SOS!! Mental Health First Aid By Miranda Watkins 

We are often trained or taught to deal with medical emergencies and physical injuries with basic education from primary school. It becomes a focus in our childhood activities, such as scouts, lifesavers and sporting endeavours and then may be a mandatory part of our induction with our workplaces as adults.  Most of us are familiar with the response plan in some form –

But how many of us have been taught and trained to identify and respond to mental health emergencies? Depressive disorders are at the rate of around 16% with 25% of depression being onset before the age of 20.  It is common for it to occur in conjunction with another disorder such as anxiety which then increases the likelihood of suffering from a mental illness.  Statistics  (2007) have estimated that almost half (45%) of the total population have experienced a mental disorder at some point in their life; and one in 5 Australians aged 16-85 having experienced mental disorders in the prior 12 months. 

This means if we look up right now we could tick off every second person as being likely to experience a condition such as depression or anxiety at some point in their life or every 5^th person suffering right now.  Now, imagine that one in two will require CPR or first aid at some point and one in 5 requiring an emergency response RIGHT NOW! It is a little overwhelming, I think.  Imagine all the crises in which we could be making an intervention.  Well, potentially that is what is happening in some people’s (including our own) mind’s right now, but we cannot necessarily physically see and therefore maybe be able to respond to this emergency. 

We don’t necessarily see the signs or symptoms, or when we do, we may feel uncomfortable or avoid making interventions.  In recent years, there has been much more media campaigning for awareness, however there is not necessarily the training and ways we can all contribute in supporting care and recovery.  This could also possibly then reduce the need for more costly interventions or longer term treatments which is what can occur when left undiagnosed, untreated and unresponded to.

You don’t need to be a university trained professional or a doctor to respond to someone in an emotional or psychological distress or crisis and with earlier detection and intervention, outcomes can be much more positive. The same general rules apply as if we could respond to a physical injury or emergency earlier, we may not require hospitalization or more intensive medical attention or treatment.

Mental illness is not laziness, attention seeking, bad lifestyle habits, mental or physical weakness or personal failure.  Anyone could develop a mental illness during their lives and when someone experiences an episode it can be debilitating on a person’s life functioning and relationships.

The most common mental disorders include; anxiety, depression, eating disorders, substance abuse and addiction and more complex disorders such as psychosis and schizophrenia.  Mental health disorders often co-occur together, for example it is common for someone who has depression to also have features of anxiety, or if a person has a substance addiction they usually have underlying anxiety conditions. 

The following are some brief guidelines in assessing and responding to some of the above issues. 

ANXIETY

Common features include; a feeling of nervousness or panic, racing heart and breathing, muscle tension and often feeling unsafe, reduced memory and concentration, problems sleeping, avoiding places, people and situations more and more, and often pretending all is ok. 

IT”S OK TO:

• Ask are you OK?  State what you have noticed about the person’s behaviour that has concerned you. 
• You just have to say, I have noticed you have not been coming out lately or have cancelled plans a lot, this isn’t like you? You don’t seem your usual self? 
• Can I help?
• You don’t have be alone, we can get help
• Ask questions to help them uncover their fears, and logical or realistic outcomes, such as ‘have you dealt with this before, and how did it go?  Is there another way to look at this issue?  Have you ever coped with this feeling before, and what helped?

Offer to be with the person.  You can research some information with them about common anxiety symptoms, to show them they aren’t alone. 

You could offer to support them by seeking further help such as seeing your local GP.  Your GP can assess to determine if there are other medical issues impacting on the person and arrange necessary care. 

TRY NOT TO:

• Say ‘you are being silly’ or ‘there’s nothing to be scared of’
• Say, ‘you’ll get over it’
• Offer too much general reassurance such as when they ask a lot of the same question, but support them in finding their own reassuring answers.

