Mental Health First Aid (MHFA) is a form of “widespread psychoeducation” that aims to improve awareness of and attitudes toward mental health amongst the general public.
The idea is that MHFA can reduce the stigma attached to mental health and also potentially help people with mental health problems access support, because others would be more likely to recognise someone as having a problem and encourage them to seek help.
MHFA also includes more direct and specific instruction as well as targeting attitudes, for example providing participants with a 5 step action plan to help people during a mental health crisis.
It’s delivered as a two-day open training course by qualified MHFA instructors, of which there are over 1,000 in England alone. The programme was developed in Australia but is now delivered in 21 countries around the world. However, the evidence base for MHFA itself has never been quantitatively synthesised, until now.
The authors of this meta-analysis searched the literature for studies up to March 2014, looking at both MHFA delivered to adults and the course for young people.
Studies were excluded if they’d used a modified MHFA, rather than the standardised programme or if they didn’t provide any quantitative evaluation data.
The outcomes investigated were:
- Mental health literacy – participant’s knowledge about the symptoms of mental illness and what treatments are available
- Attitudes toward people who have a mental health problem, measured by the social distance scale, which asks people to judge how acceptable they’d find it for someone with a mental health problem to be socially ‘close’ to them, both in terms of geography, such as living next door, and relationships, for example marrying into the family
- “Help-related behaviours”. This latter outcome was defined as instances of actual help given (rather than expressed confidence to help someone or intentions to offer help in the future)
- 15 papers were included in the meta-analysis. Two studies were from Sweden, one from Canada, and the rest from Australia
- Nine studies just used a pre/post design (asking people before and then after the training). The remaining 6 were controlled trials, of which 4 were randomised. Only 3 studies evaluated the youth course
- Effect sizes were smaller in the controlled studies, though not significantly different to those found in the uncontrolled studies
- Significant results were found for all 3 outcomes
The authors say:
Results indicate not only changes in knowledge and attitudes, but also changes in the behaviour of those who attend the training… Considering the estimated effects of the MHFA programme on knowledge, attitudes and behaviour, this intervention programme seems to be a promising public health tool for tackling stigma and taboo surrounding people with mental disorders and suicidality.
What we don’t know of course is whether there were indeed positive impacts for people with mental health problems themselves. Working out whether MHFA does encourage people to get support is going to be very difficult to demonstrate, but not impossible, though you would probably have to evaluate specific sites (for example, compare the number of people who access mental health support in a workplace which received MHFA training compared to one that didn’t.)
Given that we now have “robust” evidence that MHFA improves knowledge, reduces stigma and makes people more likely to offer help, perhaps the challenge is going to be encouraging uptake of the training. Is it possible that one day MHFA will be as common as physical first aid?
The authors themselves point out that the behavioural measure is limited in that it relies on participants having had the opportunity following training to provide help. People could report not helping anyone because they didn’t encounter the need to, rather than because they wouldn’t.
Although intended for the “general public”, it would be useful to know whether there are differences in impact depending on the particular groups involved, particularly whether it is more or less likely to be effective depending on how much mental health knowledge the person already has. It’s quite likely however that this level of detail wouldn’t have been available in the papers included, but is perhaps something to consider for future research. This knowledge may help us tailor training to specific populations, e.g. older people, who are more likely to have negative attitudes to mental illness.
The authors say “The results of this meta-analysis suggest that MHFA ultimately increases mental health literacy of the general population”, but I’d argue this might be over-stating things. It certainly seems to increase the literacy of those who attend, and it’s possible this then filters out into the broader population, but this would be very difficult to capture. It could also be argued for example that people willing to attend the course may already be quite positive about mental health, and people who have more negative views won’t be impacted.
The authors conclude that this evidence is “robust”, but it’s worth noting that only 4 of the trials were randomised. Although the authors did look at whether results were different between the randomised trials and the other studies and found them to be consistent, the former did show a smaller effect size. It’s now necessary to strengthen the evidence base for MHFA by conducting more high quality randomised controlled trials with different populations.
