Which organisation is delivering this program / service?

Mental Health First Aid Australia

What are the aims and objectives of this program / service?

In 2000, in order to improve the level of mental health literacy of the community, a Mental Health First Aid (MHFA) training course was developed by Betty Kitchener AM and Professor Tony Jorm, following the model that has been successfully applied in many countries with conventional first aid. Mental health first aid is the help provided to a person who is developing a mental health problem, experiencing a worsening of a mental health problem, or in a mental health crisis. The first aid is given until appropriate professional help is received or the crisis resolves.
The vision of Mental Health First Aid Australia, a dedicated non-for-profit health promotion charity, is a community where everyone has the first aid skills to support people with mental health problems. Our mission is to provide high quality, evidence-based mental health first aid education to everyone.
MHFA courses provide participants with:
1) Skills in how to recognise the signs and symptoms of mental health problems
2) Awareness of the evidenced-based medical, psychological and complementary treatments available
3) Skills in how to give appropriate initial help and support someone experiencing a mental health problem
4) Skills in how to take appropriate action if a crisis situation arises, such as suicidal thoughts and behaviour.

What does delivery of this program / service involve?

MHFA Australia develops, evaluates and provides a variety of training programs and courses:
1) Evidence-based MHFA courses which teach mental health first aid strategies to members of the public.
2) Instructor Training Courses which train and accredit suitable individuals to deliver these MHFA courses to communities and workplaces across Australia.

MHFA Australia has a variety of courses across the lifespan and focused on specialised topics. Our courses include:
12-hour Standard MHFA (delivered to adults to assist other adults)
14-hour Youth MHFA (delivered to adults to assist adolescents)
12-hour Older Person MHFA (delivered to adults to assist older Australians)
14-hour Aboriginal MHFA (delivered to adults to assist Aboriginal and Torres Strait Islanders) NB: This has yet to be reviewed by the Centre of Best Practice Aboriginal and Torres Strait Islander Suicide Prevention Clearinghouse.
teen MHFA (delivered to high school students in years 7-9 and years 10-12 to assist their peers)
4-hour MHFA for the Suicidal Person (delivered to adults to assist someone experiencing suicidal thoughts and behaviours)
4-hour MHFA for Non-suicidal Self-injury (delivered to adults to assist someone engaging in non-suicidal self-injury).

MHFA Australia has a de-centralised model of delivery, which has enabled it to rapidly spread across Australia. MHFA Australia conducts on average 20 Instructor Training courses across Australia per year to accredit suitable individuals to become MHFA Instructors via a rigorous 5-day Instructor Training Program. There are different selection criteria for entry into Instructor Training depending on the course that an individual wishes to be accredited to deliver.

Over 1,600 people are currently accredited as MHFA Instructors. On average 15 MHFA courses are delivered per day across Australia. More than 700,000 Australians have completed an MHFA course since 2000.

Citations
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 Journal. 2018; 13 (5).

Jorm AF, Nicholas A, Pirkis J, Rossetto A, Reavley NJ. Associations of training to assist a suicidal person with subsequent quality of support: results from a national survey of the Australian public. BMC psychiatry. 2018 Dec;18(1):132.

Cutler TL, Nicola NJ & Jorm AF. How ‘mental health smart’ are you? Analysis of responses to an Australian Broadcasting Corporation News website quiz, Advances in Mental Health, 2018, 16:1, 5-18, DOI: 10.1080/18387357.2017.1317581

Crooks CV, Lapp A, Auger M, van der Woerd K, Snowshoe A, Rogers BJ, Tsuruda S, Caron C. A Feasibility Trial of Mental Health First Aid First Nations: Acceptability, Cultural Adaptation, and Preliminary Outcomes. American Journal of Community Psychology. 2018; Mar 25

Davies EB, CBeever E, Glazebrook C. A pilot randomised controlled study of the mental health first aid eLearning course with UK medical students. BMC Medical Education. 2018; 18:45

Hart LM, Morgan AJ, Rossetto A, Kelly CM, Mackinnon A, Jorm AF. Helping adolescents to better support their peers with a mental health problem: A cluster-randomised crossover trial of teen Mental Health First Aid Australian & New Zealand Journal of Psychiatry. 2018.

Gryglewicz K, Childs KK, Soderstrom MFP. An Evaluation of Youth Mental Health First Aid Training in School Settings. School Mental Health. 2018.

Guajardo MGU, Slewa-Younan S, Kitchener BA, Mannan H, Mohammad Y, Jorm AF. Improving the capacity of community-based workers in Australia to provide initial assistance to Iraqi refugees with mental health problems: an uncontrolled evaluation of a Mental Health Literacy Course. International Journal of Mental Health Systems. 2018; 12:2.

Rose T, Leitch J, Collins KS, Frey JJ, Osteen PJ. Effectiveness of Youth Mental Health First Aid USA for Social Work Students. Research on Social Work Practice. 2017 Sep 8:1049731517729039.

