Mental Illness on Martha’s Vineyard

Helping a person in a mental health crisis.

Mental Health First Aid (MHFA) was taught at the Oak Bluffs Public Library. —Steve Myrick

Mental Health First Aid (MHFA) was taught to a group of about 20 at the Oak Bluffs Public Library on Saturday, Sept. 23. MHFA is as it sounds — first aid for folks in a mental health crisis.

“[The idea of MHFA is] to be able to recognize when someone is experiencing the signs and symptoms of a mental illness…and to figure out what is most helpful to do next [for that person],” said Kimberly Bindas, LICSW, of CeltiCare Health, who gave the training.

The goal is to provide immediate help to someone in a mental health crisis.This may be talking to a person in a caring and compassionate manner. It may be reassuring someone that everything is going to be okay. And it may be ensuring the safety of everyone nearby and seeking immediate professional help.

Illnesses discussed in the program were anxiety and depressive disorders, psychosis, and substance abuse disorders. Participants in the training learned to recognize signs of these illnesses.

For example, someone experiencing a panic attack may feel and exhibit symptoms of a heart attack. They may have short, rapid breaths and hold their hand over their heart. And someone who is not his or her usual ebullient self for a few days may be depressed. People who suffer from psychosis may be talking to themselves because they are hearing voices.

MHFA encourages people suffering from mental illness to access help. But because of the stigma often attached to mental illness — the idea that people could be dangerous or deranged — many do not seek help for fear of identifying themselves.

There are some stark statistics: Only 41 percent of those with mental illness receive help in a given year. And more than half of folks with mental illness do not receive help for 10 years. Folks trained in MHFA learn how to encourage a person to access help that she or he may not otherwise have sought.

The MHFA action plan taught by Ms. Binder in the eight-hour course is called ALGEE. Action “A” is to assess for risk of suicide or harm. Action “L” is to listen non-judgmentally and empathetically. “G” is to give reassurance and information. “E” encourages appropriate professional help, and the second ”E” is to encourage self-help and other strategies.

Participants learned to apply ALGEE to various situations. For instance, if you see someone experiencing the signs of a panic attack, you may ask if that person has had a panic attack before. If they have not and they feel as if they are having a heart attack, then call 911 and follow physical first-aid protocol.

If you know it is a panic attack, then reassure the person. Speak slowly and clearly, and acknowledge how scary and horrible it must feel, but that it is not life-threatening and will pass. You may find a quiet spot nearby and ask if the person would like to sit down.

Once the panic attack has passed, you can encourage that person to learn more about panic attacks and to seek professional help if they recur. You can let the person know that there are effective treatments. (Folks trained in MHFA should be aware of mental health resources in their community.)

MHFA has much in common with physical first aid, said Nathan Luce, program director for the Oak Bluffs library.

“It’s a matter of making sure that there’s no immediate danger, either to the sufferer or anyone else, and dealing with it if there is, but then largely getting someone else with more extensive training involved ASAP.”

Mr. Luce said he felt “better prepared to identify someone in the midst of a crisis,” but that it still can be a difficult and complicated topic. And, he said, he is unsure if he could “identify it with complete accuracy.” For instance, Mr. Luce said, how can you be sure if someone is having a panic attack or a heart attack?

There were some clear guidelines given in the training on what not to do. Never assume someone is kidding about committing suicide. Never be flippant or speak in a critical manner to someone in a mental health crisis. Do not dismiss someone’s fears as trivial, and do not put yourself in a situation where you have no safe exit.

The MHFA program was put on by the Oak Bluffs library as part of its initiative to serve folks in the community with disabilities, and was paid for by a grant from the Massachusetts Board of Library Commissioners (MBLC).

According to Oak Bluffs library director Allyson Malik, the goal is to improve and make more accessible library services to folks with disabilities and to create “a culture of acceptance.”

“We intend to demonstrate what’s possible when providing library services to those of all abilities,” she said.

Diverting folks from jail

The idea of Mental Health First Aid is to be able to recognize when someone is experiencing the signs and symptoms of a mental illness. If police haven’t been properly trained to recognize these symptoms, their default option is often to place the person in jail.

According to the National Alliance for Mental Illness (NAMI), up to 50 percent of inmates in local jails and up to 30 percent in state prisons have mental illness.

Part of the reason for these numbers can be that police have not received mental health training and do not have the resources they need when confronted with a person in a mental health crisis. As the default of first responders to a person in a mental health crisis, the police often are left with little or no option other than to place a person in jail if a law has been broken.

But with proper mental health training for the police and collaboration between community stakeholder groups, many of these — especially those with nonviolent offenses — could be diverted from jail and given help.

The strategy is twofold, according to NAMI. First, there is 40-hour crisis intervention training (CIT) for police.

Police officers are taught to recognize and understand mental illness and to verbally deescalate dangerous situations, rather than using force. Police hear from family members of folks with mental illness, and roleplay mental health situations.

The second prong is community partnerships. A mental health stakeholder group is formed. The police regularly collaborate with human services providers, doctors, EMTs, and court personnel, and others with an interest in mental illness.

With the training and community relationships, police learn to identify and de-escalate a person in a mental health crisis, and can refer that person to help rather than placing them in jail. In some situations, those in crisis can be identified and helped before a problem occurs. For example, police could make a home visit with a counselor to someone who is exhibiting signs of a mental health crisis.

According to NAMI, there is a 58 percent reduction in the recidivism rate of folks with mental illness and an 80 percent reduction in officer injury during mental health crises when this strategy is followed.

And the cost savings are enormous, says NAMI. Incarceration can cost as much as $46,000 per year, not including court costs. There are tremendous human costs as well, including loss of employment, loss of mothers and fathers in a family, and loss of housing.

Folks diverted from jail may become contributing members of society. A number of communities in Massachusetts have had success with this approach. In Fitchburg, for instance, with a grant from the Department of Mental Health, the police department trained all of its officers in Mental Health First Aid, and trained some in the 40-hour CIT program. There are regular stakeholder meetings. A CIT team that consists of a trained officer and a licensed clinician makes home visits to those with mental illness.