Various committees within the legal profession, such as the ABA’s Mental Health Committee and the Florida Bar’s Special Committee on Mental Health and Wellness, are brainstorming methods to address the increasingly sobering statistics of depression, severe anxiety, and substance abuse among lawyers . In this episode of The Florida Bar Podcast, host Christine Bilbrey talks to Joe Ankus about mental health first aid training and how it could positively impact the law firms that use it. They discuss the benefits of non-judgemental and undivided listening and give various other tips for mental health first aid.
Joe Ankus has been a legal search consultant since 1991 and is the president of Ankus Consulting, Inc.
The Florida Bar Podcast
Mental Health First Aid Training
Intro: Welcome to The Florida Bar Podcast, where we highlight the latest trends in law office and law practice management to help you run your law firm, brought to you by The Florida Bar’s Practice Resource Institute. You are listening to Legal Talk Network.
Christine Bilbrey: Hello and welcome to The Florida Bar Podcast brought to you by the Practice Resource Institute on Legal Talk Network. We are so glad you are joining us. This is Christine Bilbrey. I am the Senior Practice Management Advisor at PRI and the host of today’s show, which is being recorded from our offices in Tallahassee, Florida.
Our goal at PRI is to assist Florida attorneys with running the business side of their law practices. We will be focusing on a different topic each month and we will carry the theme throughout our newsletter and website with related tips and articles.
So this month our topic is Mental Health First Aid Training and joining me today is attorney Joseph Ankus. Joe is the President of Ankus Consulting, one of South Florida’s longest established and most respected legal recruiting firms. Before becoming a legal recruiter in 1991, Joe was an associate with two of the nation’s largest law firms, Dechert in Philadelphia and Holland & Knight in Miami.
Joe graduated from the University of Pennsylvania and then earned his JD from the University of Florida College of Law, where he was a Senior Editor of the Florida Law Review.
I have invited Joe today to discuss another role that he has recently taken on since becoming a member of the Florida Bar’s Special Committee on Mental Health and Wellness of Florida Lawyers, which is chaired by Dori Foster-Morales. Dori has encouraged Committee members to find innovative solutions to try to combat the sobering statistics that we have been hearing about from the Hazelden Study, attorney depression, addiction, suicide, and the numbers have been really startling.
Joe and another Committee member Dr. Rahul Mehra responded to Dori’s challenge and have become certified instructors of Mental Health First Aid.
So welcome to the show Joe.
Joe Ankus: Thank you Christine.
Christine Bilbrey: I have had the pleasure of getting to know you while serving as the Florida Bar’s staff person for the Special Committee on Mental Health and Wellness of Florida Lawyers. That’s the last time I am going to say the whole name of our committee. But I want you to tell our listeners a little bit about yourself, your work on the Committee and what led you to become a certified instructor of Mental Health First Aid.
Joe Ankus: I really appreciate that and before we even get started, I want to just re-thank the Bar and the Special Committee for really taking such a proactive initiative on a subject which has unfortunately not received the attention that it needs.
Essentially my work on the Special Committee was to assist Dori and the other Committee members on identifying and then taking concrete steps to formulate some easily obtainable techniques and tools which Mental Health First Aid falls squarely under.
So I was particularly interested in this topic having been an attorney in the early stages of my career with a couple of large firms and then having worked as a solo practitioner for about a decade, I was intimately familiar, both personally and professionally, with attorneys and clients suffering from a variety of mental conditions.
Ultimately when the Committee was formed, it coincided tragically with some completed suicides that occurred in South Florida. And we all collectively agreed that the time had come to what we refer to as move the needle. And Michael Higer, the President of the Bar, was instrumental in leading the charge. So that’s what brought me to the Committee.
And regarding the Mental Health First Aid, Dr. Mehra, I had never heard of Mental Health First Aid and Dr. Mehra had actually kind of brought up the idea of this program and I was attracted to it, because I thought that it really was able to fill the gap which was sorely needed. As a teenager I remember that myself and many of my friends, we all were certified in CPR, which was kind of a first line defense in the event of an unfortunate cardiac event. We knew we weren’t doctors, we knew we weren’t nurses, but we did have enough basic life support training to at least provide help until professionals could arrive.
So Dr. Mehra kind of explained that Mental Health First Aid was essentially the same thing as almost the CPR type course. So I went and took a 40-hour fairly rigorous training program, took about a week and now I am able to actually be a certified instructor so that I can bring this knowledge to the communities where it’s needed most.
