Mental Health First Aid

TUI University

By April Showalter

Capstone Integrative Project

MHD 599 Mod 5 SLP

Dr. Afrooz Afghani

June 22, 2009

a public health education program

Mental Health First Aid (MHFA)A public health education program

Mission of the MHFA ProgramVision of the MHFA ProgramWhat is mental illness?What is MHFA?The goals of MHFAMHFA program objectivesWhat does MHFA teach?Is there a need for MHFA?Who can benefit from MHFA

training? Where can MHFA be learned or

taught?MHFA training objectives part IMHFA training objectives part IIMHFA in the U.S.MHFA certified training sites

Certified MHFA sites in the U.S. Criteria to be a MHFA instructorTeaching MHFA electronicallyWho to market MHFA toKey coalition partnersWhy have coalition partners?Potential MHFA training barriersWays to evaluate MHFAWhy evaluate the MHFA

program?What aspects to evaluate and

whyFour levels of evaluation

informationTypes of program evaluationReferences

Mission of the MHFA Program

To help those in society who have a mental health problem or are in a mental health crisis.

(Kitchener, 2008)

Vision of the MHFA Program

Better recognition of mental disorders,

Changed beliefs to a less negative/stigmatizing view of mental disorders,

Decreased social distance from people with mental disorders,

Increased help and understanding of those with mental disorders, and

Increased confidence in helping a person with a mental disorder.

(Kitchener, 2008)

A health condition that changes a person’s: Thinking, Feelings, or Behavior Or all three and Causes the person distress and Difficulty in functioning.

Is severe in some cases and mild in others.

Individuals who have a mental illness don’t necessarily look like they are sick, especially if their illness is mild.

Other individuals may show more explicit symptoms such as confusion, agitation, or withdrawal.

(BSCS, 2005)

What is Mental Illness?

What is MHFA?

First Aid for the mind

Medical First Aid vs. MHFA

Definition: MHFA is the help provided to a person developing a mental health problem or in a mental health crisis.

(Kitchener and Jorm 2002)

The Goals of MHFA Are To:

1) Preserve life where a person may be a danger to themselves or others

2) Provide help to prevent the mental health problem developing into a more serious state

3) Promote recovery of good mental health

4) Provide comfort to a person suffering a mental illness

(Kitchener and Jorm 2002)

Improved recognition of MH problems. Eliminate stigmas regarding MH problems. Improve public health knowledge of MH. Change negative beliefs regarding MH issues. Increase understanding & compassion. Decrease social distancing people with MH

problems have. Increase the amount of help provided to those

with MH problems. Increase confidence in people who want to help

those with MH problems.

(Kitchener and Jorm, 2002)

MHFA Program Objectives

What Does MFHA Teach? MHFA addresses the immediate needs of the

most common mental health disorders: Depression, Suicidal thoughts and behaviors, Psychosis, Anxiety disorders Panic attacks, Non-suicidal self injury, Adult trauma, Child trauma, Eating disorders, Substance use disorders and Problem drinking.

(Kitchener and Jorm 2002)(Jorm, 2008)

Is There A Need For MHFA?

Mental illnesses are extremely common.Untreated mental illness is the leading cause of disability and suicide.

Suicide is the 11th cause of preventable death in U.S.

More than 2 million become mentally ill every year in California

Is often a social problem, costing $ billionsContributes to: Homelessness, Jail, Crime, Hospitalizations/ER's, Unemployment, Nursing home stays

(CADMH, 2003)

Who Can Benefit From MHFA Training?

Parents/Children Teachers/Instructors/Educators Students Health Care Workers Preachers/Clergy Members Paramedics/Firefighters Police Officers Social Workers/Counselors Managers/Employees Anyone!

(Kitchener, 2008)

Where Can MHFA Training Be Taught Or Learned?

School classrooms Lecture halls Senior centers Church & religious

organizations Community centers Conferences Business & industrial

work sites Library & hotel

meeting rooms

Home demonstrations PTA meetings Police & fire stations Healthcare

organizations City, county, & state

govnmnt offices Non-profit agencies Law offices Private businesses Anywhere

(Kitchener, 2008)

MHFA Traing ObjectivesPart I

Why Mental Health First Aid? The MHFA action plan Mental health problems in America What are mental health problems? How common are mental health problems?

