By Caitlyn Williams, EMT
First responders have traditionally been the ones society relies on to handle life-threatening medical emergencies, whether they’re administering CPR, controlling bleeding, or ensuring airway patency.
However, as the landscape of emergencies expands, so too must the skillset of those who respond to them. What happens when a patient isn’t experiencing a physical health crisis, but is instead battling mental health distress—such as suicidal ideations or severe anxiety?
Mental health emergencies are just as real and critical as physical trauma, and they demand an equally prompt, knowledgeable and compassionate response.
To address this gap, we conducted a survey of 119 first responders across the United States, exploring their experiences with mental health-related emergencies and identifying barriers to integrating Mental Health First Aid (MHFA) training into their continuing education.
The results revealed an overwhelming need for better resources, training and awareness, as well as a culture shift to reduce the stigma around mental health. Institutional review board approval was not required for this survey.
Recognizing the Need for Mental Health First Aid in First Response
Mental health crises can take many forms, from acute stress responses and panic attacks to psychosis, severe depressive episodes and substance abuse issues. These conditions can influence behavior, impact decision-making, and increase the risk of self-harm or aggression toward others.
However, unlike physical injuries, the signs of mental health crises can be subtle or masked by other ailments. Early recognition of these signs is crucial for effective intervention and could potentially save a life.
Despite these needs, the gap in training persists. As one EMS provider shared, “This isn’t our job. This is a cop’s job. We call the police for all mental health patients and leave it to those who are trained.”
This perspective highlights the need for more comprehensive MHFA training, especially considering that 85% of those who have received training completed less than four hours of it.
By integrating mental health first aid into their skillset, first responders can bridge the gap between immediate stabilization and the specialized care required for individuals in mental distress.
Mental health emergencies aren’t always as visibly urgent as broken bones or wounds, but with proper training, first responders can identify and appropriately address these emergencies with the same precision they apply to physical trauma before they escalate to a potentially unsafe situation.
Currently, 79% of surveyors do not feel completely confident in identifying signs of a mental health crisis, and 84% report that they have not received formal MHFA training from their current agency. This lack of preparation underscores the importance of resources like the ALGEE approach—a cornerstone of MHFA training designed to guide first responders in assessing and managing mental health emergencies.
Introducing the ALGEE Method
The ALGEE method offers first responders a structured approach to managing mental health crises:
- Assess for risk of suicide or harm: The first step is to evaluate the immediate safety of the patient and others. First responders should look for signs of suicidal ideation, self-harm, or aggression. Questions about intent or feelings of hopelessness can help gauge the level of risk.
- Listen non-judgmentally: Providing a safe space for patients to express their feelings is essential. Non-judgmental listening involves giving the patient your full attention, displaying empathy, and allowing them to speak openly without fear of judgment or repercussions. Never threaten the patient with getting the police involved to force them to cooperate.
- Give reassurance and information: Offering a calm, reassuring presence can help de-escalate the situation. Simple affirmations that they are not alone and that help is available can provide comfort and ease feelings of panic or despair.
- Encourage appropriate professional help: While first responders may not offer long-term treatment, they can encourage the individual to seek specialized support, such as a higher level of treatment at the hospital, psychiatric services, or substance abuse programs.
- Encourage self-help and other support strategies: Helping patients identify healthy coping mechanisms, personal strengths, and support networks can foster resilience and self-care. For example, recommending that the patient consider support groups or relaxation techniques can empower them to manage their well-being moving forward. Always gauge the risk level of the patient before offering support strategies; your and the patient’s safety is paramount.
While ALGEE is foundational to mental health first aid training, 99% of first responders surveyed have not received or have only received brief training in this plan.
Common Mental Health Disorders First Responders May Encounter
First responders frequently encounter individuals with conditions such as:
- Stressor-related disorders: PTSD and acute stress reactions are common in individuals who have experienced severe trauma. Patients may exhibit hypervigilance, flashbacks and heightened arousal, which can lead to unpredictable behavior.
- Substance use disorders: Many individuals with mental health issues also struggle with substance abuse. These patients may present with disorientation, aggression or withdrawal symptoms, which has the potential to complicate your treatment plan.
- Anxiety disorders: Severe anxiety or panic attacks can mimic symptoms of physical health emergencies (e.g., chest pain, difficulty breathing). Recognizing an anxiety disorder can prevent unnecessary interventions and focus the response on calming techniques.
- Psychosis: Conditions such as schizophrenia can cause delusions, hallucinations, or disorganized thoughts. Patients experiencing psychosis may be frightened or paranoid, and a calm, patient approach can prevent escalation.
Among mental health emergencies, psychosis with hallucinations is the issue first responders reported feeling least prepared to address, followed by suicidal ideation.
Addressing Pediatric Mental Health Crises
Mental health first aid is especially crucial when working with children. Young people may experience mental health crises differently than adults, and their symptoms can manifest through physical complaints, changes in behavior, or withdrawal. For instance, a child in a crisis might not have the vocabulary to articulate their distress and may instead act out or become unusually quiet.
Communication with children in distress should be age-appropriate and gentle, emphasizing empathy and creating a safe environment. Simple language, eye contact, and a calm, steady tone can help reassure the child. Additionally, it’s important for first responders to involve trusted family members or caregivers whenever possible, as a familiar presence can provide comfort.
The Importance of Continuing Education in Mental Health First Aid
Continuing education in mental health first aid is essential for equipping first responders with the skills needed to handle the evolving challenges of their profession.
Despite 53% of first responders encountering mental health-related emergencies weekly or almost daily, 87% report that their agency does not provide ongoing education on the subject.
This gap in training leaves many unprepared to address critical situations effectively, potentially compromising patient care and first responder safety.
To prepare first responders for the diverse challenges of mental health crises, many EMS agencies are incorporating mental health first aid training into their annual or quarterly educational programs.
This training not only educates responders on how to use ALGEE but also provides hands-on scenarios to practice identifying and responding to the diversity of mental health emergencies. Including both adult- and pediatric-focused modules ensures that first responders can apply these skills across all age groups, adjusting their approach based on the patient’s developmental stage.
Agencies might consider supplementing mental health first aid training with quarterly refreshers on specific topics, such as suicide prevention, managing substance abuse emergencies, or dealing with pediatric patients in mental health crises.
This regular practice ensures that first responders stay updated on best practices and feel confident in their ability to handle these sensitive situations.
Furthermore, continuing education could also benefit first responders personally, as 55% say they have not been given the tools and resources to care for their own mental health.
As one first responder noted, “Our service acts like they care about your mental health, yet as soon as you take advantage of the resources, you’re deemed unfit to handle your workload. Ask me if I’ll ever reach out for help again.”
Providing regular training and resources could not only enhance professional competency but also foster a healthier, more supportive environment for first responders themselves.
Conclusion
Mental health crises demand the same level of response and attention as any physical emergency. With mental health first aid training, first responders can be better equipped to recognize signs of distress, communicate effectively, and guide individuals toward the help they need.
By integrating the ALGEE method and adapting their approach for both adults and children, first responders can make a meaningful impact, providing not just a solution to a crisis but a compassionate bridge to recovery. Mental health first aid is more than a set of skills—it’s a commitment to understanding and supporting people in their darkest moments, reaffirming that help comes in many forms.
With this training and empathy, first responders can be the difference not only between life and death but between despair and hope.
Caitlyn Williams is an EMT for Vanderbilt Lifeflight in Nashville, Tennessee.
