Mental Health First Aid

Mental Health First Aid (MHFA) is the help offered to someone developing a mental health problem, experiencing a worsening of one, or in a mental health crisis. The framework was created in Australia in 2000 by Betty Kitchener and Professor Anthony Jorm, and is now taught in more than 25 countries.

If someone's life is in immediate danger, call 000. For ongoing support — therapists, helplines, peer groups and workplace EAPs matched to your situation — visit our sister site GuardianGuide.org, which curates the right mental health resources for you rather than a one-size-fits-all list.

The ALGEE action plan

MHFA uses a five-step plan you can apply to any mental health concern:

1. A — Approach, assess and assist with any crisis.
2. L — Listen non-judgementally.
3. G — Give support and information.
4. E — Encourage appropriate professional help.
5. E — Encourage other supports (family, peer, self-help).

Approach — opening the conversation

• Choose a private, quiet place where the person feels safe.
• Be calm, patient and respectful. Sit at the same level.
• Say what you have noticed: "I've noticed you've seemed really down lately. How are you doing?"
• It is okay to feel awkward. The fact that you asked matters more than the perfect words.

Listen non-judgementally

• Let them speak without interrupting, fixing or minimising.
• Avoid: "Cheer up", "Others have it worse", "You'll be fine."
• Reflect back what you hear: "It sounds like things have felt really heavy."
• Silence is okay. So are tears.

Suicidal thoughts — ask directly

Asking about suicide does not plant the idea. It can save a life.

• Ask plainly: "Are you having thoughts of suicide?" or "Are you thinking of ending your life?"
• If yes: ask if they have a plan, the means, and a timeframe. The more specific, the higher the risk.
• Stay with them. Remove or secure means if it is safe to do so (medications, firearms, ropes).
• Call 000 for immediate danger, or take them to the nearest emergency department. For ongoing crisis and counselling pathways, point them to GuardianGuide.org.
• Do not promise to keep suicidal thoughts secret.

Panic attack

Symptoms: racing heart, shortness of breath, chest tightness, dizziness, sense of impending doom. Can mimic a heart attack — if first time or in an older person, treat as suspected heart attack and call 000.

• Speak calmly. Reassure them this will pass — most attacks peak within 10 minutes.
• Encourage slow breathing: in through the nose for 4, out through the mouth for 6.
• Sit them somewhere quiet. Do not crowd them.

Severe anxiety

• Acknowledge how they feel. Do not argue with the worry.
• Help them ground in the present: name 5 things you can see, 4 you can hear, 3 you can touch.
• Encourage them to speak with their GP about ongoing support.

Psychosis (loss of contact with reality)

Signs: hallucinations (hearing voices, seeing things), delusions, disorganised speech, severe withdrawal.

• Stay calm. Do not argue with or play along with delusions.
• Speak slowly and clearly in short sentences.
• Reduce stimulation — quiet room, dim light, fewer people.
• If the person is a danger to themselves or others, call 000 and ask for ambulance and police.

Substance intoxication or overdose

• If unconscious and breathing: recovery position, call 000, monitor.
• Suspected opioid overdose (slow breathing, pinpoint pupils, blue lips): call 000; give intranasal naloxone (Nyxoid) if available — it is safe even if you are wrong.
• Stay with the person. Do not leave them alone.

Self-harm

• Treat the physical injury first — see Bleeding.
• Be matter-of-fact, not shocked. Self-harm is usually a coping strategy, not a suicide attempt — but ask about suicidal thoughts too.
• Encourage them to speak with their GP or a psychologist, and to use GuardianGuide.org to find ongoing support matched to their situation.

Look after yourself

Supporting someone in distress is hard. Debrief with someone you trust, set limits on what you can offer, and seek your own support if you need it. You are a first aider, not a therapist.

Training

Accredited 12-hour Mental Health First Aid courses are run across Australia through MHFA Australia. Specialised versions exist for youth, older adults, Aboriginal and Torres Strait Islander communities, and workplaces.