Mental Health First Aid has become a top priority among first responders and nonprofits, who now provide training to the public
If a family member threatens to harm himself, would you know what to do?
What if a colleague shows signs of depression?
Or a teenager has a panic attack?
Over the past two years, the pandemic has wreaked havoc with our nation’s mental health. According to published data (The State of Mental Health in America), Maryland ranks ninth best overall in the prevalence of mental illness and access to care.
This may be little comfort to anyone suffering from a mental illness—and even less to first responders who confront mental health issues every day. How do these professionals serve the public and maintain their own mental health?
This article explores how Anne Arundel County Police, Fire, emergency medical personnel, and hospital frontline staff work to protect themselves and their colleagues from harm during a mental health crisis. It also offers something you can do to help them—and yourself.
(Note: The author expresses gratitude to these professionals who shared openly about the trauma and challenges they and their colleagues routinely face.)
The Classroom
On a brisk, winter Saturday, 11 people gather in an Annapolis-area classroom. They come from government, local nonprofits, and small communities. Men and women, mostly in their 30s and 40s, are here to learn about a relatively new concept—“mental health first aid.”
The attendees come with some knowledge. If a family member or colleague cut a finger or suffered a fall, they would know what to do. But how do you apply “first aid” to situations where someone is having a mental health emergency?
Hosted by the Anne Arundel County Community Foundation, the workshop is one of several offered yearlong through Mental Health First AID USA of Maryland (MHFA), a nonprofit based on an organization originally founded in Australia in 2001. In 2008, Maryland and Missouri became the first states to adopt the program.
Severna Park resident Anne Hamel is Master MHFA Trainer with the Mental Health Association of Maryland. A self-described “recovering attorney,” Hamel was a corporate litigator when the last of her three children finished high school. What to do next?
“It became clear I was to help with mental health,” she says. “This is what I was called to do.”
Mental Health First Aid teaches individuals, businesses, professionals, and community groups the skills necessary to respond to individuals experiencing a mental health or substance use crisis. Attendees learn how to recognize symptoms of mental health problems, how to provide initial help, and support the person until appropriate care is available or the crisis resolves.
There are two types of training: one for adults and one for adults assisting youth. A third program—thanks in part to a grant from Lady Gaga’s foundation Born This Way—will teach teens to recognize problems in their peers.
“Too often,” says Hamel, “when we don’t know what to do, we don’t do anything at all.”
And that’s not tolerable in a society where the pandemic has increased mental health and substance use problems. Hamel believes now is an opportune time to promote first aid for mental health because “nothing in the history of humanity has raised the public’s awareness of mental health challenges more than this pandemic.”
Since the program’s inception in Maryland, more than 47,000 people have been trained in 3,700 sessions. Nearly 1,000 have been trained as instructors.
Among the first to certify as an instructor was Marguerite Keane Gibbons. A clinical social worker for more than 30 years, Gibbons is a counselor at Archbishop Spalding Senior High School and an adjunct professor in Anne Arundel Community College’s parent center. She has taught hundreds of classes, including local workshops.
The instructor sets the tone. The goal for the day is to help attendees learn how to prevent harm, promote recovery, and perhaps save a life. “It’s like knowing CPR,” Gibbons says. She echoes Hamel, “In the absence of not knowing what to do, we tend to do nothing.”
The class learns a basic mnemonic: ALGEE
Action A; Assess for risk of suicide or harm.
Action L: Listen nonjudgmentally.
Action G: Give reassurance and information.
Action E; Encourage appropriate professional help.
Action E: Encourage self-help and other support strategies.
Gibbons says, “People remember the steps of ALGEE. To assess, listen, give, and encourage. They are more willing to ask, ‘Are you ok?’” Adds Hamel, “This curriculum changes lives. It combats stigma. It opens the parallels between physical and mental health.”
A longitudinal study supports their findings. The National Council for Behavioral Health, which operates Mental Health First Aid in the United States, conducted a review of individuals after three and six months following their training. The results found (1) that individuals have greater mental health literacy, (2) are able to identify and combat stigma, (3) and have greater confidence and willingness to assist someone having a mental health challenge. Lastly, they report better mental-health well-being for themselves.
Hamel and Gibbons stress that the course is open to everyone. Their goal? “To have everybody take it.”
