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FINAL REPORT Mental Health First Aid: A Follow-up Survey at High Plains Mental Health Center

Investigator: Dr. Amy N. Mendenhall University of Kansas School of Social Welfare

June 2012

Report Prepared by: Amy Mendenhall Sierra Jackson

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Introduction Mental Health First Aid (MHFA) is a public education program with the purpose of educating non- mental health professionals how to assist a person in emotional or psychiatric distress and help them get to more formal supports and treatment—much as Red Cross first aid courses do for emergency physical problems. MHFA was initially developed in Australia in 2000, and has been adapted and utilized with positive response worldwide. MHFA i promotes public education related to mental health in order to reduce stigma, improve overall mental health of communities and to empower individuals. ALGEE is the acronym utilized in the course to remind respondents of the ways in which to respond when faced with a possible mental health situation. Approach the person, assess and assist with any crisis, Listen non-judgmentally, Give support and information, Encourage the person to get appropriate professional help, and Encourage other supports. The Australian versionof MHFA was adapted for use in the United States in 2008 ii. Currently MHFA is being taught by instructors in 47 states. The course is a 12-hour Mental Health First Aid course for any interested audiences in their communities iii. Instructors undergo tight credentialing by the National Council for Community Behavioral Healthcare to guarantee strict fidelity to the core Mental Health First Aid USA program model, while also maintaining the flexibility necessary to reach their unique audience needs and direct them to local resources for help. Instructors must teach the 12-hour course in its entirety and are required to provide course evaluations to the national authorities to maintain certification. Nationally, MHFA is looking towards beginning a Youth specific MHFA and a Spanish version of MHFA. Since 2009, High Plains Mental Health Center (HPMHC) has been offering the U.S. version of the MHFA course. The 20 counties the center serves are: Cheyenne, Rawlins, Decatur, Norton, Phillips, Smith, Sherman, Thomas, Sheridan, Graham, Rooks, Osborne, Wallace, Logan, Gove, Trego, Ellis, Russell, Ness and Rush Counties. Typically, the HPMHC instructor teaches the course as a 2 day course with 6 hours per day. However, there is flexibility due to the length of travel for the respondents and trainers. From 2009 to early 2012, the Center has provided 21 classes for a total of 517 students throughout the service area. These classes were all taught by Ken Loos, the Manager of Community Prevention, Education and Outreach at the Center, who is a certified MHFA instructor.

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MHFA Survey In order to determine the impact of the MHFA course in the High Plains service area, a followup survey of past MHFA graduates was conducted. The survey was jointly developed and administered by Ken Loos, the MHFA instructor from HPMHC, and Dr. Amy Mendenhall, a researcher and faculty member in the School of Social Welfare at the University of Kansas. The study was conducted to better understand the impact the MHFA course has on respondents and if respondents used course content after completing the course. The study was approved by the KU Human Subject Committee and by High Plains Mental Health Center. The online survey was emailed to MHFA graduates by Ken Loos, and a reminder email was sent approximately 6 weeks after the initial request. The survey had 31 questions and took approximately 20 minutes to complete. Participation was voluntary, and participant responses were anonymous. The data collected by the survey can be used to improve understanding of how MHFA is used and how it might be improved both locally and nationally.

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Survey Findings Characteristics of Survey Respondents Of the 517 graduates of MHFA in the service area since 2009, 176 completed the online survey, which is a 34% response rate. The majority of respondents were female (87.5%), and almost all (98.9%) identified their race as white. The range of respondents’ ages was 24 to 95, with the average age at 52. Also, more than half (61%) of the respondents had at least a 4 year college degree. See Table 1 for detailed demographics of respondents. Table 1. Characteristics of Survey Respondents Characteristics Female, % White, % Hispanic, % Age in years, Mean (Standard Deviation) Education, % Less than High School High School/GED Some College 2 year College Degree 4 year College Degree Master’s Degree Professional Degree Other Unreported Participated in MHFA for job, % County of Residence, % Cheyenne Decatur Ellis Gove Graham Lane Logan Ness Norton Osborne Phillips Rawlins Rooks Rush Russell Sheridan Sherman Smith Thomas Trego Wallace Unreported

Statistics 87.5 98.9 1.7 52 (15.82) 1.1 10.2 13.6 7.4 25.6 33.5 .6 7.4 .6 90.3 2.3 4.0 41.5 1.1 2.8 1.1 9.1 0 1.1 .6 1.1 0 2.3 1.7 2.3 4.5 1.7 .6 6.8 8.0 0 7.4

