Mental Health First Aid

Fieldwork can pose unique challenges to anyone, especially those with mental health diagnoses. When work is international or remote, it is vital that people on your team are well versed in mental health first aid so you can help someone through a crisis while you wait for emergenecy services or an evacuation. We are not lisenced counselors or medical professionals, but we can prepare to help our coworkers in a medical emergency. 

This page is adapted from the training: UC Field Safety Leadership: Mental Health First Aid for Field Settings by Shannon Anderson (UCSC EH&S)

What causes mental health crises in the field? 

We have mental health issues or crises when we become dysregulated and cannot regulate ourselves.  Dysregulation is an imbalance of states, such as staying activated (fight or flight) even when the stimulus is removed. 

Types of States

1. Parasympathetic vs Sympathetic

• Parasympathetic state is activated when you are relaxed (rest and digest, safety responses) 

• Sympathetic state is activated when you detect a threat (fight or flight, stress responses)

2. Lizard Brain vs Wizard Brain

• Lizard Brain works on threat detection, acts quickly, and has low resolution so it is not always good at using logic and solving problems

• Wizard Brain works on problem solving, needs to work slowly, and is high resolution thinking

3. Polyvagal Theory

• This theory identifies that we have multiple states that we can occupy including a safe state, danger state, and a life threat and we respond differently based on where we are.

• EX: if you move from the danger (fight or flight) stage to the life threat stage, you may freeze before you shut down or collapse

• This video provides a great explaination of this theory and how it connects to trauma and the nervous system. 

Note that we don't have conscious choice of these responses and getting out of a stress response depends on how you safe you feel, not how safe you actually are. 

Trama Informed Care Principles

We are only as safe as we feel. 

Mental wellness is unique to each person, and we can help without diagnosing our peers. 

Connection is the correction. 

We prioritize body-based interventions before brain-based solutions. 

Ask "what happened to you that is informing this behavior?" rather than "what is wrong with you?" 

Acknowledge that triggers are usually sensory in nature and can cause quick changes in mental state, especially in the field. 

Mental Health First Aid for Field Setting Systems

1. APPROACH

• You should approach any intervention with skillful empathy! 

• Before helping others, make sure that you care calm and grounded. If you are panicking, it is more likely that the other person will be panicked and unable to calm down. 

• Take deep breaths to co-regulate together. 

• Ask the person what is happening and how they are feeling. Hold space for them. Do not provide solutions at this time. Connect non-verbally and communicate safety with your body language and a soft voice. 

• When the person has shared their experience, say things like 

  • "Thank you for sharing that with me"

  • "I want to help sort this out for you"

  • "It is hard for me to understand exactly what you are going through, but I can see that it is distressing you"

• Avoid saying "I know exactly what you are going through"

2. ASSESS

• You need to assess the situation with understanding 

• Immediate risks require immediate action, so any situation that poses a harm to self or others needs to be dealt with first. 

  • Depending on the situation, you may want to ask the person if they are feeling suicidal. 

  • You should ask if they have any medical conditions that could present like a mental health crisis or impact the nervous system such as diabetes, stroke, heat illness, or head trauma

  • Determine if their basic needs are being met (drinking enough water, sleeping adequately, etc.)

• Identify what stage of dysregulation is in control. It is too soon to talk about solutions if 

  • the person isn't engaging in a two-way conversation

  • the person is shut down, dissociating, or confused

  • the person is experiencing an intense emotional and/or physical response

  • the person is distracted and not able to follow directions 

• Use active listening to name the feeling you are seeing, paraphrase their experience, and ask open-ended questions 

• Avoid dismissing their feelings, toxic positivity, pity, premature advice, or making it about you 

3. INTERVENTION

• You want to offer body-based interventions before brain-based solutions. 

• Interventions should be rhythmic, repetitive, and relational to engage the whole brain. 

• Exercises and interventions you can use include (but are not limited to)

  • box breathing, tracing a finger with each breath or blowing out candles with each finger

  • doing a body scan and relaxing each part individually

  • using your senses to ground you (ex: listing 5 things you can see, 4 things you can hear, etc)

  • stretching your body or walking around 

  • eating sour candy

  • screaming 

  • smashing something

  • splashing cold water on their face (consentually) 

  • listening to music

  • using firm, gentle taps on the collarbone or sternum

  • doing word games or math puzzles

• Prompt the exercises by saying "maybe we can try this exercise together to ground us"

• Once the moment has passed, we can talk to the person about how their brain was working  

  • teaching them grounding techniques to use in the future

  • destigmatizing the experience

  • encouraging them to journal about their mood

4. PLAN

• Now that the person is out of immediate crisis, you can offer brain-based solutions and assess the situation further.

• You need to decide whether the person and/or group should stay, leave slowly, or evacuate quickly. 

• You can STAY if 

  • the person has mild or moderate symptoms that are field manageable 

  • chronic, known mental health challenges meet all of the following criteria 

    • consistent with past history of episodes 

    • they recovered as expected

    • triggers are known and avoidable

    • the person has not had to see their physician after every incident

  • you can create a support plan that helps this person avoid a future incident

• You should GO SLOW if

  • necessary medications or coping strategies are not available or effective in the current moment, but the symptoms do not pose a safety threat to themselves or others

  • overwhelmed or underprepared group members or first responders cannot assist on their own and require outside help

  • triggers are unavoidable in the field

• You should GO FAST if 

  • there are threats of harm to themselves or others 

  • serious symptoms are not matching the patient's history

  • necessary medications or coping strategies are not available or effective AND the symptoms pose a risk to safety

Prevention and Planning

When creating a field safety plan, you should have some mention of the nearest emergency services and evacuation plans for all medical emergencies. You should also include risks or triggers that may come up during your work. 

You can see offered trainings in this topic on our Workshops page. 

For people who may experience a mental health incident in the field, you can fill out a Safety and Support Plan Template (below) that addresses potential warning signs of a crisis, coping strategies, and support systems that they can rely on. 

Mental Health Resources

• 9-8-8 Suicide and Crisis Line ﾠhttps://988lifeline.org /

• National Alliance on Mental Illness ﾠhttps://www.nami.org/ 

• California Peer Run Warm Lineﾠ(before crisis level) https://www.mentalhealthsf.org/warm-line

• UC CAPS for Studentsﾠhttps://ucop.edu/uc-health/departments/uc-student-health-and-counseling-shcs-and-counseling-and-psychological-services-caps.html

• UC Staff Assistance Programs https://ucnet.universityofcalifornia.edu/work-life-support/support-for-you-and-your-family/faculty-and-staff-assistance-programs/