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The Role of MHFA in Catastrophic Events: Lessons Learned in Puerto Rico

Natural disasters affect lives and property in many ways, devastating communities through a chain of catastrophic sequences affecting social and economic developments. These events are often difficult to predict, prevent and control. They affect individuals who must cope with trauma, loss, separation from loved ones and crisis. The effect of exposure to a traumatic event is variable and specific to the individual; both psychological and physiological responses can vary widely.

In general, those exposed to a traumatic event show increased rates of acute stress disorder, post-traumatic stress disorder (PTSD), major depression, panic disorder, generalized anxiety disorder and substance use disorder. After Hurricane Maria in Puerto Rico, we saw an increase in suicides rates and today, as we experience a period of active earthquakes period, we have to work even harder to stabilize and support the mental health needs of a fragile population.

We saw Mental Health First Aid training as a viable alternative to provide technical assistance to the community to provide the first aid to those with psychological distress because of Hurricane Maria.

I have been a Mental Health First Aid Instructor since 2011 and I know that many people have the best intentions to help, but not all of them have the basic knowledge to assist someone in emotional distress. An adverse intervention can lead to negative outcomes including a significant decline in one or more areas of an individual’s functioning. People with mental illnesses — especially those who have been traumatized in the past — are at higher risk for serious reaction to trauma, such as panic attacks, organized suicidal plans and self-medication by abusing drugs and/or alcohol. Understanding how and when to provide first aid with empathy, acceptance, genuineness and by listening nonjudgmentally are key attitudes and skills in the Mental Health First Aid action plan. Providing emotional support is often the key to someone developing a mental health illness problem or experiencing a mental health crisis and recovering from it.

In 2016, a study published by the Behavioral Sciences Research Institute of the University of Puerto Rico found that in Puerto Rico, people would wait 10 years after their first mental health episode to seek help. Stigma is associated with mental health problems and many people are not well informed about mental health problems and often do not know how to respond. Recognizing this reality, as of today, we have trained 1,800 people who want to use their MHFA skills help people identify, understand and respond to signs and symptoms of mental health and substance use challenges. After collaborating with professional affiliations, employers, health plans, private and the government sector, we can proudly say that many individuals recognize that they need to be trained in order to be effective, and taking MHFA training will give them the basics strategies to make a difference in someone life.

Our evaluations of the MHFA training have consistently shown that the training is associated with important knowledge of appropriate first aid strategies, improved knowledge of mental illnesses and their treatment and provides confidence to trained First Aiders to assist individuals with mental illness. Some of the comments related to the training are: “gained through the course knowledge regarding mental health problems,” “decreases negative attitudes toward people with mental illness” and “increases supportive behaviors toward individuals with mental health problems.” People often come to me to share their testimonies of helping someone with a mental health crisis and how confident the MHFA action plan made them feel. Teaching MHFA is one of my favorite things to do and seeing people benefiting from it is my reward. I encourage everyone to get trained in Mental Health First Aid, as it can be a vital resource when you need it most.



Fullerton, C.S., McCarroll, J.E., Ursano, R.J., & Wright, K.M. (1992). Psychological responses of rescue workers: Firefighters and trauma. American Journal of Orthopsychiatry, 62, 371-378. DOI: 10.1037/h0079363

Kessler, R. C., Foster, C. L., Saunders, W. B., & Stang, P. E. (1995). Social consequences of psychiatric disorders, I: Educational attainment. American Journal of Psychiatry, 152, 1026-1032

Dalimarie Perez, MSW, MPA, is the vice president of clinical affairs at FHC of Puerto Rico, Inc. and a MHFA Instructor. FHC is a specialized organization that manages mental health services dedicated to improving opportunities and helping people to obtain a better quality of life in Puerto Rico.

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