What do Lady Gaga, Michelle Obama, and 81 SC Lawyers Have in Common? Mental Health First Aid, 1119 SCBJ, SC Lawyer, November 2019, #42

• Author: By Beth Padgett
• Position: Vol. 31 Issue 3 Pg. 42

What do Lady Gaga, Michelle Obama, and 81 SC Lawyers Have in Common? Mental Health First Aid

Vol. 31 Issue 3 Pg. 42

South Carolina BAR Journal

November, 2019

By Beth Padgett

Mental Health First Aid, history and information

Mental Health First Aid (MHFA) is an eight-hour course that teaches you how to identify, understand and respond to signs of mental illnesses and substance use disorders. The training gives you the skills you need to reach out and provide initial help and support to someone who may be developing a mental health or substance use problem or experiencing a crisis¹ . Lady Gaga and Michelle Obama have taken the training and serve as advocates for its growth. Lady Gaga has made quite an impact on MHFA’s growth across the country, especially among the adolescent population. Currently, more than 80 South Carolina lawyers are trained in Mental Health First Aid thanks to a program sponsored and promoted by the South Carolina Bar. In fact, South Carolina is one of the first states in the country to offer this program specifically for attorneys.

MHFA was developed in Australia by Betty Kitchener, a nurse and health educator, and Anthony Jorm, a mental health literacy professor. They run MFHA Australia and are involved with others in MHFA International. MHFA first came to the United States by way of Missouri. Due to alarming rates of mental illnesses and suicides, mental health organizations in Missouri researched various options for addressing the problem and decided on MHFA. A quick look at MHFA website will show the diligence with which the program has been researched and developed. It has become an evidence-based program that is touted by the National Council on Behavioral Health and Substance Abuse and Mental Health Services Administration.

Early efforts to tackle the lawyer well-being problem

Things have changed greatly during Robert Turnbull Jr.’s tenure with the South Carolina Bar’s Lawyers Helping Lawyers (LHL) program. Robert is currently a co-director of LHL and is moving towards retirement after more than 18 years as the director. Those y ears included 10 years of working solo. He directed a team of volunteer monitors and interventionists. They mostly served older male attorneys who were experiencing career-threatening alcohol use disorders. Prior to Robert’s tenure, all the work was provided by volunteers. This is a similar story to the lawyer assistance programs across the country. The timelines are different and the programs that developed took different forms.

I came on in late 2010, beginning a law school initiative and assisting Robert and others with developing CLEs on substance use disorders and mental illnesses in the profession. The CLE was mandated by the Supreme Court of South Carolina. The first couple of years in the law schools were awkward. The audiences in the CLEs ranged from offended and anxious to appreciative. Some wondered what had taken us so long to talk about this closeted subject that was limiting, if not destroying, lawyers’ lives.

Time has passed and more changes have come to pass. Lawyers in South Carolina and across the country (and the world) have continued to suffer the consequences of these disorders, some to the point of dying from alcoholism, drug addiction and suicide. Stakeholders began to take these problems more seriously. The American Bar Association Commission on Lawyer Assistance Programs (CoLAP), along with the Betty Ford Foundation/Hazelden, conducted a survey on lawyer well-being in 2015, the first comprehensive study of this issue. A couple of years later, a national survey of law student well-being was conducted. These surveys showed alarming rates of multiple mental health problems, substance use disorders included, from law school through the profession. The numbers were hard to ignore and drove a surge of focused energy to get to the heart of the problem.

CoLAP created a task force to make recommendations for change to all involved in the legal profession. The published recommendations are thorough, touching every piece of the profession. The CoLAP website is unrecognizable from its 2010 iteration (the first time I looked at it). There is a well-being toolkit, reports of an anti-stigma campaign, well-being resolutions and pledges and a well-being template for legal employers. That is all on the national level and is good and important work.

What happened next

State by state. Law school by law school. Firm by firm. Lawyer assistance program by lawyer assistance program (LAP by LAP). Lawyers and bar associations throughout the nation started seriously addressing the issue of mental health and wellness in the profession. South Carolina led the way through its development of a Wellness Committee. In my opinion, recovery is wellness on steroids. Lawyers slip into depression, anxiety disorders, etc., partially because they let go of their wellness. Somehow they forgot to take care. Wellness and recovery go hand in h and, and the Wellness Committee has helped reduce the stigma of the mental health conversation. We are grateful for that.

