What is the Campaign Against Living Miserably?

Introduction

Campaign Against Living Miserably, or CALM, is a registered charity based in England.

CALM run a free, confidential and anonymous helpline as well as a webchat service, offering help, advice and information to anyone who is struggling or in crisis.

Brief History

Pilot and Relaunch

CALM was initially a Department of Health pilot project launched late in 1997 in Manchester with the help of Tony Wilson, and then rolled out to Merseyside in 2000. It was a helpline targeted specifically at young men who were unlikely to contact mainstream services and who were at greater risk of suicide. Jane Powell was commissioned to launch the project and ran it until 2000. When funding for the pilot project ceased in 2004/2005, Powell relaunched the pilot as a registered charity in 2006 working with some of the pilot’s original commissioners and with Tony Wilson as a founding Trustee.

In 2015 rapper and singer-songwriter Professor Green was named as CALM’s patron, and the campaign’s Trustees Board includes health professionals and leading figures from the worlds of music, advertising, and management, as well as relatives of men who have taken their own lives. Robin Millar and David Baddiel are former patrons.

The campaign has brought in significant pro bono advertising support from agencies such as Ogilvy Advertising, Tullo Marshall Warren, MTV, and Metro, and most recently Topman and BMB. This has brought CALM a significant amount of advertisements on billboards, on TV, in the underground and on radio.

In November 2018, CALM partnered with UKTV channel Dave to create a campaign called “Be The Mate You’d Want”. This started with a 3-minute ad break, voiced by comedian James Acaster, encouraging the viewer to text, chat or tweet someone who needs support. It occurred again in July 2019, this time with a “comedy festival in an ad break” which featured comedians Ahir Shah, Alex Horne, Dane Baptiste, Darren Harriott, David Mumeni, Ed Gamble, Elf Lyons, Jamali Maddix, Jessie Cave, Lou Sanders, Maisie Adam, Natasia Demetriou, Phil Wang, Pierre Novelli, Sindhu Vee, Stevie Martin and Zoe Lyons, with Jessica Knappett providing intro and outro voiceover.

Project84

In 2018, the charity commissioned the artists Mark Jenkins and Sandra Fernandez to create Project84, an art installation in London, England. The work was sponsored by Harry’s and designed to raise awareness of adult male suicide.

Conversations Against Living Miserably

In May 2019 CALM announced a partnership with Dave for a podcast called Conversations Against Living Miserably hosted by Lauren Pattison and Aaron Gillies talking to comedians about their mental health.

What is Psychological First Aid?

Introduction

Psychological first aid (PFA) is a technique designed to reduce the occurrence of post-traumatic stress disorder. It was developed by the National Centre for Post Traumatic Stress Disorder (NC-PTSD), a section of the United States Department of Veterans Affairs, in 2006. It has been spread by the International Federation of Red Cross and Red Crescent Societies, Community Emergency Response Team (CERT), the American Psychological Association (APA) and many others. It was developed in a two-day intensive collaboration, involving more than 25 disaster mental health researchers, an online survey of the first cohort that used PFA and repeated reviews of the draft.

Refer to Crisis Intervention and Mental health First Aid.

Definition

According to the NC-PTSD, psychological first aid is an evidence-informed modular approach for assisting people in the immediate aftermath of disaster and terrorism to reduce initial distress and to foster short and long-term adaptive functioning. It was used by non-mental health experts, such as responders and volunteers. Other characteristics include non-intrusive pragmatic care and assessing needs. PFA does not necessarily involve discussion of the traumatic event. Just like physical first aid, psychological first aid focuses on providing effective initial support to individuals in distress.

Components

  • Protecting from further harm.
  • Opportunity to talk without pressure.
  • Active listening.
  • Compassion.
  • Addressing and acknowledging concerns.
  • Discussing coping strategies.
  • Social support.
  • Offer to return to talk.
  • Referral.

Steps

  • Contact and engagement.
  • Safety and comfort.
  • Stabilization.
  • Information gathering.
  • Practical assistance.
  • Connection with social supports.
  • Coping information.
  • Linkage with services.

