Mental Health First Aid

1. Introduction

Version followed: Mental Health First Aid Australia / MHFA International (Standard MHFA course as currently described, Action Plan wording "Approach, Listen, Give, Encourage, Encourage", and the MHFA International guidelines: Suicidal Thoughts & Behaviours 2014 revision [2021 reprint], Non-Suicidal Self-Injury 2014 v2.3, Panic Attacks 2021 v2.3, Traumatic Events (adults) 2019 v2.3, Psychosis 2019 v2.3). The US (National Council for Mental Wellbeing) action-plan wording is noted where it differs.

Mental Health First Aid (MHFA) is not a psychotherapy. It is a public-education and training programme that teaches lay people (and professionals outside mental health) to give initial help to an adult or young person who is developing a mental health problem, whose problem is worsening, or who is in a mental health crisis, until professional help is obtained or the crisis resolves. It was established in Canberra in 2000 by Betty Kitchener and Professor Tony Jorm, modelled on physical first-aid training, and has spread internationally (Scotland and Hong Kong first, then many countries) [source: MHFA Australia, Our story; MHFA Suicide guideline]. Its content is a five-action plan (ALGEE) plus problem-specific first-aid guidelines developed by Delphi consensus panels of people with lived experience, carers and professionals [source: Suicide guideline; Psychosis guideline].

Core idea of how change happens: many people with mental health problems do not get timely help because of low recognition, stigma, shame and hopelessness; ordinary people around them who can recognise warning signs, start a conversation, listen without judgement, respond to crises and steer toward professional and other supports shorten the path to help and reduce harm in crises [source: Suicide guideline "Connecting to professional help"; MHFA Action Plan page] [synthesis for the causal wording].

How a psychotherapist uses this guide: (a) as a licensed MHFA Instructor delivering the course under its name (requires the organisation's instructor training and licence, below); (b) to coach clients' family members, carers, teachers or workplace contacts in first-aid responses; (c) to refer people to the course; (d) as a common language when working with MHFAiders in workplaces and schools. Uses (b) and (d) are [synthesis]; the programme materials address lay first aiders, not therapists.

2. Framework

MHFA has two layers: the course (training structure) and the first-aid encounter (what an MHFAider does).

A. Course structure and delivery

Standard MHFA (Australia, adults helping adults): 12 hours, currently commonly delivered blended: 5 to 7 hours of self-paced eLearning, which must be completed first, then two 2.5-hour online workshops; face-to-face delivery also exists [source: Volunteering Victoria course page; Our story notes blended options added in 2020]. Learning outcomes: recognise signs and symptoms of mental health problems in adults; start a conversation using the evidence-based action plan; assess and give initial support in a range of crises; know prevalence, impact, risk factors, treatments and supports; practise first-aider self-care [source: Volunteering Victoria].
Completion makes the participant an MHFAider; a short end-of-course assessment gives Accredited MHFAider status, valid 3 years; refresher courses exist for renewal [source: Volunteering Victoria; Our story].
US Adult MHFA (National Council for Mental Wellbeing): example blended format of a 2-hour self-paced module plus a 6-hour instructor-led session; certification valid 3 years [source: University of Nevada, Reno course page]. Other US formats exist [uncertain].
Course family (Australia): Standard MHFA and sector versions (tertiary students, finance, legal, pharmacy); Aboriginal and Torres Strait Islander MHFA; Older Person MHFA; Youth MHFA (adults helping young people) and Aboriginal and Torres Strait Islander Youth MHFA; Teen MHFA and Youth Yarns (teen peer-to-peer); specialised courses: Conversations About Suicide, Non-Suicidal Self-Injury, Gambling (each with Aboriginal and Torres Strait Islander versions); refresher courses [source: Our story].
Who may deliver: only Licensed MHFA Instructors, trained through an intensive Instructor Training Course specific to each course type; Australia reported over 3,000 accredited instructors by 2021 [source: Our story]. Instructor course length, prerequisites, licence renewal and fidelity requirements are [uncertain]; check with MHFA Australia, MHFA England, or the National Council (US) before delivering under the MHFA name.