Christine Bilbrey: That’s excellent. Well, so just like I think a lot of us have that card in our wallet, so we hope we never have to use it. So you learn a little bit of CPR, a little bit of bandaging, how to use an EpiPen, those kind of things. But if a person goes through your Mental Health First Aid training, do they have to know the person really well or could there be a specific incident that they have just stepped into that they could assist if the need arises?
Joe Ankus: That’s a great question, and the answer is, is it’s certainly useable even in the presence of a complete stranger. Obviously the more you know somebody there’s a pre-established rapport and obviously you are in a situation where you have more knowledge and frankly there’s a trust factor if the person knows you. But that being said, Mental Health First Aid is designed for intervention in a stranger situation or a family member or more relevant to our podcast, a colleague, a coworker, a staff member.
So the skills that we teach and the skills that I learned really are applicable in any wide range of situation.
Christine Bilbrey: So you completed the certified trainer course, when you go out and train people, how much time do they have to commit to go through this training themselves?
Joe Ankus: Again, another good question. The answer is it’s eight hours. I have noticed that some folks say to me, wow, can you abbreviate the course, is there a unabridged version? Lawyers want to always figure out a way to save time and I don’t begrudge them for that. But Mental Health First Aid, we are actually as instructors, we are bound to eight hours.
And the interesting part is it can’t be nine or ten hours and it can’t be seven hours. This course was designed almost 17 years ago. It came from Australia. And so the eight hours is actually necessary to cover the material. Unfortunately, there are no shortcuts to become certified as a participant or somebody that is able to render the services.
Christine Bilbrey: Well, so if someone comes to the eight hour class and this is brand new to them, what are some of the skills — are they learning to just like be present and assess that there’s a reason to step in or are they going to receive some training to interact with the person until — I am just wondering what kind of actual skills I am going to walk away with if I do that course?
Joe Ankus: Sure. So in eight hours here is what you are going to essentially learn and I am going to abbreviate it, but basically what we do is we first do fundamental education about depression, anxiety, substance use, and suicide awareness, as some general topics. And when we teach what we are trying to do is two things.
One is we are trying to educate people about these disorders and then we are also trying to destigmatize these disorders. There is so much misinformation and so much bias that still exists against having an open and frank discussion that part of our mission as Mental Health First Aid instructors is to put these topics out in the sunlight and talk about them. Without an open mind and out of willingness to engage in a meaningful dialogue, the training in and of itself would be of lesser value.
Now, after we do some of the fundamentals and some of the kind of didactic material, we then teach something called ALGEE. And ALGEE is an acronym and I am going to take you through very briefly what it is.
So everybody that gets certified as a participant in Mental Health First Aid understands that A stands for our ability to assess for risk of suicide or harm. The L in ALGEE is to listen non-judgmentally. The G is to give reassurance and information. The first E of ALGEE, it’s spelled A-L-G-E-E, is to encourage the person to get appropriate professional help and the final E is to encourage self-help and other support strategies.
And so the ALGEE model is evidence-based, which is very important to realize. The material was created by professionals in Australia, under the auspices of the University of Melbourne.
It has now reached over a million people in the world and there are approximately 13,000 certified instructors in the United States. What you find is, is that ALGEE is a tool, okay, it’s a tool and sometimes we might not follow it in order, sometimes we might listen first and then assess for risk of harm, but it doesn’t really matter how we do it, it matters that we do it.
And obviously, the way ALGEE is structured as you see, we’re not treating, we’re not diagnosing, we’re not figuring out why the person may have had a history of distress in their life, that’s not what we’re doing. What we’re doing is serving as the bridge, the bridge between somebody having a problem which could range from mild to crisis, and staying with them, either physically or just being in contact until appropriate professional help is received.
Now we have to recognize, we’re dealing with people and not everybody is going to necessarily be receptive to Mental Health First Aid. And we accept that and we understand that, but that still doesn’t mean we don’t try. Obviously, Mental Health First Aid is voluntary, we can’t force anybody but we have found from evidence and from field studies, and from the material that generally, if you are willing to listen non-judgmentally, you may very well be able to encourage a person to get the help they need.
And again, what I loved about the program being a lawyer was that it was evidence-based. This was not just pulled from the sky or drawn from the ether. This was a combination of clinical and research-based methodologies to create the program. So I don’t consider it psychology or pop therapy, it’s nothing like that. It is a set of tools that we learn to deploy when we need to deploy them.
