MHFA Course Evaluations
Since it began in 2000, Mental Health First Aid Australia has been committed to evaluating its training programs using rigorous, scientific studies. Listed here are studies that evaluated MHFA training and have been published in peer-reviewed academic journals. A number of these evaluations were conducted by MHFA or by the Population Mental Health Group led by Professor Tony Jorm at the University of Melbourne. Evaluation studies have also been conducted by independent organisations.
These evaluations consistently show that MHFA training is associated with improved knowledge of mental illnesses and their treatments, knowledge of appropriate first aid strategies, and confidence in providing first aid to individuals with mental illness, benefits which are maintained over time. Some studies have also shown improved mental health in those who attend the training, decreases in stigmatising attitudes and increases in the amount and type of support provided to others.
- Read more on MHFA Australia's impact here.
- Read more on research informing MHFA course curriculum here.
28. Experiences of a Mental Health First Aid training program in Sweden: A descriptive qualitative study
Svensson B, Hansson L, Stjernswärd S. Experiences of a Mental Health First Aid training program in Sweden: A descriptive qualitative study. Community Mental Health Journal, 2015; doi: 10.1007/s10597-015-9840-1. Abstract
A Mental Health First Aid training program was tested for implementation in Sweden among employees in the public sector. The aim of this qualitative study was to explore participants’ experiences of the program in more depth, in conjunction with a randomised controlled study. The analysis resulted in five categories illustrating the participants’ experiences of the course: increased awareness, knowledge and understanding; influence on attitude and approach; tool box and confidence; feedback on content and layout; and tangible examples of applied knowledge. The most central finding was the fruitfulness of the program’s practical focus and use, the increased confidence and inclination to act following program participation, and the importance of experienced instructors.
Byrne K, McGowan I, Cousins W. Delivering Mental Health First Aid: an exploration of instructors' views. International Journal of Mental Health Promotion, 2015; doi: 10.1080/14623730.2014.995422. Abstract
This study interviewed six experienced MHFA instructors in Northern Ireland in a semi-structured recorded meeting for schematic content analysis. Four themes are discussed: future roll out, instructor skills, challenges, networks and motivation. Results indicate that complex strategies are employed in delivering MHFA training, while the conclusion calls for the development of a mental health public awareness campaign and continuation of the MHFA program in Northern Ireland.
26. Evaluating the effectiveness of Mental Health First Aid training among student affairs staff at a Canadian university
Massey J, Brooks M, Burrow J. Evaluating the effectiveness of Mental Health First Aid training among student affairs staff at a Canadian university.Journal of Student Affairs Research and Practice, 2014. doi: 10.1515/jsarp-2014-0032. Abstract
This study evaluated the effectiveness of providing the Mental Health First Aid training program to student affairs staff. The objective of the training was to increase knowledge of mental health, enhance sensitivity, and raise confidence to intervene and assist individuals experiencing a mental health issue. Results demonstrated that the training successfully met its objectives and offers great potential to student affairs practitioners.
25. Mental Health First Aid is an effective public health intervention for improving knowledge, attitudes, and behaviour: A meta-analysis, 2014
Hadlaczky G, Hokby S, Mkrtchian A, Carli V, Wassmerman D. Mental Health First Aid is an effective public health intervention for improving knowledge, attitudes, and behaviour: A meta-analysis. International Review of Psychiatry, 2014; 4; 467-475; doi: 10.3109/09540261.2014.924910. Abstract
This paper synthesised published evaluations of the MHFA program in a meta-analysis to estimate its effects and potential as a public mental health awareness-increasing strategy. Fifteen relevant papers were identified through a systematic literature search. The results demonstrate that MHFA increases participants’ knowledge regarding mental health, decreases their negative attitudes, and increases supportive behaviours toward individuals with mental health problems. The MHFA programme appears recommendable for public health action.