The class ends as snow flurries fall across Annapolis. Each participant receives a certificate acknowledging the bearer has been “trained to provide initial help to people experiencing problems such as depression, anxiety disorder, psychosis, and substance use disorders.”
Anne Arundel County Police: When Peer Support Matters
In 2018, Anne Arundel County Police Lt. Steven Thomas was named one of the top 100 Mental Health First Aid instructors in the country. A leader with Anne Arundel County’s Crisis Intervention Team, Thomas is proud that AA County is one of the first major police departments in the state to train all members in Mental Health First Aid. The course is basically the same as that offered to the public, but modified as a public safety version. Thomas credits this training with a 21 percent drop in the use of force. He has conducted scores of classes for police and sheriff departments across Maryland, including a specialized, three-day training for groups and individuals with the U.S. Capitol Police following the January 6, 2021, insurrection
In addition to the basic course, 191 officers have received training as members of the Crisis Intervention Team. All volunteer for this duty. Thomas says he wants “police who have a passion to want to help.”
And help they do. Police often assist with mental health concerns that the public rarely sees. For example, officers trained in crisis intervention respond to Safe Station calls, the county’s unique program where anyone with a substance use problem can show up at a fire or police station and receive help.
But what the public rarely considers is the impact the profession has on the officers’ own mental health. The image of a police officer with a badge and a gun, tall and tough, able to assist in any crisis, runs counter to having a mental health struggle. The “blue line” never falters, right? In fact, a conversation about training in mental health for the public quickly turns to what police need for their own mental health.
“After all,” notes Thomas, “we’re human. How we react to a situation is based on our human experience and world view.”
In 2015, Thomas began a “peer support” program based upon the teachings of the International Critical Incident Stress Foundation (ICISF). Founded in the 1980s by two Marylanders, Dr. George Everly and Dr. Jeff Mitchell, ICISF provides training to individuals who are part of a crisis management team. It fosters peer-to-peer support to help individuals process challenges they may face following an event.
Thomas uses the expression “when our worlds collide” to convey how an officer may react to an incident where he relates personally. It happens often. An officer responds to a SIDS baby (Sudden Infant Death Syndrome) and his mind flashes to his own infant at home. An older person dies, and the officer thinks of his elderly parent.
As soon as possible after these events, officers hold a “debriefing,” a formally-led review of the incident which typically happens within a day or two afterwards and includes everyone who was part of it. Leaders acknowledge that an unfounded fear of having a gun or car taken away may make an officer reluctant to seek help. A “macho” culture can forestall admitting need for support.
“We watch out for our officers in traumatic situations,” Thomas says. “We don’t want them bringing that trauma home to the spouse or family.”
Or worse. According to national reports, suicide is a major factor in police deaths. Often under-reported, there is even an organization that tracks suicide among first-responders. Founded in 2015, Blue H.E.L.P seeks to reduce mental health stigma and urges help for post-traumatic stress among police, fire, emergency medical personnel, and 911 tele-communicators.
Thomas says, “We want the public to know that trauma is part of our lives and that officers experience it frequently. We see the worst of the worst, but we have a system in place to assist them at those times.”
Anne Arundel County Fire: Focusing on the Team
“In many ways it is easier for us,” says Trisha Wolford, Chief of the Anne Arundel County Fire Department, comparing mental health training to that of the police: “We are so used to teams. All our training is team-based. The firehouse is a family. We break bread together.”
Wolford admits that mental health is becoming a leading issue in fire service. Alcohol and substance abuse are on the rise. Marriages suffer and divorce is common.
“After all, we’re often the first ones on the scene. We see things most people don’t,” Wolford says.
Like police, all Anne Arundel County firefighters are trained in Mental Health First Aid. Since 2015, it has been standard training and is now part of Day Two at the Fire Academy. The department follows protocols set forth under Critical Incident Stress Management, or CISM, a highly-structured process for helping those involved with a traumatic event to share their emotions and receive further help if needed.
Battalion Chief Paul Doherty oversees the Peer Support Team and is very open about the need for mental health support. In 2016, he “softened” the CISM approach to focus on peer support. Peers receive special training and are embedded into all ranks, thus ensuring “if you are hurting you can go to anyone.”
A pediatric call or teen suicide can be especially scary. Also frightening are “May Day” calls, when one of their own is in trouble. As they describe it, firefighters enter a house that is pitch black. They only have so much air. They can’t breathe and then call out “May Day.” A 911 dispatcher picks up. In such cases it is not unusual for the firefighter to leave the job unless someone intervenes.