B. The first-aid encounter

Stages of the person's problem, which shape the response: developing problem, worsening problem, crisis [source: Exploring the MHFA Action Plan].
Action Plan (Australia current): A, Approach the person, assess and assist with any crisis; L, Listen and communicate non-judgementally; G, Give support and information; E, Encourage the person to get appropriate professional help; E, Encourage other supports [source: Exploring the MHFA Action Plan; ALGEE in action].
US wording: Assess for risk of suicide or harm; Listen nonjudgmentally; Give reassurance and information; Encourage appropriate professional help; Encourage self-help and other support strategies [source: UNR page].
Order: the actions are explicitly not a fixed sequence; the helper judges which to use when and stays responsive [source: Exploring the MHFA Action Plan]. Listening runs through the whole encounter [synthesis].
Criteria for moving between actions: if any crisis is present (suicidal crisis, self-harm, risk to others, panic attack, severe psychotic state, acute trauma reaction, medical emergency), assist with the crisis first using the relevant guideline, then return to listening, support and referral [source: Exploring the MHFA Action Plan; problem-specific guidelines]. Move to encouraging professional help once the person feels heard and has information; if they refuse, keep the relationship and use other supports, unless there is immediate risk [source: Exploring the MHFA Action Plan; Psychosis guideline].
End point: the first aider's role ends when professional help is engaged or the crisis resolves; follow-up contact continues where appropriate [source: Traumatic Events guideline; Suicide guideline].
Factors that change how the plan is applied: the person's background, the relationship with the helper, the type and stage of problem, the person's current state, the environment and existing supports [source: Exploring the MHFA Action Plan].

3. Guiding principles

Act promptly, even on mild suspicion: do not wait for certainty before checking in [source: Suicide guideline].
First aid, not treatment: no diagnosing, no attempting therapy; only clinicians diagnose; the helper supports until professional help arrives [source: Action Plan page; Psychosis guideline].
Safety first, including your own: check for hazards, never put yourself at risk, keep an exit, call emergency services where indicated [source: Traumatic Events; Psychosis; Suicide guidelines].
Non-judgement: listen without agreeing or disagreeing, no blame, labels or stigmatising language [source: ALGEE in action; NSSI guideline].
Directness about suicide: ask clearly; asking does not plant the idea [source: Suicide guideline].
No secrets about risk: never promise confidentiality about a suicide plan or serious risk; tell the person before you involve others and involve them in the choice of who [source: Suicide guideline; NSSI guideline].
Respect autonomy: the person makes the final treatment choice and may decline, except when at immediate risk or where local involuntary-treatment criteria apply; never threaten hospitalisation [source: ALGEE in action; Psychosis guideline].
Offer hope: treatments work, recovery is possible, early help works better [source: ALGEE in action; Psychosis; Traumatic Events].
Genuine care over perfect words [source: Suicide guideline].
Examine your own attitudes first (to suicide, self-injury): your beliefs shape your response; if you cannot ask or talk, find someone who can [source: Suicide guideline; NSSI guideline].
Cultural and spiritual context matters: some experiences or practices are normal in a community; adapt wording; in Aboriginal and Torres Strait Islander contexts involve Elders, Aboriginal health workers and community-identified supports [source: Psychosis guideline; AMHFA Suicide & DSI guideline].
Adolescents may need a more directive approach (make sure a trusted adult knows; go with them to appointments) [source: Suicide; NSSI; Psychosis guidelines].
Keep boundaries and realistic expectations: you cannot control another person's choices or take on their responsibilities [source: ALGEE in action; Suicide guideline; NSSI guideline].
Look after yourself: helping is draining; seek support afterwards [source: ALGEE in action "Revive yourself"; Suicide guideline; Psychosis guideline].
Guidelines are general: tailor them to the individual; they suit high-income countries with developed health systems best [source: Suicide guideline; Panic Attacks guideline].

4. Intervention inventory

The inventory has three parts: (A) the five Action Plan actions, which are generic; (B) problem-specific first-aid procedures from the MHFA International guidelines used here; (C) clinician tasks around the programme. All example language is illustrative unless quoted. Guidelines exist for further topics (e.g. problem alcohol use, and topic courses on gambling) but are not drawn on here [uncertain]; use the current guideline from MHFA International rather than inferring its content.

A1. Approach the person (A: approach, assess and assist with any crisis)

Purpose: open a conversation when you notice changes, or respond when the person raises it; find out whether a crisis is present. Use whenever signs of a developing or worsening problem are noticed [source: Exploring the MHFA Action Plan; ALGEE in action].
Steps:
1. Choose a time when you are both calm and sober, and a private place; plan for enough time. If you cannot give full attention now, say so and set another time [source: ALGEE in action; Psychosis guideline].
2. Choose the format the person is comfortable with (in person, phone, video, text, or talking while walking) and check who else can hear [source: ALGEE in action].
3. Name your concern by describing specific behaviours you have noticed, not a diagnosis [source: Suicide guideline].
4. Make a genuine offer of help and respect their boundaries [source: Exploring the MHFA Action Plan].
5. Scan for crisis: suicidal thoughts, self-injury, risk to others, panic attack, severe psychotic state, acute trauma reaction, intoxication. If present, switch to the relevant procedure in part B [source: Exploring the MHFA Action Plan].
6. If the person is reluctant, approach gently over time: do not push, stay in touch, talk about everyday things, and offer to help them find someone else to talk to [source: ALGEE in action; Suicide guideline].
Example language (illustrative): "I've noticed you've been leaving early and skipping lunch with us for a few weeks. I wondered how you're going. I've got time now if you want to talk, or later if that's better."
Watch for: agitation, anger, unusual risk-taking or rising alcohol and drug use as possible signs of distress, which the source notes are seen more often in men [source: ALGEE in action]. Working: the person engages, even briefly, and the door stays open.

A2. Listen and communicate non-judgementally (L)

Purpose: help the person feel heard and safe enough to say what is going on; this underpins every other action [source: ALGEE in action; Exploring the MHFA Action Plan].
Steps:
1. Use active listening: stay neutral, be patient with silences, use verbal and non-verbal cues, and use minimal encouragers (the source suggests "I see" and "ah") [source: ALGEE in action].
2. Ask open and clarifying questions; reflect back in your own words; summarise [source: ALGEE in action; Suicide guideline].
3. Do not interrupt, do not rehearse your reply while they speak, do not jump to solutions, fill silences or redirect to your own experiences or unasked-for advice [source: ALGEE in action; Exploring the MHFA Action Plan].
4. Avoid dismissive or stigmatising language; use the person's own terms [source: Exploring the MHFA Action Plan; Psychosis guideline].
5. Use the "five Rs" from MHFA Australia: Reflect on your readiness; Respect their views; Respond with simple prompts; Refrain from showing negative reactions; Revive yourself afterwards [source: ALGEE in action].
Example language (illustrative): "So it sounds like work has piled up and you've stopped sleeping properly, and you feel like you're letting everyone down. Have I got that right?"
Watch for: your own shock, pity or urge to fix. Working: the person says more, corrects your summaries, and their tension eases.

A3. Give support and information (G)

Purpose: offer empathy, hope and practical help, and information if the person wants it [source: ALGEE in action; Exploring the MHFA Action Plan].
Steps:
1. Show empathy; let them know they are not alone and that recovery is possible [source: ALGEE in action].
2. Ask before giving information about mental health problems; share only what you learned in training; do not diagnose [source: ALGEE in action; Exploring the MHFA Action Plan].
3. Explore what they have already tried; offer practical help with tasks that feel overwhelming [source: ALGEE in action; Exploring the MHFA Action Plan].
4. Accept them as they are; do not call them lazy, weak or selfish; keep expectations realistic; do not push tasks that feel too much [source: ALGEE in action].
5. Respect autonomy and the limits of your relationship; do not take over solving their problems [source: ALGEE in action].
Example language (illustrative): "What you're describing is really common, and it does get better with the right help. Would it be useful if I showed you some information, or would you rather just talk for now?"
Watch for: rescuing, over-promising, unasked-for advice. Working: the person accepts some help or information and feels less ashamed.

A4. Encourage appropriate professional help (E)

Purpose: connect the person to clinicians, who alone diagnose and treat [source: Exploring the MHFA Action Plan].
Steps:
1. Talk through options (GP, mental health professional, medication, psychological therapy, helplines, online services) and help them find a service [source: Exploring the MHFA Action Plan; Psychosis guideline].
2. Identify the barrier and respond to it. MHFA Australia names four: not knowing help exists (explain that mental illnesses are treatable, as physical ones are); doubting it will work (it has helped others; finding the right fit may take several tries); fearing what treatment involves (they make the final choice; most treatment happens in the community); seeing help-seeking as weak or a burden (reframe as strength; acknowledge their courage in opening up) [source: ALGEE in action].
3. Explain that professionals keep information confidential, with limited safety or legal exceptions [source: Psychosis guideline].
4. If decisions feel hard, offer a few options rather than many; offer practical help such as booking or going with them; for adolescents, make sure the appointment happens [source: Psychosis guideline; NSSI guideline].
5. Respect a refusal unless there is immediate risk of harm to self or others; keep the conversation open [source: Exploring the MHFA Action Plan].
Example language (illustrative): "Lots of people worry that seeing someone means being told what to do. You'd still be the one deciding. Would it help if I found the number for your GP and sat with you while you rang?"
Watch for: pressure, threats or using emergency services as a threat (to be avoided) [source: Psychosis guideline]. Working: an appointment is made or the person agrees to think about it and talk again.

