Mental Health First Aid Training: A Study of Community Members’ Pre and Post-training Responses to a 17-Item Questionnaire

Main Article Content

Abdulhameed Abdullah Al-Habeeb
Haifa Saad Aleshaiwi
Naseem Akhtar Qureshi


Background: Mental Health First Aid, an important component of metal health educational programs, targets naive community members, public, allied mental health personnel, and mental health experts with specific reference as to how these trained aiders should help people in crisis or with mental health conditions in the community.

Objective: This study aimed to describe pre-to-post-test assessment of those who were trained in MHFA program.

Setting: National Center for Mental Health Promotion, Riyadh, Saudi Arabia.

Methods: Trained mental health professionals organized MHFA courses (n=35) for training self-selected, nonrandomized community members (n=862) who were assessed pre-to-post training by using an adapted 17-item questionnaire for measuring the impact of MHFA course on their mental health knowledge, perception, attitude and practice.

Results: The participants’ responses to questionnaire were varied at pre-and post-test evaluation and 65% of them showed mild to significant positive changes in their responses, and the rest were not affected positively after this course, possibly attributed to multiple factors related to naïve community trainees, advanced questionnaire, short timeline and dissimilar instructors.

Conclusion: Although all participants well received the MHFA courses, 65% of participants’ pre-to-post-test responses improved positively. The preliminary results of this study are not generalizable to the whole community, need to be cautiously interpreted and this research is calling for more studies especially randomized controlled trials in future.

Mental health first aid, training course, community members, pre-and post-test design

Article Details

How to Cite
Al-Habeeb, A. A., Aleshaiwi, H. S., & Qureshi, N. A. (2020). Mental Health First Aid Training: A Study of Community Members’ Pre and Post-training Responses to a 17-Item Questionnaire. International Neuropsychiatric Disease Journal, 14(1), 16-31.
Original Research Article


Kitchener BA, Jorm AF, Kelly CM. Mental health first aid manual. 3rd Ed. Melbourne: Mental Health First Aid Australia; 2013.

Adams SHGD. Mental health first aid for firearm owners: Addressing the elephant in the room. Alternative Law Journal. 2019;1-6.

Kitchener BA, Jorm A. Mental health first aid training for the public: Evaluation of effects on knowledge, attitudes and helping behavior. BMC Psychiatry. 2002;2:10.

Kitchener B, Jorm A. Mental health first aid training in a workplace setting: A randomized controlled trial. BMC Psychiatry. 2004;4:23.

Kitchener BA, Jorm AF. Mental health first aid training: Review of evaluation studies. Australian New Zealand Journal Psychiatry. 2006;40:6-8.

Jorm A, Kitchener B, O’ Kearney R, Dear K. Mental health first aid training of the public in a rural area: A cluster randomized trial. BMC Psychiatry. 2004;4:33.

Jorm A, Kitchener B, Sawyer M, Scales H, Cvetkovski S. Mental health first aid training for high school teachers: A cluster randomized trial. BMC Psychiatry. 2010;10:51.

Jorm AF, Nicholas A, Pirkis J, Rossetto A, Fischer JA, Reavley NJ. Quality of assistance provided by members of the Australian public to a person at risk of suicide: Associations with training experiences and sociodemographic factors in a national survey. BMC Psychiatry. 2019;19(1):68.

Qureshi NA, Alduraihem RA, Aldossari SM, Al-Habeeb AA. Epidemiological trends, risk factors and prevention strategies of suicide. A critical review of relevant literature. Journal Advances Medicine and Medical Research. 2020;11:51-70.

Jorm AF, Korten AE, Jacomb PA, Christensen H, Rodgers B, Pollitt P. ‘Mental health literacy’: A survey of the public’s ability to recognise mental disorders and their beliefs about the effectiveness of treatment. Medical Journal Australia. 1997;166:182-186.

Jorm A. Mental health literacy. Public knowledge and beliefs about mental disorders. British Journal Psychiatry. 2000;177:396-401.

Minas H, Colucci E, Jorm AF. Evaluation of mental health first aid training with members of the Vietnamese community in Melbourne, Australia. International Journal Mental Health Systems. 2009;3(1):19.

