CPR For Mental Health

Editor’s Note: With the ongoing COVID19 pandemic, anxiety and stress levels are high. Many who are at higher risk of mental illness, as well as healthcare and essential workers on the frontline, are particularly vulnerable. It is more important now than ever to check in on each other. The Mental Health First Aid (MHFA) course will soon be offered online, combining self-paced modules and instructor-led exercises using video-conferencing technology. Check back here for updates. Through their #BeTheDifference campaign, MHFA is also offering a plethora of accessible tips for self-care, reaching out to those who are in need of support, and what to do if you are worried about someone’s wellbeing and safety.

“Is there a doctor on the train? I think he’s having a heart attack!” Deanna Nobleza, MD, looked up from her book. Someone had fainted. With a specialization in internal medicine, she felt comfortable stepping in. She made her way past the other passengers and soon caught the silhouette of a man hunched in his seat, breathing heavily and fast, an alarmed expression on his face. As a licensed psychiatrist, she quickly realized that the person had in fact suffered a panic attack, whose symptoms can actually mimic those of a heart attack.

The prevalence of panic attacks, generalized anxiety, and major depressive disorder is on the rise, especially amongst student populations. College counseling centers are often overwhelmed by an increasing volume of students seeking help; limited staff means long waiting lists and sparse sessions. Several professionals at Jefferson are trying to change that by training faculty, nurses, students, and others members of the community with Mental Health First Aid, or MHFA, a unique program that offers a toolkit to recognize signs of distress and techniques to provide immediate help.

Dr. Nobleza sat across from the man, making sure to not crowd his personal space. She calmly reassured him that he was safe and that his symptoms would pass, and that she would be there with him till he was able to get the help he needed.

“MHFA gives me the basic tools to intervene immediately and get the person to a point of safety” says Dr. Nobleza, Director of Jefferson’s Student Personal Counseling Center, and Emotional Health and Wellness Program for House Staff.

What is Mental Health First Aid?

“The premise of MHFA is that you don’t have to be a licensed mental health professional to help someone who is having a crisis or is struggling,” says Dr. Nobleza. “When someone is having a medical crisis, most of us know to call 9-1-1, some of us even may know how to do CPR. But few of us know how to react similarly when someone is having a panic attack or is depressed.”

Mental Health First Aid was created in Australia in 2001 by Betty Kitchener, a nurse specializing in health education, and Anthony Jorm, a professor in mental health literacy. It has since been adapted by several countries, including the U.S.

Answering a Need for Mental Health Support

“MHFA started at Jefferson about seven years ago,” says Dr. Nobleza. “It was around the time of the Newtown shooting, which all of us were hugely impacted by.” Her department chair, Dr. Michael Vergare made it a priority for her to get trained in MHFA. Once certified as a MHFAider and instructor, Dr. Nobleza started training sessions at Jefferson’s Center City campus. “It started small, but faculty and staff were showing genuine interest and an openness to learn, which was encouraging” she says.

As demand for the training grew, Rose Milani, a master’s student in public health and project coordinator of JeffHELP, joined Dr. Nobleza as an instructor in 2014. “From a public health standpoint, MHFA is all about creating a community that is well versed in support strategies and early intervention” says Rose. “It’s also about breaking stigma and normalizing help-seeking behaviors.”

So far, Dr. Nobleza and Rose have trained 200 people and they have a growing waitlist. “It’s clear that we are filling a need,” says Dr. Nobleza. “It’s a full-day commitment. The fact that people want to take time out of their busy schedules to talk about mental health for eight hours is really heartening.”

“We are getting two more instructors, one at East Falls and one more for Center City, and we hope that the training will soon be available to all staff at Jefferson,” says Rose.

Faculty as First Responders

For Raj Vadigepalli, PhD, professor of pathology, cell biology and anatomy in the College of Life Sciences, MHFA was exactly the tool he was looking for when he noticed that some of his students were struggling. “It was frustrating because I wanted to help, but I didn’t know how to” says Dr. Vadigepalli. “I saw a flyer for MHFA and it seemed to be a way of providing that initial help, while still respecting the boundaries of my students.”

What struck Dr. Vadigepalli about the training was that approaches that seemed intuitive to him could actually be unhelpful. “I didn’t quite appreciate what a panic attack looks like until we did some role play exercises and saw it being acted out. My first instinct would have been to try to comfort the person by putting my arm around them,” says Dr. Vadigepalli. “But in fact, the right thing to do is first ask the person if it’s OK to enter their physical space. You have to make sure that they know they’re in control.”

Since taking the training, Dr. Vadigepalli has tried to make subtle changes in his approach with trainees. “The one thing Deanna and Rose emphasized was that it wasn’t about solving their problems, but rather opening up the conversation,” he says. “So instead of asking them right away – “Did that experiment work?” Or “Do you have the data?” – I start with a simple “How are you?” which hopefully puts them at ease to open up if something is bothering them”

Dr. Vadigepalli is determined to get all the faculty in his department trained in MHFA. “As faculty, we are on the frontline of interacting with students, whether it is in our labs, classes or seminars,” he explains. “So we have a responsibility to recognize when our students may be acting out of character, and be the first responder before they can get help from an actual professional.” He admits that this is not a competency that is emphasized in faculty training. “I’ve been in academia for more than twenty years and this is the first time I’ve heard of something like this. I think it’s imperative that younger faculty are introduced to this training soon after they’re hired so that it’s part of their skillset early on.”