“Defusings” can help. A little less formal than a debriefing, it usually occurs right after the incident or, as Doherty explains, as soon as the crew can get back to the station from the hospital, restock equipment, clean up their gear, shower, eat, and sit down together. The department averages two to three per week. Defusings always follow a pediatric incident and conversation is always 100 percent confidential.
Says Doherty, “These sessions expose everything to everyone, so if someone is feeling guilt or self-blame when it’s not warranted, it helps. You can see the mood lighten.”
Doherty has conducted defusings for BWI, the Naval Academy, and Patuxent River Naval Air Station, where his team stayed a full month due to a suicide. Currently, 55 members serve on the team and 10 more are joining, including four who are communication operators.
He is especially sensitive to the 911 tele-communicators. “Most are civilians with no fire background. They haven’t experienced a fire or cardiac arrest or learned how to handle these situations.” To help, he has started bringing them into the defusings.
Like police, suicide with firefighters also is a major concern. Some 200 members of the department are also active military, a group with 17 suicides a day nationwide. Doherty says there have been 11 attempted suicides or suicide ideation in the past seven years. All eleven are still working, a not so small triumph thanks to the mental health first aid training.
“There’s no bonus for this kind of work,” Doherty notes. “We do it because we want to.”
Hospital Emergency Rooms: Caring for Both Patients and Staff
For frontline healthcare workers in Anne Arundel County’s two hospitals, the challenge is similar. Not only do they need to learn how to care for patients coming into their emergency rooms with mental health problems, but also how to care for themselves.
Both Luminis Health Anne Arundel Medical Center (AAMC) and University of Maryland Baltimore Washington Medical Center (BWMC) have dedicated staff and facilities to care for behavioral health. In 2020, AAMC opened the McNew Family Medical Center, a 16-bed inpatient hospital along with outpatient services and a psychiatric day hospital. BWMC serves patients with mental health problems in its inpatient Behavioral Health Unit and across a network of outpatient services.
Cindy Radovic, AAMC’s Clinical Director for Mental Health, oversees both the Emergency Department and inpatients in McNew. A 35-year veteran of the field, she underscores that “when staff see a patient in the ED they know they are seeing them at their worst. It can be very taxing and emotionally draining for staff.”
Similar to their police and fire counterparts, ED staff are trained in non-violent crisis intervention training—what Radovic calls “de-escalation training that is based on compassionate, ‘trauma-informed’ care.” They also conduct debriefings as soon after an incident as possible. A cup of coffee, a walk outside. “It doesn’t sound like much,” Radovic says, “but staff appreciate it.” Nancy Gardner, Director of Behavior Health at BWMC, encourages staff to strive for “work/life balance.” Peer support also is critical.
More than a decade ago, AAMC nursing staff developed C.O.P.E., a program that stands for compassion, outreach, peer, encouragement. COPE enlists employee-volunteers who are trained using Critical Incident Stress Management (CISM)—similar to police and fire—to offer individual or group debriefing services for fellow employees after stressful events.
Radovic finds it interesting that ED personnel seem to use services like COPE the least. “Staff who choose emergency medicine thrive on adrenaline…and that keeps them powered to do the difficult work they do.”
Still, she emphasizes that there is much room for improvement in how staff care for each other. “We need to take care of staff equally as we take care of patients.”
A Final Note
Given the complexities of life today, it is no surprise to discover that first-responders in AA County—across their individual organizations—are all schooled in Mental Health First Aid. The county also can take pride in that many of Maryland’s lead instructors are county residents.
What Mental Health First Aid teaches is open and available to everyone. Do we owe it to our first-responders, and to each other, to learn it, too?
“When you drill down, we are our brothers’ keepers,” Anne Hamel says. “There are never enough professional eyes on us. Providers can’t always be looking. We are the noticers. We are trained to notice and hear. This is a community empowerment mission. Because when we don’t have the tools, we look away.”
Learn to Help
To learn more about Mental Health First Aid or to enroll in a class, contact www.MHFAMaryland.org
Phone numbers to keep closely:
The National Suicide Prevention Hotline 1-800-273-TALK
Anne Arundel County Warm line 410-768-5522
Maryland’s help line for local services: 211, press 1
