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The Mental Health First AidTraining and Research Program
Mental Health First Aid Australia
September 2013
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Overview
1. Description and evaluation of the Standard MHFA course
2. Description and evaluation of the specialty MHFA courses: Aboriginal, Youth, Teen, Vietnamese and e-learning
3. Development of MHFA Guidelines
4. The future
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How the MHFA Program Began
• The 1997 National Mental Health Literacy Survey indicated the need.
• Developed by Betty Kitchener and Prof Tony Jorm in 2000 to raise level of mental health literacy of the local Canberra community.
• Gradually spread throughout Australia and overseas.
• Program moved to Melbourne mid 2005.
• Became an independent non-for-profit health promotion charity in August 2012.
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2001
Definition of MHFA
Mental health first aid is the help provided to a person developing a mental health problem or in a mental health crisis.
The first aid is given until appropriate professional treatment is received or until the crisis resolves.
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The Mental Health First Aid Course
• Follows the model that has been successful with conventional first aid.
• Trains members of the public to give early help to developing mental health problems and assistance in crisis situations.
• The course currently involves 12 hours of training: 4 modules of 3 hours each.
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MHFA Course Content
• Mental health problems in Australia• Mental Health First Aid Action Plan• Depression• Anxiety problems• Psychosis• Substance use problems• Mental health crises
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Crisis Situations Covered
• Person who is suicidal or engaging in self-injury• Person having a panic attack• Person who has experienced a traumatic event• Person in a severe psychotic state• Person with severe effects from alcohol or other
drug use • Person with aggressive behaviour.
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Conventional First Aid Action Plan: DRABC
D = Danger
R = Response
A = Airway
B = Breathing
C = Circulation
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Mental Health First Aid Action Plan: ALGEE
Hello, my name is Algee and I am the
MHFA mascot.
Where MHFA Can Help
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Who Does the Course? • About half do the course because it will help
with their work (mainly people working in human services).
• Others do it for family reasons or civic duty.• More females than males do the course.
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Website
• The website provides information about the course: www.mhfa.com.au
• Members of the public can: – Purchase manuals– Download guidelines– Find an instructor or course in their area.
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Manual
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1st Edition, 2002
2nd Edition, 2010
3rd Edition, 2013
1st MHFA Instructor Training CourseSeptember 2002, Canberra
Instructor Training
• Instructors attend a 5-day training course and receive ongoing support.
• They have a range of backgrounds, but must fulfill the following criteria:
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Instructor Selection Criteria
• Good knowledge of mental health problems • Personal or professional experience with people
with mental illness• Good background knowledge of mental health
and community services • Favourable attitudes towards people with mental
health problems • Good teaching and communication skills • Good interpersonal skills • Good business plan or organisational support.
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Course Dissemination
• Over 2,000 MHFA instructors trained covering all states and territories in Australia, with over 1000 currently accredited.
• Uptake has been stronger in rural areas.
• Has spread internationally to 20 countries so far: Bermuda, Canada, China, Denmark, England, Finland, Hong Kong, Japan, Nepal, New Zealand, Nth Ireland, Portugal, Saudi Arabia, Scotland, Singapore, South Africa, Sri Lanka, Sweden, USA and Wales.