Svennson B, Hansson L. Effectiveness of Mental Health First Aid Training in Sweden. A randomized controlled trial with a six-month and two-year follow-up. PLOS ONE, 2014; 9; 1-8; doi: 10.1371/journal.pone.0100911. Full text
This study, a randomized controlled trial, investigates if MHFA training in a Swedish context provides a sustained improvement in knowledge about mental disorders, a better ability to be helpful in contacts with people who are ill and if it changes attitudes in a positive direction. Participants were mainly public sector employees from a county in the west of Sweden. The study included an experiment group (n = 199) and a control group (n = 207) placed on a waiting list during a 6-month follow-up. At a two-year follow-up, findings demonstrated that the intervention group improved in knowledge and confidence in providing help for someone in need, with improvements maintained to a great extent.
Moffitt J, Bostock J, Cave A. Promoting well-being and reducing stigma about mental health in the fire service.Journal of Public Mental Health, 2014;13; 103-113; doi:10.1108/JPMH-02-2013-0004. Full text
This study evaluated the impact of three mental health promotion interventions, including MHFA, on attitudes and knowledge towards mental health in fire service managers at Northumberland Fire and Rescue Service in the UK. The results from this study indicate that providing training in mental health awareness and promotion, including MHFA, was considered helpful by managers in the Fire Service and had positive outcomes for attitudes and understanding about mental health.
Day A, Francisco A. Social and emotional wellbeing in Indigenous Australians: Identifying promising interventions. Australian and New Zealand Journal of Public Health, 2013; 37; 350-355; doi:10.1111/1753-6405.12083. Abstract
This article reviews evidence that supports a range of psycho-social interventions implemented to improve social and emotional wellbeing in Aboriginal and Torres Strait Islander individuals and communities. Sixteen interventions are reviewed and scored for strength of scientific evidence. Mental Health First Aid tops the list as having the strongest evidence in terms of scientific rigour, with a score of 5 out of 5.
Mendenhall AN, Jackson SC, Hase S. Mental Health First Aid USA in a rural community: Perceived impact on knowledge, attitudes and behavior. Social Work in Mental Health, 2013; doi: 10.1080/15332985.2013.812542. Abstract
This study investigated the perceived impact of MHFA on individuals who took the class through a community mental health center in rural Kansas. One hundred and seventy-six MHFA graduates completed an online survey assessing their perception of the impact of completing the MHFA course. Findings corresponded with previous Australian MHFA studies which found outcomes including improved mental health literacy and changed attitudes and behaviours but the study sample limits generalisability.
Hart LM, Jorm AF, Paxton SJ, Cvetkovski S. MHFA Guidelines: An evaluation of impact following download from the World Wide Web. Early Intervention Psychiatry, 2012; 6; 399-406. Abstract
The aim of this study was to evaluate the usefulness and impact of the MHFA Guidelines on web users who download them. Web users who downloaded the documents were invited to respond to an initial demographic questionnaire, then a follow up about how the documents had been used, their perceived usefulness, whether first aid situations had been encountered and if these were influenced by the documents. A majority of those who provided first aid reported feeling that they had been successful in helping the person, that they had been able to assist in a way that was more knowledgeable, skilful and supportive, and that the guidelines had contributed to these outcomes. Findings supported the conclusion that information made freely available on the Internet, about how to provide mental health first aid to someone who is developing a mental health problem or experiencing a mental health crisis, is associated with more positive, empathic and successful helping behaviours.
Morawska A, Fletcher R, Pope S, Heathwood E, Anderson E, McAuliffe C. Evaluation of Mental Health First Aid training in a diverse community setting. International Journal of Mental Nursing, 2012; doi: 10.1111/j.1447-0349.2012.00844.x. Abstract
Mental health first aid (MHFA) training has been disseminated in the community and has yielded positive outcomes in terms of increasing help-seeking behaviour and mental health literacy. However, there has been limited research investigating the effectiveness of this programme in multicultural communities. Given the increasing levels of multiculturalism in many countries, as well as the large number of barriers presented to these groups when trying to seek help for mental illnesses, the present study aimed to investigate the effectiveness of MHFA in these settings. A total of 458 participants, who were recruited from multicultural organizations, participated in a series of MHFA training courses. Participants completed questionnaires pre and post the training course, and 6-month follow-up interviews were conducted with a subsample of participants. Findings suggested that MHFA training increased participant recognition of mental illnesses, concordance with primary care physicians about treatments, confidence in providing first aid, actual help provided to others, and a reduction in stigmatizing attitudes. A 6-month follow up also yielded positive long-term effects of MHFA. The results have implications for further dissemination and the use of MHFA in diverse communities. In addition, the results highlight the need for mental health training in health-care service providers.
