For Mental Health Awareness Week, I have decided to write an article on Mental Health First Aid.
[*TRIGGER WARNING- discussion about mental health: suicide, self-harm, depression, anxiety and panic attacks*
*This article is written by a student with basic training, using a SMHFA manual, NOT a professional*]
A few years ago, I participated in SMHFA’s (Scotland’s Mental Health First Aid) course to become a qualified mental health first aider. Just like first aid for physical ailments, mental health first aid aims to preserve life and to provide help to prevent the worsening of a condition. It also aims to provide comfort and to promote understanding of mental health issues as well as promoting recovery. The course is designed to teach people how to recognise the signs of mental health issues and how to provide initial help while guiding a person to the appropriate professional help.
It is important to recognise that this course does not train you to be a therapist, it instead teaches you how to help someone help themselves by seeking professional support. While I am not an expert on mental health by any means, I am your average student who is able to share with you advice for how to support your peers. That being said, when you are trying to help someone, you must set boundaries with how much you are able to support them while still looking after yourself. It can be very difficult, exhausting and even scary supporting someone with mental health issues, especially if they aren’t ready to seek the professional help you are suggesting. You need to remember that it is not your job to look after the person and that you can still be compassionate to them while holding them accountable for their own behavior. It is ok to take a step back from a situation if it is beginning to become too stressful for you, or if it feels unsafe. For physical first aid, the first aider has to check their surroundings so that they do not endanger themselves trying to give aid – this it isn’t any different for mental health first aid; it isn’t selfish to put yourself first and stay safe and well. Once you have told a person how they can help themselves, it’s up to them to decide what to do with that information. You can’t blame yourself for any upsetting outcomes that may occur, it the fault of the illness itself, not the individual or the first aider that was trying to help them. Ultimately it is up to the person who is ill to accept help or not and to make their own choices about whether they need to change their behavior or reconsider what they have decided they want to do.
1 in 4 people will experience a mental health problem within a year[1], meaning that it is very likely that most people reading this will know someone who is experiencing a mental health issue, or has in the past. Hopefully, this article will give you the tools to offer comfort to that person in a time of crisis until professional help is available. 1 in 20 people have depression, with 80% of mental health problems being related to anxiety and depression.[2] Staggeringly, 70% of all GP appointments will be patients suffering with these illnesses.[3] It is a huge problem, and if you are experiencing one of them, you are definitely not alone. This article will also provide information for ways to seek professional help and other resources to allow you to help yourself. It will also include phone numbers that both people with mental health issues and people who are trying to support them can call to talk to someone for extra support (when supporting someone who is ill it is important to talk about the stress that it causes to ensure it doesn’t affect your own mental health).
Firstly, openly talking about mental health and accepting it as both a part of our physical health as well as being as important and equal to our physical health is incredibly important. The taboo and stigma surrounding mental health, while getting better in recent years, is still prevalent in our society today. By showing kindness and understanding, more and more people will feel confident and comfortable to speak out, seek help or help others.
If you are concerned that someone may be struggling with any kind of mental health issue, you can help them by following the acronym ALGEE:
A – ASK ABOUT SUICIDE
While not everyone with a mental health problem will be having thoughts of suicide, evidence shows that many people who are struggling, do have thoughts about suicide. Tragically, some people will act on these thoughts – on average more than two people in Scotland commit suicide every day, which is more people than die in road accidents. It is a common issue, that many people remain silent about.
If you think someone may be having suicidal thoughts due to the pain and distress of their illness, their situation or if you simply have a gut feeling about it, just ask. It may feel very blunt and uncomfortable, but it may be a matter of life or death. Be careful not to substitute the words “suicide” or “killing yourself” with questions like “you aren’t going to do anything silly are you?” because while this may feel less harsh, if someone is having those thoughts, that language belittles them and they will be less likely to communicate how they really feel. It is also less clear what you are referencing and so the person may not realise you are asking them if they are suicidal.
Try to say something like “Hey, you’ve seemed quite down lately, I haven’t seen you much and I’m a little worried. You’ve [insert worrying behaviours here eg. been talking about feeling worthless, hopeless, like a failure] and sometimes people who do things like that are having thoughts of suicide. Are you feeling suicidal/are you contemplating suicide?”
