Mental Health First Aid (MHFA) – Is it Working?

Mental health first aid (MHFA) was first developed in Australia to train the public in providing help to adults with mental ill-health problems. Recently there has been an increase in undertaking MHFA training and response in workplace settings.

What, When and How MHFA

Image of brain with plaster on it
MHFA

I first came across mental health first aid a couple of years ago; all of a sudden it was the ‘in’ thing and everybody was doing it. Since then it’s become embedded in occupational health practice.  Somehow the moniker of ‘first-aid’ attached to the name makes it easy to sell.

First aid in the title, suggests it is possible to have a standard treatment for all mental health crisis.  So much so, that it has achieved the status as actual first-aid, which, is supported by Regulations i.e., it is mandatory for workplaces. Was this deliberate, I wonder?

Because there is nothing to suggest that the actions taken in any way mimics, or could ever mimic a real first-aid emergency situation. In fact, I would think it would be dangerous for somebody who’d received minimal training in mental health first aid (First Aid training takes 4 days with practical sessions and regular updates) to try and talk down, say, a potential suicide victim. But the MHFA-er could be holding the situation steady until someone arrives who could; which, I suppose, is why ‘First Aid’ is used.

First aid in its true sense demands physical or action response. For example, for a blocked airway, we extend the jaw and put the patient in the recovery position.  Job done.   Not so in mental health situations.  There can be no standard response to everyone – it’s way to simplistic a model and therefore, a misleading title.

Training for MHFA

What we also have to remember that people doing the mental health first-aid responses, aren’t specialists, this isn’t their job, they might be a bricklayer, lawyer or teacher.  This is a job that they do as an addition to their day job, literally. They work alongside those who they may have future dealings with – and this may cloud the picture.

Quite an industry has developed around MHFA. Nowadays lots of people are going on the course and if you look at the Remploy site you can see the cost for this training for a two-day course (12 delegates) would be £2250+VAT. After that, more training is available to run your own course.

The Evidence

I have to admit to being totally sucked in by the concept and astonished to see that the Health and Safety Executive (HSE) wished to understand the strength of the available evidence.  Surely someone had done that?  But now we have the report on the effectiveness of the MHFA in the workplace, from the rapid scoping evidence review.

Following the scoping evidence review, the HSE writes:

“A number of knowledge gaps have been identified in this evidence review that means it is not possible to state whether MHFA training is effective in a workplace setting. There is a lack of published occupationally-based studies, with limited evidence that the content of MHFA training has been considered for workplace settings. There is consistent evidence that MHFA training raises employees’ awareness of mental ill health conditions.

There is no evidence that the introduction of MHFA training in workplaces has resulted in sustained actions in those trained, or that it has improved the wider management of mental ill-health.”

Meanwhile MHFA responds:

“We are confident that Mental Health First Aid, as a mental health awareness and skills development course, sits on a solid and growing evidence-base – both nationally and internationally. Research consistently shows the Mental Health First Aid course, delivered in 24 countries globally, improves knowledge and confidence in supporting someone experiencing mental ill health, including people in the workplace and wider community.”

Reaction

I’m surprised by this debate. The mental health first aid training came highly recommended (from Public Health England) and respectable organisations such as Re-employ.  Surely these would not have taken on such a strategy without considering all the implications of what they were doing?

So I did some research to see what Mind was saying about this situation.

A blog post on their site in October 2017 announced that 1 million people were to receive mental health first aid training designed and delivered by Public health England.

Supporters then…

Trouble at t’Mill

So what’s going on? Who to believe – two separate government departments with totally opposing views? Shock. Horror. On one side we have respectable organisations advocating and selling services in this arena. On the other hand we have research from our UK regulators stating there is no supporting evidence to say that MHFA makes a difference.

Conclusion

I’m not sure who is correct; however I agree with the HSE, in that mental health awareness is rising and needed. However, if mental health first aid is a gimmick then it needs investigating. The results so far are inconclusive. But we now have time to do a slower review, set the hypothesis. Prove or disprove the use of the service.  Because it’s one thing to adopt a strategy, but now we have this warning we must look at MHFA closely. Otherwise we leave those suffering from mental health in a worse state than they were before.

If it’s not making any difference then where does it leave those who have dealings with these new practitioners in a crisis? Moreover what of the practising MHFA’s?  They certainly believe they are making a difference. I know of one professional who has given up a career to start-up their own company.

Where to Now?

I take my hat off to the HSE, this must have been a difficult paper to write. Especially knowing that they were having to stand up against a flood of interested stakeholders. But my mind is clear, all treatments and strategies must be evidence-based where possible.  If there is not enough evidence, then tell people. Then we try it out, run a pilot study and collect data. It’s not the end, it’s the start of discovering the best way of dealing with mental health issues in the workplace.

It would have been more prudent for the two sides of the argument to have issued a joint statement. We all know this situation is only going to get more confusing until everyone reaches a resolution. In the meantime, businesses, employees and those who may benefit from this service are expected to make an informed decision as the MHFA training and service bubbles along in the background.

Further Reading

Which one do you favour – comments please…

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