Mental health first aid
|Mental health first aid|
Mental health first aid is a training program that teaches members of the public how to help a person developing a mental health problem (including a substance use problem), experiencing a worsening of an existing mental health problem or in a mental health crisis. Like traditional first aid, mental health first aid does not teach people to treat or diagnose mental health or substance use conditions. Instead, the training teaches people how to offer initial support until appropriate professional help is received or until the crisis resolves.
While first aid for physical health crises is a familiar notion in developed countries, conventional first aid training has not generally incorporated mental health problems.
Mental health problems are common in the community, so members of the public are likely to have close contact with people affected. However, many people are not well informed about how to recognize mental health problems, how to provide support and what are the best treatments and services available. Furthermore, many people developing mental disorders do not get professional help or delay getting professional help. Someone in their social network who is informed about the options available for professional help can assist the person to get appropriate help. In mental health crises, such as a person feeling suicidal, deliberately harming themselves, having a panic attack or being acutely psychotic, someone with appropriate mental health first aid skills can reduce the risk of the person coming to harm.
There is also stigma and discrimination against people with mental health problems, which may be reduced by improving public understanding of their experiences.
The Mental Health First Aid Program was developed in Australia by Betty Kitchener and Anthony Jorm in 2000. Since 2003, this Mental Health First Aid Program has spread to a number of other countries (Bermuda, Canada, Denmark, England, Finland, France, Germany, Hong Kong, India, Ireland, Japan, Malaysia, Malta, Netherlands, New Zealand, Northern Ireland, Saudi Arabia, Scotland, Sweden, Switzerland, United States, United Arab Emirates, Wales). By 2019, over 3 million people had been trained in mental health first aid worldwide.
Research on mental health first aid training
A number of studies have been carried out showing the people who are trained in mental health first aid showed improved knowledge, confidence, attitudes and helping behaviour. A meta-analysis of data from 15 evaluation studies concluded that mental health first aid training "increases participants' knowledge regarding mental health, decreases their negative attitudes, and increases supportive behaviours toward individuals with mental health problems". A later meta-analysis of 18 trials (5936 participants) supports the effectiveness of Mental Health First Aid training in improving mental health literacy and appropriate support for those with mental health problems up to 6 months after training. Overall, effects were small-to-moderate post-training and up to 6 months later. The training led to improved mental health first aid knowledge, recognition of mental disorders and beliefs about effective treatments. There were also small reductions in stigma. Improvements were also observed in confidence in helping a person with a mental health problem and intentions to provide first aid. There were small improvements in the amount of help provided to a person with a mental health problem at follow-up.
There has been research to develop international guidelines on the best strategies for mental health first aid. Mental health first aid training has been included in the US Substance Abuse and Mental Health Services Administration's (SAMHSA) National Registry of Evidence-based Programs and Practices.
California Mental Health Services Authority reviewed the evidence base for Mental Health First Aid Training in 2015 and found "no evidence of effectiveness for potential recipients of aid."
In Australia, mental health first aid training is run by the not-for-profit charity Mental Health First Aid International (trading as Mental Health First Aid Australia). A range of training courses are offered:
- Standard Mental Health First Aid is a 12-hour face-to-face course for adults to learn to assist other adults. Culturally adapted versions of this course are available for Chinese and Vietnamese Australians. eLearning and blended versions of the Standard course have been tailored for a range of professional groups, including pharmacists, the legal profession, financial counsellors, medical students and nursing students.
- Youth Mental Health First Aid is a 14-hour face-to-face course for adults to learn to assist adolescents.
- Aboriginal and Torres Strait Islander Mental Health First Aid is a 14-hour face-to-face culturally adapted course for adults to learn to assist Aboriginal and Torres Strait Islander adults. It is run by Aboriginal or Torres Strait Islander instructors.
- Teen Mental Health First Aid is a 3.5-hour classroom-based course that teaches high school students in years 10–12 how to provide mental health first aid to their friends.
- Older Person Mental Health First Aid is a 12-hour face-to-face course for adults to learn to assist people aged 65 and over.
