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Column Would you know how to respond to a mental health emergency?

Last year, Ireland became one of the most recent countries to launch an official mental health first aid training programme, writes Dr Stephen McWilliams.

SOME MONTHS BACK, my brother-in-law had the pleasure of spending an hour or two sitting in an aeroplane on the tarmac of Dublin Airport, awaiting a delayed take off. He is a seasoned traveller so this was no trouble to him, but the lady in the next row was having an altogether different experience.

She had a full-blown panic attack and nobody (not even the air stewards) knew quite what to do. Had it been a physical ailment like a minor injury or a nose bleed, no doubt somebody would have produced a first aid kit and followed a procedure. But “first aid” for mental health is an altogether more novel entity.

A novel entity in Ireland, that is. I don’t recall off hand where my brother-in-law was going on his aeroplane, but the chances are his destination was a country with well-established Mental Health First Aid (MHFA).

Mental Health First Aid movement

A movement founded in Australia in 2000 by Betty Kitchener and her husband Professor Anthony Jorm of the University of Melbourne, MHFA is strongly evidence-based in its approach.

In its first seventeen years, it has reached some 24 countries across the globe. To date, around two million people worldwide have been formally trained in MHFA skills. Kitchener has received numerous awards for her work, including the prestigious Order of Australia Medal (OAM) in 2008.

Mental health difficulties are no less common in Ireland than they are anywhere else. One in five of us will experience a diagnosable mental illness within the next year, while one in three of us will do so in our lifetime. Anxiety disorders, depression and addiction are especially common. According to a 2008 Mental Health Commission report, the estimated direct annual cost of poor mental health in Ireland is some €3 billion or 2% of GNP.

Awareness is improving but stigma, discrimination and misunderstanding are still widespread. Many people delay help-seeking as a result, despite the fact that mental health difficulties are very treatable.

Early intervention and support are ideal; conversely, without treatment, issues can reach a crisis point and professional help is not always immediately available. In this regard, MHFA is specifically designed to be provided by a friend or a colleague, or a non-health-professional such as a teacher or a guard.

“I’m grand, thanks.”

Picture the everyday conversations you have with casual acquaintances at work or in your locality. You ask, “How are you?” and receive the standard answer, “I’m grand, thanks.” This is the response you anticipate. You are busy and anything more honest may delay you or even make you uncomfortable.

It’s not that you don’t care, but rather that you feel ill-equipped. So, if you don’t receive the standard answer (or if you simply notice that someone you know has not seemed quite themselves lately) what should you do? Leave well enough alone? It’ll all blow over, right?

Many people find it difficult to start a conversation about mental health. See Change (the national stigma reduction partnership) surveyed more than 1,000 adults in relation to their attitudes to mental illness. Around 56% stated that, if they had a mental health problem, they would not want others to know.

Similarly, 41% said they would hide their mental health problem from a friend, while 24% said they would hide it from their family. At work, 57% believed that being open about a mental health problem would damage their career prospects.

Recognising mental health difficulties

This is where MHFA training comes in. Its aim is to equip ordinary people to recognise when someone near them is developing a mental health difficulty and to address it before it gets out of hand. Equally important, it gives people the skills to intervene in a crisis until professional help becomes available.

MHFA will not teach you how to be a psychiatrist or a psychologist any more than a conventional first aid course will teach you how to be an orthopaedic surgeon or a cardiologist. But it can still be a very useful and universal first step.

Specifically, the aims of MHFA are to: (a) preserve life where a person may be at risk of harm; (b) prevent a mental health problem from becoming more serious, (c) provide comfort in the immediate setting; and (d) promote recovery. It can mean anything from active listening over a cup of tea to comforting a person through the terror of a panic attack.

Last year, Ireland became one of the most recent countries to launch an official MHFA training programme. In the end, Mental Health First Aid is about helping that colleague at work who has recently been more withdrawn or that fellow air passenger as she experiences her panic attack. Those trained in MHFA have the knowledge to notice a person’s mental health difficulty and the skills to offer meaningful help.

Recently, people in Ireland have been encouraged to talk about their mental health. Mental Health First Aid can further empower people to help each other stay well.

Dr Stephen McWilliams is a consultant psychiatrist at Saint John of God Hospital, Stillorgan, Co Dublin.

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Dr Stephen McWilliams
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