Before Newtown, there was little discussion of the dismal state of mental health services. In fact, the budget knives have been sharpest at the state and local levels when it came to mental health services particularly prevention. That is not surprising. Just as police and the FBI have a hard time showing how preventive measures may have saved us from an act of terror, or an increase in violent crime, how do those in mental health prove that prevention works? And how do you show that it makes more sense than rounding up all the usual suspects and putting them in institutions as some have called for. Creating a registry won't work either because who would you put on it? The majority of those diagnosed with a mental illness are not violent, are in fact much more likely to be a victim of violence than a doer. Then there are all the undiagnosed and untreated who are totally unnoticed as well.
While the notion of prevention of mental illness has been around for over a hundred years, serious, scientifically tested and evaluated methods have existed for about 30 years. Although all mental illness cannot be prevented, we now know that some risk factors can be reduced and that protective factors can be strengthened. Since mental disorders have social biological, neurological and environmental roots, any efforts at prevention need to be multi-pronged and best practices. And they need to begin with children.
The symptoms of serious mental illness appear most often between ages 14 and 24 which means that those who work with high school and college students as well as young people in the workforce need to know what to look for and how to deal with it. The young themselves need help even earlier and yet mental illnesses and mental disabilities are not discussed and studied by teachers and school administrators although alcoholism and substance abuse disorders often are.
Every other year, the Substance Abuse and Mental Health Services administrator (SAMSHA) issues a report on mental health statistics. 2010 was the most recent edition published and according to that approximately 11 million adults (18 and up) in the United States had a serious mental illness. Adults with a serious mental illness were more likely to have a substance abuse disorder, 25.7 percent as opposed to 6.5 percent of the adult population without a mental disorder. National statistics also showed that one in eight children between the ages of 8 and 15 had a mental health disorder with boys having a higher rate than girls. The most common mental illnesses in children are ADHD, mood disorders and conduct disorders.
Virginia keeps its own statistics compiled by the Virginia Department of Health Planning District. According to their 2010 figures 329,415 people ages 18 and over have been diagnosed with a serious mental illness out of an adult population of 6,100,280 people age 18 and up. In the city of Alexandria there are 6,682 individuals diagnosed with a serious mental illness. The state has a breakdown of every diagnosis and those interested in more numbers can find them on the website of the Virginia Association of Community Service Boards. It is harder to determine how many children have mental illnesses since the statistics refer to those receiving special education. The number of children in the state between birth and age 22 who qualify for special education services is 163,143. Of those, 1,661 reside in the city of Alexandria.
Along with his proposals for gun control, President Obama has asked for funding for mental health services including prevention services calling for the training of first responders and for the public in general including those in education. Fortunately in Alexandria, we have already begun to do both. Since 2010, Alexandria police officers and sheriff's deputies have been offered crisis intervention team training (CIT). The CIT course is a 40-hour training program involving both classroom instruction and practical exercises offered by mental health professionals and law enforcement officials. The program which first began in Memphis has spread to more than 1,000 cities including several in Virginia.
Most studies of mental illness agree that the biggest barrier to getting help and getting better is the stigma against mental illness, a stigma so strong that there is legitimate fear that the calls to report anyone with a legal guardian and anyone who has been hospitalized will stop those who are troubled from seeking help. The answer to stigma is educating the public and one of the best ways is Mental Health First Aid. Mental Health First Aid is analogous to regular First Aid. There have been four detailed studies and several journal articles describing how Mental Health First Aid helps reduce stigma, teach people to recognize the symptoms of mental illness and most importantly have the confidence to offer people help. The Community Services Board offered the course to the public for the first time last October and 40 citizens enrolled in the 12 hours of classes.
Susan Drachsler, co chair of the Friends of the Alexandria Mental Health Center, took the course because she wanted to learn what mental health first aid was all about.
“One of the best activities,” she wrote in an email, “was one in which we divided into groups of three and while two people pretended to be friends meeting on the street, the third person whispered negative statements into the ear of one of the friends. This simulated the voices a person with schizophrenia might experience. The activity created an understanding of what someone with a mental health condition might be experiencing and how it might affect their relationships. I thought this understanding was extremely important for people who were going to be mental health first aiders.”
She added that despite her concerns about saying the right thing, “the class has made me more comfortable with the idea of approaching someone who may have a mental health problem. A mental health first aider is a sort of way station for someone having a problem. We are caring listeners who reassure a troubled person that treatment can help and suggest resources.”
Melodie Seau of the housing department also took the course. “I think all of us who work with the public, especially people like me in the human service professions should take the course. We are going to come into contact with folks and this is an excellent course in teaching what reasons there are for behaviors we don't understand.”
One important thing she learned was “Don't' argue with a delusion, something I found myself doing and saw other people doing.” She gave as an example a woman who called her and complained the landlord was controlling here television through the smoke detector. Of course that was not true, but there was no point in arguing the issue.
“The most important thing I got out of the course was to assess the situation and assess the possibility a person was ready to harm someone. It was a very good course and a I highly recommend it.”
Mental Health Fist Aid does not prepare someone to diagnose mental illnesses or provide therapy. Taking such a course doesn't make you a professional but it does mean you can provide emergency support until professional help is available.
In the beginning the Department of Community and Health Services looked into the program because there was no formal prevention or education services for adults that dealt with mental health and substance abuse issues.
At this point, the department has six staff members who have been trained in teaching the course and more are scheduled to take the training. In addition to the first round of courses offered to the public, the department has already offered training for staff and volunteers at Alexandria homeless shelters because they serve many individuals with mental illnesses and substance abuse disorders. Potential students include those in the business and faith communities who have already expressed the need to know more about mental illness. School personnel, hospital personnel and those working for not for profit agencies could also benefit.
But just as traditional First Aid benefits anyone who takes it, so would mental Health First Aid training. The statistics make it clear that mental illness is far more common than people believe. You would want to know what to do if someone fainted or was badly cut, or burned, so wouldn't you want to know what to do when someone you care about is in a crisis?
The next round of Mental Health First Aid begins in March, with a second offering in April and more in May. Those who attend the full 12-hours course will receive a three-year certification in Mental Health First Aid.
And there is a next step, a special program on Mental Health First Aid for Youth. Two of the city's staff have already been trained and courses will soon be offered. The training is offered by the National Council for Behavioral Health which notes that the adult Mental Health First Aid program now has a network of more than 2,500 instructors and that more than 80,000 Americans have graduated from the program.
Now Alexandrians have more opportunities to add to those numbers of people who are prepared.
Mary Anne Weber
Chair of the anti-stigma committee of the Partnership for a Healthier Alexandria