Promoting Mental Health and Well-Being

The Mental Health First Aid Training Model

Louise Underdahl, PhD, MPA, MSLS,

Lead Faculty Area Chair, College of Doctoral Studies-Health Administration

Gretheline Bolandrina, MSN Ed, RN, CRRN,

Practical Nursing Program Director, University of Phoenix College of Doctoral Studies Health Administration

Mental health and well-being issues have been cited as the number three global health challenge.  In 2001, Australia launched Mental Health First Aid, a 12-hour training program which has established a global presence.  Promoting MHFA is a judicious public health intervention to improve quality of life for the community and individuals.


Mental health and well-being have been cited as the number three global health issue (Mantzios, 2019; Nathe, 2018).  The World Health Organization World Mental Health Surveys Initiative quantifies both epidemiology of global mental disorders and existing treatment gaps (Scott et al., 2018). Adolescent mental health is an emerging public health challenge (Dávila, Polanco,  Segura, & Kingsbury, 2019; Rose et al., 2019) and approximately 25 per cent of the general population in Europe reports mental health problems (Jensen et al., 2016).  Major contemporary priorities include Post-Traumatic Stress Disorder (PTSD), depressive disorder, and stress. Mental Health First Aid (MHFA) is an initiative to train the members of the community to recognise and respond to manifestations of mental illness and substance abuse (Banh et al., 2019).

Contemporary Challenges

Also known as trauma-and stressor-related disorders, PTSD is associated with fear, horror, or hopelessness, negative cognitions, self-denigration, and negative worldviews (Arieh, Israel, & Marmar, 2017).  PTSD is characterised by the persistence of intense reactions to reminders of a traumatic event, a sense of imminent threat, altered mood, hypervigilance, and disturbed sleep (Arieh, Israel, & Marmar, 2017).  In the United States, the most frequently reported traumatic events are physical and sexual assaults, accidents, and fires (Arieh, Israel, & Marmar, 2017).

Major depressive disorder has been estimated as the fourth leading cause of disease, affects a broad demographic including farmers (Walrath, 2018), veterinarians (Larkin, 2018), healthcare practitioners and academicians (Holleman, Cofta-Woerpel, & Gritz, 2015), and students (Bond et al., 2015), and is among the most ubiquitous and costly of mental disorders (Slavich & Irwin, 2014).  Major stressful life events are one of the predictors of depression onset; only 30-35 per cent of adults achieve remission with therapeutic intervention (Slavich & Irwin, 2014).

Research suggests stress levels are rising (APA, 2017) and more Americans report stress-generated nervousness, anxiety, irritability, anger, and fatigue (APA, 2017; Nathe, 2018). Over 50 per cent of survey respondents defined stressors including uncertainty about healthcare, economy, social divisiveness, terrorist attacks, and personal financial security (APA, 2017; Nathe, 2018).  

Contemporary Solutions:  Mental Health First Aid (MHFA)

In 2001, Australia launched Mental Health First Aid (MHFA), a 12-hour training program (Jorm & Kitchener, 2011) used to train 1 per cent of the adult population in Australia by 2011.   MHFA has established a global presence including Canada, China, England, Finland, Hong Kong, Japan, Nepal, New Zealand, Northern Ireland, Singapore, South Africa, Sweden, United States, and Wales (Jorm & Kitchener, 2011).

Predicated on the first aid model, MHFA is a training course for the layperson on how to help an individual developing a mental health situation.  The first aid is administered until the individual receives professional help or the crisis resolves (Jensen et al., 2016; Jorm & Kitchener, 2011; Morgan, Ross, & Reavley, 2018).  MHFA uses the A-L-G-E-E formula (Jensen et al., 2016):

•    Assess risk of suicide and harm
•    Listen non-judgmentally
•    Give reassurance and information
•    Encourage individuals to get appropriate professional help
•    Encourage self-help strategies

Benefits include “increased mental health first aid knowledge, improved attitudes to appropriate mental health treatments, decreased stigma towards those with mental health problems, and increased confidence in providing support to people experiencing mental health problems” (Bond et al., 2011, p. 10).  As both frequency and severity of mental health issues increase, community education represents a judicious public health initiative to reduce mental health illness (Jensen et al., 2016).


Research suggests half of all patients in general hospital settings have a mental health problem (Barrett & Jackson, 2013).  Many patients receiving nursing care for physical health problems have co-existing mental health problems, including anxiety, confusion, dementia, depression, and psychosis. In 2013, the Australian Government Department of Health adapted the Australia Standard MHFA course (adults providing MHFA to adults) to meet the needs of nursing and medical students and offered face-to-face and online training venues (Bond et al., 2015).

Case Study

In 2016, Representative Joseph D. McKenna, Massachusetts House of Representatives, sponsored MHFA training courses for police and fire department members in Webster, Oxford, Sutton, and Douglas, which are municipalities within Worcester County.  Bay Path Regional Vocational Practical Nursing Academy (Bay Path Academy), a full-time evening practical nursing school serving Worcester County, partnered with the Webster Fire Department to provide MHFA certification for ten practical nursing students.

