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Rural Health Information Hub

May 15, 2014

Mental Health First Aid Offers Helping Hand in Rural Communities

by Candi Helseth

Learn more about Mental Health First Aid in RHIhub's Rural Health Models & Innovations.

After successfully completing her Mental Health First Aid course in Silver City, NM, Mandy Whitenburg hugs MHFA instructor Rebekkah VanNess.

Long before people land in treatment for mental illness, there are signs and symptoms that have often gone ignored. Nearly half of the U.S. population experiences a mental disorder in their lifetime, yet mental illness continues to be a disease habitually surrounded by silence. In rural areas where professional resources are limited, community-based resources such as Mental Health First Aid (MHFA), mental health hotlines and free screenings are being used to identify and support individuals in distress.

Identification and intervention are critical early tools that lead to successful mental health treatment and recovery. Many people are reluctant to approach a distressed individual with mental health needs, yet those same people will quickly extend a helping hand to someone who is physically injured. MHFA is changing those dynamics by equipping laypeople with the knowledge they need to help individuals with mental health issues.

"MHFA is similar to traditional first aid in that it teaches people how to recognize and respond to someone experiencing a crisis," said Atlas Research Vice President Wendy Opsahl, PhD, who recently led a national MHFA rural community outreach project. "Many of us are afraid to approach people we think may have a mental health issue because we don't know what to say or do. MHFA empowers people like you and me with the knowledge and resources we need to know how to respond."

Many rural clinics and hospitals now include mental health and addiction evaluations as part of routine physical examinations. Mental health experts say MHFA complements such existing services.

"MHFA is a perfect fit for rural communities because these areas don't have the concentration and variety of professional services that urban areas do," said MHFA National Trainer Rita McElhany. "So it's even more important that rural residents understand and are competent to respond to mental health issues."

Mental Health First Aid Gaining Ground

As of December 2013, more than 140,000 Americans have been certified as Mental Health First Aiders, according to the National Council for Behavioral Health. McElhany said participants that take the eight-hour MHFA class learn concrete tools they can use to help distressed individuals get appropriate treatment and support.

"I can't tell you how many times I've talked to someone who tells me within a short time of taking the class how they were able to use what they learned," she asserted. "This training is so incredibly powerful!"

Created in 2001 in Australia, MHFA was introduced in the United States in 2008. MHFA USA is coordinated by the National Council for Behavioral Health, the Missouri Department of Mental Health and the Maryland Department of Health and Mental Hygiene. These partners oversee nationwide program quality and standardization, instructor certification, research and program development.

Every state has implemented MHFA to some degree, according to Opsahl. Missouri and New Mexico are among states with the most active MHFA programs and numbers of trainers. Dr. Helene Silverblatt, a University of New Mexico psychiatrist, professor and leader in NM MHFA, calls MHFA a "life-saving intervention."

"Its value is that it isn't limited to the mental health care system, but reaches out to everyone in a community," she stressed. "Ideally, people who take the first aid course might be your hairdresser, a religious leader, a sister or brother…someone the person in crisis may already know and trust. MHFA is an affordable, highly effective way to reach people."

About 4,000 New Mexico residents have taken the First Aid course to date. The roster of 83 certified instructors includes every AHEC director and health extension officer in the state as well as representatives from health and social services, the faith community, law enforcement, schools, city agencies, tribal communities, correction agencies, and volunteer EMS-fire departments. Silverblatt said another 30 instructors will complete training this month.

"We've worked to see that instructors are placed strategically throughout the state and represent our diversity both geographically and culturally," she added. "We have instructors in all the rural regions and are working toward having two in every region. We're also working on developing more bilingual instructors."

In addition to grant funding for MHFA implementation and outreach, New Mexico has been approved for two research grants to study MFHA impact and outcomes, particularly among rural, tribal and underserved communities. New Mexico ranks fifth in the nation for suicide, with those statistics even higher for rural New Mexicans. The state is classified as a Mental Health HPSA (Health Professional Shortage Area) and has a high poverty rate, particularly in rural and tribal regions. Silverblatt said high poverty rates go hand in hand with increases in mental health and addiction issues. She believes the research results will benefit not only her state, but other states as well.

Missouri has 244 instructors and approximately 13,500 residents that have completed the First Aid class. MHFA classes are available in every rural region of the state.

"The support we've received from Governor Jay Nixon, the Legislature and community leaders caused an exponential increase in interest throughout the state and MHFA took off like a rocket here," said McElhany, who coordinates Missouri's rural outreach program.

To gain support in rural regions, McElhany offered free classes to local leaders in law enforcement and city, county, faith-based and school organizations. She said their enthusiasm and word of mouth recommendations have been better than any advertising budget.

Special emphasis is being given to training in school systems. Lafayette County, with 17 rural schools, has been selected for a core initiative to be extended to other school systems. Instructors trained in six school systems are teaching the eight-hour course to all adults in the school that have contact with children.

"Teachers, janitors, coaches, 4-H leaders—if they have student contact, they get training," McElhany stressed. "Anyone a child might encounter is equipped with the basic skills to recognize if this young person could be developing mental health problems. You never know who or when a student is going to choose to confide in someone."

The Missouri Department of Mental Health administers MHFA and distributes state funding for the program. The Missouri Institute of Mental Health (MIMH) administers contracts and distributes funding to community health centers and support resources providing MHFA training and quality assurance.

Increasing MHFA Access Nationwide

More MHFA instructors are still needed in every state, Opsahl said. There are two levels of training: Mental Health First Aid and Youth Mental Health First Aid. Instructors are certified to teach the eight-hour First Aid class anywhere in the United States, although most teach in their own communities or states. Last year, the Health Resources and Services Administration (HRSA) funded the development of a MHFA Rural Curriculum. This component includes instructor training relative to rural areas, such as case studies or scenarios specific to farming-related situations. Training also includes looking at action plans relative to what rural communities can do with non-existent or limited resources and long distances to healthcare services.

MHFA funding varies from state to state. In addition to federal funding, New Mexico and Missouri have funds appropriated through their state legislatures. The National Behavioral Health Council offers assistance for starting a local program and obtaining state funding.

"When you bring MHFA training into rural communities, the overall community level of awareness about resources increases and often leads to greater community collaboration," Opsahl said. "Government-funded organizations, churches and service organizations work together to create better support networks that address mental illness in their communities."

Rural communities have a chronic shortage of behavioral health providers, with approximately 57 percent of federally designated Mental Health HPSAs located in non-metropolitan counties. Twenty percent of the nation's population lives in these rural areas. The most substantial barriers to obtaining mental health and substance abuse services, according to Opsahl, are availability relative to the limited number of providers; accessibility relative to distance to services, transportation factors and financing of services; and acceptability relative to an individual's willingness to seek services given the stigma surrounding mental health and substance abuse.

Peer reviewed studies demonstrate MHFA builds mental health literacy, decreases stigma and helps the public identify, understand, and respond to signs of mental illness and addiction issues. MHFA has a vision: By 2020, Mental Health First Aid in the USA will be as common as CPR and First Aid training.

Sidebar: Resources on Rural Mental Health

Back to: Spring 2014 Issue