Mental Health First Aid Research
Since it began in 2001, Mental Health First Aid Australia has been committed to evaluating its training programs using rigorous, scientific studies. Listed here are studies that evaluated MHFA training and have been published in peer-reviewed academic journals. A number of these evaluations were conducted by MHFA or by the Population Mental Health Group led by Professor Tony Jorm at the University of Melbourne. However, there are also studies that have been conducted by independent organisations.
Evaluations have consistently shown that MHFA training is associated with improved knowledge of mental illnesses and their treatments, knowledge of appropriate first aid strategies, and confidence in providing first aid to individuals with mental illness. Some studies have also shown improved mental health in those who attend the training, decreases in stigmatising attitudes and increases in the amount and type of support provided to others.
Hart LM, Jorm AF, Paxton SJ, Cvetkovski S. MHFA Guidelines: An evaluation of impact following download from the World Wide Web. Early Intervention Psychiatry, 2012; 6; 399-406. Abstract
The aim of the current study was to evaluate the usefulness and impact of the MHFA Guidelines on web users who download them. Web users who downloaded the documents were invited to respond to an initial demographic questionnaire, then a follow up about how the documents had been used, their perceived usefulness, whether first aid situations had been encountered and if these were influenced by the documents. A majority of those who provided first aid reported feeling that they had been successful in helping the person, that they had been able to assist in a way that was more knowledgeable, skilful and supportive, and that the guidelines had contributed to these outcomes. Findings supported the conclusion that information made freely available on the Internet, about how to provide mental health first aid to someone who is developing a mental health problem or experiencing a mental health crisis, is associated with more positive, empathic and successful helping behaviours.
25. Development of key messages for adolescents on providing basic mental health first aid to peers: a Delphi consensus study, 2012
Ross AM, Hart LM, Jorm AF, Kelly CK, Kitchener BA. Development of key messages for adolescents on providing basic mental health first aid to peers: a Delphi consensus study. Early Intervention Psychiatry, 2012; 6; 229-238; doi: 10.1111/j.1751-7893.2012.00345.x. Abstract
Most young people fail to receive professional treatment for mental disorders; however, they do indicate a preference for sharing problems with peers. This article describes key messages about knowledge and actions to form the basis of a basic Mental Health First Aid (MHFA) course for adolescents to increase recognition of and help seeking for mental health problems by teaching the best knowledge and helping actions a young person can undertake to support a peer with a mental health problem. Methods: The Delphi method was used to achieve consensus among Australian and Canadian youth mental health experts regarding the importance of statements that describe helping actions a young person can take, and information they should have, to support a friend with a mental health problem. There were two expert panels, one consisting of 36 youth mental health consumer advocates and the other of 97 Youth MHFA instructors. Panellists rated each statement according to how appropriate it would be as a basic mental health first aid message for both a junior adolescent (12-15 years) and a senior adolescent (16-18 years). Results: Out of 98 statements, 78 were endorsed as key basic MHFA messages for junior adolescents and 81 were endorsed for senior adolescents. Conclusion: The study has identified key messages for adolescents on how they can help a peer. These messages will form the basis of the curriculum for an MHFA course for adolescents, which will aim to facilitate early recognition of and help seeking for mental health problems in adolescents.
Morawska A, Fletcher R, Pope S, Heathwood E, Anderson E, McAuliffe C. Evaluation of Mental Health First Aid training in a diverse community setting. International Journal of Mental Nursing, 2012; doi: 10.1111/j.1447-0349.2012.00844.x. Abstract
Mental health first aid (MHFA) training has been disseminated in the community and has yielded positive outcomes in terms of increasing help-seeking behaviour and mental health literacy. However, there has been limited research investigating the effectiveness of this programme in multicultural communities. Given the increasing levels of multiculturalism in many countries, as well as the large number of barriers presented to these groups when trying to seek help for mental illnesses, the present study aimed to investigate the effectiveness of MHFA in these settings. A total of 458 participants, who were recruited from multicultural organizations, participated in a series of MHFA training courses. Participants completed questionnaires pre and post the training course, and 6-month follow-up interviews were conducted with a subsample of participants. Findings suggested that MHFA training increased participant recognition of mental illnesses, concordance with primary care physicians about treatments, confidence in providing first aid, actual help provided to others, and a reduction in stigmatizing attitudes. A 6-month follow up also yielded positive long-term effects of MHFA. The results have implications for further dissemination and the use of MHFA in diverse communities. In addition, the results highlight the need for mental health training in health-care service providers.
