10 Steps to Mental Health First Aid

August 1, 2019


Dr Sven Hansen

We are waking up to the suffering and cost of mental illness. The World Health Organisation estimates that 1 in 4 of us will suffer from mental illness at some point in our lives. Affecting 450 million people today it is the leading cause of illness. The cost to business is USD $1 trillion.

Simple mental health initiatives at work return $4 to $10 for every $1 invested.

Each one of us – if personally concerned, as a caring family member, or as a colleague at work can apply these 10 steps to secure mental wellbeing and rediscover our joy.

1. Understand where mental illness comes from

Genes, early environment, adverse events and our personal behaviours all contribute in complex ways. We have much to learn. It appears that a positive, nurturing early environment is protective even when we inherit recognised gene patterns (1). Learning to deal with adversity early in life is helpful. Learning the practices of resilience is definitely protective and part of recovery. In tragic or traumatic events, it is normal to feel anxious or sad. In most cases recovery starts within two weeks. Extreme events can have long term consequences including anxiety, depression and post-traumatic stress (PTSD).

Destructive childhood experience, social media time (greater than 2 hours/day), sleep disturbance and increased temperature are thought to be causative. Heat, weather events and human conflict increase the risk of violence, anxiety, depression and PTSD (2). Anxious parenting, excess sensitivity, reduced activity, limited outdoor time and isolation are correlated (3).

2. Recognise distress as a normal part of dealing with adversity

Every organism needs to know what is good and what is dangerous. This is how life has been so successful. In overwhelming threat, it is appropriate to withdraw, collapse or burst into tears. This is called the Freeze reaction and is associated with sadness. In conflict, it can be appropriate to shout, bite or hit. This is called the Fight reaction and is driven by anger. When it is possible to run away or avoid a conflict we trigger the Flight reaction driven by fear. These reactions can save our lives in acute and serious events. If repeated, such as war, regular weather events or natural disasters we can be left with PTSD.

Our fast-paced, digital modern life assails us with small, continuous threats and has reduced the time we  have to recover, sleep and reconnect with loved ones. Some experience sadness as they feel worn down, dominated, isolated or abused. This can become depression. Some experience fear under continued threat or risk. This can become anxiety. Other get angry as they flail against difficulty. This can become hostility and rage.

While freeze, fight and flight force a reaction, the feelings of sadness, fear and anger can linger. Sadness is telling us to seek safety and reconnect with love and joy. Fear is telling us to move toward safety and calm. Anger is telling us to disable the threat.

These are normal emotions designed to protect and support you (4). We can learn to notice them and respond skilfully to the message. We can get stuck in in these destructive emotions. Unpleasant and repeating physical, emotional and thinking experiences dominate our being. When they become inappropriate to the context and inhibit normal function, we have to consider clinical depression, anxiety disorders or hostility disorders.

3. Know that we can recover and treatment is effective

Recovery, over time, is the normal outcome. Even in the case of schizophrenia and bipolar disorder sensible life management and treatment is effective. In the case of depression, anxiety and hostility, firm and caring support, lifestyle improvement, counselling, meditation, positivity and thinking skills can be curative. Medication should not be the default treatment (5).

4. Recognise, understand and counter anxiety

Address through the three lenses of body, emotion and mind. The body wants to run; heart rate increases, blood flows to legs (from skin and gut), breath rate increases, adrenaline in the body, nor-adrenaline in the brain and eventually cortisol increases. We feel this through the emotion of fear (nervous, anxious, terrified or horror). The mind is caught in loops of worry about future consequences.

Understanding this allows us to move about, relax our muscles, slow our breathing and seek safe, reassuring spaces – gentle music, nature, touch and sleep help. We can watch carefully for the first signs of fear and immediately remember calm, safe and peaceful images. This counters the fear with calm. Finally, we can watch for worries, write them down and challenge them. As we get better we can redirect our attention to the present moment.

5. Recognise, understand and counter depression

In depression the body wants to withdraw, collapse and be supported; posture slumps, head and eyes drop downward, fatigue increases, tears and early waking may occur. Cortisol increases. We feel disappointed, sad, isolated and hopeless. Our thoughts are trapped in personalising blame (“everything bad always happens to me”). We ruminate on negative thinking about the past. Optimism fades.

Understanding this allows us to sit up, look up and seek comfort from others. Exercise, fresh air, nature and a good sleep can help. We can acknowledge our sadness and push firmly toward happy thoughts, appreciate small things like sunshine and beauty, and seek joy and a smile. We counter sadness with appreciation, gratitude and joy. Counter the negative rumination by remembering that you are not alone, there are things to appreciate, and nurture hope and resolve that you will feel better soon. Being present to the moment helps.

6. Learn the practical steps of rapid bounce

Mastering bounce is your key to resilience – both sustaining your optimal life and growing from adversity (post-traumatic growth). Use the diagram below to help you recognise how resilience fails. Learn how you experience each level. Then practice specific practical actions that you can do to reverse the downward spiral.

7. Take care of your body

Your body and your physical wellbeing is ‘ground zero’. Thoughts and emotions have been designed to help the body deal with adversity and seek a positive state of living. Taking good care of your body is the core of a good life, prevention, resilience and recovery. It is proven to treat mental illness.  Secure enough sleep at the right time. Be physically active every day. Eat well – less sugar, more vegetables and more Mediterranean. Get out in nature and sunshine most days. Stretch every morning. Slow your breathing and relax for at least eight minutes per day.

8. Cultivate positive emotion

Positive emotions activate vagal tone, improve health, increase happiness and improve our thinking. Stimulating happiness (even a chopstick between your teeth) counters depression. Calm relaxation counters anxiety. Kindness and compassion counters hostility. Gratitude, appreciation, contentment, passion, joy, serenity and enthusiasm are others.  Every time you find a way to take time for a positive feeling you are more mentally fit.

9. Notice and direct your thoughts

Cognitive behaviour therapy (CBT) has proven to be as effective as medication in depression. It can be applied to all forms of adversity. In essence, it is simple:

  • Pay attention to the content of your thoughts – write them down
  • Challenge your thinking – test whether the thoughts are accurate
  • Reframe the thoughts in more constructive terms

For example, in depression you may notice the thought “everything bad always happens to me”. Counter with: “Well, not everything. Yesterday was a good day. Others have challenges too.”

In fear, you may notice "how will I ever meet the deadline". Counter with: "If I don't, we will get by. If I turn my focus to what I need to do right now, we might get there. No point in worrying."

10. Be kind and considerate to others

Seek joy and fulfilment by doing good things for others. Altruism (thoughtful, genuine kindness to others) helps you as much or more than those you help.

Start by being kind to yourself. Many of us are self-critical and hard on ourselves. Be gentle on yourself. Remember your goodness. Take time to enjoy and celebrate. To get started, sit quietly breathing slowly. As you inhale bring kindness inward. As you exhale let your goodness radiate out.

Use your altruism to be involved in a charity, helping someone in need, or choosing a job that does good things for others. Even sitting quietly and radiating out peace, love and joy to everyone you can think of has a powerful positive on every aspect of wellbeing – even the structure and function of your brain.


  1. Robert Sapolsky, Behave, 2017.
  2. David Wallace-Wells, The Uninhabitable Earth, 2019
  3. i-Gen, Jean Twenge, 2017
  4. Antonio Damasio, The  Strange Order of Things, 2018
  5. Johann Hari, Lost Connections, 2018

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