Using Crayola markers set on each round table, small groups of adults from the Greeley area — school outreach workers, Boys and Girls Club staff and foster parents — created poster-sized pictures of what mental health problems look like. Glum stick figures sat under rain clouds, a face contorted from happy to sad and a placid face showed no outward signs of distress.

The pictures were just one of several hands-on activities sprinkled throughout a recent day-long training that aims to teach lay-people the signs of mental health or substance abuse problems in youth, and give them action steps to follow when they spot trouble.

Called Youth Mental Health First Aid, the training originated in Australia and was unveiled in Colorado last year. There is also an adult version of the training, introduced here in 2008, called Mental Health First Aid or MHFA.

Both are gaining momentum in what mental health advocates say is a welcome development in a state saddled with one of the highest suicide rates in the country and more than its fair share of school tragedies, including a deadly shooting at Centennial’s Arapahoe High School in December and a self-immolation at Westminster’s Standley Lake High School in January.

Olga Gonzalez, a community outreach worker who participated in the recent Greeley training, said she regularly fields questions from parents who are worried about their children but don’ t know where to turn. She recounted how one family she’d worked with discovered their son had started using drugs. Another learned that their son had stolen credit card information from a customer while manning the cash register at the family’s store.

“He has money in a savings account, you know. He just did it,” she said. “I wasn’t sure what kind of support he needs.”

Youth Mental Health First Aid aims to answer such questions for people who are not mental health professionals but who work closely with young people and their families. The target audience includes lay-people like teachers, coaches, guidance counselors, school nurses and even bus drivers.

Advocates for MHFA say Colorado now has one of the largest contingents of certified instructors—around 230 so far. In addition, it’s among only a handful of states to dedicate public funds to the trainings, with $750,000 appropriated for the program next year.

“We have been at the forefront of this since the beginning,” said Brian Turner, director of Mental Health First Aid Colorado at the Colorado Behavioral Healthcare Council.

Preparing first responders

The concept behind both versions of MHFA, much like medical first-aid, is to equip first responders with the know-how to address emerging mental health or addiction problems. The youth version is also meant to help distinguish between true mental health issues and the normal mood swings and behavior changes that characterize the life of a teenager.

But the training is hardly a technical lecture. It’s participant-friendly approach is evident in the hands-on activities, the video clips, the anecdote-peppered instruction and even the pile of bite-sized candy on each table. Originally, conceived as a two-day training, it has since changed to a one-day format.

“I think we try to make it accessible in a very non-threatening way,” said Pamela Collins Vaughn, one of the instructors at the Greeley training and quality assurance program director at North Range Behavioral Health.

The five action steps in Youth Mental Health First Aid.
The five action steps in Youth Mental Health First Aid.

Gonzalez, an outreach worker with Community Care Corps, said she learned about the training at a resource fair that she helped coordinate. Her work with families at two local middle schools, as well as in surrounding neighborhoods, made her want to refresh her knowledge on mental health issues.

While Gonzalez and other MHFA participants are certainly not charged with providing treatment, they do receive a customized local resource guide to help them connect youth with professional help when necessary.

In fact, encouraging youth to seek professional help is one of five action steps—condensed in the acronym ALGEE–outlined in the training. The other four include “Assess for suicide/self harm,” “Listen non-judgmentally,” “Give assurance/information,” and “Encourage self-help/other support.”

Turner said having concrete action steps is important because “there’s a big difference between learning about mental health and substance abuse problems and being able to do something about it.”

During the Greeley training, participants were asked to come up with gestures that would convey each of the five action steps. Soon, in an effort to commit the steps to memory, Vaughn and co-trainer Noelle Hause were leading the group in miming actions like non-judgmental head-nodding and reassuring arm-patting.

Reaching out to schools

While Turner said Youth Mental Health First Aid is not yet widely offered by school districts, there is growing interest. Among the districts that have offered it for at least some staff are Douglas County, Aurora, Thompson, and Weld County District 6.

Barb Becker, division director for community programs at the Arapahoe/Douglas Mental Health Network, said the one-day format make it a very doable training for educators.

One of the pictures made by participants at a recent Youth Mental Health First Aid training.
One of the pictures made by participants at a recent Youth Mental Health First Aid training.

“It just gives a really good overview,” she said, adding, “It takes away some of the stigma associated with mental health.”

While grants to offer Youth Mental Health First Aid are sometimes available and some mental health centers offer it for free, the price of the training can be a barrier for districts. Costs typically run at least $25 per person and can max out at $50 depending on facility and food costs.

While the new $750,000 in state funding will help with expansion, Turner said advocates are also investigating whether Medicaid reimbursements received by schools can help pay for the trainings. Currently, those reimbursements are used for all kinds of school health and wellness efforts, from paying school nurses to buying P.E. equipment.

If Youth Mental Health First Aid is widely adopted by schools, it will join a growing number of tools used to detect and combat mental health problems in students. Many schools already use suicide prevention curriculums, some are adding instruction on social emotional skills and a few conduct universal mental health screenings among students.

In addition, many schools regularly convene meetings to discuss and create plans for students who are showing signs of mental health or behavioral problem. Others publicize programs like Safe2Tell that allow students, parents or staff to anonymously report bullying or threats of school violence or suicide.

While Becker noted that middle-aged white men, not teens are actually at the highest risk for suicide in Colorado, she said it is still a problem among young people.

In 2010, Colorado had the seventh-highest  youth suicide rate among states and Washington, DC, with 16.7 deaths by suicide per 100,000 people in the 15-24 age group, according to data from the Centers for Disease Control and Prevention. In general, Colorado’s suicide rates are higher in rural and mountain communities than in urban areas. They are also higher among males than females.

Becker said there are a variety of reasons, including biological changes, peer conflicts and dating strife, that adolescents experience depression, which is a leading cause of suicide.

“It’s a hard time in life,” she said.

Ultimately, Turner hopes both versions of Mental Health First Aid will be widely available in all parts of Colorado. They won’t prevent all violent incidents, he said, but they might help. They can also aid in the healing process for communities that have suffered through fires, floods, droughts and other disasters.