Psychological First Aid https://files.acrobat.com/a/preview/e63fef15-64b0-4ccd-9766-64ae469ba067 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:
- First assess.
- 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.
- 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