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The Impact of Mental Health First Aid (MHFA) Training in Libraries: A
Pilot Study

Mary Margaret Thomas, MLIS (she/her/hers)a

aClinical Education Librarian, Hardin Library for the Health Sciences, University of Iowa,
Iowa City, IA,https://www.orcid.org/0000-0003-2197-5440 , mary-m-thomas@uiowa.edu

Cite as: Thomas MM. The Impact of Mental Health First Aid (MHFA) Training in Libraries:
A Pilot Study. Hypothesis. 2025;37(2). doi:10.18060/29133

Thomas. All works in Hypothesis are licensed under a CC BY-NC 4.0
DEED Attribution-NonCommercial 4.0 International. Authors own copyright of their articles
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https://orcid.org/
mailto:mary-m-thomas@uiowa.edu
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Peer Reviewed Article Hypothesis, Vol. 37, No. 2, 2025

Abstract
Objective: This study seeks to explore how Mental Health First Aid (MHFA) training
impacts librarians working in both academic health sciences and public libraries. Specifically,
it aims to investigate how MHFA training affects their mental health literacy, professional
confidence, and their ability to provide mental health information and resources.

Methods: This qualitative research study explores the perspectives and experiences of seven
librarians from two different types of libraries, an academic health sciences library and a
public library system. Semi-structured interviews were conducted to gather participants’
experiences and insights regarding MHFA training. This project received IRB approval.

Results: Mental Health First Aid training enhances participants’ awareness of mental health
challenges, boosts their professional confidence, and improves mental health literacy. In
addition to being a skills-based training that teaches de-escalation techniques, it also helps
reduce stigma surrounding mental health conditions. After completing MHFA training,
participants report increased confidence in supporting individuals experiencing mental health
challenges and assisting them in obtaining appropriate help.

Conclusion: Mental Health First Aid is a valuable workplace training for both academic and
public libraries, benefiting all types of library staff. It enhances awareness of mental health
conditions and reduces stigma while simultaneously increasing mental health literacy and
professional confidence. Additionally, it equips participants with the skills and confidence to
appropriately assist individuals, both library staff and users, experiencing mental health
challenges. Furthermore, Mental Health First Aid training cultivates greater empathy and
compassion, contributing to a more supportive workplace culture that is welcoming and
inclusive.

Content warning: this paper discusses mental illness and suicide.

Introduction
Mental illness is very common. According to the National Institute of Mental Health, “more
than one in five U.S. adults live with a mental illness (59.3 million in 2022; 23.1% of the U.S.
adult population)”1(p1). However, even though it is very prevalent, Henderson et al., report that
"more than 70% of people with mental illness receive no treatment due to a combination of
discrimination, stigma, and access to health care"2(p777). Furthermore, the COVID-19
pandemic led to an increase in mental health conditions and exacerbated existing ones. The
World Health Organization reported that the COVID-19 pandemic triggered a 25% increase in
prevalence of anxiety and depression worldwide3.

According to Corrigan and Rao, who study mental illness stigma, "people with mental illness
have long experienced prejudice and discrimination"4(p1). They go on to explain stigma as,
"negative stereotypes, such as notions of dangerousness or incompetence, often associated
with mental illness, can be harmful to people living with mental illnesses"4(p1-2). Concealing a
mental illness, especially long-term, can have negative impacts. This statement clarifies the
challenges of stigma and thus the importance of feeling comfortable disclosing as well as

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discussing mental health conditions.

Mental health training programs, of which there are several kinds, are an effective way to
reduce stigma5,6. Mental Health First Aid (MHFA) is generally considered the gold standard
of mental health training programs because it is an evidence-based, early-intervention course
in addition to one of the most comprehensive mental health training programs available7.
MHFA is a mental health training program for laypeople. It is a standardized educational
program developed to address mental health problems and prevent suicide by educating the
public to destigmatize mental illness as well as providing de-escalation techniques. Mental
Health First Aid is often likened to CPR as both are skills-based training programs; however,
MHFA focuses specifically on mental health7,8. It is a required eight-hour minimum
educational training program taught by certified instructors. Mental Health First Aid was
originally developed and implemented in Australia but has since spread worldwide8. There
are different versions and add-ons to MHFA. For example, Higher Ed is one version which
focuses on supporting college students, the youth version is specific to adolescents, and a
popular add-on to MHFA is Narcan training.

MHFA includes many interactive learning opportunities that make applying the skills learned
in a real-life situation easier such as role-playing and scenarios. MHFA participants, called
Mental Health First Aiders, learn the five-step ALGEE action plan which is used during a
crisis. The ALGEE action plan is detailed below in Figure 1.

