New Mental Health Care App for RN Families

Royal Navy families can now access mental health support online.

The Naval Families Federation has launched a 12-month pilot scheme to provide free access to the Headspace app for families of regular and reserve RN personnel.

Working with support from Navy Command and the Royal Navy Family and People Support organisation, 3,000 licences have been bought.

To access the offer, the family member should visit www.nff.org.uk/headspace where they will be guided through the verification process.

What is Helper Theory?

Introduction

Helper theory or the helper therapy principle was first described by Frank Riessman (1965) in an article published in the journal Social Work. The principle suggests that when an individual (the “helper”) provides assistance to another person, the helper may benefit.

Riessman’s model has inspired subsequent research and practice by scholars, clinicians, and indigenous populations to address a variety of social and health-related issues plaguing individuals and communities around the world.

Refer to Peer Support and Skills and Abilities Required for Peer Support.

Riessman’s Formulation

Riessman’s seminal article explored how non-professionals supported one another in self-help/mutual-aid support groups based on Riessman’s observations of a sample of these groups, as well as his summary of the findings of research in the areas of social work, education, and leadership. This article suggested that although the “use of people with a problem to help other people who have the same problem in [a] more severe form” is “an age-old therapeutic approach,” the traditional focus on outcomes for those receiving help to the exclusion of considering outcomes for those providing help is too narrow; instead, Riessman (1965, p.27) advocated for increased consideration of the experience of “the individual that needs the help less, that is, the person who is providing the assistance” because “frequently it is he who improves!”

Although Riessman expressed doubt that individuals receiving help always benefit from the assistance provided to them, he felt more sure that individuals providing help are likely experiencing important gains; thus, according to Riessman, the helping interaction at least has the potential to be mutually beneficial for both parties involved (i.e. for both the individual giving and for the individual receiving aid), but it is not absolutely necessary for the “helpee” to benefit in order for the “helper” to enjoy the benefits of helping. In instances where true mutual benefit occurs, the helper and helpee benefit in different ways, such that the person receiving help benefits by way of receiving whatever specific form of assistance is offered to them (e.g. emotional support, information, etc.) while the person providing help benefits by the very act of providing help, regardless of the type of aid they provide.

Riessman posited several different mechanisms which may facilitate the benefits experienced by an individual engaged in a helping role:

  • Gaining an improved self-image;
  • Becoming more committed to a position through the process of advocating it (i.e. “self-persuasion through persuading others”);
  • Experiencing meaningful development of abilities after having been given a stake in a system and learning through teaching others;
  • Gaining access to a socially-valued role and the resultant sense of social status and importance;
  • Enjoying opportunities to affirm one’s own wellness following placement in a system as a role model; and
  • Shifting one’s focus from self-concerns and problems to assisting others (and thus distracting oneself from ongoing difficulties).

Health Care

Lepore, Buzaglo, Liberman, Golant, Greener, and Davey (2014) investigated the helper-therapy principle in a randomised control trial of a “prosocial”, other-focused Internet Support Group (P-ISG) designed to elicit peer-instigated, supportive interactions online among female breast cancer survivors. When compared to female breast cancer survivors who participated in a standard, self-focused Internet Support Group (S-ISG), which was not designed to explicitly provide opportunities for helping interactions to take place, analyses found that individuals in the P-ISG condition did provide more support to others yet P-ISG participants experienced a higher level of depression and anxiety following the intervention than those in S-ISG. These results fail to provide support for the helper-therapy principle which posits that “helping others is effective at promoting mental health” (Lepore et al., 2014, p.4085). In accounting for these results, Lepore et al. (2014) suggest that it is possible that women in the P-ISG condition felt hesitant to express their negative feelings out of fear that doing so might impact others adversely, whereas women in the S-ISG felt more able to unburden themselves of emotional pain and thus enjoyed better mental health outcomes.