Disability caused by mental health problems

Helpful resources

(Kitchener and Jorm, 2002)

MHFA Training ObjectivesPart II: The Disorders

Depression Bipolar Disorder

Suicidal thoughts & behaviors Anxiety Disorders

Generalized Anxiety Disorder (GAD)

Obsessive-Compulsive Disorder (OCD)

Post-Traumatic Stress Disorder (PTSD)

Phobic Disorders Panic Disorder

Psychosis Schizophrenia Bipolar Disorder Psychotic Depression Schizoaffective Disorder Drug Induced Psychosis

Panic Attacks Non Suicidal Self Injury (NSSI) Adult Trauma Child Trauma Eating Disorders Substance Use Disorders

Alcohol Tobacco Cannabis Amphetamines Ecstasy Heroin

Problem Drinking

(Kitchener and Jorm, 2002)(Jorm, 2008)

the signs & the symptoms of each MH disorder;

the potential causes of each MH disorder; the risk factors for each MH disorder; treatment options for each MH disorder; action steps on how to help and/or get help; where to get outside help; when to get outside help; other resources about MH disorders.

(Kitchener and Jorm 2002)

MHFA Training ObjectivesPart II: The Disorders

Since Coming to the U.S. in 2008, the MHFA Program Has:

Presence in more than 24 states,50 MHFA instructors,Over 1300 people trained, More than 80 community trainings to date, and

Over 1,000,000 media impressions in the first year

(Browning-McNee, 2009)

(Browning-McNee, 2009)

MHFA certified training sites include:

Community mental health centers Addictions centers, State departments of health, Hospitals, Federally qualified health centers, Faith-based organizations, State police stations, The National Guard, Mental developmental disability centers, Mental health authorities, and Other mental health advocates

(NCCBH, 2009)

Certified MHFA Training Site in the U.S.

Kitsap Mental Health Services (KMHS) - Bremerton, WA http://www.kitsapmentalhealth.org

The Workforce Diversity Network (WDN) http://www.workforcediversitynetwork.com/docs/Article_IntroducingMentalHealthFirstAid.pdf

Mental Health Association of Frederick County, Maryland http://www.fcmha.org/publiceducationandadvocacy/index.php? p=MentalHealthFirstAidTraining

Gateway Healthcare (GHI) - Pawtucket, RI http://www.gatewayhealth.org/MentalHealthFirstAid.asp

NAMI Minnesota http://www.namihelps.org/blogs/mental-health-first-aid-training-for-crisis-providers.html

Bert Nash Center - Lawrence, KA http://www.bertnash.org/services/MentalHealthFirstAid.html

Community Counseling Centers of Chicago http://www.c4chicago.org/node/255

Western Interstate Commission for Higher Education, Boulder, CO http://www.wiche.edu/mentalhealth/grand_rounds/MHFirstAid.asp

6 Criteria to be a MHFA Instructor

1) Good knowledge of mental disorders and their treatment.

2) Personal or professional experience with people with mental health problems.

3) Favorable attitudes towards people with mental health problems.

4) Good teaching and communication skills. 5) Good background knowledge of mental

health and community services. 6) Good interpersonal skills.

(MHFA, 2007)

MHFA program wants instructors who have/are:

Teaching MHFA by Electronic Means:

More efficient More convenient Cost-effective Reach a wider audience

Examples how... CD DVD Webinar Webcast Videocast Podcast

Who to Market MHFA to:

Law enforcement and other emergency response;

Schools and public education administration;

Homeless shelters; Colleges and universities; Corporations and local businesses; Community service groups; Primary and occupational health care

providers; and The general public

(NCCBH, 2009)

Key Coalition Partners1) National Alliance on Mental Illness (NAMI)

NAMI California NAMI Sacramento

2) National Council for Community Behavioral Healthcare California Council of Community Mental Health

Agencies (CCCMHA)3) California Dept of Education (CDE) 4) State/County/City Corrections Departments5) State/County/City Police Departments

Community Service Centers6) California Department of Mental Health (DMH)

Sacramento County Division of Mental Health (SacDHHS)

7) Prevention Institute (Oakland CA)8) Mental Health America (of No Cal, Sacramento CA)9) California Institute for Mental Health (CiMH)10) Institute for Mental Health & Wellness Education (IMHWE) at the California State University, Hayward

Key Coalition Partners: National Council for Community Behavioral Healthcare (NCCBH)

Offers the largest MHFA certification program in U.S.Certifies community providers to implement MHFA in communities throughout the U.S. Assists with MHFA site development & plans to reach communities.All participating sites deliver the core 12-hour program:Tight credentialing to guarantee fidelity to the

original, tested modelMaintains the flexibility necessary to reach its unique

population needs & demographics.Envisions that MHFA will become as common as CPR and First Aid training during the next decade!

