Designing Mental Health Training

June 2013

Mental health “training” is a popular way for organizations to address mental health issues by teaching people how to better “refer”, “assist”, “support”, “help”, and/or “address” those who are in distress to mental health services and resources. These training programs come in different shapes and sizes and tend to focus on knowledge and/or skill development that, at a very basic level, enables trainees to understand how to identify the signs of distress, engage with a person who exhibits these signs, and make a referral to an appropriate support.

I have been contemplating ways that mental health training is designed and implemented, and taking a look at what is out there. In considering what it means to offer “mental health training” on campus for students, staff and faculty, I have been carefully assessing the guiding values, messaging and practicality of training content. There are benefits and disadvantages of existing trainings and while I am still early in the process, I’ve noticed a few trends:

Personal Boundaries: Most trainings fail to consider the boundaries, assumptions and expectations of the person offering support. At a baseline level, I think there is something we can all do to provide some level of support to someone in distress, but at the same time, it takes a careful understanding of oneself and her/his concept of mental health, personal values, and comfortability to ascertain how this actually looks in practice. In order to “do no harm” (borrowing from primum non nocere) and not escalate a situation, it’s important to know to what extent one is expected and able to intervene.
Symptom Focus: While the aim of trainings aren’t to equip people to act as “pseudo-professionals” who can diagnose mental illness, there appears to be a lot of emphasis on identifying the symptoms of various illnesses and problematic behaviour changes. I agree that there is great value in recognizing these signs, but the emphasis placed on symptoms (by illness) can be overwhelming to remember and may encourage people to diagnose others. Coupled with a lack of understanding around personal boundaries and without coaching on how to incorporate ‘illness’ signs/symptoms into a conversation, the symptom focus may lose its effectiveness, in my opinion.
Social Construction of Illness: A lot of content doesn’t take a look at mental health in context including its various histories, perspectives, and determining factors. I find this most interesting as I imagine it would be challenging to appreciate and begin to address mental health without a better understanding of it, particularly since it can be a highly stigmatized and contentious issue to raise.
Memorable Messaging: Trainings tend to describe “steps” to follow in a help scenario. While useful, in the moment it may be difficult to recall what one has been trained to do if the messaging is too long, highly specific to a disease or host of symptoms, and not memorable. More often than not, reams of training text are compiled into a guide or book of sorts for people to read through, but I find this is personally more helpful as a reference than a practical, front-line tool. I think that people could greatly benefit and remember more if a condensed aid is available, particularly if it is visual.

From my perspective, I think one of the most interesting things about “training” is that it relies on exercising something that is innately human: our interpersonal skills. This includes conflict resolution, validation, de-escalation, talking, observation, physical language, active listening, personal boundaries, values, empathy, and guidance. While these might seem like natural qualities, they are skills that we do not make time to practice or teach each other in formal contexts…and it is interesting to see this as such a massive need when it comes to health and wellbeing. Consequently, a lot of practical skills related to training comes down to having a conversation with one another in order to reach an understanding of what’s going on and what we can do about it.

I came across this NY Times Opinion piece, How Not to be Lonely by Jonathan Safran Foer, and found a couple of beautiful quotes that speak to the precious act of taking the time to make a connection with another person:

"Most of the time, most people are not crying in public, but everyone is always in need of something that another person can give, be it undivided attention, a kind word or deep empathy. There is no better use of a life than to be attentive to such needs. There are as many ways to do this as there are kinds of loneliness, but all of them require attentiveness, all of them require the hard work of emotional computation and corporeal compassion. All of them require the human processing of the only animal who risks “getting it wrong” and whose dreams provide shelters and vaccines and words to crying strangers."

“Attention is the rarest and purest form of generosity”

In considering ways to ‘simplify’ training skills and step and make them more memorable and accessible to a general audience, I thought about how to convey training content in a minimalistic yet still informative manner. I also wanted to place focus around interpersonal skill development and interaction than disease states, which I think is a helpful shift to make.

One of the first examples I thought of was IKEA instruction manuals. IKEA is well known for its focus on its modern, simplistic, accessible and easy-to-assemble design. It was only a few years ago that IKEA’s change in typography caused a massive backlash from designers, demonstrating how a change in IKEA’s design standards could have a huge impact on the design world. In any case, over the years I have come to appreciate how visual IKEA’s instruction manuals are as they illustrate the tools, parts, and process required to assemble furniture. I thought this was an accessible way of conveying information.

As an ode to simplicity and more visual responses to distress, I created the “manual” below. Without text, I think it communicates a lot about the interpersonal nature of the skills needed for ‘intervening’ in a "mental health situation", placing emphasis on a collection of encouraged interactions and responses. It doesn’t get into the details, but I think is a helpful visual starting point.

If you’re unfamiliar with IKEA’s naming scheme, here’s a little bit of context. I chose “stödja” as the name of this manual because, in Swedish, stödja is described as meaning: “to support”, “to be helpful”, and “to be attentive.” I think is a relevant term that communicates the intention of manual. Also, please forgive me if I am using this word out of context…my Swedish is only as good as Google translate.

Tags: Stodja, Mental Health, Training, Crisis Intervention, Health Promotion, Public Health