This chapter covers the case study of Mental Health First Aid (MHFA), a training programme that teaches people how to help someone experiencing a mental health problem or a crisis. The case study includes an assessment of MHFA against the five best practice criteria, policy options to enhance performance and an assessment of its transferability to OECD and EU27 countries.
Mental Health Promotion and Prevention
Best Practices in Public Health
Abstract
Description: Mental Health First Aid (MHFA) is a training programme that teaches people how to recognise, understand and help someone who may be experiencing mental health problems. The aim of the programme is to improve mental health literacy, reduce stigma, and increase confidence in helping someone experiencing mental distress or crisis. MHFA training is aimed at the general public, but several course options are available to train adults to deliver MHFA to youth and other specific groups. The programme is applicable in a variety of settings and can be embedded in the community, workplace, tertiary institutions and schools.
Best practice assessment:
|
Criteria |
Assessment |
|---|---|
|
Effectiveness |
MHFA is effective in increasing mental health literacy, knowledge, helping-behaviour and confidence in helping people with mental health problems, with evidence also suggesting a reduction in stigmatising attitudes. |
|
Efficiency |
Economic evaluations of MHFA are not readily available. The estimated cost per person for the training course is between EUR 250 and EUR 380. |
|
Equity |
Different versions of the programme are available, including for adults and youth, and MHFA training can be embedded in the community, workplaces, tertiary institutions and schools. |
|
Evidence‑base |
The evidence‑base for MHFA is broad and includes several randomised controlled trials (RCTs), systematic reviews and meta‑analyses. |
|
Extent of coverage |
More than 6 million people have been trained in MHFA and it operates in 29 countries, with 67 000 accredited instructors. |
Enhancement options: To enhance effectiveness of MHFA, further research is needed to assess the impact of MHFA on people experiencing mental distress who have received help from MHFAiders®. Continuous learning and a clear definition and guidelines for the role of MHFAiders® can also enhance the effectiveness of the programme. To enhance efficiency, a budget should be allocated for MHFA training for frontline workers in public services, such as police officers, hospital staff and teachers. To enhance extent of coverage it is necessary to increase communication efforts and address the stigma associated with mental health, as well as partnering with organisations across various sectors.
Transferability: MHFA originated in Australia and has been adopted worldwide. It is now used in 29 countries (including 19 OECD and EU countries).
Conclusion: MHFA is effective in increasing mental health knowledge, helping-behaviour and confidence in helping people with mental health problems. Evidence also suggests that MHFA courses can reduce stigmatising attitudes.
Mental Health First Aid (MHFA) is a training programme that teaches people how to identify, understand and help someone who may be experiencing mental health problems. It aims to improve mental health literacy, reduce stigma, increase confidence and increase helping behaviours related to mental health issues (Kitchener and Jorm, 2002[1]). The MHFA strategies are aimed at the general public and the goal is to increase the participants knowledge about mental health in general and for common disorders, such as depression, anxiety, substance use, suicidal behaviours, self-harm and psychosis. Another goal is to reduce the stigma around mental disorders by addressing negative attitudes that negatively affect supportive and help-seeking behaviours (Hadlaczky et al., 2014[2]). MHFA adopts a familiar model from physical first aid training, which is well-established for handling injuries and emergencies, applying it to mental health situations.
The standard MHFA training is a 12‑hour course and is designed for adults to give them the skills, knowledge and confidence to understand and respond to someone experiencing a mental health problem or crisis, whether it is a family member, a colleague or another adult. The MHFA training is typically delivered through face‑to-face courses, although alternative options include a combination of in-person and online learning, as well as exclusively online formats. The training programme follows the “ALGEE” action plan consisting of five steps/skills (Kitchener and Jorm, 2008[3]; Morgan, Ross and Reavley, 2018[4]):
1. Approach the person, assess and assist with any crisis
2. Listen and communicate non-judgementally
3. Give support and information
4. Encourage individuals to get appropriate professional help
5. Encourage other supports
Mental Health First Aiders® (MHFAiders®) are people who have completed a MHFA course. MHFAiders® are equipped with the knowledge, confidence, and skills to provide mental health first aid assistance to people experiencing mental health problems. Specifically, they are trained to recognise clusters of symptoms of different mental disorders and mental health crises, provide initial support, and direct the individual to suitable treatment and other supportive help (Morgan, Ross and Reavley, 2018[4]). MHFAiders® are not mental health professionals but are trained to provide initial support until professional help arrives or the crisis is resolved, similar to how physical first aiders provide immediate assistance before professional medical help is available (MHFA Australia, n.d.[5]).