23. Young people’s mental health first aid intentions and beliefs prospectively predict their actions: Findings from an Australian National Survey of Youth, 2012
Yap MBH & Jorm AF. Young people’s mental health first aid intentions and beliefs prospectively predict their actions: Findings from an Australian National Survey of Youth Psychiatry Research, 2012; 196; 315–319 Abstract
Little is known about whether mental health first aid knowledge and beliefs of young people actually translate into actual behavior. This study examined whether young people’s first aid intentions and beliefs predicted the actions they later took to help a close friend or family member with a mental health problem. Participants in a 2006 national survey of Australian youth (aged 12-25years) reported on their first aid intentions and beliefs based on one of four vignettes: depression, depression with alcohol misuse, psychosis, and social phobia. At a two-year follow-up interview, they reported on actions they had taken to help any family member or close friend with a problem similar to the vignette character since the initial interview. Of the 2005 participants interviewed at follow-up, 608 reported knowing someone with a similar problem. Overall, young people’s first aid intentions and beliefs about the helpfulness of particular first aid actions predicted the actions they actually took to assist a close other. However, the belief in and intention to encourage professional help did not predict subsequent action. Findings suggest that young people’s mental health first aid intentions and beliefs may be valid indicators of their subsequent actions.
22. Farm-Link: Improving the Mental Health and Well-Being of People Who Live and Work on NSW Farms, 2012
Perceval M, Fuller J, Holley A-M. Farm-Link: Improving the Mental Health and Well-Being of People Who Live and Work on NSW FarmsInternational Journal of Mental Health, 2012; 40(2) Abstract
The Farm-Link Program aimed to improve access to and responsiveness of mental health services to the needs of people who live and work on farms in NSW, Australia. Frontline agricultural workers, who have a lot of contact with farmers and their families, received Mental Health First Aid training provided by Farm-Link staff. Across NSW, 220 participants received this training during 2008, and 133 participants received training in the New England region throughout 2009-10. Farmers’ mental health networks were developed and expanded to engage both agricultural and mental health agencies, so that pathways to mental health care could be defined, described, and utilized. An external evaluation indicated that Farm-Link successfully identified and established mental health service development interventions in target communities. Farm-Link’s ongoing work indicates further time and continuity of service in rural communities has a positive impact on the depth of knowledge built and project aims being delivered.
Jorm, Anthony F. Mental health literacy: Empowering the community to take action for better mental health. American Psychologist 2011; doi:10.1037/a0025957 (Advance online publication)
For major physical diseases, it is widely accepted that members of the public will benefit by knowing what actions they can take for prevention, early intervention, and treatment. However, this type of public knowledge about mental disorders (mental health literacy) has received much less attention. There is evidence from surveys in several countries for deficiencies in (a) the public’s knowledge of how to prevent mental disorders, (b) recognition of when a disorder is developing, (c) knowledge of help-seeking options and treatments available, (d) knowledge of effective self-help strategies for milder problems, and (e) first aid skills to support others affected by mental health problems. Nevertheless, there is evidence that a range of interventions can improve mental health literacy, including whole-of-community campaigns, interventions in educational settings, Mental Health First Aid training, and information websites. There is also evidence for historical improvements in mental health literacy in some countries. Increasing the community’s mental health literacy needs to be a focus for national policy and population monitoring so that the whole community is empowered to take action for better mental health.
20. The influence of stigma on first aid actions taken by young people for mental health problems in a close friend or family member, 2011
Marie Bee Hui Yap, Anthony Francis Jorm. The influence of stigma on first aid actions taken by young people for mental health problems in a close friend or family member: Findings from an Australian national survey of youth. Journal of Affective Disorders 2011; 134: 473 – 477.
