BASIC STEPS IN MENTAL HEALTH FIRST AID RESPONSE
Elijah had a mental health crisis (1 Kings 19) and sat under the broom tree but made a full recovery.  We will use his first name to explain the basic approach. The Mental Health First Aid qualification provides a more in depth training for pastoral care.


EMERGENCY - Assess the risk of suicide or self-harm.
 
‘Get up and eat, for the journey is too much for you’.
Elijah was hurt, angry, lonely, tired and lacked shelter (HALTS). He needed food, water and a safe place to sleep before he was able to talk and deal with the root cause of his distress. Check that the person has these things. Adult safeguarding training available through your church or local authority will equip you with the knowledge to identify signs of self-neglect or abuse.

‘I have had enough, LORD,’ he said. ‘Take my life’.

When you listen to the person does his/her language reveal their beliefs that the situation is:
• Intolerable
• Interminable (No prospect of change)
• Inescapable   (Nothing I can do can make this better. A sense of helplessness)

If all apply then the risk of suicide or self -harm is significant.
Are they talking about suicide?  Have they made preparations for suicide or arrangements after death?  Have they attempted this before?  Have they taken greater risks recently?  Do they have the means and resources to take their own life?
If you believe that the person is at risk then seek professional help immediately and do not leave them until other help is in place.

If your relative is at risk of harming themselves or others then you can contact the emergency services on 999. They may contact mental health services such as the crisis team. If an ambulance is called but the staff may be at risk, then the police might come with them.

Alternatively, if you feel safe to do so, then take to the accident and emergency (A&E) or casualty department of the Darlington Memorial Hospital.  If available, take another person with you.
Samaritans 116 123 crisis line (free call)

also

NHS 111
You can call NHS 111 when you need medical help but it’s not a 999 emergency. Call 111 if:
• you think the person needs to go to accident and emergency (A&E) or needs help from a crisis team,
• you don't know who to call or you don't have a GP to call, or
• you need health information or reassurance about what to do next.

Walk-in Centre at Darlington Memorial Hospital
Mental Health Crisis Resolution Team
Crisis teams are part of mental health services. They can support people who are having a mental health crisis in the community. They may not be able to get to you straight away if they are very busy.  
Tel. 01325 552230

LISTEN ACTIVELY AND NON-JUDGEMENTALLY

‘What are you doing here, Elijah? In other words, ‘How can I help?’

Some commentators have blamed Elijah for his lack of faith.  Perhaps, this is the case but it is not helpful to point this out at this moment.  Elijah’s behaviour does indicate the symptoms of clinical depression and anxiety.  He views his circumstances as intolerable, interminable and inescapable and suicidal language is evident.

God is ready to listen and does not judge him.  So, avoid criticism and glib advice e.g. ‘pull yourself together, pray harder, things aren’t that bad’ or overused scriptural verses. 
Use empathy and active listening skills.

INFORMATION AND REASSURRANCE

Explain that s/he has a real medical condition that is treatable with help. 
Things can improve. 
Give reassurance. 
If a person is experiencing psychosis then assure them that they are safe and seek help. 

JESUS

‘He walked until he reached Horeb, the mountain of God’.

Elijah went to the place where he could find God. The person has approached the church for help so does this mean they have a Christian faith or believe that you will be impartial and can trust you?  Understand the context and offer help.  The person may ask for prayer or need reassurance that God is still present with them. They may be questioning their faith or seeking answers. 

Don’t be afraid of acknowledging that you don’t have all the answers but do try to meet the person again and offer emotional support.  Link the person with the minister, pastor or senior leader and try to form a ‘circle of care’ with others who can come alongside to help. The NHS Chaplaincy Service may also be a source of help.

APPROPRIATE PROFESSIONAL HELP

The Samaritan took the person to a place where care could be given and maintained the relationship (Luke 10:30-35).  There is sometimes a reluctance to seek professional help due to the stigma associated with mental illness and perhaps the culture of the church is a barrier. Reassure the person that help is discrete and usually confidential and that there are services that provide help in the community.  Encourage the church not to withdraw support once the person is connected into a service as the continuing support of a faith community is often beneficial to recovery.
The person may have an allocated mental health worker such as Community Psychiatric Nurse (CPN), Social Worker or Support Worker they can contact.

HOPE AND SELF HELP

If you can offer time and support to help the person find their own path to recovery then this is often appreciated.  The good news is that there are self-help materials, support groups, and voluntary and statutory agencies that provide advice, guidance and services that address specific needs e.g. mental health, debt and financial, welfare benefits, housing, substance misuse and lifestyle choices such as the benefits of exercise and diet.  If you are regularly involved in giving pastoral care then it is worthwhile building up your knowledge of these local resources so that you can signpost the person and, where possible, help them to link up with them.

