Meet the Woman Teaching the Psychology of Survival

Wilderness first aid and first-responder courses have no industry-wide guidelines when it comes to mental health, and the American Red Cross, which teaches psychological first aid for disaster workers and community-based crisis responders, doesn’t have a course dedicated to mental health in a wilderness context. But some organizations have started to address the topic. In the United States, that includes the National Outdoor Leadership School, the American Mountain Guides Association, and Outward Bound. NOLS’s Wilderness Advanced First Aid and Wilderness First Responder courses discuss anxiety, depression, suicidal ideation, and PTSD, says Tod Schimelpfenig, curriculum director at NOLS Wilderness Medicine in Wyoming, because these are subjects that come up often. “You see the guides and outdoor leaders expressing a need for more training in this area because they’re increasingly having to manage these issues,” he says.

Baecher, who at five foot five is a compact, fit athlete, with summits of the Eiger and the Matterhorn, among other peaks, agrees. “There are simple things that would be useful in remote environments if you don’t have a psychologist there,” she says. “A lot of the psych courses out there are very urban based.”

To help, she created techniques and protocols to teach psychological first aid to people who work and play in the outdoors. She’s uniquely suited to the role. Baecher spent a decade in the Australian army as a captain and psychology officer. In 2016, while still on active duty, she earned a doctorate in psychology, exploring the impact of physical injuries on mental health. Since then she has consulted for elite athletes, corporate leaders, and the Australian special forces, with stints as a military psychologist in Afghanistan and East Timor, while spending her spare time climbing and hiking.

Baecher says that there are some similarities between wilderness expeditions and military operations, like the need to compartmentalize emotionally when exposed to challenging circumstances. Outdoor guides and athletes are also vulnerable to depression and PTSD, either immediately after a harrowing experience or down the road if they don’t process those emotions. “Either they break or they put Band-Aid upon Band-Aid upon Band-Aid, which can lead to long-term psychological issues and affect work, relationships, and daily life,” Baecher says.

For mountaineers, spending time at altitude can also strain psychological health. Multiple studies have found that the decrease in oxygen levels at altitude can increase the risk of depression, anxiety, and confusion. One study, done by researchers in the UK, reported hallucinations by 32 percent of climbers above 24,600 feet. And in a Swiss study, seven of eight world-class mountaineers who’d climbed above 27,900 feet without supplemental oxygen reported hallucinatory experiences.

Malcolm Bass had hallucinations while establishing a difficult new route on Alaska’s 14,573-foot Mount Hunter in 2001. Bass, an alpinist and clinical psychologist from the UK, saw the rocks change shape. He and his climbing partner, Paul Figg, hadn’t slept in 30 hours. Bass remembers looking up at a ridge and seeing talons reaching toward him, as if Mount Hunter were a bird of prey and wanted to consume them. He tried to explain what he was seeing to Figg, who he had begun calling Julian, a partner from a previous climb. Because Bass was aware that hallucinations occur when stressed, exhausted, and isolated in extreme environments, he managed to shake off the confusion and find a safe place to rest, but poor choices at that time could have been life-threatening. “In that kind of terrain, you’re as likely to drag each other off as to save one another,” Bass says. “There are no anchors.”

Whether you’re an amateur or a professional athlete, mental distress in the wilderness is a common experience. “Everywhere I go, I see people who are having trouble coping,” Baecher says. “That includes tough climbers on big mountains.”

Grounded in the neuroscience of fear and her own expertise in the psychology of extreme environments, Baecher’s method features a color-coded tool for assessing a distressed individual in the wilderness, a four-category scale from green (OK to stay put) to yellow (stay put, keep calm) to orange (keep safe and calm, consider evacuation) to red (evacuate). Called the ACCE model—for assess, communicate, calm, evaluate to evacuate—the approach includes calming techniques, some of which she used on Chris after he witnessed the climber’s fall, such as deep breathing and making concrete plans.

Baecher started working out the specifics for an outdoors-focused mental health training course in April 2018, after taking a wilderness first aid class from a company called Survive First Aid in Sydney. Survive’s training manager at the time, Nathan Burns, is a longtime guide and outdoor educator, a paramedic, and an old friend of Baecher’s. He’d added a section on psychology to the course two years earlier, after hearing from clients about how common mental health issues were in the field and how unprepared they felt to deal with them. In classes, Burns says, he asks who has ever dealt with a fractured femur. “You get one in a hundred who put their hand up,” he says. Next he asks who has experienced some kind of mental health event. “Almost every single person puts their hand up,” he says. “The fact is, every medical or first aid situation has an element of mental health attached to it.”