Young people are an important source of first aid for mental health problems in people they are close to, but their first aid skills remain inadequate. This study examined the influence of stigma on first aid actions taken by young people to help someone close to them with a mental health problem. Participants in a national telephone survey of Australian youth (aged 12-25years) reported on their stigmatising attitudes based on one of three disorders in vignettes: depression, depression with alcohol misuse, and social phobia. At a two-year follow-up interview, they were asked if they knew a family member or close friend with a problem similar to the vignette character since the initial interview, and those who did reported on the actions taken to help the person. Of the 1520 participants interviewed at follow up, 507 reported knowing someone with a similar problem. Young people’s stigmatising attitudes (weak-not-sick, social distance and dangerousness/unpredictability) influenced their first aid actions. Reducing stigma may help to improve the first aid that people with mental health problems can receive from young people who are close to them.
19. Noting a landmark achievement: Mental Health First Aid training reaches 1% of Australian adults, 2011
Anthony F. Jorm, Betty A. Kitchener. Noting a landmark achievement: Mental Health First Aid training reaches 1% of Australian adults. Australian and New Zealand Journal of Psychiatry 2011; Early Online, 1–6.
In an invited editorial, Betty Kitchener and Professor Tony Jorm reflect on the factors contributing to the remarkable growth of MHFA over the last ten years. In its tenth year in 2011, MHFA has reached a milestone with 170,000 adults having attended a MHFA course in Australia, equivalent to 1% of the Australian adult population. The authors attribute the following factors contributing to Mental Health First Aid’s success – building on a familiar concept of first aid, fulfilling a public need, tailoring the course to different audiences, quality control, sustainable funding model and having a strong partnership with research.
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O’Reilly, C.L., Bell, J.S., Kelly, P.J., and Chen, T.F. Impact of mental health first aid training on pharmacy students’ knowledge, attitudes and self-reported behaviour: a controlled trial. Australian and New Zealand Journal of Psychiatry, 2011 45(7): 549 – 557.
The aim of this study was to assess the impact of delivering Mental Health First Aid (MHFA) training for pharmacy students on their mental health literacy and stigma towards mental illness. A non-randomized controlled design was used, with all third year pharmacy students at the University of Sydney (n = 272) in 2009 invited to participate in one of two MHFA training courses, each of 12 hours duration. Of these, 174 students applied for MHFA training, of whom 60 were randomly selected and offered MHFA training. Outcome measures that were completed by all participants in the MHFA and non-MHFA groups before and after the MHFA training included an evaluation of mental health literacy, the 7-item social distance scale, and 16 items related to self-reported behaviour. This study demonstrated that MHFA training can reduce pharmacy students’ mental health stigma, improve recognition of mental disorders and improve confidence in providing services to consumers with a mental illness in the pharmacy setting.
Sarah Gillinson, Matthew Horne and Peter Baeck RADICAL EFFICIENCY: Different, better, lower cost public services. NESTA, England, June 2010.
The MHFA Program was chosen as one of 10 case studies of ‘Radical efficiency’ in action across the world. ‘Radical efficiency’ is about different, better and lower cost public services – innovation that delivers much better public outcomes for much lower cost.
Kelly, C.M., Mithen, J.M., Fischer, J.A., Kitchener, B.A., Jorm, A.F., Lowe, A.J. and Scanlan, C. Youth Mental Health First Aid: a description of the program and an initial evaluation. International Journal of Mental Health Systems 2011, 5(1):4 (PDF full text)
In 2007, the Youth Mental Health First Aid Program was launched in Australia with the aim to teach adults, who work with or care for adolescents, the skills needed to recognise the early signs of mental illness, identify potential mental health-related crises, and assist adolescents to get the help they need as early as possible. This paper provides a description of the program, some initial evaluation and an outline of the future directions.
Jorm AF, Kitchener BA, Fischer J, Cvetkovski S. Mental health first aid training by e-learning: a randomized controlled trial. Australian and New Zealand Journal of Psychiatry 2010; 44: 1072-1081.
A randomized controlled trial was carried out with 262 members of the Australian public. Participants were randomly assigned to complete an e-learning CD, read a Mental Health First Aid manual or be in a waiting list control group. The effects of the interventions were evaluated using online questionnaires pre- and post-training and at 6-months follow up. The questionnaires covered mental health knowledge, stigmatizing attitudes, confidence in providing help to others, actions taken to implement mental health first aid and participant mental health. Both e-learning and the printed manual increased aspects of knowledge, reduced stigma and increased confidence compared to the control group. E-learning also improved first aid actions taken more than the control group, and was superior to the printed manual in reducing stigma and disability due to mental ill health.
