East Bay programs teach the public how to help during a mental health crisis

Lauren Finston rolled up a piece of paper to make a cone. She cupped it against Maya Whitehead’s ear and whispered into the other end: “Why are you talking to her? Is she looking at you? You can’t trust her. You can’t trust anyone.”

Whitehead cringed, straining to ignore Finston’s murmurs as she tried to carry on a conversation with someone else. But her focus wavered. She began to repeat her words, lose track of the conversation. Occasionally, she’d pause and look off to the side, grimacing or laughing in discomfort.

Whitehead was playing a student experiencing an auditory hallucination, which occurs when a person perceives sounds or voices that are not actually in their environment. It’s a symptom common to a slew of mental disorders, from schizophrenia to severe depression. Finston was playing the role of the “voice,” while a third person portrayed a teacher attempting to talk to Whitehead.

Other groups performed the role-playing activity a few feet away. After a few minutes of fretful conversation, the groups gathered back together, a little bewildered. “I almost felt like the voice was calculating,” said one of the participants. “I felt out of control.” Someone else was tempted to respond to the nagging. Those who had played the teacher felt a bit disoriented and uncertain how to respond to the distracted students. Though the exercise couldn’t recreate the sensation of a real auditory hallucination, it made the group members feel sympathetic towards people who do experience them.

The simulation was part of a course held by Catholic Charities of the East Bay in Richmond, California. The program, known as USA Mental Health First Aid, is an eight-hour training designed to reduce the stigma surrounding mental illness and teach the public how to recognize these disorders. It is meant to put participants in the shoes of someone managing a mental disorder. “We’re about breaking down stigma. We’re about breaking down shame, but we’re also about building up compassion and empathy,” one of the instructors said at the training.

Almost a fifth of Americans experience a mental illness in any given year, and suicide rates are at their highest levels in 30 years. Shame, fear, and the inherent complexities of these illnesses prevent people from getting care, perpetuate misunderstanding, and can put both sufferers and observers in risky situations. People may be as reluctant to reach out for help as others are to extend it.

In the last few years, police encounters with individuals experiencing a mental health crisis have made national headlines: The Washington Post reported that one quarter of all fatal police shootings in 2015 involved the mentally ill. Around 70 percent of all youth in juvenile justice systems have a mental disorder, reports the National Alliance on Mental Illness.

So far, over 600,000 people have taken the first aid courses, which are run by the National Council for Behavioral Health, a nonprofit that advocates for public policies regarding mental health and addiction. “The more people out there that have a sensitivity to what the signs and symptoms of mental illness are, the more likely that they’re going to be able to help someone,” said Bryan Gibb, director of public education at the council. “So really, anyone is a good audience for this program.”

The council works with 2,500 member organizations that serve over 8 million Americans affected by mental illness and substance use. By the end of 2016, the institution hopes to double the number of people who have taken the course. The “one in a million” campaign is a step towards the nonprofit’s long-term goal to make mental health first aid as common and accessible as CPR.

In particular, the program aims to be useful for people working with the public, like bus drivers and school employees. There are two main curriculums — one focusing on adults and one on youth — and several others designed for specific audiences like veterans and police officers. Most courses are open to the public for a small fee and are advertised locally, but some sites offer the training for free.

Developed in Australia, mental health first aid launched in the U.S. in 2007. Since the experience of mental illness varies across communities, developing the first aid program has been a learning process for both the council and course participants. Gibb updates the curriculum with new data and customizes it for special groups. Occasionally, he hosts private VIP training sessions for people like First Lady Michelle Obama, who is now certified in mental health first aid.

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Crisis Support Services of Alameda County’s nondescript exterior makes it intentionally difficult to find, but the inside is less subtle, brightened by lime green walls, Christmas lights and abstract paintings. The center offers a 24-hour suicide hotline, support groups, and youth suicide prevention workshops for local schools. Over 60,000 calls a year come into their hotline.

“We believe in the concept that everyone plays a role in suicide prevention,” said Mercedes Coleman, the agency’s director of community education. Coleman works at schools as a health care educator and trains volunteers for the suicide hotline. But when the county contacted Crisis Support Services about mental health first aid five years ago, she also became a certified instructor for the program. Now, five instructors offer two to three free open trainings a year, depending on space and availability, and have trained over 1,500 people.

