Mental Health First Aid is a course to train people to assess warning signs of behavioral health concerns that is gaining advocates in many countries around the world, including the U.S.  It can have particular benefits for farm and other rural residents where there is a shortage of behavioral health professionals and sometimes a reluctance to seek mental health and substance misuse treatment even when needed.

The intent of Mental Health First Aid (MHFA) is to improve caregiving to persons with behavioral health symptoms through better understanding by trained peers who undertake preliminary mental health assessments and refer persons for appropriate professional follow-up care.  MHFA is designed to improve the well-being of people dealing with behavioral health issues and to prevent their suffering and self-harm. 

The National Council for Behavioral Health (, which facilitates the MHFA project, says that as of December 2013, more than 140,000 persons in communities across the country have been trained in this type of first aid through a network of 3,000 certified instructors.

MHFA training began in Australia in 2001 and has spread through many countries, including Cambodia, Canada, China, England, Japan, Saudi Arabia, and Sweden, as well as the U.S.

Training requirements.  Certified MHFA trainers must complete and pass a forty-hour course and providers must pass an 8-12 hour course and recertify every three years. 

The provider course trains people:

  • To recognize signs of behavioral health problems, including panic, depression, bipolar disorder, schizophrenia, eating disorders, addictions and deliberate self-harm
  • To not be judgmental, but to assess objectively and offer understanding
  • To connect persons needing help with resources for diagnosis and healthcare, such as professionals, but also helping to secure such benefits as self-help, peer and social supports
  • To provide emotional stabilization in times of need
  • And, while focused on 12-25 year-olds, MHFA offers basic tools for assisting people of all ages

Costs.  The cost for the week-long instructor training currently is approximately $1,500 and the cost for the shorter and more focused provider training is about $120. 

The website,, offers additional information about training courses for persons interested in becoming instructors or providers.

An evidence-based practice.  The U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) has determined that MHFA improves the behavioral health knowledge and skills of its trained caregivers and also benefits the recipients of mental health first aid. 

A growing number of scientific studies that have met requirements for objectivity and sound research methods have demonstrated proof of these hypothesized effects.

The training demystifies mental health and increases the awareness of unhealthy behaviors.  Several Australian studies that compared experimental and control groups found that MHFA saved lives, but additional empirical testing elsewhere is needed to clarify MHFA’s role in saving lives.

SAMHSA has determined that MHFA is a promising practice.

Cautions.  A potential concern is that some persons who complete the provider course may think they are able to identify and diagnose behavioral health problems, but this course does not qualify them for these responsibilities. 

Only licensed medical professionals such as physicians, and licensed behavioral health professionals may make diagnoses.  The MHFA program screens prospective trainers and providers who might be prone to assume capacities for which they lack training and certification and who may be otherwise unsuited. 

MHFA is particularly suited for providers who wish to aid their peers and the public, such as law enforcement personnel, emergency medical technicians, school and college staff, veterans, employers, and persons who have a duty to care for others, such as family members of a person who experiences behavioral health problems.

MHFA focuses on prevention of self-harm.  It is understandable why MHFA was devised in Australia, a highly rural country with a greater rate of intentional self-harm among rural residents than among urban residents. 

Like Australia, the U.S. and many countries have a higher rate of intentional self-harm resulting in death among rural than urban dwellers.  Access to professional care may require traveling long distances; MHFA providers can undertake the preliminary screening, stabilization of the person needing follow-up care, referral and transportation as necessary.

MHFA shies away from using words like commit suicide, and for good reason.  These words have acquired a pejorative connotation that makes them seem like sinful acts similar to commit murder or adultery.

The motives of most persons who undertake apparent self-imposed death are usually uncertain and often associated with depression, medical illness or circumstances others are not in a position to judge.

The terms, intentional self-harm and apparent self-imposed death, are less judgmental.  Persons who harm themselves often do not end their own lives, and their behaviors amount to “a cry for help.” 

MHFA aims to detect persons in need of assistance and protection so as to prevent self-harm. 

Farmers, ranchers and other rural residents are starting to take a look at MHFA as a type of training and service that will particularly benefit their communities.

Michael Rosmann is a Harlan, Iowa clinical psychologist (and fly-fisherman) who lives on the farm he shares with his wife.  Contact him at: