Mental Health
Stress is inherent in outdoor trips and activities. Organizations who promote character education or therapy often use perceived risk and it's associated stress as a strategy to reach their goals. And, of course, incidents that result in a near miss, injury, or illness can occur.
While people can often adapt to mild stress and return to their baseline relatively quickly, chronic, moderate, or severe stress may overwhelm an individual’s coping mechanisms and result in a mental health problem. A trip leader does not need to be a mental health professional to recognize when a client or student is experiencing stress or a mental health crisis. The purpose of this page is to present concepts, support strategies, and evacuation guidelines that will help field staff—or those providing patient care--address participant's stress during an outdoor expedition or trip.
The material on this page is summarized for field use in the Mental Health Assessment section of the Wilderness Medicine Handbook.
Contents
While people can often adapt to mild stress and return to their baseline relatively quickly, chronic, moderate, or severe stress may overwhelm an individual’s coping mechanisms and result in a mental health problem. A trip leader does not need to be a mental health professional to recognize when a client or student is experiencing stress or a mental health crisis. The purpose of this page is to present concepts, support strategies, and evacuation guidelines that will help field staff—or those providing patient care--address participant's stress during an outdoor expedition or trip.
The material on this page is summarized for field use in the Mental Health Assessment section of the Wilderness Medicine Handbook.
Contents
Mental Health Pyramid & Stress Responses
The graphic below depicts the different levels of distress and their associated evacuation levels with respect to a mental health event.
Trip leaders must be able to identify and evaluate a participant's stress levels early to avoid a mental health crisis. The process need not be onerous. To create an environment where participants feel comfortable seeking help, trip leaders must begin by acknowledging stress as an inherent part of most outdoor experiences and then discuss the mental health pyramid and stress levels with participants before or at the onset of the expedition. They should encourage those who self-identify as distressed, overwhelmed, or severely overwhelmed to approach staff privately to share their feelings and concerns and develop a support plan. Similarly, if staff or trip leaders notice behaviors indicating a participant may be in distress or crisis, they should initiate a private conversation with the same goals. Depending on the participant's situation, staff may provide support in the field or initiate an evacuation.
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Consider circling up once or twice daily—or after a potential stress-inducing incident—to check in. Use colors to help group members self-identify their current stress level. If a group member self-identifies as yellow, orange, or red, discuss the precipitating incident and work to resolve it and any accompanying stress.
S/Sx of Potential Behavioral & Psychological Distress
- Does not participate in group discussions or decision making.
- Has little or no interest in maintaining friendships or participating in daily activities.
- Withdrawn, seeks solitude whenever possible.
- Shunned by group members.
- Constantly fidgets, appears anxious or afraid.
- Appears easily annoyed, irritable, or unusually critical.
- Appears distracted, speaks unusually slowly, or rambles.
- Appears sad or unhappy, exhibits episodes of crying.
- Poor appetite or overeating.
- Shares beliefs that other group members find unusual or bizarre.
- Sudden or noticeable change in daily functioning.
- Exhibits disruptive behavior.
- Unusually emotional.
- Exhibits on-going conflict with group members or staff.
- Exhibits on-going irrational behavior.
- Complains of numerous unexplained physical ailments.
- Exhibits an inability to cope with daily problems and activities.
- Self-identifies as distressed (yellow), overwhelmed (orange) or severely overwhelmed (red).
Support Guidelines
Participants who are in distress but actively compensating (yellow) may remain in the field if supported and their daily functioning monitored. Support participants by:
- Creating a calm, safe environment
- Carefully listening to their story and concerns
- Involving them in problem-solving and self-care
- Helping them build stronger relationships with staff or trip leaders and group members
- Working with them to create practical
Evacuation Guidelines
If any of the following conditions are met, the participant should be evacuated and seen by a mental health professional; closely monitor them during evacuation.
- Field staff—or those providing patient care—are uncomfortable with the situation.
- The participant exhibits an on-going or growing inability to cope despite interventions and support.
- The participant's behavior negatively affects other trip members’ experience.
- The participant is prescribed Rx meds for a mental health condition and is not taking them.
- The participant appears to have the potential to harm themselves or others.
- The participant wishes they were dead or expresses suicidal thoughts.