Effectiveness of Mental Health First Aid: a meta-analysis

Publication Date28 November 2019
Date28 November 2019
AuthorAmy K. Maslowski,Rick A. LaCaille,Lara J. LaCaille,Catherine M. Reich,Jill Klingner
SubjectHealth & social care,Mental health
Effectiveness of Mental Health First Aid:
a meta-analysis
Amy K. Maslowski, Rick A. LaCaille, Lara J. LaCaille, Catherine M. Reich and Jill Klingner
Purpose The purposeof this paper,a meta-analysisand systematic reviewof Mental HealthFirst Aid (MHFA),
is to focus on studies that reported traineesmental healthliteracy, attitudes and helping-relatedbehaviors, as
well as the impact of the program forthe people who came into contact with trainees(i.e. recipients).
Design/methodology/approach A systematic search included several online databases of published
studies, dissertations or theses, and journals commonly publishing research in this area. Studies were randomized
or non-randomized control trials using an intervention based upon the adult or youth MHFA curriculum.
Findings Of the 8,257 initial articles, 16 met inclusion criteria. Small-to-moderate effect sizes (Hedges
g¼0.180.53) were found for the primary outcomes for the trainees with effects appearing to be maintained
at follow-up. Study quality was inversely associated with effect size. No evidence of investigator allegiance
was detected. Few studies examined the effects for those who received aid from a MHFA trainee. Preliminary
quantitative evidence appeared lacking (Hedgesg¼0.04 to 0.12); furthermore, a qualitative review found
limited positive effects.
Research limitations/implications MHFA trainees appear to benefit from MHFA; however, objective
behavioral changes are in need of greater emphasis. Additionally, considerably greater attention and effort in
testing effects on distressed recipients is needed with future empirical investigations.
Originality/value This is the first known review that includes preliminary findings on the effects of MHFA on
the distressed recipients of the aid. It is anticipated that this will prompt further investigation into the impact
of MHFA.
Keywords Mental health literacy, Stigma, Mental health training, Mental Health First Aid (MHFA),
Mental health gatekeeper
Paper type Literature review
Despite the prevalence of mental illness, only around 11 percent of people seek psychological
treatment (Wang et al., 2007). This may be due to a lack of awareness of the clinical significance
of symptoms (Henderson et al., 2013). The fear of stigma and social rejection also appears to
hamper treatment seeking (Corrigan et al., 2016; Feldman and Crandall, 2007), as adults with
mental illnesses are often perceived by the general public as dangerous and burdensome
(Parcesepe and Cabassa, 2012). Thus, public health interventions aimed at increasing
awareness and help-seeking are warranted.
Mental Health First Aid (MHFA) is a manualized interactive curriculum program that educates
laypeople about mental illness; this includes individuals who experience emotional distress
following life stressors as well as those with severe mental disorders. The main objectives are to
increase the traineesknowledge of mental health concerns, decrease stigmatizing attitudes
toward people with mental health disorders and increase confidence and helping behaviors
when mental health concerns are recognized in others (Kitchener and Jorm, 2002a, b). The
training was originally formatted as either adult or youth focused of 8- or 12-h duration, and
intentionally developed for wide dissemination with an accessible curriculum for non-mental
health professionals in the community (e.g. first responders, teachers and coaches).
The knowledge objective of MHFA aims to help participants recognize common mental health
disorders, increase awareness of treatment options and self-help strategies and develop skills to
use in a mental health crisis (Kitchener and Jorm, 2002a, b). Participants learn an action plan
Received 9 May 2019
Revised 13 September 2019
Accepted 14 September 2019
Amy K. Maslowski is Doctoral
Student at the Counseling
Psychology and Community
Services Program, College of
Education and Human
Development, University of
North Dakota, Grand Forks,
North Dakota, USA.
Rick A. LaCaille is Associate
Professor, Lara J. LaCaille is
Associate Professor and
Catherine M. Reich is Assistant
Professor, all at the
Department of Psychology,
University of Minnesota Duluth,
Duluth, Minnesota, USA.
