1. Mental Health First Aid: An Approach for Helping Others in Need 2014 Women’s Veterans Conference Matt Koren & Tina Zimmerman

2. Purpose of Today’s Session Overview of Mental Health First Aid Provide Examples of the Curriculum –Signs & Symptoms –Assessing for Risk of Suicide or Harm How to Request a Training in Your Area Resources 2

3. The Invisible Wounds of War “Many are struggling with the ‘invisible wounds’ of this war, including traumatic brain injury, post- traumatic stress, depression, and anxiety. Any attempt to characterize these individuals as somehow weaker than others is simply misguided…We remain committed to raising awareness, helping individuals increase their resiliency while ensuring they have access to the right support services and resources.” General Peter Chiarelli Former Vice Chief of Staff U.S. Army SUB 7

4. Disability Weights Exercise 4

5. What Is Mental Health First Aid? Help offered to a person developing a mental health problem or experiencing a mental health crisis Given until appropriate treatment and support are received or until the crisis resolves Not a substitute for counseling, medical care, peer support or treatment 5

6. MHFA Overview Originated in Australia Currently in 20 countries Partnership with Maryland and Missouri State Governments Adult MHFA course available in both Spanish and English Youth MHFA is designed to teach adults how to help an adolescent (age 12-18) who is experiencing a mental health or addictions challenge or is in crisis In SAMHSA’s National Registry of Evidence-based Programs and Practices In US, 180,000 First Aiders trained by 4,200 Instructors In PA 8,935 trained with 279 trainers

8. What You Learn Overview of mental health problems –Depressive/Mood disorders –Anxiety disorders –Disorders in which psychosis occurs –Substance use disorders –Traumatic Brain Injury Signs & Symptoms/Risk Factors Mental Health First Aid for crisis and non- crisis situations using ALGEE 8

9. Why Mental Health First Aid? 9 Mental health problems are common Stigma is associated with mental health problems Professional help is not always on hand Many people with mental health problems delay, or do not seek help Many people… –are not well informed about MH problems –do not know how to respond

10. U.S. Adults with a Mental Disorder in Any One Year Type of Mental Disorder% (1Year) Anxiety disorder19.1. Major depressive disorder6.8. Substance use disorder6.3. Bipolar disorder2.8. Eating disorders2.1. Schizophrenia0.45. Any mental disorder19.6 Only 41% of people with a mental illness use mental health services in any given year; Median delay in getting treatment was 10 years; Lifetime prevalence nearly 50% 10

11. MHFA ACTION PLAN Assess for risk of suicide or harm Listen nonjudgmentally Give reassurance and information Encourage appropriate professional help Encourage self-help and other support strategies 11

12. Where MHFA Can Help 12

13. The Curriculum Mental Health Disorders versus Mental Health Problems MHFA addresses both Teach about most prevalent illnesses Crisis Situation –Assess for Risk of Suicide or Harm –Safety 13

14. 14 Signs & Symptoms: Thoughts Frequent self-criticism or self-blame Pessimism Difficulty concentrating or remembering Indecisiveness or confusion Rigid thinking Racing thoughts Tendency to believe others see one in a negative light Altered sense of self Delusions or hallucinations Odd ideas; lack of insight Suspiciousness Thoughts of death and suicide

15. 15 Signs & Symptoms: Emotions Depressed mood and/or mood swings Unrealistic or excessive anxiety or guilt Excessive irritability or anger Lack of inhibition Lack of emotion or emotional response Helplessness or hopelessness Oversensitivity to comments/criticism Low self-esteem

16. 16 Signs & Symptoms: Behaviors Crying spells Withdrawal from others Neglect of responsibilities Loss of interest in personal appearance Loss of motivation Slow movement Use of drugs and alcohol Changes in energy level Obsessive or compulsive behavior Avoidance or fearful behavior Showing distress Talking rapidly

17. 17 Signs & Symptoms: Physical Cardiovascular: pounding heart, chest pain, rapid heartbeat, blushing Respiratory: fast breathing, shortness of breath Neurological: dizziness, headache, sweating, tingling, numbness Gastrointestinal: choking, dry mouth, stomach pains, nausea, vomiting, diarrhea Musculoskeletal: muscle aches and pains, restlessness, tremors and shaking, inability to relax Changes in normal patterns: overeating or not eating at all, sleeping much more or much less Appearance: Change in hygiene, unkempt, eyes bloodshot or glassy, weight gain or loss

18. Assess for Risk of Suicide or Harm Suicide Risk Assessment Gender Age Chronic physical illness Mental illness Use of alcohol or other substances Less social support Previous attempt Organized plan 18

19. Warning Signs of Suicide Threatening to hurt or kill oneself Seeking access to means Talking or writing about death, dying, or suicide Feeling hopeless Feeling worthless or a lack of purpose Acting recklessly or engaging in risky activities Feeling trapped Increasing alcohol or drug use Withdrawing from family, friends, or society Demonstrating rage and anger or seeking revenge Appearing agitated Having a dramatic change in mood 19

20. Veteran Specific Risks Frequent deployments Deployments to hostile environments Exposure to extreme stress Assault while in the service Length of deployments Service related injury

21. Questions to Ask Ask the person directly whether he or she is suicidal: “Are you having thoughts of suicide?” “Are you thinking about killing yourself? ” Ask the person whether he or she has a plan: “ Have you decided how (or when)you are going to kill yourself?” “Have you collected the things you need to carry out your plan?” Check For Two Other Risks Has the person been using alcohol or other drugs? Has he or she made a suicide attempt in the past? 21

22. How to Talk with a Person Who Is Suicidal Build Rapport Respect the individual and their experience Maintain neutrality/avoid assumptions Discuss your observations with the person Recognize potential barriers to accepting help Brainstorm some questions that might help build rapport with a Service Member, Veteran or family Appear confident, as this can be reassuring 22

23. Keeping the Person Safe Avoid Leaving an actively suicidal person alone Using guilt and threats to try to prevent suicide –You will go to hell –You will ruin other people’s lives if you die by suicide Agreeing to keep their plan a secret Address the following: Have someone stay present Provide a safety contact number Help the person identify past supports Involve them in decision making Call law enforcement if the person has a weapon or is behaving aggressively 23

24. Wrap up Military service can have both negative and positive effects on an individual and family, but by nature this is a resilient population with significant strengths. There are more resources now than ever before to help and support Service Members, Veterans and their families. You have the potential to connect people in need to resources that can help them.

25. Finding Trainings in Your Area SW PA Collaborative –http://www.ahci.org/html/mhfa/http://www.ahci.org/html/mhfa/ Mental Health First Aid website –http://www.mentalhealthfirstaid.org/find_mhfa.phphttp://www.mentalhealthfirstaid.org/find_mhfa.php 25 Matt Koren 412-325-1100, ext. 7774 mkoren@ahci.org Tina Zimmerman 412-325-1100, ext. 7764 tzimmerman@ahci.org