Unit 4

First Aid and Health Mental Health and

Psychological First Aid

Prof. Sanjay Saxena

SMS Varanasi
Unit 4: Mental Health and Psychological First Aid

Unit 4
Mental Health and Psychological First Aid
4.1. What is Mental Health?
Mental health includes our emotional, psychological, and social well-being. It affects
how we think, feel, and act. It also helps determine how we handle stress, relate to
others, and make choices. Mental health is important at every stage of life, from
childhood and adolescence through adulthood.
Over the course of your life, if you experience mental health problems, you’re thinking,
mood, and behavior could be affected. Many factors contribute to mental health
problems, including:
• Biological factors, such as genes or brain chemistry
• Life experiences, such as trauma or abuse
• Family history of mental health problems
Mental health problems are common, but help is available. People with mental health
problems can get better and many recover completely.
4.2. Mental Health First Aid
Mental health first aid is the help you give to someone developing a mental health
problem, experiencing a worsening of a mental health problem, or in a mental health
crisis.
Mental Health First Aid was created in 2001 by Betty Kitchener, a nurse specializing in
health education, and Anthony Jorm, a mental health literacy professor. Kitchener and
Jorm run Mental Health First Aid Australia, a national non-profit health promotion
charity focused on training and research.
Mental health first aid can help people experiencing:
• Depression
• anxiety problems
• psychosis
• substance use problems
• eating disorders
• gambling problems.
It can also help if a person is experiencing a mental health crisis, such as:

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• suicidal thoughts and behaviors

• non-suicidal self-injury (sometimes called deliberate self-harm)
• panic attacks
• traumatic events
• severe psychotic states
• severe effects from alcohol or other drug use
• aggressive behaviors.
4.3. Mental Health First Aid Action Plan
You can provide mental health first aid to those around you by following the steps,
which are provided in the mental health first aid guidelines:
Know the Early Warning Signs
The first step in providing mental health first aid is understanding the signs and
symptoms of an emerging or worsening mental health problem. Not sure if someone
you know is living with mental health problems? Observing one or more of the
following feelings or behaviors can be an early warning sign of a problem:
• Eating or sleeping too much or too little
• Pulling away from people and usual activities
• Having low or no energy
• Feeling numb or like nothing matters
• Having unexplained aches and pains
• Feeling helpless or hopeless
• Smoking, drinking, or using drugs more than usual
• Feeling unusually confused, forgetful, on edge, angry, upset, worried, or scared
• Yelling or fighting with family and friends
• Experiencing severe mood swings that cause problems in relationships
• Having persistent thoughts and memories you can't get out of your head
• Hearing voices or believing things that are not true
• Thinking of harming yourself or others
• Inability to perform daily tasks like taking care of your kids or getting to work or
school.

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Approach the Person

Initiate the conversation with a person whom you want to support. Be open and
honest about your concerns about his mental health. Say you’re concerned and you’re
here to help. Respect the person’s own interpretation of his symptoms. If the person
doesn’t want to talk to you, encourage him to talk to someone else he trusts.
Do not worsen the situation by doing what’s not helpful
Sometimes even with the best intentions, we can make matters worse. When reaching
out to someone you suspect might have a mental health problem, avoid:
• Telling them to get over it
• Being hostile or sarcastic
• Getting over-involved or over-protective
• Dismissing their feelings
• Trying to cure them or solve their problems.
Be Supportive
Listen well and use phrases such as I am here for you, I can see this is a really hard
time for you, and What can I do to help? Maintain the person’s dignity and respect
and do not blame him for his condition. Be consistent in your emotional support and
understanding. Give the person hope for their recovery. Find accurate and appropriate
resources for more information if the person wants it.
Encourage the person to seek help from a trained mental health aider
Ask and help the person to get help from a trained professional to get over mental
problems.
4.4. Depression and Anxiety Disorders
Depression
Depression is more than just feeling down or having a bad day. When a sad mood
lasts for a long time and interferes with normal, everyday functioning, you may be
depressed. Symptoms of depression include:
• Feeling sad or anxious often or all the time
• Not wanting to do activities that used to be fun
• Feeling irritable‚ easily frustrated‚ or restless
• Having trouble falling asleep or staying asleep
• Waking up too early or sleeping too much