On the  morning of a Saturday training in April, Coleman left her house around 4 am for her usual commute from Sacramento to Oakland. Another instructor had snagged breakfast snacks — muffins neatly halved and tangerines — for the visitors. Coleman rolled up the metal slats in front of the building and went into an office to prepare. The doorbell began to buzz and people filtered into the conference room.

Men and women sat at a long table chatting and skimming their Mental Health First Aid manuals. Coleman carried in her papers and welcomed the participants in her gentle schoolteacher voice: “You’re going to feel really tired after today,” she cautioned, the thick blue manuals suggesting a dense eight hours.

Turning on the projector, Coleman asked the group to describe how they’d define “mental illness” to an 8-year-old. Maybe you can describe how we’re all different, someone suggested. Or say it impacts the way you live, love and learn, another offered.

“Sometimes adults don’t have an actual definition of what a mental illness is,” Coleman said after a few minutes. The definition can be murky, clinical or complicated, even when someone is familiar with the subject. So mental health first aid programs try to familiarize community members with the symptoms of common disorders.

For another activity, she passed out snippets of paper with phrases like “moderate depression” and “severe chronic bronchitis or emphysema.” Each person was asked to order the mix of physical and mental illnesses from least to most severe. Participants shuffled the words around the table, often rearranging the work of others. The paper reading “breast cancer” slid from the top to the bottom, and then back up the list as people debated whether Stage IV breast cancer or a small tumor was more representative of the condition, describing their own friends who had suffered from the illness.

It depends on your perspective, the group decided.

Coleman approached the table to look over the arrangement, smiling at the debate. “This is not about designating one as worse than another,” she said. The purpose, she explained, was to show how both mental and physical illnesses have comparable effects on a person’s life.

To engage different learning styles, these classes take an interactive approach. Participants watch short videos, listen to lectures and even role-play. An important part of the class is creating a safe environment, where participants can openly discuss mental disorders as well their own personal experiences. Coleman says this is crucial, because “that stigma of silence is huge” and can leave people suffering in isolation.

“People with mental illness are people,” Coleman said, and they shouldn’t be defined by a diagnosis.

Not too far from Crisis Support Services, Catholic Charities in Richmond offers a youth version of the class, which teaches adults how to recognize the often subtle appearance of mental disorders in people ages 12 to 18. Catholic Charities started offering the class in February and now hosts about one per month.

The morning of one of these trainings, just a short walk from the Richmond BART station, people gathered in a conference room. A circle of chairs surrounded a sunflower-embroidered blanket, strewn stones and a small houseplant. Once the chairs were almost full, Catholic Charities staff member Catherine Willett took a seat, along with her co-instructor, Raelle Wilson.

Willett asked participants to shout out words teens may use to describe someone with a mental disorder. “Crazy.” “Mental.” “Weird.” Willett jotted them down on a large piece of butcher paper, nodding. She then removed it from the wall and crumpled it up. “It matters so much how we talk about these issues,” she said. Waving someone off as “crazy” will only do more damage.

At the training, participants opened up, with some describing their own suicide attempts or failures to intervene during another’s mental health crisis. One woman said she has a son with schizophrenia, and that it’s important for the public to be able to differentiate between defiance and mental illness in a child. “My friends, they all kind of learn from me, from what I’m going though. I don’t know if they completely understand,” she said. “You always have someone that tells you, well, just leave him on the street, or kick him out or something. But it’s not the right thing to do. For me, it’s not.”

Participant Connie Chan was four months into her position as a resource coordinator at a low-income housing complex in Oakland. The complex has several units reserved for people suffering or recovering from mental disorders. She occasionally works with families and sees kids. Chan wanted to learn how to better approach anyone who might be dealing with a mental issue. “Because sometimes I recognize, ‘Oh, maybe she needs more help!’ But I’m not sure how to bring it up, so that I’m not pushing them away even more,” she said.

“I think [the course] is a great thing to offer it, and I feel like it will come in very handy for everyone, because you just never know when you’ll find someone or be approached by someone who needs some extra support,” she continued. “You might even find out yourself that you might need some support.”

Bryan Gibb at The National Council thinks they will reach their goal of 1 million trainees, and that a youth peer-to-peer class may be the next curriculum they develop. Until then, open classes are listed on the National Council’s website. “A resident advisor in a dorm at UC Berkeley, a bus driver there in Alameda County, a pastor at a church there in Emeryville — really for anyone that comes in contact with the public, mental health first aid can be useful,” Gibb said.