The FIRST Framework

A Practical Approach to Mental Health First Aid

Mental Health First Aid follows a simple and structured approach called FIRST. It helps ordinary people respond calmly and responsibly when someone is experiencing emotional distress.

The five steps are: Find Out, Investigate, Reassure, Support, and Take Care.

F – Find Out: Recognising Signs of Distress

The first step is awareness.

Many people do not openly say they are struggling. In Bangladesh, emotional difficulties are often hidden because of stigma or fear of judgement. Instead, distress may appear through changes in behaviour.

You may notice that someone becomes unusually quiet, withdrawn, irritable, or tired. A student may stop attending classes. A colleague may frequently call in sick. A friend may post hopeless messages online. Someone may complain constantly of headaches or fatigue with no clear medical cause.

Finding out does not mean assuming or diagnosing. It simply means paying attention to patterns and changes that are not normal for that person.

Early noticing can prevent serious escalation.

I – Investigate: Starting the Conversation

Once you notice something is wrong, the next step is to start a gentle conversation.

Choose a private and calm setting. Do not confront the person in front of others. Speak with concern, not accusation.

A simple opening such as, “I’ve noticed you seem different lately. Is everything okay?” is enough.

The goal is to understand, not to fix.

Active listening is essential. Give your full attention. Do not interrupt. Do not immediately give advice. Allow the person to speak at their own pace.

Avoid dismissive statements like:
“Be strong.”
“Don’t overthink.”
“Others have bigger problems.”

Instead, use open-ended questions:
“How have you been feeling recently?”
“What has been most difficult for you?”

If you hear warning signs of suicide or self-harm, ask directly and calmly. Asking clearly does not create the idea. It gives permission for honesty.

Investigation builds trust.

R – Reassure: Providing Emotional Support

Reassurance helps reduce shame and fear.

In our society, many people feel weak or embarrassed about mental health struggles. Reassurance reminds them they are not alone.

Reassuring statements include:
“It’s okay to feel this way.”
“I’m glad you shared this.”
“You’re not weak for struggling.”

Reassurance does not mean making unrealistic promises. Do not say, “Everything will be fine.” Instead, focus on empathy and emotional safety.

If the person is at risk, remain calm. Your stability helps regulate their distress.

Reassurance creates emotional grounding before practical steps are taken.

S – Support / Signpost: Guiding the Next Step

Mental Health First Aiders are not therapists. Their role is to guide, not treat.

Support means helping the person identify safe and appropriate next steps. This may include:

Encouraging them to speak to a trusted family member.
Suggesting a university counselling service.
Recommending a GP or mental health professional.
Sharing verified helpline information.

In Bangladesh, access to services may vary. It is important to provide realistic and locally relevant options.

Signposting also includes digital safety when needed. If someone is facing cyberbullying or online harassment, support may include reporting mechanisms, university authorities, or cybercrime units where appropriate.

The goal is to connect the person to structured support.

T – Take Care: Safety and Self-Care

The final step has two parts: caring for the person and caring for yourself.

For the person in distress, encourage small stabilising actions. This may include staying with supportive people, avoiding isolation, maintaining basic routines, and seeking professional help.

If there is immediate danger, emergency services must be contacted.

For the Mental Health First Aider, self-care is equally important. Supporting someone in crisis can be emotionally heavy. It is important not to carry the burden alone.

Debrief with a trusted person if appropriate. Maintain boundaries. Remember that you are responsible for support, not for solving everything.

Taking care ensures sustainability of support.

Why FIRST Matters

The FIRST framework creates structure in emotionally difficult situations. Instead of panicking or ignoring distress, it gives a clear path.

Find Out what is happening.
Investigate with care.
Reassure without judgement.
Support responsibly.
Take Care of both the person and yourself.

In Bangladesh, where mental health awareness is still developing, this structured approach can strengthen peer support, reduce stigma, and encourage early intervention.

Mental Health First Aid does not replace professionals.
It strengthens communities.

Suicide Risk and Crisis Response

Understanding Warning Signs and Taking Action

Suicide is a serious public health issue. In Bangladesh, it is often hidden due to stigma, religious sensitivity, and fear of legal or social consequences. Many families avoid discussing it openly. Because of this silence, warning signs are sometimes missed.

Mental Health First Aid includes the ability to recognise suicide risk and respond safely.

Understanding Suicide Risk

People rarely decide on suicide suddenly. In many cases, there are warning signs. These signs may be emotional, behavioural, or verbal.

A person at risk may express deep hopelessness. They may say things like:

“I feel like a burden.”
“There is no point in anything.”
“Everyone would be better off without me.”

Sometimes the signs are indirect. The person may start giving away important belongings. They may withdraw completely from family and friends. They may suddenly become calm after a long period of distress, which can sometimes indicate a decision has been made.

In Bangladesh, suicide risk may also be linked to:

• Academic failure

• Relationship breakdown

• Family conflict

• Financial stress

• Public shame or humiliation

• Online harassment or cyberbullying

Young people, especially students, are particularly vulnerable in high-pressure environments.

The Importance of Asking Directly

Many people fear asking about suicide. They worry it might “put the idea” into someone’s head. Research shows this is not true.

If you suspect risk, it is important to ask clearly and calmly.

You can say:
“Have you been thinking about harming yourself?”
“Have you had thoughts about ending your life?”

Ask in a steady voice. Do not sound shocked or dramatic. If the answer is yes, remain calm.

Your reaction matters.

