Mental Health First Aid is Unproven yet Government Subsidized
Analysis by Mental Illness Policy Org (3/18/12)
SUMMARY
As part of his “Now is the Time” initiative in response to the shootings at Newtown, President Obama announced support for $15 million to Mental Health First Aid Program and a $20 million dollar bill was introduced. (1, 2) Mental Health First Aid is a commercially available training program created in Australia and now sold by non-profits elsewhere. The training program teaches people to identify the symptoms of mental illness in others and connect them to help. (3) It also licenses others to be trainers for a fee.
There is no evidence Mental Health First Aid has any impact on persons with mental illness.
RESEARCH DOES NOT SHOW ANY BENEFIT TO PERSONS WITH MENTAL ILLNESS
Thirty-six of the 55 studies on Mental Health First Aid were authored or co-authored by the founders and owners of the approach, Betty Kitchener or
Anthony F. Jorm. (4) Their two studies that purport to show it works, only show that the program made those trained feel better, more informed, and have less stigmatizing attitudes. (5) They did not show any benefits for persons with mental illness or increased referrals of persons with mental illness for treatment. A 2005 study found “There has not yet been an evaluation of the effects on those who are the recipients of the first aid” and acknowledged, “Perhaps the most important unanswered question is the benefits of being a recipient of MHFA.” (6) In other words, does having people trained to identify mental illness benefit people with mental illness? No research has yet been done on that question. (7) Likewise the most recent study did not report benefits for persons with mental illness. (8) There is no evidence Mental Health First Aid benefits people with mental illness.
SAMHSA maintains a National Registry of Evidence Based Practices. (9) Several programs are identified as evidence based to help people with mental illness. Mental Health First Aid is not on the list.
SUPPORTERS
Mental Health First Aid USA is managed, operated, and disseminated by three national authorities all of whom receive funds from SAMHSA– the National Council for Community Behavioral Healthcare (10) , the Maryland Department of Health and Mental Hygiene, and the Missouri Department of Mental Health. Only these national authorities can train and certify instructors to teach the 12-hour Mental Health First Aid USA course in local communities.(11) They support Mental Health First Aid.
CONSUMERS
Mental Health First Aid can be taught by consumers.
CONCLUSION.
Bills to address alleged mental illness in children are often introduced in the wake of tragedies. But these bills are based on the fact that 1) mental illness is going unidentified, and 2) if identified, they can be prevented. Neither of these is true. Spending more money to identify illness in children will result in more children being identified as having an illness. Already 20% of male children between certain ages has been identified as ADHD. Serious mental illnesses like schizophrenia almost always affect kids in late teens or early twenties. The illnesses can rarely be identified before then. Even if identified, there is no preventative treatment for serious mental illness.
If Congress wants to help persons with serious mental illness, they should pass bills that will get treatment to people with serious mental illness.
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FOOTNOTES
1. Page 14 at http://www.whitehouse.gov/sites/default/files/docs/wh_now_is_the_time_full.pdf.
2 Mental Health First Aid Act of 2013 (S.154.IS) allocates $20 million http://thomas.loc.gov/cgi-bin/query/z?c113:S.153:
3. https://www.mhfa.com.au/
4 3/2013 PubMed search
5. Jorm AF, et al. Mental health first aid training of the public in a rural area: a cluster randomized trial [ISRCTN53887541]. BMC Psychiatry. 2004;4(33):1-9. Kitchener BA, et al. Mental health first aid training in a workplace setting: A randomized and controlled trial [ISRCTNI3249129]. BMC Psychiatry. 2004;4(23):1-8.
6 https://www.mhfa.com.au/documents/ANZJPMHFAtrialreviewJan2006.pdf
7 https://www.mhfa.com.au/cms/evaluation-publications/
8 “Mental Health First Aid for college students: A multi-campus randomized control trial” Daniel Eisenberg, Ph.D.,Nicole Speer, Ph.D., NIMH Grant 1RC1MH089757-01 (2011?).
9 http://www.nrepp.samhsa.gov/ViewAll.aspx
10 Mental Illness Policy Org. does not know why President Obama singled out the program for funding. We think it may have been suggested to him by the National Council for Community Behavioral Healthcare one of the USA licensees of the program and/or SAMHSA which has historically supported non-evidence based interventions.
11 http://www.mentalhealthfirstaid.org/cs/become_an_instructor
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MORE NOTES ON NIMH STUDY
What this study is saying is that it had a good research design and that a lot of work went into coordinating a research protocol. It is also saying that further analyses is required before a real conclusion can be reached about the utility of MHFA. It also says that MHFA in this context had no effect on encouraging college students to seek formal mental health treatment.
However, if you look at the summary on page 6, it concludes: "However, there were no reported changes in referrals for mental health services from RAs, or reported increases in intereactions with RAs." In other words, one of the major purposes of MHFA was not met.