A5. Encourage other supports (E)

Purpose: widen the person's support beyond the first aider and professionals [source: ALGEE in action; Exploring the MHFA Action Plan].
Steps:
1. Help them identify people who can support them (family, friends, colleagues, community) [source: ALGEE in action].
2. Suggest peer support groups, self-help resources and reputable online programmes; give helpline numbers [source: ALGEE in action; Exploring the MHFA Action Plan].
3. Discuss self-care, including limiting alcohol and other drugs [source: Exploring the MHFA Action Plan].
4. Mention self-help strategies with evidence for depression or anxiety where relevant; MHFA Australia lists, among others, exercise, bibliotherapy, self-guided computerised therapy, relaxation, meditation and yoga [source: ALGEE in action].
5. If the person will not seek professional help, use these supports as an alternative route [source: ALGEE in action].
Example language (illustrative): "Who else in your life knows a bit about what's going on? Is there someone you'd feel OK telling?"
Watch for: the helper becoming the only support. Working: the person names at least one further contact or resource they will use.

A6. First-aider self-care

Purpose: protect the helper from exhaustion and distress after helping [source: Suicide guideline; Psychosis guideline; ALGEE in action].
Steps: before helping, check you are emotionally steady enough; if not, find someone better placed [source: Traumatic Events guideline]. Afterwards expect strong feelings; talk to someone you trust (keeping the person's privacy); remember you do not have to solve everything [source: Psychosis guideline]. In workplaces, debrief with the organisation's designated support [synthesis].
Example language (illustrative): "That was a heavy conversation. I'm going to check in with my supervisor about how I'm feeling."
Watch for: rumination, guilt, taking on the person's responsibilities. Working: the helper can set the experience down and stay available without burning out.

B1. Recognising suicide warning signs and preparing to ask

Purpose: notice risk early and get ready to ask [source: Suicide guideline 2014 rev.].
Steps:
1. Know the warning signs: threats to hurt or kill oneself; seeking means; talking or writing about death or suicide; hopelessness; rage or wish for revenge; reckless behaviour; feeling trapped; rising alcohol or drug use; withdrawal; anxiety, agitation or sleep change; sharp mood shifts; no sense of purpose [source: Suicide guideline].
2. Know risk factors (mental illness, poor physical health or disability, past attempts or self-harm, recent negative events, childhood abuse, recent exposure to suicide) and higher-risk groups (for example males, Indigenous people, unemployed people, prisoners, gay, lesbian and bisexual people) [source: Suicide guideline].
3. Understand two broad reasons people consider suicide: escaping unbearable pain, or communicating distress and seeking change or help [source: Suicide guideline].
4. Check your own beliefs about suicide and the person's possible cultural or religious views; if you cannot ask, bring in someone who can [source: Suicide guideline].
Example language (illustrative): "You said earlier 'what's the point'. I want to understand what you meant by that."
Watch for: vague statements; treat them seriously [source: AMHFA Suicide & DSI guideline].

B2. Asking directly about suicide

Purpose: find out whether the person is thinking of suicide [source: Suicide guideline].
Steps:
1. Ask directly, using the word suicide; directness matters more than exact wording [source: Suicide guideline]. In some Aboriginal communities where the word is unacceptable, ask whether they wish they were dead or are thinking of ending their life [source: AMHFA Suicide & DSI guideline].
2. Avoid leading or judgemental questions (for example asking whether they are going to do something "stupid") [source: Suicide guideline].
3. Stay calm and empathic even if you feel shocked; say "suicide" or "die by suicide", not "commit suicide", and never call an attempt "failed" [source: Suicide guideline].
4. If yes: listen fully, let them express any emotion, ask what they are thinking and feeling and why they want to die, acknowledge their reasons, thank them for telling you [source: Suicide guideline].
5. Avoid: arguing about whether suicide is right or wrong; guilt, threats or religious warnings; minimising; empty reassurance; your own stories; showing disinterest; daring them; diagnosing [source: Suicide guideline].
Example language (illustrative): "Sometimes when people feel this trapped they think about suicide. Are you having thoughts of suicide?"
Watch for: your relief leading you to stop at a "no" said with hesitation [synthesis]. Working: the person talks openly about the thoughts.

B3. Assessing urgency of suicide risk

Purpose: decide how quickly and with whom to act [source: Suicide guideline].
Steps:
1. Take every statement seriously; do not dismiss it as attention-seeking [source: Suicide guideline].
2. Ask whether they have a plan, how, where and when, and whether they already have access to the means [source: Suicide guideline]. (This is lethal-means assessment for safety; do not discuss method detail beyond establishing access.)
3. Ask about alcohol or drug use now, past attempts or planning, hearing voices and what the voices say, whether anyone else knows, current treatment, and recent changes in work, relationships or family [source: Suicide guideline].
4. Highest immediate risk: a specific plan, the means, a set time and intent; no plan does not mean safe [source: Suicide guideline].
Example language (illustrative): "Have you thought about how you would do it? Do you have what you'd need? Have you thought about when?"
Watch for: intoxication, recent suicide of someone close, family conflict or isolation [source: AMHFA Suicide & DSI guideline].

