Carl Maronich (Host): This is Health Dose. I'm Carl Maronich. And with me today is Dr. Jonathan Skurya, a psychiatrist with MyMichigan Health. And we're going to be talking about mental health first aid, what it is, how it works, and how each of us can be better prepared to support someone who may be struggling. Doctor, welcome to the podcast.

Jonathon Skurya, MD: Yeah, Carl, thanks so much for having me. Really excited to be here today.

Host: Yeah, great. Interesting topic. So, let's just get into it, and let me start by asking, you know, how is mental health first aid similar and different to traditional first aid?

Jonathon Skurya, MD: Yeah. So, I think that's a really good question to start with. And, you know, if you think of CPR or physical first aid for medical emergencies or situations like that, they've also developed mental health first aid, but that's going to be more so for mental health emergencies, whether it's depression or suicidal thoughts.

And, you know, I like to think of things in those medical analogies. So where you have someone with chest pain or shortness of breath, you know, you wouldn't think twice about them getting to the emergency room. But thinking about mental health in the same way can be really important as well.

And so, similarly, how CPR is supposed to be for bystanders or people that aren't professionally trained, mental health first aid is similar, where the everyday person can do it. So, you don't necessarily need to be a clinician in order to do it. But mental health first aid itself was developed in Australia in the early 2000s, and they use this acronym A-L-G-E-E or ALGEE, and it stands for assess for risk of suicide or harm, listen non-judgmentally, give reassurance and information, encourage appropriate professional help, and encourage self-help and other supports.

So, you know, some of the differences are where physical first aid stabilizes the body, stopping the bleeding, restarting the heart, mental health first aid can help stabilize the moment and building a bridge. You know, you're not necessarily diagnosing or treating, but you're going to recognize warning signs, offer non-judgmental support, and connect the person to care.

It can cover a broad range of situations, including depression, anxiety, and suicidal thoughts. And so, there is, you know, formalized training for this, which it's about an eight-hour course. And so, people interested in that can go to mentalhealthfirstaid.org and see the formalized courses for that.

Host: How does mental health first aid training prepare people to respond to serious situations like thoughts of suicide or self-harm? And is it safe and supportive and effective?

Jonathon Skurya, MD: Yeah. And that's a really important question, and I think it can be helpful to dispel a common myth there. So, a lot of people think that sometimes asking about suicide or asking about questions will make things worse. And sometimes people are afraid that, you know, you might be planting the idea in someone's head.

But, you know, there is significant research and evidence that shows that is actually not the case, and the opposite's true, where having these conversations and asking about suicide and asking about how people are doing can actually provide help and get people to the help they need.

And so, just briefly going through it, you know, the formalized training would prepare you much more for this. But some of the principles of the training are asking directly. So, asking a clear question such as, "Are you thinking about suicide?" You know, using direct language allows a person to give you a direct response. If you use a vague question, that leaves them space to be vague back, and then you're left wondering what their true intentions could be.

In the training, you're also going to be assessing for danger. So, some warning signs can be someone looking for a way out, talking about ending it all, feeling hopeless or trapped or like a burden. And then, a main premise of the training is then listening without judgment, and that can be a really important thing too, you know, just listening and being there to support someone.

And then, ultimately, what I hope everyone can take away from today is then connecting someone to professional help, whether that's calling 911, getting them to their doctor or the emergency room. We're lucky in that we have the 988 Suicide and Crisis Lifeline, so that's pretty easy to remember. It's just 988. People can dial that. And then even nowadays, there's also a text line. So, I know sometimes it's uncomfortable to have a phone call conversation, and that's where texting can be helpful. But, you know, overall, the evidence shows that mental health first aid improves people's knowledge, their confidence to help, and the amount of help they do provide. And, you know, these benefits have been demonstrated to even be six months after the training.

Host: Wow. What are some common signs that folks can look for that a friend, family member, coworker may be struggling with their mental health and some intervention may be needed?

Jonathon Skurya, MD: Yeah. And I think I may have mentioned some of these in the last question, but to kind of expand on them, you know, can be important. And so, similarly, you know how someone with chest pain may be having a heart attack, not everyone with chest pain is having a heart attack. So while these may be some warning signs, they may not be someone who's suicidal or having an emergency, but they at least warrant, you know, additional consideration and getting someone additional supports.

And so, a big premise of this as well is that it's going to be a change in someone's usual behavior. But some of these signals can be, you know, talking about death, looking for a way out, talking about feeling hopeless, trapped, being in pain, increasing alcohol or substance use, anxiety, agitation, or reckless behavior, withdrawing, isolating, or giving away possessions, and then extreme mood swings or talks of revenge.

And then, more broader signs of depression can be persistent sad mood, loss of interest or pleasure, which we call anhedonia, changes in sleep or appetite, low energy, difficulty concentrating, and feelings of worthlessness. And then, specifically, the guilt, worry, and sad mood are ones that have been linked to suicide, so those ones should definitely be taken seriously.