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• Eating more or less than usual or having no appetite

• Experiencing aches, pains, headaches, or stomach problems that do not improve
with treatment
• Having trouble concentrating, remembering details, or making decisions
• Feeling tired‚ even after sleeping well
• Feeling guilty, worthless, or helpless
• Thinking about suicide or hurting yourself
Causes of Depression
The exact cause of depression is unknown. It may be caused by a combination of
genetic, biological, environmental, and psychological factors. Everyone is different‚ but
the following factors may increase a person’s chances of becoming depressed:
• Genetic history of depression in the family
• Facing traumatic or stressful events, such as physical or sexual abuse, the death
of a loved one, or financial problems
• Having chronic illnesses, such as cancer, heart problems, etc.
• Using alcohol or drugs
Anxiety
Depression and anxiety are different conditions, but they commonly occur together.
They also have similar treatments.
Most people experience some anxiety — feelings of fear, nervousness, and worry —
from time to time. Anxiety is part of how you respond to stress related to
• before major life events
• when making important decisions
• when trying something new
But if you experience persistent or extreme anxiety on most days for several months
then the anxiety is a symptom of clinical (major) depression. You could have a
generalized anxiety disorder (GAD), panic disorder, or separation anxiety disorder.
Many people have a diagnosis of both anxiety disorder and clinical depression.
Treatment
Symptoms of both conditions usually improve with psychological counseling
(psychotherapy), medications, such as antidepressants, or both. Lifestyle changes,
such as improving sleep habits, increasing social support, using stress-reduction

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techniques, or getting regular exercise, also may help. If you have either condition,
avoid alcohol, smoking and recreational drugs.
4.5. Crisis First Aid for Suicidal Behavior & Depressive Symptoms
If you think that a friend or loved one might be suicidal, you need to act. Always take
suicidal threats seriously. Take the following actions:
Assess the signs of suicidal risks
Signs that a person is at risk of committing suicide include:
• Extreme hopelessness
• Withdrawal from friends and family
• Talking a lot about death or suicide
• Trying to get access to pills, firearms, or other possible means of suicide
• Giving away belongings or saying goodbye
• Not sleeping, seeming irritable or troubled
• Using more alcohol and drugs than usual
Talk to your friend
• Ask your friend if they are thinking about suicide.
• Try to stay supportive and not judgmental.
• Ask your friend if they have a specific plan in mind. When people have settled on
a specific means of committing suicide, they're at higher risk.
Get Help
• If you think your friend is in danger, stay with them if you can. Don’t leave a
suicidal person alone.
• Call help from the nearest hospital and take the person to an emergency room.
• Get support from other friends and family members, even if your friend asks you
not to. It's too serious to keep secret -- and you can't keep your friend safe all on
your own.
• If your friend has been seeing a mental health professional (therapist, counselor,
psychologist, social worker, or psychiatrist), call them and make them aware of the
situation.
4.6. Non-Suicidal Self Injury
Non-suicidal self-injury (NSSI) can be defined as “directly and intentionally inflicting
damage to one’s own body tissue without the intention of suicide. NSSI manifests in

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a variety of different forms, including cutting, skin carving, burning, severe abrading
or scratching, punching, or hitting, bone-breaking, biting, pinching, and interfering
with wound healing. The most common behaviours are self-cutting, self-burning, and
self-battery. Self-battery means punching or banging a body part against a hard
surface to create skin bruising.
Self-injury is not always undertaken for attention-seeking, the other common reason
is emotional regulation when people are trying to cope with overwhelming distress or
self-punishment, which has its origins in self-hatred.
4.7. Non-Crisis First Aid for Depression and Anxiety
Anyone can provide mental health first aid support to someone who struggles with
depression. The mental health first aid treatment approach is a five-step action plan
called ALGEE, which is a mnemonic for:
• Assess for risk of suicide or self-injury
• Listen non-judgmentally
• Give reassurance and information
• Encourage proper professional help
• Encourage self-help and other support strategies
Using these steps, a first aider can mitigate the risk of harm to the individual with
depression and provide them with empathetic support until professional help arrives
or can be sought.
Assess for Risk of Suicide or Self Injury
If the individual is not experiencing a crisis related to suicidal behaviors or non-suicidal
self-harm, the first aider can start a private conversation in which they can express
their concerns and offer help.
Listen Non-Judgmentally
If the person is not in a crisis that needs immediate medical attention, then the first
aider can approach the individual privately and engage in a conversation to understand
more about their situation. This step can help a person who faces depression realize
that they can talk openly about their illness without fear of judgment.
Give Reassurance and Information
One of the most important parts of a mental health first-aider’s work is showing
compassion. The societal stigma surrounding mental illnesses, including depression,

