In March 2014, Sunita* knew that life had had its way when her granddaughter, just over a year old, succumbed to cancer. Sunita's son Ajay* retreated into a shell. Stoic through the diagnosis and the failed treatment, he refused to talk about the tragedy and remained withdrawn. The warning signs of a bigger mental calamity on its way were first detected by Sunita, and she became his first line of defence.
Pic for representional purpose
"On days when is he is really low, Ajay ponders about why it happened. Experts said that my granddaughter's case was one in a million," says Sunita. She listens attentively and patiently, offers assurances rather than advice, and never brusquely asks him to 'move on'. It's her first-aid kit for her son's mental health.
For the last one year, Sunita has been learning first-aid methods under Rachana Awatramani, a Mumbai-based psychologist who designed the first mental health first-aid course in the country. Awatramani, the 28-year-old author of I am a Miracle Being, conducted the course online first in October 2015. Professionals from both psychology and non-psychology backgrounds (such as doctors and social workers) signed up for the month-long course that costs Rs 5,400.
While Awatramani has planned the first in-person session on January 18 at her Juhu office, an online batch will begin soon. This time round, non-health professionals such as HR managers and even a bunch of Pakistani students have shown interest. The mentor, on the other hand, had to get her dose of mental health first-aid from Johns Hopkins University, USA, with lack of options in India. The USA has an online course by The National Council, while www.mentalhealthfirstaid.org helps you locate the nearest mental health first-aid class. The website explains: Just as CPR helps you assist an individual having a heart attack — even if you have no clinical training — Mental Health First Aid helps you assist someone experiencing a mental health related crisis.
In October 2015, Rachana Awatramani, launched the first mental health first-aid course in the country. While it was online then, an in-person session will be held on January 17. Pic/Sameer Markande
"Every individual needs to know about mental health first aid, whether it is for daily emotional problems or major mental illnesses," she says. Her course can help you become a professional first aid-administrator, but the point is to put mental health literacy to daily use for emergencies — a one-person ambulance of sorts.
The emo kit
The mental health first-aid kit, while equated to one for physical injuries, needs some amount of imagination to be comprehended. It doesn't come with handy instruments; you become the kit. Instead of thermometers and bandages, this kit requires your availability, basic counselling, listening skills (including empathy and paraphrasing), assessment skills and, most importantly, knowing when it's time to ask a professional counsellor or psychiatrist to step in. It means knowing what to do when your friend has a breakdown in college, or when your bipolar colleague has a manic phase, or recognising that your grandmother's violent outbursts might be alarm bells for schizophrenia.
Dr Cicilia Chettiar
"Just like physical injuries, it is very important to proactively attend to mental injuries before they become full-blown disasters," says psychiatrist Dr Kersi Chavda. The concept of mental health first-aid is new to a country that is only just beginning to accept that mental illnesses exist, but Dr Chavda says the need is only set to increase. New kinds of stressors, right from terrorist attacks to global warming, will need frequent attention. "Media exposure about things happening around the world tends to wear you out. Children, for example, look at gun firings in schools abroad, and are afraid something similar will happen in their schools as well," he continues.
Unlike physical injuries, there is never truly a golden hour — the time when prompt medical care can prevent a likelihood of death — for mental illnesses. Diagnosis of mental and personality disorders needs months to pass. "People sometimes give an indication of their intention. So it's wise to pay close attention to sudden, drastic behaviour changes. Also it's a myth that people who talk about it won't do it," says Dr Cicilia Chettiar, a clinical psychologist who heads the department at psychology at Maniben Nanavati Women's College, Vile Parle. "Right now, we are fire-fighting and getting people out of a mental health situation long after it has become worse. The knowledge of symptoms, triggers and the time period for mental disorders will help people cope better," she continues.
People in charge of groups (teachers and HR teams), survivors of trauma, and professionals dealing with traumatic events (police, doctors and firefighters) are those who'll benefit with this first-aid knowledge, she adds.
Dr Amit Thadhani, surgeon and medical director of Niramaya Hospitals, Kharghar, attended to two natural disasters last year —the Nepal earthquake and the Chennai floods. After the earthquake, some pregnant Nepali women went into false labour, insomnia was on the rise, and there was the case of the woman who complained of psychosomatic body ache. "While there were psychiatrists on field, emergency trauma care at the mental level was needed too. Counselling for trauma victims needs to happen before a psychiatrist with a prescription can be reached," he says.
Right from wrong
Dr Chettiar points to misuse of mental health first aid. "We need to remember that first-aid won't prevent the onset of a mental disease. It will enable early detection, and help patients cope better," she says. The problem, she feels, is over-attention; if a friend breaks down, it is not necessary that there is a bigger mental health issue looming in the background.
Plus, the Internet is not the place to hunt for quick-fixes. It is the reason why you mistook the numbness in your fingers for fibromyalgia or why one of Awatramani's clients misdiagnosed his daughter's exam anxiety as depression, following a free online test. "Our tests, on the other hand, showed that she was faking depression to deal with exam pressure; depression shows symptoms over a period of three months, not a few days," she recalls.
However, the great thing, about mental health first aid, is that you can administer it to yourself too. Ajay's grief over his late daughter passes on to Sunita after most conversations, but she manages it with tips from Awatramani. "I reason with myself that what happened was beyond my control," she says. The age-old pairing — venting out and a shoulder to cry on — can go a long way.
*Names changed on request