People who disclose that they have a severe and enduring mental illness are likely to be involved (or have been involved) with statutory health and social care services.  You can ask if they have a care plan, what the plan is for when they are in crisis and who is involved in their care.
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BASIC STEPS IN MENTAL HEALTH FIRST AID RESPONSE
Elijah had a mental health crisis (1 Kings 19) and sat under the broom tree but made a full recovery.  We will use his first name to explain the basic approach. The Mental Health First Aid qualification provides a more in depth training for pastoral care.
DOWNLOAD OUR FACT FILE IF YOU HAVE CONCERNS
HOPE AND SELF HELP

If you can offer time and support to help the person find their own path to recovery then this is often appreciated.  The good news is that there are self-help materials, support groups, and voluntary and statutory agencies that provide advice, guidance and services that address specific needs e.g. mental health, debt and financial, welfare benefits, housing, substance misuse and lifestyle choices such as the benefits of exercise and diet.  If you are regularly involved in giving pastoral care then it is worthwhile building up your knowledge of these local resources so that you can signpost the person and, where possible, help them to link up with them.

People who disclose that they have a severe and enduring mental illness are likely to be involved (or have been involved) with statutory health and social care services.  You can ask if they have a care plan, what the plan is for when they are in crisis and who is involved in their care.
APPROPRIATE PROFESSIONAL HELP

The Samaritan took the person to a place where care could be given and maintained the relationship (Luke 10:30-35).  There is sometimes a reluctance to seek professional help due to the stigma associated with mental illness and perhaps the culture of the church is a barrier. Reassure the person that help is discrete and usually confidential and that there are services that provide help in the community.  Encourage the church not to withdraw support once the person is connected into a service as the continuing support of a faith community is often beneficial to recovery.
The person may have an allocated mental health worker such as Community Psychiatric Nurse (CPN), Social Worker or Support Worker they can contact.
JESUS

‘He walked until he reached Horeb, the mountain of God’.

Elijah went to the place where he could find God. The person has approached the church for help so does this mean they have a Christian faith or believe that you will be impartial and can trust you?  Understand the context and offer help.  The person may ask for prayer or need reassurance that God is still present with them. They may be questioning their faith or seeking answers. 

Don’t be afraid of acknowledging that you don’t have all the answers but do try to meet the person again and offer emotional support.  Link the person with the minister, pastor or senior leader and try to form a ‘circle of care’ with others who can come alongside to help. The NHS Chaplaincy Service may also be a source of help.
EMERGENCY - Assess the risk of suicide or self-harm.
 
‘Get up and eat, for the journey is too much for you’.
Elijah was hurt, angry, lonely, tired and lacked shelter (HALTS). He needed food, water and a safe place to sleep before he was able to talk and deal with the root cause of his distress. Check that the person has these things. Adult safeguarding training available through your church or local authority will equip you with the knowledge to identify signs of self-neglect or abuse.

‘I have had enough, LORD,’ he said. ‘Take my life’.

When you listen to the person does his/her language reveal their beliefs that the situation is:
• Intolerable
• Interminable (No prospect of change)
• Inescapable   (Nothing I can do can make this better. A sense of helplessness)

If all apply then the risk of suicide or self -harm is significant.
Are they talking about suicide?  Have they made preparations for suicide or arrangements after death?  Have they attempted this before?  Have they taken greater risks recently?  Do they have the means and resources to take their own life?
If you believe that the person is at risk then seek professional help immediately and do not leave them until other help is in place.

If your relative is at risk of harming themselves or others then you can contact the emergency services on 999. They may contact mental health services such as the crisis team. If an ambulance is called but the staff may be at risk, then the police might come with them.

Alternatively, if you feel safe to do so, then take to the accident and emergency (A&E) or casualty department of the Darlington Memorial Hospital.  If available, take another person with you.
Samaritans 116 123 crisis line (free call)

also

NHS 111
You can call NHS 111 when you need medical help but it’s not a 999 emergency. Call 111 if:
• you think the person needs to go to accident and emergency (A&E) or needs help from a crisis team,
• you don't know who to call or you don't have a GP to call, or
• you need health information or reassurance about what to do next.

Walk-in Centre at Darlington Memorial Hospital
Mental Health Crisis Resolution Team
Crisis teams are part of mental health services. They can support people who are having a mental health crisis in the community. They may not be able to get to you straight away if they are very busy.  
Tel. 01325 552230
LISTEN ACTIVELY AND NON-JUDGEMENTALLY

‘What are you doing here, Elijah? In other words, ‘How can I help?’

Some commentators have blamed Elijah for his lack of faith.  Perhaps, this is the case but it is not helpful to point this out at this moment.  Elijah’s behaviour does indicate the symptoms of clinical depression and anxiety.  He views his circumstances as intolerable, interminable and inescapable and suicidal language is evident.

God is ready to listen and does not judge him.  So, avoid criticism and glib advice e.g. ‘pull yourself together, pray harder, things aren’t that bad’ or overused scriptural verses. 
Use empathy and active listening skills.
INFORMATION AND REASSURRANCE

Explain that s/he has a real medical condition that is treatable with help. 
Things can improve. 
Give reassurance. 
If a person is experiencing psychosis then assure them that they are safe and seek help. 
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Emergency services (999)

If your relative is at risk of harming themselves or others then you can contact the emergency services on 999. They may contact mental health services such as the crisis team. If an ambulance is called but the staff may be at risk, then the police might come with them.