Mental health: Providing first aid for the psyche

Israelis are no strangers to stress, but even the calmest among us have found many events of the past year mentally taxing.

The pandemic, the crushing to death of 45 people on Mount Meron in April on Lag Ba’omer, two deaths in the collapse of bleachers in a Givat Ze’ev synagogue before Shavuot, thousands of rockets fired at population centers during hostilities with Hamas in May, the bruising fourth election of 2020 – Israelis have had their fair share of mental stress over the past 12 months.

While mental illness should be treated by trained mental health professionals – such as psychologists, psychiatrists and therapists – a new course of study in Israel teaches laypeople how to provide mental health assistance until health professionals can intervene. 

In 2000, Mental Health First Aid (MHFA), a skills-based training course that teaches participants about mental health and substance-use issues, was created in Australia by Betty Kitchener, a nurse specializing in health education, and Anthony Jorm, a mental health literacy professor. The course teaches individuals how to identify, understand and respond to signs of mental illnesses and substance-use disorders, and provides the skills necessary to offer initial help and support to someone who may be developing a problem or experiencing a crisis. 

Students are taught to respond using the ALGEE acronym:

• Assess for risk of suicide or harm

• Listen non-judgmentally

• Give reassurance and information

• Encourage appropriate professional help

• Encourage self-help and other support strategies. 

The Hebrew acronym is spelled differently but communicates the same message.

Over the years, the course has evolved into a global movement with more than four million people trained worldwide. The course has been offered in 29 countries since June, when Israel became the 29th country to offer the course.

HASHMONAI'M RESIDENT Stuart Katz took the MHFA course in the United States and became an instructor in 2018. Since then he has worked to bring MHFA to Israel and to help reduce the stigma of mental illness. In the summer of 2020, during the pandemic, 30 Israelis took the course online to become familiar with the concept of MHFA. The group then spent the next nine months adapting the course for Israel. 

In April, an instructor training course was held, and today 11 members of the original group are certified instructors in the Mental Health First Aid course here in Israel. The program is being offered initially in English with Hebrew, Arabic, Russian and Amharic versions added beginning in 2022. 

Katz worked with a group of 50 volunteers in Israel who have localized the curriculum for Israel, taking into account the cultural sensitivities of the ultra-Orthodox community, Arabs, Ethiopians, Russians, and the numerous other groups that make up Israeli society. 

“Mental Health First Aid is an accredited, evidence-based training program that empowers and equips individuals with the knowledge to support a friend, family member, or a co-worker who is experiencing a mental health problem or experiencing a crisis, such as being suicidal,” says Katz. He adds that mental health issues affected 30% of the population even before the onset of the corona pandemic. Now, he says, it is estimated that mental health issues will affect between 40% and 50%.

“Everyone is coming into contact with someone living with a mental illness, whether they want to admit it or not,” he says.

Katz cautions that people who take the course cannot treat patients. 

“We are not there to treat by any means,” he says. “We’re there to provide first aid.” Katz recalls an incident that occurred when he was jogging on a beach and saw a man screaming at the top of his lungs. “Before I took the course, I would have said that he was nuts. After I took the course, I approached him and asked if he was OK. He said to me, ‘What do you want?’ I said, ‘I’m here for you if you want.’ He sat down, and we started talking. Ultimately, he agreed to go to the emergency room because he was having serious issues.”

Katz says he has received a great deal of positive feedback from mental health professionals about offering MHFA in Israel.

“The most important thing,” he says, “is that we have to talk about mental health and recognize it. I am hoping that the more people who are educated, the more talk there will be surrounding mental health, which will improve the quality of care for mental health in Israel.”

MANY OF the volunteers who took the course have had firsthand experience with mental illness among their family and friends. Tiki Yeres, 27, immigrated to Israel in 2013 from Toronto and works for a Tel Aviv-based start-up. Six years ago, in June 2015, she lost her older sister, Batsheva, who lived in Israel, to suicide. Last year, on the fifth anniversary of her sister’s death, Yeres penned a blog for the Times of Israel, in which she wrote about her sister’s death and how it had affected her. Yeres’s article struck a chord among readers worldwide.