In the second paragraph, the authors state: "The preliminary evidence suggest the MHFA program increases trainee's perceived knowledge of mental illnesses and ability to effectively guide students experiencing a mental illness or crisis." First, this is a disconnect, how can you effectively guide students experiencing a mental illness or crisis if there is no increase in referals for mental health services. Second, "perceived knowledge" is not the same as actual knowledge. Furthermore, even if perceived knowledge were the same as actual knowledge, the failure to use that knowledge to refer people to mental health services suggest a substitution of a dramatically lesser trained individual for a formally trained individual. That is, the RAs became the substitute clinician for the student. I don't think this is a desirable result.
The training does help the RAs feel good about themselves. The training increased the RAs confidence. However, again, feeling good and being more confident is not sufficient.
On page 5, second paragraph, the RAS in treatment residence halls only showed trends for decreases symptoms of depression and decreased reports of binge drinking. Unfortunately, the trends are not enough to produce convincing utility of the MHFA. The trends could come from the placeo effects associated with the special focus. In other words, any training could have produced the same effects, not just the MHFA.
On page 5, third paragraph, the authors note that the preliminary results do not show any reported influences on the intervention on RAs' interactions with students. Isn't that the objective of this whole effort? RAs in treatment halls were equally likely to help students with a crisis situation as those in control residence halls, and RAs in control and treatment halls reported a similar likelihood of approaching a student having signfiicant mental health problems. In other words, the schools selected RAs who were sensitive to the issues of their charges, regardless of whether training in MHFA occurred. In short, the MHFA training was not necessary for the purpose of assisting students as long as the schools used the selection criteria that it used. One can also infer that those who chose to be RAs were ore likely to help based on the choice of the role.
On page 5, fourth paragraph. When the authors compared the fall and spring survey results, they found that non-RA students, ie, students who were not trained in MHFA, who lived in treatment resident halls, i.e, halls where the RAs had MHFA training, di not show an increase in reported service use, or an increase in interactions with RAs regarding mental health isues. "They also did not report fewer symptoms of mental illnesses than their peers in control residence halls."
The authors suggest after stating the critical conclusions that the training does "appear" to have had a protective effect on what may be a typical decline in usage from the fall to spring. This is purely speculative and not based on the preliminary data.
On Figure 2, the authors note that the control hall had a relative rate of spring counseling center service use compared to the fall was different between control and treatmnet halls. For control hals, there was a decrease in service use from fall to Spring. The Figure clearly shows this. The authors also contend that there was a slight increase in counseling usage in the treatment hall from fall to spring; however, while the Figure shows a slight increase, the increase is so slight that it is probably not an important increase and may not be a true increase, given that these are preliminary data.
OUR CONCLUSIONS:
1. Prelimary Data
2. Study shows no true advantage to MHFA
3. Study shows no increase in referrals to formal mental health services
4. Given the results, any benefit of MHFA could simply be a placebo effect, ie. the RAs felt better and more confident because they had some additional training not because they had specific MHFA training.
5. Study shows that research design and participation could be created involving college campuses, RAs and students.
This grant was awarded on 09/23/2009 for the amount of $988,937. It was funded out of Recovery Act funds. It appears to have been completed by September 30, 2011.
Conclusion: This is one of many bills that pretends to help people with serious mental illness but does not.
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Section by Section Analysis
Title I- Education Programs
Sec. 101. Short Title- Establishes that Title I may be cited as the “Achievement through Prevention Act”.
Sec. 102. Purpose- Sets forth the purpose of the title to expand the use of positive behavioral interventions and supports, as well as early intervening services in schools to improve student academic achievement, reduce over-identification of individuals with disabilities, and reduce disciplinary problems in schools.
The 'purpose' does not mention mental illness.Title II- Health Programs
Sec. 201. Garrett Lee Smith Memorial Act Reauthorization
• Codifies the suicide prevention technical assistance center to provide information and training for suicide prevention, surveillance, and intervention strategies for all ages, particularly among groups at high risk for suicide.
Groups at high risk for suicide are individuals with mental illness, those who have previously attempted suicide or those who are first degree relatives of those who completed suicide. This program does not target those groups.• Reauthorizes the Youth Suicide Early Intervention and Prevention Strategies grants to states and tribes and clarifies that states may receive continuation grants after the first grant is awarded.
• Reauthorizes the Mental Health and Substance Use Disorder Services on Campuses grant program and updates the use of funds to allow for the education of students, families, faculty, and staff to increase awareness and training to respond effectively to students with mental health and substance use disorders, to provide outreach to administer voluntary screenings and assessments to students, and to enhance networks with health care providers who treat mental health and substance use disorders. Incorporates consideration of the needs of veterans enrolled as students on campus.