B4. Keeping the person safe and making a safety plan

Purpose: reduce immediate danger and set up short-term actions [source: Suicide guideline].
Steps:
1. Once risk is established, do not leave them alone; if danger seems immediate, act quickly even if unsure; work with the person, not around them [source: Suicide guideline].
2. Remind them that thoughts need not be acted on and other ways of coping exist; focus on protective factors [source: Suicide guideline].
3. Build a safety plan together: positive actions the person can take; what will happen, who will do it, when; a short, manageable time span; contacts they agree to call (doctor, mental health professional, helpline, crisis line, trusted people). It is not the only safeguard [source: Suicide guideline].
4. Identify past supports and whether they are still available; ask how they want to be supported [source: Suicide guideline].
5. If the person has the means and will not hand them over, seek emergency help; encourage them to avoid alcohol and drugs; plan calming activities together until help arrives [source: AMHFA Suicide & DSI guideline]. Practical lethal-means steps (removing or securing means, safe storage, involving a trusted person to hold them) follow standard lethal-means counselling [synthesis].
Example language (illustrative): "For the next 24 hours, what's one thing you can do when the thoughts get loud? Who will you call, and can we put their number in your phone now?"
Watch for: a plan the person does not own. Working: they agree to specific contacts and steps and stay connected.

B5. Connecting to help by urgency, emergencies, confidentiality

Purpose: match the response to the level of risk [source: Suicide guideline].
Steps:
1. General or moderate concern: encourage contact with a doctor, mental health professional or suicide helpline [source: Suicide guideline].
2. Higher risk, or will not agree to stay safe: with their permission, contact their regular doctor or mental health professional, ideally one they trust [source: Suicide guideline].
3. Specific plan or means available: call a mental health centre or crisis line for advice [source: Suicide guideline].
4. Already self-harmed: give first aid and call an ambulance. Weapon involved: call police, tell them the person is suicidal, keep yourself safe [source: Suicide guideline].
5. Never agree to keep a suicide plan secret; explain kindly that you care too much to stay quiet; involve the person in who is told; if they refuse, share what is needed to protect them and be honest about whom you will tell [source: Suicide guideline].
6. Do not assume they will seek help alone; identify local services (hospital, clinic, mobile crisis team, helpline, emergency services) and discuss them [source: Suicide guideline].
7. Follow up after the crisis [source: AMHFA Suicide & DSI guideline].
Example language (illustrative): "I can't keep this between us, because I want you safe. Let's decide together who we call first."
Watch for: anger or feelings of betrayal; the guideline accepts this as a price of safety [source: Suicide guideline].

B6. Non-suicidal self-injury (NSSI) first aid

Purpose: respond to self-injury in a way that keeps the person safe and engaged [source: NSSI guideline 2014 v2.3].
Steps:
1. Notice your own feelings about self-injury first; if you cannot talk calmly, ask someone else to [source: NSSI guideline].
2. Talk privately, calmly, using "I" statements; listen, validate feelings and offer support without endorsing the behaviour; aim to make life more manageable, not only to stop the injury [source: NSSI guideline].
3. Do not assume suicidality: ask directly; if yes, use B2 to B5 [source: NSSI guideline].
4. If you interrupt self-injury: stay calm, show care, ask whether you can ease their distress and whether they need medical help [source: NSSI guideline].
5. Get emergency or medical care for severe or deep wounds, gaping cuts, burns about 2 cm or larger or on hands, feet or face, and any overdose or poisoning regardless of intent; seek mental health help if they ask, if injury is escalating or disrupting life, if eyes or genitals are injured, or if they mention wanting to die [source: NSSI guideline].
6. Encourage professional help while letting them stay in control: discuss options, help plan, praise steps, follow up; adolescents may need you to go with them [source: NSSI guideline].
7. Help them find healthier ways to cope with urges (telling a trusted person, distraction, soothing activities) and offer reputable information [source: NSSI guideline].
8. Avoid: minimising, trying to fix their problems, touching without permission, labels, accusing them of attention-seeking, guilt, secret pacts, ultimatums, confiscating tools to force change, showing anger, shock or revulsion [source: NSSI guideline]. Do not promise secrecy; tell them before involving anyone [source: NSSI guideline].
Cultural note: in some Aboriginal communities, small cuts made in grief are cultural practice, not self-injury; consult a local Aboriginal health worker or ask the person [source: AMHFA Suicide & DSI guideline].
Example language (illustrative): "I noticed the cuts on your arm. I'm not angry and I'm not going anywhere. I'd like to understand what's been going on for you."
Watch for: wounds needing care; suicidal statements. Working: the person discusses the feelings behind the behaviour and agrees to some help.

