Mental Health First Aid

Family Caregiving September 13, 2014 Print Friendly and PDF

When you first hear about Mental Health First Aid (MHFA), you might assume it’s been around for decades as a counterpart to medical First Aid or CPR. It makes such good sense.

But the program, developed and launched in Australia in 2001, didn’t arrive in the U.S. until 2008. It’s spreading rapidly across the nation — and the world — and you’ll probably find a class starting soon somewhere near you.

During an 8-hour interactive training delivered by certified instructors, mental health first aid helps people identify, understand, and respond to signs of mental illness and substance abuse disorders to help calm a distressed person and de-escalate a situation before it becomes a crisis.

To date, more than 250,000 Americans have been trained in MHFA through a network of more than 3,700 certified instructors.

During the training, participants learn a simple five-step action plan for supporting someone experiencing psychological distress. The acronym ALGEE helps people remember the steps:

  • Assess the situation

  • Listen non-judgmentally

  • Give reassurance and information

  • Encourage professional help if appropriate

  • Encourage self-help and other support strategies

Instructors may be trained in one or both of two modules: one for people working primarily with youth, the other for those working with adults. As with medical first-aid training, MHFA goes beyond the classroom lecture-and-textbook model, incorporating role-playing and hands-on exercises.

Nationwide, MHFA instructor trainings are coordinated by the National Council for Behavioral Health, in partnership with the mental-health departments in Missouri and Maryland, which offer trainings only in their home states.

A supplemental online training module for first-aiders working with veterans, military personnel, and their families, started early in 2014.

To remain certified, MHFA instructors must teach a minimum of three classes each year.

Instructor-advocates such as Nancy Nowell, a clinical psychologist and clinical director of West Central Behavioral Health, a community mental-health center in Lebanon, New Hampshire, emphasize that the program “is not trying to deliver people into the [professional] mental health system, nor is it intended to train people in diagnosis or counseling. You don’t need a label for what’s going on when someone is in mental or emotional distress”.

Nowell continues, “The program’s real strength lies in the two E’s of the acronym: Encouragement, of either appropriate professional help or self-help.”

"Useful for anyone who works with people"

Renette Wardlow, a human development specialist and 28-year veteran of the University of Missouri Cooperative Extension, says she jumped at the chance to become a certified instructor. Like many people attracted to the program, “I’ve always been interested in mental health because of my own personal struggles and those of family and friends,” she says.

Wardlow notes that all 50 of Missouri’s regional extension specialists in human development, 4-H, and community development have already or will soon become certified MHFA instructors. “Our targets are primarily schools—teachers, administrators, coaches, guidance counselors—though in August trained all 235 of Missouri’s Expanded Food and Nutrition Education Program (EFNEP) paraprofessionals.

“The training helps eliminate the stigma around mental illness and teach people to be more sensitive to the issues,” says Wardlow. “Most adults are afraid of others who are acting a bit differently. We don’t know what to do or say; sometimes what we do can do more harm than good. The training helps people understand what’s going on and get over their fear.

“A big part of the training is learning to assess. We’re trained to ask specific questions. There’s lots of role playing and hands-on activities. It’s all about just being there for someone in distress, helping to calm them down.

“During the instructor training, you have to do a ‘teach-back’ to the rest of your group. You get graded on your presentation and have to pass a written exam with a 90 percent or better grade to become certified. To keep your certification, you have to present three workshops to between eight and 30 people each year. I’ve done three already, including one for residence-hall directors at a small Missouri college.”

Wardlow says, “We have so many people with mental health problems, this training would be useful for anyone who works with people: law enforcement officers and dispatchers, teachers administrators and other school personnel, parents, youth workers, non-clinical hospital staff, and others.”

"We should all be doing more around youth mental health. Many young people are struggling."

Rick Alleva, a youth and family field specialist with University of New Hampshire Cooperative Extension, took the MHFA youth certification training program in June of this year.

Speaking from extensive previous experience working with youth in crisis, including managing two homeless shelters for youth and serving as vice president for clinical and education services in a psychiatric residential youth-treatment center, Alleva says, “Hey, we should all be doing more around youth mental health. Many young people are struggling with stress and related mental health issues."

“The 4-H mission is to provide research-based training and support for positive youth development,” Alleva says.  “MHFA is a terrific fit for cooperative extension 4-H staff, but also for anyone working with kids in schools, after-school programs, boys & girls clubs, scouting and other youth programs. And also for parents—especially parents who also volunteer with kids.”

The UNH extension team has set a goal of five or six programs this year, targeting after-school program staff, parents who volunteer as youth leaders (e.g. 4-H), as well as student interns at UNH working with youth,

"Providing more mental-health resources to the community at large"

Suellen Griffin, trained as a psychiatric nurse-practitioner and now CEO of West Central Behavioral Health in Lebanon, New Hampshire, says she first heard about it from President Obama in one of his TV appearances after the Sandy Hook shootings, recommending that all teachers be trained in the program.

“I thought, ‘Gee, what’s that?’, did a little research on the Web, and decided it made a great fit with one of the goals of our strategic mission, to provide more mental-health resources to the community at large.

“The instructor training is expensive —around $2500 per person—so I began fundraising. We were able to raise $10,000 from the Lebanon Rotary and another $10,000 from the Sullivan County Commissioners. That’s enabled us to send six clinical staff to instructor training, and to offer the trainings in the community for free. We’ve already trained more than 100 community first-aiders.”

“I think MHFA fills a much needed gap in community mental health,” says Nancy Nowell. “Until MHFA came along, we hadn’t found a science-tested curriculum to bring to the general public that’s not too academic. MHFA is a fabulous curriculum in helping lessen the stigma around mental health, strong emphasis on the use of language we use to talk about mental illness.

“The curriculum strikes a nice balance of video [and] practical exercises. It’s not abstract.”

Nowell says she prefers to teach the 8-hour course as part of a team. “For eight solid hours with as many as 25 people, you need to keep an eye on the well-being of participants. Many people are drawn to the course from natural interest, and the training may trigger a reaction in some folks to something they’re struggling with themselves.

“Since one in four Americans experiences some form of mental illness in a given year, we’re all surrounded by people experiencing some sort of mental illness. MHFA is about building empathy, seeing distress, understanding the ways the person could be suffering, and reaching out.”

Learn more

Mental Health First Aid: A Primer A PowerPoint presentation covering the scope of the MHFA course

Peer-reviewed evaluations of MHFA

Become an Instructor

Mental illness: facts and numbersFact sheet by the National Alliance on Mental Illness.

Now is the Time President Obama’s plan to protect children by reducing gun violence. In it, he calls for schools to implement MHFA for teachers and other school staff.

Legislative/policy activity around MHFA.

Mental Health First Aid: Impact on Maryland Communities Data collected since program started November, 2008.

Betty Kitchener’s (Australian nurse who pioneered the MHFA program) scholarly papers.

Development of mental health first aid guidelines for deliberate non-suicidal self-injury: A Delphi study Example of adapting MHFA to a specific mental-health issue.

Photo:  EmsiProduction. Some rights reserved

Written by Peg Boyles, UNH Cooperative Extension emerita,

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This work is supported by the USDA National Institute of Food and Agriculture, New Technologies for Ag Extension project.