How would you react?

Mental health prevention, intervention can help when someone 'behaves strangely'

We’ve all been there: You’re going about your daily business, just doing your job as you do every day, when you encounter someone behaving strangely.

In that moment, you make a series of assumptions. The caricature of a rambling homeless person experiencing a mental illness, for example, may have just popped inexplicably into your mind.

That’s how your brain works. It filters and organizes the input we receive in such a way as to make it into something comprehensible, as quickly as possible — usually according to prior experience and learning. 

The ability to assess and judge situations quickly, especially unknown ones, has grown from evolutionary necessity. It is essentially a defence mechanism, designed to keep us safe — to defend us from potential harm. In that sense, it is perfectly normal.

However, how this information is organized may or may not reflect the objective reality. This is especially the case when there are unknown factors involved.

The brain can, and often does, fill in missing information. It can insert an experience into our perception that was never actually there — usually a psychological one, but occasionally a physical one. It does this because it makes the circumstance more understandable to us. 

There is a level of comfort in the feeling that we understand. 

Understanding underpins certainty and certainty is safe.

An individual who is truly psychologically healthy and safe can more or less adapt to additional input. She can flexibly assimilate and accommodate new information with her existing understanding as it comes.

To varying degrees, I’ve not met a single person who can do this perfectly at all times.

Consider a young man who happens to experience extreme and acute anxiety in crowds of people. He’s in a retail store that unexpectedly becomes very busy, perhaps as a result of a big sale. 

Panicked, the young man asks for help from a nearby sales associate. Not realizing what the young man is experiencing, she tells him to calm down as the crowd closes in around him.

The young man becomes confused, erratic, hurried — all in response to his intense fear. He desperately attempts to escape to a place of safety. In the process, he knocks down an elderly woman and she shouts with pain. 

The woman’s adult son reacts based on the limited information available to him. He reacts aggressively, assuming the young man is attacking. He shoves the young man. 

Already having an aversion to the close physical proximity of strangers, the young man engages to defend himself. A fight ensues.
The sales associate nearby has observed the entire situation. She’s never been trained in how to recognize the signs of a possible mental health crisis. 

Her manager has never been trained on why developing this capacity to notice episodic mental illness is as important as noticing the possible signs of a heart attack or an allergic reaction. 

In fact, the manager may not even realize mental illness is statistically far more likely to be encountered, in the workplace and in everyday life. She certainly didn’t realize that by promoting mental health and engaging mental illness with greater contextual understanding, harm can often be reduced or prevented altogether.

If you observed this scene in your workplace, how would you react?

The manager calls security. After giving the information there was a fight and an injury, a police officer and a paramedic arrive on the scene.

Neither the officer nor the paramedic realizes (or believes) that people who experience a mental health problem or illness are far more likely to be the victims of violence than the perpetrators. Neither has been given adequate training in effective de-escalation or intervention techniques. 

They handcuff the young man and give medical attention to the elderly woman. They attempt to disperse the onlooking crowd, for reasons of image and liability.

The young man, meanwhile, is traumatized by being shackled to his fear, figuratively and literally.

Stories provide answers
These kinds of stories do not fully capture the complexity of real life. Encountering mental illness on the ground is anything but straightforward, and the same is often as or more true for mental health generally.

However, making an attempt at appreciating the context of each story as it unfolds provides us with that ever important additional information. When we are psychologically healthy and safe, we’re more likely to have the mental flexibility required to assimilate and accommodate this information into our previous understanding, and to react accordingly.

We’re still far from the ideal but the great benefit of complex stories is there are so many potential opportunities for effective promotion, prevention and intervention.

Employees of all levels and sectors develop and practise these skills in workplaces that actively cultivate and integrate psychological health and safety into the way they do business.

And sometimes it only takes just one person, making one decision, to change everything.

Imagine if you were that person. How would you react?

Mark Henick is the program manager for Mental Health Works, a program of the Canadian Mental Health Association, Ontario, which builds capacity within workplaces to address issues relating to mental health. He can be reached 
@markhenick or, for more information, visit www.mentalhealthworks.ca or call (800) 875-6213.

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