Arnold, Calhoun, Tedeschi, and Cann (2005) explored both the positive and negative sequelae of providing psychotherapy to clients who had experienced trauma and subsequent posttraumatic growth by conducting naturalistic interviews with a small sample of clinicians (N = 21). Although all interviewees indicated experiencing some degree of negative experience as a result of engaging in trauma-focused psychotherapy (such as intrusive thoughts, negative emotional responses, negative physical responses, and doubts about clinical competence), all participants also indicated some sort of positive personal outcome occurred as a result of assisting psychotherapy clients with these types of experiences. The positive reactions experienced by clinicians engaged in trauma work included: enjoying the gratification that comes through watching others grow and triumph following difficult times; increasing recognition of one’s own personal growth and development; expanding ability to connect emotionally with others; impacting one’s own sense of spirituality; increased awareness of one’s own good fortune in life; and increasing appreciation for the strength and resiliency of human beings. This finding suggests that the helper-therapy principle may operate in a clinical context whereby therapists (i.e. the helpers) benefit from engaging in the process of providing treatment to psychotherapy clients who have survived traumatic experiences.

Pagano, Post, and Johnson (2011) reviewed recent evidence examining “helper health benefits” among populations experiencing problematic involvement with alcohol, other mental health conditions, and/or general medical problems. In brief, their review suggests that when individuals with chronic health conditions (e.g. alcohol use disorder, body dysmorphic disorder with comorbid alcohol dependence, multiple sclerosis, chronic pain) help others living with the same chronic condition, the individual helper benefits (e.g. longer time-to-relapse, remission, reduced depression and other problematic symptoms, and increased self-confidence, self-esteem, and role functioning).

Additionally, Post’s (2005, p.73) review of the literature on altruism, happiness, and health indicates that “a strong correlation exists between the well-being, happiness, health, and longevity of people who are emotionally kind and compassionate in their charitable helping activities”. However, Post also notes that individual helpers may become overwhelmed by over-involvement in the lives of others, and that giving assistance beyond a certain variable threshold may lead to deleterious rather than beneficial outcomes for helpers.

Social Work

Melkman, Mor-Salwo, Mangold, Zeller, & Benbenishty (2015) used a grounded theory approach to understand:

  1. The motivations and experiences which led young adult “careleavers” (N = 28, aged 18-26) in Israel and Germany to assume a helper role; and
  2. The benefits they report enjoying as a result of helping others through volunteerism and/or human-service focused careers.

Participants reported that observing role models involved in helping roles, being exposed to prosocial values, and having opportunities to volunteer within the system in which they were simultaneously receiving care all contributed to later assumption of more stable and regular helping roles. These participants felt obliged to provide assistance to others, desired to provide this assistance to others, and felt sufficiently competent to carry out the tasks required of them in their helping role. These participants reported that helping others provided them with a sense of purpose in their lives, and also increased self-efficacy, social connectedness, and ability to cope with personal issues. Additionally, participants reported that assuming a helping role provided a sense of normalcy to their lives, as well as providing a sense of perspective on their own journey and outcomes. As one participant (a volunteer with a police department who was assigned to work with at-risk youth) shared with the researchers:

“The fact that I could bring a runaway girl back to her home and I made her trust me, the fact that I located a missing girl, the fact that I escorted a rape victim to hospital and I managed to give her strength and support her, these are the things that give me meaning, tell me that I’m in a much better situation than others” (Melkman et al., 2015, p.45).

Self-Help/Mutual-Help

Roberts, Salem, Rappaport, Toro, Luke, and Seidman (1999, p.859) found support for the helper-therapy principle among participants of GROW, a mutual-help group for individuals with serious mental illness, whereby “participants who offered help to others evidenced improvement over time in psychosocial adjustment”.

Maton (1988) reports that occupying both “helper” and “helpee” roles in a self-help/mutual-aid group (i.e. bidirectional support) was positively correlated with psychological well-being and positive perceptions regarding the benefits of group membership, and that these members with dual-roles had a greater sense of well-being and a more favourable opinion of the group than members who were helpees (i.e. recipients of assistance) only.

