Three themes were constructed from the data set providing an exploration into participants’ attitudes, beliefs and experiences regarding their role as MHFAers. These findings exemplify what it is like to be a MHFAer within a University and the challenges faced, providing insight into what support is required for MHFAers themselves.
“We are not psychiatrists; we are listeners and are there to help people get the correct support”
This initial theme provides insight into participants’ attitudes and beliefs regarding their personal role and responsibility since their MHFA training. Overall, there was the consensus that MHFAers are not there to provide advice, but instead they are there to listen and to signpost individuals to professional support services.
William - “We aren’t doctors, psychiatrists, nurses all that at all. We are just listeners; we are responsible to really take the information the person gives and check whether that person needs more help from a professional.”
Participants agreed that often their role is to be the “first point of call” for individuals, particularly for those in a crisis. All individuals in this research explained that if they were to witness somebody experiencing a mental health crisis they should intervene (if it was safe to do so) and provide that initial support.
Violet – “it’s kind of applied, that I should step in when someone is clearly in a crisis. I mean that’s what you’re there to be trained for isn’t it, to be that person that is responsible to help.”
Participants saw it as their duty to help, and to be empathetic and understanding, regardless of how they were feeling themselves. Many explained how they would put the individual in crisis before their own anxieties and nerves, as they deemed it as their role to intervene.
Alice – “I’m probably more likely to help if anything [regardless of being nervous / having anxiety] because I have that title of a MHFAer and like that’s my role, to help”
Individuals felt that during a crisis they should “act fast and immediately” to ensure the person in distress is as safe as possible. It is clear the compassionate nature of MHFAers, and sometimes the lack of self-compassion MHFAers have for themselves during and after the time of support, where coping with one’s own emotions is not part of the equation of support.
In addition to being a “first point of call”, individuals within this research explained how they had become a “buddy” for fellow University students, with many students returning to them on numerous occasions for support. All participants within this research were trained within their University and therefore predominantly provided support to University students.
Maisy – “Ninety percent of individuals I have given peer support to have returned for more support and ongoing support, so I think it is just like giving them a safety net so they can disclose how they’re feeling to me as a peer supporter and not an academic or a doctor and someone who can understand where they’re coming from”
Participants explained how individual’s value hearing lived experiences from MHFAers, enabling them to generate rapport due to their shared identity (of being University students) and understanding of common humanity, that everyone suffers.
Hardeep – “I found that they really value lived experience. I myself have anxiety, and when I talked to them about my anxiety and how I deal with it, they kind of realised that it’s not just them”
Nonetheless, despite the success of the mental health initiative set up at the University and the Peer MHFA Scheme that was established, some participants did explain that this could have a negative impact with such individuals becoming over-reliant on the MHFAers.
Baljit– “It can sort of be a negative, because you know really MHFA should be a one or two time thing, and students sort of become reliant on you. That has happened in the past where people become reliant on us in their support systems constantly, and they sort of come to you without even letting you know that they need support”
Individuals explained how this can have negative consequences for the individual who is seeking support, as well as the MHFAer, particularly when individuals turn up for support without formally arranging it and MHFAer is not emotionally resilient because they themselves are having a bad day.
In addition to the challenge of dealing with individuals who become over-reliant on MHFAers, there was also confusion amongst participants regarding whether their role as a MHFAer is a recognised position, along with where their responsibility is recognised and expected to be used. Participants spoke about the support they have provided in their personal lives, explaining that since completing the course the support they provide their friends with has now changed.
Alice – “I sometimes get friends come to me in some sort of distress mentally but I feel it’s entirely different when you’re close with someone. I do try to listen more and give my opinion less. I feel like it’s better to just be encouraging and positive than try to give advice all the time, like I’m not a professional”
Nonetheless, whilst participants explained that the way they approach distress amongst their friends has now changed, there was agreement that they are not a MHFAer with their friends; instead the support they provide is more personal.
Overall, it is clear from this theme that the general responsibility perceived by participants as a MHFAer is to listen and to signpost individuals to an appropriate organisation, however many expressed that this alone is perhaps not good enough, with many individuals wishing they could do more.
Violet – “I feel like I should do more. I think anyone in a mental health crisis, do they really process information at the time? I feel like they don’t and you’re giving them information – is that going to be processed by them at the time? I feel like it’s kind of just, maybe passing the person on”
The feeling of not doing enough and simply referring the person to someone else filled many participants with anxiety, with participants explaining how they carry this anxiety with them after they have finished providing support. Consequently, it is imperative that MHFAers themselves have a support system, with it being plausible that such support should focus on encouraging self-compassion and self-kindness to preserve the emotional wellbeing of MHFAers.