Brief History

Before PFA, there was a procedure known as debriefing. It was intended to reduce the incidences of post traumatic stress disorder (PTSD) after a major disaster. PTSD is now widely known to be debilitating; sufferers experience avoidance, flashbacks, hyper-vigilance, and numbness. Debriefing procedures were made a requirement after a disaster, with a desire to prevent people from developing PTSD. The idea behind it was to promote emotional processing by encouraging recollection of the event. Debriefing has origins with the military, where sessions were intended to boost morale and reduce distress after a mission. Debriefing was done in a single session with seven stages: introduction, facts, thoughts and impressions, emotional reactions, normalisation, planning for future, and disengagement.

Debriefing was found to be at best, ineffective, and at worst, harmful. There are several theories as to why debriefing increased incidents of PTSD. First, those who were likely to develop PTSD were not helped by a single session. Second, being re-exposed too soon to the trauma could lead to retraumatisation. Exposure therapy in cognitive behavioural therapy (CBT) allows the person to adjust to the stimuli before slowly increasing severity. Debriefing did not allow for this. Also, normal distress was seen to be pathological after a debriefing and those who had been through a trauma thought they had a mental disorder because they were upset. Debriefing assumes that everyone reacts the same way to a trauma, and anyone who deviates from that path, is pathological. But there are many ways to cope with a trauma, especially so soon after it happens.

PFA seems to address many of the issues in debriefing. It is not compulsory and can be done in multiple sessions and links those who need more help to services. It deals with practical issues which are often more pressing and create stress. It also improves self efficacy by letting people cope their own way. PFA has attempted to be culturally sensitive, but whether it is or not has not been shown. However, a drawback is the lack of empirical evidence. While it is based on research, it is not proven by research. Like the debriefing method, it has become widely popular without testing.

Today, PFA has been widely used not just for crisis intervention for natural disasters, but also personal crises such as when individuals face traumatic losses of loved ones or pets, or when organisations go through critical incidents such as the suicide or death of a colleague.

Overview of Mental Health First Aid

Introduction

Mental health first aid is a training programme that teaches members of the public how to help a person developing a mental health problem (including a substance use problem), experiencing a worsening of an existing mental health problem or in a mental health crisis. Like traditional first aid, mental health first aid does not teach people to treat or diagnose mental health or substance use conditions. Instead, the training teaches people how to offer initial support until appropriate professional help is received or until the crisis resolves.

While first aid for physical health crises is a familiar notion in developed countries, conventional first aid training has not generally incorporated mental health problems.

Refer to Crisis Intervention and Psychological First Aid.

Rationale

Mental health problems are common in the community, so members of the public are likely to have close contact with people affected. However, many people are not well informed about how to recognise mental health problems, how to provide support and what are the best treatments and services available. Furthermore, many people developing mental disorders do not get professional help or delay getting professional help Someone in their social network who is informed about the options available for professional help can assist the person to get appropriate help. In mental health crises, such as a person feeling suicidal, deliberately harming themselves, having a panic attack or being acutely psychotic, someone with appropriate mental health first aid skills can reduce the risk of the person coming to harm.

There is also stigma and discrimination against people with mental health problems, which may be reduced by improving public understanding of their experiences.

Brief History

The Mental Health First Aid Programme was developed in Australia by Betty Kitchener and Anthony Jorm in 2000. Since 2003, this Mental Health First Aid Programme has spread to a number of other countries (Bermuda, Canada, Denmark, England, Finland, France, Germany, Hong Kong, India, Ireland, Japan, Malaysia, Malta, Netherlands, New Zealand, Northern Ireland, Saudi Arabia, Scotland, Sweden, Switzerland, United States, United Arab Emirates, Wales). By 2019, over 3 million people had been trained in mental health first aid worldwide.

Research on Mental Health First Aid Training

A number of studies have been carried out showing the people who are trained in mental health first aid showed improved knowledge, confidence, attitudes and helping behaviour. A meta-analysis of data from 15 evaluation studies concluded that mental health first aid training “increases participants’ knowledge regarding mental health, decreases their negative attitudes, and increases supportive behaviours toward individuals with mental health problems”.

