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By George S. Everly
According to many authorities, currently there is a mental healthcrisis. School shootings, workplace violence, random acts of violent rage, even some acts of terrorism have been associated with, and even blamed on, acute psychological distress, depression, or more frank mental illness. Data from the National Institute of Mental Health suggests that roughly 10 million individuals in the US suffer from some form of severe mental illness characterized by severe impairments to their daily lives. But it has been further estimated that up to another 30 million people may have to deal with psychological conditions that serve to mildly or moderately interfere with their ability to most effectively function socially or at the workplace. How does society begin to address such a problem when traditional approaches are sometimes disappointing?
Using psychological first aid (PFA) to foster resilience may be one nontraditional approach. This is the third in a series of three discussions of PFA. PFA may be defined as a supportive presence designed to achieve three goals: 1) stabilize (prevent acute stress from worsening) 2) mitigate (de-escalate and dampen acute distress) 3) advocate for and facilitate access to professional assistance, if necessary. Two previous discussions in this series have addressed the first and second goals. This discussion addresses the third goal, facilitating access to supportive psychological care, if needed.
EXPANDING THE REACH OF MENTAL HEALTH SUPPORT
Getting friends, family, and others for whom you care the psychological assistance they might need is not always easy. The first step is recognition. Family members, friends, co-workers, healthcare providers, and educators all have the potential to reduce the stigma associated with seeking mental health care. Furthermore, they have the potential to help others seek professional guidance when needed. This is achieved by serving as compassionate frontline advocates for the pursuit of such professional mental health support.
As noted, the first step to removing the stigma associated with seeking mental health support as well as expanding the reach of mental health services is recognition of the problem. Listed below is a sampling of psychological or behavioral patterns of concern. Recognition of signs and symptoms such as these is a foundation of PFA.
1. Depression: Everyone gets sad, but depression is another matter. The warning signs of a significant depressive episode may be a persistent sad mood for a couple of weeks combined with a loss of appetite, chronic fatigue, awakening early in the morning (often around 3am) with difficulty falling back to sleep, and a loss of libido. We become especially concerned when there is a questioning of the value of life, and the loss of hope or a future orientation as these may herald suicidal ideation and even self-injurious or suicidal acts. Professional care in such cases is imperative.
2. Debilitating Fear: Fear may be thought of as apprehension and stress arousal in response to a specific threat or challenge. Most people have fears of one kind or another. We become concerned when those fears become debilitating interfering with one’s personal or occupational lives. Persistent phobic (irrational fear) avoidance can be crippling. For example the fear and avoidance of crossing bridges or of flying can be quite debilitating.
3. Anxiety: Anxiety may be defined as apprehension and stress arousal in response to an ambiguous threat or challenge. Anxiety can be especially challenging because of its ill-defined nature. It too can be crippling. When it becomes so, it is time to seek a professional opinion.
4. Posttraumatic Stress and Posttraumatic Stress Disorder (PTSD):These are perhaps more correctly envisioned as posttraumatic stress injuries (PTSI): Stress following the exposure to a trauma, usually thought of as either direct or vicarious exposure to a life threatening experience, can be intense and disorienting, but that stress reaction usually diminishes within weeks and resolves within months. When one becomes acutely disabled or continues to vividly re-imagine the experience, becomes psychologically numb or depressed, and experiences irritability, anger, or impulsiveness which interferes with one’s personal or professional life for more than a few weeks, it is then important to seek professional assistance.
5. Strange, erratic, or self-debilitating behavior of any kind, including self-medication: In the final analysis, whether it is crippling depression, anxiety, phobic avoidance, posttraumatic stress reactions, or self-debilitating behavior of any kind that interferes with one’s happiness or personal and professional life, the guidance of a mental healthcare provider should be sought.
Beyond recognition, what else can be done? If you recognize a perceived need for professional mental health guidance or support in someone you care for, work with, supervise, or mentor, compassionate advocacy may be useful in facilitating access to such care. Listed below are some simple steps to assist.
1. Stressful life experiences can make one feel alone and overwhelmed. Make it clear there is no reason for anyone to endure distress alone.
2. Anticipate barriers to seeking professional support and be prepared to address them. Barriers include such things as stigma, a perception of weakness, or a misunderstanding about what mental health providers actually do. Help the person reinterpret getting help as a sign of personal strength, not a weakness. Reframe seeking professional guidance more as a means of fostering resilience, less as seeking treatment. Create a positive and hopeful expectation of improvement or recovery. Point out that delaying intervention can lead to a needlessly prolonged period of distress or inability to function effectively. Lastly, suggest that getting professional support is a sign of respect and concern for others, such as family, friends, and co-workers, as well as well, as themselves.
3. Be prepared to address practical and logistical concerns such as where and how to seek professional services. Be prepared to offer specific options about trusted providers, pastoral counseling options, telephone hotlines, financial counseling services, community-based mental health services, employee assistance programs, or other employer-based services.
4. Use encouragement in a compassionate and supportive manner, but be persistent in your encouragement.
© George S. Everly, Jr., PhD, 2019.