Terry J. Experiences of instructors delivering the Mental Health First Aid training programme: a descriptive qualitative study. Journal of Psychiatric and Mental Health Nursing 2010; 17: 594 – 602.
Research relating to MHFA has centred on course attendees. Understanding experiences of instructors delivering such programmes is also key to the success of future delivery. This study sought to identify the views and experiences of instructors delivering MHFA in Wales. Fourteen MHFA instructors participated in semi-structured audio-recorded interviews, with the transcripts analysed to identify key themes. This paper explores two of the identified themes namely prerequisite skills and support required by instructors. The study highlighted that because of the ensuing emotional labour experienced by instructors, universal mental health training programmes must put in place a clear infrastructure to train, support and monitor those delivering them, for programme roll-out to be effective.
Jorm AF, Kitchener BA, Sawyer MG, Scales H, Cvetkovski S. Mental health first aid training for high school teachers: a cluster randomized trial BMC Psychiatry 2010; 10: 51. (PDF full text)
Mental illnesses often have their first onset during adolescence. For this reason, high school teachers are in a good position to provide initial assistance to students who are developing mental health problems. To improve the skills of teachers in this area, the Youth MHFA course was modified to be suitable for high school teachers and evaluated in a cluster randomised trial with teachers from 14 South Australian high schools.
Evaluation by questionnaires pre- and post-training and at 6 months follow-up found that the training increased teachers’ knowledge, changed beliefs about treatment to be more like those of mental health professionals, reduced some aspects of stigma, and increased confidence in providing help to students and colleagues. There was an indirect effect on students, who reported receiving more mental health information from school staff. Most of the changes found were sustained 6 months after training.
12. Evaluation of Mental Health First Aid training with members of the Chinese community in Melbourne, Australia
Lam AY.K, Jorm AF, Wong DF.K. 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 2010; 4: 18. (PDF full text)
This is the third published paper on an evaluation of a cultural adaptation of the MHFA Australia program. MHFA Hong Kong Instructor Angus Y Lam spent some time studying in Melbourne. Whilst here, he carried out an evaluation of the 12-hr MHFA delivered to 108 people from the Chinese community in Melbourne. Angus used the adapted Chinese translated MHFA manual from the MHFA Hong Kong Program. He also conducted the course in Cantonese, which was simultaneously translated into Mandarin by another participant. Pre and post measurements in this uncontrolled trial found this training to be effective in improving recognition of mental disorders, in reducing negative stigmatizing attitudes and in changing beliefs about the helpfulness of treatment.
Pierce D, Liaw ST, Dobell J, Anderson R. Australian rural football club leaders as mental health advocates: an investigation of the impact of the Coach the Coach project. International Journal of Mental Health Systems 2010; 4: 10. (PDF full text)
The Rural Health Academic Centre in the rural city of Ballarat in Victoria delivered the MHFA course to 36 football coaches from 12 rural clubs in Victoria. More than 50% of club leaders who undertook the training showed increased capacity to recognise mental illness and 66% reported increased confidence to respond to mental health difficulties in others. The study concluded that rural football clubs appear to be appropriate social structures to promote rural mental health awareness. Club leaders, including many coaches, benefit from MHFA training, reporting increased skills and confidence. Benefit to club players from this approach was less obvious. However, the generally positive findings of this study suggest further research in this area is desirable.
10. Evaluation of Mental Health First Aid training with members of the Vietnamese community in Melbourne, Australia, 2009
Minas H, Colucci E, Jorm AF. Evaluation of Mental Health First Aid training with members of the Vietnamese community in Melbourne, Australia. International Journal of Mental Health Systems 2009; 3: 19. (PDF full text)
This is the second published paper on an evaluation of a cultural adaptation of the MHFA Australia program. Pre and post measurements in this uncontrolled trial of the Vietnamese MHFA program found significant reductions in stigmatising attitudes, improved knowledge of mental disorders and improved knowledge about appropriate forms of assistance to give to people in the Vietnamese community with mental disorder.