I am a member of the Wellness Committee. During a meeting, Kathy Schillaci brought up the idea of training lawyers as peer counselors. Her thought was to train a team of lawyers across the Bar to be skilled listeners for colleagues who were in the grip of extreme stress, who needed to unload without being judged, and who needed a dose of hope that some ease was around the next corner. Kathy and I tossed ideas around for a while and then the MHFA program came to mind. I had presented a CLE on lawyer well-being and the work of LHL at a Greenville Mental Health Conference. After my hour, Robyn Ellison, a mental health educator at what was then Greenville Hospital System (now Prisma) introduced herself and suggested I consider using the MHFA program with lawyers and law students. She explained a bit about it and mentioned that she trains residents and other health care professionals/workers in the program. I was intrigued, but not sold. We had a few exchanges of emails, and I accepted an invitation to attend a training and get certified in MHFA. Any doubt I had about the program disappeared during the day. I liked the materials, the interactive learning approach, and the trainer!

One South Carolina lawyer who took the training said she always thought of mental illness as being schizophrenia or other disorders with psychosis. She was surprised to learn that depression and anxiety are the mental illnesses that affect so many people who are coming to work and appearing (mostly) normal and healthy. “I always thought if people were showing up for work, surely they didn’t have a mental illness.” She then realized that she, herself, was a person with depression. Now she’s taking medication and otherwise working on recovery, and life is much better. She also pointed out how the symptoms of depression look like a bad job evaluation . . . Not focused. Unproductive. Often out of work or late. As bosses/supervisors, what are we missing? Are we missing opportunities to help our employees find healing from depression and just labeling them as poor employees that are not cut out for the job?

Another part of the training having a lasting impression on this lawyer was the psychosis stimulation. Two lawyers try to have a conversation while another lawyer mimics internal voices into one lawyer’s ear. It lets you see what it might be like to be having auditory hallucinations (hearing voices) and trying to look and act like nothing is happening. It gives you some understanding of how much of a struggle it would be to live like that. And, no matter what the mental illness is, that’s what the experience is like. With depression, there is something going on that only the person with it can see and feel, and they are trying to look and act like there is nothing happening. That makes people with mental illnesses seem superhuman!

This lawyer added that she is often served her morning coffee by a barrista she believes has schizophrenia and was slightly uncomfortable around him because she didn’t understand his symptoms and behaviors. After the training, she’s not been uneasy around this barrista. He’s been humanized in her eyes. That’s good for her and terrific for the barrista!

About our Mental Health First Aid trainer

Robyn Ellison is an education coordinator at Prisma-Upstate Department of Psychiatry and a MHFA instructor extraordinaire. She’s been a school teacher of special needs students and is the daughter of one of the first psychiatrists in the Upstate. These environments have created in her a deep love and appreciation for all of humanity. Coming from a small community, she knew many of her father’s patients and saw his love and care for them outside of the clinical relationship.

She is certified as an instructor in the youth and adult programs. Of the 4,000 people who have been trained in South Carolina, Robyn has trained 1,000 certified Mental Health First Aiders just since January 1 of this year! Robyn notes that South Carolina is lagging in the MHFA movement, having a lower percentage of the population trained than in most other states. She aims to play a major role in catching our state up by committing to training 1,000 people per year until South Carolina becomes a leader. She sees training lawyers and other professionals as an important part in moving the Palmetto State forward. She enjoys teaching various groups of professionals, learning similarities and differences (personality, perspective, habits) as she trains groups of doctors, accountants, clergy members, and lawyers. Each group makes her more equipped to teach the next. She has taught veterans through Upstate Warrior Solutions, faculty and staff at multiple school districts, resident advisors at Furman University, and the Circe du Soleil troupe who performed in Greenville recently.

Robyn and I have a long history of reviewing mental health/ recovery-based curricula. Both of us believe there is something unique about MHFA that dedicates us to advocating for this program. What is this unique nature? Robyn says that the way the materials are written and using a multisensory approach to teaching merge to create a more appealing and more impactful experience. One of the intervention steps that is taught is to listen nonjudgmentally. Nonjudging is one of the foundations of MHFA and permeates each workshop. Participants have an experience of being in a safe space to have difficult conversations. That takes away fear, as does learning the facts of various mental illnesses and practicing intervention skills. These things change culture. Mental illnesses are not so frightening as we think. They are brain-based diseases that have cures. Recovery is not only possible, it’s expected. Recovery begins by people, like the more than 80 South Carolina lawyers who are certified Mental Health First Aiders, engaging with their colleagues (or clients, friends, family members) openly and without judgment.