Olson, Jason, Ferrari, and Hutcheson (2005) reviewed the existent literature on four mutual-help organisations (Alcoholics Anonymous, Oxford House, GROW, and Schizophrenics Anonymous). They suggest that the processes of change framework found within the transtheoretical model of intentional behaviour change (Prochaska, Diclemente, and Norcross, 1992) is a useful model to conceptualise the activities of mutual-help organization members throughout their journey of mental health recovery. They explicitly link social liberation, the last of the ten processes of change articulated by the model (the others being: consciousness raising, self-re-evaluation, helping relationships, self-liberation, environmental re-evaluation, dramatic relief/emotional arousal, stimulus control, reinforcement management, and counterconditioning) to the helper-therapy principle, along with a related concept known as bidirectional support (Maton, 1988). Per Olson et al. (2005), social liberation “involves the person in recovery focusing attention away from oneself and developing a broader recognition of social issues that contributed to the targeted problem” which encourages “recovering individuals to take more helping-related attitudes toward others who face similar problems” (Olson et al., 2005, p.174). In reviewing the research conducted among members of these four self-help/mutual-help organisations, they identify three different mechanisms which might underlie the therapeutic effect of mutual-help:

  1. When an individual helps another, the helper’s social functioning improves because the act of providing help to another allows the helper to work through their own difficulties;
  2. When an individual helps another, the helper’s social functioning improves because the act of providing help to another allows the helper to reinforce their own personal learning about recovery; and/or
  3. When an individual helps another, the helper experiences an increase in their own sense of competence and usefulness to others and enables the helper to adopt a “strength-based roles that have not been fully exercised in other areas of life” (Olson et al., 2005, p.175).

In reviewing the research on GROW, specifically, 67% of members of this organisation sampled by Young and Williams (1987) who were asked how they most benefited from participation reported that involvement in GROW “taught [them they] could help others” (the most endorsed answer among all listed categories). As suggested by a study by Maton and Salem (1995), this idea is most succinctly expressed by way of an axiom of GROW which is often recited at meetings: “If you need help, help others.”

A review of empirical studies investigating the effect of mutual help group participation for individuals with mental health problems by Pistrang, Barker, and Humphreys (2008, p.110) provides “limited but promising evidence that mutual help groups benefit people with three types of problems: chronic mental illness, depression/anxiety, and bereavement”.

References

Arnold, D., Calhoun, L. G., Tedeschi, R. & Cann, A. (2005). Vicarious posttraumatic growth in psychotherapy. Journal of Humanistic Psychology. 45(2), pp.239-263.

Lepore, S.J., Buzaglo, J.S., Liberman, M.A., Golant, M., Greener, J.R. & Davey A. (2014) Comparing standard versus prosocial internet support groups for patients with breast cancer: A randomized controlled trial of the helper therapy principle. Journal of Clinical Oncology. 32(36), pp.4081-4086.

Maton, K.I. (1988). Social support, organization characteristics, psychological wellbeing and group appraisal in three self-help populations. American Journal of Community Psychology. 16(1), pp.53-77.

Maton, K.I. & Salem, D.A. (1995). Organizational characteristics of empowering community settings: A multiple case study approach. American Journal of Community Psychology. 23(5), pp631-656.

Melkman, E., Mor-Salwo, Y., Mangold, K., Zeller, M. & Benbenishty, R. (July 2015). Care leavers as helpers: Motivations for and benefits of helping others. Children and Youth Services Review. 54, pp.41-48.

Olson, B.D., Jason, L.A., Ferrari, J.R. & Hutcheson, T.D. (2005). Bridging professional and mutual-help: An application of the transtheoretical model to the mutual-help organization. Applied and Preventive Psychology. 11(3), pp.167-178.