If the person isn’t suicidal, they may be a little shocked at the question but will also probably be grateful that someone cares enough about them to notice them and their behaviour. You will not put the idea of suicide into someone’s mind by asking them this. Try not to worry about someone being offended by the question – it is much better to ask when someone’s life might be on the line.
If the person responds that they are suicidal, it is important to stay calm. They may just need someone to listen to what they have to say about not wanting to live. By doing so and showing kindness, the person may talk themselves out of ending their own life if they feel someone really cares. Don’t try and solve the person’s problems or argue with them in order to get them to change their mind about suicide. Simply listen, without judgement. If the person feels judged they may close up. Focus on what they have to say, and if you find yourself getting upset or frustrated, tell yourself you will process these feelings later, once you are out of the current situation. Remember that by listening you really are helping the person. Do not promise the person secrecy – you can promise them support and that you will use your discretion, but if they are in danger, you need to seek help.
If they are planning to act on their thoughts, you need to try and keep them safe until help arrives. Remove any items in the immediate area that the person could use to kill themselves. Phone a helpline to get guidance from someone with suicide prevention skills or contact local services such as a GP or a mental health service. Do not be afraid to call an ambulance if you feel like one is needed. Do not leave the person alone during any of this, keep them involved in what you are doing and if possible, take them to someone or ask someone else to bring the help to you.
L – LISTEN AND COMMUNICATE NON-JUDGEMENTALLY
Regardless if the person is suicidal or not, as long as they aren’t in any immediate danger or endangering you, the next step is to listen to what they want to share with you, without judgement. Often when someone is experiencing a mental health issue, they feel as though they will not be able to talk about it without being judged as weak or crazy. By simply listening to the person, showing them compassion and kindness, you can build a safe environment for them to talk about their feelings. This can help them realise that they are not alone, that they are supported, and that they can get better, it will be ok.
G – GIVE REASSURANCE AND INFORMATION
This step is not about trying to solve the persons problems, or even about offering them advice. Instead, it is about reassuring them that they are not alone and that they will not feel like this forever; there is effective help and support available and plenty of things to do to offer some immediate relief.
E – ENCOURAGE THE PERSON TO GET PROFESSIONAL HELP
Getting professional help is essential to recovery from a mental health issue. This may be from their GP, local support groups or therapy/counselling. The end of this article will provide you with information on where different forms of help can be found.
E – ENCOURAGE SELF HELP STRATEGIES
Sometimes professional help is not instantly available. While waiting, and alongside receiving professional help, the person should be encouraged to help themselves, with different strategies for specific mental health issues.
The following are some of the most common mental health issues and more detail and advice on what may help each problem:
SELF-HARM
People self-harm for many different reasons. It may be used as a way to relieve them of emotional pain, to express their mental pain, to elevate feeling numb or for a number of other reasons. Self-harm can be done in a number of ways and is when someone causes themselves physical pain through injuring themselves on purpose. When the body feels sudden pain, endorphins are released as the body’s natural pain reliever. This rush of endorphins can temporarily make the person feel better. Common ways to do this is by cutting or scratching their skin, burning themselves, biting or punching themselves and/or hitting their body against something – although it should be noted that there are many other forms of self-harm and that these are just a few examples. There is a mindset of judgment towards people that self-harm, as others see it at attention-seeking behaviour, therefore lacking patience or empathy for those that are hurting themselves. In a lot of cases, this is a huge misconception, as the person who is self-harming feels ashamed of their behaviour and tries to keep their injuries hidden and a secret from their peers. However, there are some people that are seeking attention from their injuries. This does not mean that they are not suffering and isn’t something that should lead to judgement. While being “attention-seeking” is looked down upon in our culture, it is actually hugely important for our wellbeing that we receive attention. If someone is feeling lonely or isolated it can have a big impact on their mental health. Some people may also find it hard to communicate their emotional pain to others using words. In these situations, these individuals need attention, and their self-injury is a cry for help and support.
To help someone recover from self-harming you can suggest visiting their GP to assess for any underlying mental health conditions causing them to feel the need to injure themselves. Going to therapy or counselling may also be helpful for them to be able to determine why they feel the need to use this unhealthy coping mechanism as well as learn some healthier coping techniques.