“The response from people was overwhelming,” she reports. “People from all over the world, including rabbis and community leaders, were getting in touch with me.”

Yeres says that writing the blog was a difficult decision. 

“I lost someone that I love, and for five years, I felt like I could barely talk about it. Writing the post was a huge deal. I didn’t even know if I was going to go through with it until the last minute when I pressed ‘Submit.’” 

For years, says Yeres, even saying the word “suicide” was difficult for her. After her blog appeared online, Katz reached out to her. 

“I’ve been really looking for this ever since I lost my sister,” she says. Yeres was in the inaugural group of instructors trained in Israel and now is a certified instructor in the MHFA Youth Course. She is also working to help launch and get the organization running in Israel.

The overall goal of Mental Health First Aid, says Yeres, is to stimulate discussion and educate people about mental health.

“We want to ultimately bring about change, but [first] we need to start the conversation.” Yeres says there is a great deal of stigma surrounding mental illness in Israel, and the more that people can discuss the subject, the greater the chance the stigma will be reduced.

“The course explains to people about the different types of mental illnesses, the types of signs to look for, and how we can help this person get professional help,” she says. As an example of how people can be in a unique position to notice changes in others, Yeres cites the example of a school librarian, who may see some students enter the library sitting alone, wearing headphones, isolated from others. 

“If a student is having a hard time in school, he might gravitate toward hanging out in the library a lot alone, or maybe he has headphones on and stays to himself.” A school librarian might not qualify as a mental health professional, but a librarian can be a first responder and notice if something is amiss. The librarian may want to strike up a conversation with the student in order to be able to help them or get them to a counselor or teacher who can help.

RABBI SHALOM and Gabi Hammer of Beit Shemesh lost their 18-year-old daughter, Gila, to suicide in December 2019. They learned about the Mental Health First Aid course after Gila’s death and took the class via Zoom. Given the circumstances, Shalom Hammer says, “It was very hard for us, but the reason we had an interest was because of the personal tragedy that happened.

“The number of mental health professionals in Israel who won’t say the word ‘suicide’ is mind-boggling,” he adds. “There is a huge stigma in the professional mental health world.”

Rabbi Hammer is a well-known Jewish educator who lectures to IDF soldiers on Jewish topics. Through his organization, Makom Meshutaf (“A Unified Place”), he advocates for tolerance and unity between religious and secular Jews in Israel. Since the death of his daughter in 2019, he has spoken to teens and adults about mental health as well. Hammer says that mental illness can be challenging in the teenage years. 

“Many mental illnesses reveal themselves between the ages of 16 and 24,” he says. “At that age, they are fighting an uphill battle between peer and societal pressure, as well as physical and hormonal changes. They end up exerting a tremendous amount of energy, not only to deal with the illness but to cover it up. Part of their need to cover up their illness emanates from the stigma that exists in society – even within their own age group.”

Hammer has a Facebook page that deals with breaking stigmas (facebook.com/rabbihammer). He says, “If attendees walk away with the understanding that someone who suffers from mental illness should be treated the same way as someone who suffers from a physical illness, and with the understanding that mental illness is manageable, then we will have achieved one of our goals.”

OTHERS ACTIVE in the course have found it useful in their professional development. Reuven Harow, the CFO of a biotechnology company and Beit Shemesh resident, has worked with Magen David Adom Israel for 20 years as a first responder, driver, medic and instructor. He took the Mental Health First Aid course on Zoom in August 2020 due to the increased number of teen suicide cases in Beit Shemesh.

“This is something that youths in Magen David Adom are not equipped to handle,” he says.

Harow notes that the class provided good role-playing scenarios and increased his level of understanding. 