Figure 1. Five-Step ALGEE Action Plan

Mental Health First Aid addresses many misconceptions, such as the belief that asking
someone if they are thinking about killing themself will cause them to act on it9,10. Coupled
with dispelling common myths, it also teaches Mental Health First Aiders to ask difficult
questions such as, "are you thinking of hurting yourself?" to people in distress9. While
ALGEE, the five-step action plan, was designed to be used in crisis situations, it can be used
in non-emergency situations as well. Typically, instructors bring Algee to the training, a
stuffed koala wearing a MHFA shirt. See Figure 2. He is the mascot but also helps Mental
Health First Aiders remember the mnemonic for the action plan.

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Figure 2. Algee Koala

The ALGEE action plan was developed to guide Mental Health First Aiders, typically
laypeople, in providing effective help and support to individuals experiencing a mental health
crisis. The first step of ALGEE, "assess for risk of suicide or harm," helps determine the
urgency of the situation and if immediate action is needed. This step is crucial but can be
difficult especially when asking someone if they are thinking of killing themself. However,
this step gets easier with practice. The next four steps are more natural for library
professionals, in the author’s opinion, as they are already a part of their professional skill set.
"Listen nonjudgmentally" is important to make the other person feel comfortable and allow
them to say as much as possible. Oftentimes, if a person feels judgment or senses stigma, they
may choose not to disclose their true feelings or share their experiences. The "giving
reassurance and information" step is important to offer support and validate what they are
experiencing. "Encouraging appropriate help" is vital since so many people with mental
illness do not seek treatment but to also assist them in finding appropriate treatment. These
two steps correspond with providing consumer health information, a skill possessed by many
librarians. The final step is to "encourage self-help or self-care"5. It is essential that Mental
Health First Aiders prioritize their own mental health when supporting an individual
experiencing any type of mental health crisis, not only serious crises such as individuals
considering suicide or self-harm. Providing support can be exhausting. Even less stressful
mental health challenges necessitate self-care, such as supporting a friend going through a
divorce.

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Efficacy of MHFA Training

Numerous studies, including systematic reviews, have been conducted to evaluate the
effectiveness of this training as an intervention. Currently, the majority of these studies focus
on populations such as healthcare professionals (e.g., pharmacists and nurses) or specific
settings such as the MHFA youth training for adolescents. Advincula et al., found in their
systematic review that, "Pharmacists who completed MHFA training were found to engage in
conversations about mental health more frequently, offer compassionate support, and
demonstrate a willingness to assist individuals struggling with mental health crises"11(p2). The
most frequently reported outcomes following MHFA training are increased confidence
regarding mental health issues and reduced stigma11.

Connection to Libraries

In libraries, mental health challenges come in a variety of situations and are not solely an
issue for public-facing staff12-14. There is a widespread belief that mental health challenges in
libraries are limited to public-facing roles, such as dealing with a disruptive patron at the
service desk or supporting a student in psychological distress15-17. While these examples are
valid, it is equally important to recognize that mental health challenges arise in a variety of
other situations within library settings. Potential scenarios for applying MHFA skills in
non-public-facing situations include listening to a coworker who is struggling and helping
them identify appropriate help, or a supervisor encouraging their employee to utilize the
Employee Assistance Program (EAP).

It is common for workplaces, including libraries, to offer a variety of training sessions such as
CPR and Stop the Bleed to better equip staff for emergency situations. Mental health
challenges occur regularly in all types of libraries, both for staff as well as users. Navigating
these situations can be intimidating, and library staff may not feel comfortable assisting an
individual with appropriate mental health help or treatment in the same way they would when
assisting with a physical health condition.

MHFA training can help with this, since it increases participants’ knowledge of mental health
conditions, professional confidence, and mental health literacy. It also reduces mental illness
stigma. After completing MHFA training, participants feel more confident helping someone
experiencing a mental health challenge11. MHFA teaches participants that a person
experiencing a panic attack should be treated similarly to a person who broke their arm since
they are both health conditions and require treatment. In a randomized control trial, Kitchner
and Jorm found “improvements in participants’ mental health literacy, including knowledge,
stigmatizing attitudes, confidence and help provided to others"18(p1) post MHFA training.

