Sometimes hurting people are surrounded by friends and family who love them, but no one knows how to stop the bleeding.
Some don't try. Some clumsily attempt to assist and fail. Some make unhelpful, accusatory comments about the cause of the injury.
If the blood is gushing from an injured person, you remove any visible dirt, bandage the wound and raise the body part while you wait on professional help to arrive.
There are also ways to stop the bleeding when a loved one is hurting due to mental illness.
Last week, Andrea St. Clair, assistant program director at HELP4WV, and Hope Siler, southern regional director for Prevent Suicide West Virginia, held a free "mental health first aid" training at First Choice Health Systems in Charleston. HELP4WV refers to the 844-HELP4WV substance abuse and mental health hotline, a project of First Choice Health Systems and the state Department of Health and Human Resources.
"Mental health first aid is the help offered to a person developing a mental health problem or experiencing a mental health crisis," Siler explained, referring to the definition in a manual they had passed out. "The first aid is given until appropriate treatment and support are received or until the crisis resolves."
"You're there to help until help arrives," she added.
Group members ranged from social services workers to Jason Favor, a threat preparedness coordinator from the Fayette County Health Department who wanted to learn to better assist flood victims.
Favor knows how to design disaster plans. But he realized after the flood hit that he didn't know how to talk to people about their trauma symptoms, and his six years in the Navy had not prepared him well.
"As bad as it sounds, it's almost the opposite of mental health," he said. "The military attitude is just suck it up and go on."
The group established their own ground rules, such as "be respectful" and "take care of self." They were told to leave the room if they needed to take a moment, but to give the thumbs up first to show they were OK.
The direction was necessary because the group, many of whom knew people with stories or had experiences with mental illness themselves, was about to begin eight hours spent on sensitive topics.
And some of the activities, meant to build empathy, could be disconcerting.
It's one thing to learn that the symptoms of schizophrenia include hallucinations and delusions. It's another to try to carry on a conversation while someone whispers "Don't trust him," or, "Why would she want to talk with you?" in your ear, in an effort to provide a glimpse into the lives of people with schizophrenia.
Other activities were educational. The group learned how to follow the "ALGEE" method of responding to a suffering friend or other loved one.
ALGEE stands for:
n Assess for risk of suicide or harm
n Listen non-judgmentally
n Give reassurance and information
n Encourage appropriate professional help
n Encourage self-help and other support strategies
They learned helpful questions to ask, such as, "What helped you when you've been in this situation before?" and "Do you plan to kill yourself? (if so, then get medical help right away). They also learned about those unhelpful comments, like, "Snap out of it," and those that can seem accusatory, such as, "You're never happy," or, "You've always been this way."
It was also educational because the course provided a basic overview of some of the most common and the most serious mental illnesses, although many of those attending were already well-versed.
The course is supposed to be aimed at a general population. But it's difficult to find someone who hasn't been affected, especially in West Virginia.
Even those who didn't work in social services had personal stories. They all knew someone, or had experienced mental illness themselves.
Jack Runion's father died by suicide. Runion, a middle school teacher, already watches for signs of mental illness in his students, but took the course because he wanted to learn more.
"For me, it's not wanting anyone else to experience that pain," Runyon said. "It's worth it if it helps someone else."
According to the Substance Abuse and Mental Health Services Administration 2014 Survey on Drug Use and Health, about one in five adults had a mental illness in the previous years.
West Virginia has a higher rate of adults who have mental illness with more severe symptoms. In 2012-2013, the last time period from which state-level statistics are available, about 5.2 percent of West Virginia adults had a severe mental illness, compared to a national rate of 4.1 percent, also according to SAMHSA.
Mental health care providers in flood-ravaged areas have also predicted that the problem could get worse after a catastrophic flood hit West Virginia.
It's been more than a month since the flood. During the part of the training that focused on trauma, Siler said that means if survivors are still feeling upset and fearful, it could be time to seek professional help.
She said because of the flood, it's an ideal time for more people to participate in upcoming trainings.
"That could be considered a massive traumatic event because it impacted so many people and it was so severe," Siler said.
The Mental Health First Aid program is a project of the National Council for Behavioral Health and the Missouri Department of Mental Health.
President Barack Obama has touted the program as a tool for fighting against gun violence. SAMHSA has given grants to educators who wanted to participate in the training in an effort to prevent school shootings. Some states and Congress have also appropriated money toward implementing the program.
To find a training in your area, visit www.mentalhealthfirstaid.org and click on Find A Course.
Continuing education credits are available.
Reach Erin Beck at erin.beck@wvgazettemail.com, 304-348-5163, Facebook.com/erinbeckwv, or follow @ErinBeckWV on Twitter.