Baecher first met Burns in 2013 while volunteering for an organization called Backpacker Medics, which Burns founded to send paramedics, hospital workers, and other experts on humanitarian missions around the world. She was enjoying the Survive course and was eager to participate in the psych component. It was more than other outdoor companies in Australia were doing on mental health, Baecher says. But the psych content was based on a curriculum designed to train paramedics working on ambulance crews in urban areas, and in Baecher’s assessment that made it less applicable to wilderness professionals, who usually can’t talk to a supervisor or call for help. Baecher, who laughs easily and says exactly what she thinks, thought there was room for improvement. “I was like, ‘Nathan, can you please let me write this?’ The more research I did, I couldn’t find anything that was relevant for the outdoors.”

To correct this, Baecher looked into published research on a variety of related topics, including mental health first aid, trauma, and risk assessment in the outdoors. She incorporated techniques she’d learned in the military, wilderness first aid protocols, and the mental health continuum, a model for thinking about psychological states as a spectrum, from healthy and coping to injured or ill. Burns collaborated with her, helping develop the color scale, an action plan, and a training module for instruction, along with a memorable acronym. “We brought it all together and mashed it up and drank some wine and finally finished it,” she says. In August 2018, Survive First Aid began incorporating the new approach into its three- and five-day wilderness first aid courses.

On a sunny but cool afternoon last July, I attend one of Baecher’s training sessions, along with a group of Australian guides and wilderness educators, in a conference center an hour south of Sydney. It’s the third day of a weeklong Survive wilderness first aid course, and the group has already practiced splinting shoulders, bandaging snake bites, and bracing broken legs. Now it’s time for the psych unit, which includes a video recorded by a climber in April 2015 during a devastating earthquake-triggered avalanche on Mount Everest that left at least 19 people dead, around 70 injured, and many climbers stranded at higher camps.

The video begins with the sound of a German climber saying “The ground is shaking” as he looks around Base Camp. Someone in the background chuckles nervously. Suddenly, people are running away from the mountain, and then he sees why: a massive avalanche is barreling toward him. He dives behind his tent with another climber as a tidal wave of snow engulfs them. “Fuck, fuck, fuck, fuck,” he says, again and again, until moments later the worst of it has passed. He stands up, not physically hurt. But he doesn’t seem OK. His breathing is rapid. His panic is palpable.

After the video ends, a role-playing exercise begins in which the students imagine that they’re a day’s walk from Base Camp when the avalanche hits, and they decide to go help. Baecher observes from a corner of the classroom as a course instructor named Joe Knight reads the fictional script for the exercise. “When you arrive, you see three people who are physically fine but very distressed,” says Knight, a 38-year-old Australian remote-area medic, freediving instructor, and former ocean-survival trainer. The German climber, referred to as Hans in the exercise, is holding one of his shoes in his hand and sobbing uncontrollably. “His mates are sitting next to him, distressed, but not as distressed as Hans,” Knight continues. “Hans notices you immediately, looks you in the eye, and says pleadingly, ‘Help me. Help me.’”

Standing in front of a whiteboard, Baecher launches into an explanation of what happens in the human brain when panic and anxiety strike. “I’m going to go psych nerd for a moment,” she says.

When someone senses danger, Baecher says, the sympathetic nervous system kicks in, causing accelerated breathing, higher blood pressure, narrowed vision, and a cascade of other physical reactions collectively known as the fight-or-flight response. It’s an evolutionary survival mechanism controlled by the limbic system, often referred to as the “lizard brain” because it overrides higher-order thinking and invokes primal emotions that are beyond reason.

Outdoor guides and athletes are vulnerable to depression and PTSD, either immediately after a harrowing experience or down the road if they don’t process those emotions.

“Your brain starts racing and saying, ‘Something’s wrong, something’s wrong.’ And then you get more panicked. You start breathing faster. And this whole cycle continues,” Baecher says. There are a few dramatic ways of short-circuiting this negative feedback loop, she says. These include slapping the panicked person, holding them tight, and putting a hand over their mouth to slow their breathing and halt the panic-perpetuating cycle of oxygen deprivation that can occur while hyperventilating. None of these techniques are appropriate for a guide dealing with a client.

Instead, Baecher’s color-coded ACCE model offers alternatives for grounding someone in the moment and restoring calm, including one that puts everyone in the Sydney classroom into a mindfulness trance: asking a partner to name four things they can see, hear, and feel, then three more of each, then two, then one. (When I did this exercise with the class, I was jet-lagged and anxious about driving on the left side of the road, in the dark, back to my rental apartment. The technique was so effective that months later I continue to use it to help me and my kids deal with pandemic-related stress, school closings, and other life challenges.)