Jill Klingner is Associate
Professor at the Department of
Economics, University of
Minnesota Duluth, Duluth,
Minnesota, USA.
DOI 10.1108/MHRJ-05-2019-0016 VOL. 24 NO. 4 2019, pp. 245-261, © Emerald Publishing Limited, ISSN 1361-9322
PAG E 24 5
and accompanying skills: learning how to assess an individuals risk of suicide or harm, listening
non-judgmentally, giving reassurance and information, encouraging seeking of appropriate
professional help and utilizing other social supports and self-help strategies (Kitchener and Jorm,
2002a, b). Trainees are also taught how to respond in a crisis situation involving suicidal thoughts
or other mental health emergencies. Common mental illnesses such as depression, anxiety,
substance use disorders and psychotic disorders are also described.
Another objectiveis to change traineesattitudes aboutmental health stigma (Kitchener and Jorm,
2002a,b) which might interfere with providing support to those in need ( Jung et al., 2017).
Specifically,personal stigma has been conceptualized as ones own beliefsabout mental illnesses,
whereas perceivedstigma refers to traineesbeliefs aboutwhat other people believe about mental
illnesses ( Jorm et al., 2010b). Attitude outcomes also include traineesavoidance or tolerance
(i.e. social distancing) with people who have mental health disorders (Griffiths et al.,2004).
Connecting a person in need to mental health resources is the ultimate objective of MHFA
training. Researchers have typically measured this outcome by having trainees rate their
confidence in helping someone, the number of times they had contact with an individual with a
mental illness (i.e. recipients), if they offered help and if they referred an individual to professional
services. This is generally measured through self-report of helping behaviors or confidence via
post-training surveys (Link et al., 1999).
MHFA implementation in the USA
The MHFA curriculum was originally developed in Australia (Kitchener and Jorm, 2002b) and
has been implemented and evaluated in other parts of the world. The specific use of MHFA
within the USA is a newer phenomenon. In 2012, the US Substance Abuse and Mental Health
Services Administration added MHFA to its National Registry of Evidence-based Programs;
however, the three t rials that supported its in clusion were authored by th e MHFA founders
(SAMHSA, 2012). Unfortunately, this may introduce an unintentional bias when a researcher
has a strong allegiance to one experimental condition over another (Berman and Reich, 2010).
Nonetheless, the US Government placed an emphasis on funding MHFA training for
widespread implementation by allocating $35m toward MHFA interventions in 23 states
(National Council for Behavioral Health, 2014).
Given the emphasison disseminating MHFA,it is important to systematicallyreview and summarize
the evidence forthis training program, particularlyin the USA. In addition, the MHFAUSAprogram
has some modificationsthat may differentiate it from other versions of MHFA. MHFAUSA is only
offeredas an 8-h course, but it still covers thesame skills taught in the 12-h course.MHFAsimpact
may be different in the USA because of cultural beliefs, and media coverage of mental
health-related violence, in comparison to other countries. Additionally, programming in the USA
might be different givensome political beliefs and media coverageperpetrating the misconception
that individuals with mental illness are at increased risk of violence (APA, 2019; Friedman, 2019).
Given this context, one might reasonably wonder if participants from the USA might have more
persistent stigma beliefs regarding violence and mental illness relative to participants from other
countries, thereby impacting the effectiveness of the course.
Previous reviews of MHFA outcomes
An early narrative review by Kitchener and Jorm (2006) of their three MHFA evaluation studies (all
randomized controlled trials (RCTs)) suggested that trainees experienced improved knowledge,
confidence, self-reported helping behavior and decreased stigma over waitlist controls. Another
review (Booth et al., 2017), focusing on crisis training within law enforcement, examined three
MHFA studies and concluded that the program yielded short-term positive benefits.
Prior to the current investigation, two MHFA-exclusive meta-analyses had been published
(Hadlaczky et al., 2014; Morgan et al., 2018). Hadlaczky et al.s (2014) review examined 15 MHFA
studies (nine of which were prepost evaluations without control groups) evaluating knowledge,
attitude and behavioral outcomes for trainees. The review suggested that MHFA had
VOL. 24 NO. 4 2019

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