“MHFA is a big weight to have on your shoulders; I need to look after myself to support others”
This second theme provides insight into the impact being a MHFAer can have upon an individual’s psychological wellbeing. The consensus was that being a MHFAer is “a big weight on your shoulders”, with many individuals within this research discussing the anxiety that accompanies the role, and the nerves they experience when approaching someone in distress.
Violet – “Nervous [at the thought of helping someone] because ultimately you are dealing with someone’s life potentially, so you know it’s a big weight to have fall on you”
Participants explained how their anxiety is largely due to them wanting to help others as much as possible, however feelings of being inexperienced, along with their own mental health difficulties impairs their perceptions on how helpful they are.
Hardeep – “I don’t have the authorities to kind of reassure them sometimes because I myself have that anxiety as well. It feels sometimes I’m just giving advice but I’m not actually taking my own advice, and sometimes I feel like with anxiety I can’t really help very much because I struggle.”
In terms of mental health, this research demonstrates the need for MHFAers to have their own support system to ensure their wellbeing is preserved whilst supporting others. Such support could focus on encouraging self-compassion in an attempt to discourage MHFAers being self-critical as one form of intervention.
In addition to the nerves individuals feel when approaching someone in distress and providing support, many also spoke about the anxiety they experience after they have provided support. Participants explained that when reflecting on events they over-analyse what happened, and then worry about the outcome and whether they will have actually helped the individual.
Alice – “I worry that I maybe said something wrong because they’re sensitive subjects and you are there to make sure you help them get better not worse. I’d hate to be responsible for making them worse. I worry I said the wrong thing”
The anxiety surrounding “saying the wrong thing” or “making others worse” was very much prevalent within the data. This anxiety is intensified when individuals do not know the person they are supporting, and therefore cannot “check-in” on their progress as they would with friends. There was also the fear of blame amongst participants, worrying that if the individual they are supporting was to come to harm, that the blame would lie with the MHFAers.
Violet – “I felt anxious the first time like what if they do something bad and then the blame lies with me for not doing enough, or maybe not saying the right thing”
It is clear from participants discourse the support that is required for MHFAers to help them deal with the responsibility and pressure that accompanies their role, in order to protect their mental health. Participants did explain that over time and with experience you can disconnect from “encounters”, being able to “take five minutes” after supporting someone and then move on with the rest of their day, being confident that they did their best for that person.
Maisy – “I’ve been a MHFAer now for so long and working with students that are distressed and dealing with mental health difficulties. I sort of just get on with my day, and I know that sounds really bad but I also work for the NHS […] I’m older than most of the MHFAers, I’ve gone through some hard stuff in my life. I’m not really emotionally affected and I think that’s why I’m good at supporting others cause I don’t get emotionally attached”
Such individuals did approach their role differently, appeared less critical regarding their ability to provide support, explaining how positive they feel after providing support to others. Does this experience of detachment and potentially approaching the role with more of a self-compassionate and self-kind attitude (or less self-critical attitude) stem from additional roles and experiences within the NHS?
In terms of how individuals cope with their role as a MHFAer, many explained how their main coping mechanism is to talk to others, explaining that talking enables them to clear their mind and move on from the situation, being reassured by others that they have done and / or said the right thing.
Hardeep – “I think my main mechanism is talking about it to other people. If I don’t, I think about it too much […] if I dwell on it then it’s worse for me and my mental health. I have to tell someone to get it out and then kind of forget about it after that”
Whilst the majority of participants discussed how beneficial talking to others is for their own wellbeing, some did explain how they were unsure whether they could talk to others due to the issue of confidentiality.
Alice – “I wouldn’t want to keep any trauma to myself, but with confidentiality actually I don’t really know, like if that is appropriate or would be appropriate for me to discuss someone else”
Consequently, there were barriers to seeking support. The participants within this research were all MHFAers within a University where a support system had been created compromising of fellow MHFAers (academics and university students), with all participants praising this support mechanism. Accordingly, all participants within this research had someone they could talk to; however, the same support would not be available for all MHFAers, especially those who have not undertaken training within an organisation. Some changes need to be employed to ensure support mechanisms are in place for all.
In addition to talking, other participants discussed the need for “me-time” after supporting individuals in their role as a MHFAer, explaining that they need time to relax and let go of the anxiety and stress that accompanies their role.
Natasha – “After I’ve chatted with them I’ve had chocolate, have a nice hot bath, some sort of self-care. I make sure that I’m taking care of me as well because at the end of the day like you can’t help somebody else, if you’re not helping yourself”
Overall, the need for self-compassion is clearly illustrated within the data, with provisions needing to be in place to ensure MHFAers have access to appropriate sources of support, as well as understanding the need for self-kindness. MHFA training should not just focus on the support that MHFAers need to provide to others, but self-help techniques should be emphasised and integrated into the course for MHFAers to utilise for their own wellbeing.