(NCCBH, 2009)

Key Coalition PartnersNational Alliance on Mental Illness

(NAMI)Largest MH grassroots organization in USANAMI CaliforniaNAMI Sacramento (California)

Key concepts are essential to improving the wellness and quality of life of all persons affected by mental illness:RecoveryResiliencySupport

Their action areas:Public educationPeer Education and SupportRaising Awareness and Fighting StigmaState and Federal Advocacy

(NAMI, 2009)

Key Coalition PartnersThe California Department of Mental

Health (CaDMH)

Oversees the statewide delivery of mental health services at county level.

Assures compliance with state and federal laws and regulations.

Is a direct services agency. Is an agency of: Advocacy Education Innovation Outreach Oversight Understanding Monitoring Quality improvement

(CaDMH, 2009)

Key Coalition PartnersMental Health America

(aka National Mental Health Association)

Country’s leading nonprofit dedicated to helping ALL live mentally healthier lives.

Have more than 320 affiliates nationwide. One of their program goals is to educate the

public about mental health. Mission is to:

Promote mental health, Prevent mental disorders, Achieve victory over mental illness by:

Advocacy Education Research Services

(MHA, 2009)

Key Coalition PartnersCalifornia Institute for Mental Health

(CiMH)

Establishes regional partnerships per Department of Mental Health’s “Five-Year Workforce Education & Training Plan”

Provide technical assistance and support in planning, development & ongoing implementation for each of the regional partnerships throughout California.

Serves as an employment and educational resource for the public mental health system.

(CiMH, 2009)

Why Have Coalition Partners?

To conserve resources. To achieve a much more widespread

audience. To accomplish objectives beyond scope of

any one group/organization. For greater credibility. For more range of advice. For more perspectives to the lead agency. To provide a forum of shared information. Can be a vital tool when planning,

implementing, and administering a proposed health education program!

(Cohen, 2003)

Potential MHFA Training Barriers

Cost to the consumers Time it takes to get trained Location Lack of awareness Lack of certified trainers Low or lack of funding Age and gender (Kitchener, 2006)

Denial for need of MHFA (Kitchener, 2006)

Transportation issues Personal beliefs (Jorm, 2005)

Ways to Evaluate the MHFA Program

1) Questionnaires– Pre- and post- training knowledge

checks2) Interviews3) Focus groups4) Surveys – telephone, internet, mail5) Program documentation reviews6) Observation7) Case studies

(Washington, 1999)

Why Evaluate the MHFA Program?

Provide accountability to your funders, stakeholders and the community. Improve program quality Provides feedback Evidence that the program is doing what it claims to do Help allocate resources What resources are needed? Are resources being used effectively?

(Washington, 1999)

What Aspects to Evaluate & Why Implementation: Were MHFA program activities

put into place as originally intended? Effectiveness: Is the MHFA program achieving

the goals and objectives it was intended to accomplish?

Efficiency: Are the MHFA program’s activities being produced with appropriate use of resources such as budget and staff time?

Cost-Effectiveness: Does the value or benefit of achieving the MHFA program’s goals & objectives exceed the cost of producing them?

Attribution: Can progress on goals and objectives be shown to be related to the MHFA program,as opposed to other things that are going on at the same time?

(CDC, 2005)

Four Levels of Evaluation Information...

...that can be gathered from clients: 1. Reactions and feelings (feelings are often poor

indicators that your service made lasting impact)

2. Learning (enhanced attitudes, perceptions or knowledge)

3. Changes in skills (applied the learning to enhance behaviors)

4. Effectiveness (improved performance because of enhanced behaviors)

(McNamara, 1997)

Types of Program Evaluation1) Process evaluation

Measures and documents all program activity

2) Impact evaluation Measures the impact the program

had on participants Measures changes in knowledge,

attitude, skills, behavior, policies, or the environment.

3) Outcome evaluation Measures the outcome of the program Asks did the program have an effect

on individual or community health? Measures the long term

(Washington, 1999)

Types of Evaluation Design

1 Experimental design - use random assignment to compare the outcome of an intervention on one or more groups with an equivalent group or groups that did not receive the intervention.

2 Quasi-experimental design – make comparisons between nonequivalent groups and do not involve random assignment to intervention and control groups (in community settings it is hard, or sometimes even unethical, to have a true control)

3 Observational design - time–series analysis, cross-sectional surveys, and case studies.

4 Goal-based evaluation - uses predetermined program goals and the underlying program theory as the standards for evaluation, thus holding the program accountable to prior expectations.

(CDC, 2005)

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