MHFA was originally developed in Australia in 2000 and has since been implemented globally. The programme operates in more than 29 countries (including 19 OECD and EU countries) worldwide and more than 6 million people have been trained in MHFA. MHFA offers several versions of the programme to meet the needs of different groups (such as youth, teens, older people, veterans, suicidal people, people with gambling problems) and to fit to specific contexts (such as the workplace) (Box 9.1).
The workplace is an important setting for health promotion and disease prevention, including early intervention and support for people experiencing or living with mental health problems (OECD, 2022[6]). Poor mental health in the workplace has been linked to absenteeism and presenteeism, leading to reduced performance and productivity at work and an increased risk of unemployment (Tóth et al., 2023[7]; OECD, 2022[6]). Mental health related stigma has been identified as one of the main barriers to seeking help. Interventions aimed at reducing mental health stigma, such as MHFA, can lead to improvements in employees’ knowledge and supportive behaviour towards people with mental health problems (Tóth et al., 2023[7]).
MHFA training provides employees with the essential skills to recognise signs of mental health problems, initiate conversations about mental health, and provide help to colleagues in need. These are skills that anyone in the workplace can learn and are an important strategy for promoting early help-seeking. MHFA training at the workplace is an important part of building more mentally healthy workplaces where employees feel supported, valued, and confident in to talk openly about mental health (MHFA Australia, n.d.[8]).
MHFA at the workplace trains employees to recognise and respond to colleagues who are experiencing mental health problems or crises. The benefits of implementing MHFA training in the workplace include (MHFA Australia, n.d.[8]):
Improve employee engagement and well-being
Improve overall performance and productivity
Attract and retain employees
Implementing MHFA in the workplace can help to improve the well-being of employees. As more workplaces adopt MHFA training, it can also reduce the stigma surrounding mental health and promote a more inclusive and supportive working environment.
This section analyses Mental Health First Aid against the five criteria within OECD’s Best Practice Identification Framework – Effectiveness, Efficiency, Equity, Evidence‑base and Extent of coverage (see Box 9.2 for a high-level assessment). Further details on the OECD Framework can be found in Annex A.
Effectiveness
There is strong evidence that MHFA leads to improvements in mental health knowledge (effect size d = 0.63).
MHFA is effective in improving confidence in helping people with mental health problems (effect size d = 0.58) and the intentions to provide mental health first aid (effect size d = 0.75) after the intervention.
Evidence suggests that MHFA can reduce stigmatising attitudes up to six months following the intervention, but the long-term effects (i.e. after 12 months) are uncertain.
Efficiency
Economic evaluations of MHFA are not readily available.
The cost of MHFA varies according to location, type of course and the instructor. The estimated cost per person for the training course is between EUR 250 and EUR 380.
Equity
Various versions of the programme are available, including programmes for the adult population and for the youth population.
MHFA training can be embedded in a variety of settings, including the community, workplaces, tertiary institutions and schools.
Evidence‑base
The evidence‑base for MHFA is well-established, with several randomised controlled trials (RCTs), systematic reviews and meta‑analyses.
An RCT was used to assess the impact of MHFA and the evidence was rated as strong in several areas.
Extent of coverage
More than 6 million people have been trained in MHFA and it operates in 29 countries.
MHFA have more than 67 000 accredited instructors worldwide.
Note: d refers to Cohen’s d effect size and is generally interpreted as small (0.20), medium (0.50) and large (0.80).
