The Time is Now for Mental Health First Aid


May is Mental Health Awareness Month and in our world today there’s plenty of  reason to want to be aware.

Vermont has established as a policy if not in practice that physical and mental health deserve and must receive an equitable healthcare commitment and investment. But our metrics for mental health wellness, especially among our young and aging populations, show that we’re failing in delivering on physical and mental health parity. Still, there are some positive changes in the works.

The mental health system has been allowed to deteriorate for years. What was left of the Vermont State Hospital in Waterbury was closed permanently in 2011 after severe damage by hurricane Irene.  In an effort to maintain treatment facilities, 25 beds were opened at the new state facility in Berlin, 16 at the Brattleboro Retreat and six at Rutland Regional. These 47 acute beds actually exceeded the number available when Waterbury closed, since seven had been occupied by long-term patients, some of whom had been at the State Hospital for years. This effort was an acknowledgement that mental illness requires treatment, but it delivered care that ran the gamut from inspired (The Pig Barn and its innate understanding of the healing capacity of caring for animals) to inhumane (the cells in the basement where “mental defectives” were essentially incarcerated) which ended in the early ‘60s.

In 1915, the Brandon Training School opened. Named originally “The Vermont State School for Feebleminded Children,”   ̶   no doubt in response to the rising enthusiasm for eugenics at UVM   ̶   it further reflected our poor knowledge of the science and epigenetics of mental health and closed permanently in 1993.

We’ve learned a lot in the intervening years. We now understand the critical role that trauma plays in disrupting both mental and physical health. In the ‘50s when I was a child, no one had ever heard of or imagined what we now understand as adverse childhood experiences (ACES). That’s not to say they didn’t exist, but a sort of “family code of honor” meant that one kept them to oneself. Whether sexual abuse, physical abuse, pregnancy out of wedlock, family suicide, an incarcerated family member, alcoholism, or drug addiction (yes, pharmaceutical drug addiction was common back to World War I. It existed in my own family.), these facts were kept quiet. The good news for mental health today is that we acknowledge these issues more freely. This has opened new paths to treatment such as “trauma-informed awareness and counseling” and recovery.

The newest approach in cutting-edge science is calling into question the very existence of “mental illness” as we have understood it, while clearly acknowledging the existence of the symptoms of mental illness. New research at Harvard Medical School and McLean’s Hospital, presented in the book Brain Energy by Christopher Palmer M.D., the Director of the Department of Postgraduate and Continuing Education at McLean Hospital and Assistant Professor of Psychiatry at Harvard Medical School, focuses on metabolic dysfunction as evidenced in an analysis of human mitochondria showing a connection to the symptoms of mental disorders.

Patients with symptoms such as anxiety disorder, depression and even bipolar disorder have seen recovery when their diets are changed, hinting at the relationship between what is still conventionally called mental illness and the wide use of chemical soil amendments to support an industrial processed-food supply. This research has given rise to the science of psycho-nutrition.

Ironically, here at home in Vermont, Governor Scott has just vetoed a bill designed to limit the use of neonicotinoids, which is only one of the three major toxins systematically applied to our soils and draining into our waterways.

But, for now, a practical response draws on the venerable tradition of volunteer fire brigades and emergency medical services teams (EMS) in communities around the state. These dedicated first-responders and emergency medical technicians (EMTs) are well trained in first aid diagnostics and treatments. They respond to calls for help, whether at the scene of an accident resulting in traumatic injury or at home emergencies such as a cardiac arrest or diabetic coma.

Medical advances and first-aid training have migrated some emergency care into ambulances, so emergency care starts with EMTs in the ambulance in radio contact with medical personnel at the hospital so that emergency room personnel are aware and ready for an arriving patient.

A promising new healthcare model has emerged in the last decade that parallels our community EMS services. It focuses on emergency mental health crises and is called Mental Health First Aid. As of 2023, more than 3 million people in the U.S. have received training in Mental Health First Aid (MHFA), including First Lady Michelle Obama, by some 1500 certified instructors.

What is the size of the problem? Vermont’s older population is our fastest growing age group. If trends continue, by 2030, one in three of us will be over 60 and older adults have high rates of late-onset mental health challenges like anxiety and depressive disorders, often brought on by loneliness or lack of regular human connection. Males over 75 have a higher rate of suicide than any other population cohort.  Mental Health First Aid for Older Adults can be a protective factor for our family members, neighbors, colleagues, and friends.

When we think of Mental Health First Aid, we must also take stock of the rising rate of mental distress in our young people. Mental illness does not discriminate by age. It is spiking in our oldest and youngest populations.

Suicide rates among our young are rising. Many of our emergency rooms are filled with young people suffering from suicidal ideation or attempts at suicide, self-harm, depression, anxiety, addiction, and eating disorders and we have little or no care facilities for them. And these mental health manifestations are rising in our schools which struggle to find and fund resources to deal with them.

The case for addressing mental health crises among our youngest and oldest populations is urgent and training in Mental Health First Aid is a critical step in the right direction.

By way of example, you come home after work and find your live-in grandfather despondent and talking to himself about ending his life. You know there’s a gun in the house. Or perhaps your teenage son has disappeared from family events and meals, lives on his cellphone and no longer responds to questions about his wellbeing. A person trained in MHFA would be able to identify and respond to symptoms like these.

We will also need trained MHFA-trained people available in our hospitals, nursing homes, colleges and schools. Mental Health First Aid is akin to cardio-pulmonary resuscitation (CPR). We can always use more people knowing how to apply CPR and the more people trained in CPR, the safer we all are.

If you need emergency mental health care or know someone who does, you can reach out here for help. Locally, United Way is offering free training in June.

Physical and mental wellbeing are integrally linked and we are finally developing the resources to care for both in an emergency. This is progress in healthcare.

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