Hossain D, Gorman D, Eley R. Enhancing the knowledge and skills of Advisory and Extension Agents in mental health issues of farmers. Australian Psychiatry 2009; 17: 116-20.
The Centre for Rural and Remote Area Health, University of Southern Queensland, evaluated the effectiveness of the MHFA training for Advisory and Extension Agents, who are a main line of contact of farmers in rural Queensland. The agents’ mental health literacy and skills in dealing with people with mental illness were significantly improved.
b) Hossain D, Gorman D, Eley R, Coutts J. Farm Advisors’ reflections on MHFA training. Australian e-Journal for Advancement of Mental Health 2009; 8: 1. (PDF full text)
A second article discusses the reflections of farmer advisors about the MHFA training. They reported that the MHFA course materials were new, well presented and relevant for them.
c) Hossain D, Gorman D, Coutts J. Value of Mental Health First Aid training of Advisory and Extension Agents in supporting farmers in rural Queensland. Rural and Remote Health 2010; 10: 1593. (PDF Full text)
A third article is a one-year follow-up. It showed that MHFA training improved Advisory and Extension Agents’ confidence level and their knowledge of mental health issues and increased their empathy toward persons with mental health problems. Furthermore, providing training on mental health issues to Advisory and Extension Agents was perceived by stakeholders to be beneficial to both farmers and Advisory and Extension Agents.
Kanowski L, Jorm A, 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.(PDF full text)
This is the first published paper on an evaluation of a cultural adaptation of the MHFA Australia program. An initial qualitative evaluation of the uptake and acceptability of the Aboriginal and Torres Strait Islander MHFA program found the program is culturally appropriate, empowering Aboriginal people and providing information that is highly relevant in assisting Aboriginal people with a mental illness.
Sartore GM, Kelly B, Stain HJ, Fuller J, Fragar L, Tonna A. Improving mental health capacity in rural communities: Mental health first aid delivery in drought-affected rural New South Wales, Australian Journal of Rural Health 2008; 16: 313–318. (PDF full text)
The Centre for Rural and Remote Mental Health in NSW evaluated the effectiveness of the MHFA training in drought-affected rural and remote Australia, as part of a strategy to improve capacity among farming communities to provide early intervention for mental health problems. Data were obtained from 99 participants recruited across 12 New South Wales towns, before and after delivery of MHFA seminars emphasising the role of front-line workers from agricultural-related services. Surveys assessed knowledge of, confidence in dealing with, and attitude towards people experiencing mental illness, along with the impact of training on response to mental health problems among target population of farmers and farming families. Rural support workers and community volunteers attended MHFA seminars because of perceived mental health needs in the workplace. A majority of responses reflect a concern with giving appropriate advice and support well outside narrow job definitions. Participants’ ability to identify high prevalence disorders and endorse evidence-based interventions for both high and low prevalence disorders increased following MHFA training, as did their confidence in their ability to provide appropriate help. The study concluded that MHFA training can form an effective part of a strategy to improve systems of care and pathways to early intervention in rural communities by using local networks to provide mental health support.
6. MHFA Training: review of evaluation studies, 2005
Kitchener BA, Jorm AF. Mental Health First Aid training: review of evaluation studies. Australian and New Zealand Journal of Psychiatry 2006; 40: 6-8. (PDF full text)
This paper reviewed studies evaluating mental health first aid (MHFA) training. The results found that most mental health first aiders tend to be middle-aged women whose work involves people contact. All trials found the following statistically significant benefits 5–6 months post-training: improved concordance with health professionals about treatments, improved helping behaviour, greater confidence in providing help to others and decreased social distance from people with mental disorders. Only one trial evaluated the mental health benefits to participants and this found positive effects. The paper concluded that although MHFA training has been found to change knowledge, attitudes and helping behaviours, and even benefit the mental health of participants, there has not yet been an evaluation of the effects on those who are the recipients of the first aid.
