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Mental Health First Aid in Action: The Importance of the Follow-up

Joe CoffeyWhat we say and do in response to the signs and symptoms of a mental health or substance use challenge can have a tremendous impact on the perceptions, actions and outcomes of all involved. That’s really true for public safety officers!

Mental Health First Aid (MHFA) focuses on identifying and responding to the early signs and symptoms of a challenge. After all, the earlier we can intervene, the better. MHFA for Public Safety, a community-centered MHFA course, is tailored to the unique experiences of sworn and nonsworn personnel employed in federal, state, local or tribal agencies.

That education can have a crucial impact on how law officers and staff react during pivotal moments during and after an incident involving someone’s mental wellbeing. That’s important: Those essential, initial actions may very well avert far more serious outcomes, including trouble with the law.

The need goes on

Just as important, the course provides guidance on how to continue to offer support days, weeks or even months later. Many times, MHFA is not a “one-and-done” process.

That’s because there are a lot of different levels to the help that’s needed! While one person’s mental health challenge might result from a situation, like a robbery or house fire, another’s might stem from a lifetime of events and trauma. You just don’t know.

You also don’t know how they’re experiencing their symptoms. Oftentimes people hide, ignore or dismiss their symptoms. Or they may delay, refuse or never seek help. Their willingness — and readiness — to get help can take time.

First Aiders should be patient and gently persistent as the person they are supporting navigates what is happening, explores why it’s happening and weighs the often unfamiliar options for care. This processing may include their feelings about profound and frightening signs, as well as real worries concerning mental illness stigma. Both can cause them to pause their search for help.

And remember: Signs and symptoms may not appear immediately following an event, and when they do, their severity can ebb and flow.

Continued support

As we consider all the reasons why people may not seek or welcome help, we can imagine the opportunities for a follow-up and the value of reapplying the MHFA Action Plan.

As a former, now retired police officer, I can attest to the countless times and various types of follow-ups performed by members of the public safety community: investigations, hazard mitigation, community complaints, victim notification, etc. and allocate significant resources to accomplish this important function. Many leaders do understand the benefits of mental health interaction follow-ups as well, and they have invested in providing continued community mental health support, often in collaboration with mental health and substance use care practitioners.

One of the investments? Increasingly, it’s training their staff in MHFA for Public Safety. The agencies are bringing MHFA in as part of their overall pledge to address ongoing community mental health needs. In fact, the Bureau of Justice Assistance National Training and Technical Assistance Center (BJA NTTAC) recently started a new initiative to offer MHFA for Public Safety and MHFA Public Safety Essentials training to public safety personnel, nationwide. This commitment allows their agencies to #BeTheDifference now and later.

Public safety officers offer initial help, but they can also reconnect to “offer consistent emotional support” or “provide practical help” and practice all the steps of the 5-Step MHFA Action Plan (ALGEE): Assess and assist, Listen nonjudgmentally, Give reassurance and information, Encourage appropriate professional help, Encourage self-help and other support strategies.

Applying the MHFA Action Plan throughout a person’s mental health journey creates opportunities for many of the following helpful possibilities and associated action steps to occur:

  • Listen nonjudgmentally: Often friends and/or family call police for help when someone they care about needs emergency mental health services. During that call, officers may determine the person’s condition meets criteria for an immediate evaluation. Establishing this threshold and the ensuing actions can be difficult for all present. Timely follow-up with the person who called for public safety assistance provides considerable opportunities to establish trust and rapport. Checking on their wellbeing and expressing genuine interest in the progress of the person who received care can also help build confidence, trust and rapport.
  • Assess for risk of suicide or harm: Use MHFA noticing and listening skills to identify any new or changing signs and symptoms. These may include delayed trauma warnings following a traumatic event the officers responded to. Changes can also be positive, showing signs of resilience.
  • Encourage appropriate professional help: Offer non-emergency or voluntary professional help resources and self-help strategy considerations. Because of the emergency nature of certain public safety mental health encounters and the need for immediate evaluation, you may not have time to discuss other types of professionals, resources or self-care.
  • Encourage self-help and other support strategies: Discuss department mental health resources, such as crisis intervention teams, imbedded clinical staff, a MHFA course or other committed persons or units. Awareness of such options and the agencies’ sincere interest in mental health encounter outcomes can increase caller confidence when deciding to involve public safety in any future incidents.
  • Give reassurance and information: Identify steps, actions or measures that may assist in providing effective future response. Helpful information often includes safety precautions, cultural considerations, treatment barriers, best contacts and established relationships within the public safety agency.

Tested by experience

As I said earlier, I’m a retired police captain. I also live with a mental health challenge and sought treatment while active on the police force. From my experience, I can tell you just how meaningful it was to have people who cared about me — from within my department and from outside of it — and offered support beyond my initial leave for treatment.

While I was on leave, I experienced many of the concerns I’ve heard from my peers in a similar state, including worry over perception, fear of stigma, fitness-for-duty targeting and recovery likeliness. The reassurance and other MHFA functional steps applied to me offered not only hope in my recovery but also offered real testament to the usefulness and effectiveness of the follow-up.

As a MHFA National Trainer, Joe Coffey co-authored MHFA for Public Safety, 1st Edition, trained over a thousand MHFA Instructors and certified thousands of MHFA First Aiders over the last ten years. He is a retired Captain of the Warwick, Rhode Island Police Department, where he established and led his department’s Mental Health Crisis Response Team. Prior to his twenty-year policing career, Joe worked ten years in Corrections, achieving the rank of Captain, and served in the Army and Army Reserve. Joe is a 2013 graduate of the FBI National Academy, Quantico, VA. He earned a Bachelor of Science Degree from Roger Williams University and a Graduate Certificate from the University of Virginia. Joe served on several mental health boards and committees as well as volunteering for many community organizations, including the Providence MET, Boys & Girls Scouts, Special Olympics, Honor Flight and Quell Foundation.

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