I’ve lived in New York City for six years now, and most of the subway ads I see fall into two categories: trendy start-up (Casper or Blume perhaps) or slightly sketchy flyers for local psychics and guitar teachers. Which is why I was so surprised to step on the subway one very hot summer day and see a new set of ads that defied both categories for a free mental health first aid training class offered by the city.
As a health editor, talking about mental health is a huge part of what I do at Well+Good, whether it’s through sharing real people’s experiences with anxiety or suicidal thoughts or talking to mental health professionals about what they do to help maintain their mental well-being. But I had never heard of mental health first aid—which is how I found myself signing up for a class over Labor Day weekend at the Gregory Jackson Center in the Brownsville neighborhood of Brooklyn.
The mental health first aid curriculum was originally developed in 2001 by Australians Betty Kitchener and Anthony Jorm. It was adopted for use in the U.S. and 24 other countries around the world, including India, Canada, and Sweden. The City of New York City offers trainings for free through its Thrive NYC mental health initiative.
“[Mental health first aid is] the ability to assess and approach someone in need,” explains Coach D. Williams, one of my two instructors. The goal, as she emphasized over and over in our training, isn’t to be able to diagnose a person—that’s what professionals are for. Rather it’s about giving people the ability to spot signs of potential mental health crises among members of their community in order to effectively intervene.
The fundamental basics of mental health first aid can be summed up with the program’s go-to acronym, ALGEE:
- A: Assess for risk of suicide or harm
- L: Listen non-judgmentally
- G: Give reassurance and information
- E: Encourage appropriate professional help
- E: Encourage self-help and other support strategies
This basic action plan can be applied to nearly any mental health-related situation. We were walked through ways to use it in cases of depression and anxiety, suicide risk, drug and alcohol misuse, and psychosis. Each situation has its own unique hurtles and challenges that require tweaks to ALGEE—a person experiencing a psychotic episode, for example, might require a different approach than a friend who is struggling with suicidal ideation—but the overall method of addressing each situation remains the same.
ALGEE is of course an extremely simplistic distillation of what I learned in my training. But that’s kind of the point—it’s simple enough to remember even in the height an emergency. (There’s a reason why the number for emergency services is 911 and not a standard 1-800 number.) Williams explained it like this during our training: When someone on the street is having a heart attack, a first aid responder isn’t about to perform open-heart surgery on them—they’re giving them CPR to keep them alive until professional help arrives. Similarly, mental health first aid gives trainees the language and framework to ensure a person gets the proper help they need.
“I wanted to be a resource for my kids,” says Williams. “I was coaching boys’ basketball and realized a lot my kids were getting into certain drugs because of anxiety,” she recalls. “I had to check myself and ask, ‘What am I doing every day?'” She took the class to grow her skills, but it also forced her to do a lot of self-work to make sure that she was truly embodying the things she was teaching to her students. Over the summer she launched her 100 Coaches Certified program, where she hopes to train 100 other athletic coaches to be mental health first aid responders for the benefit of their teams and themselves.
“Every body has a brain and everyone has a mind. Yet we approach physical health with a sense of urgency that we don’t with mental health.” —Coach D. Williams, mental health first aid instructor
I’m not a sports coach, but Williams says she wants lots of people to be trained in mental health first aid in order to help spread the knowledge and awareness surrounding mental health. Indeed, the 20 people present at the training course I took came from a variety of backgrounds. Some people worked for the city; some were social workers or counselors themselves; one person had previously worked in prisons. “Every body has a brain and everyone has a mind,” Williams says. “Yet we approach physical health with a sense of urgency that we don’t with mental health,” because it’s often not visible, she says. But the lack of urgency has led to a lot of suffering, and a lot of stigma.
Aside from the core method of ALGEE, the language we use to talk about mental health is a huge focus of Williams’ teaching. She consistently pushed back against members of the group who used words like “crazy” and “psycho” during the class. “I do not like the word crazy,” she says. A huge part of mental healthcare is having compassion, she argues, and using words like crazy only serves to dismiss or “other” people who are struggling. “It creates this separation [between people] that is not true and is not real. For anyone to say, ‘they’re crazy,’ it undermines their experience as a human and that other person’s ability to be a human,” she adds.
She and her co-instructor Brandi Meertens stressed the importance of language even in more clinical terms. We were not to say that a person committed suicide, for example, since the word “commit” is often used in relation to crimes. Instead, we were to say a person attempted or completed suicide. Similarly, the term “substance misuse” was preferable to abuse. Even subtle shifts in language, they argued during the course, can help remove some of the shame and negative connotations often associated with mental health issues.
Empathy and vulnerability was another theme of the training. “It’s about compassion,” Williams says. “We all experience those emotions, we’ve all been anxious, fearful, angry, sad; we’ve all been hurt and betrayed.” She wants people who take her training to understand that mental health “is an everyone issue,” and that mental illness is very real to people who experience it. In one exercise, we broke into teams of three people, where two people tried to have a conversation while the third person talked directly into someone’s ear to mimic the experience of auditory hallucinations. It sounds like a silly camp exercise, but you learn very quickly that it’s really hard to think or do anything with very real, competing voices shouting in your head.
Perhaps the most difficult moment of the day for me came during the suicide risk portion. The program teaches trainees to be prepared and comfortable asking someone who seems to be potentially experiencing depression or anxiety if they have thought about suicide, since depression is a major risk factor for suicide. (It’s the A in ALGEE for a reason.) It’s a tough conversation to have, so Williams had us break out into groups to practice asking each other, “Are you having thoughts of suicide?” and “Are you thinking about killing yourself?” It was seemingly a very simple, straightforward thing to do. But looking into the eyes of even a stranger and asking them if they’d thought about suicide was surprisingly very emotional for me. There’s really nowhere to hide from those words, whether you’re the one asking the questions or on the receiving end of them.
At the end of the training, we were quizzed one last time on ALGEE, filled out our evaluation forms, had our photos taken for Williams’ Instagram, and officially became mental health first aiders. I exited the room simultaneously exhausted from information overload and elated about everything that I had learned that day. Equipped with a newfound sense of empowerment, the intangible now feels at my fingertips.
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