18. Farm-Link: Improving the Mental Health and Well-Being of People Who Live and Work on NSW Farms, 2012
Perceval M, Fuller J, Holley AM. Farm-Link: Improving the Mental Health and Well-Being of People Who Live and Work on NSW Farms. International Journal of Mental Health, 2012; 40(2). Abstract
The Farm-Link Program aimed to improve access to and responsiveness of mental health services to the needs of people who live and work on farms in NSW, Australia. Frontline agricultural workers, who have a lot of contact with farmers and their families, received Mental Health First Aid training provided by Farm-Link staff. Across NSW, 220 participants received this training during 2008, and 133 participants received training in the New England region throughout 2009-10. Farmers' mental health networks were developed and expanded to engage both agricultural and mental health agencies, so that pathways to mental health care could be defined, described, and utilized. An external evaluation indicated that Farm-Link successfully identified and established mental health service development interventions in target communities. Farm-Link's ongoing work indicates further time and continuity of service in rural communities has a positive impact on the depth of knowledge built and project aims being delivered.
O'Reilly CL, Bell JS, Kelly PJ, Chen TF. Impact of mental health first aid training on pharmacy students’ knowledge, attitudes and self-reported behaviour: a controlled trial. Australian and New Zealand Journal of Psychiatry, 2011 45(7): 549 - 557. Abstract
The aim of this study was to assess the impact of delivering Mental Health First Aid (MHFA) training for pharmacy students on their mental health literacy and stigma towards mental illness. A non-randomized controlled design was used, with all third year pharmacy students at the University of Sydney (n = 272) in 2009 invited to participate in one of two MHFA training courses, each of 12 hours duration. Of these, 174 students applied for MHFA training, of whom 60 were randomly selected and offered MHFA training. Outcome measures that were completed by all participants in the MHFA and non-MHFA groups before and after the MHFA training included an evaluation of mental health literacy, the 7-item social distance scale, and 16 items related to self-reported behaviour. This study demonstrated that MHFA training can reduce pharmacy students’ mental health stigma, improve recognition of mental disorders and improve confidence in providing services to consumers with a mental illness in the pharmacy setting.
Gillinson S, Horne M, Baeck P. Radical efficiency: Different, better, lower cost public services. NESTA, 2010. Full text
The MHFA Program was chosen as one of 10 case studies of ‘Radical efficiency’ in action across the world. ‘Radical efficiency’ is about different, better and lower cost public services – innovation that delivers much better public outcomes for much lower cost.
15. Reducing the stigma of mental disorders at work: A review of current workplace anti-stigma intervention programs, 2010
Szeto CH, Dobson KS. Reducing the stigma of mental disorders at work: A review of current workplace anti-stigma intervention programs. Applied and Preventative Psychology, 2010; 14: 41-56. Abstract
This article reviews MHFA as a workplace anti-stigma program. Further, MHFA is listed as the only international program in this space with published evidence of effectiveness.
Kelly CM, Mithen JM, Fischer JA, Kitchener BA, Jorm AF, Lowe AJ, Scanlan C. Youth Mental Health First Aid: a description of the program and an initial evaluation. International Journal of Mental Health Systems 2011, 5(1):4. Full text
In 2007, the Youth Mental Health First Aid Program was launched in Australia with the aim to teach adults, who work with or care for adolescents, the skills needed to recognise the early signs of mental illness, identify potential mental health-related crises, and assist adolescents to get the help they need as early as possible. This paper provides a description of the program, some initial evaluation and an outline of the future directions.
