A widely used mental health “first aid” course has no good evidence showing that it has any medical benefits, nor has it been carefully investigated to see whether it could cause harm, a major review of the research has found.
The idea behind the Mental Health First Aid programme, first developed in 2000, is to train members of the public to support people with conditions such as depression and anxiety and advise them how to seek medical help. It is now common for workplaces or community groups in many countries to offer the training to non-medical professionals, typically providing it over four half-days, either face-to-face or online.
Participants learn how to spot signs of mental health problems in others; how they can offer basic support, such as non-judgemental listening; and how to steer those affected to professional help. A modified version is also offered to teenagers in some schools.
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Many studies have found that people who do the training have improved knowledge, feel more confident about offering support and believe that it reduces stigma about mental health conditions. But it is unclear whether the courses offer more concrete benefits, such as reducing symptoms of depression or anxiety in the communities targeted.
An analysis last month by the Cochrane Collaboration, an independent medical evidence review body, found there have been 21 randomised trials where Mental Health First Aid training was compared with either doing nothing or offering a control intervention, such as a physical first aid course. They included more than 22,500 people and were in settings such as workplaces, schools and colleges across a variety of countries.
Only five of the trials looked at whether the courses boosted mental health, and these found that any differences between the groups were so small that they could have arisen by chance. There were also problems with the research methods, such as these five studies not including enough people to draw firm conclusions.
“It is striking that a training programme that has been so widely adopted is not better supported by solid evidence that it is effective in improving mental health. This seems to me to be the key test of how well it works,” said , who helped carry out the review, in a .
None of the 21 trials systematically gathered evidence about whether the course could do any harm. “It is not difficult to imagine that there might be disadvantages,” said Richardson. “Would first-aiders ‘take on’ too much – would they feel overly responsible”?
at the University of Melbourne in Australia, who developed the programme, says that while randomised trials are the best way of assessing medicines, it can be hard to carry them out for psychological interventions. “Participants have to agree to random assignment and may not get the intervention they want,” he says. “It can be challenging to recruit participants.”
at the University of New South Wales in Sydney, who wasn’t involved with the study, says the findings will generate concerns for mental health practitioners. “We need to tread carefully when we are running ahead to widely implement initiatives when the evidence base is weak.”
Cochrane Database of Systematic Reviews
