Imagine yourself in one of the following situations:
- You are shopping in a large crowded supermarket and join a long queue at a checkout. You notice that the woman in front of you is looking around in a distracted manner; she seems to become increasingly confused and very breathless
- You notice that a work colleague has been losing weight recently and looks tired; she does not seem to be coping with her normal work activities and tells you she has stopped doing her normal obbies. One day you find her tearful and crying.
- Your teenage son seems to be becoming more and more isolated and does not interact with his friends any longer. He spends a lot of time alone in his bedroom. One day when you enter his room you see that he has covered the window with dark material and also covered his television, radio and mirror. You feel uneasy (see note 1).
Would you know what to do in these situations? Would you know what to say? First aid courses teach the public how to assist someone in a physical health emergency, such as a heart attack or accident, but they do not teach people how to respond to someone developing a mental illness
It was this observation by an Australian nurse named Betty Kitchener, which later grew into an idea and then a project proposal put together by herself and her husband Tony Jorum, a professor at Melbourne University.
Out of that was born Mental Health First Aid- a 12 hour course to give ordinary people the skills to help someone who is developing a mental health problem. This is about early intervention, helping and supporting someone experiencing mental health issues before this escalates into something more serious. Volunteers do not treat mental illness as a professional would; they support and signpost, listen and respond in ways that are sensitive, effective and practical.
Why is such an early intervention approach so important? because of the considerable cost in added human suffering, not to mention the monetary costs, of a ‘do-nothing’ approach.
- if we look at the human cost, common sense is supported by research which shows that early intervention (see report radical efficiency section on Mental Health First Aid) has a proven impact for depression, anxiety, psychosis and for people with with substance abuse – and a much greater chance of recovery. Conversely, late intervention means that illness is prolonged and recovery is slower and less certain. At present there is a significant gap between the number of patients who seek treatment and the people who actually need it.
- the monetary costs are eye-watering. Adult mental health costs the UK government £10bn each year in benefit payments alone – which in turn is part of a bigger figure of £48.6 billion (service costs £22.5 billion plus lost earnings £26.1 billion).
Yet according to Health England ‘Prevention and preventative spending’ 2009, only 3.7% of health expenditure in England is spent on preventative interventions, while only £2 million is spent on mental health promotion activities like promoting self-esteem and coping skills.
Mental Health First Aid helps personal development and builds community capacity
Mental Health First Aid is not a magic bullet for human suffering, rather, it is a skillset and awareness raising approach that can be widely shared and embedded in communities and local businesses. It builds individual capacity to be more effective and empathetic as a neighbour and friend; it also develops community resilience to cope with the social and psychological impacts resulting from continuing economic recession and high unemployment.
Such courses also demonstrate a powerful, grassroots way of tacking the stigma of mental illness. While it is very difficult to measure what doesn’t happen – and early intervention strategies fall into that category- research is much clearer about the impact on volunteer participants to the training programme. Many come away with much greater empathy and awareness, with the confidence to support someone in difficulty and the willingness to challenge mental health stigmas. Moreover, a good few who go on such courses , have themselves been touched by mental illness – and the research suggests the course is also beneficiall to their wellbeing. (see Perspectives in Public Health Publication)
The key to its success
It is worth looking at how Mental Health First Aid was developed as a programme, because of its potential as a training model for other health and social issues. For take note: this is not a social enterprise, nor public sector delivery programme. There is no central organisation, no franchise or corporate ‘brand’ with all the accompanying intellectual property right and copyright restrictions. It is essentially a toolkit and training package. Yet since the year 2000 it has spread rapidly from Australia to twenty other countries including, Japan, Canada, Finland, South Africa – with next to no government money. ‘Brand’, such as it is, is the incidental outcome of a very successful programme.
There seem to be two key factors highlighted by the report ‘Radical Efficiency’.
The first is a co-design approach: while Betty Kitchener and Tony Jorum are both health experts, they put immense efforts into ongoing evaluation and rapid modifications of the programme. Betty gave the first MHFA courses for free on the condition that participants agreed to participate in an evaluation of the project.
“I think it’s the answer to the secret of the program…we couldn’t do it either of us individually, it is having the quality of research and evaluation and Betty being an expert trainer.”
Scalability is the second key ingredient: MHFA had to be capable of working and spreading effectively throughout society. And that meant partnerships with existing community organisations rather than setting up a separate organisation. It is community organisations that have the trust, local knowledge and social networks to both promote the course and the benefits it offered.
As a result, MHFA courses are delivered by a wide variety of organisaions. The Red Cross deliver courses alongside traditional First Aid courses. Other participating organisations include telephone help lines, marriage guidance counsellors, religious organisations and the police – and a glance at MHFA England website will show Unilver, the Royal British Legion, Tata steel and the YMCA>>>
It is trust and familiarity, the values that communty organisations offer, are critical. As the report says “people with mental illnesses are more likely to seek help when approached by a person or oganisation they are familiar with”.
Could this approach be applied elsewhere?
What applies to mental health also applies to other issues, whether we are talking about alcohol or drug abuse, anti social behaviour issues or household debt. People are more likely to seek help from other people and organisatons they know. To take household debt, the success of door step lending with its exorbitant interest rates is due in part because the lender is known to a client or introduced by a friend. What attracts people to doorstep lending is the ease and convenience; very few understand the very real financial dangers they are putting themselves and their families in. If there were a toolkit and training programme modelled on the same lines, which also informed participants of valuable alternatives such as Credit Unions, might this grass roots approach be far more effective than the top down PR broadcast campaigns favoured by central government?
note 1: all three examples are taken from ‘perspectives in public health’ paper on the MHFA England website