Brenda Crawford was taught the textbook description of psychosis while she was studying for a masters degree in counseling, decades ago.
“It was always explained as ‘hearing voices in your head’,” said Crawford, who works for Wyoming’s state employee assistance program. “Which I had no way of really understanding.”
That is, until she took her first Mental Health First Aid class. In one exercise, Crawford had to hold a conversation with another student while a third stood behind her, jabbering away on an unrelated topic into her ear. This wasn’t just a quiet voice inside her head — it was a loud, pushy voice competing with her own thoughts and her own communication with the outside world.
“It was impossible to focus on the other conversation, it was chaos,” she said. “I never had thought of psychosis like this, even after years of interacting with people with schizophrenia and other serious mental illnesses.”
Crawford wasn’t alone. Now a class instructor, she’s met hundreds of students whose perceptions of mental illnesses have been challenged and debunked through the 8-hour training.
Developed in the U.S. by the National Council for Behavioral Health in 2008, MHFA classes are meant to give people the tools they need to identify mental illness in people they interact with on a regular basis — and support them in finding help. Breaking stigmas and misconceptions about mental illness is just an added bonus.
MHFA is a nationally recognized and increasingly popular resource. Congress included a $15 million appropriation for MHFA in its gargantuan spending bill released in December, marking the third year in a row it has financially supported the program. Shortly after the bill passed, the program announced its goal to get 1 million Americans certified in MHFA by the end of 2016. Currently, roughly half that number of people have gone through the process, but a growing number of instructors like Crawford may get the program on a sure path to its goal.
Bryan Gibb, public education director for the National Council for Behavioral Health, said he’s seen a big push across police departments, social service agencies, and other public health groups to get their staff trained to teach this new form of first aid to both current and future employees. And since he first started working with MHFA program six years ago, Gibb said the motivation behind getting trained appears to be changing.
“When [former U.S. Representative] Gabby Giffords was shot, people wanted training to ‘learn how to protect us from the crazy people’,” he said.”But now they’re saying ‘we have people in our community who are suffering — how can we serve them?’”
That’s where MHFA comes in to play. NCBH’s “train the trainer” programs now certify around 200 new MHFA instructors per week across the country, according to Gibb. He compares the training to any other medical certification class, like CPR.
Unlike basic first aid, where you learn how to react after a crisis takes place — a twisted ankle or a serious cut — MHFA aims to confront the problem long before a crisis has hit. That means people trained in MHFA may put their skills to use more often.
“In reality, it’s far more common to find people struggling with emotional problems than choking on a steak,” said Gibb.
Instructors teach their students how to identify signs of mental illness, how to talk comfortably with someone about it, and how to best guide a person suffering from a mental illness to get help. The point is to catch the illness before it gets worse — just like the approach to any other disease.
“It’s like cancer,” sad America Paredes, who teaches MHFA in Washington, DC. “You don’t wait until a person has stage four cancer to treat them. You start as soon as the cancer’s detected.”
Paredes said she’s been constantly surprised by how uninformed people are about the basics of mental health. Many of her students come in with pop culture as their only previous source of information about mental illness.
Others are intimately familiar with mental health issues because they’ve come to Paredes’ classes to learn how to get their friends or family to understand what they’re going through — without forcing their loved ones to take the class themselves. When those students open up about their own mental illnesses, it can help put a friendly face on something so unfamiliar to many.
“I’ve seen people in classes be like, ‘You have depression? But I’ve been sitting next to you this whole time and you’ve just been normal,’” she said. “When those kind of connections are made, the stigma just fades away.”
Gibb said he hopes someday the training will become as universally mandatory as standard first aid courses. And some states already see it that way.
In Wyoming, where suicide rates are the fourth highest in the country, some state agencies have required staff to go through the training. And Crawford, who has been a certified MHFA instructor for barely a year, has already taught the course to the staff of the five major state prisons in Wyoming. And, as a state so traditionally seeped in gun culture — but so affected by gun-related suicides — she knows her job is more important than ever.
“it’s amazing the stuff that comes out of these classes,” she said. “I’m always surprised by how many people have a personal story of how suicide affected their life — whether its their father, their friends, their friend’s friend. It’s clearly very close to home for almost everyone in the room.”
But she’s not trying to push any agenda. Linking gun accessibility and suicide is something she’s watched students do on their own during a course, whether or not its related to mental health.
“I know mental health training isn’t the only way the state can help change things, but it starts the conversation, and breaks the silence,” she said. “I have hope.”
Jill Ramsey, who has trained over 4,000 people in Alaska in MHFA, said that shattering this stigma-driven silence is key in getting communities — especially small, rural ones — to face real mental health crises. Alaska ranks second in the country for having the highest suicide rate.
“These conversations have to happen. This isn’t just family business, something to be ashamed of, this is something we have to talk about,” she said.
In many cases, Ramsey has taught a group who has recently lost a community member to suicide — often sparked by an undetected mental health struggle. “It’s heartbreaking have a classroom asking you what the should have done differently,” she said.
Alaska also has a drastically small number of health care providers for its population and state size. Ramsey sometimes travels a thousand miles to remote towns or Native Alaskan communities to teach. In some small communities that lack any mental health resources whatsoever, people without a college degree are the most informed on the issue — just because they’ve taken the MHFA.
Like other instructors, Ramsey said her favorite part of teaching is watching her students’ transformation.
“Undoing preconceived judgments and misinformation is a beautiful process,” she said. “The people who come in with one strict opinion and leave open minded — they are the true champions of the class.”