Mental Health First Aid

by Roshi Kipp Ryodo Hawley

Are we prepared to respond when a visitor is having a psychological crisis?

This question has been on my mind for a long time. What if a stranger appears on the property, disoriented? What if a newcomer starts acting delusional in an Introductory Zazen class? What if a longtime member starts showing signs of a deep depression? Do we know what to do?

Several months ago I ran across articles on Mental Health First Aid, a training course developed in Australia at the beginning of the millenium and now taught internationally. People across all walks of life have done the training and highly recommend it, from Michelle Obama to Congressman Patrick Kennedy to Lady Gaga. I was impressed by the format and intention of the program, which is to give us tools to immediately deal with a crisis situation and not be simply overwhelmed.

The result was that on February 29, ZCLA held an eight-hour training in MHFA for senior students and other interested members. Along with providing foundational information, our instructor, Theresa Reed, led us through role-playing in multiple crisis scenarios and other activities that built our awareness of how people can come to the point of having psychotic episodes and how we can best respond to them.

MHFA explicitly defines itself as first aid: it is given until appropriate treatment and support are received or until the crisis is resolved.

Here is the description of the course from the MHFA website:

Mental Health First Aid is a course that teaches you how to identify, understand and respond to signs of mental illnesses and substance use disorders. The training gives you the skills you need to reach out and provide initial help and support to someone who may be developing a mental health or substance use problem or experiencing a crisis.

It’s not about diagnosing

MHFA doesn’t attempt to give us the deep knowledge that mental health professionals have. But, just the way we don’t need a medical degree to apply CPR or temporarily stop blood loss for someone after an accident, we can take real steps to help someone in an emotional crisis. We don’t learn to make specific diagnoses, but we are given practical information on critical issues like anxiety and depression, which can lead to such episodes as panic attacks, incoherent behaviors and warning signs of suicide that we might need to address on the spot.

The heart of the program is embodied in the acronym ALGEE:

Assess for risk of suicide or harm to self or others.
Listen non-judgmentally.
Give reassurance and information.
Encourage appropriate professional help.
Encourage self-help and other support strategies.

A few video presentations helped anchor the shift we can make in this training, illustrating both appropriate and inappropriate responses to someone in crisis. For me, what stood out most was the emphasis on asking direct yet open-ended questions and open-hearted listening to responses. Instead of saying something reactive like, “What’s wrong with you?” we can offer support by asking, “Is there something you would like to talk about?”. This, followed by reflective listening and follow up questions, reassures the person in crisis that we are there to help, along with giving us information for assessing what risk they may pose to themselves or others.

Instructor Theresa Reed made this an interactive course, and everyone was engaged. She emphasized that this kind of first aid is something we can practice every day: she “does ALGEE” with just about everyone she meets. But even an all-day class on a new skill like this is just an introduction – to really be able to use it when the emergency occurs, we need to have become comfortable with it through practice over time. To help with this, the course includes an extensive yet accessible resource book for further studies. I’ve been consulting this manual to review what I learned in the class as well as dig deeper into the disorders underlying many mental health crises and guidelines for dealing with them.

For me, this was a valuable course that I hope more of us decide to experience. And, I would like to see more classes along these lines of human interaction. Isn’t this what practicing with the Sangha Treasure is all about?

Roshi Ryodo is a teacher at ZCLA and leads Westchester Zen Circle.