Jorm AF, Kitchener BA, Fischer J, Cvetkovski S. Mental health first aid training by e-learning: a randomized controlled trial. Australian and New Zealand Journal of Psychiatry 2010; 44: 1072-1081. Abstract
A randomized controlled trial was carried out with 262 members of the Australian public. Participants were randomly assigned to complete an e-learning CD, read a Mental Health First Aid manual or be in a waiting list control group. The effects of the interventions were evaluated using online questionnaires pre- and post-training and at 6-months follow up. The questionnaires covered mental health knowledge, stigmatizing attitudes, confidence in providing help to others, actions taken to implement mental health first aid and participant mental health. Both e-learning and the printed manual increased aspects of knowledge, reduced stigma and increased confidence compared to the control group. E-learning also improved first aid actions taken more than the control group, and was superior to the printed manual in reducing stigma and disability due to mental ill health.
Jorm AF, Kitchener BA, Sawyer MG, Scales H, Cvetkovski S. Mental health first aid training for high school teachers: a cluster randomized trial. BMC Psychiatry 2010; 10: 51. Full text
Mental illnesses often have their first onset during adolescence. For this reason, high school teachers are in a good position to provide initial assistance to students who are developing mental health problems. To improve the skills of teachers in this area, the Youth MHFA course was modified to be suitable for high school teachers and evaluated in a cluster randomised trial with teachers from 14 South Australian high schools.
Evaluation by questionnaires pre- and post-training and at 6 months follow-up found that the training increased teachers’ knowledge, changed beliefs about treatment to be more like those of mental health professionals, reduced some aspects of stigma, and increased confidence in providing help to students and colleagues. There was an indirect effect on students, who reported receiving more mental health information from school staff. Most of the changes found were sustained 6 months after training.
11. Evaluation of Mental Health First Aid training with members of the Chinese community in Melbourne, Australia
Lam AY.K, Jorm AF, Wong DF.K. Mental health first aid training for the Chinese community in Melbourne, Australia: effects on knowledge about and attitudes toward people with mental illness. International Journal of Mental Health Systems 2010; 4: 18. Full text
This is the third published paper on an evaluation of a cultural adaptation of the MHFA Australia program. MHFA Hong Kong Instructor Angus Y Lam spent some time studying in Melbourne. Whilst here, he carried out an evaluation of the 12-hr MHFA delivered to 108 people from the Chinese community in Melbourne. Angus used the adapted Chinese translated MHFA manual from the MHFA Hong Kong Program. He also conducted the course in Cantonese, which was simultaneously translated into Mandarin by another participant. Pre and post measurements in this uncontrolled trial found this training to be effective in improving recognition of mental disorders, in reducing negative stigmatizing attitudes and in changing beliefs about the helpfulness of treatment.
Pierce D, Liaw ST, Dobell J, Anderson R. Australian rural football club leaders as mental health advocates: an investigation of the impact of the Coach the Coach project. International Journal of Mental Health Systems 2010; 4: 10. Full text
The Rural Health Academic Centre in the rural city of Ballarat in Victoria delivered the MHFA course to 36 football coaches from 12 rural clubs in Victoria. More than 50% of club leaders who undertook the training showed increased capacity to recognise mental illness and 66% reported increased confidence to respond to mental health difficulties in others. The study concluded that rural football clubs appear to be appropriate social structures to promote rural mental health awareness. Club leaders, including many coaches, benefit from MHFA training, reporting increased skills and confidence. Benefit to club players from this approach was less obvious. However, the generally positive findings of this study suggest further research in this area is desirable.
