harm or suicide, listening nonjudgmentally, giving reassurance
and information, encouraging appropriate professional help,
and encouraging self-help and other support strategies.
The classes are highly interactive. To simulate what it’s
like to have — and talk to someone who has — the auditory
hallucinations of schizophrenia, one exercise has a participant
whispering in the ear of a second participant, who’s trying to
carry on a conversation with a third participant.
The classes are also effective, according to preliminary
evaluations. In a 2012 article in American Psychologist, Jorm
offers an overview of the evidence to date. Four randomized
controlled trials have found that the training enhances
participants’ knowledge about mental illness, increases their
confidence about providing help and actual helping behavior,
and reduces stigmatizing attitudes. These improvements are still
observed half a year later.
Jorm and Kitchener are now turning their attention to
whether the training actually benefits Mental Health First
Aid recipients. They hope to find out by training parents of
adolescents and then assessing the long-term effect.
Although most of the research thus far has been carried out
by Jorm and Kitchener themselves, independent evaluators
are jumping in. In a 2011 non-randomized controlled trial
of pharmacy students published in the Australian and New
Zealand Journal of Psychiatry, for example, pharmacist Claire L.
O’Reilly, PhD, of the University of Sydney and colleagues found
that Mental Health First Aid training improved pharmacy
students’ recognition of mental disorders and their confidence
in providing services to consumers with mental illnesses.
The move to independent evaluations is welcome, says Lynn
Bufka, PhD, assistant executive director for practice research
and policy in APA’s Practice Directorate.
“You always like to have research confirmed by someone
On American shores
who’s not invested in the origination of ideas,” she says. “And
the majority of the research has been done in Australia, so it’s
important to evaluate it in a variety of other settings.”
The research to date has already prompted widespread
adoption of Mental Health First Aid on its home turf and
beyond, however. As Jorm and Kitchener report in a 2011 paper
in the Australian and New Zealand Journal of Psychiatry, 1
percent of Australian adults have already undergone training.
In the United States, Mental Health First Aid has joined similar
efforts that were already under way when the Australian import
arrived five years ago. There’s the National Coalition for Mental
Health Recovery’s Emotional CPR program, for example, which
also teaches people how to help others through emotional
crises. There’s also Psychological First Aid, which trains
American Red Cross workers and others to provide basic care
and support to individuals experiencing stress after disasters.
Now Mental Health First Aid is quickly spreading across the
United States, says Bryan Gibb, director of public education at
the National Council for Community Behavioral Healthcare.
In 2008, the council joined with the Maryland Department of
Health and Mental Hygiene and the Missouri Department of
Mental Health to bring Mental Health First Aid to this country
and adapt it to the American context. The three entities now
manage, operate and disseminate Mental Health First Aid USA.
The appeal? “Anyone could take the program and walk away
with useful skills,” says Gibb.
Since its U.S. launch, the program has certified 3,000
instructors who have trained more than 100,000 people in all
50 states. High-profile incidents of violence, such as the Aurora
theater shooting and the Newtown school massacre, are part of
what’s driving that interest, says Gibb. But while such tragedies
offer an opportunity to talk about the need for early intervention,
promoting Mental Health First Aid as a violence prevention
initiative can reinforce stereotypes about mental illness.
“We try to temper concern with facts,” says Gibb. People
with mental illness are no more likely to be violent than other
people and are in fact more likely to be victims of violence than
perpetrators, he emphasizes. “We also try to make the point that
most interactions that a First Aider will have are low intensity,”
While it’s often workplaces that offer the training, more and
more city and county governments are coming on board.
In Philadelphia, for instance, psychologist Arthur C. Evans
Jr., PhD, commissioner of the city’s Department of Behavioral
Health and Intellectual disAbility Services, has put into place
what he says may be the country’s “most audacious” Mental
Health First Aid program.
The program will help solve what Evans says is one of the
greatest challenges that behavioral health systems face. “There
are some people who have mental illness who recognize they
have a problem and go into treatment voluntarily; people
who have reached a threshold of dangerousness to themselves
or others can be involuntarily committed to treatment,” he
explains. “Then you have this gray zone.”
Mental Health First Aid can help reach people in that zone,
Evans believes. About a year and a half ago, the city started
training criminal justice and public safety staff, then expanded
the program to other employees. The city has also forged an
agreement with the American Red Cross that will result in
first aid training that covers both physical and mental health
conditions, something Evans believes is the country’s first
holistic training. The goal is to train 10 percent of the city’s
population — more than 150,000 people — in Mental Health
First Aid over the next two years.
“The fact that we already have 1,300 more people in the
city who can recognize problems and intervene is enormously
important,” says Evans. “[W]e recognize that we have to have
more than just mental health professionals who can intervene
The city will also participate in an evaluation conducted by
Drexel University researchers.