B7. Panic attack first aid

Purpose: help someone through a panic attack and rule out a medical emergency [source: Panic Attacks guideline 2021 v2.3].
Steps:
1. Introduce yourself if they do not know you; ask whether they know what is happening and whether this has happened before; if they cannot speak, use yes/no questions answered by nods or gestures [source: Panic Attacks guideline].
2. Check for a medical cause: ask; look for a medical alert bracelet, pendant or tattoo and follow it. If they have never had a panic attack and do not think this is one, follow physical first aid. Call emergency services if you suspect a medical cause, if they lose consciousness or have severe breathing difficulty [source: Panic Attacks guideline].
3. Make the scene safe (move away from hazards; if driving, pull over) [source: Panic Attacks guideline].
4. Reassure: they are safe, it is frightening but not life-threatening and will pass, they are not going crazy [source: Panic Attacks guideline].
5. Ask what helps; give space; remove sources of distress and ask unhelpful onlookers to leave; speak slowly in short positive sentences; support coping strategies they already use [source: Panic Attacks guideline].
6. Encourage slow, even breathing, demonstrating and talking them through it [source: Panic Attacks guideline]. Paper-bag breathing is not in the guideline.
7. Afterwards, check they are OK to be alone before leaving; tell them effective treatments exist; suggest a doctor or health professional if attacks recur or they have started avoiding things [source: Panic Attacks guideline].
8. Avoid: "just calm down", criticism or pity, overloading with talk, demanding explanations, grabbing or restraining, pressure [source: Panic Attacks guideline].
Example language (illustrative): "You're safe. This is a panic attack and it will pass. Breathe with me, slowly in, and slowly out."
Watch for: chest pain or breathing that does not settle (medical). Working: symptoms peak and subside, usually within 5 to 20 minutes [source: Panic Attacks guideline].

B8. First aid immediately after a traumatic event

Purpose: provide safety, practical help and calm support right after a traumatic event [source: Traumatic Events (adults) guideline 2019 v2.3].
Steps:
1. Check for hazards (fire, weapons, debris) before approaching; call emergency services if needed; if professionals are present, follow their lead and do not undermine them [source: Traumatic Events guideline].
2. Check your own steadiness; if you are not able to help, look after yourself and find someone better placed [source: Traumatic Events guideline].
3. Introduce yourself and your role; stay calm and unhurried; move the person away from danger; protect dignity (cover them, keep onlookers and media away); watch for delayed signs of injury [source: Traumatic Events guideline].
4. Give accurate information, admit what you do not know, make no promises you cannot keep; help with decisions if they are overwhelmed; shield them from anyone acting against their interests [source: Traumatic Events guideline].
5. Speak as an equal; let them feel what they feel (do not ask them to stop crying); tell them reactions are understandable and recovery has its own pace; if they feel guilty about how they reacted, explain that such reactions are usually automatic [source: Traumatic Events guideline].
6. Do not force them to talk or question them about details; do not compare, minimise, offer ill-fitting religious comfort or imply fault [source: Traumatic Events guideline].
Example language (illustrative): "I'm Sam, I'm a first aider here. You're away from the road now. You don't have to talk about what happened. What do you need right now?"
Watch for: deterioration, emerging injuries, dissociation. Working: the person is safe, oriented and connected to practical help and people they trust.

B9. Supporting someone in the weeks after trauma (incl. flashbacks and abuse disclosure)

Purpose: support natural recovery and spot when professional help is needed [source: Traumatic Events guideline].
Steps:
1. Explain common reactions (distress, anxiety, sleep or appetite change, sadness, guilt, fear, anger), which usually settle within about a month [source: Traumatic Events guideline].
2. Offer breaks; ask what they need rather than pushing them to talk; do not take withdrawal or irritability personally [source: Traumatic Events guideline].
3. During a flashback: remind them they are safe, bring attention to the present, avoid startling them [source: Traumatic Events guideline].
4. Anticipate triggers (anniversaries, media coverage) and offer extra support then [source: Traumatic Events guideline].
5. Encourage professional help if after about four weeks they remain very distressed or fearful, behave very differently, have jumpiness or nightmares, cannot stop thinking about it or enjoy life, or relationships and daily functioning are affected; immediately if suicidal; also if using alcohol or drugs to cope [source: Traumatic Events guideline].
6. If abuse is disclosed: listen without judgement or disbelief, thank them, know local mandatory-reporting law, encourage specialist services, help plan for safety, tell them before sharing anything [source: Traumatic Events guideline].
7. Adolescents: let them know you are available and ask whether they would prefer someone else; if you have no ongoing role, help them find a trusted adult or service [source: Traumatic Events guideline].
Example language (illustrative): "You're here with me, in the office, it's Tuesday afternoon. Feel your feet on the floor. You're safe right now."
Watch for: symptoms persisting beyond a month or emerging later. Working: gradual return to routine; help sought if criteria met.

