Mental Health First Aid
Mental Health First Aid (MHFA) is a training course to help laypeople know how to assist individuals with mental health problems or at risk for problems such as depression, anxiety, and substance use disorders. Courses last 8 to 12 hours and include information about signs and symptoms of mental health problems and appropriate responses, as well as interactive activities using MHFA’s five-step action plan: assess risk of self-harm, listen non-judgmentally, reassure and share information, encourage self-help, and encourage professional help. The MHFA curriculum has been adapted for various populations, including youth, older adults, college students, members of the military, and veterans1, 2.
What could this strategy improve?
Expected Benefits
Our evidence rating is based on the likelihood of achieving these outcomes:
Increased knowledge of mental health
Reduced stigma
What does the research say about effectiveness?
There is some evidence that Mental Health First Aid (MHFA) increases participants’ understanding of mental health and confidence helping individuals with mental health problems, and modestly improves attitudes toward mental illness, with small reductions in stigma3, 4, 5. Effects can persist six months post training; longer term effects are unclear4. However, additional evidence is needed to confirm effects and determine whether individuals at risk for or with mental health problems receive more mental health services after engaging with MHFA participants5.
Following participation in MHFA training courses, college students demonstrate increased knowledge of mental health and confidence in their ability to help others1. Participants in a MHFA course adapted for military and veteran populations may improve their responses to others with mental health problems6. In a variety of settings, MHFA has greater effects on participants’ intention to provide help than on help provided, although evidence suggests that such intentions predict future behavior4. MHFA training may support increasing knowledge for individuals without prior mental health training, including reducing stigma7.
Youth Mental Health First Aid (YMHFA) programs, MHFA programs tailored to address youth mental health, are designed to train peer youths and adults who interact with adolescents8, 9 and increase their mental health literacy10. YMHFA appears to improve responses to youth with mental health needsin the juvenile justice system11. Adult participants in a MHFA course adapted for youth appear to increase knowledge about youth emotional distress and confidence assisting young people in psychological distress or crisis12, 13.
MHFA has been shown to modestly increase knowledge about and improve attitudes regarding mental health in Australia, the UK, Sweden, and many other countries4, 14, 15, 16. International studies indicate mixed effects on individuals using the skills learned through the course and no effects on the helpfulness of the trainees’ actions on the recipients’ mental health17.
How could this strategy advance health equity? This strategy is rated inconclusive impact on disparities.
It is unclear what impact Mental Health First Aid can have on disparities in mental health, mental health literacy and knowledge.
Researchers suggest MHFA has the potential to improve awareness of the importance of mental health and promote service use in rural areas, especially when communities strengthen treatment infrastructure19, 20, 21. In under-resourced areas, MHFA has the potential to support school staff in addressing students’ mental health issues10.
What is the relevant historical background?
Mental health conditions and neurodiversity have long been stigmatized by society, seen as a source of shame for both the individuals who suffer from it and their families22. Mental illness was typically viewed as a moral or spiritual failing23; people with mental health conditions were viewed as a burden and ignored or minimized at best. Individuals with more severe issues would be locked in asylums and kept from greater society, where treatments were often brutal, and almost always ineffective24. The system could also be exploited, and those who stepped outside the bounds of society could be subjected to cruelty and incarceration in asylums, and later institutions25.
While society’s understanding of and treatments for mental health have evolved over time, stigma around mental health conditions remains common in many communities22. Stigma against mental health and substance use disorders, as well as distrust of the mental health care system, may prevent those who need help from seeking care, even if it is covered by their insurance26, 27. Barriers in access to care for mental illness are a problem worldwide, and estimates for the U.S. suggest that less than half of individuals with mental illness receive treatment28. In western cultures, including the U.S., there are often assumptions about individuals with mental health conditions, such as the mistaken belief that they are unpredictable or dangerous, contributing to discrimination and social exclusion22, and reducing options for work, education, housing, and social connections29.
Equity Considerations
- Does your community offer Mental Health First Aid programs? What infrastructure, services, and resources are needed to help your local MHFA programs increase participation and thrive?