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Almost all respondents (90.3%) participated for their job or employment. There was a majority of respondents who worked within the field of education in some capacity. There were also multiple respondents in the areas of emergency services, social service, and mental health/ health. Table 2. Field of Employment of Survey Respondents Field of Employment

Percentage

Education Teacher Early Childhood Educational Support Services Special Education

50.6 13.6 9.1 21.6 6.3

Law Enforcement/EMT/ Dispatch

9.1

Faith Based Organization

2.3

Social Service

6.8

Mental Health

1.7

Health

3.4

Volunteer

15.9

Other

8.7

Unreported

.6

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Remembering & Using MHFA The first set of questions in the survey assessed how much of the MHFA course content respondents remembered and had used it since completing the class (Figure 1). Almost all (98%) indicated that they remembered some amount of the general MHFA content, but slightly fewer (86%) remembered the meaning of ALGEE. Approximately three-fourths (76%) of the respondents did report using MHFA in their professional (76%) and personal (73%) lives since taking the course. One professional stated, “I use aspects of MHFA in my work everyday.” One mother explained, “I have a son who is diagnosed with bipolar disorder…Using the tools learned during MHFA has given me the patience and understanding to deal with his ongoing issues.” A slightly smaller portion (64%) reported using MHFA content for themselves. One respondent stated, “I actually pursued counseling for help with my own phobias after the course.” Another respondent explained how she uses the content in all aspects of her life, “I use the basic principles for interacting with challenging individuals whether they have mental illness or not--- Listening non-judgmentally is really important.” Figure 1. Remembering and Using MHFA Survey Questions

100% 90% 80% 70% 60% No

50%

Yes 40% 30% 20% 10% 0% Remembered MHFA Content

Remembered some degree of ALGEE

Used MHFA in Professional Life

Used MHFA in Personal Setting

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Outcomes of the Course The second set of questions on the survey assessed outcomes or gains from taking the MHFA course. Almost all of the respondents (90%) learned something new from the MHFA course. One respondent explained, “Taking the MHFA course helped me to recognize signs of mental illness and gave me steps to use to help someone with mental health issues when needed. I feel more confident knowing that there are steps I can take to be helpful until they get more professional help.” Another respondent stated, “I was surprised by the prevalence of mental illness in our society. Recognizing that many people at some point in their lives will deal with some type of mental health issue has made it not as ‘scary’ for me.” Additionally, many of those who were already familiar with the content still found the course to be helpful. One mental health professional stated, “It helps to refresh your memory and make sure you are staying current.” Many respondents (56%) stated that their attitude towards mental health had changed due to the education provided in the MHFA course. One participant admitted, “I used to think some people were ‘faking it’ but now I know they may be covering up a more serious problem.” Another participant stated, “I just took a closer look at my own personal life and realized that I needed to be more tolerant of those with mental issues and that self-reflection was needed in order for me to help others.” A similar percentage of respondents (58%) reported that their behavior towards or with individuals with mental illness had changed as a result of completing the MHFA course. A respondent explained, “I think I’ve learned to listen better and not be judgmental” and another respondent similarly stated, “I would be more willing to approach someone with a mental illness now.” Three fourths of the respondents (74%) said taking the course made them more confident in helping someone with a mental health problem. A respondent stated, “It has empowered myself, as well as others whom I know, who do not necessarily have the credentials to professionally help those individuals struggling with mental health needs. We are now able to ‘troubleshoot’ the severity of the situation, and direct the individual toward lasting, comprehensive, and professional mental health supports.” The majority of respondents (76%) would recommend taking the course to other coworkers, and slightly fewer (66%) would recommend taking this course to family and/or friends. One respondent stated, “I think everyone should take this course.” Similarly, another person said, “It’s a very good course and I wish more people would take it, so they would feel more confident when trying to deal with anyone with mental illness.”

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100% 90% 80% 70% 60% 50%

No

40%

Yes

30% 20% 10% 0% Learned Something New in MHFA

Changed their Changed their Feel more Behavior Attitude confident in towards those towards helping with with Mental Mental mental health Illness Illness problems

Since taking MHFA, 70% of the respondents reported encountering a person suffering from mental illness, and almost all of those respondents who encountered someone suffering from mental illness (90%) offered the person assistance. More than half (56%) reported “some” or “a lot” of confidence in helping, and almost all (95%) used the MHFA course information when helping. Most (85%) reported using ALGEE when helping. Figure 3. Utilizing MHFA with a Person in Distress