Many people do not feel comfortable disclosing or discussing their mental illness with a
supervisor or coworker due to stigmatization and fear19,20. In their article Academic
Librarians’ Experiences and Perceptions on Mental Illness Stigma and the Workplace, Burns
and Green discuss the results of their study on academic librarians living with mental illness
in their workplaces (academic libraries). They found that due to stigmatization and shame,
"many people felt that they could not share their mental health diagnosis with their coworkers
or supervisors"17(p649). Unfortunately Burns and Green’s most obvious finding was, "there is a
fear of disclosing one’s own mental illness in the academic library environment"17(p653). Burns

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and Green’s findings underscore the importance of training programs like MHFA that provide
education on mental health conditions and teach non-stigmatizing language. Supervisors and
administrators have a huge impact on their employees’ lives and by appropriately handling
mental health challenges, they create positive work environments and foster overall
well-being in their libraries.

Many types of libraries support students, particularly academic libraries serving large
undergraduate populations, and can help students navigate and access healthcare. In her
article Libraries as a Mental Health Resource, Lozano makes the connection as to how
uniquely situated academic libraries are in supporting students’ mental health. She explains
that libraries are

often thought of as information hubs and are already established as free sources
of academic support. Since the library is already used for research and study,
information obtained at the library has more gravitas and is more likely to be
trusted14(p67).

A considerable number of colleges and universities have student counseling centers where
students can access behavioral health treatments. Lozano suggests that libraries create
resources such as flyers with 988, the suicide and crisis Lifeline, along with other resources
and services for students14. This highlights the importance of libraries utilizing their
information expertise to provide resources and better support the communities they serve.

Public libraries are at the forefront in implementing Mental Health First Aid training. This is
unsurprising given that many public libraries act as safety nets for their communities and that
their staff interact regularly with patrons living with serious and persistent mental illness21-23.
Throgmorton, a public librarian, recommends Mental Health First Aid as a workplace training
for libraries, noting that "while Mental Health First Aid may not work miracles, it can
deescalate library disruptions"24(p23).

Study Purpose

To date few studies exist examining the impact of Mental Health First Aid training on
librarians. The purpose of this study is to investigate the benefits and remaining gaps of
MHFA training in libraries, whether and how librarians are utilizing the training in their jobs,
and whether the training is sufficient for librarians to provide mental health resources to their
communities. By understanding these effects, this study hopes to inform future
implementation of MHFA training programs in library settings to better support both library
staff and patrons.

Theoretical Framework

The theoretical framework that most informs this research study is mental health literacy.
Mental health literacy is a subcategory of health literacy and is a major component of the
Mental Health First Aid program. Health literacy focuses on improving people’s ability to
understand medical information and make effective medical decisions, primarily concerning
physical health conditions. Jorm et al., defines mental health literacy as "knowledge and
beliefs about mental disorders which aid their recognition, management or prevention"11(p182).
Jorm et al., later built on the previous definition by adding the following components:

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knowledge of how to prevent mental disorders; recognition of when a disorder is
developing; knowledge of help-seeking options and treatments available;
knowledge of effective self-help strategies for milder problems; and first aid skills
to support others who are developing a mental disorder or are in a mental health
crisis25(p231).

Consequently, improved mental health literacy strengthens help-seeking behaviors, resulting
in more people getting help.

Methods
This study included seven participants from two contrasting libraries within the state of
Colorado: four participants were from an academic health sciences library and three
participants were from a public library system. The Strauss Health Sciences Library is located
on the University of Colorado’s Anschutz Medical Campus and serves a large public research
university situated in an urban area. Douglas County Libraries is a public library system with
eight libraries located in suburban areas within Douglas County.

Participants were invited to take part in this study via emails sent to their respective libraries,
as the author was aware those libraries had previously held Mental Health First Aid training
programs. Requirements for participants were as follows: hold a master’s degree in library
and information science, must be working as a library professional, and have taken MHFA
training within the past five years. This study employed convenience sampling to select
participants and included all individuals regardless of whether they held public-facing or
behind-the-scenes positions. See figures 3 and 4 for participant demographics.

Figure 3. Participants’ Library Type

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Figure 4. Participants’ Position Type

Semi-structured interviews lasting 30-45 minutes were conducted with each participant during
the spring of 2022 via Zoom. The interviews were designed in sections, beginning with
simpler questions to ease participants into the interview, with questions getting more difficult
as time went on. The first section began with participants sharing factual details, such as when
they completed MHFA, the format of the training, and an example of something they learned.
In the next section, participants were asked to describe their job, how MHFA has influenced
their work as librarians, and whether they had developed any digital or physical mental health
resources, such as LibGuides or bookmarks. Participants were also asked whether their
library offered physical health resources, in order to compare with mental health resources.
Then they were asked how MHFA has shifted their professional confidence, to rate their
professional confidence after MHFA, and to explain what confidence means to them. The last
section covered the gaps of MHFA training and whether interviewees would recommend
MHFA to other librarians, along with anything else they wished to share. See figure 5 below
for a complete list of interview questions.

