When someone has a heart attack or stops breathing, a bystander often rushes over and performs CPR, keeping the person alive until trained medics arrive.
King County offers training that aims to make helping someone in a mental health crisis just as second-nature.
The Mental Health First Aid program, based on a national curriculum, teaches people how to approach someone in crisis and offer them initial support until they can get help from a professional. Rather than chest compressions and calling 911, mental health first aid actions could include talking someone having a panic attack through deep breathing, or contacting a crisis hotline or mental health worker when someone is in psychosis.
Valley Cities Behavioral Health, a local mental health provider, contracts with King County to provide free in-person or virtual training to anyone living or working in the county. The Valley Cities program has three full-time staff, and also works with about 40 independent contractors who provide trainings.
“If there are 10 people walking around and someone has a heart attack, one of those 10 will be able to help until we can get that person to the hospital,” said Lisa Floyd, the program manager for King County’s behavioral health and recovery division, which funds the training. “We’re trying to get to that point in King County with mental health. If someone is having a mental health crisis in public, to be able to say, ‘Can I help you?’”
Based on a program started in Australia in 2001, the program aims to reduce the stigma of mental illness. The eight-hour sessions — compared to about two hours for CPR or basic first aid training — take participants through scenarios of someone experiencing a range of challenges, from depression, anxiety and substance use disorders to trauma and psychosis.
At the end, they’ll receive a list of crisis lines they can call, many of which are specific to different communities or issues. Some of the trainings are focused on mental health challenges in adults, while others are for people who work with youth.
The training is guided by an acronym — ALGEE — to remember the steps for responding:
- Assess for risk of suicide or harm
- Listen nonjudgmentally
- Give reassurance and information
- Encourage appropriate professional help
- Encourage self-help and other supportive strategies
Mental health first aid can be used in a range of situations, from someone facing depression or anxiety to someone in active psychosis. It could mean simply listening and validating someone who’s stressed out by a new job and is feeling down, or it could mean calmly talking to someone who’s experiencing delusions while calling a mental health professional to help them further.
The training is not meant to replace mental health treatment, and it doesn’t qualify anyone to diagnose or treat a person. Participants are encouraged to keep their own safety and comfort in mind, stepping back if they feel ill-equipped to respond to a situation.
During a training at the Auburn School District in late June, a group of staff members from the district’s health and security teams put their new skills into play.
The scenario: A high school student was in a serious car accident last summer. He has healed physically, but staffers notice he’s become more withdrawn from friends and activities, and is more emotional than he was in the past. How should they approach him?
Some staff members said they would check in with the teen more frequently, but didn’t want to make him feel uncomfortable by bringing up the accident. Others were more direct, asking how he was doing after the crash, and offering their support if he needed anything.
Trainers advised the approach should be based on listening more than speaking, and that they should ask open-ended questions that give students the space to respond.
RaShawn Caw, a security officer at West Auburn High School, said the situation wasn’t far from what he and his colleagues might encounter on a regular day.
“I think the biggest thing that really caught my eye is some of the warning signs,” he said. “Maybe it’s not asking if something’s wrong, but just checking in with them and having those extra conversations.”
Kathryn Wentzel, a health technician at Pioneer Elementary School, said it’s been helpful to learn tactics for starting the discussion with kids who might be struggling.
“There are different ways of starting the conversation and keeping the door open,” she said. “If they’re not ready to talk right now, they can come to you later on.”
Some of the training covers more intense subjects, such as approaching someone who’s experiencing psychosis or suicidal ideation. Participants can opt out of those sections if they choose.
But for some, those challenging topics are the most meaningful part.
“It really opens the door to have those harder conversations they’re not accustomed to and maybe haven’t had before,” said Brandy Atkinson, Valley Cities’ mental health first aid program manager.
Data from the National Council for Mental Wellbeing, which oversees training standards and curriculum, shows that since 2008, 3 million adults nationwide have completed mental health first aid training. And quotes from people who’ve taken the training nationwide show how some have used the training in their own lives.
Rick Denton, an Army veteran who took the course in Nevada in 2015, told the national organization that his training helped him talk a young veteran through a mental health crisis. The man was hearing voices telling him to harm himself, and Denton, drawing on his training, asked directly whether he was considering suicide. Denton told the young man he was going to get him some help, then stayed on the phone with him, keeping him calm until his mother arrived to drive him to the hospital.
Locally, Atkinson said, groups like the King County Housing Authority and Seattle Children’s hospital have done repeated trainings.
“Seeing people come back and say they want to offer it to their staff and community shows that there’s a huge need,” Atkinson said.
Funded by taxes
Since 2017, King County has offered mental health first aid training for free to any teen or adult who lives or works in the county. The program, which costs about $550,000 annually, is one of the mental health initiatives funded by the Mental Illness and Drug Dependency tax, a 0.1% sales tax applied to all King County residents. The county is now conducting mental health first aid training in the Auburn, Highline and Vashon Island school districts.
Nearly 8,000 people in King County have gone through the program since its inception, said county spokesperson Marc Seligson.
The county has made a recent push to offer more trainings to marginalized communities and communities of color. Seligson said the county provided eight trainings directly to those groups in 2022, and increased that number to 15 trainings in 2023. The county now funds interpreters who can translate trainings into Spanish, Korean and Amharic.
As the program grows, trainers believe it will help people in crisis and continue to reduce the stigma of talking about mental health.
Caw, the West Auburn High School security officer, said he hopes the increased discussions around mental health will have a positive effect on students.
“Not everyone is comfortable having those conversations with students or even approaching them,” he said. “A lot of kids want the help, but they don’t know how to ask. So if we get more comfortable with offering help, they’ll get more comfortable asking for it.”
To sign up for a course, visit valleycities.org/mental-health-first-aid.