O’Reilly CL, Bell Skelly PJ, Chen TF. Impact of mental health first aid training on pharmacy students’ knowledge, attitudes and self-reported behaviour: A controlled trial. Australian New Zealand Journal Psychiatry. 2011;45:549-557.

Sartore GM, Kelly B, Stain HJ, Fuller J, Fragar L, Tonna A. Improving mental health capacity in rural communities: Mental health first aid delivery in drought‐affected rural New South Wales. Australian Journal Rural Health. 2008;16(5):313-318.

Hart LM, Morgan AJ, Rossetto A, Kelly CM, Mackinnon A, Jorm AF. Helping adolescents to better support their peers with a mental health problem: A cluster randomized cross-over trial of teen mental health first aid. Australian New Zealand Journal Psychiatry. 2018;52:638-561.

Reavley NJ, Morgan AJ, Fischer J, Kitchener B, Bovopoulos N, Jorm AF. Effectiveness of eLearning and blended modes of delivery of mental health first aid training in the workplace: Randomized controlled trial. BMC Psychiatry. 2018;18: 312.

Jorm AF, Mackinnon AJ, Hart LM, Reavley NJ, Morgan AJ. Effect of community members’ willingness to disclose a mental disorder on their psychiatric symptom scores: Analysis of data from two randomized controlled trials of mental health first aid training. Epidemiology Psychiatric Sciences. 2020;29:e46,1-5.

Haggerty D, Carlson JS, McNall M, Lee KS, Williams S. Exploring youth mental health first aider training outcomes by workforce affiliation: A survey of project AWARE participants. School Mental Health. 2019;11:345-356.

Tyler JN. Exploring the use of youth mental health first aid skills in schools (Thesis). Georgia State University; 2020.

Jorm AF, Kitchener BA, Mugford SK. Experiences in applying skills learned in a mental health first aid training course: A qualitative study of participants' stories. BMC Psychiatry. 2005;5:43.

Janusonyte G, Lawani K, Hare B, Lawrence M. Evaluating the impact of Mental Health First Aid (MHFA) training for UK construction workers. In: The International Council for Research and Innovation in Building and Construction (CIB) World Building Congress. Constructing Smart Cities; 2019.

Lee OE, Tokmic F. Effectiveness of mental health first aid training for underserved Latinx and Asian American immigrant communities. Mental Health & Prevention. 2019;13:68-74.

El-Den S, Moles R, Choong HJ, O’Reilly C. Mental health first aid training and assessment among university students: A systematic review. Journal American Pharmacists Association; 2020. (Advanced Publication).

Crone DM, Sarkar M, Curran T, Baker CM, Hill D, Loughren EA, Dickson T, Parker A. Mental health first aid for the UK Armed Forces. Health Promotion International. 2020;35(1):132-9.

Jorm AF, Kitchener BA, Reavley NJ. Mental health first aid training: Lessons learned from the global spread of a community education program. World Psychiatry. 2019;18(2):142-143.

Link BG, Phelan JC, Bresnahan M, Stueve A, Pescosolido BA. Public conceptions of mental illness: Labels, causes, dangerousness and social distance. American Journal Public Health. 1999;89: 1328-1333.

Jorm AF, Korten AE, Jacomb PA, Rodgers B, Pollitt P, Christensen H, Henderson S. Helpfulness of interventions for mental disorders: Beliefs of health professionals compared with the general public. British Journal Psychiatry. 1997;171:233-237.

Gysin-Maillart A, Soravia L, Schwab S. Attempted suicide short intervention program influences coping among patients with a history of attempted suicide. Journal Affective Disorders. 2020;264:393-399.

Krysinska K, Heller TS, De Leo D. Suicide and deliberate self-harm in personality disorders. Current Opinion Psychiatry. 2006;19(1):95-101.

Ferrara M, Terrinoni A, Williams R. Non-suicidal self-injury (NSSI) in adolescent inpatients: Assessing personality features and attitude toward death. Child Adolescent Psychiatry Mental Health. 2012;6(1):12.

VanWinkle K, Kaur S, Parsh B. Screening adolescents for suicide risk. Nursing. 2020;50(2):19-20.

The Joint Commission. Detecting and treating suicide ideation in all settings. Sentinel Event Alert. 2016;56.