Effectiveness
MHFA is effective in increasing the participants mental health knowledge
Research has extensively explored the impact of MHFA on improving participant’s knowledge and understanding of mental health, with strong evidence showing significant improvements in mental health knowledge. A Swedish randomised controlled trial (RCT) study found that the intervention group that received MHFA training, improved their knowledge about mental disorders and how to act and behave when in contact with affected individuals, as compared to controls with an effect size of d1 = 0.63 (Svensson and Hansson, 2014[9]). A meta‑analysis based on 15 relevant studies found MHFA to be effective in increasing participants knowledge regarding mental health with a mean effect size of Glass’s delta Δ = 0.56 (95% CI ranged from 0.38 to 0.74). The effect was regarded as highly robust with a moderately high effect size (Hadlaczky et al., 2014[2]). These findings are confirmed in a more recent systematic review and meta‑analysis based on 18 studies with a total of 5 936 participants, that show improvements in three measures of mental health knowledge (Morgan, Ross and Reavley, 2018[4]). First, beliefs about effective treatments for mental health problems improved significantly at post-intervention (Cohen’s effect size d = 0.45) and up to 6‑months follow-up (d = 0.19). Second, for accurate identification of mental health problems, small non-significant improvements were observed at post-intervention (d = 0.22), increasing to moderately significant improvements at 6‑month follow-up (d = 0.52). Third, for MHFA knowledge, a moderate‑to-large significant improvement was found at post-intervention (d = 0.72). The effect was reduced at 6‑month follow-up (d = 0.54) and at 12‑month follow-up (d = 0.31).
MHFA is increasing participants helping behaviour and their confidence in helping people with mental health problems
MHFA is effective in improving participants’ helping behaviour towards people with mental health problems. A Swedish RCT study found that the intervention group improved their readiness to provide help in a mental health crisis situation compared to the control group who did not receive the training, with an effect size of d = 0.22 (Svensson and Hansson, 2014[9]). They also showed improved confidence in providing help compared to controls, with an effect size of d = 0.32 After two years of follow-up, the results showed that the MHFA training still had a notable impact on the awareness of mental health and its treatment, and that it led to a change in behaviour in terms of willingness to engage more with people with mental health problems (Svensson and Hansson, 2014[9]).
MHFA leads to improvements in confidence in helping a person with a mental health problem. Moderate significant improvements were found at post-intervention (d = 0.58) and at follow-up at 6‑months (d = 0.46), while the effects beyond 6‑months were small (d = 0.21) (Morgan, Ross and Reavley, 2018[4]). Furthermore, moderate to large effects were observed on the intentions to provide mental health first aid at post-intervention (d = 0.75) and at 6‑month follow-up (d = 0.55). Similar effects were also found in a meta‑analysis based on nine studies, which found that MHFA is effective in increasing help-providing behaviour, with a mean effect size of Glass’s Δ = 0.25 (CI95% ranged from 0.12 to 0.38) (Hadlaczky et al., 2014[2]).
Evidence suggests that MHFA courses can reduce stigmatising attitudes, but the long-term effect is uncertain
A meta‑analysis based on 14 studies found that the participation in an MHFA course was effective in decreasing negative attitudes towards people with mental health problems. A very robust moderate effect was found (Glass’s Δ = 0.28, 95% CI ranged from 0.22 to 0.35) with a highly significant difference between individuals in the control and intervention groups and in the pre‑post measures (Hadlaczky et al., 2014[2]). Furthermore, evidence shows small reductions in stigmatising attitudes at post-intervention (d = 0.14) and at six‑months follow-up (d = 0.14), while a very small non-significant effect was observed at 12‑month follow up (d = 0.08) (Morgan, Ross and Reavley, 2018[4]).
Efficiency
Economic evaluations of MHFA are not readily available. The cost of MHFA varies according to location, type of course and the instructor. Available information from MHFA England values the course at GDP 325 (EUR 380) per person, offering four sessions of 3 hours and 45 minutes over two weeks, with a limited number of 16 people per course (MHFA England, n.d.[10]). In France, the cost of the MHFA course is EUR 250. This includes 14 hours of training, which can be delivered either face‑to-face or remotely (Premiers Secours en Santé Mental France, n.d.[11]).
