Course Instructor John Noullet holds up a drawing where participants were asked to draw what anxiety looks like during a Mental Health First Aid training at the Lebanon County Mental Health building on Friday, Sept. 16, 2016. (Photo: Jeremy Long, Lebanon Daily News)
"After receiving a recent call from Philhaven regarding a patient with a propensity for violence, Cornwall Police Patrolman Robert Peebles knew he had a responsibility to keep everybody safe. His mental health training told him something else as well: that people suffering mental health crises are often aggravated by the presence of police. After talking it over with Philhaven staff, Peebles stayed in the background – and staff were able to resolve the crisis at the behavioral health hospital in West Cornwall Township without him ever needing to get involved. To Peebles, it’s an example of how good policing can avoid dangerous confrontations. “I’m a lover, not a fighter. I’d much rather talk my way out of a situation than get involved in rolling around on the ground,” he said. Although societal attitudes about mental health have shifted, acute symptoms are still often thought of as bizarre, selfish, or even criminal.
Mental Health First Aid classes provided by Philhaven suggest a different approach – and the techniques they teach may help everyone from police to school nurses and even bystanders provide a happier ending to life-threatening mental health crises.
Between seven and 10 percent of police interactions involve mental illness crises, according to Police Chief magazine.The national dispute over police shootings became inflamed in Harrisburg on Aug. 7, when a Harrisburg police officer fatally shot Earl Pinckney, a 20-year-old man whose mother said he had bipolar disorder. The shooting immediately created questions about where to place the blame.Instead, Harrisburg community volunteer Melissa Manning came to Lebanon for a recent Mental Health First Aid training seeking solutions. To Manning, the shooting of Pinckney is emblematic of a “systemic problem” in which everyone from police to members of the public don’t have sufficient training on deescalating a mental health crisis. She was trying out the training to see if it would be something to recommend to others in the Harrisburg community. For Cornwall and Lebanon police officers, at least, the answer is yes. Lebanon Police Chief Todd Breiner said he and several other Lebanon police officers have attended the training. For Peebles, attending it in March helped reinforce an attitude toward policing that comes from his background as a school teacher. “I’ve always felt that on this job, a lot of the issues we deal with are more mental health related than the general public realizes and even a lot of police officers realize,” Peebles said.
“The most important part of doing this job is communicating with people.” Peebles was quick to emphasize that policing can’t be reduced to a few soothing words, either. He has to keep people safe, and the best way to do that varies from case to case – sometimes including being a “tough guy” or making an arrest.“ It’s very difficult to put your finger on a hard and fast rule for making decisions,” agreed Breiner. But for Peebles, knowledge of diffusing a mental health crisis is another tool in the “officer’s toolbox” that wasn’t emphasized when he completed Police Academy training in 1992.
Stemming a crisis
Mental Health First Aid is the proper name of an 8-hour course operated by the National Council for Behavioral Health that started in Australia in 2001, and it is available for anyone in the community, not just police. There are other, more rigorous trainings also available to police, including Crisis Intervention Training. According to course advocates, the name Mental Health First Aid uses an important metaphor: just like physical crises like choking or a heart attack, administering first aid can often save a person’s life until they can receive professional treatment.
Mental Health First Aid is a certificate program similar to CPR, mental health care educator and course instructor Jayne Miller said. That analogy is important because people still have differing attitudes toward physical and mental health, Miller said. “Are we going to bring a casserole over to someone with severe schizophrenia?” Miller asked a Mental Health First Aid class during a Sept. 16 training at the Lebanon County Mental Health Building at 220 E. Lehman St. in Lebanon. Just like CPR training doesn’t make you a doctor, certification in Mental Health First Aid doesn’t mean being an amateur psychologist or being able to diagnose a disorder, she said. “(CPR) is giving help to someone that might be experiencing a medical emergency until the professionals can take over,” Miller said. “When we’re acting on our CPR knowledge, we’re not diagnosing anyone, we’re not figuring out if they’re having a heart attack or something else, we’re just giving them the immediate help. Well, that’s what Mental Health First Aid is as well.” Also like a heart attack or a breathing crisis, someone suffering a mental crisis can recover and resume a healthy, normal life, said Amy Nelson, program director for the Mental Health Association of Lebanon County.
