Mental Health First Aid

1 Understand what mental health is

Mental health: mental health as a continuum, different from person to person, social well-being, emotional well-being, psychological well-being, behavioural well-being, impact on individuals.

Why it is important to be aware of mental health: global statistics, address any problems before they become severe, reduce stigma, and provide support and guidance.

How stigma surrounding mental health can impact on individuals: mental health impact, impact on those with a mental health problem, impact on those without a mental health problem, outsider theory.

Impact of mental health on an individual's life: physical symptoms, impact on relationships, impact on work life, severe impacts, productivity, quality of life.

2 Be able to speak to an individual about mental health and offer mental health first aid where needed

Identifying mental health resources using search engines:

Where none are available within your own locality, refer to those available in the UK, as listed here

• National Health Service (NHS)
• Charities: mind, specific needs charities, local charities, Samaritans, etc.
• Paid services
• Workplace support
• Verifying sources
• Avoiding misinformation

Starting a conversation about mental health: where to start, reducing stigma and assumptions, speaking to individuals who have mental health problems, speaking to individuals who do not have mental health problems, recognising uncomfortable people, triggers, space, remote workers. 

Non-judgmental conversations about mental health: confidentiality, limits of confidentiality, compassion, empathy, managing emotions, personal safety (emotional and physical).

Supporting in reducing stigma around mental health in the workplace: training, openness, honesty, discrimination, harassment, misconceptions, mental health campaigns, inviting experts to speak.

Giving guidance on support for mental health: point to support, know limitations of mental health first aid, individuals who do not want support.

3 Understand workplace symptoms of common mental health problems

Symptoms of depression: lack of enjoyment in activities the individual normally enjoys, depressed mood, lack of energy and tiredness, feelings of worthlessness and guilt, thinking about death or suicide, difficulty concentrating or making decisions, moving slowly, becoming agitated, unable to settle, sleeping difficulties, sleeping too much, changes in diet, changes in weight.

Symptoms of anxiety: a churning feeling in the stomach, feeling light-headed or dizzy, pins and needles, feeling restless or unable to sit still, headaches, backache or other aches and pains, faster breathing, a fast, thumping or irregular heartbeat, sweating or hot flushes, sleep problems, grinding r teeth (especially at night), nausea (feeling sick), needing the toilet more or less often, changes in sex drive, having panic attacks.

Symptoms of substance use problems

• varied by types of substance
• alcohol: changes in behaviour, reduced inhibitions
• depressant substances: drowsy, sedated
• stimulants: increase in energy, more confidence, more alert

Symptoms of eating disorders: dieting, binge eating, laxative use, vomiting, excessive obsessive or ritualistic exercise patterns, changes in food preferences, rigid patterns around food selection preparation and eating, food avoidance (especially in social settings), lying about food or weight (or evasive behaviour around these topics), behaviours focused on food, behaviours focused on body shape and weight, development of repetitive or obsessive behaviours relating to body weight or shape, social withdraw, avoidance of previously enjoyed activities, weight loss or weight fluctuations, sensitivity to cold, feeling cold most of the time, changes to menstruation, fainting, calluses on knuckles, damage to teeth (from vomiting), swelling around cheeks or jaw, pre-occupation with food, pre-occupation with body shape, pre-occupation with weight, extreme body dissatisfaction, distorted body image, sensitivity to comments or criticisms (about weight, food, body shape or exercise), anxiety around meal times, depression, anxiety, irritability, black and white thinking, low self-esteem.

Symptoms of gambling harm: regularly thinking about gambling, gambles most days, increased time spent gambling, gambling for linger than planned, craving gambling, strong desire to gamble, boredom when not gambling, restless when not gambling, gambling instead of activities the individual used to enjoy, gambles despite promising to stop, unsuccessful in in cutting back or stopping gambling, uses gambling to escape problems, celebrates winning with more gambling, gambles after a loss, evasive about gambling losses, lies to cover up or fund gambling, commits illegal acts to fund gambling, defensive or angry when asked about gambling, blames others for consequences of gambling, blames others for gambling, gambling for long periods without breaks, lack of reaction to world when gambling, continues gambling after friends leave, only stops gambling when venue closes and difficulty stopping even at that point, regularly gambles as soon as venue opens, individuals checking if the induvial is at venue, withdraw cash more than once a session, leaves venue to find money, asks for loans or credit from venue, gambles until out of money, significant changes in mood during session, sad or depressed after session, anger while gambling, blame venue for losses, does not look after self, final signs (only spends on gambling, increased credit cards usage, mounting debt, money does not represent work, debt collections, owes money to loan shark, sensitive about money, unexplained loss of money, valuables disappear), social signs (gambling negatively impacts social life, isolation, money conflicts), signs in workplace (gambling at work, ability to work negatively impacts, stealing)

Symptoms of psychosis: changes in emotion, changes in motivation, changes in thinking, changes in perception, changes in behaviour.

How symptoms could appear differently in different people

• Genetics: likelihood of developing, how symptoms present
• Neurobiology
• Physical health
• Personality traits
• Coping mechanisms
• Past experiences
• Cultural background: suppress symptoms, somatisation
• Stigma and support: impact how safe the individual feels experiencing symptoms
• Environmental stressors: can exacerbate symptoms
• Conditions have a variety of symptoms
• Age and development stage: children and adolescents may display different symptoms than adults
• Gender: socialisation impacts on symptom expression

4 Be able to recognise mental health problems and provide mental health first aid using the CARE approach

Identifying form of mental health problem: signs, symptoms, prior diagnoses, knowing limitations of mental health first aid (unable to diagnose, seeking help when needed), concerns raised.

