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Mental Health First Aid

First-aid training equips anyone to help people who are injured or physically ill. Which raises the question: Could mental-health first-aid training enable anyone to help people with panic attacks, suicidal thoughts or hallucinations?

“I have a lot of friends who struggle with depression and anxiety,” says Agata Jasinska, a nanny and part-time catechism teacher in Chicago. “If there’s any way we can help,” she says, “we should train ourselves.”

Ms. Jasinska was one of 14 people who paid $65 to attend a recent eight-hour class in Chicago offered by Mental Health First Aid, a fast-growing program that trains people to identify, understand and respond to others who are in emotional distress—whether on the job, in community spaces, on the streets, or at home.

Since its introduction in the U.S. a decade ago, Mental Health First Aid, or MHFA, has trained more than one million people across the country. Since 2014, the Substance Abuse and Mental Health Services Administration, part of the U.S. Department of Health and Human Services, has provided more than $15 million to state and local education agencies to implement MHFA programming.

“People understand that mental-health problems are common,” says Myra Rodriguez, who has conducted 30 MHFA courses in Chicago since becoming a certified instructor last year.

“Everyone has been touched by it, whether it’s your own experience or someone close to you,” she says. “There’s an appetite for knowledge and to have the skills to help someone in need.”

A debate on efficacy

The program’s impact on mental illness, however, is hard to measure. Bruno Anthony, a professor of child and adolescent psychology at the University of Colorado School of Medicine, published a study on MHFA earlier this year in the American Journal of Health Promotion. While participants showed an almost 30% increase in knowledge about mental-health issues and confidence in offering assistance, there’s scant data on how such interventions benefit the recipients, says Dr. Anthony. “The impact on those who are touched by MHFA trainees is still to be determined,” he says.

Some critics say the program diverts attention and resources from efforts to help those with severe mental illness. The national priority, they say, should be removing barriers to care, such as a shortage of clinicians, insurance disparities, and laws that make it almost impossible to compel someone to get treatment

How to Help

Mental Health First Aid’s basic plan, known as Algee, as taught in its courses

Source: Mental Health First Aid USA

“Identifying mental illness is not the problem; getting services is,” says DJ Jaffe, who runs Mental Illness Policy Org, a nonprofit that provides policy analysis. As for the MHFA program, “there’s absolutely no evidence on how this affects the very people they’re trying to help,” he says.

Supporters of the program stress the value of educating the general population about mental-health disorders. “Making Americans aware that mental illnesses are exactly that—illnesses—and that people can and do recover should lead to better funding,” says Peter Earley, an activist who writes frequently about the mental-health system. “Just as knowledge about the AIDS epidemic prompted more research and treatment.”

Linda Rosenberg, chief executive of the National Council for Behavioral Health, which sponsors MHFA training nationwide, rejects the idea that the program siphons attention and resources away from other mental-health issues. “Are we so poor a country that we accept the forced choice of education versus treatment?” she asks. “Do we do that with other diseases? I understand the dedication to people with the most serious mental illness, but I refuse to believe that all else needs to be sacrificed.”

In a typical MHFA training session, participants role-play various scenarios, following a template for how they should respond called Algee, for the five steps it includes: assess for risk; listen nonjudgmentally; give reassurance and information; encourage professional help when needed; and encourage self-help.

For example, if a co-worker seems unusually withdrawn or isn’t completing work, there’s a big difference between saying “What’s wrong with you?” versus “I’m concerned about you. I’ve noticed a change. Is there something you’d like to share?” says Betsy Schwartz, vice president for public education and strategic initiatives at the National Council for Behavioral Health. “One sounds accusatory, while the other is creating empathy without being overly intrusive.”

For someone who may be suicidal, first-aiders practice very specific, direct language: “Are you thinking of killing yourself?” “Have you decided how or when?” “Have you collected things to carry out your plan?” If the person answers “yes” to any of these questions, a first-aider will talk in a calm and reassuring manner, not leave the person alone and seek professional help immediately.

At the conclusion of the program, trainees leave with phone numbers for referrals. They are reminded to use their skills to de-escalate situations, but to never put themselves at risk.

“If you take CPR, you are not trained to be a cardiologist; you are learning how to help someone until they can get professional care,” Ms. Schwartz says. As for liability issues, trainees cannot be held responsible for a bad outcome, similar to Good Samaritan laws for citizens who intervene in a medical emergency, Ms. Rosenberg says.

Help for students

At the University of Chicago, more than 500 staff, faculty and students have taken the MHFA course since 2015, according to Julie Edwards, director of health promotion and wellness at the university. She says the class became a requirement last fall for resident assistants—students who advise dorm residents on virtually everything, from roommate problems to planning dorm activities.

The academic environment can be intense, filled with high achievers who hold themselves to rigorous standards, says Hamilton Wilson, who is starting his second year as a resident assistant at the university. A senior majoring in sociology, Mr. Wilson is responsible for 100 students on three dorm floors. He has never dealt with a suicidal student, he says, but the MHFA training has still come in handy—in helping not just students, but also friends and family. “I was able to talk them through what they were feeling,” he says.

The training also has given him resources and people to turn to for help. “When one of those situations comes up, I can always reach out to someone who is better equipped,” he says. “The community is always there.”

Ms. Rubin is a writer in Chicago. She can be reached at

Appeared in the September 17, 2018, print edition as ‘First-Aid Training Targets Mental Health.’

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