Mental health first aid

Dr Abhishek Chowhan
Psychiatry research has progressed leaps and bounds over the last few decades. Many new and effective medicines are available to cure severest of psychiatric disorders with negligible side effects. Gone is the era of tranquilisers and sedatives and those medications which acted by calming the patient alone. However what has changed little is the awareness about psychiatric illnesses in the general masses. Many people believe that psychiatric illnesses are rare and “happen to someone else”, which is a myth. In fact mental illnesses are common and widespread. In India, about 5% people suffer from some form of mental illness which translates to a population of 6 crores. Nearly 50% of these people are not treated due to lack of awareness of the illness or not knowing the treatment options. About 20% of these develop severe mental illnesses. Generally speaking about one in four among us will develop mental health difficulty in our lives but will receive little or no help because of the lack of awareness of early psychiatric symptoms in them or their near and dears. Keeping in view this so called “treatment gap” the theme of this year mental health day is ‘Mental Health First Aid’. Mental health day is celebrated worldwide on 10th of October every year to promote social and emotional well being to the community, encouraging people to maximize their health potential and increasing awareness about psychiatric illnesses.
Mental health first aid aims to teach general public how to identify the early signs of mental illnesses (including drug addiction) or early signs of relapse of an existing mental illness. The rationale is that community in general and family in particular is the first contact of a psychiatrically ill person and many crises can be averted if a timely help is provided or a proper referral made. Mental health first aid does not intend to teach people to diagnose or treat psychiatric illness or drug use disorder but to provide an initial support until a professional help is received or crisis is resolved. Thus, if a person is suicidal, having feelings to harm him or others, is having a severe anxiety attack (panic attack), is showing signs of getting violent, has refused eating or drinking or is overtly psychotic, someone with appropriate mental health first aid skills can reduce the risk of person coming to harm. Mental health first aid programme was first developed in Australia by Betty Kitchmer and Anthony John in 2000 and since then it has spread to a number of other countries. A number of studies have concluded that people trained in recognising early signs of psychiatric illnesses showed compassion, reduces prejudice and has lesser stigma concerning psychiatric illnesses and the psychiatrically ill. Thus mental health first aid is important not only for early recognition and awareness of psychiatric illness but also for reducing the stigma around mental illnesses.
In psychiatric illnesses patient have emotional, behavioural or thinking disturbances resulting in an inability to cope with life’s ordinary demands and routines. There are more than 200 psychiatric illnesses and common among them include depression, anxiety, bipolar disorder, schizophrenia etc. In children attention deficit hyperactivity disorder (ADHD), conduct disorder, autism etc. are common. In adults the psychiatric illnesses can present with confused thinking, sadness, irritability, mood swings, excessive fear, worry or anxiety, social withdrawal, dramatic changes in eating or sleeping habits, strong feelings of anger, strange thoughts (delusions), seeing or hearing things that aren’t there (hallucinations), problems at work place, numerous unexplained physical symptoms, drug abuse etc. In older children and adolescents they present in the form of drug abuse, difficulty in coping with daily problems, changes in sleeping or eating habits, defiance of authority, changes in peer relationships, academic problems, and frequent anger outbursts. In younger children they can present with poor school performance, school refusal, changes in sleeping or eating pattern, changes in play pattern, hyperactivity, social withdrawal, excessive crying, aggression, disobedience or temper tantrums.
In addition to the recognition of the routine early symptoms of the psychiatric illnesses, mental health first aid aims to teach people ways to tackle at least two psychiatric emergencies. These include suicidal intent and aggressive or violent behaviour. Suicidality is the prototype psychiatric emergency. It is said that 8 out of 10 persons who commit suicide has talked about it to someone in the preceding days. A suicidal person may not ask for help, but that does not mean that help isn’t wanted. Thus, recognition of warning signs of suicide becomes important. Major warning signs for the suicide include talking about killing or harming oneself, talking or writing about death or dying, seeking things that could be used in a suicide attempt and recent web searches for methods of suicide. Knowledge of such signs and a timely intervention can save innumerable lives which are in need of our help. Psychiatrically ill patients can sometime present with aggressive or violent behaviour. The skills to tackle such behaviour are called de-escalation techniques. De-escalation aims to reduce the verbal aggression, talking with patient in a calm and comfortable voice, approaching the patient in a non-confrontational way, provide a soothing atmosphere to patient (e.g., spacious, well lit room), remove sharp objects from patient’s vicinity etc.
Thus if community is made aware of such warning signs by teaching them mental health first aid by ways of lectures, courses, role plays, mass media etc., many trivial psychiatric illnesses can be prevented to blow up into major psychiatric emergencies. Also such awareness can be helpful in establishing support networks, reducing stigma and in better understanding of the treatment options available for psychiatric illnesses.
(The Author is a Consultant Psychiatrist, Govt Hospital Gandhi Nagar, Jammu.)
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