Equity
The MHFA programme promotes equity in mental health support by offering various versions of the programme targeting different groups. This ensures a widespread accessibility and relevance of the programme. The standard version of the MHFA programme focusses on mental health problems in the adult population and is suitable for anyone over the age of 18 (Hadlaczky et al., 2014[2]). Youth MHFA is a different version of the programme designed to teach families, parents, teachers, peers, neighbours, and school staff, how to help young people (aged 12‑18) who are experiencing mental health or addiction problems or are in crisis.
MHFA is applicable in a variety of settings and the training can be embedded in the community, workplace, tertiary institutions and schools. In Australia, a specialised course trains adults to deliver MHFA specifically for Aboriginal and Torres Strait Islander communities, and is available in both adult and youth versions, enhancing the cultural sensitivity and inclusivity of the programme. Several course options are available, including training to support someone experiencing a gambling problem, someone with non-suicidal self-harm and someone with suicidal thoughts and behaviours (MHFA Australia, n.d.[12]).
Evidence‑based
Results for the effectiveness of MHFA is based on data from RCTs, as well as systematic reviews and meta‑analyses. For the purpose of this case study, the study by Svensson and Hansson (2014[9]) was used to assess the evidence‑base. This study was selected because it is a peer-reviewed journal article with an RCT design, and it evaluates MHFA in an OECD and EU country (Sweden).
The Quality Assessment Tool for Quantitative Studies rates the quality of the evidence as strong in several domains (see Table 9.1). The study was rated as “strong” for study design and adjusting for confounders and “moderate” for selection bias. Blinding was rated as “weak” as blinding of participants was difficult due to the nature of the study. Data collection was also rated as “weak” because validity and reliability for the data collection tools were not reported.
Source: Effective Public Health Practice Project (1998[13]) “Quality assessment tool for quantitative studies”, https://www.nccmt.ca/knowledge-repositories/search/14; Svenson & Hansson (2014[9]) “Effectiveness of mental health first aid training in Sweden. A randomized controlled trial with a six-month and two-year follow-up”, https://doi.org/10.1371/journal.pone.0100911.
Extent of coverage
MHFA was originally developed in Australia in 2000 and has then been transferred to multiple countries. More than 6 million people have been trained in MHFA and the programme is currently being delivered in 29 countries worldwide (including 19 OECD and EU countries). More than 67 000 people are accredited as MHFA instructors worldwide (MHFA International, n.d.[14]).
Enhancing effectiveness
Further research is needed to assess the benefits of MHFA on individuals who received assistance from MHFAiders®. The current evidence clearly shows that MHFA improves the capacities of MHFAiders® such as participants’ knowledge, attitudes and behaviours, and it appears to be a promising public health tool for tackling the stigma associated with people with mental disorders and suicidality (Hadlaczky et al., 2014[2]). However, there is an evidence gap of the MHFA impact on people who experienced mental distress and crises and who received help from MHFAiders®. Further research should focus on collecting data on the recipients of MHFA support (Morgan, Ross and Reavley, 2018[4]; Maslowski et al., 2018[15]). Evaluations could include for instance the time of recovery, impact on social and occupational functioning, and satisfaction.
Fostering an environment of continuous learning is essential to enhance the effectiveness of MHFA. Ideally, MHFAiders® should receive regular updates on the latest mental health research and practice. Understanding and skills can be deepened through specialised training targeted at specific mental health conditions or populations. MHFAiders® could benefit from support mechanisms, such as supervision or peer groups, where they can discuss challenges and ensure that they remain effective and confident in their role.
Enhancing efficiency
Efficiency is calculated by obtaining information on effectiveness and expressing it in relation to inputs used. Therefore, policies to boost effectiveness without significant increases in costs will have a positive impact on efficiency.
Enhancing equity
Increasing the accessibility of the MHFA training programme to diverse communities will enhance equity. Involving leaders and organisations in the design and the delivery of the programme will help ensure that MHFA training meets the specific needs of diverse communities and workplaces, making the programme more equitable.
