This story is a part of “The Loneliness Project,” a collaboration between The Ithaca Voice,WRFI, The Cornell Daily Sun and the Ithaca College Park Scholars Program. In a series of long-form online articles and multimedia, we will take a careful look at loneliness and its impact on mental health in Tompkins County. This fall, we will examine increasing reports of loneliness among young people nationally and what students are facing locally. Engaged Cornell and The Sophie Fund are funding this collaboration. See more stories from the project here.
TOMPKINS COUNTY, N.Y. – We all know people who seem sad, stressed, hopeless or on edge. Most of us probably know people whose sense of reality does not always line up with our own. Yet as much as depression, anxiety and even psychosis are part of everyday life, we might not know how to respond when someone’s symptoms worry us.
“Not knowing how to respond to mental health problems often prevents people from responding at all,” said Melanie Little, director of youth services at the Mental Health Association in Tompkins County and a certified instructor of the Mental Health First Aid USA program.
Little and co-instructor David Bulkley, director of adult services for MHATC, led a session of the first aid program at Tompkins County Public Library on Jan. 22 and 23. The eight-hour curriculum offered a crash course on mental health for community members who enrolled, including people who work in human services, law, retail and communications.
For those who didn’t partake, some simple takeaways can make it less daunting to respond appropriately when someone needs help.
Learning how to respond to physical injuries and illnesses, from minor scrapes to heart attacks, is a typical part of school and job training curriculums. For the first time, basic education about mental health was added to New York K-12 curriculum requirements in 2018, too. Still, many people reach adulthood without ever getting reliable, practical information about how to care for someone experiencing mental health problems. Mental Health First Aid training, which is offered multiple times a year in Ithaca, aims to fill in that gap.
“Anxiety and depression are a normal part of the human condition,” Bulkley said, “the question is the severity and duration of symptoms.”
Early intervention can make the difference between a person remaining able to participate fully in their community and experiencing symptoms that become disabling.
About 19 percent of adults experience a diagnosable mental health disorder in a given year, according to a 2013 national survey cited in the Mental Health First Aid USA course materials. More people experience mental health problems that might not warrant diagnosis but can nevertheless interfere with daily life. For the vast majority of people, mental health problems are temporary and treatable.
“People can and do recover from mental illness all the time,” said Bulkley.
Learning to respond responsibly and respectfully when concerned about someone’s mental wellbeing can help mitigate a crisis and set them on the path to recovery.
Recognizing a problem
Participants do not leave Mental Health First Aid training ready to diagnose or treat mental illness. The eight-hour training is not a substitute for the expertise of mental health professionals. Instead, the class aims to prepare participants to identify when people need help so they can steer people to appropriate community or professional care.
“It sounds cheesy,” Little told a class in mid-January, “but you’re mental health first aiders, not crusaders.”
The outward signs of mental health problems can be difficult to recognize, Little and Bulkley acknowledged.
In some cases, feelings or behaviors that are a normal part of life might not cause concern until they become persistent, severe or disabling. For instance, a person who experiences a traumatic event might seem disoriented or sad or exhausted, emotions that are common given the situation. If a month later the person still appears to be having trouble enjoying life – perhaps they’re missing work or their relationships are becoming strained – that might warrant concern.
In other cases, psychological symptoms could be mistaken for signs of physiological illness. Often, people experiencing depression report physical signs like fatigue, weight gain or loss, or insomnia before reporting underlying feelings like hopelessness or self-doubt. People experiencing anxiety might report headaches, muscle pain or nausea. During acute episodes, like a panic attack, signs can mirror acute medical issues like heart attacks, with symptoms including chest pain, difficulty breathing or dizziness.
Providing first aid does not require diagnosing the cause of a problem; it just requires recognizing that one exists and requires help.
“As a mental health first aider you won’t be able to tell the difference between a panic attack and a heart attack sometimes,” Little said by way of example. “But you can ask, ‘Do you know what’s happening?’ and ‘Can I help?’”
How to help
The Mental Health First Aid curriculum, which is used in countries around the world, is built around a simple action plan: the ALGEE plan. The steps in the plan are flexible and non-linear, but provide general cues to follow when engaging with a person who is in crisis or developing a mental health problem.
Participants in the January training session discussed a variety of everyday situations where the ALGEE plan could be helpful, from interacting with clients who appear distressed to checking on a stranger who looks agitated to starting a conversation with a friend or loved one who seems to be having a hard time.
The acronym calls on responders to (A) assess for risk of suicide or harm, (L) listen nonjudgmentally, (G) give reassurance and information, (E) encourage appropriate professional help, and (E) encourage self-help and other support strategies.
The first step might be uncomfortable, Little said, but is critical to determining whether a situation is an emergency. Little encouraged participants to ask straightforward questions, like “Are you having thoughts of suicide?” or “Are you thinking of killing yourself?”
“It’s really important to ask the questions directly,” she said, and to signal that you’re ready to hear any answer by remaining calm and confident.
If a person indicates that they are considering suicide, and especially if they say they have a plan in place to carry it out, Little and Bulkley say the situation should be handled as an emergency.
“If a person is actively suicidal,” Bulkley said, “treat it like a heart attack. It needs immediate action.”
Emergency responses encouraged by the course include calling 911 or calling a crisis hotline, while staying with the person until help arrives.
If a person does not appear to be at risk of suicide or self-harm, the other steps in the ALGEE plan encourage responders to guide people to self-care strategies or professional care while putting the person experiencing a mental health problem in the driver’s seat.
“Never tell a person to snap out of it,” Bulkley said. “We want our problems solved yesterday, but mental health doesn’t work that way.”
Instead, first aid responders should be calm and patient, he said. Listen respectfully, ask questions, and offer information about available resources – not advice.
Tompkins County resources
Mental Health First Aid training provides tools for supporting someone until appropriate treatment and support are available. Responding effectively to mental health problems therefore requires knowing what support resources exist throughout the community.
If an emergency is life-threatening, the Tompkins County Mental Health Services Department says to call 911.
Calling 911 will initiate a police response and will get a person transported to the emergency room.
Some people might hesitate to involve the police in a mental health crisis, due to concerns that it will escalate a situation or entangle a person in the criminal justice system. Little said she understands such hesitation, but said: “911 is the system we have.” She and Bulkley said officers in the Ithaca Police Department are trained to respond to mental health calls and can help prevent injury when a situation feels unsafe.
During business hours, the county Mental Health Services Department has an Emergency Outreach Services team available to help during crises. EOS can be reached at 607-274-6200.
The Crisisline at Suicide Prevention and Crisis Services can be reached 24 hours a day at 607-272-1616. The same number can be used to request help from a mobile crisis team after business hours.
Those who prefer to seek help from someone who is not local can call the national Crisisline at 800-273-8255 (but note that if you dial from a phone with a 607 area code you will be directed to the local line).
For longer-term treatment after a crisis is mitigated, a range of professionals are available to help, including primary care doctors, clinical social workers, psychiatrists, psychologists, counselors and peer support specialists. A directory of local services is available on the Mental Health Association in Tompkins County’s website.
Little emphasized that recovery plans are not one-size-fits-all; not all people experiencing mental health problems want or need professional help. Relying on friends and family who have been supportive in the past, joining support groups, and finding time for leisure, exercise or relaxation activities are self-care strategies that can help people cope with difficult periods.
While mental health crises more often make it into the news than crises averted, for every mental health problem that reaches an unfortunate end there are countless stories of recovery. Eliminating stigma and fear around mental health problems and learning basic first aid skills can help ensure people who need support find it.
Featured illustration by Jacob Mroczek/The Ithaca Voice