Case Study: Mental Health First Aid

MENTAL HEALTH FIRST AID

The issue

A key aim of the MERIT Vanguard is to develop and implement an evidence based model of recovery to help people with mental health problems in their journey to recovery. We undertook a systematic review of the research evidence to clearly identify the key factors which have been shown to positively enhance such recovery.

This identified that focusing our efforts on work within the Trusts alone was unlikely to achieve this goal. It clearly suggested a need to develop stronger community connections which would enable more support to be offered to people with mental health problems within their communities, and also reduce the ignorance and stigma which can often make recovery more difficult.We looked at a number of different tools which might do this and concluded that Mental Health First Aid training offered what we needed.

Intervention chosen

Mental Health First Aid (MHFA) was first developed in Australia in 2001 and brought to England in 2007.

The aims of MHFA training are to:

• increase the population’s understanding of their own and others’ mental health,
• increase both knowledge and confidence in how to support someone experiencing a mental health issue
• empower people by connecting them to support networks and resources, and
• reduce the stigma often associated with mental ill health.

It therefore seemed to fit well with our key objectives.It was also evidence based. Repeated evaluations have shown that the skills learnt on MHFA courses are used by between 68.5% - 88% of Mental Health First Aiders if they encounter someone experiencing mental ill health after attending a course, with many providing support to more than one person.It has also been demonstrated to have a direct positive impact on attendees’ own mental health and wellbeing, with many reporting an increased ability to manage their own mental health.

MHFA is also well established and is supported by a Community Interest Company, Mental Health First Aid England, who provide training materials, feedback forms and ongoing support.

In addition, one of our trusts (BSMHFT) has been delivering this training to staff, carers and patients and community members for the last two years, and so we had a level of expertise internally that we could use to develop and grow this across the other three trusts and beyond, into the wider community.

The training delivered by BSMHFT has been well received with consistently positive feedback from a wide range of participants from a very diverse population. They had mainly delivered this through their Community engagement team up to this point, offering both the standard two day course and also a three hour MHFA lite three hour taster course.Many people who undertook the lite course went on to do the two day programme or to recommend it for their workplace.

How it was implemented

In order to deliver the MHFA training trusts need to train people to deliver this training and, equally importantly, ensure that these instructors have sufficient availability to run MHFA courses on a regular basis.

A course to train one MHFA instructor (run by MHFA England) typically takes 7 days, spread over six weeks, and costs around £2,800 per person.In addition, once trained, the trainee instructor has to teach two supervised courses before gaining full accreditation.

MHFA England values the two-day course at £300 per person and recommends that courses accommodate up to 16 people[1].Courses are typically delivered by two trainers who would, typically, be at a band 5 or 6 banding.

MERIT already had three people trained to deliver MHFA training, but they all came from just one of the four trusts.The Vanguard funding is enabling us to train further instructors and to expand this programme across all trusts.

The instructors currently have clinical or recovery focused jobs within the Trust.Whilst some can fit these courses into their current job, others have found this difficult. Two experts by experience were part of the first cohort of instructors trained Moving forward we are planning to recruit and train additional instructors from our wider workforce as well as from the strong body of Experts by Experience (ie, service users) who already work with us on a number of programmes such as offering peer support.We are also exploring working more closely with local third sector organisations and faith communities some of which also deliver this training.

Trainers need to have the resources to organise courses, advertise these and recruit people to courses.The cost of running a course includes:

• Resources to organise courses;
• The cost of instructor time;
• The cost of training materials, including a manual for each participant.

The model used to date has been to offer some courses to paying participants and then to use some of this income to fund the training for those people who can’t afford to pay, such as carers.Courses have been offered through a number of routes including through already established recovery colleges, community centres and workplaces. Venues for the training have included:

• A local large construction firm;
• Universities;
• Gurdwaras;
• Islamic Relief;
• Mosques;
• Community Housing Associations;
• Mental Health Trust premises;
• A Somali community centre.

It is certainly possible, with this model, to ensure that the costs of delivering the course can be recouped through charging in this way which makes it much more sustainable given the ongoing financial constraints within the NHS.

We are currently working with a number of large employers in the region who wish to purchase this training for their employees and see this as a key way forward.

At the same time as the Vanguard has been developing our work, the West Midlands Combined Authority (WMCA) was developing a region-wide strategy to focus on improving the mental health of the local population.One of the key aims of this strategy is to train up to half a million people in MHFA techniques over the next ten years.As MERIT represents the Mental Health Trusts which cover much of the same footprint as the WMCA, we are working closely with the WMCA Mental Health Commission to ensure that we can support each other to deliver our key aims.