There has been research to develop international guidelines on the best strategies for mental health first aid. Mental health first aid training has been included in the US Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Registry of Evidence-based Programmes and Practices.

By Country

Australia

In Australia, mental health first aid training is run by the not-for-profit charity Mental Health First Aid International (trading as Mental Health First Aid Australia). A range of training courses are offered:

  • Standard Mental Health First Aid is a 12-hour face-to-face course for adults to learn to assist other adults.
    • Culturally adapted versions of this course are available for Chinese and Vietnamese Australians.
    • eLearning and blended versions of the Standard course have been tailored for a range of professional groups, including pharmacists, the legal profession, financial counsellors, medical students and nursing students.
  • Youth Mental Health First Aid is a 14-hour face-to-face course for adults to learn to assist adolescents.
  • Aboriginal and Torres Strait Islander Mental Health First Aid is a 14-hour face-to-face culturally adapted course for adults to learn to assist Aboriginal and Torres Strait Islander adults.
    • It is run by Aboriginal or Torres Strait Islander instructors.
  • Teen Mental Health First Aid is a 3.5-hour classroom-based course that teaches high school students in years 10-12 how to provide mental health first aid to their friends.
  • Older Person Mental Health First Aid is a 12-hour face-to-face course for adults to learn to assist people aged 65 and over.

By 2015, Mental Health First Aid training had been received by over 350,000 people, which is more than 2% of the Australian adult population.

Mental health first aid training programmes in Australia have won a number of awards for excellence including:

  • Gold Achievement Award 2007 – winner of the Mental Health Promotion Mental Illness Prevention Programme or Project category at the MHS Conference.
  • Suicide Prevention Australia – 2005 Life Award.
  • Victorian Public Health Programmes Award for Innovation, 2006.
  • Enterprise and Resourcefulness Award – NSW Aboriginal Health Awards 2010.
  • Silver Achievement Award for Aboriginal and Torres Strait Islander Programme – Mental Health Promotion or Mental Illness Prevention Programme or Project category at the MHS Conference 2010.
  • Silver Achievement Award for Youth Mental Health First Aid Programme – TheMHS, Mental Health Promotion or Mental Illness Prevention Programme Category, 2014.
  • TheMHS Medal (the top award of the Mental Health Service Awards of Australia and New Zealand which “honours a unique and inspiring contribution to Mental Health by an individual or organisation”), 2017.

England

Mental health first aid (MHFA) came to England in 2007 and was developed and launched under the National Institute for Mental Health in England, part of the Department of Health, as part of a national approach to improving public mental health. Mental Health First Aid England was launched as a community interest company in 2009.

MHFA England offer a range of courses:

  • Standard MHFA, a two-day course which qualifies a participant to become a Mental Health First Aider
  • Youth MHFA, a two-day course which qualifies a participant to become a Youth Mental Health First Aider.
    • This course is designed for those who are working, living or interacting with young people.
    • It was first launched in England in 2010 and revised and re-launched in October 2013.
  • Youth MHFA Schools & Colleges, a one-day course which is based on Youth MHFA and designed to fit into school training timetables.
  • Armed Forces MHFA, a two-day course which qualifies participants to become an Armed Forces Mental Health First Aider.
    • This course was designed for the whole Armed Forces community, including veterans, serving personnel and their families.
    • It was launched 2013.
  • MHFA Lite, a three-hour introductory awareness course launched which is based on the Standard MHFA course.
    • MHFA Lite was launched in 2011.
    • There is also a Lite version of the Youth MHFA course.
  • MHFA Instructor Training, a seven-day course accredited by the Royal Society for Public Health to qualify as a Mental Health First Aid instructor who can deliver one or all of the two-day courses (Standard, Youth and Armed Forces).

Since 2007, more than 114,000 Mental Health First Aiders have been trained in England and more than 1,600 people have trained as Mental Health First Aid instructors. The Department of Health encouraged all employers in England to provide mental health first aid training as one of three steps in its 2012 “No Health Without Mental Health: Implementation Framework”. In 2016 Mental Health First Aid was recommended for all workplaces by the charity Business in the Community.

Scotland, Wales, and Northern Ireland have broadly similar courses to the above.

