How to administer basic mental health first response

The standards for pre-registration nursing programmes (Nursing and Midwifery Council, 2018) state that all nurses must be able to administer basic mental health first aid at point of entry to the register. Mental Health First Aid (MHFA) as a concept is a copyrighted strategy and a recognised training course across the world (MHFA England, 2022). The description below is not meant to replicate this but takes some of the basic principles and how this might apply to nurses administering mental health first response in the workplace. For the purpose of this guide, and due to the difference between this intervention, and the formal patented mental health first aid training course, the following procedure shall be reframed as mental health first response (MHFR).

In the same way as when learning physical first aid, MHFR teaches people how to recognise those crucial warning signs of mental ill health and feel confident to

Skills and attributes and knowledge required when administering mental health first response:

Interpersonal skills

• Active listening
• Recognise and respond to verbal and non-verbal cues
• Use prompts and positive verbal and non-verbal reinforcement
• Use appropriate non-verbal communication including touch, eye contact and personal space
• Make appropriate use of open and closed questioning techniques
• Use caring conversation techniques
• Check understanding and use clarification techniques
• Be aware of own unconscious bias in communication encounters (Nursing and Midwifery Council, 2018)
• Ability to establish a rapport and maintain a therapeutic alliance
• Ability to tolerate and work with silence within an interaction
• Ability to convey empathy via explicit validation statements

Attributes

• Self-awareness particularly with regards to occasions when a person's values and morals may conflict with your own
• Ability to critically reflect
• Awareness of your own professional limitations and when to seek support and advice
• An understanding of personal and professional boundaries (Hamilton, 2010)
• Appropriate self-disclosure

As with any intervention within healthcare settings the aim is to preserve life, prevent things getting worse, promote recovery and provide comfort. There is a structured approach to providing a mental health first response for non-mental health professionals that will adhere to principles and remain within the limits of the role (Hammett, 2021). 

The setting

Ensure you have a clean calm and private space, free from interruption or distraction. Offer the person a drink and have a box of tissues available. Leaflets with information and contact details of local support such as groups and charitable organisations are helpful. Make sure you have a notebook and pen to write down the action plan; you can photocopy this to share a copy with the person who needs the response and then formalise it in a typed document later.

• Establish a rapport by asking general questions and demonstrating the core therapeutic qualities of

Risks when administering mental health first response

• Going beyond the scope of your role and not referring on appropriately - this procedure is not about diagnosis or offering therapy
• Unclear relational boundaries leading to lack of containment for the individual in receipt of the support and potential burn out and overwhelm for the member of staff administering MHFR
• Over disclosure leading to violation of boundaries or conversely too distant a stance inhibiting rapport and the therapeutic alliance
• Not recognising or responding appropriately when an individual presents with an immediate risk to themselves, to others, or from others; this could be due to lack of skill, experience, or confidence.

References

Hammett E. Mental Health First Aid: A practical guide for workplaces, schools, families, friends, carers and everyone needing support with their mental health. First Aid For Life, London UK; 2021

Keyes CLM. The mental health continuum: From languishing to flourishing in life. Journal of Health and Social Behavior. 2002; 43:207–222. https://doi.org/10.2307/3090197

Lister SE, Hofland J, Grafton H. The Royal Marsden manual of clinical nursing procedures. (10th edn). Wiley-Blackwell;UK:2022

MHFA. MHFA England launches new mental health first aid course. 2022. https://mhfaengland.org/mhfa-centre/news/MHFA-England-launches-new-Mental-Health-First-Aid-course/?gclid=EAIaIQobChMIraXPsYGz-wIVBtDtCh3Kcw78EAAYASAAEgK4xPD_BwE (accessed 16 November 2022)

Nursing and Midwifery Council. Part 3: Standards for pre-registration nursing programmes. 2018. https://www.nmc.org.uk/globalassets/sitedocuments/standards-of-proficiency/standards-for-pre-registration-nursing-programmes/programme-standards-nursing.pdf (accessed 16 November 2022)

Rogers CR. On becoming a person: a therapist's view of psychotherapy. Boston: Houghton Mifflin;Boston:1961

NHS. Add|wellbeing. 2022 https://tavistockandportman.nhs.uk/training/workforce-development/addwellbeing-mental-health-and-wellbeing-workplace/ (accessed 16 November 2022)