9. Evaluation of Mental Health First Aid training with members of the Vietnamese community in Melbourne, Australia, 2009
Minas H, Colucci E, Jorm AF. Evaluation of Mental Health First Aid training with members of the Vietnamese community in Melbourne, Australia. International Journal of Mental Health Systems 2009; 3: 19. Full text
This is the second published paper on an evaluation of a cultural adaptation of the MHFA Australia program. Pre and post measurements in this uncontrolled trial of the Vietnamese MHFA program found significant reductions in stigmatising attitudes, improved knowledge of mental disorders and improved knowledge about appropriate forms of assistance to give to people in the Vietnamese community with mental disorder.
Hossain D, Gorman D, Eley R. Enhancing the knowledge and skills of Advisory and Extension Agents in mental health issues of farmers. Australian Psychiatry 2009; 17: 116-20. Abstract
The Centre for Rural and Remote Area Health, University of Southern Queensland, evaluated the effectiveness of the MHFA training for Advisory and Extension Agents, who are a main line of contact of farmers in rural Queensland. The agents’ mental health literacy and skills in dealing with people with mental illness were significantly improved.
b) Hossain D, Gorman D, Eley R, Coutts J. Farm Advisors’ reflections on MHFA training. Australian e-Journal for Advancement of Mental Health 2009; 8: 1. Full text
A second article discusses the reflections of farmer advisors about the MHFA training. They reported that the MHFA course materials were new, well presented and relevant for them.
c) Hossain D, Gorman D, Coutts J. Value of Mental Health First Aid training of Advisory and Extension Agents in supporting farmers in rural Queensland. Rural and Remote Health 2010; 10: 1593. Full text
A third article is a one-year follow-up. It showed that MHFA training improved Advisory and Extension Agents’ confidence level and their knowledge of mental health issues and increased their empathy toward persons with mental health problems. Furthermore, providing training on mental health issues to Advisory and Extension Agents was perceived by stakeholders to be beneficial to both farmers and Advisory and Extension Agents.
Kanowski L, Jorm A, Hart LM. A mental health first aid training program for Australian Aboriginal and Torres Strait Islander peoples: description and initial evaluation. International Journal of Mental Health Systems 2009; 3: 10. Full text
This is the first published paper on an evaluation of a cultural adaptation of the MHFA Australia program. An initial qualitative evaluation of the uptake and acceptability of the Aboriginal and Torres Strait Islander MHFA program found the program is culturally appropriate, empowering Aboriginal people and providing information that is highly relevant in assisting Aboriginal people with a mental illness.
Sartore GM, Kelly B, Stain HJ, Fuller J, Fragar L, Tonna A. Improving mental health capacity in rural communities: Mental health first aid delivery in drought-affected rural New South Wales, Australian Journal of Rural Health 2008; 16: 313–318. Abstract
The Centre for Rural and Remote Mental Health in NSW evaluated the effectiveness of the MHFA training in drought-affected rural and remote Australia, as part of a strategy to improve capacity among farming communities to provide early intervention for mental health problems. Data were obtained from 99 participants recruited across 12 New South Wales towns, before and after delivery of MHFA seminars emphasising the role of front-line workers from agricultural-related services. Surveys assessed knowledge of, confidence in dealing with, and attitude towards people experiencing mental illness, along with the impact of training on response to mental health problems among target population of farmers and farming families. Rural support workers and community volunteers attended MHFA seminars because of perceived mental health needs in the workplace. A majority of responses reflect a concern with giving appropriate advice and support well outside narrow job definitions. Participants' ability to identify high prevalence disorders and endorse evidence-based interventions for both high and low prevalence disorders increased following MHFA training, as did their confidence in their ability to provide appropriate help. The study concluded that MHFA training can form an effective part of a strategy to improve systems of care and pathways to early intervention in rural communities by using local networks to provide mental health support.
