Your Mental Health First Aid Kit: Tools For Tough Days

We all have a clear idea about how to get to our plasters if we happen to cut ourselves. We know where our antiseptic is kept, where the bandages can be found, and what needs to be done in the first minutes after an accident. Very few of us know how to deal with an injured mind, even though it needs the same treatment as a burn, blister or burst skin. This is the gap that a mental health first aid kit aims to fill.

In essence, this is your own toolkit, that is made up of all those coping techniques, tools, information and tips that you prepare for yourself ahead of time, so that when you have a difficult day you don’t need to try thinking about how to cope when your mind is clouded by everything else going on. You just take out whatever has been prepared in advance.

Preparing in advance; what's the point?

The very moment when stress, depression or anxiety start showing up is the very moment when your brain shuts down its most rational, problem-solving function (your prefrontal cortex). Under stress our brains switch into a more primitive mode that focuses on threats. That is part of the brain that throws back to having to defend yourself from a pack of wolves, but our brain still pulls this feeling and physical sensation up when something is anxiety inducing. This is not a weakness. It is biology at work, and this process occurs with every single person.

This is the exact reason why firefighters practice responses to emergencies even when there isn’t an emergency yet, why surgeons practice surgeries before stepping into an operating room, and why sportspeople practice every move countless times before an actual game. Under pressure and with depleted cognitive capacity you rely on your preparedness.

A first aid kit removes the element of making a decision in times of a crisis. The decisions have been made on another day when you had plenty of time to think what would be helpful. Now, in a tough situation, you don’t need to search for the solutions; you just follow the instructions which were made by you in calmer days.

There is also something quietly empowering in preparing for it before you need it. It is a kind gesture towards yourself in the future, and it usually changes the approach to tough situations. You are no longer helpless in the face of the wave because you can feel that you will know how to deal with it.

The science behind a mental health first aid kit

Psychological research clearly shows that the presence of a pre-determined coping strategy leads to better outcomes in times of stress, anxiety, and depression, which does not happen because it is some kind of magic, but rather because it helps to ease cognitive load precisely when it is maximum.

Implementation intention is the version of such pre-determined strategy which has been researched the most. It basically means "if this, then" plan, i.e., “If I start to feel anxious, then I will do breathing a exercise”. People who have set such plans are much more likely to act upon them than those who only intend to cope with their problem. This happens due to the specificity of this intention. A mental health first aid kit can be considered as a set of your very own implementation intentions.

Contents of the Mental Health First Aid Kit

There is no one true form of the kit, and that’s because there is not one true path to self-recovery. Each person knows better than anyone what helps him or her, and therefore it’s up to each individual to figure out the contents of the kit they need.

In general, however, most successful kits contain some or all of the following:

1. A grounding technique

Once anxiety attacks and the overwhelming flood of emotions takes its toll on you, the feeling of being in the present moment disappears altogether. Your mind starts either going back to the past or thinking about the future. This is why grounding techniques are needed to interrupt this chain and bring the person back to reality.

The most popular among those is the “5-4-3-2-1 technique”: Describe five objects you see around you, four objects you can touch, three sounds you hear, two smells you notice, and one taste you feel. In the moment it can be hard to know which numbers relate to which senses, so don’t worry if that happens. It is act of trying the technique through your senses that helps, not the actual numbers.

An alternative is “body-grounding techniques”: pressing both feet down into the ground and paying attention to how they feel; holding something cool and focusing on its temperature and texture. It works because our body is always in the present moment, whereas our minds are prone to wander away.

Remember to choose at least one or two techniques that you have already used and that really worked for you, not just those which seem good in theory. Some other ones to look into are: listing, naming on animal for every letter of the alphabet, breath work, and self soothing.

2. A breathing technique

Breathing is the only part of your autonomic nervous system that you can control in the present moment. Prolonging the exhalation process especially activates the parasympathetic nervous system, the "rest and restore" mode of our organism, which neutralises the effects of stress and anxiety.

An easy way to start is “4-7-8 breathing”: breathe in for 4 seconds, hold for 7 seconds, and breathe out for 8 seconds. The long exhalation is the critical step. Another way to do it is “square breathing”: in for 4, hold for 4, out for 4, hold for 4. Square breathing is popular among therapists, soldiers, and a lot of people who need to regulate their nervous system because it is effective and doesn’t need anything but your body.