Another positive of MHFA is that there is no expectation for the first aider to fix the problem. First aiders are conduits to care. Robyn prepares a list of local resources including professional mental health workers and community supports. This approach to helping takes pressure off the helper and offers dignity and autonomy to the person in distress.

Robyn likes to think of MHFA being so ubiquitous that parents will be learning at work and children will be learning at school. Then it can be supper table conversation, normalizing and removing stigma. She’d like to see lawyers in South Carolina and other states whose lawyers have been introduced to MHFA to push the National Council for Behavioral Health to create a specific module for attorneys. Those already exist for several professions. The National Council needs to hear from lawyers and stakeholders saying, “We need this!” The statistics and our lived experience say this is true. If South Carolina takes a role in making this happen, there likely will be more investment by our lawyers, and they can become advocates for the program within the bar and in their communities. Another hope of Robyn’s is to begin training law students so they can help their classmates and so that a significant number of bar applicants will already be first aiders.

“It’s a great new avenue for lawyers to become more aware of their colleagues’ wellbeing. It can be a tremendous help to lawyers who have clients with mental or emotional struggles. Over time I believe it will become a critical service offered by the SC Bar,” Turnbull said.

What participants learn

During an eight-hour workshop participants learn signs and symptoms of various mental illnesses including substance use disorders, eating disorders, panic attacks, and reactions to traumatic events. There is discussion about how these disorders appear in a legal environment. There is discussion about the need for confidentiality and how to take care of that need during an intervention. There is a five-step action plan that is reviewed multiple times during the training day and practiced during role plays. There is an acronym for the steps: ALGEE. Here we notice the Australian origin, ALGEE is the name of the MHFA mascot, a koala bear.

ALGEE: The 5 step action plan

• Assess for risk of suicide or harm

• Listen nonjudgmentally

• Give reassurance and information

• Encourage appropriate professional help

• Encourage self-help and other support strategies All participants get a 133-page manual that is an excellent reference book. It can help you in reviewing the essentials of the program and is a good marketing material for persuading colleagues to take the class.

Current and future goals

So far the SC Bar has hosted trainings in Beaufort, Charleston, Greenville, and two in Columbia. After that, we hope to host in the Horry/Georgetown area, Florence, Aiken, Rock Hill, and Greenwood. Then we will start over. We hope both of the law schools will host, too. We need students trained for multiple reasons-to help each other, to help destigmatize mental illnesses and to help normalize the practice of planned noticing and helping their colleagues who are struggling be seen. If this becomes normal among law students, it will become abnormal not to within the profession.

If you are interested in taking the course and becoming a certified Mental Health First Aider, we can arrange that for you. Please send an email to beth.padgett@scbar. org if you are interested in either taking a class or hosting a class in your area. The classes depend on participation from the attendees, so the maximum class size is 25. There is no cost to lawyers for the training. The South Carolina Bar is providing funding for the classes. Another important note is that in addition to the course certificate, lawyers will receive 7.5 hours of CLE (SA/MH) credit.

No one thing will resolve the mental health crisis within the legal profession. We do believe that MHFA will be one of the factors that makes a significant difference in the conversations around mental health, substance use disorders, and suicide. We believe many lawyers, and over time judges and law students, will use the skills learned in these classes to save careers and lives, and to make the profession more aware of the importance of well-being. Lawyers do important, vital work for society. Lawyers deserve to be mentally and emotionally healthy so they can work with less distress and experience the richness of life that comes from be-ing mentally and emotionally well.

Please remember that Lawyers Helping Lawyers is available to help all members of the South Carolina Bar who are experiencing problems with alcohol or who are experiencing any mental, emotional, substance use or stress-related problem. You can reach Robert Turnbull at 803-603-3807 or Beth Padgett at 803-240-6526.

Also, remember that South Carolina lawyers can access five free counseling sessions each year. Call 855-321-4384 for a brief assessment and referral to a counselor in your area.

Services provided by Lawyers Helping Lawyers are confidential.

Beth Padgett is the co-director of the Lawyers Helping Lawyers Program at the South Carolina Bar. She served as program chair for the 2019 National Conference for Lawyer Assistance Programs.

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Notes:

[1] Mental Health First Aid homepage, Mental Health USA (last visited September 16, 2019 https://www.mentalhealthfirstaid.org/).

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