“We get a lot of calls from people with suicidal tendencies and suicidal thoughts,” he says. “We’re not trained in how to respond to that when we get there. There are psychologists in MADA, and there are people that have the training, but the regular run-of-the-mill response team is not necessarily trained in it.” 

One of the most important skills the course teaches, he says, is developing the ability to listen to patients. 

“Listening skills are very important. Tolerance, patience and listening can be incredibly helpful to someone in a stressful situation where they don’t know what to do, and they don’t know how to be. If I take one message that came out of the course, it’s to listen non-judgmentally.”

Ruchie Bromberg, a Beit Shemesh-based speech therapist and ADHD coach, is not directly involved in the mental health field but has met many people who have experienced difficulties.

“People were telling me their difficulties and challenges,” she says, “whether it was through speech therapy or families that I became friendly with. People started telling me their life challenges, and were in despair, and didn’t know who to turn to. All of the people I spoke with felt they were alone in their challenges, not wanting to speak about it with anyone else, and not knowing where to go. It was frustrating because everyone came back with the same things: ‘We don’t know where to go. We don’t have who to turn to.’ It was painful to see it.”

Bromberg found out about Katz’s initiative to bring the MHFA course to Israel, and she, too – like Yeres, Harow, Hammer and others – took the course via Zoom in 2020. Then, along with the others, she began to adapt the material for an Israeli audience.

Bromberg says that mental health issues can be found in all parts of Israeli society. 

“I’ve seen it in all circles,” she points out. “It’s in haredi communities, and I’ve seen it in the elderly. Also, especially now during this whole year, there is such a decline, depression and anxiety. I think that has also exacerbated things. People are starting to talk. The more people talk, the more people feel they can talk.”

She adds that taking the course made her feel more aware and better equipped to approach people and ask them how they are feeling, allowing them to respond and talk if they needed.

“It gave me more confidence to go out there and open my eyes even more. I think in this whole period of COVID, everyone was in their own place. I saw someone whom I hadn’t seen in a long time, and I said to them, ‘I haven’t seen you in a long time.’ The person broke down and began to cry.”

Avi Tenenbaum, who has an extensive background in addiction counseling and psychotherapy, is the curriculum coordinator for the MHFA program in Israel and has worked in the field of psychological first aid. He is responsible for adapting the original Australian program for Israel, with its varied populations and cultures.

Tenenbaum says that Mental Health First Aid is a grassroots-type of program that can be used by non-professionals to help those in crisis. 

“I believe that mental health professionals do not have a monopoly on mental health, and that regular people aren’t given enough of a voice to share their experience and their wisdom. In psychological first aid, you can train anybody in just a few hours to give basic trauma health to anyone going through a crisis.”

Says Tenenbaum, “You can train anyone in a few hour course to approach a sad, single mom in the makolet (grocery) who you haven’t seen in a few days, and say ‘Hey, how are you feeling? What’s going on? Is there anything I can do for you?’ and through that, to change someone’s life.”

A person who has taken the MHFA course, he says, will understand how to empathetically approach that woman in the makolet in a respectful and gentle way, how to open up a conversation, and see if she needs help. 

“You’re not their psychologist, and you’re not going to be, but maybe you can tell them how to find professional help, because you learned basic information about accessing mental health professionals via the kupot holim [health funds] or about some of the many mental health organizations servicing people in Israel, such as Bishvil Hachaim, Metiv, or Bayit Cham.”

Helping that person in just one small way, says Tenenbaum, can be a lifesaver.

“The idea of taking regular people – especially people who interact with others – it could be a police officer, an educator, it could be the makolet guy, could be a cab driver – giving them training and saying, ‘OK, here’s your place. Here’s your goal. Here are some ideas. Go out there and see how you can influence people within your role. We’re not asking you to be a psychiatrist for somebody, but within the boundaries of what’s appropriate, you can make a big difference.’

“If a community can be understanding of one another and be helpful to one another, this can make a major, major difference and that’s exciting for me to see. I want to see that happen.”