An emergency aid course for mental health problems

Samuel has always been an active and cheerful boy, but for some time now the 14-year-old has rarely left his room, listening to music and playing on his mobile phone. «Why don't you go out and meet up with friends,» his mum tries to encourage him. «I'm not up for it» or «Just leave me alone» is usually the curt reply.

Samuel's mother realises that something is wrong with her son. But she feels helpless and doesn't know how to broach the subject: Is it right to get involved? And what should she say?

Many parents are in a similar situation. During puberty, young people's behaviour and relationship with their parents often changes dramatically. The opinions of their peers take centre stage and parents are no longer seen as role models or advisors, but increasingly as «annoying» and «embarrassing».

«Separation and a certain amount of withdrawal from parents is completely normal during puberty and is part of the healthy process of cutting the cord at this age,» explains Kurt Albermann, a specialist in child and adolescent psychiatry and psychotherapy and head physician at the SPC Social Paediatric Centre at Winterthur Cantonal Hospital.

Mothers and fathers who sense that something is wrong with their child are also often reluctant to address the issue specifically.

However, if young people also withdraw from their friends, often appear discouraged, depressed or aggressive, show addictive behaviour and hardly do anything, this could indicate the onset of a mental illness, says the expert.

Mental health problems are still considered taboo

Sometimes parents don't even realise that their child is suffering. But even mums and dads who sense that something is wrong with their child are often reluctant to take the first step and specifically address the issue. Usually because they don't know how to proceed and also because they are afraid of doing something wrong.

«Mental health problems and mental illness are still a big taboo in our society and are associated with many prejudices,» says Roger Staub, explaining this hesitant behaviour. Staub is Managing Director of the Zurich-based Pro Mente Sana Foundation, which campaigns for mental health in Switzerland.

«People with mental health problems are often stigmatised and are seen as weak and unable to cope.» For this reason, many sufferers keep their fears, self-doubt, depressive feelings or even thoughts of suicide to themselves for far too long instead of confiding in someone and getting professional help.

«The Ensa project, «First aid courses for mental health», aims to actively change this and help to reduce fear of contact and create more understanding for people with mental health problems overall,» says Staub.

«Ensa» means «answer» in the language of the Aboriginal Australians and is the Swiss version of the «Mental Health First Aid» programme developed in Australia in the early 2000s. Ensa was established in Switzerland in 2019 by Pro Mente Sana with the support of the Beisheim Foundation.

The first aid course for mental health was initially developed for the prevention and early detection of mental stress in adults and is designed in this form as a counterpart to the classic first aid course for medical emergencies. Expert Staub: «All the content of the course is based on scientific findings. The effects achieved are also regularly examined in studies and the programme is further developed accordingly.»

Since autumn 2021, the Ensa course has also been available in Switzerland with a focus on young people. This first aid course is aimed at lay adults who are entrusted with young people. These could be parents, grandparents, teachers, school social workers, youth group leaders or vocational trainers.

The aim of this special course is to provide participants with basic knowledge about mental health and also to enable them to quickly recognise signs of mental stress in young people and distinguish them from normal signs of puberty.

Knowledge creates understanding

«In the courses, participants are informed about the most common mental illnesses of depression, anxiety disorders, psychoses and addictions, as well as eating disorders and behavioural addictions,» says Staub.

How does depressive behaviour manifest itself? When should I assume that my daughter has developed an eating disorder? And above all: How do I confront her with my suspicions? What we have learnt is put into practice and practised in role plays.

Participants take on the role of the victim, the first aider and an observer providing feedback and learn how to conduct a structured first aid discussion based on five steps.

The five steps for first aid in psychological emergencies are called ROGER, analogous to GABI, the abbreviation for the most important action steps in physical emergencies, which is still familiar to many from earlier emergency aid courses.

The «R» stands for «React», i.e. recognise and assess symptoms correctly, address those affected and support them. The «O» stands for «Listen and communicate openly and impartially». «G» is the abbreviation for «Give support and information», «E» for «Encourage professional help» and the «R» means «Reactivate resources».

At the end of the first aid course, participants are tested on what they have learnt and receive a certificate. «As with the classic first aid course, trained and certified first aiders on the Ensa courses remain laypeople and do not make any diagnoses, but offer discussions and encourage those affected to accept professional support if necessary in order to receive effective help and relief,» Staub admits.

More security at home

Since the youth courses were launched in Switzerland at the end of last year, over 500 people have already taken part. One of them is Bianca Indino from Kreuzlingen TG, mother of three children. «I completed the «Focus on young people» course primarily with a view to my role as a school social worker at the vocational college at the time,» says Indino.

«I wanted to be able to better assess difficult situations with teenagers and react more confidently.» She particularly benefited from the role plays. «On the one hand, I was able to practise applying what I had learnt, and on the other, I was able to put myself in the shoes of the person concerned and realise how uncomfortable it is when questions come too quickly or there are no pauses.»

She now feels much more confident in challenging situations and would recommend the course to all parents, says one participating mum.

But the 43-year-old has also learnt a lot personally and as a mother. «The course has also made me much more sensitive when dealing with my own children. I now know how important it is to create a basis of trust at an early age and to talk openly about emotions,» emphasises Indino.

She now feels much more confident as a mother, even in challenging situations, and can therefore recommend the course not only to parents with difficult adolescents, but generally to all families with children, in order to prevent mental illnesses from developing in the first place or to be able to recognise and treat them as early as possible.

Call an emergency doctor in an emergency

However, not everyone has the time or money to invest in a mental health first aid course. «What's more, the Ensa course is primarily intended to be preventative,» emphasises child psychiatrist Kurt Albermann.

In acute emergencies such as a suicide threat, it can be crucial to get immediate professional support.

«It does not train participants to become therapeutic professionals. That's why it's important to know your personal boundaries well and respect them accordingly.» Because in some cases, such as when massive problems already exist or an acute emergency such as a suicide threat or even a suicide attempt occurs, it can be crucial to receive immediate professional support.

«Parents or guardians should then contact their family doctor or paediatrician and, in the event of imminent danger, should not hesitate to contact an emergency psychiatric clinic, a psychiatric emergency service or the police,» says Albermann.