A husband-and-wife team came up with first aid for mental health on a dog walk.
The training session starts with a drawing of a T-shirt on paper. The adult students are asked to write on the front examples of negative assumptions and labels that people use about an imagined co-worker who is experiencing depression, unknown to the colleagues.
The judgments come rolling in: lazy loner, negative person, not a team contributor, and whinger, slang here in Australia for a complainer.
The students, who commonly do this kind of exercise early in the two-day class, are learning a skill that’s growing in demand: mental health first aid. When people finish the course, they have the confidence and tools to talk supportingly with someone who has a mental health condition that is new or worsening, perhaps reaching a crisis stage. The first-aider can be a bridge to move a person toward helplines, counselors, supportive local groups, and doctors.
The idea to create these courses came to us one evening while walking our dog. With the support of funding from Rotary members in Australia, we pursued extensive research to develop the training. Our Mental Health First Aid courses that started 25 years ago have reached more than 8 million people through nonprofit and government organizations in over 40 countries. (Lady Gaga even promoted training in the U.S. for teens to support peers.)
I’m Tony Jorm, an emeritus professor at the University of Melbourne who has researched ways to encourage more people to intervene early to help those with mental health conditions. I’ve studied and tested consensus methods in science, the approach used to create mental health first aid guidelines that determine what to say, and what not to say, when assisting a person with a mental health condition.
I’m Betty Kitchener, a former teacher, educational counselor, and registered nurse who taught Red Cross first aid for years. I have had some serious bouts of depression, starting when I was a teenager. I’ve wondered if my parents and teachers could have supported me better growing up if they’d had this training. Could better support have prevented subsequent episodes in my adult life? But I don’t dwell on those thoughts too long because coping with depression and moving on to my happy life with my husband helped us create the training and makes me a capable, empathetic messenger of our evidence-based curriculum.
The authors at their club’s 2025 changeover dinner to celebrate the new Rotary year.
Courtesy of Betty Kitchener
There’s a strong chance that someone in your social circle will experience a mental health condition — your loved one, a co-worker, a neighbor. Think about the enormity of this troublesome number: In any given year, an estimated 1 in 5 adults in our home country of Australia have a mental health disorder, such as clinical depression, debilitating anxiety, or a substance use disorder.
The prevalence of people with mental disorders in Canada and the U.S. is the same: about 20 percent each year. The worldwide figure is about 1 in 7 people (statistics can vary depending on the conditions included). That makes mental health conditions a leading source of health burden globally. And people are alarmed by an increasing number of adolescents who report poor mental health in countries that track robust data.
What mental health first-aiders around the world learn is based on work funded by Rotary members. Australian Rotary Health, run by Rotary districts in the country, gave us our first grant for extensive studies on what to teach. To develop the curriculum, we collected consensus feedback from three expert groups: mental health professionals, people who have experienced mental illness, and people who care for others with these health conditions. We presented the groups with exhaustive lists of existing recommendations on how to give support outside of a health professional’s office. We asked these experts: Which of these recommendations are the highest priorities that you want helpers to know? At least 80 percent of the experts had to agree on every first aid strategy included in our courses.
Surprising advice
The following are a few examples from Mental Health First Aid training that surprise many people and that the courses might not have included without the research on what expert groups recommend:
- Don’t go straight to problem-solving and try to talk a struggling person out of their negative thoughts. If you tell a severely depressed person to appreciate the beautiful day, their secure finances, and their family, you may pile on to the guilt they already feel. Really listen and allow them to talk about how they are feeling without judging them.
- Sometimes people with anxiety want to avoid activities they find stressful. However, if you repeatedly agree to stay home with or accompany the person, you may unwittingly reinforce their condition. Support a person with anxiety in learning ways to gradually manage their discomfort.
- When you suspect someone is weighing whether the world would be better off without them, ask clearly and directly: Are you thinking about killing yourself? The evidence shows asking about suicide is helpful rather than harmful. The person with suicidal thoughts will feel more comfortable talking about them if you’re straightforward.