Pagano, M.E., Post, S.G. & Johnson, S.M. (2011). Alcoholics Anonymous-Related Helping and the Helper Therapy Principle. Alcoholism Treatment Quarterly. 29(1), pp.23-34.

Pistrang, N., Barker, C. & Humphreys, K. (2008). Mutual Help Groups for Mental Health Problems: A Review of Effectiveness Studies. American Journal of Community Psychology. 42(1-2), pp.110-121.

Post, S.G. (2005). Altruism, happiness, and health: it’s good to be good. International Journal of Behavioral Medicine. 12(2), pp.66-77.

Prochaska, J.O., DiClemente, C.C. & Norcross, J.C. (1992). In search of how people change: Applications to the addictive behaviors. American Psychologist. 47(9), pp.1102-1114.

Riessman, F. (1965) The ‘Helper’ Therapy Principle. Social Work. 10(2), pp.27-32.

Roberts, L., Salem, D., Rappaport, J., Toro, P.A., Luke, D.A. & Seidman, E. (1999). Giving and receiving help: Interpersonal transactions in mutual-help meetings and psychosocial adjustment of members. American Journal of Community Psychology. 27(6), pp.841-868.

Young, J. & Williams, C.L. (1987). An Evaluation of Grow, a Mutual-Help Community Mental Health Organisation. Community Health Studies. 11(1), pp.38-42.

Should We Integrate Mental Health Support for those Diagnosed with Hearing Loss?

Research Paper Title

Prevalence of Depression and Anxiety in Adolescents With Hearing Loss.

Background

To develop and implement a universal screening protocol for depression and anxiety in adolescents serviced in an otology and audiology practice and to estimate the prevalence of depression and anxiety in adolescents with hearing loss, while also comparing rates by degree of hearing loss and type of hearing device used.

Methods

A cross-sectional study set in a university tertiary medical centre. One hundred four adolescents 12- to 18-years-old who attended an otology clinic in a large metropolitan hospital in the southeastern United States.

Main outcome measure(s): Depression (PHQ-8), anxiety (GAD-7), degree of hearing loss, type of hearing loss, and type of hearing device utilised.

Results

Twenty-five percent of adolescents scored above the clinical cutoff on at least one of the depression and/or anxiety measures, with 10% scoring in the elevated range on both measures. Specifically, 17% scored above the cutoff on the PHQ-8 and 16% scored in the clinically significant range for the GAD-7. An additional 30 and 21% scored in the at-risk range for depression and anxiety, respectively. Older adolescents were more likely to score within the elevated range for depression (r = 0.232, p = 0.026). Also, adolescents with severe to profound hearing loss had higher rates of depression and anxiety.

Conclusions

Integration of mental health screening is needed in otology and audiology practices both to identify those who require psychological support and to provide appropriate treatment to reduce long-term impact of hearing loss on quality of life and mental health functioning in adolescents.

Reference

Cejas, I., Coto, J., Snachez, C., Holcomb, M. & Lorenzo, N.E. (2020) Prevalence of Depression and Anxiety in Adolescents With Hearing Loss. Otology and Neurotology. doi: 10.1097/MAO.0000000000003006. Online ahead of print.

What is the Role of Telehealth in Reducing the Mental Health Burden from COVID-19?

Research Paper Title

The Role of Telehealth in Reducing the Mental Health Burden from COVID-19.

Background

The psychological impact of the coronavirus disease 2019 (COVID-19) pandemic must be recognized alongside the physical symptoms for all those affected. Telehealth, or more specifically telemental health services, are practically feasible and appropriate for the support of patients, family members, and health service providers during this pandemic. As of March 18, 2020, there were >198,000 COVID-19 infections recorded globally, and 7,900 deaths. Psychological symptoms relating to COVID-19 have already been observed on a population level including anxiety-driven panic buying and paranoia about attending community events. Students, workers, and tourists who have been prevented from accessing their training institutions, workplaces, homes, respectively, are expected to have developed psychological symptoms due to stress and reduced autonomy and concerns about income, job, security, and so on. The Chinese, Singaporean, and Australian governments have highlighted the psychological side effects of COVID-19, and have voiced concerns regarding the long-term impacts of isolation and that the fear and panic in the community could cause more harm than COVID-19.