This is a qualitative study. Therefore, the author performed a content analysis of the
qualitative data and a descriptive analysis of the quantitative data. Excel and Word were used
for the descriptive analysis visualizations.

The Institutional Review Board at Emporia State University granted permission to conduct
this research study (Protocol ID: 22044).

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Figure 5. Participants’ Interview Questions

Results
Unanimously, participants agreed that Mental Health First Aid training was beneficial. They
were also grateful that the training came to their library, making it more convenient for them
to attend. Additionally, every single participant would recommend it to others without
reservations.

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Themes

During the content analysis of the interview transcripts five themes emerged. The first theme
identified in this study is that Mental Health First Aid is a skills-based training. Participants
learn the five-step action plan, ALGEE, and de-escalation techniques for crisis situations. In
addition to the ALGEE action plan, participants repeatedly mentioned the MHFA manual as a
most liked item. They found it to be a useful resource and appreciated being able to keep it.

The second theme that emerged is that MHFA supports building better relationships. It
improves listening skills which enhances awareness of users’ needs. It also elevates
non-judgmental behavior which is important for gaining trust and destigmatization.

The third and fourth themes are interconnected. The third theme that stood out is that MHFA
plays a key role in raising awareness about mental illness and mental health challenges. The
fourth theme revealed increased mental health literacy post MHFA. These themes are
interwoven because increased mental health awareness typically leads to increased mental
health literacy. Furthermore, enhanced mental health literacy fosters more effective
professional dialogues among supervisors, employees, and coworkers, as well as enriching
personal relationships outside the workplace.

The fifth theme revealed that the majority of participants applied the knowledge and skills
gained from MHFA training in their personal lives while supporting friends and family.
Participants shared that the most frequently used skills and tools included drawing on their
background knowledge of mental illnesses, using appropriate and educated language,
recognizing signs of individuals in distress, navigating mental health information and
treatment options, and providing support to individuals experiencing mental health conditions.

Professional Confidence

Mental Health First Aid elevates professional confidence regarding mental health. Six out of
seven participants saw an increase in their professional confidence regarding mental health
treatments and resources post MHFA training. The seventh participant already had high
professional confidence prior to MHFA training, thus there was no change. Unfortunately, the
five-point Likert scale was too limiting, and a seven-point Likert scale would have been
preferable, since two participants responded "confident" which was not available on the
five-point scale. Accordingly, only the participants’ textual labels of confidence (e.g., "more
confident") were included. See figure 6.

Figure 6. Connection between Participants’ Professional Confidence and Position Type

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Among the six librarians who reported an increase in their overall professional confidence
after MHFA training, scores were related to their position type. All librarians with
public-facing roles responded, "more confident" while the behind-the-scenes librarians
responded "confident." Both participants who responded "confident" clarified what they
meant with hypothetical scenarios involving assisting patrons at the service desk. One
participant who responded "confident" explained what professional confidence meant to them
as:

yeah, so that I was thinking, it would mean that I would know like right off the
top of my head, like some resources, probably web-based resources to go to, and
that I just know them off the top of my head or maybe a specific like if there was
like a database that focused on mental health. So right now, I’d be using my
librarian skills like from a known association or government entity, not being able
to rattle off a list of them that I learned.

It is noteworthy that professional confidence levels after MHFA training vary depending on
the type of position held. The author speculates that librarians in public-facing roles reported
higher confidence levels because they possess a stronger skill set as practicing information
professionals regarding assisting patrons with mental health information, resources, and
treatments. However, more research is needed to determine the true cause or if this is a
coincidence. Additionally, the reduced levels of professional confidence reported by
participants who selected "confident" may be attributed to the researcher’s lack of clarity
regarding the scope and definition of professional confidence, since both participants who
responded "confident" elaborated on their responses by referencing scenarios in which they
assisted patrons at the service desk. Accordingly, the author recommends that future
researchers explicitly acknowledge that mental health challenges can arise in various library
settings, including behind-the-scenes environments, and are not confined solely to
public-facing roles.

