It’s not a typical classroom lesson. One student tries to conduct an interview while another talks into the interviewees ear, saying things like, “Don’t trust her. She wants to hurt you.” But the exercise — part of a 12-hour Mental Health First Aid course — provides a dramatic glimpse into the life of someone who has a mental illness.
“The students are just amazed,” said Yuko Johnson-Bautista, RN, MSN, MBA, a member of the nursing faculty at Pima Community College in Tuscon, Ariz., who teaches the course in the community and works parts of it into her nursing curriculum. Johnson-Bautista asks students to imagine having a voice in their ear constantly, while trying to sleep or at a job interview, for example. “They are definitely much more empathetic,” she said.
Whenever mental illness makes the news, it’s usually in a frightening or tragic way such as a shooting or a suicide. But evidence shows the kinds of mental health disorders most people will encounter are hardly the stuff of headline news — a co-worker having a panic attack, a relative who can’t seem to get out of bed, a patient hearing voices, a friend who seems to be drinking too much. Though not usually life-threatening, these situations often are frightening enough to make those around feel helpless and unsure of what to do.
Building a toolbox
Much like the way first aid and CPR courses teach participants to provide emergency care to someone who is choking or having a cardiac arrest, Mental Health First Aid offers simple tools for people to help others experiencing mental health issues. Just as those classes use mnemonics such as ABC, Mental Health First Aid — a public education program created by Betty Kitchener, an Australian nurse, and her husband, Anthony Jorm, a mental-health literacy professor — uses a checklist called ALGEE: Assess for potentially serious harm; Listen nonjudgmentally; Give reassurance and support; Encourage — but do not force — professional help; and Encourage self-help strategies. The objective is to give support until people can get appropriate professional help, course instructors said.
“It gives you a strategy,” said Lorraine Chiappetta, RN, MSN, CNE, professional faculty member in nursing and health sciences at Washtenaw Community College in Ann Arbor, Mich., and an MHFA instructor. “You’re not expected to diagnose something; you’re not expected to fix it. But once you have some skills, you know when to intervene.”
She and other nurses who teach the course say it should be required or at least strongly encouraged for all nursing students and professionals, no matter where they work. “I would love to see all nurses certified in MHFA,” Chiappetta said. “It just makes such good sense.”
Spreading the word
The program has been well-received in Australia since its inception in 2001, and now is established in 17 countries, said Bryan Gibb, director of public education for the National Council for Community Behavioral Healthcare and a trainer for Mental Health First Aid USA. MHFA came to the U.S. in 2008 through a joint effort by the mental health departments of Maryland and Missouri and the Washington, D.C.-based National Council and has grown exponentially since then, he said.
More than 60,000 people in almost all 50 states have taken the course, and about 2,000 have become instructors, Gibb said. Most classes are open to the public. Many courses have been offered as part of training for teachers, police officers, emergency workers and healthcare providers, including nurses. Though the basic program is designed for adult mental health, the National Council recently introduced a special version for counselors, teachers, parents and mature teens and young adults, who may encounter mental health problems in people ages 10 to 20. Other specialized courses are planned or being piloted.
Studies of the Australian course have found that benefits for participants include a better recognition of mental disorders and understanding of treatments; more confidence in providing help to others; improved personal mental health; and a decrease in stigmatization of people with mental health disorders. Though the National Council and governments of Maryland and Missouri still are collecting data about the U.S. program, instructors said they are seeing similar results.
The U.S. version of the basic course examines common mental health disorders including anxiety, depression, schizophrenia, substance abuse and eating disorders, and explains how chemical imbalances can lead to mental health issues. It includes role-playing designed to put participants in the shoes of those with mental illness and help them become more comfortable talking about mental health.
Instructors relay statistics such as that one in four people will experience a mental health disorder of some type, and people with mental health problems are no more likely than the rest of the population to become violent. Course participants learn how to approach someone experiencing hallucinations or someone who may be considering suicide.
“The main thing we always emphasize is personal safety,” Johnson-Bautista said. If someone is suicidal and has a weapon, or if the person is hallucinating and threatening harm, students are taught to keep a safe distance and immediately call for help.
The course also helps reduce the stigma of mental illness. Johnson-Bautista said a nurse who took the course told her, “I’ve always thought of the mentally ill as ‘those people.’ Now I realize I’ve been using the wrong approach with them. I wouldn’t treat someone with cancer that way.”
In the past, chronic mental illness often was regarded as a hopeless condition with little that could be done for patients, said Beth Jelesky, RN, MSN, CNO and director of quality and risk at Linden Oaks at Edward Hospital in Naperville, Ill. But recent evidence shows many people with mental health disorders can be helped with treatment and management. “Treatment can help people recover, and early identification is critical,” she said.
Even psychiatric nurses report learning things from the course, the nurse instructors said. They appreciate the course’s simple, nonclinical approach. “In the beginning you think, ‘I’m a nurse, I’m clinically trained, what more can they teach me?” said Kathleen Linthicum, RN, BSN, PHN, who trained as an MHFA instructor as part of her job as a public health nurse with the Ventura (Calif.) County Health Care Agency. The course also provides a list of local resources of which many nurses are unaware. “I’m always looking for tools that can help me get people into treatment,” she said, “and for ways to improve communication.”
Nursing faculty who have incorporated the course into their curricula say it helps prepare students for clinicals with psychiatric patients and opens their minds to the idea of psychiatric nursing as a career. Before Chiappetta began teaching the Mental Health First Aid course as part of her unit on psychiatric nursing, she said, students were nervous about working with patients with mental illness, and very few wanted to go into psychiatric nursing. But the students seemed much less anxious and more confident in clinicals when they took the MHFA class first, and they seemed more receptive to the idea of working in mental health. Some told Chiapetta they wished they had been offered the course in their first semester of nursing school rather than waiting until their psych rotation.
The course also is a way to spread mental health awareness throughout the community, said Roberta Schweitzer, RN, PhD, FCN, assistant professor of nursing at Purdue University in West Lafayette, Ind., and an MHFA instructor. She teaches the course to nursing students and community members, including farmers, who rarely have access to mental health resources. “It really is a godsend to them,” she said. “This is a great program to get people into early intervention and prevention.”
Gibb sees the course as especially important for those in high-stress jobs, including nursing, because it teaches them to assess their own mental health and that of their colleagues and family members. “Nurses are starting to see that it can be valuable to their patients in daily use,” he said, “but also it can make their own lives easier on a day-to-day basis.” Instructors said they have seen participants become aware of and work to improve mental health habits through diet and exercise. Some realized while taking the course that they were depressed and decided to seek help. Others reported that once they knew what questions to ask, they were able to help neighbors and friends who were considering suicide.
“Just learning how to approach people with concern is a great thing,” Schweitzer said. “Mental health first aid is a very simple idea, but it’s very powerful.”