Suicide Prevention and Resource Center. Suicide screening and assessment; 2014. 91814%20final.pdf

Maj M. Physical health care in persons with severe mental illness: A public health and ethical priority. World Psychiatry. 2009;8(1):1.

Hardy S, Price B. Well-being, physical and mental health: Part 1. Mental Health Practice. 2020;23(1).

Eisenberg D, Golberstein E, Gollust SE. Help-seeking and access to mental health care in a university student population. Medical Care. 2007;594-601.

World Health Organization. Mental health: Strengthening mental health promotion (Fact Sheet No 220). Geneva: WHO; 2007.

World Health Organization; Commission on Social Determinants of Health. Closing the gap in a generation: Health equity through action on the social determinants of health.

Cuijpers P, Van Straten A, Andersson G, Van Oppen P. Psychotherapy for depression in adults: A meta-analysis of comparative outcome studies. Journal Consulting Clinical Psychology. 2008; 76(6):909.

Cuijpers P, Karyotaki E, Eckshtain D, Ng MY, Corteselli KA, Noma H, Quero S, Weisz JR. Psychotherapy for depression across different age groups: A systematic review and meta-analysis. JAMA Psychiatry; 2020.

Castro A, Gili M, Ricci-Cabello I, Roca M, Gilbody S, Perez-Ara MÁ, et al. Effectiveness and adherence of telephone-administered psychotherapy for depression: A systematic review and meta-analysis. Journal Affective Disorders. 2020;260:514-26.

Bjørklund LB, Horsdal HT, Mors O, Gasse C, Østergaard SD. Psychopharmacological treatment of psychotic mania and psychotic bipolar depression compared to non-psychotic mania and non-psychotic bipolar depression. Bipolar Disorders. 2017;19(6):505-512.

Pilarinos A, Barker B, Nosova E, Milloy MJ, Hayashi K, Wood E, et al. Coercion into addiction treatment and subsequent substance use patterns among people who use illicit drugs in Vancouver, Canada. Addiction. 2020;115(1):97-106.

Szmukler G. Involuntary detention and treatment: Are we edging toward a “Paradigm Shift”? Schizophrenia Bulletin. 2020;46(2):231–235.

Lauckner C, Warnock CA, Schipani-McLaughlin AM, Lambert DN, Muilenburg JL. The relationship between perceived parental leniency, access to alcohol at home, and alcohol consumption and consequences among rural adolescents. Journal Rural Mental Health. 2020;44(1): 26.

Burda C. Substance use disorders: Semantics and stigma. The Nurse Practitioner. 2020;45(1):14-17.

Smith PH, Chhipa M, Bystrik J, Roy J, Goodwin RD, McKee SA. Cigarette smoking among those with mental disorders in the US population: 2012–2013 update. Tobacco Control. 2020;29(1):29-35.

Streck JM, Weinberger AH, Pacek LR, Gbedemah M, Goodwin RD. Cigarette smoking quit rates among persons with serious psychological distress in the United States from 2008 to 2016: Are mental health disparities in cigarette use increasing? Nicotine Tobacco Research. 2020;22(1):130-134.

Harwood RH. How to deal with violent and aggressive patients in acute medical settings? Journal Royal College Physicians (Edinburgh). 2017;47(2):94-101.

Strachan LP, Hyett MP, McEvoy PM. Imagery rescripting for anxiety disorders and obsessive-compulsive disorder: Recent advances and future directions. Current Psychiatry Reports. 2020;22(4):1-8.

Tayem YI, Jahrami HA, Ali MK, Hattab SW. Ambulatory pharmacotherapy of five psychiatric disorders in Bahrain: A descriptive study. Psychiatric Quarterly. 2020;1-0.

Camacho-Gomez M, Castellvi P. Effectiveness of family intervention for preventing relapse in first-episode psychosis until 24 months of follow-up: A systematic review with meta-analysis of randomized controlled trials. Schizophrenia Bulletin. 2020;46(1):98-109.

Roca M, Vilaregut A, Palma C, Barón FJ, Campreciós M, Mercadal L. Basic family relations, parental bonding and dyadic adjustment in families with a member with psychosis. Community Mental Health Journal. 2020;1-7.