You can find further information on the various UK courses here.

Ireland

In May 2014 Saint John of God Hospital signed a Memorandum of Understanding with MHFA Australia to adapt the course for Ireland and in October 2014 Betty Kitchener came to Saint John of God Hospital to advise on the rollout of the MHFA Ireland Programme.

United States

In 2008, the National Council for Behavioural Health, in partnership with the Missouri Department of Mental Health, brought mental health first aid to the United States. Since 2008, more than 1.5 million people have been trained on the Mental Health First Aid USA course by an instructor base of more than 15,000. There are people trained in mental health first aid in all 50 states, Puerto Rico and Guam. The course is offered to a variety of audiences, including hospital staff, employers and business leaders, faith communities and law enforcement.

In 2012, youth mental health first aid was introduced in the United States to prepare trainees to help youth ages 12-18 that may be developing or experiencing a mental health challenge. Specialised versions of Mental Health First Aid USA including the Veterans, Public Safety, Higher Education, Rural and Older Adults modules and a Spanish version of the Youth and Adult curriculum are also available.

Mental Health First Aid USA was included in President Barack Obama’s plan to reduce gun violence and increase access to mental health services. In 2014, Congress appropriated $15 million to SAMHSA to train teachers and school personnel in youth mental health first aid. In 2015, an additional $15 million was appropriated to support other community organizations serving youth. The Mental Health First Aid Act of 2015 (S. 711/H.R. 1877) had broad bi-partisan support and would authorise $20 million annually for training the American public. Fifteen states have made Mental Health First Aid a priority by appropriating state funds, including Texas which allocated $5 million.

Canada

Mental health first aid debuted in Canada in 2007, and has operated under the leadership of the Mental Health Commission of Canada since early 2010.

MHFA Canada offers a range of courses, which, upon completion, certify a participant in mental health first aid:

  • MHFA Basic, a two-day 12 hour course.
  • MHFA for Adults who Interact with Youth, a two-day 14 hour course.
  • MHFA Seniors, a two-day 14 hour course.
  • MHFA Veteran Community, a two-day 13 hour course.
  • MHFA Northern Peoples, a three-day 18 hour course.
  • MHFA First Nations, a three-day 20 hour course.
  • MHFA Inuit, a three-day 24 hour course.
  • MHFA Police, an eight-hour course including 15-30 minutes online.
  • MHFA Instructor Training, a course which allows the participant to become a Mental Health First Aid instructor.

Different instructor courses are required to become a MHFA Basic, Youth, Seniors, Veteran Community, First Nations or Northern Peoples instructor. The duration of these courses vary from five to six days. First Nations & Northern People versions require two instructors/facilitators to deliver the course.

Since 2007, more than 400,000 Canadians have been trained in Mental Health First Aid, and more than 1,200 people have been trained as instructors.

United Arab Emirates

Mental health first aid debuted in the UAE in December 2017. MHFA UAE operates under the leadership of the Lighthouse Centre for Wellbeing, an out-patient mental health clinic in Dubai composed of more than 25 licensed psychologists. The Lighthouse is the only accredited provider of MHFA in the UAE.

MHFA UAE offers 3 courses:

  • Adult to Adult MHFA, a 12-hour training which qualifies a participant to become a Mental Health First Aider.
    • This course is designed for those who are working, living or interacting with other adults.
  • Adult to Adolescent MHFA, a 14-hour course which qualifies a participant to become a Youth Mental Health First Aider.
    • This course is designed for those who are working, living or interacting with young people.
  • Teen to Teen MHFA, a 4-hour course which qualifies teens to become Teen Mental Health First Aiders.

What is Crisis Intervention?

Introduction

Crisis intervention is a time-limited intervention with a specific psychotherapeutic approach to immediately stabilise those in crisis.

Refer to Mental Health First Aid and Psychological First Aid.

Implementation

A crisis can have physical or psychological effects. Usually significant and more widespread, the latter lacks the former’s obvious signs, complicating diagnosis. Three factors define crisis: negative events, feelings of hopelessness, and unpredictable events. People who experience a crisis perceive it as a negative event that generate physical emotion, pain, or both. They also feel helpless, powerless, trapped, and a loss of control over their lives. Crisis events tend to occur suddenly and without warning, leaving little time to respond and resulting in trauma.