Morrissey H, Moss S, Alex N, Ball P. Do Mental Health First Aid™ courses enhance knowledge? The Journal of Mental Health Training, Education and Practice. 2017; 12: 69-76.

Burns S, Crawford G, Hallett J, Hunt K, Chih HJ, Tilley PM. What’s wrong with John? A randomised controlled trial of MHFA training with nursing students. BMC Psychiatry. 2017; 17: 111.

Kelly J, Birks M. 'It’s the simple things you do first that start the process of help’: Undergraduate nursing and midwifery students’ experiences of the Mental Health First Aid course. Collegian. 2017; 24 (3).

El-Den S, O’Reilly CL, ChenTN. Does Mental Health First Aid training affect MPharm students’ literacy, knowledge and attitudes towards perinatal depression? A pre-test/post-test pilot study. Research in Social and Administrative Pharmacy. 2016; 12: e19–e47.

Melioli T, Rispal M, Hart LM, Chabrol H, Rodgers RF. French mental health first aid guidelines for eating disorders: an exploration of user characteristics and usefulness among college students. Early Intervention in Psychiatry, 2016.

Martin, J. An exploratory study of the benefits of youth mental health literacy studies for social work students. Social Work in Mental Health. 2016;14: 42-60. DOI: 10.1080/15332985.2015.1057312.

Aakre JM, Lucksted A, Browning-McNee LA. Evaluation of Youth Mental Health First Aid USA: A program to assist young people in psychological distress. Psychological Services. 2016; 13
2):121-6 DOI: 10.1037/ser0000063

Kirschbaum M, Peterson G, Bridgman H. Mental health first aid training needs of Australian community pharmacists. Currents in Pharmacy Teaching & Learning. 2016

Bovopoulos N, LaMontagne A, Martin A, Jorm AF. Delivering mental health first aid training in Australian workplaces: exploring instructors’ experiences. International Journal of Mental Health Promotion. 2016 doi: 10.1080/14623730.2015.1122658.

Bond KS, Jorm AF, Kitchener BA, Reavley, NJ. Mental health first aid training for Australian financial counsellors: an evaluation study. Advances in Mental Health Journal. 2016; 14:65–74. doi: 10.1080/18387357.2015.1122704.

Jensen KB, Morthorst BR, Vendsborg PB, Hjortoj C, Nordentoft M. Effectiveness of MHFA training in Denmark: a randomized trial in waitlist design. Social Psychiatry and Psychiatric Epidemiology. 2016;doi: 10.1007/s00127-016-1176-9.

Svensson B, Hansson L. Mental health first aid for the elderly: A pilot study of a training program adapted for helping elderly people. Aging & Mental Health. 2016; doi: 10.1080/13607863.2015.1135873.

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. DOI: 10.1186/s13033-016-0034-1.

Lucksted A, Mendenhall A, Frauenholtz, Aakre J. Experiences of graduates of the Mental Health First Aid-USA course. International Journal of Mental Health Promotion. 2015; doi.10.1080/14623730.2015.1013670.

Wong DFK, Lau Y, Kwock S, Wong P, Tori C. Evaluating the Effectiveness of Mental Health First Aid Program for Chinese People in Hong Kong. Research on Social Work Practice. 2015; doi: 10.1177/1049731515585149.

Subedi P, Li C, Gurung A, Bizune D, Dogbey MC, Johnson C, Yun K. Mental Health First Aid training for the Bhutanese refugee community in the United States. International Journal of Mental Health Systems2015; doi: 10.1186/s13033-015-0012-z.

Bond K, Jorm AF, Kitchener BA, Reavley NJ. Mental Health First Aid training for Australian medical and nursing students: An evaluation study. BMC Psychology. 2015; doi: 10.1186/s40359-015-0069-0.

Svensson B, Hansson L, Stjernswärd S. Experiences of a Mental Health First Aid training program in Sweden: A descriptive qualitative study. Community Mental Health Journal. 2015; doi: 10.1007/s10597-015-9840-1.

Byrne K, McGowan I, Cousins W. Delivering Mental Health First Aid: an exploration of instructors' views. International Journal of Mental Health Promotion. 2015; doi: 10.1080/14623730.2014.995422.

Hadlaczky G, Hokby 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; 4; 467-475; doi: 10.3109/09540261.2014.924910.

Svensson B, Hansson L. Effectiveness of Mental Health First Aid Training in Sweden. A randomized controlled trial with a six-month and two-year follow-up. PLOS ONE, 2014;9; 1-8; doi: 10.1371/journal.pone.0100911.

Moffitt J, Bostock J, Cave A. Promoting well-being and reducing stigma about mental health in the fire service. Journal of Public Mental Health, 2014;13; 103-113; doi:10.1108/JPMH-02-2013-0004.

