Mental Health First Aid

Mental Health First Aid: A Course and a Movement

Margaret Paccione-Dyszlewski, PhD

By Margaret R. Paccione-Dyszlewski, PhD, director of clinical innovation at Bradley Hospital and clinical assistant professor in the Department of Psychiatry and Human Behavior at Brown University.

We are on Main Street and a middle-aged man clutches his chest in cardiac crisis. A member of the community trained in medical first aid administers cardiopulmonary resuscitation (CPR) until paramedics arrive. A life is saved.

We are on Main Street and a young woman is acting recklessly and threatening to hurt herself. A community member trained in behavioral first aid intervenes until professional help can be obtained. Another life is saved.

In the past decade, over 740,000 individuals in the United States, called First Aiders, have been trained in Mental Health First Aid (MHFA).

Just as CPR can assist a person having a heart attack, MHFA can assist someone experiencing a psychiatric or substance use-related crisis.

MHFA is an eight-hour course designed for laypeople to increase their knowledge of mental health issues, reduce stigmatization of those with such issues, and encourage skilled and supportive reactions toward individuals experiencing behavioral health crises. The course is taught by certified trainers utilizing a manualized curriculum. Individuals who participate in an MHFA course receive information regarding psychiatric symptoms, treatment, and ways in which a person in distress can be supportively approached.

The mental health issues covered include: depression, anxiety, trauma, substance use disorders, psychosis, self-harm, and suicide. The course was developed for persons from all segments of the community who do not have specialized expertise in behavioral health. Mental Health First Aiders are taught a single five-step strategy that includes assessing for risk of suicide or harm, listening nonjudgmentally, giving reassurance and information, encouraging appropriate professional help, and encouraging self-help and other supports. A defining feature of the MHFA course is the opportunity for participants to practice the intervention strategy rather than to simply learn it conceptually.

MHFA Adult and MHFA Youth are the most popular versions of the course.

Youth MHFA is primarily designed for individuals who interact with adolescents ages 12 through 18. The course introduces the core mental health issues covered in all the MHFA courses, with additional attention paid to typical adolescent development, disruptive behavior disorders, attention-deficit hyperactivity disorder, and eating disorders. Intervention strategies focus on noncrisis as well as emergent situations. Specialized modules for higher education; public safety; military members, veterans and military families; older adults and those with later-life issues; and rural designation are also available. A high school-level peer-to-peer training module is currently in development.

The program originated in Australia in the year 2000. MHFA USA is listed in the Substance Abuse and Mental Health Services Administration's National Registry of Evidence-based Programs and Practices. A growing body of research supports the findings that certified First Aiders demonstrate:

  • increased knowledge of the signs, symptoms and risk factors of mental and substance use disorders;
  • improved concordance with health care providers;
  • increased confidence in and likelihood to help an individual in crisis; and
  • decreased social distance from individuals with mental disorders.

According to Susan Blue, the board chair of the National Council for Behavioral Health, "With one in four Americans experiencing a mental health or addiction disorder each year, the National Council is committed to making this important training as common as CPR:' In fact, several states have begun to train or mandate training for discrete cohorts such as police officers, correction officers and teachers. Legislation has resulted in federal grant programs in support of MHFA being made available each year since 2014 and has resulted in several funded initiatives on the state level.

Mental health professionals and organizations should support and encourage the adoption of MHFA as part of our public health efforts to destigmatize and increase access to mental health services.

MHFA is uniquely positioned at the intersection of behavioral health knowledge transfer, values clarification, cultural competence, and active skill development.

In a single eight-hour course, participants are invited to peel away the unfamiliar cloak of mental health and substance use disorders, gain basic competence and confidence in their ability to support an individual in crisis until professional help can be obtained, challenge long-held beliefs about psychiatric illness, and gain awareness of their own mental health.

Each educator, first responder, faith-based community leader, food bank volunteer, civic leader, physician, child care worker, human resource director, receptionist, attorney, nurse, or member of any facet of our community that is certified in MHFA adds immeasurably to the mental health literacy of our citizenship and increases the safety of those with behavioral health disorders and the public at large. Mental health professionals and organizations should support and encourage the adoption of MHFA as part of our public health efforts to destigmatize and increase access to mental health services.

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This article was published in the Brown University Child and Adolescent Behavior Letter, in cooperation with Bradley Hospital.