- Who is at a high risk of poor mental health in your community? Who in your community would benefit from completing a Mental Health First Aid training (i.e., students, parents, community members, etc.)?
- Who should receive MHFA training (e.g., teachers, school staff, community service organizations, parents, law enforcement, etc.)?
- What barriers are there to expanding and distributing MHFA programs in your community?
Implementation Examples
Mental Health First Aid (MHFA) has been implemented in over 29 countries since it was first developed and implemented in Australia in 2001. As of 2025, more than 4.5 million people have been trained in MHFA across the U.S.2.
Due to the significant challenges rural communities face in accessing mental health resources, including shortages of mental health professionals, MHFA has rolled out Mental Health First Aid for Rural Communities. This course is specialized to address the disparities in service access and to harness the unique strength that small, supportive rural communities possess18.
Implementation Resources
‡ Resources with a focus on equity.
MHFA-USA - Mental Health First Aid (MHFA) USA. Be the 1 to make a difference.
MHFA-USA Toolkit - Mental Health First Aid (MHFA) USA. (2021). Teen Mental Health First Aid USA in-person delivery implementation toolkit. Retrieved October 22, 2025.
CDC-Suicide prevention resource 2024 - Centers for Disease Control and Prevention (CDC). (2024, May 15). Promising approaches to promote social connection. Retrieved October 22, 2025.
Footnotes
* Journal subscription may be required for access.
1 Lipson 2014 - Lipson SK, Speer N, Brunwasser S, Hahn E, Eisenberg D. Gatekeeper training and access to mental health care at universities and colleges. Journal of Adolescent Health. 2014;55(5):612-619.
2 MHFA-USA - Mental Health First Aid (MHFA) USA. Be the 1 to make a difference.
3 Cochrane-Richardson 2023 - Richardson, R., Dale, H. E., Robertson, L., Meader, N., Wellby, G., McMillan, D., & Churchill, R. (2023). Mental Health First Aid as a tool for improving mental health and well-being. Cochrane Database of Systematic Reviews, 2023(8).
4 Morgan 2018 - Morgan AJ, Ross A, Reavley NJ. Systematic review and meta-analysis of mental health first aid training: Effects on knowledge, stigma, and helping behaviour. Public Library of Science ONE. 2018;13(5):e0197102.
5 RAND-Wong 2015 - Wong EC, Collins RL, Cerully JL. Reviewing the evidence base for Mental Health First Aid: Is there support for its use with key target populations in California? RAND Health Quarterly. 2015;5(1):19.
6 Mohatt 2017 - Mohatt NV, Boeckmann R, Winkel N, Mohatt DF, Shore J. Military Mental Health First Aid: Development and preliminary efficacy of a community training for improving knowledge, attitudes, and helping behaviors. Military Medicine. 2017;182(1):e1576-e1583.
7 Costa 2020 - Costa, T. F. O., Sampaio, F. M. C., Sequeira, C. A. D. C., Ribeiro, I. M. O. C., & Parola, V. S. D. O. (2021). Review of Mental Health First Aid programs. Western Journal of Nursing Research, 43(12), 1146–1156.
8 Sanchez 2020 - Sánchez, A. M., Latimer, J. D., Scarimbolo, K., Von Der Embse, N. P., Suldo, S. M., & Salvatore, C. R. (2021). Youth Mental Health First Aid (Y-MHFA) trainings for educators: A systematic review. School Mental Health, 13(1), 1–12.
9 Ng 2021 - Ng, S. H., Tan, N. J. H., Luo, Y., Goh, W. S., Ho, R., & Ho, C. S. H. (2021). A systematic review of youth and teen Mental Health First Aid: Improving adolescent mental health. Journal of Adolescent Health, 69(2), 199–210.
10 Wachutka 2025 - Wachutka, K., Echevarria, M., & Walsh, J. (2025). Youth Mental Health First Aid (YMHFA): A change initiative in an underresourced school. The Journal of School Nursing, 41(5), 632–641.
