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Improving Outcomes Associated with Mental Health First Aid


Amy Goldstein, Ph.D.
Division of Services and Intervention Research


The goal of this initiative is to further the evidence base for Mental Health First Aid (MHFA), a widely disseminated mental health course in which non-mental health professionals are trained to identify the signs and symptoms of mental illness, in order to facilitate early detection and intervention. Despite wide dissemination, there is little evidence of the program’s impact on referral to and receipt of mental health services or a reduction in mental health symptoms.


MHFA is a mental health literacy program often used as a “gatekeeper” intervention in which non-mental health professionals in community settings are trained to identify indicators of untreated mental illness and intervene by referring at-risk individuals (adults and youth) to accessible settings for further screening and treatment. The program was originally developed in Australia, where it is widely used. MHFA has been widely promoted in the United States recently, in spite of a lack of evidence supporting its effectiveness in improving outcomes for the targeted population (i.e., at-risk individuals who are in need of care). The majority of studies of MHFA have been either uncontrolled trials or program evaluations, focusing on the outcomes of mental health literacy, attitude change, and self-reported behavior among individuals who are trained.1 The only multi-site randomized controlled trial to date that focused on receipt or referral of services was funded by NIMH.2 The study found that training college Resident Advisors in MHFA had no measurable effect on connecting college students to mental health services, although there was an increase in the trained gatekeeper’s own use of mental health services.3

This proposed initiative aims to support a range of studies intended to enhance the effectiveness MHFA for achieving the goals of accurate identification of youth with early mental illness symptoms and referral to the appropriate level of care.

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1Hadlaczky G., Hokby S., Mkrtchian A., Carli V., Wasserman D. Mental Health First Aid is an effective public health intervention for improving knowledge, attitudes and behavior: a meta-analysis. International Review of Psychiatry. 2014; 26: 467-475.
3Lipson SK., Speer N., Brunwasser S., Hahn E., Eisenberg D. Gatekeeper training and access to mental health care at colleges and universities. Journal of Adolescent Health. 2014; 55: 612-619.