Jorm AF, Blewitt KA, Griffiths KM, Kitchener B, Parslow RA. Mental health first aid responses of the public: results from an Australian national survey, BMC Psychiatry 2005; 5 :17. (PDF full text)
A national survey of 4000 Australian adults examined how they would respond to someone they know and care about who has a mental disorder. Survey participants were given a description of a person with either depression or schizophrenia and asked what they would do to help the person. Many people said they would listen to the person and encourage professional help-seeking. However, a significant minority did not even mention these basic first aid strategies. Few said they would contact a professional on the person’s behalf or accompany them to a professional. Mental health first aid responses were generally more appropriate in women than men, and in participants with less stigmatizing attitudes. Participants who could correctly recognise depression or schizophrenia in the descriptions also had better first aid responses. These results show that mental health first aid skills need improving in a number of areas. They also show that lack of knowledge of mental disorders and stigmatizing attitudes are barriers to people providing first aid.
Jorm A, Kitchener B, Mugford SK. Experiences in applying skills learned in a mental health first aid training course: a qualitative study of participants’ stories. BMC Psychiatry 2005; 5: 43. (PDF full text)
People who have completed the Mental Health First Aid course often tell stories about how they have used their first aid skills to help someone. These stories are particularly interesting because they tell about the effects of the first aid on the person helped. In order to systematically analyse such stories, 131 former course participants were approached 19-21 months following the course and asked to complete a questionnaire about their experiences. 94 of these people responded. It was found that 78% had used their first aid skills. Many positive effects were reported, including increased empathy and confidence and being better able to handle crises. There was no evidence that people were over-reaching themselves because of over-confidence. Participants were very positive about the benefits of the course and keen to see it repeated and extended.
Jorm A, Kitchener B, O’Kearney R, Dear K B.G. Mental health first aid training of the public in a rural area: a cluster randomized trial. BMC Psychiatry 2004; 4: 33. (PDF) full text
A trial was carried out with members of the public in a large rural area of New South Wales, as a partnership between the New South Wales Southern Area Health Service and the Centre for Mental Health Research. Eight of 16 local government areas on the Southern Area Health Service received the course immediately and the other 8 were placed on a waiting list to receive the training later in the year (the controls). There were 753 participants in total in the trial: 416 were in areas that received the course immediately and 337 in the control group. People who did the course showed a number of changes relative to the control group:
- Better recognition of disorders from case descriptions of a person with either depression or schizophrenia.
- Less negative attitudes towards people with mental disorders.
- More like health professionals in their beliefs about what treatments are likely to be helpful
- Greater confidence in providing help to someone.
- More likely to actually provide help to someone.
The course did not change the following:
- Number of people with mental disorders that the participant had contact with.
- Advising people to seek professional help.
Kitchener BA, Jorm AF. Mental health first aid training in a workplace setting: A randomized controlled trial. BMC Psychiatry 2004; 4: 23. (PDF full text)
Because the first study had no control group, a second trial was conducted in which course participants were compared with a wait-list control group. This randomized controlled trial was carried out in 2002 with employees of two Australian government departments who did the course during their work time. This trial involved 301 participants who were randomized to either participate immediately in a course or to be wait-listed for 5 months before undertaking the training. The trained group improved more than the wait-list control group in the following areas:
- Greater confidence in providing help to others.
- Greater likelihood of advising people to seek professional help.
- Improved concordance with health professionals about treatments.
- Decrease in stigmatizing attitudes.
- Improved mental health in the participants themselves.
The mental health benefits of the course to participants were unexpected because the course does not provide therapy and promises no personal benefits. We think the course may mental health benefits by providing participants with good quality information which allows them to make better choices about their own mental health care.
Jorm AF, Kitchener BA. Mental health first aid training for the public: evaluation of effects on knowledge, attitudes and helping behaviour. BMC Psychiatry 2001; 2: 10. (PDF full text)
The first evaluation study of MHFA was an uncontrolled trial in 2001 with members of the public living in Canberra. This trial examined the effects of the course on knowledge of mental disorders, stigmatizing attitudes and help provided to others. 210 participants were given questionnaires at the beginning of the course, at the end, and at 6 months follow-up. The course was found to produce the following benefits:
- Better recognition of mental disorders from case vignettes.
- Changed beliefs about treatment to be more like those of health professionals.
- Decreased social distance from people with mental disorders.
- Increased confidence in providing help.
- Increase in the amount of help provided to others.
There is also a report of this article in the British Medical Journal