Sunday 13 July 2014

Mental Health First Aid

Here are some personal reflections of the two-day workshop I attended, accredited by Mental Health First Aid (MHFA) England.  This is a relatively new course, originally developed in Australia, with content approved and written by MH professionals and charities.

The stated aims of the MHFA course (see: ) is to equip attendees to:
- spot the early signs of a mental health problem 
- feel confident helping someone experiencing a problem
- help prevent someone from hurting themselves or others 
- help stop mental ill health from getting worse
- help someone recover faster 
- guide someone towards the right support
- reduce the stigma of mental health problems.

These skills are discussed under four main course topics:
  • What is mental health?
  • Suicide
  • Anxiety and depression
  • Psychosis
So far so good.  I duly signed up (after having noticed some twitter chatter between @BipolarBlogger and @ProjectLibero about #MHFA instructor training they were both doing).  I thought the course might be useful for my PANDAS peer support group, and especially the MBU hospital visiting I was doing.  So, with my charity/peer supporter/lived experience hat on, I found myself in a room full of HR professionals.  For the first time since leaving my City job over three years' ago, I was sat in an office meeting room, with course materials and PowerPoint and expensive-looking stationery.  

I was pleasantly surprised by how genuinely interested the HR managers seemed in the course material, and how much they wanted to help the many, many, workers who end up in front of HR with a mental illness, or in mental distress.  With 1 in 4 adults expected to experience a mental illness during their lifetime, MHFA is acutely relevant to all work settings, large and small.

Day 1 first covered some general information on mental health and mental illnesses, before devoting the afternoon to the topic of depression, and suicide.  Depression is one of the most common mental health conditions, but certainly no less serious for that.  We learned about both risk and protective factors.  And, importantly, what can be done as a friend, colleague, manager (or even sympathetic stranger) to help someone struggling with symptoms such as low mood, inability to concentrate, tearfulness, and anhedonia (inability to take pleasure in things).

We were introduced to the course's main mneumonic: ALGEE.  This technique/model came up again and again, across many different conditions and scenarios.  In the context of someone experiencing a depressive episode it looks like this:
Assess risk of suicide or self-harm
Listen non-judgementally
Give reassurance and information 
Encourage the person to get appropriate professional help
Encourage self-help strategies.
(Source: MHFA England manual, 2013, p33.  For more information on the history of ALGEE see the Australian MHFA site here: )

Some more traditional "first aid" techniques were taught in a discussion of suicide, and suicidal thoughts and actions.  (We try to steer away now from using criminal terminology such as "attempted" or "committed" suicide.). There is another mneumonic, CPR, which is particularly useful in the assessment (by a non professional first-aider) of suicide risk:
Current plan 
Prior behaviour
(Source: MHFA England manual, 2013, p35)

An important point I noted from this session is that it is a myth that people who talk about suicide never actually go on to do it.  But it is very unlikely you will make the situation worse by talking about it.  Rather, listening non-judgementally and validating the person's feelings and distress can go a long way to making them feel less hopeless and alone.

Even within a room of mentally well people, we felt our attitudes to suicide change over the course of the day.  It's hard to describe in words, but I think the change was attitudinal: we came away less likely to judge someone who wants to end their own life.  Instead of the usual "how could you do it to your family?!" / "Think of the pain you will leave behind!" reactions, we might instead say something like "I'm so sorry, you must be feeling awful to want to do this.  It must be really, really, hard for you".  It's a subtle but important shift.

Day 2 focused on anxiety (a wide range of conditions from General Anxiety Disorder, Panic Disorder, PTSD, through to the very commonly misunderstood OCD), and then psychosis (another wide range of conditions including bipolar disorder, psychotic depression, schizoaffective disorder and schizophrenia).  We learned a lot about the features (symptoms, risk and protective factors) of these conditions, as well as practical techniques for helping someone in the grips of an anxiety or panic attack, or indeed hearing voices or otherwise losing touch with reality.

No surprises that the ALGEE technique could equally be applied in these cases.  With some important additional emphases on keeping all parties safe from harm during a psychotic episode.

The material was brought to life through a variety of group exercises and videos.  This was particularly effective in a hands-on "hearing voices" exercise, and in an actor's incredibly realistic portrayal of psychosis.

I would urge anyone to take the MHFa course.  In particular I would imagine it to be useful for line managers, carers, volunteers, peer supporters, teachers or anyone who is keen to be able to support someone through a mental health problem.  The course is quite prescriptive in its content (it has to be, in order for participants to receive the accreditation). But it is wide-ranging enough to cover the most likely scenarios and eventualities.  My special interest is in perinatal and maternal mental health, but I think I can apply the tools learned here to this.

Verdict: highly recommended.

If you would like further information on MHFA (including upcoming courses) please visit: 


  1. What an amazing course, it sounds so useful. I wish these were more widely available. It might help generate a better awareness of mental ill health and how to help people who suffer from it - and help break the stigma. Great post, and good on you for doing it xxx

  2. I am very very interested in these course! Promising and hopefully available in my area. Thanks for sharing. #pocolo

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