Christine Bilbrey: And you bring up an important point because I think attorneys as a group are skeptical, they want you to prove to them it’s going to do some good. So is this endorsed by any of the associations here in the US, like psychologists, psychiatrists?
Joe Ankus: The short answer is, is that in the US, what we find is a lot of community behavioral healthcare providers are basically kind of some of the most visible proponents of Mental Health First Aid. I do believe but I can’t cite to it, I do believe it is gaining traction among attorneys on a nationwide basis, but I simply don’t have any statistics I could share with you today.
What I can tell you is when I got trained in it initially, just to become a mental first aid provider, being certified not as an instructor but I took the eight-hour class first and that was taught by a local community behavioral healthcare provider, who definitely believe in its implementation.
That said, I can tell you that there’s no doubt that the program can improve a person’s mental health, meaning the provider because we become educated, we understand ourselves a little better. We increase the understanding of mental health issues. We connect people with care. Part of this is really being able to have some effective resources that we can share.
And the fourth is to reduce the stigma, which really underpins a lot of the reason why we need to do this. It’s one of the biggest ironies and I’ve seen it in my professional career, is that, if you talk to somebody at any level, past a hello or a goodbye, it’s amazing how many people either directly or indirectly are affected by either depression, anxiety, substance abuse, bipolar disorder, psychosis, it doesn’t really matter. We’re not interested in the label.
But I can tell you that in my 26 years as a legal recruiter, combined with my 26 years of being a lawyer as well as just being a citizen, I can tell you that more likely than not, somebody in your family or your circle of connections have or are experiencing some sort of issue that would be appropriately addressed in the mental health context.
You had pointed out the Hazelden study, the ABA has taken quite a lead in this as well, as well as the Florida Bar but just to give you an idea, and it’s kind of stunning, just some real brief statistics.
21 to 36% of lawyers are considered problem-drinkers, which we would consider substance use; 28% struggle with depression, 23% struggle with stress and 19% struggle with anxiety.
Now, the goal of all this and I think, Christine, because you know so much about working so closely with the committee is part of this is to recognize it’s not about trying to figure out a way to make everybody happy. It’s not about trying to make everybody happy.
“Happiness” in and of itself is a troubling word because everybody can define it differently. But what we’re trying to do is bring some balance and some contentment and some restorative guidance to the members of the Bar. Nobody — and I’m speaking only for myself, nobody should have to suffer in today’s day and age with a mental illness. Nobody should have to suffer. There are resources available.
Christine Bilbrey: And that’s a good point. So you talked about is that the first E that’s in ALGEE for Encourage, encourage them to get help because it is — there is such a stigma to it. If you’ve assessed and you’ve listened and you’re there and you’ve realized that you do need to encourage them to get some professional help. If someone has gone through the Mental Health First Aid training who do you direct them to or is there something that’s specific to each region or does the training say, here’s a number they can call, what do you give them after you tell them you really need some help?
Joe Ankus: Great, great question. And it’s probably one of the more important things that we actually do as mental health first aiders is that before I will teach a group about Mental Health First Aid, I will have done my homework and prepared a resource sheet, so that everybody leaves with a resource sheet.
Now, that resource sheet is going to contain two major categories. It’s going to contain information about national programs, okay, so for example, we will have the National Suicide Health Hotline as one of the most important things that we can distribute. We will also have other national resources on there.
Then we will also have a section with local resources; for example, when I took my 8-hour class, I was given a handout with a combination of both national resources and a lot of resources for Broward County and for those listeners that are in the northern and middle part of the State. Broward County is essentially the area; Fort Lauderdale would be a good guiding point for you to consider Broward County.
So I would have local and national resources that covered a wide range of areas that you might encounter in your role as a mental health first aider, but we don’t — again, we provide the information, it’s up to the individual to decide if they want to act on it unless it’s a situation where 911 needs to be called or a crisis intervention officer needs to be called.
Christine Bilbrey: Okay, and I love that this is the way you compare it to regular first aid because everyone there’s no stigma about that, there’s so many people that can jump in and help. Now that you’ve gotten certified, what is your plan to get this into the law firms because we know that that’s the crisis area for us at the Bar?
How are you going to spread the word?
Joe Ankus: Sure. So the committee has discussed a few different things and essentially it’s really going to be I think a three-pronged approach, subject to final committee approval but the three-pronged approach would go something like this. One is targeting this education as early as the law school because sadly, the law students aren’t immune from any of this.