The review also demonstrates that ensuring studies have long-term follow ups (rather than just pre- and post-training) is important to ensure impact on behaviour beyond the training is captured.
Hadlaczky G. et al (2014) Mental Health First Aid is an effective public health intervention for improving knowledge, attitudes, and behaviour: a meta-analysis. Int Rev Psychiatry 2014 Aug;26(4):467-75. doi: 10.3109/09540261.2014.924910. [PubMed abstract]
Mental Health First Aid improves knowledge, reduces stigma and makes people more likely to offer support: Sara… http://t.co/A6HwdwPI6j
RT @Mental_Elf: Mental Health First Aid improves knowledge, reduces stigma and makes people more likely to offer support http://t.co/A1yTQZ…
@Mental_Elf totally agree! We offer the mental health first aid (armed forces) version and it is fantastic
MHFA improves knowledge, reduces stigma and makes people more likely to offer support http://t.co/uPUirF2K54” @PoppyJaman
Mental Health First Aid improves knowledge, reduces stigma and makes people… http://t.co/NYR1sZp4IH #MentalHealth http://t.co/seacOVrqGf
GRT news4 @MHFAEngland community! first ever quantitatively synthesised evidence base for MHFA has been published. https://t.co/1VNZqz092w
RT @dr_know: New blog by me @Mental_Elf http://t.co/QLCZEoqr8X mental health first aid – does it work? Wld love to hear opinion of any trai…
RT @dr_know: I think issue is whether mental health first aid truly a ‘public’ intervention or works for select few http://t.co/QLCZEoqr8X
Are you a Mental Health First Aid trainer? Please read our blog and share your experiences http://t.co/A1yTR0hwtg
Today @dr_know summarises a recent meta-analysis of Mental Health First Aid http://t.co/A1yTR0hwtg #MHFA
@Mental_Elf @dr_know My experiences not positive. It was awful. At no point was I treated as an equal in the group. Upsetting, humiliating.
Mental Health First Aid Meta-Analysis: training improves MH literacy & attitudes & helping @Mental_Elf http://t.co/r6wpX4WSKu @MHFAEngland
Mental Health First Aid improves knowledge & reduces stigma via @Mental_Elf #mhaw15 #ei2015 http://t.co/hH7rzuOLMR
Mental Health First Aid improves knowledge and reduces stigma http://t.co/HvrEH2NTn4
@drknow @Mental_Elf my @supportmuted colleagues investing in becoming #MHFA trainers thanks for evidence base article http://t.co/ss6YxU3Pmq
RT @Mental_Elf: Don’t miss: Mental Health First Aid improves knowledge, reduces stigma & makes people more likely to offer help http://t.co…
I had a horrendous experience on my MHFA course. I wasn’t the only person to feel this way. If I try and summarise a very upsetting experience it would be as follows. The comments are taken from the three blogs I wrote in April.
1. Depression was consistently discussed as a lifestyle choice rather than an illness. I.e. the trainers confused wellbeing/wellness with illness, despite trying to explain the MH continuum to the group.
2. Discussions about mental health issues were facilitated using language that suggested that the people affected by them were separate and somewhat inferior to our group. The training comprised of a steady stream of unchallenged misconceptions and discussions that reinforced that the people present were different – and better – than those who have mental health issues. E.g. (laughter) “well you know these services users…” (more laughter) The mixed group of participants were never treated on an equal footing. In fact, when I tried to challenge how the trainers were talking about service users because it was rather belittling, I asked “please can I remind you that there are service users in the room” and I got told not to worry that I wasn’t a professional, they wouldn’t use any technical terms and I could still help people as well! It was patronising to say the least. I have MH issues, I’m not daft (see title of my blog!)