Enhancing the evidence‑base
A longer evaluation period would help to improve the evidence base. There is a lack of evidence about the long-term impact of MHFA, particularly beyond six months. Therefore, future research should focus on examining the sustainability of MHFA training (Morgan, Ross and Reavley, 2018[4]).
Enhancing extent of coverage
To enhance the reach and enrolment in MHFA training, it is necessary to increase communication efforts and to address the stigma surrounding mental health. Effective communication strategies should emphasise the benefits of MHFA, such as how it increases mental health knowledge and how it can help build a more mentally healthy workplace. Mental health stigma can be addressed by promoting the positive outcomes of MHFA training. To increase the uptake, organisations can encourage individuals to participate in the programme.
Forming partnerships with organisations across various sectors can enhance the extent of coverage for MHFA. By extending the reach of the programme and collaborating with new educational institutions, corporations, healthcare providers and community organisations, MHFA can be integrated into new locations. This broadens the reach of the programme and ensures that more people in different settings and environments receive the training.
Allocating a budget for MHFA training for frontline workers in public services, such as teachers, social service providers and religious services, can enhance the extent of coverage of MHFA. Providing MHFA training to key groups who are most likely to be in regular contact with people experiencing mental health problems or crises can maximise the reach and impact of MHFA. Training these workers can help build a more resilient public service workforce that is better prepared to manage stress and trauma.
This section explores the transferability of MHFA and is broken into three components: 1) an examination of previous transfers; 2) a transferability assessment using publicly available data; and 3) additional considerations for policymakers interested in transferring MHFA.
Previous transfers
MHFA originated in Australia, where it was developed in 2000. Since then, the programme has been adopted worldwide and is now used in 29 countries (including 19 OECD and EU countries). Countries like Australia, Canada, France, Sweden, the United Kingdom and the United States, have adapted MHFA for their populations, showing how flexible the programme is.
Transferability assessment
This section outlines the methodological framework to assess transferability followed by analysis results. In order to assess the transferability of the MHFA programme, this case study will draw on the Swedish programme, which has been studied by Svensson and Hansson (2014[9]).
Methodological framework
A few indicators to assess the transferability of MHFA were identified (see Table 9.2). Indicators were drawn from international databases and surveys to maximise coverage across OECD and non-OECD European countries. The assessment is intentionally high level given the availability of public data covering OECD and non-OECD European countries.
Results
The main findings of the transferability assessment are summarised below:
a) In Sweden, the proportion of people who had volunteered in the last month was 16%, suggesting that countries with a higher proportion will have an enabling environment for the transfer of MHFA.
b) As in Sweden, the vast majority of countries (90%) have a strategy or action plan to guide the implementation of mental health policy. This suggests that MHFA would be likely to receive political support in most potential transfer countries.
c) Mental health awareness and literacy policies are implemented or underway in 88% of countries (38 out of 43), including in Sweden. MHFA aims to increase mental health awareness and literacy, and policies that support these aims enhance the transferability of MHFA.
d) The majority of countries (83%) have policies and programmes in place to address stigma and discrimination, including Sweden. MHFA aim to reduce stigma, and countries with policies that support this have a better potential for transferability.
e) Sweden spends 4.93% of current health expenditure on preventive care, compared with the median of 4.42% in OECD and EU countries. Countries with a higher spending on prevention are more likely to have economic support for the transfer of MHFA.
A darker shade indicates MHFA is more suitable for transferral in that particular country
Note: n/a = no available data. The shades of blue represent the distance each country is from the country in which the intervention currently operates, with a darker shade indicating greater transfer potential based on that particular indicator (see Annex A for further methodological details). The full names and details of the indicators can be found in Table 9.3.