B10. Approaching and talking with someone who may be developing psychosis

Purpose: open a safe, non-confrontational conversation with someone showing early signs of psychosis [source: Psychosis guideline 2019 v2.3].
Steps:
1. Know early signs: changes in mood and motivation (low mood, irritability, suspiciousness, flat affect, low energy), thinking and perception (poor concentration, sense that things have changed, unusual ideas, altered senses), behaviour (sleep problems, withdrawal, declining functioning). A cluster or marked out-of-character change matters more than one sign; consider cultural and spiritual context; consult a professional if unsure [source: Psychosis guideline].
2. Talk one-to-one, privately, somewhere calm with enough time; adapt to their state (give space if suspicious) [source: Psychosis guideline].
3. Start from common ground and move gradually to concerns; do not use the word psychosis or speculate about diagnosis; let them set the pace and use their terms [source: Psychosis guideline].
4. Treat hallucinations and delusions as real to the person; neither confirm nor deny them; do not argue, mock or pretend to agree; respond to the feelings; ask what helps them cope; stop others from joking about them [source: Psychosis guideline].
5. With paranoia: be honest about what you do and do not perceive, keep a comfortable distance, give simple directions, do not whisper [source: Psychosis guideline].
6. Do not touch without permission; avoid tense or hovering body language [source: Psychosis guideline].
7. Encourage help with hope (early treatment works better, care is often community-based); suggest a GP to start and to check physical causes; offer a limited choice of options; for adolescents, secure the appointment and offer to go [source: Psychosis guideline].
Example language (illustrative): "I can't hear the voices you're hearing, but I can see they're really frightening you. What usually helps when they're like this?"
Watch for: rising suspicion or agitation (back off, slow down). Working: the person stays in conversation and accepts at least a GP visit.

B11. Severe psychotic state and aggression

Purpose: keep everyone safe when hallucinations, delusions or disorganisation are overwhelming or behaviour is dangerous [source: Psychosis guideline].
Steps:
1. Prioritise safety: keep a safe distance and a clear exit; take threats seriously; leave and get help if frightened [source: Psychosis guideline].
2. If safe, remove nearby weapons or objects that could be used as weapons; if the person is armed, do not approach and call emergency services [source: Psychosis guideline].
3. De-escalate: listen more than talk, use short calm sentences, reduce stimulation, ask before any physical contact, involve a trusted person if possible [source: Psychosis guideline].
4. Get urgent assessment; describe specific observations rather than the label; tell services about weapons, prior diagnoses or suicide risk; if police come, tell them psychosis may be involved [source: Psychosis guideline].
5. With aggression: do not threaten, argue or fire questions; withdraw if it escalates. People with psychosis are more often at risk of harming themselves than others [source: Psychosis guideline].
6. Postpartum psychosis can escalate fast: call a mental health crisis team immediately and make sure someone stays with mother and baby [source: Psychosis guideline].
Example language (illustrative): "I'm going to sit over here. No one is going to hurt you. Let's turn the TV off so it's quieter."
Watch for: escalation, weapons, suicide risk (switch to B2 to B5).

B12. Culturally adapted first aid (Aboriginal and Torres Strait Islander MHFA)

Purpose: deliver first aid that fits Aboriginal and Torres Strait Islander community norms; MHFA Australia runs dedicated courses and guidelines developed with Aboriginal clinicians [source: Our story; AMHFA Suicide & DSI guideline 2008].
Steps (from the 2008 suicide and self-injury guideline): learn which warning signs matter in the person's community; adapt the wording of the suicide question if the word is unacceptable; identify trusted people (family, Elders, Aboriginal health workers, counsellors) and help the person reach them; make sure a professional, health worker, family member or Elder is present to guide them in a crisis; distinguish cultural grief practices from self-injury [source: AMHFA Suicide & DSI guideline].
Who holds authority: Aboriginal and Torres Strait Islander instructors and community members; a non-Indigenous clinician should refer people to these courses and partner with Aboriginal community-controlled services rather than adapting content alone [synthesis]. Whether non-Indigenous instructors may deliver these courses was not confirmed [uncertain].
Watch for: imposing mainstream wording or help pathways. Working: community-endorsed supports are involved.