3. Language is incredibly emotive. The MHFA course consistently talked about stigma. Stigma is the action of one person seared onto the skin of another. The stigmatised are marked with a shame that isn’t even theirs to own. I will not wear the shame of someone else’s ignorance. The words prejudice and discrimination place the spotlight back onto the person responsible for them. The shame is on them, as is the burden of responsibility for putting things right. Imagine if the fight for racial equality talked about ‘the stigma of being black’. It would quite rightly be challenged in the most vociferous ways – so why is this any different?
Thanks for reading. I still find it incredibly hurtful. I felt so humiliated and unvalued. When I left (half way through) because I couldn’t take it any more I explained why I was leaving but nobody has contacted me to ask for feedback. I submitted my own in the end.
Mental Health First Aid improves knowledge & reduces stigma – from the Mental Elf http://t.co/mFNtXGjGcO
Mental Health First Aid improves knowledge & reduces stigma http://t.co/IkDmwpgT3n
Mental Health First Aid improves knowledge & reduces stigma ⭐️important research @ProfAndySmith @EHUSportandPA http://t.co/tc84XpHu1r
RT @Mental_Elf: Thousands of people in the UK have received Mental Health First Aid training. Are you one of them? Tell us about it http://…
“Mental Health First Aid improves knowledge, reduces stigma and makes people more likely to offer support” http://t.co/oTxE5RPtgU
#SMHFA #MHFA Mental Health First Aid improves knowledge & reduces #stigma – research. http://t.co/ZwXWIHM1dt #MHScot #MentalHealth
We have studies in England that show 68% of people trained in MHFA use the 5 steps to supporting someone at least once in the first 3 months of being trained. With 94k MHFAiders trained in England that’s a lot of people people having well informed high quality conversations about their personal mental wellbeing.
we now have even more “robust” evidence that MHFA improves knowledge, reduces stigma and makes people more likely to offer support. I agree that the international MHFA movement now need to invest in research that looks at the experience and outcomes for the person supported. This is a challenge as in every day life people may not be aware that their confidante is using MHFA skills. Having said that we have workplace clients, where MHFA is an integral part of the companies health and wellbeing programand with identified referal pathways, who are persuing exactly this question.
MHFA is absolutely a driver for creating behaviour change in an individual. It gives people who were previously unsure as to how to have a good quality conversion that is structured and supportive. People generally feel worried about making things worse or saying something that will offend or hurt. MHFA teaches us to navigate our way through what is often a very emotional conversion with confidence and trust that we can go on someone’s journey in a positive helpful way.
It is not the answer to everything. We need national awareness raising campaigns we need more evidence so that we can fine tune our programmes and get even better at what we do.
Mental health education is a hearts, minds, behaviour and culture change challenge and that requires a multi facetted global approach and of course time!
Thanks @PoppyJaman @MHFAEngland for your comment on @dr_know’s blog http://t.co/A1yTR0hwtg I’m sure @CNSBlogger will want to respond
Mental Health First Aid improves knowledge & reduces stigma via @Time4Recovery @Mental_Elf http://t.co/aUAe1Td18j
“Mental Health First Aid improves knowledge & reduces stigma” via @Mental_Elf http://t.co/cjN3PAnWpc
#MentalHealth #FirstAid improves knowledge, reduces #stigma and makes people more likely to offer support | http://t.co/KB2S0htNei
Thanks for letting my share my experiences. MHFA England have been really supportive and it’s clear that my situation isn’t at all reflective of how the training is usually facilitated. They’ve been great, feeling really positive about it now.
I have just read your comments about how awful you found the training. I am doing an article for a national newspaper on the negatives of MHFA and would be pleased if you would like to get in touch. My personal email firstname.lastname@example.org. (you can be anonymous, if wanted)
Mental Health First Aid improves knowledge,reduces stigma & makes people more likely to offer support https://t.co/diHsEvpu4x via @sharethis
Future research also needs to capture cost-effectiveness i.e. is any benefit attained cost-effective-the courses cost money and time taken up by participants.. We’re developing a MHFA programme specifically for front-line staff including police, heath care workers, housing officers etc and plan to evaluate this, including economic evaluation