CARE Approach

• Checking for significant risk of suicide or harm: looking for significant risk, indicators of suicidal thoughts (voicing intention to end life, threats to harm self, looking for ways to hurt self, talking or writing about death or suicide, hopelessness, rage, anger, seeking revenge, reckless behaviour, feeling trapped, increased alcohol or drug use, withdrawal, changes in sleep patterns, anxiety, no sense of purpose in life, no reason for living, dramatic changes in mood), who to contact are concerned.
• Applying non-judgmental communication skills: give full attention, letting them share feelings, patience, body language, eye contact, open-ended questions, repeat what the individual said to show understanding and listening.
• Reassuring and providing information: remind the individual about those who cares, remind the individual it’s okay to share, show gratitude, do not make assumptions, do not try to diagnose.
• Encouraging self-help strategies: lifestyle changes, self-help (getting active, sleep, diet, socialising, self-help books, mindfulness, avoiding drugs and alcohol, peer support groups).

5 Understand a mental health crisis

Mental health crises that an individual may experience in a workplace: self-injury, panic attacks, severe alcohol or drug usage, severe psychotic states, suicidal thoughts and behaviours, trauma. 

Limitations of mental health first aid when addressing a mental health crisis: call for medical support, comfort, physical safety, cannot diagnose.

Symptoms of a panic attack: shaking, trembling, sweating, rapid heart rate, palpitations, pounding heart, the sensation of shortness of breath or smothering, feelings of choking, chest pain, abdominal distress, lightheaded, nausea, dizziness, chills, heat sensations, numbness, tingling, derealization, detachment, fear of loss of control, fear of dying.

Signs an individual may be experiencing suicidal thoughts and behaviours: threats to harm self, looking for ways to hurt self, talking or writing about death or suicide, hopelessness, rage, anger, seeking revenge, reckless behaviour, feeling trapped, increased alcohol or drug use, withdrawal, changes in sleep patterns, anxiety, no sense of purpose in life, no reason for living, dramatic changes in mood.

Confidentiality in mental health first aid: criminality, harm to others, harm to self, making this clear in discussion.

6 Be able to respond to a mental health crisis

Assisting an individual who is having a panic attack: ascertain if the individual knows what is happening, ask if it has happened before, reassurance, simple questions, non-verbal communication, assess if a medical concern, consider their physical safety, find out what the individual needs, acknowledge their experience, confidence, space, remove individuals who are making it worse, try to remove anything causing distress, be aware of individuals preferences for help (may not want to talk, maybe the wrong person to help them), coping strategies.

Speaking to an individual who is experiencing suicidal thoughts and behaviours: preparing for the discussion, considering if right person to speak to them, making an approach, acting quickly, direct questions, being supportive, reassurance, asking about thoughts and feelings, painful conversations, patience, non-judgemental listening, open-ended questions, show listening, clarify any confusion, empathy, assess urgency, assess risk level, staying with the individual, develop a plan with the induvial, guidance on support, informing the best person/people, actions if an individual has already acted on thoughts (first aid, emergency services), protecting self (self-care.) 

Assisting an individual who is experiencing a severe psychotic state: safety concerns (exits, physical safety of everyone), assessing risks, removing risks, listening, speaking (direct, simple, calm), ways to de-escalate, getting medical help, speaking to medical staff, looking after self.

Offering guidance for individuals who are or have experienced traumatic events: assess situation (assess safety, emergency support presence, is the individual already being helped), calmness, help with decisions, help with the dignity of individual, keep them informed, active listening non- judgmental listening, abuse disclosure (know the law, limits of confidentiality, safeguarding policies and laws), when to suggest professional help.

Assisting an individual who is experiencing severe effects of drug and alcohol abuse: when to suggest support, contacting medical professionals, priorities own safety and the safety of individuals the individual may be affecting, considering outcomes of the discussion, selecting timing and locations, non-judgemental discussions, focus on behaviour rather than personality, “I” statements, limitations of support, providing information, reducing harm, pregnancy and breastfeeding, avoiding conflict or violence, encourage support, relapse, stages of change (pre- contemplation, contemplation, preparation, action, maintenance, termination), individuals who are unwilling to get support, interventions, intoxication, aggressive behaviour.

7 Understand the risk factors for experiencing mental health problems 

Risk factors for mental health problems

• Genetic and lifestyle risk factors
  
  • Genetic: recent research, brain development, genetic  conditions, comorbidity, family history, polygenic risk scores, neurodevelopment.
  • Lifestyle: drugs and alcohol, financial concerns, childhood development, ethnicity, culture, stress, technology overuse, sleep deprivation, poor diet, social isolation, unhealthy relationships, chronic illness, lack of purpose or goals.
• Work roles and responsibilities: work-life balance, stress, burnout, remote working (isolation), growth opportunities, workload, skills gap, workplace bullying, long hours, lack of breaks, workplace culture, work environment, lone working, poor managerial support.
• Traumatic events: variety of events, individual responses to events, post-traumatic stress disorder (PTSD), childhood trauma.

Key indicators and measures of staff wellbeing: sick leave, retention, turnover, staff satisfaction, data collected by human resources (HR), open discussions, staff feedback. 

8 Be able to advise on ways to reduce some of the risk factors for mental health problems 

Demonstrating positive self-care habits: medication, wellness, work-life balance, exercise, sleep patterns, healthy eating, hydration, relaxing activities, setting goals and priorities, staying connected, practising gratitude, and positivity.

Implementing specific initiatives to enhance staff well-being in identified areas: flexible working options, healthy communication channels, peer support programs, policies (mental health, sickness, return to work, performance management, disciplinary action, diversity and inclusion, bullying and harassment, personal development, work environment), staff training, support.

Providing opportunities for teams to talk about their well-being: one to one meetings, open discussions, training, mentorship.

Reviewing current research and ideas related to staff wellbeing: industry trends, credibility, reliable sources.