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Would you recognize the signs and symptoms of a mental health crisis in someone else? How would you react? We hear about an expanding public program whose aim is to ensure everyone ‘Knows What to Do’ when faced with another’s depression, obsessive-compulsive disorder, schizophrenia, or something else.
- Bryan Gibb Director of Public Education, National Council for Community Behavioral Healthcare
- Senora Simpson Participant, Mental Health First Aid; and Professor of Physical Therapy, Howard University
- Kay Hong Participant, Mental Health First Aid
MR. KOJO NNAMDIIt's a good idea to learn CPR. Everyone agrees you never know when you'll need it and you may save a life. The same goes for the Heimlich maneuver. You'd hate to see someone choking and not help. But what if you saw someone going through a mental health crisis? Would you know what to do? Can we learn to reach across the stigma to help those suffering from that, which some would rather not name. We're talking mental health first aid and how ordinary people can make a difference for someone who needs help.
MR. KOJO NNAMDIJoining us in studio is Bryan Gibb, the director of public education for the National Council for Community Behavioral Healthcare. He teaches mental health first aid and also trains course instructors. Bryan Gibb, thank you for joining us.
MR. BRYAN GIBBThank you, Kojo.
NNAMDIAlso with us is Senora Simpson, a professor of physical therapy at Howard University who took the course from Bryan. Senora Simpson, thank you for joining us.
MS. SENORA SIMPSONThank you.
NNAMDIAlso with us in studio is Kay Hong who also took the course from Bryan. She is a military spouse. Kay Hong, glad you could join us.
MS. KAY HONGThank you. Glad to be here.
NNAMDIAnd if you have questions about mental health first aid, call us at 800-433-8850. Bryan, mental health first aid is a 12-hour course that teaches participants to recognize and understand mental illness. Students learned a five-step action plan that they can use to help people in the midst of crisis or difficulty. What are those five steps?
GIBBThank you, Kojo. Those five steps in mental health first aid are ALGEE, A-L-G-E-E. That's our mnemonic. That's how we remember it. And ALGEE is our -- little koala is also our mascot. And ALGEE stands for assess for risks of suicide or harm, listen non-judgmentally, give reassurance and information, encourage appropriate professional help, and encourage self-help and other support strategies. And so in the course, we go through different scenarios and activities, and we apply this action plan in a way so that members of the general public can feel more comfortable in approaching someone who may be in crisis.
NNAMDIHow does one -- how do students identify situations where that five-step plan may be necessary?
GIBBWell, in the course, we go through five categories -- depression, anxiety, psychosis, substance use disorders and eating disorders. And we go through some of the signs and symptoms that someone may see in someone who's experiencing this disorder and then we talk about how to reach out to somebody, how to help somebody who's in crisis and, you know, how to get somebody help if they need additional help.
NNAMDIKay, it's my understanding that your husband served in Iraq for a year. How did that lead to your involvement with Mental Health First Aid?
HONGWell, that wasn't the easiest year of my life to say the least. It wasn't just a year when he was deployed to Iraq, but leading up to it, leading up to -- leading up to it and him coming back home, the whole process, it was a stressful time for me and also for his family, my in-laws. What, kind of, opened my eyes was on the one hand I'm having hard time and I'm trying to find a way to cope with the stress, you know, finding different resources and all that, and that made me, in a way, also more aware of all the people, all the spouses I come in contact with who are dealing with the same issues.
HONGOn the other hand, all this well-meaning friends, who are the family members, who are not immediate family members, who ask me how I'm doing, you know, trying to help. But even though I'm fully aware that they are trying to help and they, you know, mean nothing but good things, sometimes some things they say would actually make it more challenging for me to deal with things that also, kind of, made me think, wait a minute, I complained that my co-worker said something that actually made me stressed out even more about them being away, but am I never in a situation where I've done that to other people?
NNAMDIHow has Mental Health First Aid helped you in that regard?