In the absence of a medical cure for COVID-19, the global response is a simple public health strategy of isolation for those infected or at risk, reduced social contact to slow the spread of the virus, and simple hygiene such as hand washing to reduce the risk of infection. While the primary intervention of isolation may well achieve its goals, it leads to reduced access to support from family and friends, and degrades normal social support systems and causes loneliness, and is a risk for worsening anxiety and depressive symptoms. If left untreated, these psychological symptoms may have long-term health effects on patients and require treatment adding to the cost burden of managing the illness. Clinical and nonclinical staff are also at risk of psychological distress as they are expected to work longer hours with a high risk of exposure to the virus. This may also lead to stress, anxiety, burnout, depressive symptoms, and the need for sick or stress leave, which would have a negative impact on the capacity of the health system to provide services during the crisis.

Treatment protocols for people with COVID-19 should address both the physiological and psychological needs of the patients and health service providers. Providing psychological treatment and support may reduce the burden of comorbid mental health conditions and ensure the well-being of those affected. Our challenge is to provide mental health services in the context of patient isolation, which highlights the role of telehealth (through videoconference, e-mail, telephone, or smartphone apps). The provision of mental health support (especially through telehealth) will likely help patients maintain psychological well-being and cope with acute and post-acute health requirements more favourably.

Examples of and evidence to support the effectiveness of telemental health are fairly diverse, especially in the context of depression, anxiety, and PTSD. Videoconferencing, online forums, smartphone apps, text-messaging, and e-mails have been shown to be useful communication methods for the delivery of mental health services.

China is actively providing various telemental health services during the outbreak of COVID-19. These services are from government and academic agencies and include counseling, supervision, training, as well as psychoeducation through online platforms (e.g., hotline, WeChat, and Tencent QQ). Telemental health services have been prioritised for people at higher risk of exposure to COVID-19, including clinicians on the frontline, patients diagnosed with COVID-19 and their families, policemen, and security guards. Early reports also showed how people in isolation actively sought online support to address mental health needs, which demonstrated both a population interest and acceptance of this medium.

Additional telehealth services have been previously funded by the Australian Government (Better Access Initiative programme), to address mental health needs of rural and remote patients during emergency situations, such as long-term drought and bushfires. In response to COVID-19, the Australian Government has responded with additional funded services through the Medicare Benefits Schedule, enabling a greater range of telehealth services to be delivered, including telehealth consultations with general practitioners and specialists. However, the expanded telehealth programme is restricted to special needs groups and the wider population does not have access to the programme. A major benefit of expanding telehealth, including mental health, with no restrictions would reduce person-to-person contact between health service providers and COVID-19 and reduce the risk of exposure of non-infected but susceptible patients in waiting room areas. To date, most of the Australian Government’s focus has been on managing medical needs of people during the epidemic, rather than providing resources to meet short- and long-term mental health implications. An expansion of access to telemental health support services with a focused public education campaign to promote these services would begin to address this need.

Communication of all health needs is important when patients are having to be isolated. The researchers support the use of telehealth as a valuable way of supporting both physical and psychosocial needs of all patients irrespective of geographical location. Simple communication methods such as e-mail and text messaging should be used more extensively to share information about symptoms of burnout, depression, anxiety, and PTSD during COVID-19, to offer cognitive and/or relaxation skills to deal with minor symptoms, and to encourage access to online self-help programmes. For people with COVID-19, telehealth can be used to monitor symptoms and also to provide support when needed.

While there is growing awareness of mortality rates associated with COVID-19, we should also be cognisant of the impact on mental health – both on a short- and a long-term basis. Telemental health services are perfectly suited to this pandemic situation – giving people in remote locations access to important services without increasing risk of infection.

