BABCP Response - NICE Consultation January 2022

Psychological First Aid for Business, GP’s and others

Psychological First Aid mirrors CBT evidence based treatment protocols for specific disorders and the ultimate target is recovery from that disorder. It went down well when I introduced it to GP’s  on Merseyside in meetings spanning 18 months just after the millenium. I also introduced similar materials to ICI (now Ineos) managers in day long training sessions over a couple of years. Given that GP’s are often the first port of call with mental health problems and  and that mental health sees 300,000 people leave their job each year [‘Thriving at Work’ (2017) report by Paul Farmer], the material seems particularly opportune.

Here is an example from the panic disorder section:

  1. First assess.
  2. Conceptualise: a) panic attacks fuelled by catastrophic interpretation of unusual but not abnormal bodily sensations. View panic attacks as a ‘Big Dipper Ride’, ascending the symptoms get worse, tempting to get off near the top, but if you don’t do anything comes down the other side within ten minutes. b) use of ‘safety behaviours’ that prevent learning that nothing terrible would happen if they did nothing at all in the panic situation.
  3. Treatment: a) review of last bad panic attack. Identification of characteristic misinterpretations e.g. ‘I am going to faint…have a heart attack….make a show of myself’ b) challenging misinterpretations e.g almost impossible to faint with increase in blood pressure c) giving up the ‘safety behaviours’ e.g. escape, deep breaths, sitting down d) in session hyperventilation challenge (provided no heart problems) to help patient ‘know with their guts not just their head’ that panic symptoms are not dangerous e) daring to gradually expose to avoided situations

Psychological First Aid needs updating for the DSM-5 criteria, I developed it in the DSM IV era.

Mental Health First Aid targets ‘stress’ or ‘mental wellbeing’. This ‘disorder’ without boundaries approach, makes the outcomes of intervention always ‘fuzzy’ [ see Towards a Mental Health System that Works Scott (2017) London: Routledge]. But unfortunately ‘stress’/ mental wellbeing’ and their supposed antidotes are a more marketable commodity. Much supposed psychological first aid should be more appropriately labelled mental health first aid because of its’ fuzzy focus. Nevertheless Businesses and Pastoral Workers in Churches can feel more comfortable with Mental Health First Aid because the ‘stress/mental wellbeing’ emphasis means they are not straying  out of their comfort zone into what is perceived as more medical. By contrast psychological first aid has a clear recovery from disorder focus. Pragmatically Mental Health First Aid can be a good starting point but it is unlikely to lead very far.

Coming Soon ‘Improving Mental health via GP’s and Business’ will be the topic of a further post.

Dr Mike Scott

BABCP Response - NICE Consultation January 2022

Soothing, Improvement and Recovery – vested interests in muddying the waters

The list of those with a vested interest in consciously or non-consciously muddying the waters of mental health outcomes (fake news) is staggering and include Charities, IAPT and Independent Practitioners. Consumers, Businesses and Clinical Commissioning Groups beware!

Most client’s of mental health services are glad of the help proferred, they find them ‘soothing’ but this is a far cry from recovery from identifiable disorder. I’ve just put ‘Voltarol’ on my sprained ankle it is soothing, less of a burning sensation, but it doesn’t actually speed up the rate of recovery or increase gait velocity (improvement). Recovery would be back to what I was before I crumpled getting out of the taxi. Blurring the distinction between soothing, improvement and recovery is good for the marketing of a product, analgesic/wares of a mental health service provider, but the ‘injured’ are not well served and ill equipped to protest. As a consequence the juggernaut of existing services continues. There is a pressing need to go beyond expressions of client satisfaction.


E-cigarettes look like a good way of helping people giving up smoking cigarettes, but the long term effects are unknown, a Parliamentary Committee has just been appointed to look at the matter. There is an understandable wariness about wide dissemination in the abscence of evidence.  But there is no such critical awareness when it comes to mental health.


Dr Mike Scott

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