HONGIt helped me, I would say, in two ways. One is it made me really humble. I walk into a class thinking that, oh, I know one or two things about mental health issues. I've, you know, dealt with minor forms of it before like I've dealt with, you know, difficult situations before. I've had close people who had to deal with these things before. But as we're going through exercises, especially the exercise where we had to empathize with a person who's in the middle of a crisis, I really don't know. I didn't know what these things. I didn't know these facts. I didn't know what it's like to have mental health issues. That's one thing.
HONGAnother thing is that, it might sound contradictory, but it also kind of helped me have a confidence, realizing that it's not precisely what I say or what I do, but if I approach it with the right attitude, then I might be (word?) clinician of help to especially people I'm close to -- my family, my friends, the military spouses I come in contact with. So that was really helpful for me.
NNAMDIFull disclosure here. I could ask where Mental Health First Aid has been all my life. My older brother has struggled with mental illness his entire life and even though we live in different countries, whenever he has a crisis, I get the call to go and persuade him to seek treatment. Again, I wish I'd had Mental Health First Aid along with me in those years so that I could identify it before that even became necessary. Senora, you've been involved with mental health education for many years, and you've worked to integrate mental health education into your physical therapy courses at Howard University. It's my understanding that you were skeptical of Mental Health First Aid, the course, at first. What made you change your mind?
SIMPSONWell, having been involved in all of the issues in mental health for years and years and years, because I have family members also who are involved. I wanted to see was this just another gimmick and something else to sell to the public because it became very popular, of course, during the Tucson incident. So what changed my mind was one, like everybody says, you think you know a lot until you take this course. And so I had lots of trouble with -- in the assessment for suicide and harm.
SIMPSONIn health, we don't like to use certain terms, so like asking somebody are they gonna kill themselves became very problematic for me, and then to learn how to overcome that. I have a child who has schizophrenia, so the exercise of actually having voices talk to you while you are trying to think brought it home very clearly as to what would be going on with someone in crisis particularly those with serious mental illness. So in addition to finding that it certainly could be meld between health and mental health, it also taught me some things that says that even after 50 years you -- there's a lot to learn.
NNAMDIBryan, according to the National Institute of Mental Health, 18.1 percent of adults in the United States will experience an anxiety disorder in their lifetimes, yet only 36.9 percent will seek treatment. Why is that?
GIBBWell, I think that, as you mentioned before, Kojo, stigma is a big part of why people don't reach out for treatment. They're afraid of being branded as somebody who is a mentally ill or suffers in this way, and so there's some resistance to that. Also, you know, people who are experiencing mental illness don't always know what's happening to them. And those close to them don't always know how to, you know, look for the signs and symptoms. I mean, a lot of individuals who experience mental illness will go to their primary care physician and report physical symptoms of aches and pains or sleeplessness, and that is where a lot of people, kind of, can get help as well, so.
NNAMDIWe have a caller. Tim, at the University of Maryland, who I think has a question along that line. Tim, you're on the air. Go ahead, please.
TIMGood afternoon, Kojo. It's a pleasure.
TIMI'm calling about a very tragic suicide at the University of Maryland student that occurred recently. And even though I didn't know the student, I feel affected by it because, you know, as a body of students what affects one, affects us all. And apparently from the report, his friends said that there are no indicators, you know, his family didn't really feel like he was doing that bad and, you know, he was hanging out with friends even, you know, up to eight or 12 hours before it happened. And I was wondering what kind of indicators can appear and look for in a fellow peer that are not as obvious to help prevent something like this from happening.
GIBBThank you and thanks for your call. It -- I think a lot of us have been touched by -- either directly or indirectly by those who have completed suicide. And 35,000 Americans last year completed suicide in this country. You know, in Mental Health First Aid we go through a series of warning signs for individuals who are at risk for suicide. Those may be as seemingly innocuous as sleeplessness or isolation or as serious as somebody actually writing about death and dying or talking about suicide.