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MHFA Manuals Developed in Other Countries
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MHFA Manuals Developed in Other Countries
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AWARDS to the MHFA Program
• The Mental Health Services (TheMHS) awards, 2003, 2007 and 2010
• Victorian Public Health, 2006• Suicide Prevention Australia, 2007• National Council for Community Behavioral
Healthcare, USA, 2008• Australian Rotary Health (ARH) Knowledge
Dissemination Award, 2010
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EVIDENCE THAT THE 1ST EDITION MHFA COURSE IS EFFECTIVE
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Evaluation Trials of the Standard MHFA Course
Four major studies have been conducted:
1. Members of the public in an urban settingBMC Psychiatry 2002, 2:10
2. Public servantsBMC Psychiatry 2004, 4:23
3. Members of the public in a rural areaBMC Psychiatry 2004, 4:33
4. Analysis of storiesBMC Psychiatry 2005, 5:43
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Main Findings
• The trained group showed more improvement on:
• Confidence in providing help
• Likelihood of advising people to seek professional help
• Concordance with health professionals in beliefs about treatments
• Social distance (stigmatizing attitudes)
• Participants’ own mental health24
Mental Health First Aid is included in the U.S Government Department Substance Abuse and Mental Health Services Administration's (SAMHSA) National Registry of Evidence-based Programs and Practices:
www.nrepp.samhsa.gov/ViewIntervention.aspx?id=321
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MHFA for Chinese Australians
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Tailored Standard Course for medical students, nursing students, & financial counsellors
• Funded by Aust Government Dept of Health and Ageing
• Face-to-face courses delivered by endorsed Standard Instructors
• eLearning at online.mhfa.com.au
Example of Using MHFA in the Workplace
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“I recognised clinical depression that was leading to suicide thoughts in one of my work colleagues. I listened, did not prejudge, even though it was through drug related issues as well as personal issues. My work colleague became calm and easy going as he knew I was not a threat to him and I was able to give suggestions on what he / we could do, e.g. GP, counsellor, mental health team.”
Example of Using MHFAto Help a Stranger
“I was sitting next to a woman suffering an anxiety (panic) attack on a flight from Perth. I offered to help her, (and as a result) she was able to control her anxiety. I distracted her young child who was travelling with her. I think it helped her to know that I knew something about panic attacks and that I was comfortable with her situation.”
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DESCRIPTIONS AND EVALUATIONS OF THE SPECIALTY MHFA COURSES:
ABORIGINAL, VIETNAMESE, YOUTH, TEEN AND eLEARNING
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• This program began March 2007 with OATSIH funding.
• This 14-hour course is for Aboriginal communities in urban, rural and remote settings nationally.
• There has been significant input from Aboriginal people in its development.
• There is a 5-day Instructor Training Course for Aboriginal people and a 3-day Instructor Training Course for accredited MHFA Instructors.
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2nd Edition, 2011
1st Edition, 2007
2nd Edition workbook, 2013
Research on Aboriginal & Torres Strait Islander MHFA
• 417 Aboriginal instructors trained (currently around 150 active) and more than 6,500 people have done the course.
• Focus groups carried out with instructors and course participants to assess strengths and weaknesses.
• Widespread agreement that course is culturally appropriate and useful, but modification is needed for participants with poorer written literacy. Workbook developed in 2013 to meet this need.
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Int J. Mental Health Systems 2009, 3:10
• The MHFA manual, the 12 hour MHFA course and the 5-day MHFA Instructor Training course have been written and translated for Australians who are Vietnamese speaking.
• So far, 8 instructors have been trained from this community and 420 course participants have attended this VMHFA course.
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1st Edition, July 2008
Evaluation of Vietnamese MHFA Course
• An evaluation via written questionnaires given at beginning and end of course.
• This showed increased recognition of mental disorders, improved knowledge of how to assist someone and reduction in stigma.
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Int J. Mental Health Systems 2009, 3:19
• This program began April 2007 with National Suicide Prevention Strategy funding.
• This 14-hour course is suitable for adults working with adolescents.
• Existing chapters adapted to be youth-specific.
• Additional chapters added on eating disorders and non-suicidal self-injury.
• There is a 3-day Instructor Training Course for accredited MHFA Instructors and a 5.5-day course for new instructors.
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3rd Edition, 2013
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1st Edition, 2007
2nd Edition, 2010
Uncontrolled Trial of Youth MHFA
• An uncontrolled trial has been completed with 246 people in Western Melbourne.
• Questionnaires on knowledge, attitudes and first aid actions were given pre-course, post-course and after 6 months.
• Results showed improved knowledge, reduction in stigma and increased actions taken to help a young person.
• Gains were maintained over 6 months.
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Int J of Mental Health Systems 2011; 5:4
Cluster Randomised Trial of Youth MHFA for High School Staff
• A customised version of the Youth course has been developed for high school teachers in SA.
