By NANCY FRAZIER O'BRIEN
Sandra C. Candelaria remembers the moment when she became convinced of the importance of training in mental health issues through the Mental Health First Aid program.
Now a program coordinator at the Puerto Rican Cultural Center in Chicago, Candelaria was working for another agency a year and a half ago when a woman receiving counseling for a substance abuse problem mentioned that she was considering taking her own life.
An exercise in a Mental Health First Aid class gives participants a sense of what it is like to be in a conversation while having an auditory hallucination. Here, Elaine Seaton, left, fights Rosemary Callahan's attempt to distract her. The women were participants in the training held in late August at Presence Saint Joseph Hospital in Chicago.
Photo by: Rich Chapman/© CHA
"We knew exactly what we were supposed to be doing," Candelaria said, because she and others at the agency had participated in an earlier Mental Health First Aid course. "We followed the protocol and were able to calm down the client and follow up with her in the future to help her."
Candelaria, who previously received the Mental Health First Aid training in English, recently completed the same training in her native Spanish, thanks to the efforts of Presence Health to introduce the curriculum to community leaders and public officials as a step toward the city of Chicago's goal of becoming "a trauma-informed city." The city's "Healthy Chicago 2.0" plan defines a trauma-informed city as one where services reflect a thorough understanding of the neurological, biological, psychological and social effects of violence and trauma.
Ten shootings a day
"Chicago has experienced an extreme spike in violent crime this year, and we wanted to train city leaders and other community leaders to get everyone talking about the same thing," said Will Snyder, Presence Health vice president, external affairs.
Dr. Julie Morita, commissioner of Chicago's Department of Public Health, said the city is partnering with Presence Health in its Mental Health First Aid initiative "because Chicago's aldermen and their staff often encounter community members needing assistance" with mental health-related issues.
By the middle of 2016, Chicago had logged more than 1,900 shootings — more than 10 a day and twice the combined total of shootings in New York and Los Angeles. The number of homicides at midyear had increased by nearly 50 percent over the same time last year to 312.
It is impossible to know how many of the shootings can be attributed to mental health issues, but the average person is much more likely to encounter a person in need of mental health assistance than to be a victim of gun violence.
Start with the basics
"In our community assessment of health needs, overwhelmingly mental health was the number one problem in every service area we touch," Snyder said. "There was not much out there for entry-level interventions, and you can't really start shifting the policy framework until everyone has the basic skills and resources."
The National Council for Behavioral Health launched the public education program in the U.S. in 2008 along with the Missouri Department of Mental Health. (See sidebar.)
Mental Health First Aid involves eight hours of training in terminology and appropriate interventions for those facing a wide variety of mental conditions and disorders. Trainees also role-play various strategies to handle different situations and participate in exercises designed to give them a glimpse into life with mental illness.
Competing voices
In one exercise, two people try to keep up a conversation while a third person whispers in the ear of one of them "to give people a sense of what it's like when you are hearing voices," Snyder said.
"Even when you know what is going on, you get a small sense of what that experience might do to people," he added.
Liliana Escarpita, director of communications and policy for the 12th Ward, said the group at the training session she recently attended was a good mix of political and community leaders, as well as individuals with hands-on experience dealing with mental health issues.
"In Chicago there is a lack of funding for mental health, and the city is looking to do some restructuring to allocate more to mental health facilities," she said. "It is helpful to understand the need for additional resources.
"In this country there is a lack of education on mental health," she added. "We need to be individual advocates as we go about our daily lives and continue the conversation about the need for intervention."
Bilingual education
Escarpita, who took the training in Spanish, said the 12th Ward is made up primarily of "undocumented and Mexican immigrant families that shy away from any kind of mental health" assistance.
She found it helpful to learn the names of certain mental health conditions and disorders in Spanish. "A lot of times the terminology is difficult," she said. "You don't hear these terms so often."
Candelaria also appreciated learning mental illness terminology in Spanish.
"In my experience, when you are able to talk to people in their own language with very good knowledge, you are able to create that trust, which is imperative for their well-being," she said. "There is a willingness to hear you in a different way."
Snyder said Mental Health First Aid "empowers people to be able to identify" specific mental health issues "and then connect with the appropriate resources." It also helps them to distinguish when the police should be called and when a different kind of intervention would be more helpful.
"There are absolutely circumstances when calling the police is appropriate and necessary," he said.
This summer, Presence Health trained some 150 people in Mental Health First Aid. About half of them staff aldermanic offices in the city's 50 wards and the rest are community leaders and other interested parties. Presence Health said the course prepares elected officials to become better advocates for expanding community mental health resources.
Funding for Presence Health to offer the Mental Health First Aid training came from several philanthropic organizations.
"We're aiming to reach a thousand people over the next year," Snyder said. Eventually the trainings could be expanded to include schoolteachers, librarians, clergy, paramedics and others who come into frequent contact with the public, he added.
CPR for the mind: Facts about Mental Health First Aid  Rhonda Morris role-plays during an exercise at a Mental Health First Aid class at Presence Saint Joseph Hospital in Chicago. Presence Health is offering the curriculum to community leaders to advance their understanding of mental illness and to build support for mental health services.
Photo by: Rich Chapman/© CHA Think of Mental Health First Aid as CPR for the mind and emotions. "Just as CPR helps you assist an individual having a heart attack, Mental Health First Aid helps you assist someone experiencing a mental health or substance use-related crisis," according to an explanation on the program's website. "In both situations, the goal is to help support an individual until appropriate professional help arrives," the site adds. The eight-hour training session in Mental Health First Aid focuses on a five-step action plan that the participants can remember with the acronym ALGEE: - Assess for risk of suicide or harm.
- Listen nonjudgmentally.
- Give reassurance and information.
- Encourage appropriate professional help.
- Encourage self-help and other support strategies.
The types of situations covered in the course include panic attacks, suicidal thoughts or behaviors, non-suicidal self-injury, acute psychosis such as hallucinations or delusions, overdose or withdrawal from alcohol or drug use and reaction to a traumatic event. The training features a combination of statistics and research, role-playing, and sharing of stories and local resources. Mental Health First Aid was founded in Australia in 2001 by nurse and health educator Betty Kitchener and Tony Jorm, a professor with the Population Mental Health Group at the Melbourne School of Population and Global Health at the University of Melbourne. By 2015, more than 1 million people in nearly two dozen countries had been trained in Mental Health First Aid. In the U.S., the program is operated by the National Council for Behavioral Health and the Missouri Department of Mental Health. More than 660,000 people have been trained in the U.S. by 10,000 instructors, who must participate in a five-day interactive training to receive certification. Sandra C. Candelaria, a program coordinator at the Puerto Rican Cultural Center in Chicago who has taken the training in both English and Spanish, said it is worthwhile "even if we only affect one life." — NANCY FRAZIER O'BRIEN |