The statistics are fairly sobering when you research about how law students are suffering from some of these issues, including depression and anxiety, and just to give you an idea, just I’m not a statistics person, but just to give you just a rough idea, 43% of law students report binge drinking at least once in the prior two weeks and 23% of them self-report mild or moderate anxiety, 14% report severe anxiety, 17% report depression, and sadly, 6% have suicidal thoughts.
So Ben Gibson is on our Committee and Ben works a lot with young lawyers in the Florida Bar, so we are thinking that it’s kind of a tri-pronged approach. One is, is to deploy this to the law schools.
Number two is to deploy it right into the law firms and I am excited to be doing my first actual real life training in late June at a law firm in Miami that I will be going to.
And then the third thing is to work with the judiciary. We are very fortunate to have Judge Nushin Sayfie on our Committee, who is very committed to this, as well as Judge Steve Leifman, who has been invaluable.
And part of our goal would be to train a number of attorneys, both in the governmental sector and in the private sector to essentially be Mental Health First Aid ambassadors that can spread the word and are trained in this.
But we are going to be targeting the judiciary, we are going to be targeting the law schools and we will be targeting the 100,000 plus members of the Bar.
As a side note, I will tell you that there have been articles in the Florida Bar news which have really brought this issue to the forefront. In fact, Chief Justice Labarga was quoted as making sure that the Florida Supreme Court was doing its part to promote destigmatization as recently as May 1st. There was an article entitled ‘When lawyers need help, let’s make sure they don’t fear getting it’ and that was Chief Justice Labarga saying that.
Chief Justice Labarga was quoted as saying, this is not a question of shame, it’s a question of health, and I can’t agree with the Chief Justice any more than that. So we have got tremendous support for this initiative and we have definitely embarked, the train has left the station and I am very pleased to be a passenger.
Christine Bilbrey: That’s wonderful. So you are down you said in the Broward County area, what if I am up in Pensacola or Jacksonville, how can I find out if there is someone who is offering the Mental Health First Aid training in my area?
Joe Ankus: Sure, great question. And certainly I encourage anybody that’s listening, they can always go to the Mental Health First Aid website, and I will just read it. It’s HYPERLINK “www.mentalhealthfirstaid.org” www.mentalhealthfirstaid.org, and you can find programs possibly in your area. If you have to expand the geographic range, you can certainly expand the geographic range. That’s one way you can certainly do it. And I found their website to be fairly user friendly and helpful and full of good information.
Christine Bilbrey: Have you found yourself applying what you have learned to some people that you have encountered already, like do you feel like you are tuned in?
Joe Ankus: It’s funny. I think the direct answer to your question is, is that — the short answer is yes, with an explanation. So even before I became an instructor, which was very recently, I found just through my experiences as a practitioner and as a recruiter that active and nonjudgmental listening really, really, really is important. And for those people that are participating on the podcast today, if you were to leave with anything that could be a kind of a takeaway other than actually getting Mental Health First Aid training, the takeaway is learning to really listen to someone without interrupting them and without judgment. It is a practice skill.
And lawyers, we tend to be advocates. We tend to think quick. We tend to think we know what’s best for everybody. We tend to mentally cut people off maybe 30 seconds before they are done speaking. I get it. Look, I am not immune from it. I do it too. But if you really learn to listen to somebody and you really practice the skill to put yourself in that person’s shoes and suspend your own beliefs and ideals, I can tell you that you will really appreciate the power of listening.
We are so distracted, Christine knows this, we are so distracted with our cell phones, with the Internet, with Facebook, all these distractions, so if you are going to actually have a real conversation (which I encourage you do), if you are going to have a real conversation, put your phone face down, put it on mute, don’t look at the computer screen, just be with the person you are with and give them your undivided attention.
And that really is the L in ALGEE, which is listening non-judgmentally. I expounded on it, but basically that’s what it means, listen non-judgmentally. And listening doesn’t mean cutting somebody off, even if it’s in your own mind. If they are talking, you should be listening and trying to really understand what they are saying, why they are saying it and where they are coming from.
Christine Bilbrey: So important, and making that connection with the people around you goes a long way to approaching happiness, a little more health and wellness. That’s an excellent point.
Joe Ankus: It does and the funniest part is and kind of a running joke is, especially among people in the mental health profession, of which I am not, is that the funniest thing is, is that many times some of the best therapists don’t do anything but listen and the person will emerge from the session going, I feel so much better, thanks so much, and the therapist just smiles and literally says, no problem, glad you feel better.
