1. The Mental Health First Aid Training and Research Program Mental Health First Aid Australia September 2013 1

2. Overview 1.Description and evaluation of the Standard MHFA course 2.Description and evaluation of the specialty MHFA courses: Aboriginal, Youth, Teen, Vietnamese and e-learning 3.Development of MHFA Guidelines 4.The future 2

3. How the MHFA Program Began The 1997 National Mental Health Literacy Survey indicated the need. Developed by Betty Kitchener and Prof Tony Jorm in 2000 to raise level of mental health literacy of the local Canberra community. Gradually spread throughout Australia and overseas. Program moved to Melbourne mid 2005. Became an independent non-for-profit health promotion charity in August 2012. 3

4. 2001

5. Definition of MHFA Mental health first aid is the help provided to a person developing a mental health problem or in a mental health crisis. The first aid is given until appropriate professional treatment is received or until the crisis resolves. 5

6. The Mental Health First Aid Course Follows the model that has been successful with conventional first aid. Trains members of the public to give early help to developing mental health problems and assistance in crisis situations. The course currently involves 12 hours of training: 4 modules of 3 hours each. 6

7. MHFA Course Content Mental health problems in Australia Mental Health First Aid Action Plan Depression Anxiety problems Psychosis Substance use problems Mental health crises 7

8. Crisis Situations Covered Person who is suicidal or engaging in self-injury Person having a panic attack Person who has experienced a traumatic event Person in a severe psychotic state Person with severe effects from alcohol or other drug use Person with aggressive behaviour. 8

9. Conventional First Aid Action Plan: DRABC D = Danger R = Response A = Airway B = Breathing C = Circulation 9

10. 10 Mental Health First Aid Action Plan: ALGEE Hello, my name is Algee and I am the MHFA mascot.

11. Where MHFA Can Help 11

12. Who Does the Course? About half do the course because it will help with their work (mainly people working in human services). Others do it for family reasons or civic duty. More females than males do the course. 12

13. Website The website provides information about the course: www.mhfa.com.auwww.mhfa.com.au Members of the public can: –Purchase manuals –Download guidelines –Find an instructor or course in their area. 13

14. Manual 14 1 st Edition, 2002 2 nd Edition, 2010 3 rd Edition, 2013

15. 1 st MHFA Instructor Training Course September 2002, Canberra

16. Instructor Training Instructors attend a 5-day training course and receive ongoing support. They have a range of backgrounds, but must fulfill the following criteria: 16

17. Instructor Selection Criteria Good knowledge of mental health problems Personal or professional experience with people with mental illness Good background knowledge of mental health and community services Favourable attitudes towards people with mental health problems Good teaching and communication skills Good interpersonal skills Good business plan or organisational support. 17

18. Course Dissemination Over 2,000 MHFA instructors trained covering all states and territories in Australia, with over 1000 currently accredited. Uptake has been stronger in rural areas. Has spread internationally to 20 countries so far: Bermuda, Canada, China, Denmark, England, Finland, Hong Kong, Japan, Nepal, New Zealand, Nth Ireland, Portugal, Saudi Arabia, Scotland, Singapore, South Africa, Sri Lanka, Sweden, USA and Wales. 18

19. MHFA Manuals Developed in Other Countries 19

20. MHFA Manuals Developed in Other Countries 20

21. AWARDS to the MHFA Program The Mental Health Services (TheMHS) awards, 2003, 2007 and 2010 Victorian Public Health, 2006 Suicide Prevention Australia, 2007 National Council for Community Behavioral Healthcare, USA, 2008 Australian Rotary Health (ARH) Knowledge Dissemination Award, 2010 21

22. EVIDENCE THAT THE 1 ST EDITION MHFA COURSE IS EFFECTIVE 22

23. Evaluation Trials of the Standard MHFA Course Four major studies have been conducted: 1. Members of the public in an urban setting BMC Psychiatry 2002, 2:10 2. Public servants BMC Psychiatry 2004, 4:23 3. Members of the public in a rural area BMC Psychiatry 2004, 4:33 4. Analysis of stories BMC Psychiatry 2005, 5:43 23