- When people are injuring themselves without suicidal intentions, resist the natural response to focus your conversation on stopping the physical injury. Experts consistently advise to remain nonjudgmental and stay focused on addressing the distress that is driving the person to self-harm, perhaps with cuts or burns.
Our team was successful in winning further Australian Rotary Health grants to support research on teaching courses through e-learning and to teens. We can’t overstate how awestruck we were by Rotarians who think health research is so important that they raise large amounts of money year after year, through walks and other events in their communities, to support researchers like us through Australian Rotary Health. We were so impressed that we joined Rotary.
You can help
Back in the classroom with the T-shirt exercise, the students turn over the paper shirt after they’ve learned more about depression. They write a new set of phrases on the back about what the “coworker” with depression is experiencing: I feel hopeless. I feel helpless. I’m no good at this job. I can’t concentrate. The activity is powerful at helping first-aiders understand the importance of engaging with people without judging them.
Now, if you’re doubting whether you could ever feel comfortable, let alone qualified, to help someone facing a serious mental illness, let us reassure you: Mental Health First Aid courses are for everyone. The training prepares you to provide early intervention for a person experiencing mental health distress or crisis, such as having suicidal thoughts or a panic attack, being out of contact with reality, or coming out of a traumatic experience. In some situations, the social support provided by the mental health first-aider is sufficient. Mental health first aid isn’t a replacement for professional help, but that initial support is especially important when wait times to see specialists are long and the cost of psychological health care may delay people from seeking treatment.
These days, many Mental Health First AID courses are sponsored by workplaces for employees and by universities for students and staff. Mental Health First Aid International, the nonprofit organization we formed and the curriculum copyright holder, has worked with people including debt counselors, lawyers whose clients are going through divorce or other family challenges, and workers who administer social services like subsidized housing.
First-aiders learn to consider a person’s culture when assisting. Mental Health First Aid International has used the same consensus research approach to create a curriculum for Aboriginal people, and the nonprofits administering the courses in other countries have developed guidelines appropriate for other groups or cultures. Alterations might reflect a group’s customs and terminology or incorporate videos of people the learners identify with. While there are other programs that teach how to help people with mental health conditions, our commitment to the highest research standards for the curriculum sets Mental Health First Aid apart.
This type of first aid for the mind is only one piece of a jigsaw puzzle to help individuals and, more broadly, to reduce mental illness in society. People often face a suite of risk factors that need systemic solutions, and Mental Health First Aid brings awareness of important ones, such as discrimination, poverty, inadequate education, and homelessness.
In developing the instruction model, we took cues from physical first aid training, which is built on the cultural norm that most people want to learn to help someone with an injury or other trauma to their body. Many people take physical first aid courses simply to be good citizens, and others, like scout leaders or sports coaches, for example, need the training for their jobs or various types of interactions with people.
In our light bulb moment on that dog walk in the late 1990s, we wondered: Why don’t we have similar first aid for people who are feeling suicidal, having a panic attack, self-harming, or experiencing any of a wide range of mental health conditions?
We can all learn basics like how to listen nonjudgmentally. You don’t have to be a professional to do that. Society needs professionals’ high level of expertise, but everyone needs to have baseline skills. People often think that others’ mental health is private and they shouldn’t intervene. We tell people the opposite: Be on the lookout and talk about mental health freely.
After all, a psychologist won’t be on the spot when a teenager first musters the courage to voice that they’re fighting to trudge through each day because they’re so depressed by a breakup and are having uncontrollable dark thoughts. But you might be there.
A health professional won’t be on the golf course when your playing buddy opens up about feeling down, having fights with his family, and knowing he needs to cut back on his worsening drinking habit.
But you might be there.
Outside of their work to expand Mental Health First Aid, Betty Kitchener and Tony Jorm are members of the Rotary Club of Coffs Harbour in Australia, where they relish working on the club’s secondhand book sale that supports service activities including providing books to children.
This story originally appeared in the January 2026 issue of Rotary magazine.