Source: OECD/WHO Regional Office for Europe (2023[17]), Mental Health Systems Capacity Questionnaire 2023 - Strategy or action plan that guide implementation of the mental health policy; OECD/WHO Regional Office for Europe (2023[18]), Mental Health Systems Capacity Questionnaire 2023 - Policies and programmes to improve mental health awareness and literacy; OECD/WHO Regional Office for Europe (2023[19]), Mental Health Systems Capacity Questionnaire 2023 - Policies and programmes to address stigma and discrimination; OECD (2022[20]), OECD Data Explorer - Prevention spending as a percentage of current health expenditure, http://data-explorer.oecd.org/s/1nl (accessed on 11 April 2025).
To help consolidate findings from the transferability assessment above, countries have been clustered into one of three groups, based on indicators reported in Table 9.2. Countries in clusters with more positive values have the greatest transfer potential. While this analysis provides a high-level overview assuming some simplifications, it is important to note that countries in lower-scoring clusters may also have the capacity to adopt the intervention successfully. For further details on the methodological approach used, please refer to Annex A.
Key findings from each of the clusters are below with further details in Figure 9.1 and Table 9.4:
Countries in cluster one have population, political and economic arrangements in place to facilitate the transfer of MHFA and therefore have conditions in place to readily transfer MHFA to their local context. Countries in this cluster are considered to be less likely to encounter issues in implementing and operating MHFA in their local context. This group includes 16 countries.
Countries in cluster two have political arrangements in place to transfer MHFA, but they may not have the population context and economic feasibility to support the transfer of MHFA. Compared to cluster one, countries in cluster two have lower levels of volunteering and community engagement, and lower spending on prevention than in cluster one. This group includes 23 countries.
Countries in cluster three do not have conditions in place regarding population, political and economic contexts to support the transfer of MHFA. This cluster has a small number (four) of countries. Countries in cluster three may have relatively lower levels of volunteering and community engagement. They may not have an action plan that guides the implementation of mental health policy, or programmes to increase mental health literacy and address stigma. Spending on prevention is relatively lower than in cluster one.
Note: Bar charts show percentage difference between cluster mean and dataset mean, for each indicator.
Source: OECD analysis.
Source: OECD analysis.
New indicators to assess transferability
Data from publicly available datasets alone is not ideal to assess the transferability of public health interventions. Box 9.3 outlines several new indicators policymakers could consider before transferring MHFA.
In addition to the indicators within the transferability assessment, policymakers are encouraged to collect information for the following indicators:
Population context
What is the level of mental health literacy in the population?
What is the level of stigma associated with mental illness?
Sector specific context
What is the share of workers who receive health-related trainings?
Political context
Has the intervention received political support from key decision makers?
Has the intervention received commitment from key decision makers?
Economic context
Are there government-led financial incentives for promoting mental health in specific contexts (e.g. at the workplace)?
MHFA is a training programme that teaches people how to recognise, understand and help someone who may be experiencing mental health problems and is aimed at the general public. The programme aims to improve mental health literacy, reduce stigma, increase confidence and increase helping behaviours related to mental health issues. The programme is applicable in a variety of settings and can be embedded in the community, workplace, tertiary institutions and schools.
MHFA has been effective in increasing mental health knowledge, helping-behaviour and confidence in helping people with mental health problems. Evidence suggests that MHFA courses can reduce stigmatising attitudes, although the long-term effect is uncertain. Several course options are available to train adults to deliver MHFA to youth or other specific groups, such as training to support people with gambling problems, non-suicidal self-harm and people with suicidal thoughts. Economic evaluations of MHFA are not readily available, however evidence shows that the training course costs between EUR 250 and EUR 380.
MHFA originated in Australia and has been adopted worldwide. It now exists in 29 countries (including 19 OECD and EU countries). More than 6 million people have been trained in MHFA and the programme has 67 000 accredited instructors. The transferability analysis using clustering suggests that MHFA can be readily transferred to 37% of countries, which were included in the cluster of highest transferability. Besides, 53% of countries were included in the cluster of intermediate transferability.
Box 9.4 outlines next steps for policymakers and funding agencies.
Next steps for policymakers and funding agencies to enhance MHFA are listed below:
Ensure funding to continue the implementation of the programme as well as for future scale‑up and transfer efforts.
Support further research on the effectiveness of MHFA, in particular on the benefits for individuals who received assistance from MHFAiders®.