24. Main Findings The trained group showed more improvement on: Confidence in providing help Likelihood of advising people to seek professional help Concordance with health professionals in beliefs about treatments Social distance (stigmatizing attitudes) Participants’ own mental health 24

25. Mental Health First Aid is included in the U.S Government Department Substance Abuse and Mental Health Services Administration's (SAMHSA) National Registry of Evidence-based Programs and Practices: www.nrepp.samhsa.gov/ViewIntervention.aspx?id=321 25

26. MHFA for Chinese Australians 26

27. Tailored Standard Course for medical students, nursing students, & financial counsellors Funded by Aust Government Dept of Health and Ageing Face-to-face courses delivered by endorsed Standard Instructors eLearning at online.mhfa.com.au online.mhfa.com.au

28. Example of Using MHFA in the Workplace 28 “I recognised clinical depression that was leading to suicide thoughts in one of my work colleagues. I listened, did not prejudge, even though it was through drug related issues as well as personal issues. My work colleague became calm and easy going as he knew I was not a threat to him and I was able to give suggestions on what he / we could do, e.g. GP, counsellor, mental health team.”

29. Example of Using MHFA to Help a Stranger “I was sitting next to a woman suffering an anxiety (panic) attack on a flight from Perth. I offered to help her, (and as a result) she was able to control her anxiety. I distracted her young child who was travelling with her. I think it helped her to know that I knew something about panic attacks and that I was comfortable with her situation.” 29

30. DESCRIPTIONS AND EVALUATIONS OF THE SPECIALTY MHFA COURSES: ABORIGINAL, VIETNAMESE, YOUTH, TEEN AND eLEARNING 30

31. This program began March 2007 with OATSIH funding. This 14-hour course is for Aboriginal communities in urban, rural and remote settings nationally. There has been significant input from Aboriginal people in its development. There is a 5-day Instructor Training Course for Aboriginal people and a 3-day Instructor Training Course for accredited MHFA Instructors. 31

32. 32 2 nd Edition, 2011 1 st Edition, 2007 2 nd Edition workbook, 2013

33. Research on Aboriginal & Torres Strait Islander MHFA 417 Aboriginal instructors trained (currently around 150 active) and more than 6,500 people have done the course. Focus groups carried out with instructors and course participants to assess strengths and weaknesses. Widespread agreement that course is culturally appropriate and useful, but modification is needed for participants with poorer written literacy. Workbook developed in 2013 to meet this need. 33 Int J. Mental Health Systems 2009, 3:10

34. The MHFA manual, the 12 hour MHFA course and the 5-day MHFA Instructor Training course have been written and translated for Australians who are Vietnamese speaking. So far, 8 instructors have been trained from this community and 420 course participants have attended this VMHFA course. 34

35. 35 1 st Edition, July 2008

36. Evaluation of Vietnamese MHFA Course An evaluation via written questionnaires given at beginning and end of course. This showed increased recognition of mental disorders, improved knowledge of how to assist someone and reduction in stigma. 36 Int J. Mental Health Systems 2009, 3:19

37. This program began April 2007 with National Suicide Prevention Strategy funding. This 14-hour course is suitable for adults working with adolescents. Existing chapters adapted to be youth-specific. Additional chapters added on eating disorders and non-suicidal self-injury. There is a 3-day Instructor Training Course for accredited MHFA Instructors and a 5.5-day course for new instructors. 37

38. 3 rd Edition, 2013 38 1 st Edition, 2007 2 nd Edition, 2010

39. Uncontrolled Trial of Youth MHFA An uncontrolled trial has been completed with 246 people in Western Melbourne. Questionnaires on knowledge, attitudes and first aid actions were given pre-course, post-course and after 6 months. Results showed improved knowledge, reduction in stigma and increased actions taken to help a young person. Gains were maintained over 6 months. 39 Int J of Mental Health Systems 2011; 5:4