Our journey so far:

• Undertook a systematic review of the most effective tools to support mental health recovery.
• Identified mental health first aid training as a key tool that we wished to adopt/use.
• Reviewed the current position across MERIT and confirmed that just one trust currently had instructors and could offer this training.
• Obtained funding and commissioned MHFA to set up a dedicated course to train 12 instructors from across MERIT (provisionally three from each of the partner Trusts).
• Offered the training to each trust and asked for nominations to attend.
• Course went ahead and trained 12 people.
• Next three months – new trainers set up courses locally which they could deliver as part of their supervision, so that they could gain full accreditation.
• Next two months – delivered courses.
• Now ready to go and set up local programmes of MHFA in their own trusts.
• This requires more work to establish the best way to do this in each trust. An options paper is in development but for reasons of commercial confidentiality, we do not wish to share this at this time.This also includes plans to identify a larger cohort of instructors, perhaps on a dedicated basis, and a strategy to manage this work hereafter so that it can be significantly upscaled and made more sustainable.

We feel that although progress has been made, we are still very much in the implementation phase of this piece of work.

Impact

Our first cohort of 11 instructors was trained in December 2016. One of our four Vanguard trusts was unable to release anyone to attend, so places were taken up by three trusts.

280 people have received the training across the four trusts, however the majority of these (71%) have been trained by BSMHFT as they already have the infrastructure in place, together with a greater number of instructors.

MHFA England provide a standard evaluation form which participants complete immediately after their training.This shows consistently high percentages of participants saying that the course increased their knowledge and understanding of mental health as well as their confidence and ability to help someone with mental ill health.They also said that as a result of the training they are less likely to judge people with MH issues negatively.

Our independent evaluation partner is building on this to follow up course participants between three and six months after they have completed a course, to find out what impact this has had both on themselves and their family and friends, local community or workplace.

Conditions for success

We are implementing MHFA training as part of a system wide focus on recovery.The training alone can add impact, but is likely to be much more successful if delivered within a whole system which focuses clearly on mental health recovery and sees this as a priority.

Other key factors for this to work include:

• Availability of funding to train instructors.
• Organisations who are willing to release instructors from other duties (where relevant) to concentrate on delivering this training.
• Administrative support to organise training and the administrative tasks that go with this.
• Marketing and promotion of courses to private sector will require sustained effort.

We are planning a funding workshop to be held with stakeholders/ commissioners (inc WMCA) to discuss joint bids and long term funding strategy/approaches to this and other elements of our Recovery strategy. Two STPs across the West Midlands are also now investing in MHFA Train the Trainer events and have partnered with MERIT to organise and roll this out.

Learning from key challenges

We have faced a number of challenges in implementing this programme.Getting each trust to identify and release individuals for the seven-day MHFA Instructor course proved very difficult.

Because of funding confirmation, the notice to attend the courses was fairly short which led to difficulties for participants and their organisations. We left it to each organisation to put names forwards and did not screen people.

Some of the people who eventually went on the course and completed the training were in roles which meant that they have only limited time to actually offer the training once back in their day job. This has restricted the number of courses offered in some trusts, in some cases very significantly. In hindsight, we would have made this clearer to participating organisations and made it a condition of training that each instructor should be available to deliver a set number of courses each year.In addition, it is intended to recruit further instructors from non-clinical groups, whose release from their everyday duties may be easier to secure. Currently the number of future MHFA course dates is low at some of the Vanguard trusts.

Another challenge that we faced was that some of the training resources including video clips) provided by MHFA England did not reflect the diversity found in the West Midlands population.

To address this, the Vanguard trusts worked together to make a series of training films featuring people who have experienced or cared for people with mental ill health from across our local communities, appointing Fresh@CU, part of Coventry University, as the film-making partner. The training clips now available are now much more representative of our local communities. They also cover specific issues relevant to them for example djinns, which are a prevalent belief in some Muslim communities, and the additional pressures presented being an lesbian, gay, bi-sexual or transgender user of mental health services.Seven films have so far been made, with an option to make three more (subject to the availability of service users who were unable to make the original filming dates). These will be shared with MHFA who will be able to offer them to other Trusts with similarly diverse local communities.

To address the challenge of how our Vanguard will take this forward, in particular to clarity how this work can continue to expand in a sustainable manner and can dovetail with the aspirations of our key partners we have put together an options paper. This covers potential use of internal, private sector and third sector provision.It describes the likely costings involved in providing the training package, particularly using the competitive advantage which NHS trusts may enjoy in the mental health training marketplace.

In common with other aspects of the Vanguard’s work, an evaluation will examine the impact this work has made (for publication at the end of the funding period in Spring 2018).

Further information

If you should require further information, please contact us.

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