“More preparation is needed from MHFA training; the course should be longer, incorporate more role play, and encourage MHFAers to care for themselves as well as others”
This final theme provides insight into participants’ perceptions regarding whether MHFA training truly prepares individuals for the reality of being a MHFAer. All participants spoke positively regarding the training they had received, with many explaining that it gave them key information on how to help someone in distress and deliver MHFA by developing rapport with others. A number of participants explained how the training course instilled confidence in them regarding their ability to help others in distress.
Lucy – “If you want to do the course in the first place then you already are in that place where you want to help people. I think the course just instils that confidence in you to help someone. Before you might have just looked on and thought well I can’t help or I don’t want to say the wrong thing. When you’ve got the training you’ve got that badge of honour where you can help and say the right things”
Their confidence was improved further following “positive endings” for individuals they had provided support to, with participants explaining how reassuring it is to receive positive feedback on their ability to help others, with this encouraging them to continue providing mental health support. Participants who demonstrated the most confidence in their role explained how this is due to the course alongside their experiences in their personal lives. Predominantly, participants explained how age (and therefore life experience) improves your confidence to intervene in a crisis, as well as your professional roles outside that of being a MHFAer, with one participant explaining how their role within the NHS means they are confident in dealing with mental health. Furthermore, some participants explained how their own experience with mental health has instilled their confidence to help others in a similar position, with the MHFA training providing them with the tools to do this effectively.
Maisy– “I have actually experienced mental health […] I think the training sort of refreshed my memory if that makes sense and helped my understanding; a more in-depth understanding of how to approach people and students”
In particular, participants explained how the course has helped with their active listening, helping them be more present within a conversation and truly listen to what people are saying, rather than “trying to rush to find an answer”.
Whilst all participants valued the mental health first aid training, some individuals did believe that the training can only prepare you so much; whilst the training explains how to approach someone who is in distress, in reality the situation can be completely different. Consequently, the majority of participants explained that whilst they were happy with the training, they did initially lack confidence in their ability to provide support.
Violet – “At first I didn’t feel confident at all and I sort of doubted my own ability. I don’t think anything can ever set you up for someone who is experiencing a mental health crisis really”
Many outlined their beliefs that the course could be improved to prepare people more thoroughly for the reality of supporting others in a mental health crisis. The consensus was that the course should be longer than just two days in order to cover more disorders in-depth, with many believing that there was a large emphasis on anxiety and depression, and therefore they were not well equipped to deal with other mental health difficulties (e.g., eating disorders, bipolar). In addition, many believed that there should be refresher sessions to ensure that MHFAers have up to date knowledge regarding how to support individuals effectively.
Violet – “It should be a bit longer […] there is so much to cover in such a short time and like regular review sessions. Like they could send out little quizzes and refreshers maybe. Things update all the time , you need to make sure you are fresh and up to date […] I think with the responsibility as a MHFAer there is so much that you could be faced with that two days seems like such a short period”
Another suggestion was that the course should entail more role-play, to help individuals understand more thoroughly what they should do and / or say when supporting others with their mental health, with participants believing that role-play would make the information more memorable.
Baljit – “I think maybe there could have been more role-play rather than actually watching videos like doing it ourselves […] I think that could be developed especially around having those difficult conversations [e.g. regarding suicide]”
In addition to suggestions focusing on how to improve the course to improve the ability of the MHFAers to provide support to others, some individuals made suggestions on how the course could be improved to ensure the physical and psychological safety of MHFAers. Some participants explained that there needs to be more emphasis on when MHFAers should not intervene in a crisis e.g., due to the situation being unsafe for themselves, or because the MHFAer is not in a good place with their own mental health. Participants believed there needed to be a discussion regarding what to do in such instances.
Maisy– “I definitely think it [when not to intervene] should be spoken about a lot more in the MHFA training because obviously if someone was being discriminated against or in distress you don’t know who’s carrying knives and things like that. We have to take those things into consideration now”
Overall, there was the consensus that the MHFA training needs to make sure that MHFAers have support themselves.
Baljit – “I had my MHFA training at University so I had the support of academics but I think somebody who’s not in that environment, who would support them? That’s one of the things that always worries me because anybody can get mental health and it’s quite difficult if you’re experiencing a crisis to help somebody else in a crisis”
Consequently, it is suggested that the training course needs to ensure that MHFAers are cared for themselves, making them aware that they can access appropriate support. If we aspire for MHFA to be as prevalent as physical first aid, we need to take care of those who are undertaking the training and providing such support, creating a community where MHFAers support each other (not just when organisations set up this support themselves). It is admirable the compassion that MHFAers provide to others; however, this should not be at the expense of self-compassion and this should be instilled within the training course. We cannot expect individuals to care for others without caring for their own psychological wellbeing.