GIBBOne of the things that really surprised me when I came to this work was one risk factor is someone who seems to be depressed or down and then all of a sudden has a dramatic change in mood. They -- the cloud seemed to have parted. They seem to have lightened up. And so I think a lay person we think, okay, you know, we're out of the woods. The person is doing better, but in fact that's a very serious risk factor because that person may have found a solution. That solution for them is suicide, and so they're not conflicted anymore, so they may appear better, but in fact they're very much at risk.
GIBBSo, you know, in Mental Health First Aid, we try to go through some of these signs and symptoms, some of these warning signs and then how to engage with somebody to ask a direct question -- are you thinking of suicide?
NNAMDITim, thank you very much for your call. You, too, can call us. Do you have a friend or a relative who you think might be dealing with mental illness and you don't know how to raise it? We're talking with Bryan Gibb, director of public education for the National Council for Community Behavioral Health Care. He teaches mental health first aid and also trains course instructors. Senora Simpson is a professor of Physical Therapy at Howard University who took Bryan's course as did Kay Hong, who is a military spouse. Again, the number is 800-433-8850. We all know the risks of someone with severe mental illness resisting treatment. But for someone with a mood disorder like depression or an anxiety disorder, what are the costs of keeping silent?
SIMPSONIt -- because it affects the entire community, the family, as well as the individual, the costs are great. And I think that even if you're not talking in monetary terms, which I often look at, that it is very costly monetarily. But it's also so costly emotionally from all the people who are involved, so that it is great cost to the community and to the person who is -- happens to have the disorder.
NNAMDIWhat kinds of activities do students engage in during the course, Bryan? And then I'd like to talk to Kay about the activities she's involved in and how she thinks they may have helped. But you first.
GIBBWell, some of the activities, I think, as Senora mentioned, we go through a process of simulating somebody hearing voices so that people who take the course can get some empathy about what it might be like to experience the world through the filter of psychosis. And when we teach this course, actually, to law enforcement audiences, they simulate a traffic stop of somebody who may be hearing voices and why that person may be behaving unpredictably. So that's one example.
NNAMDIKay, can you tell us a bit about the exercises that you've participated in, the kind of things you did?
HONGOne exercise, actually, that's affected me the most was the final exercise we did at the very end of the course. We were given scenarios -- you know, real life situation -- that you might confront, you know, someone needing help. And the scenario I got with my partner was your father just lost -- you just lost your mother. Your father is having a hard time coping with your mother's death. And it was really, really close to home because my parents are still back in Korea. They are just living by themselves. They are aging.
HONGAnd having to actually go through what would I do if I were in that situation, I think that's actually distinguished this course from, say, reading any book about the topic 'cause it kinda forces you to think in terms of real life situations that you might have dealt with, you might have to deal with. And it was quite an emotional moment, but also quite helpful, made me feel that, okay, I think I have an idea what I might think or I might do if, you know, the day comes when one of my parents passed away and I have to help the other person cope with it.
NNAMDIHere's Dwayne in Frederick, Md. Dwayne, you're on the air. Go ahead, please.
DWAYNEYeah. I wanted to just kind of see if you have any suggestions about how to deal with someone who is severely bipolar and you are the person that they are reaching out to. However, in fact, they aren't reaching out because they're having a bipolar episode, and instead of reaching out, they're actually lashing out.
GIBBWell, I should premise my answer by saying that I'm not a clinician. You know, I don't treat individuals with mental illness, and I don't diagnose them. But one of the things we do teach in the course is that, you know, if somebody is behaving in a way that is unpredictable to the point where the first aider feels unsafe, we absolutely encourage the first aider to call in for additional help. First aiders don't diagnose mental illness. They don't treat mental illness. They're first aiders, just like you wouldn't -- it you're taking a first aid course, you wouldn't learn how to set a bone or give someone a tracheotomy. That said, you know, if somebody is really suffering, there are lots of resources here in the District of Columbia that you can call. You can call the Department of Mental Health.
GIBBSenora, do you wanna say more about that?
SIMPSONI wanted to tell the caller that the one -- first thing is to listen non-judgmentally...