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can discourage people from speaking up about their conditions, or make them feel
alone, isolated, and ashamed. Someone who struggles with a mental illness needs
support and encouragement and deserves to be treated with respect and dignity.
To offer reassurance to someone who struggles with depression, a first aider should:
• Not blame the person for their depression
• Offer consistent emotional support and understanding
• Give the person hope for recovery
• Offer informational resources about depression
Encourage Appropriate Professional Help
Depression is a serious mental illness that deserves comprehensive treatment.
Professional care for depression is warranted if someone has struggled with
depression for at least two weeks and it has severely disrupted their daily functioning.
To encourage appropriate professional help for depression, a first aider should:
• Discuss options for treatment
• Encourage the person to contact health professionals
Encourage Self-Help and Other Support Strategies
The patient may recover faster if they are surrounded by a network of supportive
individuals. First aiders should encourage someone to reach out to friends, family
members, faith communities, or support groups to further discuss their experience of
depression and receive support.
Additionally, a mental health first aider can suggest daily self-help strategies that can
empower someone to form healthy coping mechanisms as they heal from depression.
These strategies can be small lifestyle changes and can include:
• Physical exercise, including walking
• Self-help books
• Meditation
• Relaxation training
• Light therapy
4.8. Crisis First Aid for Panic Attacks
Individuals diagnosed with panic disorder experience unexpected and recurring
attacks that last for a few minutes or longer. People with this condition may attempt
to avoid social interactions and experience professional or financial difficulties. These

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issues may prompt the development of depression, anxiety, other mental health issues
or substance use disorders.
Symptoms of a Panic Attack
A person often feels drained and exhausted when the panic attack finally ends.
The physical sensations of a panic attack include:
• Trembling and shivering
• Feelings of looming disaster
• Tightness in the chest and throat
• Feelings of detachment and lack of control
• Chills or hot flashes
• Numb or tingling sensations
• Feelings of queasiness, stomach cramping and vomiting
• Headache
• Dizziness or lightheadedness
• Sweating
• Increased heart rate
• Rapid breathing and shortness of breath
Mental Health First Aid for Panic Attacks
Follow the ALGEE action steps:
Assess for Risk of Suicide or Harm
Before assisting someone having a panic attack, it is critical to assess for harm. Ask
whether the person’s symptoms are stemming from anxiety or fear, or if they may be
related to another medical issue, as symptoms of a panic attack can also be indicative
of cardiac distress. It is important to assess if an individual has ever experienced a
panic attack in the past. If they haven’t and do not believe that they are currently
having one, call medical help and follow medical first aid protocols.
Listen Non-Judgmentally
Practice active listening skills by:
• Maintaining strong eye contact
• Keeping body language open and relaxed
• Reflecting back what the person has said and ask questions to show understanding
• Being comfortable with crying, silence and awkward moments in conversation

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• Demonstrating patience
Give Reassurance and Information
Ensure them that the panic attack will pass quickly and be over soon. Speak clearly
and with patience and stay with them for the duration of the attack. If the person is
breathing rapidly, remain calm and encourage them to breathe more slowly.
Encourage Appropriate Professional Help
Encourage the person to contact health professionals
Encourage Self-Help and Other Support Strategies
Encourage the person to access other support systems including family, friends,
religious groups, and trusted others in the community. Let them know that there are
support groups specific to those who experience anxiety and panic attacks and
encourage them to reach out to them.
4.9. Crisis First Aid for Traumatic Events
A traumatic crisis is caused by a sudden, unexpected, and intense incident.
The following are the examples of traumatic events:
• traffic accident
• a fire
• natural disasters (earthquakes, floods, etc.)
• serious illness
• death of a close one
• violence, robbery, attack, rape, etc.
• financial difficulties
• relational difficulties
• suicide attempt
These traumatic events produce a significant emotional shock that temporarily
overwhelms the individual.
Mental Health First Aid for Traumatic Event
After a traumatic event, lifesaving first aid is a top priority. It is important to start by
limiting physical injuries. You must first and foremost give lifesaving first aid where
necessary, to make sure that the injured persons get to the hospital alive.