Reference

Zhou, X., Snoswell,, C.L., Harding, L.E., Bambling, M., Edirippulige, S., Bai, X. & Smith, A.C. (2020) The Role of Telehealth in Reducing the Mental Health Burden from COVID-19. Telemedicine and e-Health. 26(4). https://doi.org/10.1089/tmj.2020.0068.

Inclusion & Paternal Mental Health

Research Paper Title

Paternal Mental Health During the Perinatal Period: A Qualitative Systematic Review.

Background

To examine fathers’ experiences and needs associated with mental health during the perinatal period.

Qualitative studies were meta-synthesised using the steps outlined by Sandelowski and Barroso.

Six databases (PubMed, Embase, PsycINFO, CINAHL, Scopus and ProQuest) were searched for qualitative studies from each database’s inception to 24 June 2019.

Methods

Studies were critically appraised using the Critical Appraisal Skills Programme tool. Qualitative data were extracted, meta-summarised, then meta-synthesised.

Results

Fourteen studies were included and four themes were identified:

  1. Negative feelings and psychological difficulties;
  2. Role strain and role conflict with multiple sources;
  3. Coping strategies that buffered negative feelings and psychological difficulties; and
  4. Support needs to enhance mental health.

Conclusions

Fathers reported poor mental health and expressed needs to enhance their mental health across the perinatal period. Future studies can focus specifically on paternal mental health. The development of theory-guided, family inclusive, technology-based healthcare services are needed to manage mental health. Healthcare providers can promote positive mental health to prepare fathers, increasing their awareness to manage their mental health and to seek timely help.

Impact

Problem-focused coping (i.e. support and problem-solving with partners and childcare involvement) helped fathers to buffer their negative feelings and psychological difficulties. Future studies should focus on paternal mental health rather than on general fathering experiences. Healthcare providers should focus on promoting positive mental health and well-being. Policymakers should create awareness on paternal mental health across the perinatal period.

Reference

Shorey, S. & Chan. V. (2020) Paternal Mental Health During the Perinatal Period: A Qualitative Systematic Review. Journal of Advanced Nursing. 76(6), pp.1307-1319. doi: 10.1111/jan.14325. Epub 2020 Feb 25.

Book: Dementia: Support for Family and Friends

Book Title:

Dementia: Support for Family and Friends

Author(s): Dave Pulsford and Rachel Thompson.

Year: 2019.

Edition: Second (2nd).

Publisher: Jessica Kingsley Publishers.

Type(s): Paperback and Kindle.

Synopsis:

A comprehensive and practical guide to dementia, this book is essential reading for anyone who has a friend or relative with the condition.

This updated edition reflects new guidance on approaches to supporting people with dementia, focussing especially on the UK, and includes quotes from people with dementia as well as from family carers.

The book explores each stage of the journey people with dementia face and explains how it affects the person, as well as those around them both at home and in residential settings.

It shows how best to offer support and where to get professional and informal assistance.

Focussing on the progressive nature of dementia and the issues that can arise as a result, it gives practical advice that can help to ensure the best possible quality of life both for the person with dementia and the people around them.

Post-Traumatic Growth & Support: Consider Quality & Quantity

Research Paper Title

The impact of received social support on posttraumatic growth after disaster: The importance of both support quantity and quality.

Background

Few studies have investigated the relationship between received social support (actual help received) and posttraumatic growth (PTG), and these studies focused only on the quantity of support received.

This study examined the joint implications of both the quantity and quality of post-disaster received social support for PTG.

Methods

Data were collected from Lushan earthquake (China, in 2013) survivors at 7 (n = 199) and 31 (n = 161) months after the earthquake.

The main effects of quantity and quality of received support, and the interaction between support quantity and support quality, were examined using hierarchical multiple regression analyses controlling for the extent of disaster exposure, post-disaster negative life events, and sociodemographic factors.

