Assessment of the need for and implementation of Mental
Health First Aid (MHFA) in north-east England
Paul Biddle
University of Northumbria
1. The Presentation
• Findings from a research project that examined the need for and
implementation of MHFA in north-east prisons.
• Funded by the North East Offender Health Commissioning Unit.
• Undertaken in 2010-11
• Principal Investigator: Dr. Wendy Dyer
2. Background and Context
• Prisoners are at greater risk of experiencing poor mental health
than the overall UK population.
• Since the 1980s the proportion of the prison population showing
signs of mental illness has increased sevenfold.
• High rates of self-harm and suicide.
3. Background and Context
• The extent of mental health issues in the prison population has
been increasingly recognized by policymakers and those
commissioning and delivering services.
• Mental health services for prisoners have been expanded and
improvements made:
– Creation of Mental Health In Reach Teams
– Development of the Care Programme Approach
– Prior to the recent public expenditure cuts, funding for prison
mental health in-reach had increased substantially.
4. Background and Context
• Ongoing policy commitment to improve outcomes:
• Breaking the Cycle: Effective Punishment, Rehabilitation and
Sentencing of Offenders’ (2010) and
• No Health without Mental Health’ (2011) recognised the
importance of effective mental healthcare for offenders to
reduce re-offending.
5. Background and Context
•
Despite improvements, problems remain with mental health
services for prisoners:
–
Under-staffed services
–
Difficulties achieving ‘equivalence of care’ to ensure
prisoners receive interventions broadly comparable with
those available in the community
–
Mental Health In Reach Teams struggle to cope with demand
and lack clarity of purpose:
•
Some focus on severe cases
•
Some provide a more generalist service
6. Background and Context.
–
Wider prison staff lack sufficient capacity and training to
intervene to support prisoners with mental health issues.
–
Limited integration, collaboration and partnership working
between individuals, functions and prisons - and between
community-based mental health services.
–
Security priorities can influence ability to deliver optimal
services.
–
Unmet need - A cohort of prisoners exist with mental health
issues just below the level of severity required to trigger an
intervention.
– Prisoners face difficulties accessing information, advice and
guidance about therapies and medication options.
7. MHFA
• A course aimed at those with little or no knowledge of how to
help someone who is suffering from a mental health problem.
• Designed to enable someone to help an individual experiencing a
mental health problem prior to professional help being obtained.
• Provides information about recognizing and responding to a range
of mental health problems including:
– Depression
– Suicide
– Anxiety Disorders
– Self Harm
– Psychotic Disorders
8. MHFA
• Regulated by the National Institute for Mental Health in England
and the Care Services Improvement Partnership.
• A 12 hour course to enable participants to:
– Recognise distress
– Have confidence to provide immediate interventions
– Help and guide a person to wider support.
• Those participating in the training and qualifying (via successful
completion of activities and assignments) become MHFA
instructors who can train colleagues in their own organisations
9. Methodology
• 2 stages:
– Stage 1 –
• Literature review
• Attendance at MHFA training
• Interviews with 35 individuals in who worked in a range of roles within
the 3 prisons to explore existing levels of knowledge, capacity, responses
across each prison
– Stage 2
• Interview with 5 staff who had received MHFA training (represents half of
the 10 staff who were trained at the point stage 2 began)
• Explored impact and roll-out of MHFA
– Stage 3
• Currently undertaking a follow up to gain information to inform a journal
article.
Evaluation Findings
10. Stage 1 - Needs Assessment
• Improvements to mental health services in all 3 prisons in recent
years.
• Staff had received variable and limited training around mental
health issues (focus on suicide, self harm and ACCT). Reliance on
experience to identify prisons with mental health issues.
• Limited knowledge of mental health, how to recognise these
conditions and appropriate responses.
• Limited time and resources to respond to prisoners with suspected
mental health issues.
11. Stage 1 - Needs Assessment
• Wing staff often provide the initial response to inmates
experiencing a mental health crisis.
• Response to suicide and self harm are increasingly effective.
• Responses to other mental health issues more variable and are
influenced by:
– Training and experience
– Prisoner staff relationships
– Time
– Individual staff understanding of their role
12. Stage 1 - Needs Assessment
• Those prisoners whose conditions do not have implications for
the smooth operation and good order of the prison can be
missed.
13. Stage 1 - Needs Assessment
• MHFA could potentially assist prisons to:
– Better identify prisoners with mental health issues
– Give staff more knowledge of more conditions and how to
respond appropriately to these
– Increase institutional capacity to respond to the mental health
issues of prisoners.
14. Stage 2 - Implementation Findings
• Core group of staff trained who had various roles in their
respective prisons:
– Wing Staff
– Reception Staff
– Staff with ACCT management responsibilities
15. Stage 2 - Implementation Findings
• Those trained reported:
– Greater awareness and understanding of mental health problems
that prisoners may have
– Improved understanding of how to respond to inmates suspected
of mental health problems
– A greater awareness of community-based services inmates could
be referred to
16. Stage 2 - Implementation Findings
• Instructors have trained colleagues in two prisons, with training
planned in a third
• Instructors selected colleagues who were the easiest to organise
training for, not those for whom training might have been most
appropriate.
17. Stage 2 - Implementation Findings
• Lack of strategic management and delivery of MHFA across the
regional prison estate
• Ltd commitment from senior management to roll-out MHFA???
• Roll out of MHFA compromised by difficulties releasing staff for
training.
• Participation in MHFA training not mandatory – crowded out by
other training that has to be undertaken. Exacerbated by
difficulties back-filling staff on training.
18. Stage 2 - Implementation Findings
• The details of MHFA-trained staff were not formally disseminated
to colleagues so they could be contacted to provide
information/advice to other prison staff.
• Maintenance of Instructor status is likely to be problematic as
instructors cannot train sufficient colleagues in time periods
required.
• Stage 3 findings suggest few, if any, instructors have delivered
training since March 2012.
19. Conclusions
• MHFA can be a valuable part of a wider approach to improve
responses to prisoners with mental health issues
• MHFA cannot replace specialist mental health services in prisons.
• A missed opportunity – the value of MHFA undermined by its roll
out?
20. Recommendations
• Strategic management and commitment, with strong institutional
messages about the importance of MHFA.
• Publicise details of those trained throughout each prison so
relevant staff can be a resource for their colleagues.
• MHFA training for both staff AND prisoners.
• Explore delivery of shorter MHFA course
Assessment of the need for and implementation of Mental Health
First Aid (MHFA) in north-east England
Mr Paul Biddle
University of Northumbria