Mental Health First Aid (MHFA) is the big new thing in mental health. But does the reality live up to the hype? And why are so many people in the mental health community concerned that this benign looking programme may cause harm?

MHFA is an international public health programme that aims to increase mental health literacy in society. The programme was developed in Australia and has now been expanded to 21 countries. Delegates undertake a short course which lasts for a day or two. They are taught to recognise human distress as mental illness and then to provide mental health first aid.

Most use the ALGEE model – 1) Assess risk, 2) Listen non-judgmentally, 3) Give reassurance and information, 4) Encourage professional help, and 5) Encourage informal support. To date, 185,000 people have received training in the UK, almost two million internationally. MHFA courses are run regularly in companies, universities, for the armed forces, the police and even those in the construction industries. Schools are the next target, with the government ring fencing £200,000 to assure there is a one-day trained MHFA Champion in each and every state school. 

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The enthusiasm of course leaders and delegates is undeniable and admirable. But others are concerned. Why?

First, MHFA is sold on its evidence-base, but this is far more problematic than the hype suggests. Yes, MHFA has positive effects. Courses seem to improve delegates’ attitudes to mental health, and increase their confidence in starting difficult conversations. However there is next to no evidence on whether these changes actually help people suffering from mental distress, ie the entire population the intervention purports to help. This is shocking. It is like training two million adults to help kids learn maths, being impressed when the adults report feeling more confident in teaching maths, but failing to see whether this actually helps the kids learn maths!

More damagingly, MHFA is predicated on the idea that further help is readily available with adequate signposting. The dewy optimism of the MHFA movement, based on evangelical excitement that our attitudes to mental health are changing, clashes catastrophically with the lived reality of seeking help from the NHS today.

Jeremy Hunt penned an article upon launching the MHFA programme, detailing that “we know early intervention massively increases the chances of making a good recovery” and that the “question of prevention” is “vital”. Yet, preventative services do not exist in many areas, and if they do they are seeing a real-time decrease in funding. It is clear that Hunt recognises the problem, and the solution, but is willing to do nothing about it. 

Ever increasing numbers of people in suicidal distress, and with life-threatening conditions such as anorexia, are being turned away. Being encouraged to seek help, and then being turned down, often worsens a situation. Whatever people may know about cuts, not getting much-needed help nearly always intensifies feelings of worthlessness, isolation and despair. Rejection is experienced personally.

The other major concern is ideological. Most MHFA courses take certain beliefs about mental health problems as given truths. These include ideas such as that: depression, anxiety and schizophrenia are meaningful constructs with clearly identifiable symptoms backed up by scientific evidence and that it is the individual rather than the environment that they inhabit that needs to change. These ideas are fraught with controversy, with legions of patients having found their contact with psychiatric ideology damaging and traumatic. 

Question Time: I have been waiting since 2015 for NHS mental health counselling

The “first aid” metaphor implies that a toolkit can be used to help wounded individuals with superficial injuries, at least temporarily, and that physical and mental health are equivalent. Yet the majority of mental anguish is inseparable from far deeper and wide ranging problems such as social fragmentation, trauma and discrimination. The idea of first aid serves to individualise and depoliticise mental distress at the expense of the very real changes in society that we need to foster a mental health friendly society. 

The MHFA programme creates a new form of benevolent oppression, peppering everyday conversations with psychiatric discourse and producing a new breed of lay-diagnosticians ever watchful for signs of your mental illness, whether you like it or not. For how can informed consent remain a possibility if the psychiatric gaze is now ever present in the classroom, the university, the office, the supermarket? How can this be anything but a new form of social control and surveillance to police minds in the interests of neoliberal governance?

Public health campaigns such as MHFA are no doubt well-intentioned. Elements of the programme are exciting, for example the emphasis on non-judgmental conversations, speaking about suicidal thoughts, and self-care. However, there is simply no need to package these into a framework which may cause more suffering than good. Bandages, after all, rarely stick.

Jay Watts is a clinical psychologist and psychotherapist


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