Should Bystanders Intervene When They Identify Mental Illness?

In two days of training, people are learning to recognize conditions like bipolar disorder and schizophrenia in strangers, and what to do about it.
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(Alan Cleaver/flickr)

I’m trying to have a conversation, but the hissing voice keeps interrupting: Don’t trust her, it says. Is she looking at you?

I laugh inappropriately. My eyes dart and my brow furrows. My friend looks worried, uncomfortable. She’s asking simple questions, but I stutter the answers. At first I’m not threatened by what the voice in my head says, but then I hear this: You are a failure. It knocks the wind out of me.

Thankfully, this is not a real auditory hallucination, but an exercise. And I don’t have schizophrenia, but for the first time, I genuinely understand how the illness might alienate and terrify.

The voice in my head is a fellow participant who is reading from a script in a training called Mental Health First Aid. We've gathered in a well-lit conference room in Marin, California on a warm fall day. Most of the attendees are experienced professionals from local government agencies that manage housing, employment, and health benefits. They encounter mental illness in the form of depression, anxiety, bipolar disorder and other diagnoses often, but like most of us, they don’t know if or how they should try to help. This training, which ranges from eight hours to two days, aims to teach them the skills to do just that.

The program, which has been taught in the U.S. since 2008, seems tragically useful these days, given the relatively recent shootings in, among other places, Tucson, Aurora, Sandy Hook, the Washington Navy Yard, and the Los Angeles Airport. In each case, the shooter showed signs of mental illness prior to the rampage, but he never accessed help, or if he did, it wasn't enough to suppress a violent, psychotic break from reality.

When a nurse in Australia developed Mental Health First Aid more than 10 years ago, it wasn't to prevent mass shootings—and that’s still not the goal. Rather, the educational program is meant to familiarize laypeople with mental illness, from its signs and symptoms to how it can be treated. MHFA is also predicated on the idea that if you nudge someone toward getting support and treatment as early as possible, particularly if he or she might be experiencing psychosis, the likelihood of recovery increases dramatically.

MHFA was part of the president’s gun violence reduction plan following the Sandy Hook school shooting; he proposed to spend $15 million on training for teachers. Legislation for that funding has bipartisan support, but it was attached to the doomed gun control legislation and hasn't been called up for a vote since.

Anyone can attend a MHFA class, and its techniques can be used with friends and family just as with acquaintances or strangers. More than 120,000 people nationwide have received training, according to the National Council for Behavioral Health.

The group’s CEO, Linda Rosenberg, helped import MHFA to the U.S., and like many advocates of the program, likens it to the typical first aid offered at community recreation centers. The major difference, she says, is that the average person is more likely to encounter someone who is depressed or suicidal than someone in the throes of a heart attack.

Back at the training in Marin, instructor Gina Ehlert, a cheerful woman in business attire, is comparing physicawhere the l ailments, which tend to elicit sympathy, to mental illnesses, which can unnerve or frighten bystanders instead.

“If there were an individual trying to cross the boulevard in a wheelchair, we’d run to help them,” she says. “But if that person seemed to have a mental illness, we wouldn't.”

That’s where the auditory hallucination exercise becomes revelatory: Those who experience it are able to understand why someone might scream back at a voice in his head. Instead of reacting with fear, the mental health first aider could use the program’s five-step plan to intervene.

The program doesn't urge students to approach every person who might be in need, but rather to use the skills when they feel emotionally prepared and it feels safe and appropriate to do so. This could mean talking to a distressed-seeming stranger on the street, but the trainers also note that it’s also acceptable to keep walking if the circumstances just aren't right.

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Rebecca Ruiz

Rebecca Ruiz is a reporter based in Oakland. She has written for NBC NewsForbes, and The American Prospect.

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