In 2017, Bay Path Academy worked with Community Healthlink (CHL) to conduct MHFA training for 25 practical nursing students and five faculty members through a grant funded by the federal Substance Abuse & Mental Health Services Administration (SAMHSA).  In September 2018, 30 practical nursing students participated in MHFA training and became MHFA certified.


MHFA training and MHFA awareness campaigns are replicable in medical/nursing and non-medical/non-nursing populations, such as high school teachers, financial counsellors, law enforcement, and pharmacy students (Bond et al., 2015; Delaney, Ferguson, Nazon, M. & Bynum, 2016).  MHFA training is scalable from local units such as high schools, colleges, community centers, and specifically, nursing schools.  Research indicates MHFA training decreases negative attitudes and stigma, increases mental health knowledge, and strengthens supportive behaviors toward mental health problems (Jorm & Kitchener, 2018).  Promoting MHFA education is a judicious public health intervention to improve quality of life for the community and individuals with mental health problems (Jorm & Kitchener, 2018).

Conflict of Interest Statement

The authors state they have no conflicts of interest.


American Psychological Association. (2017). Stress in America: The State of Our Nation.  Retrieved from

Arieh, S., Israel, L., & Marmar, C. (2017). Post-traumatic stress disorder. New England Journal of Medicine, 376(25),2459-2469.

Banh, M. K., Chaikind, J., Robertson, H. A., Troxel, M., Achille, J., Egan, C., & Anthony, B. J. (2019). Evaluation of mental health first aid USA using the mental health beliefs and literacy scale. American Journal of Health Promotion, 33(2), 237-247.

Barrett, P., & Jackson, A. (2013). Swimming without the water: A critical perspective on mental health experience for adult nursing students. Nurse Education in Practice,13(6), 487-491.

Bond, K. S., Jorm, A. F., Kitchener, B. A.  et al.  (2015). Mental health first aid training for Australian medical and nursing students: An evaluation study. BMC Psychology,3(1), 11-20.

Dávila, M. G., Polanco, V. P., Segura, L., & Kingsbury, D. (2019). An intervention to improve mental health first aid among adolescents. American Journal of Public Health, 109(1), 7.

Delaney, R., Ferguson, D., Nazon, M. & Bynum, R. (2016, May/June). Reentry and offenders with special needs: Mental illness and addressing criminogenic needs. American Jails, 20-25.

Holleman, W. L., Cofta-Woerpel, L M., Gritz, E. R. (2015). Stress and morale of academic biomedical scientists. Academic Medicine, 90(5), 562-564.

Jensen, K. B., Morthorst, B. R., Vendsborg,P. B., et al. (2016). Effectiveness of mental health first aid training in Denmark: A randomized trial in waitlist design. Social Psychiatry and Psychiatric Epidemiology, 51(4), 597-606.

Jorm, A. F., & Kitchener, B. A. (2011).  Noting a landmark achievement: Mental health first aid training reaches 1 per cent of Australian adults. Australian and New Zealand Journal of Psychiatry, 45 (10), 808-831.

Jorm, A. F., & Kitchener, B. A. (2018). The truth about mental health first aid training. Psychiatric Services,69(4), 492-492.

Larkin, M. (2018, June 15). Suicide trend in the profession stretches back decades. JAVMA News.  Retrieved from

Mantzios, M. (2019). Mental health first aid and exciting opportunities for peer-support networks within universities with prospects of influencing public health and treatment. Journal of Public Health, 1-3.

Morgan, A. J., Ross, A., & Reavley, N. J. (2018). Systematic review and meta-analysis of mental health first aid training: Effects on knowledge, stigma, and helping behaviour. PloS One, 13(5), e0197102.

Nathe, M. 10 global health issues to watch in 2018.  Retrieved from

Rose, T., Leitch, J., Collins, K. S., Frey, J. J., & Osteen, P. J. (2019). Effectiveness of youth mental health first aid USA for social work students. Research on Social Work Practice, 29(3), 291-302.

Scott, K. M., de Jonge, P., Stein, D. J. et al. (Eds). (2018). Mental disorders around the world: Facts and figures from the WHO world mental health surveys. Cambridge, UK: Cambridge University.

Slavich, G. M., & Irwin, M. R. (2014). From stress to inflammation and major depressive disorder: A social signal transduction theory of depression. Psychology Bulletin, 140(3), 774-815.

Walrath, R. (2018). The CDC just retracted its farmer suicide data. That could be terrible news for farmers.  Mother Jones.  Retrieved from

Louise Underdahl, PhD, MPA, MSLS

Louise Underdahl, PhD, MPA, MSLS - Served UCLA from 1978 to 1992, UCLA Health Risk Management from 1992 to 2017, and University of Phoenix since 2004. She is currently Lead Faculty Area Chair, College of Doctoral Studies-Health Administration.

Gretheline Bolandrina, MSN Ed, RN, CRRN

Gretheline Bolandrina, MSN Ed, RN, CRRN - Practical Nursing Program Director and doctoral student in the University of Phoenix College of Doctoral Studies-Health Administration

Latest Issue
Get instant
access to our latest e-book
Sanofi Dubai Derma 2023