Small Actions with Big Impact

Alison Moss, who is a PhD candidate in Dr. Vadigepalli’s lab and also took the MHFA training, has taken notice of the changes her advisor has made. “We had a big deadline for a manuscript, it was an all-hands-on-deck situation,” explains Alison. “The Friday before, he told us to go home early, not check our emails over the weekend, get good sleep, and come back next week refreshed. Small gestures like that helps to humanize us as trainees.”

In talking to other graduate students, the role of peer support is essential too. “Coming into graduate school, I started reading about how PhD students are more than three times likely to develop anxiety and depression, compared to the general public,” says Medha Sengupta, a first year PhD candidate. “MHFA has helped me feel more confident and comfortable in approaching a fellow student who may seem like they’re having a hard time.”

A big part of knowing how to approach someone is knowing the appropriate language to use, something Eric Brown, a PhD candidate in Neuroscience, admits he had limited knowledge of before MHFA. “There’s this myth that if you are worried that someone might hurt themselves, asking them about it might put the idea in their head,” says Eric. “But Dr. Nobleza and Rose taught us the right wording to use – ‘Are you thinking of hurting yourself? Are you having thoughts of suicide?’ I would have never thought to ask so directly, but it’s a simple step that actually lets the person know you’re concerned for their safety.”

For Tess Cherlin, a PhD candidate in the Genetics, Genomics, and Cancer Biology program and president of the Graduate Student Association, it’s important to facilitate support for what students go through on a daily basis. “We are all under tremendous stress and pressure. MHFA emphasized to me that we all need to be paying more attention to each other,” says Tess. “Something as simple as that can help you notice what somebody else might be going through.”

Adding to the Tool Belt of Future Healthcare Providers

In 2014, as Jefferson’s College of Nursing was looking to expand the behavioral health component of the Nursing curriculum, Dr. Kathryn Shaffer came across a Philadelphia Inquirer article describing how first responders were going through MHFA training. “I thought to myself, nurses are in many ways first responders when they engage with someone – why aren’t we getting trained in this?”

As of today, over 750 faculty, staff, students and nurses have been certified. Perhaps most significantly, they are the first College of Nursing to adopt it as part of the undergraduate curriculum and to expand it to graduate students. “We are committed to educating nurses of the future, who understand how to care for a person, not just a patient,” says Dr. Shaffer.

Neva White, a nurse practitioner and senior health educator at Jefferson’s Center for Urban Health, does all the trainings for nursing students. “Not only do students in healthcare professions suffer from burnout and anxiety, they also have to be equipped with the proper tools and skillset to provide for their own patients who may have mental health concerns,” says Dr. White.

A similar need was found in the occupational therapy program. “Through our anonymous course evaluations, we learned that our students did not feel equipped to deal with patients with severe mental health challenges like schizophrenia or psychosis,” says Tina DeAngelis, EdD, OTR/L, associate professor and program director of the occupational therapy doctorate program. “So first I and other faculty took the training,” says Dr. DeAngelis. “It reassured us that what we were doing was up to date, but it also exposed us to new thinking and approaches to share with our students.” The MHFA training covers de-escalation techniques, especially in the context of a psychotic break, or auditory and visual hallucinations. “Incorporating these strategies in the classroom made our students feel more comfortable going out into these settings and be able to help patients both safely and effectively,” explains Dr. DeAngelis.

A Community Built on Empathy

Alison, who has had several people close to her experience mental illness, says at the end of the day it’s all about empathy. “You could know all the strategies and tools, but it’s the willingness to listen and understand that really makes the difference,” she says. “I think MHFA pivots you to a point of caring, instead of being complacent.”

Dr. Vadigepalli envisions a time when the whole community at Jefferson is trained in MHFA. “Can you imagine, walking around, knowing that instead of only being able to seek help from a counseling center, you have a whole community around you who cares and would be able to help you?”

Indeed, this is the ultimate goal of Drs. Nobleza and White, and Rose. “We’ve had people who took the course call us and tell us how they used what they learned,” says Rose. “It means that our MHFAiders are continuing to foster conversations and hopefully breaking the stigma to the point that it will be the norm to be a MHFAider.”

“MHFA reminds us to be kind to others and also have self-compassion,” says Dr. Nobleza. “It helps us recognize that there’s a shared humanity, and no one has to suffer alone.”

Resources at Jefferson:

• Student Personal Counseling Center or call 215-955-HELP to make an appointment
• Emotional Health & Wellness Program for House Staff or call 215-955-HELP to make an appointment
• First Call Employee Assistance Program for all Jefferson employees

General Resources:

• Department of Behavioral Health and Intellectual Disabilities Services (DBHIDS)
• National Suicide Prevention Lifeline, 1-800-273-8255 (TALK); suicidepreventionlifeline.org
• Crisis Text Line: 741-741; www.crisistextline.org
• National Behavioral Health Treatment Services Locator: https://findtreatment.samhsa.gov/