The more you practice a particular type of breathing on your usual, normal days, the easier it will be for you to do it on an unusually difficult day. Make sure you get into the habit of doing it through trying it before sleep, while walking, after waking up or when going for a walk.

3. Your people

It may seem like an obvious point, but it's important to be clear. "I will speak to somebody" is not a plan. A plan is: "I will call [name], or if he/she is unavailable, then I will send him/her a text."

Your plan needs to involve having a small, named list of two or three people who you can actually contact. This does not involve having the broad category of "friends and family," but actual people, with who you already have stored means of contact. It is also useful to have a thought beforehand of what you might say, or perhaps even have discussed it with these people so that they know that you consider them as someone who you will contact if you need help. This does not mean that you need to figure out how to ask for help.

4. Physical reset

The relationship between our psychological state and physical state is closer than one can realise in practical everyday experience. Poor blood sugar, dehydration, physical tension, and sleep disturbance not only influence one's physical health but also influence mood, anxiety level, and ability to reason logically.

Your tool set needs to contain a small physical reset protocol that one can use on a tough day. This may be drinking a big glass of water, having a snack, going outside for 10 minutes, doing a mini stretch session for 5 minutes. Not to solve the problem but to give yourself a chance to think through the problem more clearly.

In case you find that your body holds tension during times of stress (tightness of shoulders, clenching of a jaw and a chest), then it will be useful to find out where you store your tension and develop a strategy of working through it. This could be shoulder rolls, body scan, hand unclenching, cold water exposure, or exercising.

5. Go-to coping list

Various things will work on various days, and it's good to have multiple options instead of relying only on one thing. Some possible options for your go-to list might include: a particular playlist, walking, taking a hot shower, reading a favourite book, watching a series of shows that make you feel more calm rather than excited, engaging in some sort of creative activity, and breathing exercises.

It should not include those things which may provide temporary relief but will cause harm in the long run such as spending too much time on social media, drinking, and avoiding the situation. They aren't bad in themselves but aren't coping mechanisms but postponements, and the list is most effective when consisting of things that can actually help you.

Write down your list and be very specific about what you need to do. "Go for a walk" is better written as "put on my headphones, go out of the front door, walk to the end of the road and back."

6. A gentler self-talk script

The voice that pops into your head during times of pressure is inevitably far more judgmental than what would be said out loud to anyone else. A mental first aid kit should include a script of sorts to challenge that particular voice.

Not because of toxic positivity or ignoring what you’re going through, but rather because of something realistic and reassuring, such as "This is tough, and it’s normal to find it tough. It may be a valid feeling, but it will pass. I’ve felt this way before and got through it."

Having this written down ahead of time helps you not to struggle with developing a compassionate point of view when you are at the least capable of doing so.

7. Journaling prompt

Journaling does not have to be long entries of thoughts. In tough times, just a few minutes spent with one truthful question will help you transfer the burden of what is happening in your mind onto paper, and it makes it easier.

One of the most helpful prompts that should stay in your tool belt is "What do I really need at the moment?". The question seems pretty easy, but it goes straight to the point. Some other good prompts are "What does this feeling want to tell me?" and "How would I comfort my best friend having these feelings?".

8. Information about professional help

This is the part that most people forget to include, and possibly the most essential part of all. If it gets to the point where your toolkit won’t do, then being prepared with somewhere to go makes all the difference.

It could mean having your GP’s number saved, knowing the name of a therapist or counsellor who you could reach out to, finding out any relevant helpline numbers (like Samaritans on 116 123, which operates 24 hours a day in the UK), or knowing what your employee assistance program has to offer if you have one. You don’t have to be in an emergency situation to find this out. Finding out beforehand ensures you’re ready if you are.

Bringing your mental health first aid kit all together

Take twenty to thirty minutes on a day that’s neither extremely difficult nor particularly easy and go through the categories outlined above. Put your answers somewhere you’ll be able to get at them: an entry in your phone, a slip in your wallet, the first page of your diary, or even on a laminated sheet if you want.

Check in every few months; because what works may vary over time. Something that was helpful during a stressful period in your job life may not necessarily be applicable in a relationship problem. Make sure it is current.

A mental health first aid kit doesn't mean having everything figured out. It means being ready for those moments when nothing seems to make sense anymore.