• A cluster-randomised trial of the schools version has been completed with 14 schools.
• Results showed increased MHFA knowledge, improved beliefs about treatment, greater confidence, and reduced stigma.
• Students reported receiving more mental health information from teachers, but not more help with mental health problems.
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BMC Psychiatry 2010; 10:51
• Guidelines were developed to determine the content of the course (Junior, years 7-9 and Senior, years 10-12)
• Materials were developed for the Senior program in 2012.
• Modified action plan.
• Two videos; a suicide intervention drama and a talking heads video.
• There is a 3-day Instructor Training Course for accredited YMHFA Instructors.
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teen Mental Health First Aid:A program for teenagers helping their friends
1st Edition, March 2013
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• The modified Action Plan:Look, Ask, Listen, Help Your Friend.
• Emphasis is on getting an adult involved quickly and not taking too much on.
Evaluation of teen MHFA Course
• The course is being evaluated in 2013. Results will be available in 2014.
• The initial responses to the program have been excellent. It is valued by students and staff and referrals to school counselling services to appear to increase after the training.
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• An e-learning version on a CD-ROM of the 1st edition 12-hr Adult MHFA course launched in May 2008.
• A specialised 3.5-hr face-to-face course was available (till Dec 2010) with an Instructor of the standard MHFA course to complete course requirements to receive certificate.
• This CD version has been particularly useful for shift workers and rural & remote locations.
• Web based e-learning rolling out from 2013.45
Evaluation of e-learning MHFA
• 262 members of the public were randomized to e-learning, printed manual or wait-list.
• On-line questionnaires were filled out pre-, post- and 6-months following intervention.
• Both e-learning and manual improved knowledge, increased confidence and reduced stigma.
• E-learning led to greater reduction in stigma and increased first aid actions taken.
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Aust & NZ J of Psychiatry 2010; 44:1072-1081
Other Evaluations of MHFA
• MHFA for NSW rural drought areasAust J Rural Health. 2008 16(5): 313-8
• MHFA for Qld agents working with farmersAust Psychiatry. 2009 Aug;17
• MHFA for Vic football coaches Int J Mental Health Systems 2010, 4:10
• MHFA for Chinese community in Melbourne Int J Mental Health Systems 2010; 4:18
• Experiences of instructors delivering MHFA in WalesJ. Psychiatric & Mental Health Nursing 2010; 17:7
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DEVELOPMENT OF MHFA GUIDELINES
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National / InternationalMHFA Guidelines
• There has been a need for national guidelines like those for conventional first aid.
• In 2005, MHFA guidelines development began.
• Five crisis situations
• Five developing disorders
• Projects funded by Australian Rotary Health, NHMRC, beyondblue, University of Melbourne and NCPIC.
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Guidelines for MHFA
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Guidelines and articles are available from the MHFA website:www.mhfa.com.au/cms/mental-health-first-aid-guidelines-project/
How the MHFA Guidelineswere Developed
• Delphi methodology
• Consensus method – the most highly rated actions were included in the guidelines.
• Panels of experts: professionals (clinicians, researchers), carers and consumers.
• These experts came from English –speaking developed countries
• For information on the method, see the journal articles on the‘Guidelines’page of the MHFA website.
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Guidelines for Other Cultural Groups
• Guidelines have been developed for Aboriginal people using Aboriginal mental health workers as experts on a Delphi panel.
• First aid guidelines have been developed for psychosis in Asian countries using Asian clinicians as experts.
• First aid guidelines have been developed for suicidal thoughts in India, the Philippines and Japan using their clinicians as experts.
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Aboriginal Guidelines
• eLearning Standard MHFA course, with tailoring for others groups possible in future
• teen MHFA to be rolled out across Australia
• MHFA for the Older Person manual & 12 hr course
• Youth Aboriginal MHFA supplementary booklet
• Guidelines for banking staff and financial counsellors
• Youth MHFA randomised controlled trial with parents of young teenagers, with long-term follow-up (underway as of 2012)
• Refresher training.
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The Future
www.mhfa.com.au
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