Wednesday, 23 September 2020

The Problem with ‘Mental Health First Aid’

According to the Mental Health First Aid website it is an eight hour course that “teaches you how to identify, understand and respond to signs of mental illnesses and substance use    koala         disorders in your community.” It is geared particularly toward first responders, family, and others in the community who don’t typically offer support to people in distress for a living. Its mascot is a cuddly Koala named ALGEE (an acronym that stands for Assess for risk of suicide or harm; Listen nonjudgmentally; Give reassurance and information; Encourage appropriate professional help; Encourage self-help and other support strategies).

On the surface that doesn’t sound so bad. However, Mental Health First Aid is rife with problems. First, it is yet another approach that is largely absent any input from people who actually have psychiatric histories themselves. In fact, so many people with first hand experience with deep emotional and/or mental distress were upset about Mental Health First Aid that they have invested a great deal of time in creating alternatives to it. For example, Emotional CPR was developed by a large team of people with psychiatric histories. (Find out more about that approach here) The Icarus Project has also periodically worked to create similar approaches. (Find out more about the Icarus Project here.) And, of course, the Western Mass RLC offers many trainings and supports (Alternatives to Suicide, etc.) that are useful.

But the problems don’t stop there. In 2016, Patrick Hahn (a professor of biology at Loyola University) published an article in the Baltimore Sun speaking to his experience attending a Youth Mental Health First Aid training in which he found that the training seemed geared toward pushing more young people toward more psychiatric drugs without regard for scientific evidence. Also in 2016, Sera Davidow (Director of the RLC) wrote a piece detailing the many disturbing aspects of a Mental Health First Aid training detailing the many disturbing aspects of a Mental Health First Aid training she’d just attended, including an exercise in which she and other participants were required to order which ‘disability’ or ‘disease’ (e.g., breast cancer, schizophrenia, diabetes, etc.) was the worst. Closing out the year, Jan Nadine Defehr of the University of Winnipeg published an article about the approach, claiming that it was a tool of social control masquerading as something much more benevolent. Then, in 2017, Philip Hickey, a retired psychologist living in Colorado, wrote an article on Mental Health First Aid in which he reviewed its website and related outcomes, finding it to be largely a tool to funnel more people into the mental health system without regard for efficacy.

In spite of its acronym, Mental Health First Aid does not do a good job of promoting genuine connection, listening, or supporting someone to make meaning of their experiences. It prioritizes referral into clinical services over all else. Although, as with any approach, a participant’s experience may vary substantially based on the trainers and what they’ve                 decided to do with the material, it appears to be a tool to further entrench a medical model way of thinking about emotional distress, regardless of an individual’s personal beliefs, culture, or knowledge of what works for them. Unfortunately, Mental Health First Aid isn’t going anywhere soon. It is heavily funded, and has been promoted by both the Substance Abuse and Mental Health Services Administration (SAMHSA) and the National Council on Behavioral Health. Nonetheless, it is important that we determine for ourselves how we want to approach each other during times of struggle. We can (and need to) do better.

For more on this topic:

Drug Companies Pray on Children, by Patrick Hahn, Baltimore Sun

Mental Health First Aid: Your Friendly Neighborhood Mental Illness Maker, by Sera Davidow, Mad in America

Inventing Mental Health First Aid: The Problem of Psychocentrism by Jan Nadine Defehr, Studies in Social Justice

Mental Health First Aid: Another Psychiatric Expansionist Tool by Philip Hickey, Mad in America



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