After successfully completing her mental health first aid course in Silver City, New Mexico, Mandy Whitenburg hugs MHFA instructor Rebekkah VanNess.

[imgcontainer right][img: mental-health-first-aid-course-2.jpg][source]The Rural Monitor[/source] After successfully completing her mental health first aid course in Silver City, New Mexico, Mandy Whitenburg hugs MHFA instructor Rebekkah VanNess. [/imgcontainer]

Long before people land in treatment for mental illness, there are signs and symptoms that have often gone ignored. In rural areas where professional mental health services are limited, community-based resources such as mental health first aid (MHFA), mental health hotlines and free screenings are being used to identify and support individuals in distress.

Many people are reluctant to approach a distressed individual with mental health needs, yet those same people will quickly extend a helping hand to someone who is physically injured. MHFA is changing those dynamics by equipping laypeople with the knowledge they need to help individuals with mental health issues.

“MHFA is similar to traditional first aid in that it teaches people how to recognize and respond to someone experiencing a crisis,” said Wendy Opsahl, Ph.D., who recently led a national MHFA rural community outreach project. “Many of us are afraid to approach people we think may have a mental health issue because we don’t know what to say or do. MHFA empowers people like you and me with the knowledge and resources we need to know how to respond.”

Many rural clinics and hospitals now include mental health and addiction evaluations as part of routine physical examinations. Mental health experts say MHFA complements such existing services.

“[Mental health first aid] is a perfect fit for rural communities because these areas don’t have the concentration and variety of professional services that urban areas do,” said MHFA trainer Rita McElhany. “So it’s even more important that rural residents understand and are competent to respond to mental health issues.”

Mental Health First Aid Gaining Ground

More than 140,000 Americans have been certified as Mental Health First Aiders, according to the National Council for Behavioral Health. McElhany said participants who take the eight-hour MHFA class learn concrete tools to help distressed individuals get treatment and support.

“I can’t tell you how many times I’ve talked to someone who tells me within a short time of taking the class how they were able to use what they learned,” she said. “This training is so incredibly powerful.”

Created in 2001 in Australia, MHFA was introduced in the United States in 2008. MHFA USA is coordinated by the National Council for Behavioral Health, the Missouri Department of Mental Health and the Maryland Department of Health and Mental Hygiene.

Every state has implemented MHFA to some degree, according to Opsahl, a vice president with Atlas Research. Missouri and New Mexico are among states with the most active MHFA programs and trainers.

Dr. Helene Silverblatt, a University of New Mexico psychiatrist, professor and leader in NM MHFA, calls MHFA a “life-saving intervention.”

“Its value is that it isn’t limited to the mental health care system, but reaches out to everyone in a community,” she said. “Ideally, people who take the first aid course might be your hairdresser, a religious leader, a sister or brother … someone the person in crisis may already know and trust. MHFA is an affordable, highly effective way to reach people.”

[imgcontainer][img: algeeometer-Dec2013.jpg][source][/source]The map lists the number of individuals who have been trained in mental health first aid as of December 2013. The number of trainers in each state is listed in parentheses. (Click map to enlarge.)[/imgcontainer]

About 4,000 New Mexico residents have taken the first aid course to date. The roster of 83 certified instructors includes every director of Area Health Education Centers and health extension officer in the state as well as representatives from health and social services, the faith community, law enforcement, schools, city agencies, tribal communities, correction agencies and volunteer EMS-fire departments. Silverblatt said another 30 instructors will complete training this month.

“We’ve worked to see that instructors are placed strategically throughout the state and represent our diversity both geographically and culturally,” she said. “We have instructors in all the rural regions and are working toward having two in every region. We’re also working on developing more bilingual instructors.”

In addition to grant funding for MHFA implementation and outreach, New Mexico has been approved for two research grants to study MFHA impact and results, particularly among rural, tribal and underserved communities. New Mexico ranks fifth in the nation for suicide, with that statistic is even higher for rural New Mexicans. The state is classified as a Mental Health HPSA (Health Professional Shortage Area) and has a high poverty rate, particularly in rural and tribal regions. Silverblatt said high poverty rates go hand in hand with increases in mental health and addiction issues. She said she thinks the research results will help other states as well.

Missouri has 244 instructors and approximately 13,500 residents that have completed the class. MHFA classes are available in every rural region of the state.

“The support we’ve received from Governor Jay Nixon, the Legislature and community leaders caused an exponential increase in interest throughout the state and MHFA took off like a rocket here,” said McElhany, who coordinates Missouri’s rural outreach program.

To gain support in rural regions, McElhany offered free classes to local leaders in law enforcement and city, county, faith-based and school organizations. She said their enthusiasm and word-of-mouth recommendations have been better than any advertising budget.

[imgcontainer][img:1471-244X-12-98-1-l.jpg][source][/source]Like traditional medical first aid, mental health first aid has simple and memorable protocols to follow. This one, which goes by the acronym ALGEE, provides an action plan for treatment. [/imgcontainer]

Special emphasis is being given to training in school systems. Lafayette County, with 17 rural schools, has been selected for a core initiative to be extended to other school systems. Instructors trained in six school systems are teaching the eight-hour course to all adults in the school that have contact with children.

“Teachers, janitors, coaches, 4-H leaders—if they have student contact, they get training,” McElhany said. “Anyone a child might encounter is equipped with the basic skills to recognize if this young person could be developing mental health problems. You never know who or when a student is going to choose to confide in someone.”

The Missouri Department of Mental Health administers MHFA and distributes state funding for the program. The Missouri Institute of Mental Health (MIMH) administers contracts and distributes funding to community health centers and support resources providing MHFA training and quality assurance.

Increasing MHFA Access Nationwide

More MHFA instructors are still needed in every state, Opsahl said.

There are two levels of training: Mental Health First Aid and Youth Mental Health First Aid. Instructors are certified to teach the eight-hour first aid class anywhere in the United States, although most teach in their own communities or states. Last year, the Health Resources and Services Administration (HRSA) funded the development of a MHFA Rural Curriculum. Training includes looking at how to help when healthcare services are more limited than in urban areas.

MHFA funding varies from state to state. In addition to federal funding, New Mexico and Missouri have funds appropriated through their state legislatures. The National Behavioral Health Council offers assistance for starting a local program and obtaining state funding.

“When you bring MHFA training into rural communities, the overall community level of awareness about resources increases and often leads to greater community collaboration,” Opsahl said. “Government-funded organizations, churches and service organizations work together to create better support networks that address mental illness in their communities.”

Rural communities have a chronic shortage of behavioral health providers, with approximately 57 percent of federally designated Mental Health HPSAs located in non-metropolitan counties. Twenty percent of the nation’s population lives in these rural areas. The most substantial barriers to obtaining mental health and substance abuse services, according to Opsahl, are availability because of fewer providers; accessibility because of distance, transportation constraints and funding; and individual willingness to seek help because of social stigma around mental health and substance abuse.

Nearly half of the U.S. population experiences a mental disorder in their lifetime, yet mental illness continues to be a disease habitually surrounded by silence.

This article is adapted from the spring 2014 edition of the Rural Monitor, a publication of the Rural Assistance Center

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