Baecher’s procedures are simple enough to fit into a pocket-size handbook, with instructions to aid in the assessment of a struggling individual or group. Her hope is that they’ll help guides and adventurers get past any discomfort in dealing with psychological distress in the outdoors. “A lot of people worry that they’ll do something wrong and make it worse. As a result, they kind of shut down and don’t have a lot of insight into why we have emotions and what goes wrong,” Baecher tells the class. “There’s also not been the right level of training in and around what to do.”

Next, she stands by as groups of four students decide together that Hans is in the orange zone—in need of support but not immediate evacuation. Finally, Baecher offers additional strategies for distraction, grounding, and calming techniques that might help Hans and others in a situation like his. “You can breathe with them,” she says, squatting on the gray-carpeted floor and looking around the room. “In, two, three, four. Out, two, three, four.” She also suggests maintaining eye contact, keeping your voice calm and your words clear, and giving frequent, easy-to-follow updates about what’s happening.

By the end of the session, Knight informs the group that Hans is doing much better. The grounding exercises were effective. Now, according to the group’s assessments, he’s between the green and yellow zones. He is no longer in a state of emergency, and they can help him to leave the mountain.

Without mental health intervention, Hans’s outcome could have looked very different: He might have suffered frostbite from having removed his shoe and not been able to hike out. He might have been too panicked to make quick, smart decisions about the rapidly changing environment.

Or he might have been at a higher risk for long-term trauma.

The day after the psych session, Baecher picks me up outside my rental in Wombarra, a coastal town near the conference center. She shows up in her silver 2003 Mazda for the two-hour drive northwest to Blue Mountains National Park. Baecher, who makes eye contact when she talks and listens intently, has a brain that churns, and she tends to prioritize new ideas over practical tasks, like repairing her car. The passenger-side door handle is busted; when you want to get out, you have to roll down the window and open it from the outside. She laughs every time. “I seem professional until you get to know me,” she jokes.

The park encompasses a dramatic gorge that drops 1,200 feet. Getting down requires descending a metal staircase that hugs the rock face before meeting up with a trail. It’s a cool, blue-sky day, and at the start of the 15-mile hike, Baecher talks about growing up a sporty kid in Sydney and then runs through her eclectic résumé. With Burns’s disaster-response organization Backpacker Medics, she volunteered in Nepal after earthquakes and in Bangladesh after an influx of Rohingya refugees, following mass killings in Myanmar. In addition to her work on the ACCE model, she runs a coaching business with her brother, Chris, a former air-traffic controller.

Baecher has also worked as a staff psychologist on reality-TV shows, including Shark Tank and a British program called I’m a Celebrity … Get Me Out of Here, in which famous people are taken into the jungle to compete Survivor-style. On I’m a Celebrity, one of her tasks was to debrief participants and crew members after long, unpredictable days in hostile terrain. On one occasion, she helped an arachnophobic contestant after a terrifying encounter with spiders.

By the time she’d enrolled in Burns’s wilderness first aid course at Survive, Baecher had spent years working in remote, extreme environments, where she accumulated experience helping people struggling to function far outside their comfort zone.

Many guides get by on intuition and social skills to calm clients in tough situations, Baecher tells me as we hike out of the gorge. Often they get it right. But it’s easy to miss signs of distress or even to make matters worse, dredging up trauma while lacking the tools to help clients process it. Unlike a broken bone, which is treated pretty much the same way every time, psychological injuries are more nuanced, she says, and intuition can lead well-intentioned guides astray.

“If you’re unraveling people and can’t put them back together, and you’re like, ‘Shit, now what?’—that’s what really worries me. We don’t want someone who isn’t a psychologist to go down that pathway where they’re acting like one. The risk of that going wrong is really quite significant,” Baecher says, noting again that poor decision-making can lead to injury, life-altering trauma, or death. “The ACCE model gives people parameters and structure. The aim is first aid. We’re going to patch you up and keep you safe. It’s comfort as much as anything else, and making sure they do it right.”

Baecher isn’t the only one making inroads into this new field. In British Columbia, clinical counselor and wilderness guide Donetta Faye Cooper, who goes by Daye, had an aha moment similar to Baecher’s during a wilderness first aid refresher course in 2016. She noticed an almost total absence of mental health topics during discussion and in the course manual. “It basically said that if someone makes a suicide attempt on a trip, you should evacuate them urgently,” says Cooper, the 34-year-old former executive director of the Sea Kayak Guides Alliance. “And it’s like, great, that’s a good start. But how much more could we talk about?’”

The embrace of mental health in the outdoors is trickling down to guide culture, says Brenton Reagan, lead guide and marketing manager at Exum Guides. “The openness to talk about things—emotions, fear, troubles—in large groups has grown greatly,” he says.