Promote “lessons learnt” from countries and regions that have transferred MHFA to their local setting.
References
[13] Effective Public Health Pratice Project (1998), Quality assessment tool for quantitative studies, https://www.nccmt.ca/knowledge-repositories/search/14.
[16] Gallup (2023), Share of individuals volunteering time to an organization in the past month (%).
[2] Hadlaczky, G. et al. (2014), “Mental health first aid is an effective public health intervention for improving knowledge, attitudes, and behaviour: A meta-analysis”, International Review of Psychiatry, Vol. 26/4, pp. 467-475, https://doi.org/10.3109/09540261.2014.924910.
[3] Kitchener, B. and A. Jorm (2008), “Mental health first aid: An international programme for early intervention”, Early Intervention in Psychiatry, Vol. 2/1, pp. 55-61, https://doi.org/10.1111/j.1751-7893.2007.00056.x.
[1] Kitchener, B. and A. Jorm (2002), Mental health first aid training for the public: evaluation of effects on knowledge, attitudes and helping behavior, http://www.biomedcentral.com/1471-244X/2/10.
[15] Maslowski, A. et al. (2018), Examination of the Effectiveness of Mental Health First Aid Among the Public: A Meta-Analysis.
[5] MHFA Australia (n.d.), Mental Health First Aiders, https://www.mhfa.com.au/about-us/mhfaiders/ (accessed on 22 March 2024).
[12] MHFA Australia (n.d.), Specialised Courses, https://www.mhfa.com.au/our-courses/specialised-courses/ (accessed on 8 April 2024).
[8] MHFA Australia (n.d.), Workplaces, https://www.mhfa.com.au/training-pathways/workplaces/ (accessed on 20 March 2024).
[10] MHFA England (n.d.), Become a Mental Health First Aider, https://mhfaengland.org/individuals/adult/mental-health-first-aid/ (accessed on 19 March 2024).
[14] MHFA International (n.d.), What is Mental Health First Aid?, https://mhfainternational.org/ (accessed on 20 March 2024).
[4] Morgan, A., A. Ross and N. Reavley (2018), “Systematic review and meta-analysis of mental health first aid training: Effects on knowledge, stigma, and helping behaviour”, PLoS ONE, Vol. 13/5, https://doi.org/10.1371/journal.pone.0197102.
[20] OECD (2022), OECD Data Explorer - Prevention spending as a percentage of current health expenditure, http://data-explorer.oecd.org/s/1nl (accessed on 11 April 2025).
[6] OECD (2022), Promoting Health and Well-being at Work: Policy and Practices, OECD Health Policy Studies, OECD Publishing, Paris, https://doi.org/10.1787/e179b2a5-en.
[19] OECD/WHO Regional Office for Europe (2023), Mental Health Systems Capacity Questionnaire 2023 - Policies and programmes to address stigma and discrimination.
[18] OECD/WHO Regional Office for Europe (2023), Mental Health Systems Capacity Questionnaire 2023 - Policies and programmes to improve mental health awareness and literacy.
[17] OECD/WHO Regional Office for Europe (2023), Mental Health Systems Capacity Questionnaire 2023 - Strategy or action plan that guide implementation of the mental health policy.
[11] Premiers Secours en Santé Mental France (n.d.), Je Deviens Secouriste, https://www.pssmfrance.fr/etre-secouriste/ (accessed on 19 March 2024).
[9] Svensson, B. and L. Hansson (2014), “Effectiveness of mental health first aid training in Sweden. A randomized controlled trial with a six-month and two-year follow-up”, PLoS ONE, Vol. 9/6, https://doi.org/10.1371/journal.pone.0100911.
[7] Tóth, M. et al. (2023), “Evidence for the effectiveness of interventions to reduce mental health related stigma in the workplace: a systematic review”, BMJ Open, Vol. 13/2, https://doi.org/10.1136/bmjopen-2022-067126.
← 1. d refers to Cohen’s d effect size and is generally interpreted as small (0.20), medium (0.50) and large (0.80).