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Behave Calmly: Behaving calmly has a very soothing effect on the casualties and
the psychically affected persons. Behaving calmly means speaking quietly in a normal
pitch and showing clearly that you have time to take care of the affected person.
Listen to the Affected Person: The affected person must be given the opportunity
to tell what he has experienced. This is called Venting. You must accept what he tells
you, and you must not comment on it; only ask questions that make him enlarge upon
the subject.
Physical Contact: It helps incredibly and creates an immediate sense of security if
you take the hand of the affected person or put an arm around his shoulder while you
listen to him. If he cries - which in itself is very good for him - you can allow him to
put his head on your shoulder.
Allow A Person to Have a Good Cry
Crying is a strong outburst of feeling and a means of getting rid of extremely
oppressive feelings. It is therefore very important to cry when the urge to do so arises.
Do Not Let the Affected Person Be Alone
Even if the affected person does not like to have people around him, it is not a good
idea to leave him alone with his psychic crisis. His feelings will seem much more
oppressive when he is alone with them.
4.10. Understanding Disorders in Which Psychosis May Occur
Psychosis involves a loss of contact with reality and can feature hallucinations and
delusions. It is a symptom of schizophrenia and bipolar disorder, but there are many
other causes. Psychosis affects how a person thinks, and their perceptions. Their
senses may seem to detect things that do not exist, and they may find it difficult to
determine what is real and true.
People with psychosis may:
• Hear voices
• See people or items that are not there
• Smell odors that other people cannot detect
• They may also believe that they are in trouble, someone is chasing them, or they
are especially important when these situations are not the case.
Causes of psychosis
The exact causes of psychosis are not well-understood but might involve:

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Genetic factors: Research shows that schizophrenia and bipolar disorder may share
a common genetic cause.
Hormones: Some people experience postpartum psychosis after giving birth. Due to
this, and the fact that the early signs of psychosis often occur first in adolescents,
some experts have suggested that hormonal factors may play a role in those with
genetic susceptibility.
Brain changes: Tests have found differences in brain chemicals — specifically, the
activity of the neurotransmitter dopamine — in people who experience psychosis.
Schizophrenia
Schizophrenia is a serious mental disorder in which people interpret reality abnormally.
Schizophrenia may result in some combination of hallucinations, delusions, and
extremely disordered thinking and behavior that impairs daily functioning and can be
disabling. It's not known what causes schizophrenia, but researchers believe that a
combination of genetics, brain chemistry, and environment contributes to the
development of the disorder.
Bipolar Disorder
Bipolar disorder, formerly called manic depression, is a mental health condition that
causes extreme mood swings that include emotional highs (mania or hypomania) and
lows (depression).
Mania and hypomania are two distinct types of episodes, but they have the same
symptoms. Mania is more severe than hypomania and causes more noticeable
problems at work, school, and social activities, as well as relationship difficulties. Mania
may also trigger a break from reality (psychosis) and require hospitalization.
4.11. Crisis First Aid for Acute Psychosis
Apply ALGEE Method.
Assess for Risk of Suicide or Harm
A person with acute psychosis may hallucinate which encourages them to harm
themselves or others. Delusional thoughts could make them believe that others are
trying to persecute or harm them, and they could become aggressive. If this occurs,
it is known as a crisis.

