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Times Like These Call for Mental Health First Aid

Medic 21, Rescue 8, respond with law enforcement to an EDP (emotionally disturbed person), 5522 Hollow Town Road. Cross streets are Jameson and Benton. The subject’s girlfriend will meet you at the scene. Time out: 20:15.

We respond to these calls too often. Patients feel out of control, depressed, or suffer from other demons. Addiction runs amok. Funding for psychiatric hospitals and mental health has decreased. There are more people with unresolved issues on our streets than ever before. Critical Incident Stress Debriefing (CISD) and Critical Incident Stress Management (CISM) have left their marks on the battlefield and responder ranks. Now we need more, not more of the same.

Mental Health First Aid

Mental Health First Aid (MHFA) is an international training program that helps identify self-help and professional resources for those with addiction or mental illness. For EMS providers it increases knowledge of the signs, symptoms, and risk factors of mental illness and addiction. 

The MHFA program bolsters caregivers’ confidence to help people in mental distress and increases the likelihood they will provide needed help. Attendees often show an increase in their own mental well-being as well.

MHFA was created in 2001 by Betty Kitchener, a nurse specializing in health education, and Anthony Jorm, a mental health literacy professor. Together they run Mental Health First Aid–Australia. The nonprofit charity focuses on health promotion, training, and research.

Mental Health First Aid–USA adapted the Australian program. Twenty-seven countries are part of Mental Health First Aid–International. As of May 2017 the Mental Health First Aid–USA program had taught more than a million people nationwide. Together MHFA–International has trained more than three million worldwide.

How It’s Helping 

The MHFA program removes our hesitation in starting a conversation about mental health and substance use. It gives us the information we need to start connecting, so we can provide people with the help they desperately need. It begins with the ability to identify issues in the people we encounter that allow us to start talking. We can often steer them in the right direction for self-help or professional care.

Identifying and understanding the signs of mental illness or substance use are paramount. We often go idly by, ignorant of the suffering that goes on around us. Melissa Taylor, a nurse consultant with the Tennessee Department of Health’s Emergency Preparedness Program, teaches the course in Northeast Tennessee and is recognized as one of its leading instructors in the United States. Taylor is excited about how the public and emergency response communities embrace the program. “This training is a game-changer,” she says, “because it empowers people to feel confident about reaching out to friends, family members, coworkers, and even strangers to ask those critical questions: ‘Are you OK?’ ‘Is there something I can do to help?’ And ultimately, if indicated, ‘Are you thinking about killing yourself?’ 

“Suicide rates among our youth and in our first responder communities are soaring. I believe we can change this, and the first step is education.”

The Bristol (Tenn.) Fire Department has put all its fire and EMS personnel through the program. Tommy Castle, assistant chief of operations, believes the program provides an added benefit of showing younger employees the benefit of talking to one another. 

“The younger guys,” he says, “are on their phones doing things instead of talking with each other, as we used to do. The program teaches them to recognize feelings or thoughts they may be having, or when something may not be right with someone they’re working with. This helps us just as much or more than learning about what to do and say, or what not to do and say, when dealing with patients and their families on calls.”

Research has found the MHFA program reduces social isolation and the cynical views of people with mental illness. Such studies reinforce the effectiveness of the program in bringing people together.1


While CISD is well known and used frequently in the first response community, its effectiveness has not been proven.2 CISD is conducted in a single session within a week of its precipitating trauma. The session may include up to 20 people who are asked to detail their experiences. The group is encouraged to share emotions. Sharing is the method used to normalize their reactions and support one another. The CISD program has been found to have potentially detrimental effects in some cases. 

CISD and MHFA are two different animals, though the implementation of MHFA has dramatically decreased the need for CISD/CISM sessions in Northeast Tennessee, according to Taylor.

Implementing Public Safety Programs

In only eight hours the MHFA program can teach emergency personnel how to identify, understand, and respond to signs of mental illnesses and substance use disorders. The initial support first responders can provide to someone developing a problem can make a difference. The MHFA program is recommended for family members too. 

Why does mental health matter for fire and EMS workers?

  • 85% of first responders have experienced symptoms related to mental health issues;
  • 75% of rescue workers report mild symptoms of psychological trauma following disasters;
  • 40% of responders said there would be negative repercussions for seeking mental health help at work.

The MHFA for fire and EMS program can help by reducing the stigma of mental health issues. It does this by increasing mental health and substance use literacy and teaching skills to safely address colleagues’ challenges. It also benefits the public, as it teaches skills to help providers address mental health and substance use problems on emergency scenes.

Getting Started

Only certified MHFA instructors teach the course to the public. Instructors provide the core program model and key messages using a range of adult learning styles. They may tailor the presentation to diverse audiences and learning environments. The program will teach risk factors and warning signs and strategies for helping. 

Instructors cover depression and mood disorders, anxiety, trauma, psychosis, and substance use. The takeaways involve recovery and resiliency. People with mental and substance issues can get better if they use their strengths and resources to help them stay healthy.

To become an instructor, you must be certified by Mental Health First Aid–USA. Certifying as an instructor requires completion of a three- or five-day interactive course. Instructor programs are for individuals, not organizations. 

Teaching both the youth and adult course types requires certifying as an instructor through a new instructor training, then teaching at least one course before applying to become certified in the secondary curriculum. After acceptance you can attend a shortened version of the five-day training or a three-day training for the other course.  

Sidebar: ALGEE

The Mental Health First Aid course teaches an approach represented by the acronym ALGEE:

  • A—Assess for risk of suicide or harm;
  • L—Listen nonjudgmentally;
  • G—Give reassurance and information;
  • E—Encourage appropriate professional help;
  • E—Encourage self-help and other support strategies.


1. Mitchell JT. When Disaster Strikes…the Critical Incident Stress Debriefing Process. J Emerg Med Serv, 1983 Jan; 8(1): 36–9.

2. McNally RJ, Bryant RA, Ehlers A. Does early psychological intervention promote recovery from posttraumatic stress? Psychol Sci Public Interest, 2003 Nov; 4(2): 45–79. 

John M. Dabbs is a consultant and investigator for the Northeast Tennessee Regional Health Office. 


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