If you panic, judge, or immediately lecture, the person may shut down. Instead, thank them for telling you. Let them know you are glad they shared it. Tell them they are not alone.

What to Do If They Say Yes

If someone confirms they are having suicidal thoughts, your first priority is safety.

Stay with them if possible. Do not leave them alone if the risk feels immediate. Remove access to harmful objects if it can be done safely.

Ask simple questions to understand urgency:
“Have you thought about how you would do it?”
“Have you made any plans?”

If they have a clear plan and immediate intent, this is an emergency.

In Bangladesh, emergency support options may include:

• Calling local emergency services

• Taking the person to the nearest hospital emergency department

• Contacting a trusted adult or family member if appropriate

• Reaching out to verified mental health crisis helplines

It is important not to promise full confidentiality if someone’s life is at risk. Saving life takes priority.

If the Risk Is Present but Not Immediate

If the person has suicidal thoughts but no immediate plan, continue to listen and reassure. Encourage them to seek professional help as soon as possible.

Help them identify at least one safe person they can talk to within the next 24 hours. Encourage small protective steps, such as not staying alone for long periods.

You can also help them create a simple safety plan:

• Who can they call if they feel worse?

• Where can they go if they feel unsafe?

• What activities help reduce distress even slightly?

Even small steps reduce risk.

Cultural Sensitivity in Bangladesh

In Bangladesh, conversations about suicide may involve religious beliefs, family honour, or fear of community judgement. Avoid using fear-based language such as “It is a sin” or “Think about your parents.”

Focus instead on safety, dignity, and hope.

People in crisis are not seeking religious debate. They are seeking relief from pain.

Respond with compassion, not moral pressure.

After the Immediate Crisis

Once the immediate risk is stabilised, follow up matters. Check in with the person later. Let them know they are still supported.

If you are the helper, take care of yourself as well. Supporting someone at suicide risk can be emotionally heavy. Speak to a supervisor, mentor, or trusted person if needed. Do not carry the responsibility alone.

A Final Reminder

Talking about suicide does not increase suicide.

Ignoring warning signs can.

Mental Health First Aid does not replace professionals. But early recognition, calm conversation, and responsible action can prevent tragedy.

Silence increases risk.
Safe conversation reduces it.

Digital Safety and Mental Health

Understanding Online Harm in the Bangladesh Context

Digital spaces are now part of everyday life in Bangladesh. Young people spend hours on Facebook, Instagram, TikTok, YouTube, messaging apps, and online gaming platforms. While these platforms create connection, they also create new forms of psychological harm.

Cyberbullying, online harassment, body shaming, revenge posting, fake accounts, and public humiliation can cause serious emotional distress. Women and marginalised groups are especially vulnerable. In many cases, the harm spreads quickly and becomes public, increasing shame and fear.

Online harm can lead to anxiety, panic attacks, depression, social withdrawal, and suicidal thoughts. The damage is not “just online.” The emotional impact is real.

Warning signs of digital distress may include sudden account deletion, fear of checking messages, obsessive monitoring of comments, staying awake late at night due to online conflict, or visible fear when phones vibrate.

If someone is facing online harassment, the response should remain calm and practical. Do not blame the victim. Avoid statements like “Why did you post that?” or “Just ignore it.” Instead, validate their distress.

Encourage documentation of evidence such as screenshots. Support them in blocking and reporting abusive accounts. If necessary, guide them towards university authorities, workplace reporting systems, or legal support including cybercrime units.

Digital safety is now part of mental health first aid. Emotional harm online deserves the same seriousness as harm offline.

Recognising Common Mental Health Conditions

Awareness-Level Understanding

Mental Health First Aid does not require deep clinical knowledge, but basic awareness helps.

Anxiety may appear as constant worry, restlessness, difficulty concentrating, and physical symptoms like sweating or rapid heartbeat. In Bangladesh, anxiety is often dismissed as “thinking too much,” but persistent anxiety affects daily functioning.

Depression is more than sadness. It may involve hopelessness, loss of interest, fatigue, changes in sleep, and feelings of worthlessness. A person may withdraw from social contact or stop caring about things they once enjoyed.

Panic attacks involve sudden intense fear, shortness of breath, chest tightness, dizziness, and fear of losing control. They can feel like a medical emergency.

Self-harm is a coping behaviour, not attention-seeking. It often reflects deep emotional pain and difficulty expressing distress.

Addiction may involve loss of control over substances or behaviours, secrecy, withdrawal from responsibilities, and mood instability.

ADHD and autism are neurodevelopmental conditions, not mental illnesses. However, social misunderstanding and stigma can increase stress and anxiety for individuals living with these conditions.

Mental Health First Aiders do not diagnose. They recognise patterns, respond with empathy, and guide toward professional help when needed.

Safeguarding and Ethical Boundaries

Protecting the Person and Yourself

Safeguarding means protecting vulnerable individuals from harm. In Bangladesh, safeguarding is especially important when working with children, adolescents, and vulnerable adults.

If someone discloses abuse, self-harm, or suicidal intent, it is not enough to simply listen. Depending on the severity, responsible adults, institutions, or authorities may need to be informed.

Confidentiality is important, but it has limits. If someone’s life is at risk, safety comes first. It is important to communicate this clearly: “I want to respect your privacy, but if you are in danger, I may need to involve someone who can help keep you safe.”

Mental Health First Aiders must also maintain personal boundaries. Do not become the only support person. Do not provide therapy. Do not allow yourself to be emotionally overwhelmed by trying to “rescue” someone.

Healthy boundaries ensure sustainable support.