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
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
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!"
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
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
"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
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
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
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.