Mixed Feelings about Mental Health First Aid

This week, after some false starts over the past two years, I finally got to take part in a so-called Mental Health First Aid (MHFA) training sponsored by one of my employers. This involved a full-day seminar held in person on campus after a couple of hours of online work.

MHFA originated in Australia two decades ago. The American version of the program enjoys funding from state and federal governments—and endorsements from Lady Gaga and Michelle Obama. The Biden White House has identified it as an important program for educators.

After taking part and getting my certificate as an official “Mental Health First Aider,” I won’t say I found the program a waste of time. It was a good thing to do. But I do have some reservations.

First, my positive assessment: Fundamentally, I found the Mental Health First Aid training useful for building confidence that I can initiate difficult conversations and steer people in the direction of professional help. The in-person portion of the training also included detailed information about how our own campus health center operates and thus the various ways a student or colleague can be shepherded toward their services.

Generously, that was about four hours’ worth of material, I think, in the eight-hour course.

I don’t mean this as a criticism of my in-person trainer, who did a very good job. Rather, the official course materials took us in some odd directions.

For example, the program’s “action plan”—that is, the rubric a certified Mental Health First Aider is supposed to use in a challenging situation—involves a very strange mnemonic device. It’s the heart of the program. ALGEE is an acronym for both approach and assess, listen, give, encourage, and … another encourage. The amateurish doubling of verbs—to fit an acronym that isn’t even a word—makes it difficult, even after hours of training, to remember what each step in the MHFA action plan actually covers.

Even so, this week’s program required us trainees to apply the ALGEE mnemonic to a variety of scenarios describing people in distress. Some of these scenarios were presented on paper. Others were presented by actors in short videos.

Going through these exercises with the other students, I found that the ALGEE acronym often provided little help addressing what we saw happening. More fundamentally, I saw little indication that the “mental health first aid” metaphor was appropriate to describe what we were being asked to do. For instance, one scenario ended with a character who was presumably trained in actual first aid administering naloxone to another character—a form of emergency assistance entirely distinct from any training we were receiving. In several other cases, offering “mental health first aid” in a crisis seemed to mean mostly just calling 911.

At the end of the training, I was left uneasy about the self-importance of the “first aider” metaphor, considering how little preparation we were getting for helping in an emergency. My unease is compounded by what I’ve seen of the research on MHFA’s effectiveness.

Studies conducted around the world show that MHFA is effective in changing trainees’ state of mind (i.e., their knowledge, confidence, and intentions) in the short term. But these studies have not shown that MHFA makes trainees more effective in helping other people. They have not established that MHFA programs improve outcomes for people actually facing mental health challenges.

I’m left with the upsetting impression that the primary beneficiary of my participation in the Mental Health First Aid program might be me.