By 2015, Mental Health First Aid training had been received by over 350,000 people, which is more than 2% of the Australian adult population.
Mental health first aid training programs in Australia have won a number of awards for excellence including:
- Gold Achievement Award 2007 – winner of the Mental Health Promotion Mental Illness Prevention Program or Project category at the MHS Conference
- Suicide Prevention Australia – 2005 Life Award
- Victorian Public Health Programs Award for Innovation, 2006
- Enterprise and Resourcefulness Award – NSW Aboriginal Health Awards 2010
- Silver Achievement Award for Aboriginal and Torres Strait Islander Program – Mental Health Promotion or Mental Illness Prevention Program or Project category at the MHS Conference 2010
- Silver Achievement Award for Youth Mental Health First Aid Program – TheMHS, Mental Health Promotion or Mental Illness Prevention Program Category, 2014
- TheMHS Medal (the top award of the Mental Health Service Awards of Australia and New Zealand which "honours a unique and inspiring contribution to Mental Health by an individual or organisation"), 2017
Mental health first aid (MHFA) came to England in 2007 and was developed and launched under the National Institute for Mental Health in England, part of the Department of Health, as part of a national approach to improving public mental health. Mental Health First Aid England was launched as a community interest company in 2009.
MHFA England offer a range of courses:
- Standard MHFA, a two-day course which qualifies a participant to become a Mental Health First Aider
- Youth MHFA, a two-day course which qualifies a participant to become a Youth Mental Health First Aider. This course is designed for those who are working, living or interacting with young people. It was first launched in England in 2010 and revised and re-launched in October 2013.
- Youth MHFA Schools & Colleges, a one-day course which is based on Youth MHFA and designed to fit into school training timetables.
- Armed Forces MHFA, a two-day course which qualifies participants to become an Armed Forces Mental Health First Aider. This course was designed for the whole Armed Forces community, including veterans, serving personnel and their families. It was launched 2013. In March 2016 the research findings from an evaluation report conducted by the University of Gloucestershire into the effectiveness of the Armed Forces MHFA training will be published.[needs update]
- MHFA Lite, a three-hour introductory awareness course launched which is based on the Standard MHFA course. MHFA Lite was launched in 2011. There is also a Lite version of the Youth MHFA course.
- MHFA Instructor Training, a seven-day course accredited by the Royal Society for Public Health to qualify as a Mental Health First Aid instructor who can deliver one or all of the two-day courses (Standard, Youth and Armed Forces).
Since 2007, more than 114,000 Mental Health First Aiders have been trained in England and more than 1,600 people have trained as Mental Health First Aid instructors. The Department of Health encouraged all employers in England to provide mental health first aid training as one of three steps in its 2012 "No Health Without Mental Health: Implementation Framework". In 2016 Mental Health First Aid was recommended for all workplaces by the charity Business in the Community. Siren Training is one of the main MHFA course providers in England.
In May 2014 Saint John of God Hospital signed a Memorandum of Understanding with MHFA Australia to adapt the course for Ireland and in October 2014 Betty Kitchener came to Saint John of God Hospital to advise on the rollout of the MHFA Ireland Programme.
In 2008, the National Council for Behavioral Health, in partnership with the Missouri Department of Mental Health, brought mental health first aid to the United States. Since 2008, more than 1.5 million people have been trained on the Mental Health First Aid USA course by an instructor base of more than 15,000. There are people trained in mental health first aid in all 50 states, Puerto Rico and Guam. The course is offered to a variety of audiences, including hospital staff, employers and business leaders, faith communities and law enforcement.
In 2012, youth mental health first aid was introduced in the United States to prepare trainees to help youth ages 12–18 that may be developing or experiencing a mental health challenge. Specialized versions of Mental Health First Aid USA including the Veterans, Public Safety, Higher Education, Rural and Older Adults modules and a Spanish version of the Youth and Adult curriculum are also available.
