NYC plan trains lay people as mental health screeners
The training session asked workers how they would respond to troubled people — a drug user, an abuse victim or someone with bipolar disorder — that they might encounter on the job.
They weren’t doctors or therapists, and their employer, a wide-ranging youth outreach organization called The Door, isn’t only a counseling center. But mental health how-tos are part of everyone’s training, whether they’re career advisers or basketball coaches, and reaching out to offer help is part of everyone’s job.
New York City is about to put that idea to a major test: a $30 million plan to provide mental health training to staffers at social service organizations. They’ll be prepared to screen people for possible psychological problems, provide information and try to motivate them to make changes in their lives.
“Everyone can be a healer,” city First Lady and mental health advocate-in-chief Chirlane McCray said in a statement.
It’s an increasingly popular approach to extending the thinly stretched mental health system, fostering awareness and reaching people who don’t seek out professionals. But there has also been some debate over what role nonprofessionals should play.
The concept dates to the 1960s but has taken new hold recently in places from Philadelphia, which trained 10,000 workers and residents in “mental health first aid” and is aiming for 150,000, to Goa, India, where a 2,700-patient experiment found some benefits to including lay counselors in psychological care.
The World Health Organization has called nonprofessionals “a valuable resource for mental health care.” The White House led a push that is directing $15 million a year to train teachers in mental health first aid, which 450,000 people nationwide have taken since 2008. About 1,000 people have gone through a separate program called “emotional CPR.”
Part of the rationale is sheer numbers: More than 43 million American adults had some diagnosable mental illness in 2013, according to a federal estimate. Meanwhile, more than 97 million Americans live in areas, some in New York City, which the government says have too few mental health professionals.
“If we’re really going to take on mental illness, as widespread and impactful as it is, we’re not going to reach that scope of impact with one provider at a time,” says Dr. Gary Belkin, who heads the city Health Department’s mental health division.
Mental health advocates stress that training the public shouldn’t substitute for having enough professionals, and solace and support aren’t the same as treatment. Still, proponents say lay people can be what licensed specialists sometimes can’t: eyes and ears outside a therapist’s office and familiar figures who can start conversations about what’s wrong.
Shatiera Freeman doesn’t hesitate to broach those conversations at The Door, where she teaches about health. She’s not a mental health expert, and sometimes, she’ll suggest a youth talk to one. But first she’s ready to lend her own ear, remembering the various staffers she turned to as a teenager using The Door’s services herself.
“It’s not ‘let’s just send them to therapy.’ It’s ‘let’s sit down and figure out what’s going on,'” says Freeman, 23. “Our job is to care.”
That’s why every worker learns about trauma, adolescent development and how to help, Deputy Executive Director David Vincent said. (The Door’s offerings, which range from recording studios to a drop-in-center for runaways, got international attention when Britain’s Prince William and his wife, Kate, visited last year.)
As New York City takes a page from places like The Door, mental health advocates are cheering — loudly— but sounding notes of caution.
“It could, depending on how it’s done, have a normalizing function … (or) disparage people or make people feel like they’re in a worse condition than they are,” says Harvey Rosenthal, the executive director of the New York Association of Psychiatric Rehabilitative Services.
Advocates worry about nonprofessionals slipping from noticing possible problems to diagnosing them, or overblowing unusual behavior into mental illness. Some researchers see having lay people do screenings as a recipe for false positives and unneeded follow-up; others, however, say it can accurately assess a community’s psychological needs and link people to professional help.
Officials say New York’s project will study how well the nonprofessionals do at connecting people to mental health services and how they fare.
Back at The Door, Freeman has her own perspective on what nonprofessionals need to be effective.
Training is useful, she said, but so is “the instinct that we already have … we’re here to help.”