In Australia, 1 in 5 people will experience a mental illness each year, and while first aid training for physical conditions and injury is widely accepted most courses don't cover the skills required in a mental health crisis.

As a result, Mental Health First Aid (MHFA) is gaining momentum as a valuable skill set for healthcare professionals to provide first response care in a mental health crisis.

Mental health first aid training is particularly necessary for nurses who frequently interact with people diagnosed mental health disorders, those at high risk of mental health conditions and people experiencing a mental health crisis, explained Mental Health Nurse Denise Warmington.

A Principal Master Instructor for Mental Health First Aid Australia Ms Warmington said: “The MHFA Action Plan, which participants learn in an MHFA course, provides a framework for nurses to use when they have a conversation with someone about their mental health and to encourage them to seek appropriate professional help.

“Mental health first aid training teaches participants to identify signs of a developing mental health problem and signs of a crisis and how to provide appropriate support, including crisis first aid,” said Ms Warmington.

What is a mental health crisis?

A mental health crisis is an emergency in which an individual is in danger of harming themselves or others. In a hospital setting, harm may be inflicted on the patient, a nurse, other staff or patients on the ward. 

What is Mental Health First Aid?

Mental Health First Aid is a universal training program, available in 23 countries, that teaches people how to help a person developing a mental health problem, experiencing an escalation of an existing mental health problem or in a mental health crisis.

Mental health first aid training for patient care

Clinical Adviser for Beyond Blue, Dr Grant Blashki, said the hospital setting could be stressful for patients diagnosed with a mental health condition, and nurses are highly trusted health professionals who can be the first point of call.

“Apart from the highly specialised skills of mental health nurses, all nurses need a suite of basic mental health skills.

“Mental health symptoms that can be exacerbated in a hospital setting include anxiety, sleep problems, depression and, for people with psychotic or bipolar disorders, in particular, the change in routine can increase the risk of relapse.

“Basic mental health skills are essential for all general nurses during their undergraduate training and throughout their career.

“This includes listening and empathic counselling skills, understanding the main diagnostic categories, awareness of and access to psychoeducation materials, and knowledge of the various treatment types.

“For most nurses, some simple counselling skills such as problem-solving, activity planning and cognitive behaviour therapy techniques can be useful in everyday work with patients.

“There are evidence-based resources on the Beyond Blue website such as fact sheets and information about the various mental health conditions that can be a great resource for nurses and patients alike,” said Dr Blashki.

Mental health first aid training for peer support

Mental health first aid training is also invaluable to support colleagues at risk of mental health conditions, said Ms Warmington, as health professionals experience higher rates of mental health problems.

The National Mental Health Survey of Doctors and Medical Students found that doctors reported substantially higher rates of psychological distress and suicidal thoughts compared to both the Australian population and other Australian professionals.

“The MHFA courses teach participants how to use the Action Plan in a variety of settings including how to offer support to a peer,” said Ms Warmington.

Mental health first aid training in action

A study of over 15,728 nursing students who received MHFA revealed that participants experienced positive effects on intentions to provide MHFA and confidence in helping a peer, improvements in MHFA knowledge and a reduction in stigma.

“Participants consistently reported finding the MHFA course beneficial and of finding the knowledge and practical skills learnt relevant to their nursing practice,” said Ms Warmington.
Mental Health Nurse Consultant, and facilitator of ‘Mental health. You’re already doing it’, Sharyn Amos, said nurses are on the frontline and need better access to mental health first aid training.
“They have a unique opportunity to provide holistic care in the primary care setting.  The training provides nurses with the skill set to manage the many levels of complexity that present with a patient in the primary care setting. 
“The training gives nurses the skills and confidence to explore what is happening with the patient's mental state. This can then translate to supporting the client to access services, see their general practitioner or nurse practitioner to discuss their mental health,” said Ms Amos.
Despite this, training is not always supported, especially for nurses working in smaller clinics, so there can be a financial burden.
“The key issue is that nurses in primary care may have greater difficulty in accessing free education and time to attend education that is funded.
“If the training is not supported with coverage of nurse hours there is significant pressure to not attend to the training,” said Ms Amos.

Mental health: You’re already doing it

The topics covered in this MHFA training course include: 

• What is mental health?
• Mental health problems vis mental illness
• What contributes to first episode mental health disorders in older Australians
• Biopsychosocial view of mental health
• Mental health assessment
• What to look for as part of a mental health assessment
• Risk and what does risk look like
• Chronic pain and assessment tools used in primary care
• Treatment for chronic pain and the relationship with addiction
• Stages of the addiction cycle
• Screening tools used to understand a person's use of, i.e. alcohol
• How to ask the difficult questions
• When to refer and whom to refer to at the local level
• Self-care and the importance of self-care for nurses
• Information on where to seek support as a nurse

Key learning objectives:

• Improve understanding of the complexity of issues (biological, psychological and social) impacting on an individual
• Highlighting how a more holistic, biopsychosocial response to mental health can correlate with improved outcomes for people
• To improve knowledge of current mental health tools
• The impact of mental health for the aging population
• Learning about the role and impact of stigma for a person with a mental illness
• Learning about the impact of chronic pain
• Learning about addiction and the relationship with mental health
• To improve understanding of the importance of looking after self.

Mental health training benefits all areas of nursing practice

Comprehensive mental health curricula would benefit all areas of nursing, but it would compete for time and resources against other equally essential nursing subjects, said Brett Holmes, General Secretary, NSW Nurses and Midwives' Association.

“Competent mental health practice requires practical experience to fully develop and utilise the skills necessary. This translates to more time in clinical placements, which is already in short supply in NSW, even now with student mental health placements.

“Individual nurses’ preparedness to cope with mental health challenges often depends on their level of education, experience and personal resilience.

“But a more comprehensive mental health education would help to strengthen their knowledge and expand their skill set,” said Mr Holmes.