Mental Health First Aid USA was included in President Barack Obama's plan to reduce gun violence and increase access to mental health services. In 2014, Congress appropriated $15 million to SAMHSA to train teachers and school personnel in youth mental health first aid. In 2015, an additional $15 million was appropriated to support other community organizations serving youth. The Mental Health First Aid Act of 2015 (S. 711/H.R. 1877) has broad bi-partisan support and would authorize $20 million annually for training the American public.[needs update] Fifteen states have made Mental Health First Aid a priority by appropriating state funds, including Texas which allocated $5 million.
Mental health first aid debuted in Canada in 2007, and has operated under the leadership of the Mental Health Commission of Canada since early 2010.
MHFA Canada offers a range of courses, which, upon completion, certify a participant in mental health first aid:
- MHFA Basic, a two-day 12 hour course
- MHFA for Adults who Interact with Youth, a two-day 14 hour course
- MHFA Seniors, a two-day 14 hour course
- MHFA Veteran Community, a two-day 13 hour course
- MHFA Northern Peoples, a three-day 18 hour course
- MHFA First Nations, a three-day 20 hour course
- MHFA Inuit, a three-day 24 hour course
- MHFA Police, an eight-hour course including 15-30 minutes online
- MHFA Instructor Training, a course which allows the participant to become a Mental Health First Aid instructor.
Different instructor courses are required to become a MHFA Basic, Youth, Seniors, Veteran Community, First Nations or Northern Peoples instructor. The duration of these courses vary from five to six days. First Nations & Northern People versions require two instructors/facilitators to deliver the course.
Since 2007, more than 400,000 Canadians have been trained in Mental Health First Aid, and more than 1,200 people have been trained as instructors.
United Arab Emirates
Mental health first aid debuted in the UAE in December 2017. MHFA UAE operates under the leadership of the Lighthouse Center for Wellbeing, an out-patient mental health clinic in Dubai composed of more than 25 licensed psychologists. The Lighthouse is the only accredited provider of MHFA in the UAE.
MHFA UAE offers 3 courses:
- Adult to Adult MHFA, a 12-hour training which qualifies a participant to become a Mental Health First Aider. This course is designed for those who are working, living or interacting with other adults.
- Adult to Adolescent MHFA, a 14-hour course which qualifies a participant to become a Youth Mental Health First Aider. This course is designed for those who are working, living or interacting with young people.
- Teen to Teen MHFA, a 4-hour course which qualifies teens to become Teen Mental Health First Aiders.
- Mental health triage - A brief overview of the Australian concept for dealing with psychiatric emergencies, similar to regular triage.
- Medically indigent adult
- Political abuse of psychiatry
- Involuntary commitment
References and notes
- Kitchener, B.A., Jorm, A.F. & Kelly, C.M. (2015). Mental Health First Aid International Manual. Melbourne: Mental Health First Aid International.
- Kohn R, Saxena S, Levav I, Saraceno B. The treatment gap in mental health care. Bull World Health Organ 2004; 82: 858-866.
- Kitchener BA, Jorm AF. (2008). Mental Health First Aid: an international program for early intervention. Early Intervention in Psychiatry, 2, 55-61.
- Mental Health First Aid International Newsletter, November 2012. "Archived copy" (PDF). Archived (PDF) from the original on 19 September 2015. Retrieved 25 September 2015.CS1 maint: archived copy as title (link)
- Hadlaczky G, Hökby S, Mkrtchian A, Carli V, Wasserman D. Mental Health First Aid is an effective public health intervention for improving knowledge, attitudes, and behaviour: a meta-analysis. International Review of Psychiatry 2014; 26: 467-475.
- Morgan AJ, Ross A, Reavley NJ. Systematic review and meta-analysis of Mental Health First Aid training: Effects on knowledge, stigma, and helping behaviour. PLoS One. 2018 May 31;13(5)
- Jorm AF, Ross, AM. Guidelines for the public on how to provide mental health first aid: a narrative review. BJPscyh Open, 2018.
- Bond KS, Jorm AF, Kelly CM, Kitchener BA, Morris SL, Masson RJ. Considerations when providing mental health first aid to an LGBTIQ person: a Delphi study.Advances in Mental Health. Jan 2017.