NNAMDII was about to ask you about that. How -- what does it mean to listen non-judgmentally? What does that accomplish?
SIMPSONWell, certainly, attitudes of all types come across. And so that if you're listening, body language, everything will tell the individual whether you really care or whether you're really listening. And making judgments about whether they are unreasonable -- and I know that in bipolar, quite often, we may think a person is maybe unreasonable. But the first thing is to listen non-judgmentally and to seek help so that you want to have the numbers available. You want to have in your cap a number of places that you can call, just as you would if you were in the situation of calling 911 for a physical ailment. For the 24-hour Access Helpline for the Department of Mental Health D.C., it's 1-888-793-4357. That's 1-888-7-WE-HELP.
NNAMDII'm glad you brought that up because with state budgets cut and making it increasingly hard to find affordable psychotherapy, you gotta ask, what can a layperson do to help someone access services? Thank you for those numbers that you just gave out. Those will be a significant help to some people. Here is Ray in Fredericksburg, Va. Ray, you're on the air. Go ahead, please.
RAYHi. My question was what recommendations would you have for helping someone who is long distance? I have a brother who's bipolar in Maine, and I'm in Virginia. And then I've got a good friend who I think is severely depressed, going through a third divorce out in Washington. I'm not physically there to be there for them or to listen or -- you know, what can I do from long distance?
GIBBI would say that, you know, there is, actually, a lot you can do on the telephone, certainly. You know, as Senora was saying, listening non-judgmentally, talking to the person, you know, talking about what kind of resources they may have locally. You know, and again also to -- we tell this of our -- we have more than 1,200 instructors around the country who teach this course. And they all locally have local resources, just like the number that Senora mentioned. So a key is, you know, figuring out what these local resources are.
NNAMDIGlad you mentioned that because, Ray, mental health first aid courses originated in Australia, then were adopted by Maryland and Missouri, the two states that first adopted the program in the U.S. Currently, courses are available everywhere from native communities in Alaska to Seventh Day Adventist churches. How can our listeners access this course in their own neighborhoods?
GIBBWell, certainly, in Washington, D.C., we're teaching courses throughout the year, and you can go to www.mentalhealthfirstaid.org.
NNAMDIWe have a link to that at our website, kojoshow.org.
GIBBIf you're listening to the show online or in another community, you can go to -- there's a Find an Instructor tab there on that website, and you can find a course based on your zip code. And we have instructors in 43 states, and we're teaching the course, as was mentioned, from sea to shining sea.
NNAMDIWell, Maryland, we mentioned, was one of the first states to adopt mental health first aid, along with Virginia. But it's my understanding, Senora, that you didn't have that great an experience in Maryland.
SIMPSONWell, I really did not. In trying to make the calls to the Mental Health First Aid in Maryland, I did not get answers. And unfortunately this may happen with the listeners, but you never give up. I had much more response from the District Mental Health First Aid. But in answer for the other -- the person who had talked about getting help over the phone, Bryan -- I agree with Bryan that just talking to the person over the phone and encouraging them to get help.
SIMPSONBut now that we have so much online, all of the communities will have some Department of Mental Health that they can access and ask for help through that. So even though they may not be in the city, they can always get some help for their family.
NNAMDIAnd we strongly encourage you to go to our website, kojoshow.org, where you will find a link to Mental Health First Aid that can help you to find access or to get you to get access to help somebody who may be in need of help. I'm afraid that's all the time we have. Senora Simpson, thank you for joining us.
SIMPSONThank you for having me.
NNAMDISenora Simpson is a professor of physical therapy at Howard University. She took Bryan Gibb's course. He is the director of public education for the National Council for Community Behavioral Healthcare. He teaches mental health first aid and also trains course instructors. Bryan Gibb, thank you for joining us.
NNAMDIKay Hong took the course from Bryan, and she is a military spouse. Kay Hong, thank you for joining us. Good luck to you.
NNAMDIAnd thank you all for listening. I'm Kojo Nnamdi.
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