5. MHFA Training: review of evaluation studies, 2005
Kitchener BA, Jorm AF. Mental Health First Aid training: review of evaluation studies. Australian and New Zealand Journal of Psychiatry 2006; 40: 6-8. Abstract
This paper reviewed studies evaluating mental health first aid (MHFA) training. The results found that most mental health first aiders tend to be middle-aged women whose work involves people contact. All trials found the following statistically significant benefits 5–6 months post-training: improved concordance with health professionals about treatments, improved helping behaviour, greater confidence in providing help to others and decreased social distance from people with mental disorders. Only one trial evaluated the mental health benefits to participants and this found positive effects. The paper concluded that although MHFA training has been found to change knowledge, attitudes and helping behaviours, and even benefit the mental health of participants, there has not yet been an evaluation of the effects on those who are the recipients of the first aid.
Jorm A, Kitchener B, Mugford SK. Experiences in applying skills learned in a mental health first aid training course: a qualitative study of participants' stories. BMC Psychiatry 2005; 5: 43. Full text
People who have completed the Mental Health First Aid course often tell stories about how they have used their first aid skills to help someone. These stories are particularly interesting because they tell about the effects of the first aid on the person helped. In order to systematically analyse such stories, 131 former course participants were approached 19-21 months following the course and asked to complete a questionnaire about their experiences. 94 of these people responded. It was found that 78% had used their first aid skills. Many positive effects were reported, including increased empathy and confidence and being better able to handle crises. There was no evidence that people were over-reaching themselves because of over-confidence. Participants were very positive about the benefits of the course and keen to see it repeated and extended.
Jorm A, Kitchener B, O'Kearney R, Dear K B.G. Mental health first aid training of the public in a rural area: a cluster randomized trial. BMC Psychiatry 2004; 4: 33. Full text
A trial was carried out with members of the public in a large rural area of New South Wales, as a partnership between the New South Wales Southern Area Health Service and the Centre for Mental Health Research. Eight of 16 local government areas on the Southern Area Health Service received the course immediately and the other 8 were placed on a waiting list to receive the training later in the year (the controls). There were 753 participants in total in the trial: 416 were in areas that received the course immediately and 337 in the control group. People who did the course showed a number of changes relative to the control group:
- Better recognition of disorders from case descriptions of a person with either depression or schizophrenia.
- Less negative attitudes towards people with mental disorders.
- More like health professionals in their beliefs about what treatments are likely to be helpful
- Greater confidence in providing help to someone.
- More likely to actually provide help to someone.
The course did not change the following:
- Number of people with mental disorders that the participant had contact with.
- Advising people to seek professional help.
Kitchener BA, Jorm AF. Mental health first aid training in a workplace setting: A randomized controlled trial. BMC Psychiatry 2004; 4: 23. Full text
Because the first study had no control group, a second trial was conducted in which course participants were compared with a wait-list control group. This randomized controlled trial was carried out in 2002 with employees of two Australian government departments who did the course during their work time. This trial involved 301 participants who were randomized to either participate immediately in a course or to be wait-listed for 5 months before undertaking the training. The trained group improved more than the wait-list control group in the following areas:
- Greater confidence in providing help to others.
- Greater likelihood of advising people to seek professional help.
- Improved concordance with health professionals about treatments.
- Decrease in stigmatizing attitudes.
- Improved mental health in the participants themselves.
The mental health benefits of the course to participants were unexpected because the course does not provide therapy and promises no personal benefits. We think the course may mental health benefits by providing participants with good quality information which allows them to make better choices about their own mental health care.
Jorm AF, Kitchener BA. Mental health first aid training for the public: evaluation of effects on knowledge, attitudes and helping behaviour. BMC Psychiatry 2001; 2: 10. Full text
The first evaluation study of MHFA was an uncontrolled trial in 2001 with members of the public living in Canberra. This trial examined the effects of the course on knowledge of mental disorders, stigmatizing attitudes and help provided to others. 210 participants were given questionnaires at the beginning of the course, at the end, and at 6 months follow-up. The course was found to produce the following benefits:
- Better recognition of mental disorders from case vignettes.
- Changed beliefs about treatment to be more like those of health professionals.
- Decreased social distance from people with mental disorders.
- Increased confidence in providing help.
- Increase in the amount of help provided to others.
There is also a report of this article in the British Medical Journal