Study: No reliable evidence of mental health first aid’s effectiveness

There is no reliable evidence to suggest that mental health first aid is effective, and studies examining the practice are at a ‘high risk of bias’.

This is according to Cochrane, the charity that examines medical research to help medical professionals formulate an evidence-base for the health interventions they enact.

Researchers reviewed 21 trials of mental health first aid (MHFA) training, involving 22,604 participants, and found that many studies did not measure relevant outcomes, lacked good-quality evidence, were not sufficiently large enough to show potential differences in outcomes, and had a “high risk of bias”.

MFHA is a brief training programme that was developed in Australia, but has been rolled out by hundreds of employers worldwide and is widely used in the UK. Many employers have nominated ‘mental health first aiders’ among their workforce.

The programme covers the symptoms of various mental health conditions, including when someone might be experiencing a crisis, and trainees are often taught how to provide immediate help to people experiencing mental health difficulties and how to signpost to professional services.

However, many employee health and wellbeing professionals have been critical of the programme and have raised concerns about it being used as a tick-box exercise. The pressure it puts on employees who have volunteered as mental health first aiders has also been raised as a concern.

Cochrane’s Mental Health First Aid as a tool for improving mental health and well‐being report found that the 15 studies that compared MHFA training with no other intervention showed that MHFA “may have little to no effect on the mental health of individuals at six to 12 months, but the evidence is very uncertain”.

No study measured mental health service usage at six to 12 months, and the researchers could not find published data on any adverse effects or harms resulting from MHFA.

Only one study with usable data compared MHFA training with an alternative mental health literacy intervention, but it did not measure outcomes in individuals in the community, nor did it examine outcomes at six to 12 months after the training programme was completed.

The authors concluded there was a “lack of good quality evidence” as to the efficacy of MHFA training.

Lead author of the review Rachel Richardson, a researcher at Cochrane, told OHW+ that they found only a small number of papers that attempted to answer the question of whether MHFA training actually improves the mental health of employees.

She said: “The evidence that we did find was of very low certainty – there were flaws in the way that the research had been designed and carried out which made the findings less reliable.

“Broadly speaking, we did find some evidence that MHFA training may improve mental health literacy and reduce stigma among trainees, although there were frequently too few people included in the studies to be able to reach definitive conclusions.”

Richardson suggested that employers should consider what they are aiming to achieve and then decide on an intervention based on the evidence available.

“If the aim is to improve the mental health and wellbeing of staff, for example, then there is no good evidence that MHFA will achieve this,” she said.

“Unfortunately, looking at other interventions, it’s clear research has not delivered the evidence that we would like to use as the basis for any generally applicable shift in policy or workplace practices to improve employees’ mental health. In the absence of any such broad interventions, employers might like to ask staff whether there are specific issues in the workplace that negatively affect their mental health and address these directly,” Richardson added.

Earlier this year Conservative MP Dean Russell proposed legislation that would make offering MHFA training a legal requirement in UK workplaces, however there has been no indication this would be taken forward.