Mental Health Assessment

Stress is inherent in outdoor trips and activities. People can often adapt to mild stress and return to their baseline relatively quickly; however, chronic, moderate, or severe stress may overwhelm an individual’s coping mechanisms and result in a mental health problem. S/Sx include increasing inability to cope with the challenges of the trip, activity, or group. The graphic below depicts the different levels of distress and their associated evacuation levels with respect to a mental health even

To help avoid a mental health crisis on expeditions or trips, it is critical to identify and evaluate an individual’s distress early. Check in with the group or individuals daily or after potentially stressful events as part of the expedition culture and stress management. Consider using colors as a tool to help group members self-identify their current stress level.

Green = no distress
Yellow = distressed and actively compensating or coping
Orange = overwhelmed having difficulty compensating or coping
Red = severely overwhelmed and no longer compensating or coping

People who self-identify as distressed, overwhelmed, or severely overwhelmed need support and should be encouraged to seek out and speak with staff or the trip leaders privately. Similarly, if staff or trip leaders observe behaviors that indicate a participant may be in distress or crisis, they should speak privately with the individual. Depending on the participant’s story and presenting S/Sx, they may  elect to support them in the field or begin an evacuation.   

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• Withdrawn, seeks solitude whenever possible.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 step-by-step solutions with measurable (visible) outcomes
  

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.
  
• Patient exhibits an on-going or growing inability to cope despite interventions and support.
  
• Patient’s behavior negatively affects other trip members’ experience.
  
• Patient is prescribed Rx meds for a mental health condition and is not taking them.
  
• Patient appears to have the potential to harm themselves or others.
  
• Patient wishes they were dead or expresses suicidal thoughts.