40. Cluster Randomised Trial of Youth MHFA for High School Staff A customised version of the Youth course has been developed for high school teachers in SA. A cluster-randomised trial of the schools version has been completed with 14 schools. Results showed increased MHFA knowledge, improved beliefs about treatment, greater confidence, and reduced stigma. Students reported receiving more mental health information from teachers, but not more help with mental health problems. 40 BMC Psychiatry 2010; 10:51

41. Guidelines were developed to determine the content of the course (Junior, years 7-9 and Senior, years 10-12) Materials were developed for the Senior program in 2012. Modified action plan. Two videos; a suicide intervention drama and a talking heads video. There is a 3-day Instructor Training Course for accredited YMHFA Instructors. 41 teen Mental Health First Aid: A program for teenagers helping their friends

42. 1 st Edition, March 2013 42

43. 43 The modified Action Plan: Look, Ask, Listen, Help Your Friend. Emphasis is on getting an adult involved quickly and not taking too much on.

44. Evaluation of teen MHFA Course The course is being evaluated in 2013. Results will be available in 2014. The initial responses to the program have been excellent. It is valued by students and staff and referrals to school counselling services to appear to increase after the training. 44

45. An e-learning version on a CD-ROM of the 1 st edition 12-hr Adult MHFA course launched in May 2008. A specialised 3.5-hr face-to-face course was available (till Dec 2010) with an Instructor of the standard MHFA course to complete course requirements to receive certificate. This CD version has been particularly useful for shift workers and rural & remote locations. Web based e-learning rolling out from 2013. 45

46. Evaluation of e-learning MHFA 262 members of the public were randomized to e-learning, printed manual or wait-list. On-line questionnaires were filled out pre-, post- and 6-months following intervention. Both e-learning and manual improved knowledge, increased confidence and reduced stigma. E-learning led to greater reduction in stigma and increased first aid actions taken. 46 Aust & NZ J of Psychiatry 2010; 44:1072-1081

47. Other Evaluations of MHFA MHFA for NSW rural drought areas Aust J Rural Health. 2008 16(5): 313-8 MHFA for Qld agents working with farmers Aust Psychiatry. 2009 Aug;17 MHFA for Vic football coaches Int J Mental Health Systems 2010, 4:10 MHFA for Chinese community in Melbourne Int J Mental Health Systems 2010; 4:18 Experiences of instructors delivering MHFA in Wales J. Psychiatric & Mental Health Nursing 2010; 17:7 47

48. DEVELOPMENT OF MHFA GUIDELINES 48

49. National / International MHFA Guidelines There has been a need for national guidelines like those for conventional first aid. In 2005, MHFA guidelines development began. Five crisis situations Five developing disorders Projects funded by Australian Rotary Health, NHMRC, beyondblue, University of Melbourne and NCPIC. 49

50. Guidelines for MHFA 50 Guidelines and articles are available from the MHFA website: www.mhfa.com.au/cms/mental-health-first-aid-guidelines-project/

51. How the MHFA Guidelines were Developed Delphi methodology Consensus method – the most highly rated actions were included in the guidelines. Panels of experts: professionals (clinicians, researchers), carers and consumers. These experts came from English –speaking developed countries For information on the method, see the journal articles on the‘Guidelines’page of the MHFA website. 51

52. Guidelines for Other Cultural Groups Guidelines have been developed for Aboriginal people using Aboriginal mental health workers as experts on a Delphi panel. First aid guidelines have been developed for psychosis in Asian countries using Asian clinicians as experts. First aid guidelines have been developed for suicidal thoughts in India, the Philippines and Japan using their clinicians as experts. 52

53. 53 Aboriginal Guidelines

54. 54 www.mhfa.com.auwww.mhfa.com.au -> Shop

55. eLearning Standard MHFA course, with tailoring for others groups possible in future teen MHFA to be rolled out across Australia MHFA for the Older Person manual & 12 hr course Youth Aboriginal MHFA supplementary booklet Guidelines for banking staff and financial counsellors Youth MHFA randomised controlled trial with parents of young teenagers, with long-term follow-up (underway as of 2012) Refresher training. 55 The Future

56. www.mhfa.com.au 56