When guiding, Cooper says, she deals on a weekly basis with someone experiencing anxiety or going through trauma in their home life that surfaces on a trip. To illustrate this, she told me a story inspired by a real event, changing some of the details to preserve confidentiality. On a wilderness outing, she found a client sitting on a log, her head down, barely responding to questions and, Cooper soon learned, thinking about suicide. The group was supposed to be getting into canoes for a long day of paddling, but the situation required a different plan. Cooper, who had completed suicide-intervention training for volunteer work on a crisis hotline, altered the itinerary to allow time for thorough conversation and assessment. With the client’s consent, she and a coleader used a satellite phone to contact the person’s psychiatrist, who offered insight and a medication adjustment. Based on the collaborative assessment, Cooper arranged an evacuation the next day so the client could be better supported. A friend of Cooper’s had died by suicide earlier that year, which had raised complex emotions for her; she was grateful that she knew what to do. “I was thinking, What if I hadn’t done that suicide-intervention training?” she says. “It would have been so much more challenging for me.”

In response to those complexities, Cooper developed Mental Health Wilderness First Aid, a workshop she first offered in British Columbia in 2018. Since then she has taught at least 15 courses incorporating emotional-regulation techniques and her own decision-making scale. (The workshops are now available via Zoom.) Her initial focus was on anxiety but soon expanded to include depression, trauma, and mood disorders. She’s also working on a book about mental health first aid in the wilderness.

“There’s a real hunger,” Cooper says, referring to interest in the kind of work and she and Baecher are doing. She often hears from students who say they wish they’d had this kind of training earlier. “There’s a sense of, I can’t believe this hasn’t been a thing before.”

Feedback has been equally overwhelming for Baecher’s psychology session in the Survive courses. “Students come up to us after and say, ‘Thank you so much for doing this,’” Nathan Burns says. “‘Thank you for giving us a tool to use.’”

The embrace of mental health in the outdoors is also trickling down to guide culture, says Brenton Reagan, lead guide and marketing manager at Exum Guides in Wyoming. Many years ago, he says, some certification courses were notoriously tough. An instructor might unlock a carabiner just to see if the student noticed. “They were trying to set you up so you had a really hard time,” he says.

While Reagan recently took a wilderness first-responder recertification course that didn’t mention mental health, he says that Exum uses a program called Brain Gyms to teach guides breathing and movement techniques for calming anxiety. He notes that he deals with anxious clients nearly every time he’s in the field. “The openness to talk about things—emotions, fear, troubles—in large groups has grown greatly,” says Reagan, who has been guiding for 20 years.

Also, prominent adventurers are airing their struggles in public, including mountaineer Cory Richards, who has been open about the PTSD and alcoholism he endured after surviving an avalanche on the descent from Gasherbrum II in 2011. Conrad Anker, a veteran climber who has lost multiple friends in the mountains, welcomes the transformation. Close climbing companions have always been willing to talk to each other, he says, but sharing happens more than it used to, maybe because of social media, or because more people are climbing. “Thirty years ago it was, yeah, climbers were tough,” he says. “You just went up there.”

After experiencing a series of tragedies in the wilderness, climber Madaleine Sorkin partnered with the American Alpine Club to launch the Climbing Grief Fund, an online mental health resource for mountaineers and other athletes affected by loss related to alpinism. Mental health awareness is infusing adventure at the college level, too. At Dartmouth, for instance, student trip leaders on wilderness outings get training in mental health topics before group overnight hikes. And for solo adventurers, a new app called Drift, designed by UK scientists, helps users manage their psychological well-being while off the grid.

North Carolina–based Seth Collings Hawkins, an emergency physician, executive editor of the Wilderness Medical Society’s Wilderness Medicine magazine, and editor of the textbook Wilderness EMS, says that the field of wilderness emergency medicine is experiencing a mental health revolution. He put me in touch with Laura McGladrey, a family and psychiatric nurse practitioner at the University of Colorado’s Stress Trauma Adversity Research and Treatment Clinic and a NOLS Wilderness Medicine Institute instructor. She helped create an organization called the Responder Alliance, which provides resources, training, and education to mountaineers, wilderness organizations, wildland firefighters, and other groups about the long-term health risks of exposure to high-stress situations. Her work calendar is full of lectures and seminars. “This is a radical rethinking of how we approach people in difficult situations in the wilderness,” Hawkins says. “I’m pretty certain it will be one of the next big things, and completely commonplace in ten years, but right now it’s on the cutting edge.”

For her part, Baecher is developing a full-day course addressing a wider assortment of issues, including self-harm, suicidal thoughts, and self-care techniques in wilderness settings. She’s also working on a strategy for others to teach the course. She’s well along the path to her larger goal: to help guides and educators make the right decisions when psychological distress arises in the outdoors. Given the growth in awareness, she’s confident that once she builds it, the outdoor community will embrace it. “The time is right,” she says.

Meet the Woman Teaching the Psychology of Survival

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