the goal of the class is to equip people who work with the public to get help to the mentally ill, before their conditions escalate. About 250 people have taken the mental health first aid course so far, including teachers, nonclinical social workers, health care providers, police, probation officers, faith community nurses and health ministers.
Not always prepared
Ten Pittsburgh Mercy staff have received training to teach the course. Each session follows a formal agenda that includes an overview of the five-step action plan to respond to mental illness (see sidebar), a review of different mental diagnoses and their symptoms and videos and role-playing of situations that could arise with people with mental health needs. There is a version of the course for those working with adults, another for those working with teens or children.
Rogalsky said Pittsburgh Mercy is offering the course because while mental health conditions are pervasive, mental health training is inconsistent among people who work with the public, and who could be in a good position to intervene. He said that while some teachers, police and health care providers, for instance, receive some education and training in mental health, not all do, and the level of preparedness varies widely.
Nurses Dorothy Mayernik and Amy Armanious are Pittsburgh Mercy health ministry specialists — that position supports faith community nurses in Pittsburgh Mercy's service area. The two arranged for a group of faith community nurses to attend a mental health first aid course last year, and attended the course with the group.
Armanious said that while many nurses have some knowledge of, or training in, mental health, many parish nurses are away from direct patient care. And those who have undergone mental health training may have done so a long time ago — some not since nursing school. "Over the years, you may forget some of the details you learned," she said.
Also, said Mayernik, many parish nurses may be able to recognize more common illnesses like anxiety and depression, but may not be able to identify deeper and rarer psychoses. The mental health first aid course covers a full range of conditions, including panic attacks, depression, anxiety, schizophrenia and addiction.
Mayernik added that the course is valuable because "people are not real comfortable dealing with people with mental illness — they may shy away from people who are behaving differently, they may not know how to handle the situation. Also, there is a stigma with mental illness." The course helps attendees confront their feelings about mental illness and helps them feel prepared to respond.
Mental health concerns can present themselves in many different ways, said Rogalsky, Mayernik and Armanious. Perhaps a student in a teacher's class has a sudden change in grades and social habits. Perhaps a parishioner acts overly agitated at a parish nurse's church and has an uncharacteristic outburst. Perhaps a parent will confide in a parish nurse that her child is anxious and has lost an interest in his favorite activities.
Various signs can point to sometimes-serious mental health problems — Mayernik mentioned the spate of school shootings in the U.S. in recent years. She said people wonder in the wake of these tragedies if anyone saw the signs, if anyone could have intervened, and how.
In the mental health first aid course, and at Pittsburgh Mercy in general, "we're big on prevention," said Armanious. "We are trying to prevent crises."
Rogalsky said that a mental health episode "could happen at any time and in any context — our hope is that there is someone close by with the training" to intervene.
The course guides responders to watch for warning signs before a situation escalates, such as talk of suicide, reckless actions, increased use of drugs or alcohol and dramatic mood changes. The responders should encourage the person to talk about the situation, and listen in a compassionate way. They should show the person respect and dignity. And they should let the person know about ways that they can get help. They also can describe self-soothing strategies the person can use, such as meditating, deep breathing, seeking out friends, reading helpful books and relaxing.
Talking through issues
Of course, challenges can arise at any step of this intervention.
"It can be hard to approach mental health (topics), and especially with a stranger," said Armanious.
If people are advanced in their illness, "they may talk a lot and not make sense," said Mayernik.
"They may refuse help," said Armanious.
During the course participants talk and role-play such scenarios.
Rogalsky noted the training can be intense for some. "We put out a disclaimer — we're talking about heavy issues (in this course) — drugs, alcohol, suicide — so we ask that (course participants) let us know if they're sensitive. And, you never know the life experience of people in the training — maybe they had mental illness in their family, or with themselves.
"But we hit it straight on," he said.
Armanious said the course takes a body-mind-spirit approach to helping the mentally ill, and that is ideal for the parish nurses who attended. "We look at the person holistically, and that type of perspective is important in the care of people who are mentally ill."
Course teaches acronym for effective response
In the mental health first aid course, participants learn the ALGEE acronym for responding to people's needs:
A = Assess for risk of suicide or harm.
L = Listen nonjudgmentally.
G = Give reassurance and information.
E = Encourage appropriate professional help.
E = Encourage self-help and other support strategies.
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