The government’s overemphasis of the Mental Health First Aid scheme shifts the responsibility for our wellbeing onto society, writes RUTH HUNT
AS THE mental health crisis veers from bad to worse with the young particularly affected, attention has turned to a scheme that on first glance seems like common sense.
Mental Health First Aid (MHFA) aims to train individuals to identify others in their workplace or school who may be experiencing a mental health problem and to support and signpost them to services both formal and informal. However, this scheme has also been attacked for transferring responsibility from the state to individuals.
A scheme which could let the government off from the very real damage its policies cause.
It’s a scheme which is basic, user-friendly, and puts people into diagnostic boxes with clearly defined symptoms, but it potentially ignores the very messy nature of a mental health crisis, which might be as much about housing and lack of community support than anything else.
And with over 185,000 people already trained in MHFA, it is a scheme coming to your workplace and your child’s school soon.
MHFA, which originated in Australia, has become a worldwide initiative. It involves a one or two-day course, where individuals are taught usually using the “Algee” acronym: (1) assess risk, (2) listen non-judgementally, (3) give reassurance and information, (4) encourage professional help and (5) encourage informal support.
You might be wondering what is wrong with that? Surely having someone on hand to provide support to someone having a mental health crisis is a laudable idea?
In theory that is the case. Often people with lived experience of mental health become instructors, who are able to add real-life experiences.
However, what about the more complex cases, the cases where people don’t want but need help, or who need urgent secondary support such as an in-patient bed, which can’t be found?
What if their mental health problem was linked to poverty or problems at home with their parents? Does that “fit” with the MHFA approach, which focuses so much on the belief that mental illness has a simple biological explanation, with clearly identifiable symptoms?
Emeritus Professor of Psychiatry and author Linda Gask feels that focusing on diagnoses runs the risk of suggesting that it’s possible to “identify” people with those diagnoses.
“That’s always been my worry when doing basic mental health education,” she says. “I think a more problem-oriented approach is better. What is worrying the person? What are they experiencing? What can you do to help/ signpost? When should you be acting urgently? It is ‘first aid’ and the first-aider doesn’t diagnose but looks to help with the immediate problems.
“Another major problem for me is raising the expectation that the second and third-line help is easily available — which it often isn’t for mental health.
“You may find that you are on your own in a way that is unlikely in a situation where you are administering physical first aid. You can call the ambulance and help will be there. There is so much justification often required to obtain help for someone with a mental health problem. By getting involved you are taking responsibility, whether you want to or not. That can be daunting and this is why peer-support networks should be accessible in organisations where MHFA is initiated.
“There is an interesting pilot school study just been published (Wise — Wellbeing in Secondary Education study), where additional back-up has been given to the teachers, who were in turn supporting their pupils. However, the full trial hasn’t run yet. But despite that Theresa May has ringfenced £200,000 to roll-out MHFA in schools, without any evidence it will really make a difference to those ‘helped.’ This lack of support is a major concern. What I’ve learned from training front-line professionals over the years is that if they don’t have that, they can feel dumped on by society and back off.”
An MHFA instructor who has lived experience of mental illness was particularly concerned when MHFA was presented as “the answer” in schools.
The instructor said: “It seems to me to be setting teachers up to fail if they are going to be expected to single handedly sort out students’ mental health problems, particularly as Child and Adolescent Mental Health Services have been cut and cut and there are either no services to refer to, or the waiting list is huge.
“I feel the Department of Health is shirking its responsibility to fund care by presenting MHFA as ‘the answer.’ My advice would be to not make MHFA into something it’s not.”
Through her work in this area, Gask is clear that MHFA, like all front-line training interventions can only ever be one part of a strategy.
“I’ve been doing training to prevent suicide for decades, and we know this alone won’t be enough; it has to be part of a multifaceted strategy.
“I’m sure that’s how the Australians who developed MHFA envisaged it. But I worry that it is being seen as a simple solution to solve a complex problem by policy makers. It’s not enough, and runs the risk of devaluing what those who’ve received the training clearly view as a very useful course on basic skills and knowledge.
“Self-help and self-management have become fashionable in our era as a way of shifting responsibility onto the population in need and away from the state.
“There is a risk that “time to talk” and “MHFA” initiatives might be seen as a way of shifting the burden of mental health care onto society, and onto particular institutions such as schools.
“If there is back-up and clear routes to further help and support, then these initiatives might work as part of an integrated, fully funded model.
“However, I don’t see that kind of liaison work being emphasised. It takes time and money and people to put it in place who have the time to do it.
The couple who started MHFA, Professor Tony Jorm and Betty Kitchener, describe it as “an aim to increase mental health literacy in members of the community, including reducing stigmatisation and people learning simple first aid skills to see mental illness as like any other illness.”
From that description it is clear it was intended as a basic tool to improve understanding and tackle stigma.
However, with the chronic underfunding of mental health, MHFA has been seen as a quick and easy solution. By placing so much emphasis on MHFA, the flaws in the training become more obvious. This surely is not the fault of the MHFA but the government which sees it as a one size fits all approach rather than properly funding mental healthcare.