Teaching mental health

23 Feb 2015 07:37
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Disputing convention

I don't like how most street medic trainings teach mental health. There is generally something about recognizing "serious mental illness," screening for suicidality in distressed people, and referring the person into the psychiatric system by some route or another. Other "red flags" in some medic trainings include (as I've heard medics describe it), "someone who does not share your reality" or "someone who has gone off their meds."

These messages go against more than a century and a half of civil rights agitation by people who have been subject to mental health systems (and their allies who work in the system).1 The approach of medicalizing distress and preventatively calling 911 is counter to current national best practices of trauma-informed and recovery-focused care.

Training agenda

I teach "social health" when I train. If I framed that section as mental health, I would teach:

  • Recovery-affirming and trauma-informed attitudes
  • HALTS and wellness planning
  • Helping someone make a decision
  • Understanding and using warmlines, hotlines, and other crisis resources
  • Setting good boundaries, using your own support, consent and disclosure

I would briefly touch on basic harm reduction and recovery options for alcohol and other drug use, and highlight sexual assault crisis options. I might teach some basics about helping when someone is suicidal and about learning to be okay with self-inflicted violence.

Good resources

The National Empowerment Center is a great resource for trauma-informed, recovery-focused approaches. Their crisis alternatives page links to information about Emotional CPR (including a free archived webinar) and Intentional Peer Support trainings, and to warmlines and peer-run respites. The rest of their website is also a treasure trove. Check out the archived webinar on alternatives to suicide support groups and the video on Afiya house.

If you learn by reading, see the 36 page PACE manual for a good introduction to recovery. It's part of a curriculum (like Intentional Peer Support) for people to provide support based on their own recovery stories. I think all medics could benefit from a look at the diagram on page 16 to see mental illness as temporary and a civil rights issue.

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The 96-page Engaging Women in Trauma-Informed Peer Support manual goes way beyond what we would teach in a medic training, but it is really useful for evaluating whether your attitudes and approaches are trauma-informed, and answering your questions about taboo subjects like self-inflicted violence.2

Moving Toward Healing: A Nunavut Case Study is a sensitive and practical 37-page examination of a very low-cost, trauma-informed, peer-run program that is the de-facto mental health, sexual assault, and domestic violence program for an Inuit community in Northern Canada. I think it digs the deepest of all the resources on this page into fundamental questions about healing without professional help.3

Finally, many people (including me) have found wellness planning to be an essential part of their recovery process. My favorite guide, despite its medicalizing language, is the 13-page Action Planning for Prevention and Recovery. To do wellness planning with someone (or yourself) in crisis, start out with a post crisis plan.

Conclusion

I don't expect medics to be professional mental health workers, or even to get training beyond a 20-hour; I'm just thinking about how we organize the 2-4 hours in the training devoted to these topics to be less diagnostic/stigmatizing/ineffective. I think many medics are excellent with people in sometimes overwhelming distress; our trainings should reflect our best practices, not our worst.

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