Action plan – first steps to offering support

Approaching someone with mental health problems

If you think mental health first aid is needed, it’s important you take action, as you may be the only support the person. Approaching someone demonstrates that you care and that their well-being matters. It also provides a starting point for further discussion and pathways for support.

There are a range of different circumstances in which you might need to approach someone, including:

1. You’ve noticed something concerning about a family member, friend, colleague or someone you know, and you think they may be experiencing a mental health problem.
2. Someone comes to you for support or divulges information about their mental health or problems they are facing.
3. Someone has drawn your attention to someone who is struggling with mental health problems.
4. You are called in to support someone with a mental health problem or crisis situation in your role as an accredited MHFAider® or MHFA Officer.

All of these possible approach scenarios are valid and regardless of the setting, timing, relationship, or situation, you can use the ALGEE Action Plan.

Tips to remember: 

• Prepare yourself – be available, present, undistracted, open minded and calm.
• Think about the timing –approach when the person will be receptive to talking, and when you have enough time to see the Action Plan through.
• Provide a safe space – consider a location with privacy, accessibility, and comfort.
• Offer location options – ask the person if they’d like to sit with you in a meeting room, suggest a walk, shout them a coffee, or ask where they’d like to go to talk.
• Be genuine – make it clear that you are available to provide non-judgemental support.

Assessing the situation

Your role is not to diagnose, treat or know all the answers. You can however help the Action Plan process by reading signs, practicing active listening, and considering the bigger picture of what may be going on.

Assessing the situation helps you to manage the conversation and decide on the actions needed to keep the person safe while working towards further support options.

Tips to remember:

• Look for cues and signs that provide insight into what the person is experiencing:

– Moods: agitated, sad, downcast, erratic mood swings, angry, nervous, confused, anxious, panicked, worried.

– Body language: flat, slumped over, jittery, shaking, bodily/facial ticks or involuntary movements, unusual mannerisms or movements.

– Emotional expressions: outbursts, crying, yelling, unusual silence, appearing disoriented, any out of character emotions.

– Behaviours/actions: withdrawing, refusing to participate, hiding away, sleeping too much/too little, missing important activities, making uncharacteristic mistakes, hyperactive or manic actions, risk taking, unhealthy use of alcohol/drugs, hurting themselves, not taking care of themselves or making unusual plans.

– Words: negative self-talk, expressing negative feelings, talking about difficult circumstances, talking about mental illness symptoms, saying they are not coping, language that is worrying or out of character, talking about suicide or self-harm, preoccupation with matter of death or dying, saying others would be better without them, expressing worry or distress, saying they are giving up, expressing hopelessness, saying they need help.

• Practice active listening – don’t jump to conclusions, rush or seek the next moment to talk (listen to understand).
• Keep personal judgements and stigma out of your assessment – avoid myths and misconceptions about mental illness.
• Take steps to keep yourself and the person safe – assess the environment, situation, the persons words and actions to identify any risks to safety and wellbeing.

Assisting with a crisis situation

Mental health conversations can go in several different directions depending on the situation, the people involved, and factors influencing the person’s mental health problem. You will need to decide about the urgency and risk associated with the conversation.

Not everyone you offer support to will be in mental health crisis – this doesn’t mean their problems are not valid and in need of help. If there is no crisis present, you can continue with the rest of the Action Plan.

Mental health crises include situations when a person is: 

• Suicidal or expressing suicidal thoughts and behaviours.
• Participating in self-injury or at risk of hurting themselves.
• Having an immediate panic attack.
• In the aftermath of a very recent traumatic event.
• Experiencing a severe psychotic state/psychosis.
• Severally impaired by the effects of alcohol/inebriation.
• Severely impaired by the effects of drugs or other substances.
• Demonstrating immediate aggressive behaviours or a risk to others.

If the person is experiencing a crisis mental health problem, you will need to take action that prioritises safety for both you and the person you are supporting. You are not responsible for someone else’s actions, but you can play a role in crisis intervention that gets the person to a safer, calmer state and space, so that they can get the support they need.

It can be helpful to know that most people experiencing a mental health crisis will welcome support. Your actions can keep someone safe, start the process for recovery, and even save a life.

Tips to remember:

• Believe that you can make a positive difference and your support is helpful. This can promote the confidence needed to continue.
• Work to understand the crisis – a person having a panic attack may need immediate support, but their experience is unlikely to be life threatening, whereas someone having suicidal thoughts and behaviours may be at risk of death.
• Take all thoughts, threats or admissions of suicidal thoughts or plans seriously. Never dismiss these words or behaviours as ‘attention seeking’, exaggerations or something that will pass.
• Ask the person questions and keep them talking to explore the situation. You will need to practice active listening and ask questions that do not just require ‘yes’ or ‘no’ responses.
• Remain calm and composed – this can be particularly important if the person is in a heightened state of agitation, panicking or experiencing psychosis.
• Express empathy, respect and understanding through reassurance, kind words, and open body language. Let them know you are taking their situation seriously.
• Clarify points about feelings, moods, situations, behaviours and plans by repeating back if necessary. This helps you be on the same page and assess risks.
• Take steps to keep the person safe – find a safe space, remove dangers if applicable (and safe), stay with them, ask what they need to be safe.
• Practice the ALGEE Action Plan relevant to the type of crisis (you will have learnt this in your training).
• Get help – in a severe crisis, you may need to get help from a professional and this is ok.

Get professional crisis help when:

• The person’s life is in immediate danger e.g. imminent suicidal behaviour where intervention is not possible.
• The person is actively hurting themselves or has injuries requiring medical attention.
• The person is so intoxicated or under the influence of substances that an intervention is not possible.
• The person is experiencing severe psychosis or a ‘break from reality’ and intervention is not possible.
• The person is a child/youth at risk of injury or harm, or their safety is compromised at home, school or in any other setting.

Crises vary in severity – some may be alleviated with your support, while others will need intervention by medical or other professionals. If the crisis needs emergency professionals such as ambulance, police, a mental health unit, or other first responders, then your role as the First Aider will come to an end as you hand over.

What’s next?

Once you have approached, assessed and assisted with any crisis measures, you are ready for the next steps of ALGEE:

A – Approach the person, assess and assist with any crisis

L – Listen and communicate non-judgementally

G – Give support and information

E– Encourage the person to get appropriate professional help

E – Encourage other supports