This evaluation has found several benefits from Mental Health First Aid training. The course improved the ability to recognize a mental disorder in a vignette, changed beliefs about treatment to be more like those of health professionals, decreased social distance (stigmatizing attitudes), increased confidence in providing help to someone with a mental health problem, and increased the amount of help provided to others. All these changes were found with a conservative intention-to-treat analysis. In this type of analysis, those who did not answer a questionnaire at post-test or follow-up were assumed to show no benefit from the course.
On the negative side, participants were less likely to advise seeking professional help when they provided first aid to someone. Although this change failed to reach the conventional significance level (P = .052), it merits comment because it is contrary to the training given in the course to encourage the person with the mental health problem to seek professional help. A possible reason may be that some members of the public decided to participate in the course because they had had recent contact with a person having a mental health problem. Following the course, new contacts may have been fewer and hence there was less opportunity to recommend professional help. One could imagine, for example, the situation of a family carer who enrolled in the course to gain better helping skills, but had no contacts with additional people having mental health problems following the course. Consistent with this interpretation, participants reported having contact with significantly fewer people with mental health problems following the course. Nevertheless, the participants reported that the degree of help they provided was greater after the course.
A potential criticism of Mental Health First Aid training for the public is that it will lead to the labelling of ordinary life problems as mental disorders. To check on the possibility of increased labelling, we asked participants about whether they themselves or members of their family had ever experienced a mental health problem. We found trends towards an increase, with P-values of .050 and .052, which are unlikely to be due to a true change in lifetime prevalence over a six month period, so must reflect increased labelling. However, the increases were small in magnitude and are appropriate given that many mental disorders are not recognized and professionally treated [1
There are several limitations of the present evaluation study. The major limitation is the lack of a control group. There is no reason to expect that knowledge, attitudes and behavior would improve over time without training. However, it is possible that repeated testing alone produced some change or that the participants were biased towards reporting improvements to please the researchers. To overcome this limitation, we are currently carrying out randomized controlled trials with wait-list control groups. Another limitation is that the participants were largely well-educated women. We do not know whether the findings can be generalized to the broader population. It is also not known whether the intervention increased access to care or produced other benefits to people with mental health problems, since the potential beneficiaries of Mental Health First Aid could not be directly assessed.
As an approach to improving mental health literacy, Mental Health First Aid contrasts with broad-scale community education campaigns such as the Defeat Depression Campaign in the UK [9
], the Depression Awareness Recognition and Treatment (DART) program in the USA [10
] and the TIPS project in Norway [11
]. It aims to give more intensive education to a smaller number of interested people rather than less intensive education of the whole community. Of course, these contrasting approaches complement each other. However, a major problem with all mental health literacy campaigns is their sustainability. They require a large amount of government funding and generally run for only a few years. However, Mental Health First Aid has the advantage of being potentially sustainable in the long term. Just like conventional first aid courses, it can be run on a fee-for-service basis and requires no long-term government commitment. Mental Health First Aid was initially funded by a grant from the Australian Capital Territory government, but now that this has ended the course is being run as a fee-for-service program and demand continues, particularly from workplaces.