11 Anderson 2020 - Anderson, R., Treger, J., & Lucksted, A. (2020). Youth Mental Health First‐Aid: Juvenile justice staff training to assist youth with mental health concerns. Juvenile and Family Court Journal, 71(1), 19–30.
12 Rose 2017 - Rose T, Leitch J, Collins KS, Frey JJ, Osteen PJ. Effectiveness of Youth Mental Health First Aid USA for social work students. Research on Social Work Practice. 2017:1-12.
13 Aakre 2016 - Aakre JM, Lucksted A, Browning-McNee LA. Evaluation of Youth Mental Health First Aid USA: A program to assist young people in psychological distress. Psychological Services. 2016;13(2):121-126.
14 Hadlaczky 2014 - Hadlaczky G, Hökby S, Mkrtchian A, Carli V, Wasserman D. Mental Health First Aid is an effective public health intervention for improving knowledge, attitudes, and behaviour: A meta-analysis. International Review of Psychiatry. 2014;26(4):467-475.
15 MHFA-England 2017 - MHFA England. Summary of evaluations of Mental Health First Aid. 2017.
16 Svensson 2014 - Svensson B, Hansson L. Effectiveness of Mental Health First Aid training in Sweden. A randomized controlled trial with a six-month and two-year follow-up. PLOS ONE. 2014;9(6):e100911.
17 Forthal 2021 - Forthal, S., Sadowska, K., Pike, K. M., Balachander, M., Jacobsson, K., & Hermosilla, S. (2022). Mental Health First Aid: A systematic review of trainee behavior and recipient mental health outcomes. Psychiatric Services, 73(4), 439–446.
18 MHFA-USA Rural Communities - Mental Health First Aid (MHFA) USA. (n.d.). Mental Health First Aid for rural communities. Retrieved October 22, 2025.
19 Talbot 2017 - Talbot JA, Ziller EC, Szlosek DA. Mental Health First Aid in rural communities: Appropriateness and outcomes. The Journal of Rural Health. 2017;33(1):82-91.
20 Mendenhall 2013 - Mendenhall AN, Jackson SC, Hase S. Mental Health First Aid USA in a rural community: Perceived impact on knowledge, attitudes, and behavior. Social Work in Mental Health. 2013;11(6):563-577.
21 O’Neill 2014 - O’Neill AM, Leyva VL, Humble MN, Lewis ML, Garcia JA. Mental Health First Aid USA: The implementation of a Mental Health First Aid training program in a rural healthcare setting. Contemporary Rural Social Work. 2014;6:117-125.
22 Ahad 2023 - Ahad, A. A., Sanchez-Gonzalez, M., & Junquera, P. (2023). Understanding and addressing mental health stigma across cultures for improving psychiatric care: A narrative review. Cureus, 15(5), e39549
23 NLM-Psychiatric timeline - National Library of Medicine (NLM). Timeline of early psychiatric hospitals & asylums. Early American psychiatry: Diseases of the mind. National Institutes of Health.
24 PBS American Experience-Mental illness - American Experience. A brilliant madness timeline: Treatments for mental illness. PBS Wisconsin.
25 CSP-Mental illness - Concordia University St. Paul (CSP). (2020, July 13). A history of mental illness treatment: Obsolete practices.
26 Heboyan 2021 - Heboyan, V., Douglas, M. D., McGregor, B., & Benevides, T. W. (2021). Impact of mental health insurance legislation on mental health treatment in a longitudinal sample of adolescents. Medical Care, 59(10), 939–946.
27 Carlo 2020 - Carlo, A. D., Barnett, B. S., & Frank, R. G. (2020). Behavioral health parity efforts in the U.S. JAMA, 324(5), 447.
28 Sugarman 2023 - Sugarman DE, Busch AB. Telemental health for clinical assessment and treatment. BMJ. 2023;380:e072398.
29 APA-Stigma - American Psychiatric Association. (2024). Stigma, prejudice and discrimination against people with mental illness.
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