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Listen Non-Judgmentally
This step is especially important if the individual is experiencing active hallucinations
or delusional thoughts. If they have agreed to talk with you, let them set the pace of
the conversation. Choose a place to speak to them that is private and free of
distractions. Be sensitive to their behavior. For instance, if they are avoiding eye
contact or appear suspicious, give them space.
• Ask them what would help them feel safe or in control
• Offer the person, choices of how you can help them
• Find out if they’ve experienced this before, and if so, what helped them in the past
• Let them know there is hope and treatment available
Encourage Appropriate Professional Help
In the case of acute psychosis, professional medical help is necessary. Many times,
patients with acute psychosis go to the emergency room. By being present and
showing genuine concern, you may be able to reach them during the acute psychosis
process and convince them to seek professional treatment.
Encourage Self-Help and Other Support Strategies
The following self-help strategies can help improve the symptoms of psychosis and
reduce instances of psychosis:
• Locate reliable medical help early on
• Stay connected to supportive and understanding friends
• Reduce stress
• Continue learning about psychosis
• Avoid drugs and alcohol
• Take time to exercise and do things you enjoy
4.12. Understanding Substance Use Disorder
Drug addiction, also called substance use disorder, is a disease that affects a person's
brain and behavior and leads to an inability to control the use of a legal or illegal drug
or medication. Substances such as alcohol, marijuana, and nicotine also are
considered as drugs. When you're addicted, you may continue using the drug despite
the harm it causes. It is considered a disease because drugs change the structure of
the brain and how it works.

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Symptoms
Drug addiction symptoms or behavior include, among others:
• Feeling that you must use the drug regularly — daily or even several times a day
• Having intense urges for the drug that block out any other thoughts
• Over time, needing more of the drug to get the same effect
• Taking larger amounts of the drug over a longer period than you intended
• Making certain that you keep a supply of the drug
• Spending money on the drug, even though you can't afford it
• Attempts to stop drug use may cause intense cravings and make you feel physically
ill (withdrawal symptoms).
4.13. Crisis First Aid for Overdose
A drug overdose is characterized by slowed breathing and heart rate and a loss of
consciousness. If you think someone has taken an overdose:
• Stay calm.
• Call for an ambulance.
• If the person is unconscious but breathing, place them gently on his side in the
recovery position. Ensure his airway stays open by tilting the head back and lifting
the chin. (This can help him to breathe and stop him from choking if he vomits).
• Check his breathing and watch his condition until help arrives.
• Do not try to make the person vomit.
• Do not give him anything to eat or drink.
• Keep any pill containers to take to the hospital.
• If a person is unconscious and not breathing, then start CPR.
4.14. Crisis First Aid for Withdrawal
Powerful drugs like opiates, heroin, and methamphetamine lead to some of the most
severe examples of life-threatening drug withdrawal symptoms. Extreme delusion and
hallucinations during the withdrawal may cause a person to hurt themselves or others.
Withdrawal Management
• The withdrawal management area should be quiet and calm. Patients should be
allowed to sleep or rest in bed if they wish, or to do moderate activities such as
walking. Offer patients opportunities to engage in meditation or other calming
practices.

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• Patients in withdrawal should not be forced to do physical exercise. There is no

evidence that physical exercise is helpful for WM. Physical exercise may prolong
withdrawal and make withdrawal symptoms worse.
• Patients in withdrawal may be feeling anxious or scared. Offer correct, realistic
information about drugs and withdrawal symptoms to help alleviate anxiety and
fears.
• Do not try to engage the patient in counseling or other psychological therapy at
this stage. A person in withdrawal may be vulnerable and confused; this is not a
suitable time to begin counseling.

References
1. Indian First Aid Manual
2. Red Cross First Aid/CPR/AED Instructor Manual
3. Alan Carr, (2012). Clinical Psychology: An Introduction, Routledge. 1st edition
4. https://www.betterhealth.vic.gov.au/health/healthyliving/Mental-health-first-aid
5. https://www.cdc.gov/tobacco/campaign/tips/diseases/depression-anxiety.html
6. https://www.mayoclinic.org/diseases-conditions/depression/expert-
answers/depression-and-anxiety/
7. https://www.webmd.com/first-aid/suicidal-thoughts-treatment
8. https://www.therecoveryvillage.com/mental-health/first-aid/suicidal-thoughts/
9. https://www.healthline.com/health/mental-health/depression-and-
anxiety#coping-tips
10. https://www.medicalnewstoday.com/articles/
11. https://www.mayoclinic.org/diseases-conditions/drug-addiction/symptoms-
causes/
12. https://www.therecoveryvillage.com/mental-health/first-aid/acute-psychosis/

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