Mental health first aid (MHFA) is the help provided to a person developing a mental health problem or experiencing a mental health crisis. Just as physical first aid is given before medical treatment can be obtained, mental health first aid is given until appropriate professional help is received or the crisis resolves.
The ALGEE Action Plan
The mental health first aid ALGEE action plan provides a structured approach to helping someone in distress.
A — Approach, assess, and assist with any crisis. Approach the person calmly and respectfully. Assess for risk of suicide or harm. Ensure immediate safety. If there is an immediate crisis (suicide attempt, severe agitation, overdose), call 911 or 988 (Suicide and Crisis Lifeline). If no immediate crisis, proceed with the next steps.
L — Listen non-judgmentally. Give the person your full attention. Use open-ended questions (Tell me more about what is happening). Reflect what you hear to confirm understanding. Avoid minimizing, judging, or offering quick solutions. Your role is to understand, not to fix. Non-judgmental listening builds trust and reduces shame.
G — Give reassurance and information. Normalize the experience: Many people go through similar things. Provide accurate information about mental health problems and available treatments. Reassure the person that help is available and recovery is possible. Avoid stereotypes or negative language. Match the persons language for their experience.
E — Encourage appropriate professional help. Provide information about resources: primary care provider, mental health professionals (psychiatrists, psychologists, clinical social workers, licensed counselors), community mental health centers, and crisis services. Normalize help-seeking: This is just like seeing a doctor for any other health condition. Offer to help make phone calls, schedule appointments, or accompany the person to a visit.
E — Encourage self-help and other support strategies. Self-help strategies may include: exercise, sleep hygiene, healthy eating, relaxation techniques, mindfulness, peer support groups (NAMI, DBSA, AA/NA), and online resources. Encourage maintaining social connections and meaningful activities. The goal is to support recovery, not to replace professional treatment.
Suicide Prevention
Risk Assessment
Direct questions are essential. Ask directly: Are you thinking about killing yourself? Do you have a plan for how you would do it? Do you have access to what you would use? Have you made any preparations (writing a note, giving away possessions)? Asking about suicide does not plant the idea — it reduces risk by opening communication.
Risk factors. Mental disorders (depression, bipolar, PTSD, schizophrenia, substance use) are present in 90% of suicides. Other risk factors: previous suicide attempt, family history of suicide, access to lethal means, male sex (men die by suicide 3.5× more often than women), older age, social isolation, chronic physical illness, recent loss or crisis (relationship breakup, financial crisis, legal trouble), and military veteran status.
Warning signs. Talking about wanting to die or kill oneself, looking for ways to kill oneself, talking about being a burden, increased substance use, hopelessness, purposelessness, anxiety/agitation, withdrawal from others, rage or seeking revenge, reckless behavior, dramatic mood changes, and saying goodbye or making arrangements.
Safety Planning
A safety plan is a prioritized list of coping strategies and sources of support that the person can use during a suicidal crisis. Components: recognize warning signs; use internal coping strategies (relaxation, distracting activities); contact social contacts for distraction; contact family members or friends for help; contact professionals (therapist, crisis line); and restrict access to lethal means. The safety plan is documented on a card or in a phone app. It is more effective than no-intervention contracts.
Lethal Means Restriction
Reducing access to lethal means is one of the most effective suicide prevention strategies. Firearms are used in 50% of US suicides (most lethal method). Counseling patients and families about safe storage (lock boxes, gun safes, removing from the home temporarily) saves lives. Medication safety: limiting quantities dispensed, using blister packs, and involving family in medication management.
Anxiety and Panic Crises
When someone is having a panic attack or severe anxiety: stay calm and speak in a calm, reassuring voice. Validate the experience: This is very scary but it will pass. It is not dangerous. Encourage slow breathing (four seconds in, four seconds hold, four seconds out). Grounding: name five things you can see, four things you can touch, three things you can hear, two things you can smell, one thing you can taste. Avoid minimizing (Just relax) or escalating (This is a heart attack!). After the panic passes, encourage follow-up with a healthcare provider.
Substance Use Crises
Overdose. Recognize opioid overdose: unresponsive, slow or absent breathing, pinpoint pupils. Administer naloxone (Narcan) nasal spray if available. Call 911. Perform rescue breathing or CPR. Place in recovery position if breathing. Opioid overdose is reversible with timely naloxone.
Severe intoxication. Stay with the person until the effects diminish. Alcohol intoxication: place on side (recovery position) to prevent aspiration if vomiting. Severe agitation or aggression: maintain safe distance, call for help. Do not leave an intoxicated person alone.
Psychosis and Aggression
Recognizing psychosis. Hallucinations (talking to someone not there, responding to unseen stimuli), delusions (expressing fixed false beliefs), disorganized speech (illogical, tangential), and disorganized behavior (agitation, catatonia, bizarre posturing).
De-escalation techniques. Remain calm — your emotional state is contagious. Use a low, slow, gentle voice. Give the person space — do not corner them or invade personal space. Do not touch without permission. Use short, simple sentences. Validate feelings without agreeing with delusions: I can see that you are very frightened. Avoid arguing about delusions or hallucinations. Offer choices when possible. Have an exit route. If the person becomes physically aggressive, prioritize safety — leave the area and call for professional help.
Self-Care for Helpers
Providing mental health first aid can be emotionally demanding. The helper must attend to their own well-being: set boundaries — you can help without fixing everything; debrief after the situation with a trusted person; monitor for compassion fatigue, secondary trauma, and burnout; seek consultation if uncertain; and recognize the limits of your role — mental health first aid is not a substitute for professional treatment.
Summary
Mental health first aid is a practical, evidence-based approach to helping someone experiencing a mental health crisis. The ALGEE action plan provides a clear framework: approach, listen, give reassurance, encourage professional help, and encourage self-help. Suicide risk should be assessed directly — asking about suicide saves lives. Safety planning and means restriction are effective prevention strategies. De-escalation techniques help manage acute crises involving anxiety, substance use, or psychosis. The 988 Lifeline provides immediate access to crisis support. Self-care for helpers is essential.