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Over the weekend Dr. Jay Watts wrote to The Independent to share her thoughts on Mental Health First Aid (MHFA). Dr. Watts raised a number of thought provoking points and her article focused my heart and mind on the growing gap between the need and supply of quality mental health services, and also the crucial role MHFA has and continues to play in surfacing and supporting bridging this gap. Globally, the MHFA community is two million people strong and I can say with great confidence and certainty that MHFA is a valuable educational course with a clear evidence based framework that is an important ‘part’ but certainly not the ‘whole’ solution to improving the mental health of our society.
When first developed in Australia in 2000, the premise of the MHFA model was simple – to see mental ill health like any other health issue and to provide an educational course which could skill people to assist those who are experiencing a mental health issue or crisis. MHFA England started in 2007 as a small programme within the Department of Health under the then Labour government. Now with 17 years of global experience and evidence base as its foundation, and 10 years of implementation in England with 194,00 people trained, I would suggest to term it ‘the new big thing in mental health’, as Dr. Watts does, is inaccurate. MHFA is a global movement, the first of its kind to be translated across cultures and languages in 22 countries, including the education sector. The recently-launched government-funded Youth MHFA in Schools programme builds on our work in schools which started seven years ago in 2010 – MHFA England has trained 25,000 school staff in over 500 schools and colleges.
In her article, Dr. Watts questions the efficacy of MHFA and its impact on those receiving support. In doing so, this has reignited my focus on the absolute need to call for a new validated paradigm within which to research the efficacy of mental health interventions. The truth is that the nature of the support that MHFAiders provide, and the conversations that take place are confidential in nature and therefore difficult to evaluate using traditional scientific methodologies. This is not an issue that is unique to MHFA – randomised controlled trials are acknowledged as a problem area for the social sciences. Equality for mental health needs to be demonstrated in academia and research funding too. MHFA is however in the process of commissioning a longitudinal evaluation to assess the impact our training has on those who are supported by MHFAiders. We very much welcome working collaboratively with the academic community and others to determine how best to develop a research paradigm to facilitate this. In the meantime, based on a large body of studies, both qualitative and quantitative, we are assured that MHFA is a positive influence when it comes to improving attitudes and help-seeking behavior, because there is no evidence to suggest that MHFA is damaging anyone.
I’d also like to address Dr. Watts suggestion that MHFA is predicated on the idea that further help is readily available with adequate signposting and that being encouraged to seek help, and then being turned down often worsens a situation. MHFA courses do not make the assertion or assumption that mental health services are readily available – instead our training provides delegates with access to a very large list of organisations, both government and non-government funded, which offer support across a range of mental health issues. I think it is very important to note that not everyone who has a mental health issue will require the support of mental health services, but that those who do very much deserve to be able to get the right support and treatment when they need it.
One of MHFA’s core strengths has been organic growth built on the passion of our community of instructors and MHFAiders – of whom 61% and 65% respectively have personal lived experience of mental health issues. For me, this is the single most important validation that our course content is fit for purpose. It’s also worth noting that delegates on our course certainly do not finish the course with a pair of rose tinted glasses – the reality is that our ever-growing community of MHFAiders are very active and vocal around the need for better mental health provision. I very much agree with Dr. Watts that MHFA should not be considered a replacement to mental health services and yes, much more needs to be done by government to get this right, however educating people, as we do on MHFA courses, to have a better understanding around mental health is surely part of the long-term solution.
I think it’s also important to clarify what MHFA is and what MHFA is not. On all our courses our instructors make it clear that we are not training people to be therapists, counsellors or psychiatrists. MHFA teaches people to have a greater awareness of their own and others’ mental health, to listen non-judgmentally and to detect early warning signs and symptoms. As a result, the need for complex mental health care later down the line is potentially reduced or is accessed earlier. I agree however, that services are not always available and the knowledge to navigate the health system to access the right service may also be a challenge – an issue we surface and discuss on our courses.
At the heart of it, MHFA is a global movement which seeks to improve and increase mental health awareness across society and provide the skills necessary to have a non-judgmental conversation and encourage support – in doing so it aims to be exactly one of the many ways we can foster a mental health friendly society. It certainly does not set out to individualise or depoliticise mental distress, and I would suggest that the MHFA community, both in England and around the world has been, and continues to be, a strong advocate of the need for social change and parity of esteem so that those affected by mental ill health receive the support they need. We do not wish to see MHFA replace or indeed be positioned as replacing vital mental health services but we do believe we have a role to play in ensuring as many people as possible have access to good quality, well researched and positively evaluated mental health training course, delivered by an organisation which is committed to its social mission of raising mental health awareness and support skills.
To find out more about our research and evaluations click here.
Poppy Jaman is CEO of Mental Health First Aid (MHFA) England.