Managing someone in mental health distress in the outdoors

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By Cory Jones, Director and senior trainer at First Aid training Co-operative.

First Aid Training Co-operative (FATC) has been running outdoor first aid courses for countryside land managers, rangers, ecologists and educators for over a decade. Post covid there has been an increasing demand for mental health first aid training to deal with mental distress experienced by either a colleague or site visitor. In the last few months, FATC has been leading a working group of outdoor practitioners developing specific mental health training for outdoor workers.

Comparing Mental Health First Aid to Physical First Aid

Outdoor practitioners are trained to handle physical injuries, a twisted ankle, bleeding cut from a tool injury or a bang to the head from a fall. But how do you deal with a mental health first aid incident? The truth of the matter is that with both physical and mental health first aid the key aims are the same – preserve life, provide immediate support, prevent further damage and promoting recovery by getting help or support for the casualty. The key difference lies in visibility: physical injuries are often obvious, while mental health concerns may be hidden.

To deal with physical first aid incidents staff are trained to follow an incident system, normally based on the ABC’s (Airway, Breathing, Circulation, etc.) of first aid. So, is there a system for dealing with mental health distress, as there is for physical injury?

F.I.R.S.T. Incident Procedure for mental health distress

FIRST is a systematic way to manage a casualty in mental health distress in the outdoors.

F – Find Out or Figure Out

Be observant. Outdoor practitioners must be attuned to subtle signs of distress, such as changes in behaviour, emotional outbursts, or withdrawal from group activities. Look for signs that someone is struggling, such as changes in mood, communication, or engagement. Trust your instincts if something feels 'off'.

I – Investigate

If you feel something isn’t right, investigate by starting a conversation: 'I’ve noticed you seem quiet today; is everything okay?' Ask open questions and listen actively to the casualty’s reply. You can then move onto reassuring the casualty. If the conversation leads you to suspect suicidal thoughts, it’s important to ask directly: 'Are you thinking about suicide?' Evidence shows this does not plant the idea but instead provides relief by showing you care*.

R – Reassure

Often there are simply things that can be done to reassure the casualty, stop or alter the activity that is causing distress. If someone has a physical injury you wouldn’t think twice about stopping or altering what you are doing to make sure they are well cared for. Why should it be any different for someone in mental health distress? If a casualty’s distress requires attention, adapt your day to prioritise their needs.

If it is something external which is a problem, let the person know they are not alone and that you’re there to help. Use calm, empathetic language and avoid judgment. After listening and giving reassurance many casualties may already be feeling more comfortable. However, if they are still in need of care move onto ‘support’.

Most outdoor workers are not doctors, therapists, or counsellors. Avoid trying to diagnose conditions or making assumptions about what someone is experiencing. Instead, focus on listening, supporting, and guiding them to professional help.

S – Support & Signpost

Guide the casualty toward resources, such as a GP, mental health hotline, or a trusted professional. If the casualty is in immediate danger (e.g. suicidal intent) then provide immediate support, such as staying with them until further help arrives from the emergency services.

T – Take Care

Encourage the casualty to engage in self-care when they’re ready. This will be different for each person but often taking some quiet time to reflect, journaling, taking exercise can all be beneficial.

As the responder, remember to prioritise your own self-care to manage the emotional toll of looking after a casualty.

*Should We Ask About Suicide?

Yes. If you suspect someone may be suicidal, ask the question directly. Research confirms that asking about suicide does not increase the risk; instead, it shows you care and provides a vital opening for them to share their feelings. Use empathetic phrasing, such as: 'Sometimes, when people feel like this, they think about suicide. Is that something you’re feeling?' If they confirm, follow up with: 'Have you thought about how you would do it?' This helps gauge the severity of the risk and inform next steps.

Summary

Dealing with mental health distress in the outdoors can be approached in a systematic way as would be the way when responding to physical injuries. By observing signs of distress, engaging in compassionate conversations, and using the FIRST system, outdoor practitioners can provide immediate support and guide individuals toward further help.

Mental health is as vital as physical health. We have the opportunity to normalise seeking help, adapting plans, and prioritising wellbeing which can help reduce the stigma around mental

health.

Free digital Mental Health First Aid Manual – As of the working of FATC a digital Mental First Aid manual has been developed which can be downloaded onto a SMART phone allowing anyone to have a Mental First Aid manual in their pocket for when it may be required. To download your free mental health first aid manual simply follow the link.

https://firstaidtrainingcooperative.co.uk/free-mhfa-manual/

Mental Health Awareness for Outdoor Practitioner course – For anyone looking to learn more about managing mental health distress then training is available simply follow the link.

https://firstaidtrainingcooperative.co.uk/mental-health/

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