Results

Neither quantity nor quality of received social support exerted significant main effects on PTG.

However, the influence of the amount of received social support on PTG was moderated by the quality of received social support.

Among survivors who appraised the post-disaster social support they received as higher in quality, greater amounts of received support were associated with more subsequent PTG.

Among those survivors who appraised the post-disaster social support they received as lower in quality, greater quantity of received support was associated with lower levels of reported PTG.

Conclusions

This study calls attention to the importance of enhancing the quality of help provided to disaster survivors because simply “more” support is not necessarily better.

Reference

Shang, F., Kaniasty, K., Cowlishaw, S., Wade, D., Ma, H. & Forbes, D. (2020) The impact of received social support on posttraumatic growth after disaster: The importance of both support quantity and quality. Psychological Trauma: Theory, Research, Practice, and Policy. doi: 10.1037/tra0000541. [Epub ahead of print].

4 Quick Tips for Coping with Depression

Four quick tips for those with a friend or relative with depression.

  1. Be aware that depression can be a hidden illness.
    • You may not know that someone close to you is struggling.
    • Keep an eye out for any telltale signs.
  2. Be there for your relative or loved one.
    • Even though they will not necessarily always appreciate it.
  3. Stay in touch with someone if you think they are struggling.
    • An individual with depression may try to withdraw and not contact you, but do not take it personally.
    • Be proactive when it comes to keeping in contact.
  4. Offer support as best you can.
    • But do not forget to also look after yourself.

Mental Health & Social Support

Everyone requires a social network to satisfy the human need to be cared for, accepted, and emotionally supported, particularly in times of stress.

Research has shown that strong social support may significantly improve recovery from both physical and mental illnesses.

Changes in society have diminished the traditional support once offered by neighbours and families.

As an alternative, self-help groups and mutual aid groups have sprung up throughout the country.

Some self-help groups, such as Alcoholics Anonymous and Narcotics Anonymous, focus on addictive behaviour.

Others act as advocates for certain segments of the population, such as the disabled and older people, or provide support for family members of people who have a severe mental illness.

First Aid for Mental Health

Mental health first aid (MHFA) is the first step in helping a person experiencing a mental health crisis, and is intended to be used until other help arrives.

Just like physical first aid, the first aim of MHFA is to preserve life.

Evidence shows that many people experiencing a mental health crisis have thoughts of suicide, and some people act on these thoughts. This is why asking about suicide is the first step in offering help.

The current model of MHFA is known by the five-step acronym A.L.G.E.E.

Step 1: Ask About Suicide

This does not mean that you should ask everyone you meet about suicide, regardless of their situation.

What it does mean is that when you suspect that a person may be having suicidal thoughts, because of their level of pain or distress, or because of their situation, or even because you have a gut feeling that they may be considering suicide, you should ask them.

This may seem very challenging and difficult to begin with, but the MHFA course covers the skills and practice that will make this step feel more natural.

Once we are sure that the person is not in immediate danger we can put the next step into practice.

Step 2: Listen and Communicate Non-Judgmentally

People who are feeling distressed or experiencing mental health problems can feel that no one is able to listen to them, or to accept their feelings without judging them as weak or inferior.

Being able to listen to the person, and offering them the simple human kindness of the time to talk about how they feel, can help them realise that they are not alone.

Step 3: Give Reassurance and Information

This is not about offering advice or solving the person’s problems. It is about reassuring them that there is effective help available and that there are things we can do immediately to help the situation.

Step 4: Encourage the Person to get Professional Help

This is essential to their recovery.

Help may be in the form of their general practitioner (GP), other support groups, or therapy.

The help they need will depend on the type of problem(s) they are experiencing.

The MHFA course provides you with the information on where different types of help can be found quickly.

Step 5: Encourage Self-Help Strategies

When a person is experiencing mental health problems, there are things that can be done in the short-term to alleviate their distress.

Similarly, when treatment is underway there are often things a person can do to help recovery.