Mendenhall A, Jackson S. Instructor insights into delivery of Mental Health First Aid USA: A case study of mental health promotion across one state. International Journal of Mental Health Promotion. 2013 15; doi.10.1080/14623730.2013.853420.

Day A, Francisco A. Social and emotional wellbeing in Indigenous Australians: Identifying promising interventions. Australian and New Zealand Journal of Public Health. 2013;37; 350-355; doi:10.1111/1753-6405.12083.

Mendenhall AN, Jackson SC, Hase S. Mental Health First Aid USA in a rural community: Perceived impact on knowledge, attitudes and behavior. Social Work in Mental Health. 2013; doi:10.1080/15332985.2013.812542.

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.

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.

Perceval M, Fuller J, Holley AM. Farm-Link: Improving the Mental Health and Well-Being of People Who Live and Work on NSW Farms. International Journal of Mental Health.2012; 40(2).

O'Reilly CL, Bell JS,Kelly PJ, Chen TF. 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.

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Szeto CH, Dobson KS. Reducing the stigma of mental disorders at work: A review of current workplace anti-stigma intervention programs. Applied and Preventative Psychology. 2010; 14: 41-56.

Kelly CM, Mithen JM, Fischer JA, Kitchener BA, Jorm AF, Lowe AJ, 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.

Jorm AF, Kitchener BA, Fischer J, Cvetkovski S. Mental health first aid training by e-learning: a randomized controlled trial. Australian and blank Zealand Journal of Psychiatry. 2010; 44: 1072-1081.

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.

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.

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.

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.

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.

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.

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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.

Kitchener BA, Jorm AF. Mental Health First Aid training: review of evaluation studies. Australian and New Zealand Journal of Psychiatry. 2006; 40: 6-8.

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.

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.

Kitchener BA, Jorm AF. Mental health first aid training in a workplace setting: A randomized controlled trial. BMC Psychiatry. 2004;4: 23.

Jorm AF, Kitchener BA. Mental health first aid training for the public: evaluation of effects on knowledge, attitudes and helping behaviour. BMC Psychiatry. 2002;2: 10.




The Mental Health First Aid (MHFA) program Reviewers Summary

Mental Health First Aid (MHFA) is a valuable program that has had a significant impact on the community's awareness of mental health problems and suicide and strategies to support people experiencing mental health problems, suicidal thoughts or behaviour. The program has been rigorously evaluated in a range of settings with different participant populations and has involved experts by experience.
The agency has provided thorough evidence of the impact of the training it provides. It also appears to utilise a rigorous approach to research, providing evidence of the use of both quantitative and qualitative studies. It has an active research/evaluation program, and has marshalled evidence into an impressive number of journal articles, showing a strong contribution to the field. Further scope has been identified for the agency to use evaluation to extend the range of domains and questions investigated, including a focus on the effectiveness of the agency's delivery of the program. 

Impact:
In a number of randomised controlled trials it has been demonstrated that people receiving the MHFA program have better outcomes than those who do not in terms of mental health literacy, attitudes towards people with mental health problems, suicidal thoughts and behaviours and confidence supporting someone experiencing a mental health crisis, including suicidal thoughts and behaviour.
The further impacts of the actual application of the training to real cases do not appear to be illuminated in the evidence provided.

Safety protocols:
The discussion of monitoring suggests that it has a limited focus on the delivery of training and principally uses questionnaires/surveys for this purpose. A broadening in the areas covered by monitoring and the methods used (e.g. observation) could be useful.

 

Reviewers have identified the following consideration(s) relating to this program / service review

Partial Evidence 

Research/evaluation activity has only focussed on certain components/target groups/settings; and/or the body of evidence indicates inconsistency in terms of whether the program or service achieves its impact(s); and/or rating only based on one or two research/evaluation projects.

In the submission, it is not always clear whether the focus of the research cited is on the train-the-trainer context, or on members of the general public who receive the training. Both contexts are important to the success of the model identified, and it appears that both need to be thoroughly researched/evaluated.

Program adaptations and adjustments 

Significant program adjustments have occurred since evaluation activity was conducted; and/or the program/service not been specifically adapted for the Australian context; and/or the program/service has been adapted for the Australian context but the adapted version has not been researched/evaluated.

Only limited details are provided as to adjustments that have occurred in the program as a result of research undertaken.

Specificity of the body of evidence 

While there is evidence behind the program or service, the organisation itself has not been evaluated in terms of its delivery of the program or service.

The body of evidence focused on the impact of the training provided, but there is little evidence of the organisation being evaluated in terms of its delivery of the program. Information provided on current research and evaluation studies being undertaken suggest that evaluative activity is underway, but not necessarily focusing on the organisation itself.

Independence 

Research/evaluation activity was conducted by staff from the same organisation as that which delivers the program or service.

Two of the three main studies cited as evidence are identified as being carried out by internal research/evaluation staff; and the third by an independent researcher/evaluator.