There are many self-help techniques to help the person distract themselves from the urge to hurt themselves. Being creative can help to express feelings in a non-verbal way while also being relaxing and fun. Exercising, going for a walk, baking and listening to calming music can help with relaxation. Practicing yoga and meditating can also help with this. Alcohol and drugs should be avoided as they can lead to more impulsive behaviours which increases the risk of self-harm.
Depression
Depression is a common but serious illness that affects around 7 in every 100 adults in Scotland each year.[4] It can occur with other mental and physical health problems, either as a single episode or as several throughout someone’s life. Symptoms of depression include but are not limited to:
- A very low mood
- Loss of enjoyment in activities of interest
- Lack of energy/tiredness
- Difficulty sleeping or sleeping too much
- Loss of interest in food or eating too much
Mental health is unique to everyone and so not everyone will experience all of the same symptoms. The more severe the illness, however, the more symptoms a person will experience. These symptoms can have a huge impact on someone’s life. They can affect emotion, thinking, behaviour and have physical effects. Some of these effects include:
- Anxiety, guilt and/or anger
- Feeling hopeless and helpless
- Lack of emotional responsiveness
- Self-criticism, self-blame, and worry
- Confusion
- Thoughts of suicide
- Crying spells
- Withdrawal from others
- Neglect of responsibilities
- Loss of motivation
- Chronic fatigue
You can help someone with depression by listening to how they are feeling without judgement or viewing them as weak. Do not be critical of their behaviours and avoid the use of humour to gloss over certain aspects of what they are struggling with. Don’t tell them to “cheer up” or “pull themselves together” as this is something that they cannot do due to their illness and may upset them. You can reassure the person that depression is a common illness, with effective treatments available for it. Assure the person that it is not because they are weak or lazy. You can advise the person to go and speak to their GP, who can recommend appropriate support and possibly also medication. Professional help can come in the form of doctors, mental health nurses, psychiatrists, counsellors, and phycologists. Reassure the person that they are being incredibly brave in seeking help and that there is no shame in going to counselling/therapy or taking medication.
There are several self-help strategies that the person might find effective and will help them feel that they are regaining control of their life. Exercise has great benefits for depression as the release of “feel good” chemicals help to lift low mood and help the person sleep better. Going to depression support groups can also be a great source of support. A hugely important thing for someone who is depressed is having the support of family and friends, which has been shown to help people recover faster.
ANXIETY
Anxiety is a natural human reaction that keeps us safe in dangerous situations. We all have a fight or flight response, which provides the body with enough energy to get to safety. The “flight” response triggers a series of physical responses: making the blood rush from the skin to muscles in the arms and legs and the heart begins pumping faster to get the blood to those muscles as fast as possible. Instant changes happen within the nervous system to make use of spare glucose, sending it directly to the muscles as energy. The digestive system also stops or slows down in order to better use the energy spent on it to get the body out of danger. The “fight” response is similar to the flight response, except that you will also feel a sudden rush of anger. These primal responses can leave you feeling breathless, shaky, sweaty, tearful, nauseous and give you a dry mouth and a pale face. It is an unpleasant feeling but in appropriate situations, it saves lives.
Anxiety becomes an issue when an individual feels these physical symptoms when there is no real danger. An anxiety disorder differs from normal anxiety as it is more severe, is long-lasting and interferes with the person’s daily life and relationships. Anxiety is a common problem, with 1 in 10 adults in Scotland suffering from an anxiety disorder.[5] The National Institute for Health and Care Excellence (NICE) guidelines state that anxiety disorders are chronic, the cause of considerable distress and disability but are also treatable through a range of effective interventions.
Anxiety comes in many forms (something to perhaps be discussed in a future article) but each has physical, phycological and behavioural effects on the person suffering from it. Some of these include:
-A rapid or uneven heartbeat
– Over-breathing or shortness of breath
-Dizziness
-Nausea
-Chocking
-Vomiting
-Excessive fear and worry about past or future events
-The mind racing or going blank
-Decreased concentration and memory
-Restlessness
-Tiredness (sleep disturbances)
-Irritability, impatience and/or anger
-Avoiding situations
-Obsessive or compulsive behaviour
-Phobic behaviour
Anxiety is different for everyone, and not everyone who suffers from an anxiety disorder will experience the same or all of these symptoms. You can help someone with anxiety by accepting that their worries and fears are real for them, however irrational they may seem. Don’t try and persuade them they are “worrying about nothing” or try to problem-solve. It helps to encourage the person to talk about how they feel instead of just what is making them anxious. Simply being there for the person can be of great comfort to them. You can reassure the person that an anxiety disorder is a common illness – not a weakness and that effective help is available. There are skills that they can learn to help ease the effects of their illness. You should encourage the person to visit their GP to check for any physical conditions that are causing them these problems. They can also refer the person to appropriate support such as cognitive behavioural therapy or counselling. Medication can also be used to treat anxiety and its physical effects.