C1. Clinician tasks around the programme [synthesis unless tagged]

Delivering the course: complete the MHFA Instructor Training for the specific course and hold a current licence; deliver the course as published; complete assessments for accreditation [source: Our story; Volunteering Victoria]. Fidelity monitoring, instructor reaccreditation rules and teaching methods (e.g. role-play) are [uncertain].
Coaching a client's family member or carer: teach the Action Plan and the relevant guideline (e.g. psychosis or suicide) in a session; rehearse approaching, the direct suicide question and the no-secrets explanation; give the free guideline from MHFA International for their situation [synthesis; guideline content as above].
Referring: suggest the matching course to carers (Standard or Older Person MHFA), parents and teachers (Youth MHFA), teens (Teen MHFA), or workplaces [source: Our story for course list].
Working alongside workplace or school MHFAiders: agree clear handover routes, crisis numbers and consent-to-share rules; clarify that MHFAiders are not counsellors and do not hold ongoing caseloads [synthesis].

5. Handling problems

Problems the MHFA guidelines address

Person will not talk: do not push; keep in touch with everyday contact; offer to help them find someone else; try again later [source: ALGEE in action; Suicide guideline].
Person refuses professional help: keep encouraging; explore reasons (stigma, not knowing where to go, fear); expect several conversations; suggest help for a problem they do acknowledge; respect refusal unless at immediate risk or local involuntary-treatment criteria apply; never threaten hospitalisation; seek advice from a crisis line, mental health centre or professional, describing specific observations [source: Psychosis guideline; Suicide guideline; NSSI guideline]. If they still will not go, build other supports such as social or peer groups [source: ALGEE in action].
Adolescent refuses help: make sure someone close (family, friend) knows; seek advice from a mental health professional; be more directive [source: Suicide guideline].
Anger or sense of betrayal after you involve others: expect it, do not take hurtful words personally; the guideline holds that anger is better than losing the person [source: Suicide guideline].
Person asks you to keep a secret: do not agree for suicide plans or serious risk; explain why; tell them before you share [source: Suicide guideline; NSSI guideline].
Overwhelm in panic: give space, slow speech, yes/no questions, guide slow breathing; check medical causes [source: Panic Attacks guideline].
Overwhelm after trauma: do not probe details; offer breaks; ground during flashbacks [source: Traumatic Events guideline].
Aggression or severe psychotic state: distance, exit, de-escalation, withdraw if escalating, emergency services if armed [source: Psychosis guideline].
Intoxication: choose another time for non-urgent talks; in a crisis, treat intoxication as raising risk and encourage avoiding further alcohol and drugs [source: ALGEE in action; Suicide guideline; AMHFA Suicide & DSI guideline].
First aider not ready (own distress, own attitudes): pass to someone better placed [source: Suicide; NSSI; Traumatic Events guidelines].

Problems the sources do not address [synthesis]

Rupture between helper and person ("you're treating me like a patient"): name it, apologise for any pressure, return to listening and ask what kind of support they want; keep the door open.
MHFAider over-involvement (becoming the person's only support, late-night calls, rescuing): reinforce A5 (other supports), set clear availability, hand over to professionals; in workplaces, use supervision or the organisation's support line.
Course participants distressed by content (lived experience, recent bereavement by suicide): as instructor, warn about content in advance, allow breaks and opt-outs from role-plays, check in privately, give support contacts. Check the licensing organisation's own participant-wellbeing procedures [uncertain].
Trained people who do not act (common gap between knowledge and helping): rehearse the opening sentence and the suicide question aloud; plan follow-up contacts; refresher courses every 3 years [source for refresher only: Volunteering Victoria].
Therapist role confusion: when a therapist uses ALGEE outside a therapy contract (colleague, community member), stay in the first-aid role and refer onward rather than starting informal treatment.
Clients' carers who over-apply crisis responses (calling emergency services for developing problems): coach them to match response to stage (developing, worsening, crisis) and use the urgency tiers in B5.
Cultural mismatch (guideline wording or help pathways do not fit): use community-specific guidelines where they exist, involve cultural supports, and do not assume that help-seeking routes common in high-income health systems are available.
Workplace or school confidentiality pressure (manager wants details): share only what is needed for safety, with the person's knowledge; follow local law and policy.

Sources

Sources:

Further reading (not drawn on) [uncertain]: MHFA International guidelines index (mhfainternational.org/guidelines); the problem alcohol use guideline; course manuals (MHFA Australia Standard MHFA manual; MHFA USA Adult manual), which are participant materials and were not consulted. Course-manual contents, instructor-training details and fidelity requirements are therefore not covered.

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