But again, you know, a lot of times it will be someone's big change from their baseline. So, it might be a talkative friend who goes quiet, a reliable coworker who stops showing up, or a family member who may seem checked out.

Host: You, touched on this a little bit ago also, but many people worry about saying the wrong thing. As you brought up, even mentioning suicide, some people worry that's going to give them the idea. You make it clear that isn't generally the case. How should folks approach someone who they're concerned about?

Jonathon Skurya, MD: Yeah. And again, you know, that can be a very common fear and worry. But, you know, it can actually be really hard to say the wrong thing in these situations. And as long as you're approaching it with an open mind, listening non-judgmentally, and coming from a place of caring, you know, that will really come across in these conversations, and the person will see that you are worried about them and caring.

And, you know, more times than not, you're going to be more helpful than you are hurting. And so, you know, they've also studied that in research as well. When people are asked directly about suicide, they feel like it's appropriate, valuable, and not intrusive at all. And again, you know, going into the training, they would provide a lot more detail than this, but some of the main principles can be, picking a private moment, asking non-judgmentally, saying, "I've noticed you've been doing this. I care about you. What's been going on?" And then, again, you know, listening more than you're talking, and that can be a really important skill. You know, a lot of times when friends come for advice or you go to friends for advice, you know, they may just be looking for someone to listen instead of immediately just trying to fix all their problems.

And then, through those conversations, if you are worried, you know, I'd encourage people to ask directly about suicide. And then, if that does happen, you know, reassuring someone that there is help available, that they can go to the emergency room, their doctor, or dial the 988 lifeline can be very helpful.

And again, you know, when in doubt, the 988 number can be a really good resource we can give people, help them call, or even help them text to get to further help. And again, you know, I like using the chest pain analogy, so you don't need to be a cardiologist in order to say that someone should get help for their chest pain. But, you know, you can provide them additional resources or help them get to an emergency room.

Host: Great, advice there. You mentioned this began in the early 2000s in Australia?

Jonathon Skurya, MD: Yeah, exactly. Yes, it was developed there.

Host: Yeah. It seems like we're at a time in the world where mental health is even more in people's minds or there are more struggles certainly. Are you seeing that's generally true? Are there more struggles with mental health today?

Jonathon Skurya, MD: Yeah, I think there are a lot of significant struggles with mental health. And then, I also think too, you know, we are screening for it more and talking about it. So it's also that it's being more well-known and the more understanding we have about it, the more we're seeing. So it may seem like there's more cases, but I think it's also a better knowledge and better screening and understanding of it.

Host: More awareness certainly. And that leads to the, to this question about how mental health first aid may help kind of reduce the stigma around mental health

Jonathon Skurya, MD: Yeah. And so, you know, even though we've come a long way with mental health, there is still a lot of stigma related to it. And Mental Health First Aid itself is really developed to help reduce the stigma. And, you know, it directly does this by increasing knowledge, whether that's about mental health conditions as well as how to get treatment with it.

And so, they've also looked at studies with this, and they looked at 6,000 participants who went through the course, and 90% of them at six months were able to say that they did use the skills from this training to help someone and that they actually felt comfortable in doing so. And so, you know, I'd encourage people to think that, you know, mental health and physical health should just be thought of as health in general and inseparable.

And, you know, people with serious mental illness do die earlier, unfortunately, because sometimes their health is treated as separate or secondary. So I think, you know, reframing mental health as health and something we screen for, talk openly about, and treat is exactly the mindset shift that can help erode stigma and get people the help that they need.

Host: Yeah. Doctor, what's the one thing you'd like people listening to this to take away when it comes to the idea of first aid mental health?

Jonathon Skurya, MD: Yeah. So I think we talked a lot of important things today, but I do think that, you know, I'd encourage people to start thinking about their mental health or start having more conversations about it. And, you know, in doing so, I think that can really help reduce the stigma and really have a cumulative effect to get people more treatment and get people the help that they need, you know.

And treating mental health similarly to people who might be having chest pain, you know, notice, stay with them, and help them get the type of help that they need. And so, you know, that's kind of the entire premise of mental health first aid is noticing these things, asking about it, and getting people to help.

And, you know, for people interested in taking the course, they could go to mentalhealthfirstaid.org or look at their local colleges and universities that offer courses. And then, also, I'd encourage everyone to remember the 988 number, which they could have people call or text if they need to.

Host: Yeah. Doctor, a lot of great advice and the analogy to chest pain is really a great one. It gives people a easy way to understand how significant and important this is and how anybody can really help in this situation

Jonathon Skurya, MD: Yeah. Thank you. I think the analogies can be really helpful to help reduce stigma.

Host: Well, doctor, thanks again for being with us on the podcast.

Jonathon Skurya, MD: Thanks for having me.

Host: For more information, go to mymichigan.org/mentalhealth. If you enjoyed this podcast, please share it on your social channels and check out the entire podcast library for topics of interest. I'm Carl Maronich, and this is Health Dose. Thanks for listening.