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

No Yes

Offered "Some" or the Person "a lot" of Assistance confidence when helping

Used MHFA when helping

Used ALGEE when helping

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Significance Since 2009, High Plains Mental Health Center has been working to increase mental health literacy in the surrounding rural community by offering the MHFA course throughout its 20 county service region. Results from a follow-up survey of MHFA course graduates from HPMHC were extremely positive. Most respondents learned something new about mental health from the course and that knowledge remains with them and is utilized when needed. Additionally, more than half of the respondents reported that the MHFA course led them to change their attitude about mental health and/or their behavior towards individuals with mental illness. The majority of respondents reported that they would feel more confident in assisting during a mental illness crisis, and in fact, many respondents reported using the MHFA content and skills in an encounter with an individual with mental illness since they completed the course. The survey findings suggest that HPMHC is making initial progress towards meeting the MHFA goals of educating the public, reducing stigma, and improving community mental health. The public education obtained through the MHFA course has positive implications for the High Plains region as a whole. According to the literature from the original developers of MHFA in Australia, the goal in the initial years was to train approximately 2% of the population in MHFA. According to the Census iv data from 2010, the estimated population for the 20 county service area of HPMHC was 103,247 and 2 percent of that would be approximately 2,064. From these estimates, it can be estimated that HPMHC has trained approximately 0.5% of the population in its service region in less than 3 years. This is a notable accomplishment as the HPMHC service area consists of approximately 20,000 square miles and all of the courses were taught by one instructor. In order to further strengthen the work being done by HPMHC and help the Center in reaching an even larger portion of the population, the researcher highlights some of the findings and provides the following recommendations: (1) Offering courses outside of employment Other than a group of volunteers, almost everyone participated in the MHFA course as part of their job. It is important to provide this education to those in jobs where they interact with people on a day-to-day basis, and especially important for those in fields where they have a high likelihood of coming into contact with a person in a mental health crisis (ie. law enforcement, EMTs). However, this information can also be very beneficial for groups outside places of employment, and so HPMHC may consider further promoting the class to organizations and groups such as churches, fraternal organizations, local parks and recreation departments, etc.

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(2) Finding ways/venues to offer to those with lower education levels The survey findings suggest that HPMHC is successfully reaching professionals as discussed in item (1). In fact of those who responded to the survey, the majority has some level of college education as seen in Figure 4. Figure 4. Education Level of Survey Respondents

61% 7%

4 year degree/ Masters Degree/ Professional Degree

14% 7%

11%

Associate Degree

This suggests that there may be a missing group of people, those with lower education levels, who are not being trained as frequently in MHFA. Based on census data from 2006-2010, the estimated population percentages of individuals with less than a high school diploma up to some college in the counties within the HPMHC service region is between 66.4% -85.1% (Table 3). Table 3. Estimated Population Percentage (25 years +) with Education of Less than HS Diploma through Some College County Estimated Percentage Cheyenne 83.6 Decatur 82.4 Ellis* 66.4 Gove 83.1 Graham 75.8 Logan 82 Ness 81.1 Norton* 82.7 Osborne 82 Phillips* 82.9 Rawlins 80.2 Rooks* 79.6 Rush 83.8 Russell * 79.6 Sheridan 78.2 Sherman * 80.9 Smith 85.1 Thomas * 76.6 Trego 77.8 Wallace 76.6 Data from U.S. Census Bureau website; * denotes a county population estimate of greater than 5,000

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This suggests that HPMHC should consider ways to reach the less educated demographic. This could be done through organizations and groups such as was suggested in (1) or by targeting workplaces that employee individuals from various educational backgrounds. For example, in hospitals, it may be beneficial for the clerical and custodial staff to also be trained instead of just health care professionals. (3) Have more than one certified MHFA instructor With such a large service region, reaching all 20 counties seems like an insurmountable task for one MHFA instructor. HPMHC may find that they can more efficiently reach larger portions of the population by having two certified instructors instead of one. Overall, HPMHC is making a positive impact in its community through the MHFA courses it offers. The survey results suggest that the courses have the potential to increase mental health literacy, decrease stigma and empower individuals in a rural area where widespread educational and prevention efforts can be difficult. HPMHC stands out as a national example of a rural agency that is seeking to improve public health through MHFA. i

www.mhfa.com USA MHFA manual: Kitchner, B.A., Jorm, A.F. and Kelly, C.M. (2009). Maryland Department of Health and Mental Hygiene, Missouri Department of Mental Health, and National Council for Community Behavioral Healthcare. Mental Health First Aid USA. Pp.: 1-79. iii http://www.mentalhealthfirstaid.org/cs/program_overview/ iv www.census.gov ii