Maxwell A, Tsoutsoulis K, Menon Tarur Padinjareveettil A, Zivkovic F, Rogers JM. Longitudinal analysis of statistical and clinically significant psychosocial change following mental health rehabilitation. Disability Rehabilitation. 2019;41(24):2927-39.

Aly R, Naeem F, Javed A. Psychosocial interventions in rehabilitation: An intercultural perspective. In: Intercultural Psychotherapy. Springer, Cham. 2020; 361-376.

Freudenreich O. Forensic aspects of schizophrenia care. In: Psychotic Disorders. Humana, Cham. 2020;435-450.

Maylea C, Ryan CJ. Decision-making capacity and the Victorian mental health tribunal. International Journal Mental Health Capacity Law. 2018;2017(23):87-108.

Meuret AE, Tunnell N, Roque A. Anxiety disorders and medical comorbidity: Treatment implications. In: Anxiety Disorders. Springer, Singapore. 2020;237-261.

Okuro RT, Freire RC, Zin WA, Quagliato LA, Nardi AE. Panic disorder respiratory subtype: Psychopathology and challenge tests–an update. Brazilian Journal Psychiatry; 2020.

Dazzi T, Gribble R, Wessely S, Fear NT. Does asking about suicide and related behaviours induce suicidal ideation? What is the evidence? Psychological Medicine. 2014;44(16):3361-3363.

Manton A. Suicide prevention…ask the question! Journal Emergency Nursing. 2016;42(6):467-468.

SAMSA/HRSA Center for Integrated Health Resources. Screening tools: Suicide risk screening tools.

Klonsky ED. The functions of deliberate self-injury: A review of the evidence. Clinical Psychology Review. 2007;27(2): 226-239.

John-Evans H, Davies B, Sellen J, Mercer J. Functions of non-suicidal self-injury in prisoners with mental health diagnoses. Mental Health Practice. 2020;23(1). DOI: 10.7748/mhp.2018.e1282

Patterson P, Whittington R, Bogg J. Measuring nurse attitudes towards deliberate self-harm: The Self-Harm Antipathy Scale (SHAS). Journal Psychiatric Mental Health Nursing. 2007;14(5):438-445.

Klonsky ED, Weinberg A. Assessment of nonsuicidal self-injury. In: MK Nock (Ed.), Understanding nonsuicidal self-injury: Origins, assessment and treatment. American Psychological Association. 2009;183-199.

Stanton R, Reaburn P. Exercise and the treatment of depression: A review of the exercise program variables. Journal Science Medicine Sport. 2014;17(2):177-182.

Ashdown-Franks G, Firth J, Carney R, Carvalho AF, Hallgren M, Koyanagi A, et al. Exercise as medicine for mental and substance use disorders: A meta-review of the benefits for neuropsychiatric and cognitive outcomes. Sports Medicine. 2020;50(1):151-170.

Huang Y, Li L, Gan Y, Wang C, Jiang H, Cao S, Lu Z. Sedentary behaviors and risk of depression: A meta-analysis of prospective studies. Translational Psychiatry. 2020;10(1):1-0.

Park LB. Special observation in the care of psychiatric inpatients: A literature review. Issues Mental Health Nursing. 2001;22(8): 769-86.

Whitehead E, Mason T. Assessment of risk and special observations in mental health practice: A comparison of forensic and non-forensic settings. International Journal Mental Health Nursing. 2006;15(4):235-241.

Sinvani L, Strunk A, Patel V, Shah S, Mulvany C, Kozikowski A, et al. Constant observation practices for hospitalized persons with dementia: A survey study. American Journal Alzheimer's Disease & Other Dementias®. 2019;34(4):223-230.

Rodenburg-Vandenbussche S, Carlier I, van Vliet I, van Hemert A, Stiggelbout A, Zitman F. Patients' and clinicians' perspectives on shared decision-making regarding treatment decisions for depression, anxiety disorders and obsessive-compulsive disorder in specialized psychiatric care. Journal Evaluation Clinical Practice. 2020;26(2): 645-658.

Ward T, Garety PA. Fast and slow thinking in distressing delusions: A review of the literature and implications for targeted therapy. Schizophrenia Research. 2019; 203:80-87.