Research shows that those college age who are most likely to commit suicide are those not in college. In 2011, full-time college students aged 18 to 22 were less likely than other adults aged 18 to 22 to have serious thoughts of suicide (6.5 vs. 8.4 percent), make suicide plans (1.5 vs. 2.4 percent), or attempt suicide (0.8 vs. 1.8 percent) in the past year. By focusing on those in college, it ignores those more likely to commit suicide. (The 2011 National Survey on Drug Use and Health)
• Reauthorizes grants to states, political subdivisions of states, Indian tribes, tribal organizations, and nonprofit private entities to train teachers, appropriate school personnel, emergency services personnel, and others, as appropriate, to recognize the signs and symptoms of mental illness, to become familiar with resources in the community for individuals with mental illnesses, and for the purpose of the safe de-escalation of crisis situations involving individuals with mental illness.
Sec. 203. Children’s Recovery from Trauma
Indentification has never been a problem. Parents know their kids are ill. The problem they have is getting treatment. Jared Loughner, who shot Gabrielle Giffords; James Holmes, who shot up a movie theater in Aurora, Colo.; John Hinckley Jr., who shot President Reagan; Aaron Bassler, who shot a former mayor of Fort Bragg, Calif.; Ted Kaczynski, the Unabomber, who mailed explosive packages around the country; Ian Stawicki, who shot five others and then himself in Seattle; Eduardo Sencion, who shot five National Guardsmen at a Nevada IHOP restaurant; Russell Weston, who shot two guards at the U.S. Capitol building; and Adam Lanza, who shot his mother, 26 others, and himself in Newtown, Conn. -- all were known to be ill before they became headlines. The problem wasn't lack of identification. It was lack of treatment.
• Reauthorizes the National Child Traumatic Stress Initiative (NCTSI), which supports a national network of child trauma centers, including university, hospital, and community-based centers and affiliate (formerly funded) members.
"Trauma" (having a parent die, moving, being bullied is not a mental illness. It is a normal part of living. Only when it elevates to PTSD is treatment needed. Children are amazingly resilient but we are medicalizing normality.• Supports the coordinating center’s collection, analysis, and reporting of child outcome and other data to inform evidence-based treatments and services. Also supports the continuum of training initiatives related to such evidence-based treatments, interventions, and practices offered to providers.
• Encourages the collaboration between NCTSI and HHS to disseminate evidence-based and trauma-informed interventions, treatments, and other resources to appropriate stakeholders.
Sec. 204. Assessing Barriers to Behavioral Health Integration
• Requires a GAO report on the federal requirements impacting access to mental health and substance use disorder treatment related to integration with primary care, administrative and regulatory issues, quality measurement and accountability, and data sharing.
This has already been requested by Congressman Murphy and Ranking Member Diana DeGette of the House Oversight and Investigations SubcommitteeSec. 205. Improving Education and Awareness of Treatments for Opioid Use Disorders
• Directs the Substance Abuse and Mental Health Services Administration (SAMHSA) to advance, through its current programs, the education and awareness of providers, patients, and other stakeholders regarding FDA-approved products to treat opioid use disorders.
• Calls for a report on such activities, including the role of adherence in the treatment of opioid use disorders, and recommendations on priorities and strategies to address co-occurring substance use disorders and mental illness.
Sec. 206. Examining Mental Health Care for Children
• Requires a GAO report on the utilization of mental health services for children, including information about how children access care and referrals; the tools and assessments available for children; and the usage of psychotropic medications.
Sec. 207. Evidence-Based Practices for Older Adults
• Encourages the Secretary to disseminate information and provide technical assistance on evidence-based practices for mental health and substance use disorders in older adults.
The two sections above affect Children and Older Adults but not Adults (the most likely victims and perpetrators and most likely to experience homelessness, incarceration, etc. ) These efforts focus on mental 'health' not mental 'illness' (Note: SAMHSA maintains a database of evidence based practices for adults but it is innaccurate and includes very little on mental 'illness'.
Sec. 208. National Violent Death Reporting System
• Encourages the Director of the Centers for Disease Control and Prevention to improve, particularly through the inclusion of other states, the existing National Violent Death Reporting System.
• The reporting system was created in 2002 and currently collects surveillance data from 18 states.
Sec. 209. GAO Study on Virginia Tech Recommendations
• Recommendations were outlined in a report to President Bush in 2007 by the Secretaries of Health and Human Services and Education and the Attorney General of the United States after the Virginia Tech tragedy.
• This provision requires a GAO study on the status of implementation of the recommendations, as well as identification of any barriers to implementation and identification of additional actions the Federal government can take to support states and local communities to ensure the Federal government and laws are not obstacles at the community level.
• The report will only address those recommendations that require participation by the Department of Health and Human Services.