At a global level, when a mass trauma from an event like as a terrorist attack occurs, counsellors are trained to provide resources, coping skills, and support to clients to assist them through their crisis. Intervention often begins with an assessment. In countries such as the Czech Republic, crisis intervention is an individual therapy, usually lasting four to six weeks, and includes assistance with housing, food, and legal matters. Long waiting times for resident psychotherapists and in Germany, explicit exclusions of couples therapy and other therapies complicate implementation. In the United States, licensed professional counsellors (LPCs) provide mental health care to those in need. Licensed professional counsellors focus on psychoeducational techniques to prevent a crisis, consultation to individuals, and research effective therapeutic treatment to deal with stressful environments.

School-based

The primary goal of school-based crisis intervention is to help restore the crisis-exposed student’s basic problem-solving abilities and in doing so, to return the student to their pre-crisis levels of functioning. Crisis intervention services are indirect. People often find school psychologists working behind the scenes, ensuring that students, staff, and parents are well-positioned to realize their natural potential to overcome the crisis. School psychologists are trained professionals who meet continuing education requirements after receiving their degree. They help maintain a safe and supportive learning environment for students by working with other staff. such as school resource officers, law enforcement officers trained as informal counsellors and mentors.

At a school-based level, when a trauma occurs, like a student death, school psychologists are trained to prevent and respond to crisis through the PREPaRE Model of Crisis Response, developed by NASP. PREPaRE provides educational professionals training in roles based on their participation in school safety and crisis teams. PREPaRE is one of the first comprehensive nationally available training curriculums developed by school-based professionals with firsthand experience and formal training.

Misuse

When using crisis intervention methods for the disabled individual, every effort should first be made to first find other, preventative methods, such as giving adequate physical, occupational and speech therapy, and communication aides including sign language and Augmentative Communication systems, behaviour and other plans, to first help that individual to be able to express their needs and function better. Too often, crisis intervention methods including restraining holds are used without first giving the disabled more and better therapies or educational assistance. Often school districts, for example, may use crisis prevention holds and “interventions” against disabled children without first giving services and supports: at least 75% of cases of restraint and seclusion reported to the US Department of Education in the 2011-2012 school year involved disabled children. Also, school districts hide their disabled child’s restraint or seclusion from the parents, denying the child and their family the opportunity to recover.

The US Congress has proposed legislation, such as the “Keeping All Students Safe Act”, to curtail school district use of restraint and seclusion. Even with bipartisan support, the bill has repeatedly died in committee.

SAFER-R

The SAFER-R Model, with Roberts 7 Stage Crisis Intervention Model, is model of intervention much used by law enforcement. The model approaches crisis intervention as an instrument to help the client to achieve their baseline level of functioning from the state of crisis. This intervention model for responding to individuals in crisis consists of 5+1 stages. They are:

  • Stabilise.
  • Acknowledge.
  • Facilitate understanding.
  • Encourage adaptive coping.
  • Restore functioning or,
  • Refer.

Other models include Lerner and Shelton’s 10 step acute stress & trauma management protocol.

Critical Incident Debriefing

Critical incident debriefing is a widespread approach to counselling those in a state of crisis. This technique is done in a group setting 24-72 hours after the event occurred, and is typically a one-time meeting that lasts 3-4 hours, but can be done over numerous sessions if needed. Debriefing is a process by which facilitators describe various symptoms related PTSD and other anxiety disorders that individuals are likely to experience due to exposure to a trauma. As a group they process negative emotions surrounding the traumatic event. Each member is encouraged to continue participation in treatment so that symptoms do not worsen.

Commentators have criticised critical incident debriefing for its effectiveness on reducing harm in crisis situations. Some studies show that those exposed to debriefing are actually more likely to show symptoms of PTSD at a 13-month follow-up than those who were not exposed. Most recipients of debriefing reported that they found the intervention helpful. Based on symptoms found in those who received no treatment at all, some critics state that reported improvement is considered a misattribution, and that the progress would naturally occur without any treatment.