- Langlands, R.L, Jorm, A.F., Kelly, C.M. & Kitchener, B. (2008). First aid for depression: A Delphi consensus study with consumers, carers and clinicians. Journal of Affective Disorders, 105, 157-165.
- Langlands RL, Jorm AF, Kelly CM, Kitchener BA. (2008). First aid recommendations for psychosis: using the Delphi method to gain consensus between mental health consumers, carers and clinicians. Schizophrenia Bulletin, 34, 435-443.
- Ross AM, Kelly CM, Jorm AF. Re-development of mental health first aid guidelines for suicidal ideation and behaviour: a Delphi study. BMC Psychiatry 2014; 14: 241.
- Ross AM, Kelly CM, Jorm AF. Re-development of mental health first aid guidelines for non-suicidal self-injury: a Delphi study. BMC Psychiatry 2014; 14: 236.
- SAMHSA. "Mental Health First Aid". Archived from the original on 8 August 2017. Retrieved 8 August 2017.
- Wong, Eunice C.; Collins, Rebecca L.; Cerully, Jennifer L. (15 July 2015). "Reviewing the Evidence Base for Mental Health First Aid". Rand Health Quarterly. 5 (1): 19. ISSN 2162-8254. PMC 5158252. PMID 28083372.
- Minas, H.; Colucci, E.; & Jorm, A. F. (2009). "Evaluation of Mental Health First Aid training with members of the Vietnamese community in Melbourne, Australia". International Journal of Mental Health Systems, 3, 19.
- Lam, A. Y. K.; Jorm, A. F.; & Wong, D. F. K. (2010). "Mental health first aid training for the Chinese community in Melbourne, Australia: effects on knowledge about and attitudes toward people with mental illness". International Journal of Mental Health Systems, 4, 18.
- Bond KS, Jorm AF, Kitchener BA, Reavley NJ. "Mental health first aid training for Australian medical and nursing students: an evaluation study". BMC Psychology 2015; 3: 11.
- Bond KS, Jorm AF, Kitchener BA, Reavley NJ. "Mental Health First Aid training for Australian financial counsellors: An evaluation study". Advances in Mental Health 2016; 14: 65-74.
- Kelly CM, Mithen JM, Fischer JA, Kitchener BA, Jorm AF, Lowe A, Scanlan C. "Youth mental health first aid: a description of the program and an initial evaluation". International Journal of Mental Health Systems 2011; 5: 4.
- Kanowski LG, Jorm AF, Hart LM. "A mental health first aid training program for Australian Aboriginal and Torres Strait Islander peoples: description and initial evaluation". International Journal of Mental Health Systems 2009; 3: 10.
- Hart LM, Mason RJ, Kelly CM, Cvetkovski S, Jorm AF. "'Teen Mental Health First Aid': a description of the program and an initial evaluation". International Journal of Mental Health Systems 2016; 10: 3.
- Mental Health First Aid Australia. "Mental Health First Aid Australia Media Release 6th March 2015" (PDF). Archived (PDF) from the original on 25 September 2015. Retrieved 25 September 2015.
- Mental Health First Aid Australia. "Mental Health First Aid Awards". Archived from the original on 28 February 2016. Retrieved 1 February 2016.
- TheMHS. "2017 Winners Awards TheMHS" (PDF). Retrieved 23 September 2017.
- "Who We Are". Mental Health First Aid England. Archived from the original on 15 February 2016. Retrieved 11 February 2016.
- "Mental Health First Aid England". Archived from the original on 15 February 2016. Retrieved 11 February 2016.
- "No health without mental health: implementation framework" (PDF). Archived (PDF) from the original on 19 January 2017. Retrieved 11 February 2016.
- "Leading on mental wellbeing, transforming the role of line managers". 4 February 2016. Archived from the original on 15 February 2016. Retrieved 11 February 2016.
- "MHFA Ireland". Retrieved 9 January 2020.
- "Program History". www.mhfa.ca. 17 May 2018.