The Mental Health Association is a non-profit organization with three part-time employees that spreads education, facilitates support groups, and runs a recovery plan for people with mental illness. One of the programs organized by the association is called the Wellness Recovery Action Plan, helping people in post-crisis to deal with the aftermath of their problems and resume a normal life, she said.
What many people don’t need in a mental health crisis, several experts agreed, is to be directed into the criminal justice system rather than the mental health system. “They can write the laws in the books a certain way, but to get compliance, it isn’t always a cuff ’em and stuff ’em type of mentality.” Cornwall Police Patrolman Robert PeeblesIn fact, the County Commissioners Association of Pennsylvania emphasized the idea of mental health crisis training for police and prison workers in a recently released report on reducing size of the prison population with behavioral health problems. People charged and convicted of a crime often lose access to their health care benefits, making it more difficult for them to receive treatment for their underlying problems, said Brinda Penyak, deputy director of CCAP. According to the Bureau of Justice Statistics, more than 60 percent of inmates in local jails have a mental health problem. “I’m all for avoiding arrest,” said Peebles, who considers arrest a last resort. “They can write the laws in the books a certain way, but to get compliance, it isn’t always a cuff ’em and stuff ’em type of mentality.” Police aren’t the only ones who can help to calm a situation before it could lead to confrontation or arrest. Unlike police, EMS providers often have a natural advantage in attempting to calm someone who is combative in a crisis situation because the provider is seen as someone who wants to help, said Bryan Smith, executive director of Lebanon-based First Aid and Safety Patrol. That means that using proper de-escalation techniques may be more likely to lead to successful outcomes. “We do find an awful lot of folks want to relate to the EMS provider,” Smith said.
A training for everyone
Mental Health First Aid was added in 2013 to the Substance Abuse and Mental Health Services Administration’s National Registry of Evidence-based Programs and Practices.According to a 2015 report by the Rand Corporation, Mental Health First Aid helps to reduce stigma but there is no evidence that it creates better outcomes for people suffering from mental illness, a concern also noted in an American Psychological Association article about the subject. That may simply be because of a lack of studies properly designed to detect such effects rather than an actual concern about the program’s effectiveness, the Rand Corporation report says.People involved in the course run by Philhaven who found the course helpful came from a variety of backgrounds: behavioral health hospitals, community volunteers, an occupational therapist, and even a school nurse. Lebanon Nursing Coordinator Toni Henning said school nurses often encounter students suffering with depression, anxiety, or self-harm, especially at the middle and high school levels. A nurse needs to listen to what the student is saying, express sympathy, and know how and when to get them in touch with professional help.The median age of onset for anxiety disorders is only 11, according to the National Institute of Mental Health. Nicole Snyder, director of mental health case management services at Lebanon County MH/ID/EI, is planning to bring information about mental health needs from the class back to her employees. They are often called to help a consumer in a crisis, and when Snyder started, she didn’t have the crisis training that she would have wanted, she said. Even Susquehanna Valley Pregnancy Services once had 30-40 volunteers decide to take the class, said Director of Client Operations Katie Boatwright. Their volunteers frequently interact with people overwhelmed by difficult circumstances. “Situational crises are enough to take a person to the breaking point where they don’t even see hope for a better tomorrow,” Boatwright said. To Snyder, you don’t even have to fit any of those categories to find basic mental health knowledge useful. For example, someone who works at Wal-Mart and encounters an agitated customer might be better able to use their mental health first aid training to relieve the situation without even having to call the police. “Anytime people have more knowledge, they can do better,” Snyder said. “I think we could avoid a lot of bad situations if we had some basic knowledge (that) something may be off with this person and I can help.”
About Mental Health First Aid
What is it?
Mental Health First Aid is an 8-hour certification course developed in Australia and currently operated in the United States by the National Council for Behavioral Health.
What does it include?
The course itself is a combination of providing information (PowerPoint slides, and every participant receives a book with mental health information to take with them), discussion among group participants and course leaders, and hands-on exercises depicting problems like extreme anxiety and auditory hallucinations. Substance abuse is also included, because it is a behavioral health issue.
Who do I find a course offering?
Philhaven offers mental health first aid classes to community members at no cost. Dates of courses open to the public are available on Philhaven’s website, and groups can contact mental healthcare educator Jayne Miller to schedule a private course."