And the ironic part is, is they didn’t really say very much, because we all at the fundamental core, we all want to be heard. And not only heard, we want to be understood. That doesn’t mean that people are going to agree with us, and it doesn’t mean that you as a mental health first aider agree with everything the person may say or share or do, but what it means is that you suspend your judgment and let them express themselves. That mere fact of giving them that safe space may be the difference between a crisis and averting a crisis.
Christine Bilbrey: That’s very valuable. So I have to mention that the theme for this year’s annual convention is guess what Mental Health and Wellness, and I know there’s going to be some activities and CLEs going on that support this theme. So Joe, will we see you at the 5K Run or the Yoga Class?
Joe Ankus: I will be at the Florida Bar Convention. It’s funny that you say that and it’s funny that you say that, but I will tell you, just as a personal side note, for the last six months I have made a very conscious effort to exercise. And I used to pooh-pooh that and everything, and I have to tell you that that is the most inexpensive, easiest way to restore you and make you actually — there is so much empirical evidence that I won’t even bore you, but if you are looking for some revival and restoration, as Carl Schwait on our Committee would say, I am going to tell you exercise is a very, very, very good thing to do.
So the answer is I am not quite up to a 5K yet and I am not flexible for yoga, but I will be at the Florida Bar Convention and if anybody listens and happens to see me, by all means stop and say hello if you listen to the podcast.
Christine Bilbrey: Okay, excellent. And I want to mention that the Special Committee is going to be hosting a CLE entitled Mental Health and Wellness of Florida Lawyers. It’s one of the President’s Showcase Seminars this year. So there’s going to be seven excellent speakers that will offer solutions to our members that they can incorporate into their lives to begin to improve their mental health and wellbeing. It’s on Friday, June 15 at 1:00 p.m.
And I want to let you know that the headliner is Florida Supreme Court Justice Alan Lawson. He has been a big supporter of the Committee and everything that the Bar is trying to do for our members. We are going to be providing healthy refreshments, some fun giveaways to attendees, so if you would like to attend, it’s Course Number 2866 on your Annual Convention Registration Form, so look for that.
Joe Ankus: Last thing, real quick, and also you can mention, we have online the All Rise CLE Program too.
Christine Bilbrey: Good point, yeah, and that is free CLE credit and you will get to see Joe in that.
Joe Ankus: You get to see myself, Dr. Rahul Mehra, who is our resident psychiatrist, Judge Nushin Sayfie and Judge Steven Leifman. So it’s a great panel if you wanted to get a free CLE as well.
Christine Bilbrey: Thank you. It looks like we have reached the end of our program. So I want to mention that all of the health and wellness resources available to Bar members can be found by going to HYPERLINK “http://www.floridabar.org” floridabar.org, hover over Members and then click on Health and Wellness Center in the dropdown menu.
Thank you Joe Ankus for joining us today.
Joe Ankus: Thank you for having me. It has been a real pleasure.
Christine Bilbrey: If our listeners have questions or want to follow up, how can they reach you Joe, do you have a webpage, are you on social media?
Joe Ankus: The easiest way is email. My email is HYPERLINK “[email protected]%20” [email protected] and that also serves as my website, HYPERLINK “http://www.ankusconsulting.com” ankusconsulting.com. If you have any questions, feel free to email me, I will be happy to reply.
Christine Bilbrey: Great. Thank you. If you liked what you heard today, please rate us in Apple Podcasts and join us next time for another episode of The Florida Bar Podcast, on Legal Talk Network. I am Christine Bilbrey. Thank you for listening.
Outro: Thanks for listening to The Florida Bar Podcast, brought to you by The Florida Bar’s Practice Resource Institute and produced by the broadcast professionals at Legal Talk Network.
If you would like more information about today’s show, please visit HYPERLINK “http://www.legaltalknetwork.com/”legaltalknetwork.com. Subscribe via iTunes and RSS. Find The Florida Bar, The Florida Bar Practice Resource Institute and Legal Talk Network on Twitter, Facebook and LinkedIn, or download the free app from Legal Talk Network in Google Play and iTunes.
The views expressed by the participants of this program are their own and do not represent the views of, nor are they endorsed by Legal Talk Network, its officers, directors, employees, agents, representatives, shareholders, and subsidiaries. None of the content should be considered legal advice. As always, consult a lawyer.