Lancellotta E, Bortolotti L. Are clinical delusions adaptive? Wiley Interdisciplinary Reviews: Cognitive Science. 2019;10(5): e1502.

Altman DG, Machin D, Bryant TN, Gardner MJ, (Eds). Statistics with Confidence, 2nd Ed. BMJ Books. 2000;49).

Campbell I. Chi-squared and Fisher-Irwin tests of two-by-two tables with small sample recommendations. Statistics in Medicine. 2007;26:3661-3675.

Richardson JTE. The analysis of 2 x 2 contingency tables - Yet again. Statistics in Medicine. 2011;30:890.

Alhabeeb AA, Alasmari SS, Alduraihem RA, Qureshi NA. Mental health awareness phone polling surveys: Focus on community knowledge, attitude and practice, Saudi Arabia. International Neuropsychiatric Disease Journal. 2019; 13(1):1-14.

Mahmoud MA. Knowledge, awareness regarding mental health and barriers to seeking psychiatric consultation in Saudi Arabia. Asian Journal Pharmaceutical Research Health Care. 2019;10(4):109-16.

Alosaimi FD, AlAteeq DA, Bin Hussain SI, Alhenaki RS, Bin Salamah AA, AlModihesh NA. Public awareness, beliefs and attitudes toward bipolar disorder in Saudi Arabia. Neuropsychiatric Disease Treatment. 2019;15:2809-2818.

Adolescent Mental Health-World Health Organization; 2019. Available:

Ross AM, Kelly CM, Jorm AF. Re-development of mental health first aid guidelines for suicidal ideation and behaviour: A Delphi study. BMC Psychiatry. 2014;14(1).

Nicholas A, Rossetto A, Jorm A, Pirkis J, Reavley N. Importance of messages for a suicide prevention media campaign. Crisis. 2018;1–13.

Fazel M, Stratford HJ, Rowsell E, Chan C, Griffiths H, Robjant K. Five applications of narrative exposure therapy for children and adolescents presenting with post-traumatic stress disorders. Frontiers Psychiatry. 2020;11:19.

Freedman SA. Psychological interventions to prevent PTSD. Psychiatric Annals. 2019;49(7):314-319.

Giancola PR, Josephs RA, Parrott DJ, et al. Alcohol myopia revisited: Clarifying aggression and other acts of disinhibition through a distorted lens. Perspective Psychological Sciences. 2010;5:265-278.

Crane CA, Schlauch RC, Miller KE. Caffeinated alcoholic beverages and intimate partner violence victimization. Journal Caffeine Adenosine Research. 2019;9(2):60-63.

Ranjbar E, Memari AH, Hafizi S, Shayestehfar M, Mirfazeli FS, Eshghi MA. Depression and exercise: A clinical review and management guideline. Asian J Sports Med. 2015;6(2):e24055.

Stier A, Hinshaw SP. Explicit and implicit stigma against individuals with mental illness. Australian Psychology. 2007;42: 106-117.

The World Health Organization. Mental health gap action programme: Scaling up care for mental, neurological and substance use disorders. Geneva: WHO; 2008.

Sartorius N. Stigma and mental health. Lancet. 2007;370:810-811.

Phokeo V, Sproule B, Raman-Wilms L. Community pharmacists’ attitudes toward and professional interactions with users of psychiatric medication. Psychiatric Services. 2004;55:1434-1436.

Jorm AF, Patten SB, Brugha TS, Mojtabai R. Has increased provision of treatment reduced the prevalence of common mental disorders? Review of the Evidence from Four Countries. World Psychiatry. 2017;16: 90-99.

Thornicroft G, Mehta N, Clement S, Evans-Lacko S, Doherty M, Rose D, Koschorke M, Shidhaye R, O'Reilly C, Henderson C. Evidence for effective interventions to reduce mental-health-related stigma and discrimination. The Lancet. 2016; 387(10023):1123-1132.

Reavley NJ, Jorm AF. Experiences of discrimination and positive treatment in people with mental health problems: Findings from an Australian national survey. Aust N Z J Psychiatry. 2015;49:906-913.

Rickles N, Dube G, McCarter A, Olshan J. Relationship between attitudes toward mental illness and provision of pharmacy services. Journal American Pharmacists Association. 2010;50:704-713.