The person can also use self-help strategies to relieve their anxiety. Exercise helps to release “feel good” chemicals and help the person to sleep, both of which help to reduce anxiety. Learning relaxation techniques can be very helpful as well as avoiding caffeine as it can increase anxious feelings.
PANIC ATTACKS
Panic attacks are very common, with 1 in 10 people experiencing one occasionally. It is when a person experiences a sudden onset of terror in a situation where it is not appropriate to feel so fearful. These attacks can happen very suddenly and may make the person feel a sense of impending doom or like they are dying. Many of the physical symptoms of a panic attack are similar to that of a heart attack. They include (but are not limited to):
-Increased awareness of their heartbeat
-Sweating
-Shaking
-Shortness of breath
-Chest pain
-Nausea
-Dizziness
-Numbness
-Chills or hot flushes
As there are some medical conditions that have similar symptoms to a panic attack, it is important that the person has a medical assessment to determine if they are having a panic attack or suffering from a physical problem. After a person has experienced a panic attack, they often fear having another one and avoid places where they have experienced one before.
If you have doubts that someone is having a panic attack and are concerned that it could be a heart or asthma attack or the person is in high amounts of distress, you should call an ambulance. If possible, the ambulance should be called by a bystander while you focus on helping the person.
You can help the person to calm down by encouraging slow breathing in unison with your own. You can try getting them to breathe in through their nose for a few seconds and give out as full a breath as possible through their mouth. During this you should speak to the person slowly and gently, reassuring them that you know how to help and that they will feel much better soon. You can also assure them that you will stay with them and keep them safe until the attack stops.
Even if the person is having a heart or asthma attack instead of a panic attack, these steps can help them by getting them to breathe in lots of oxygen.
SUMMARY
You can use Mental Health First Aid to help support your peers. The acronym ALGEE can help you aid someone having a mental health issue or crisis, while you encourage them to seek professional help. Remember that you are in no way obligated to become someone’s therapist or doctor, you are simply their friend or acquaintance. You have to set boundaries and put yourself first to look after your own wellbeing and mental health.
Also remember, the person that is suffering hasn’t changed, it is just their behaviours that have. With support, that person can fully recover. Being mentally ill is like having any other physical illness, it isn’t the fault of the person suffering. They need time and help to get better.
If you are supporting someone who is ill, or have a mental illness, please know that you are not alone. Stay strong. Things can and will get better.
RESOURCES
*IN AN EMERGENCY DO NOT HESITATE TO CALL 999*
Aberdeen University provides help through Student Support and their Counselling Service. There is also the student run Night Line service that students can call for advice and information:
-Student Support: Top Floor of the Student Union, 9am-4:30pm. Tel: 01224 273935
-Aberdeen University Counselling Service: counselling@abdn.ac.uk Tel: +44 (0)1224 272139
-Night Line: http://aberdeen.nightline.ac.uk/ , nightline@abdn.ac.uk Tel: 01224 27 28 29
Other resources:
–Breathing Space: https://breathingspace.scot Tel: 0800 83 85 87
-Samaritans: www.samaritans.org Tel: 116 124
-Scottish Association for Mental Health (SAMH): www.samh.org.uk Tel: 0141 530 1000
-Penumbra: www.penumbra.org.uk Tel: 0131 475 2380
-MIND: www.mind.org.uk
–MoodJuice: www.moodjuice.scot.nhs.uk
-Living Life to the Full: https://llttf.com
-Mood Gym: https://moodgym.com.au/
-Anxiety UK: www.anxietyuk.org.uk Tel: 03444 775 774
-No Panic: www.nopanic.org.uk Tel: 0844 967 4848