Fear of People with Mental Illness Fades When We Know How to Help

Trends in the public marketplace of ideas:

• There are more houseless people around us
• Many churches, congregations, and volunteers of all sorts are trying to help
• Some local governments are trying to restrict these efforts
• Claims are made in support of these restrictions that people with mental illness are dangerous

The following post is a repeat from a few years ago. It seems time to repeat it. It does not address the mistaken notion about mental illness and violence, nor the scapegoating of people who are in need. It does address the issue of fear. I hope to provide resources for people who are exercising their constitutionally protected right to the free practice of their religion.

Mental Illness First Aid

We know how to do this. A car hits a light pole -- somebody, maybe you will call 911. Somebody is choking in a restaurant -- somebody else, maybe I will leap up to do the Heimlich Maneuver.

It doesn't have to be an emergency. If a friend has a persistent cough, or mentions a bruise that won't go away, or complains about chest pains, we urge them to see a doctor. We have learned to recognize signs of cancer, heart disease, stroke. We get involved, we even get on their case when the people we care about need help.

Most of the time we do. Sometimes we turn away. Last week I kept having the same two conversations over and over. The first was about a man who dangled by a chain from the end of a crane. He reached out to catch a woman caught in the boil of a dam, to rescue her from drowning. The second was with friends who just didn't know what to do -- about a cousin who is irrational, a daughter who doesn't get out of bed, a godson who can't keep a job, each of them diagnosable with a serious mental illness, none of them getting treatment.

What To Do When A Friend Has A Mental Illness

The juxtaposition of these two conversations struck me, the immediate, eager help in one and the bafflement in the other. My baffled friends are not callous. They are baffled. And it struck me, somebody taught me how to do the Heimlich maneuver.  But nobody taught me what to do when my brother or sister goes crazy, except -- be scared.

First Aid

A crisis is less scary when you know what to do. Did you ever take a first aid class?   I learned to put pressure on a bleeding wound in Girl Scouts. I learned CPR in Health Class. What if we had a first aid course for mental illness?

I believe that well-meaning people will do the best they can. I also believe they can do better if they know better. We need the same basic information about mental illness as we have about physical illness, how to recognize signs, how to negotiate the immediate crisis, and how to get the person to appropriate help.

I just discovered that such a thing exists, when a friend took a class in Mental Health First Aid. Mental Health First Aid is a public education program that helps the public identify, understand, and respond to signs of mental illnesses and substance use disorders. The 12 hour course presents an overview of mental illness and substance use disorders in the U.S. and introduces participants to risk factors and warning signs of mental health problems, builds understanding of their impact, and overviews common treatments. Check it out. Look on the website for a course in your area. 

The good news about first aid for mental illness -- there will not be blood.

Communication Skills

Meanwhile, I am quite taken by a card that NAMI Johnson County in Iowa distributes. It is 1 1/2 by 2 1/2, laminated, and gives practical guidance.

The front is about communicating with someone in crisis who has a psychiatric illness.

Proceed to interact as you:

 
1 - Be calm and give firm, clear instructions
2 - Assess the situation for safety
3 - Maintain adequate space between you and the person
4 - Respond to apparent feelings
5 - Respond to delusions and hallucinations by talking about the person's feelings rather than what is said
6 - Be helpful, encouraging and supportive

Avoid:
 
1 - Reinforcing behavior related to the person's illness
2 - Staring at the person (this may be interpreted as a threat)
3 - Confusing the person
4 - Giving multiple choices, this may increase confusion
5 - Whispering, yelling ridiculing, deceiving or touching, this may cause fear and lead to violence.

The back is a list of behaviors and responses.

Someone with a psychiatric illness might... 
                                               So you need to...

 
Have trouble with reality.......... Be simple, truthful
Be fearful.............................. Stay calm
Be insecure........................... Be accepting
Have trouble concentrating...... Be brief, repeat
Be over stimulated................. Limit input
Easily become agitated........... Recognize agitation
Have poor judgment........... Not expect rational discussion
Be preoccupied....................... Get attention first
Be withdrawn......................... Initiate relevant conversation
Have changing emotions.......... Disregard
Have changing plans............... Keep to one plan
Have little empathy for you...... Recognize as a symptom
Believe delusions............... Ignore delusions, don't argue
Have low self-esteem and motivation..... Stay positive

For what it is worth, this list describes well what would be helpful to me when I am in a crisis, what has been helpful. I would add one item:

Someone with a psychiatric illness might feel shame. So you need to demonstrate respect. 

For each of these, the essential point is to recognize the symptom. The behaviors that make people turn away from those who are mentally ill are symptoms. They are not about you. They give you important information, that the person needs help.

If you stay focused on that, it may be easier not to turn away. You could be the person who reaches to the one who is caught in the boil. You could keep your friend from going under.

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red cross in the public domain