DEPRESSION

Common symptoms include; feeling depressed for at least a two week period, problems in sleep, slowing down in movement or activities, loss of interest and less interaction and going out with others or in general.  Maybe increase in angry mood or use of drinking alcohol or substances.  You may notice the person stays alone or isolates themselves more, and they may even talk more negatively about life, themselves and others.  They may even have suicidal thoughts. 

IT”S OK TO:

• Ask, Are you ok?  You seem sad, or distant.  What is going on?
• It is also ok to ask, have you thought of harming yourself?
• If the person is suicidal, seek medical help for referral and safety support.  If the person cannot guarantee their safety, then you can call 000 and an ambulance or police can assess the situation and seek further help and monitoring to ensure the person’s safety until they are feeling more safe with themselves.(Yes, it’s the same as First Aid!!) 
• There are suicide helplines and lifelines that are 24 hours and have trained counselors available to help and guide you and the suicidal person through the emergency.
• Help them look up and get information about depression. 

TRY NOT TO:

• Say, ‘Your life is good, get over it.  You have nothing to be depressed about’
• Say nothing
• Avoid the person
• Promise to keep secrets that could harm the person further.

EATING DISORDERS

The most common eating disorders include Anorexia, Bulimia Nervosa and Binge Eating Disorder.  The combined prevalence of eating disorders is around 7-9% (1 in 10 approximately).  Bulimia and Anorexia are the 8^th and 10^th leading causes of injury and disease in young women.  It doesn’t just occur for women however, and men and teenage boys also suffer from this condition. 

The main symptoms include a preoccupation with body image and appearance; dieting, whether restricting food or feeling out of control with food. In anorexia, starvation often leads to emaciation and very low body weight, which can have serious health issues.  Excess exercise or use of purging (vomiting, laxatives, excess exercise) can also result in serious and life threatening health issues.  The person often tries hard to keep the symptoms hidden, and often feels guilt, shame and may avoid talking about the problem.

If you have a concern for someone, here are some basic first aid guidelines:

IT’S OK TO:

• Encourage the person to seek help, these conditions and illnesses often get worse rather then better over time.
• Help research different treatment options
• Try to understand or ask how they are feeling inside, as the preoccupation with food and appearance is a way to deal with emotional pain and suffering. 
• Be sensitive to comments about appearance or food. Again, focus on the qualities of the person, such as their strengths, kindness, caring nature, or something positive about them (not relating to their appearance!!)
• Talk to the person’s trusted people (may be family or friends) to encourage support and seeking help – often people feel helpless and will try to monitor and control the person’s food or eating habits, which makes the problem worse at times, and the person may further withdraw and bottle up their feelings.

TRY NOT TO:

• Comment on their appearance or say things, such as ‘you look a bit healthier today’ or you look well.  A person with an eating disorder may interpret that as ‘they think I’ve gained weight or I look fat or disgusting’
• Instead, ask, how are you going or how are you coping with things today.
• See the person and the eating disorder as one; the person is separate from their eating disorder, but the eating disorder may be in control of their behaviours, and they may be more moody, irritable, and irrational in their thinking.
• Try not to become frustrated or impatient, and say things such as ‘just eat, I don’t know what the fuss is about’ or make comments about food. A person with Binge eating disorder finds it difficult to stop consuming food, until they are extremely full and will often feel highly self conscious and judge themselves.
• Most eating disorders are about a person using food to deal with pain, so try to understand what the pain is about for them, or where it comes from. 
• All people with eating disorders need love, as it is often a lack of love for themselves that underlies the problem. 

These tips are some basic first aid responses we can use in identifying and responding to common mental health issues and illnesses.  No one is immune from experiencing a mental illness, and it is probable that either ourselves or someone close to us will be touched by mental illness at some time in our life. If we can get better at understanding and responding more quickly and helpfully, we can support the path of recovery. 

Future blogs will cover some more mental health conditions and first aid for these disorders. The more conversations we have, the more we can share knowledge and come together in healing. 

Prevalence Of Mental Disorders In The Australian Population