Shortcomings

This study examined whether participants used MHFA to create mental health resources,
digital (e.g., LibGuides) or physical (e.g., bookmarks), in their current positions.
Unfortunately, due to several factors, none of the librarians interviewed created mental health
resources. Although some librarians were constrained by their current roles and unable to
develop mental health resources themselves, these resources were being created elsewhere
within their library system by other staff members. Others felt it was unnecessary for their
patrons, given the availability of nearby mental health resources such as a crisis center.
Additionally, some librarians noted that their health sciences library already had appropriate
resources within the collection. Finally, those who were not public-facing did not consider it
part of their position. Moreover, the use of convenience sampling may have introduced bias,
as participants could have self-selected based on favorable perceptions of MHFA. Despite
these shortcomings, the author still recommends MHFA as a worthwhile training program for
its effectiveness in reducing stigma.

Lessons Learned

Another finding from this study is that the MHFA training format matters. One participant
reported feeling "emotionally burned out" after the training and requested trigger warnings

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before tough subjects. They explain below why an all-day training session was too much:

It was underestimated how emotionally difficult it (MHFA) is. I know it took me
probably two to three days to get out of the emotional burnout or fog. The videos
are so well done, the exercises are so well done that you really get involved in
this. And having an all-day thing you deal with personal memories and maybe
personal experiences.

This training deals with serious emotional content, includes many realistic scenario videos,
and may trigger and cause difficult memories to resurface for some participants. Therefore,
based on participant feedback, the author recommends changing the format of the training by
breaking it up into multiple sessions on different days, offering a quiet room for breaks, and
using trigger warnings.

Furthermore, the quality of the instructor matters. Participants reported an overall more
positive experience and held a more favorable perception of MHFA training when the
instructor was enthusiastic and engaged, compared to those who were indifferent. Moreover,
given that all participants were librarians, they particularly valued instructors who recognized
and addressed the unique challenges of libraries, an insight that most instructors lacked.

Additionally, participants were questioned about ways to improve the training. A few
participants felt there was not enough role play practice in MHFA. They wanted more practice
including scripted language to use in real-life situations or practice focusing on a couple of
specific situations. Ryan Dowd’s Homelessness training, a series of online training courses
aimed at improving library professionals’ interactions with individuals experiencing
homelessness, were given as an example since this training gives scripted responses for
certain situations26.

Figure 7. Participants’ Perspectives on MHFA Training

Conclusion
Given the small scale and qualitative nature of this study, further research is recommended to
explore the impact of Mental Health First Aid in library settings. There is a need for more
awareness of Mental Health First Aid and other mental health training programs in addition to
implementing these training programs in libraries, especially academic libraries. Currently,

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most libraries implementing MHFA are public libraries; however, this training program
teaches beneficial skills that are applicable in other types of libraries as well. Even though
participants in this study did not use their MHFA skills to create mental health resources, the
program remains valuable and with broad applications. This is especially important given
how pervasive stigma is, as MHFA serves as an effective tool in combating it.

Since mental health challenges occur outside of work, knowing how to handle these situations
anywhere is beneficial. As previously stated, many Mental Health First Aiders, including
participants in this study, use their MHFA skills in their personal lives, listening, encouraging,
and assisting friends and family with getting help. Consequently, the widespread use of
Mental Health First Aid skills by participants has the potential to generate a positive ripple
effect, enhancing overall well-being across the broader community.

Overall, this study establishes that Mental Health First Aid is beneficial and relevant training
for academic and public libraries. MHFA training helps libraries educate staff, destigmatize
mental illness, and provide de-escalation techniques to better meet their community’s needs.
The COVID-19 pandemic underscored the need for greater advocacy and interventions
regarding mental health. Mental Health First Aid increases mental health awareness and
literacy, fostering greater empathy and compassion for individuals experiencing mental health
challenges. Additionally, it enhances librarians’ professional confidence regarding mental
health, contributing to a more supportive and inclusive workplace culture. MHFA supports an
integrative approach to well-being by addressing mental health conditions and improves
parity between mental and physical health.

Library professionals routinely interact with individuals, both library staff and users,
experiencing mental health challenges. The goal is to ensure these individuals receive the
same level of empathy, support, information, and resources as those experiencing physical
health conditions. Moreover, MHFA is a natural extension of librarians’ skill sets since
librarians are information professionals who possess existing expertise in navigating accurate
and reliable information. Libraries strive to be welcoming and inclusive. Mental Health First
Aid helps create both a psychologically welcoming and physically safe environment for
library users and staff.

Acknowledgments
The author gratefully acknowledges Janna Lawrence, Jennifer DeBerg, and Sarah Andrews
for their valuable assistance with this research paper. Special thanks are also extended to
Susan Lessick, Emily Vardell, Shanda Hunt, and Kevin Thomas for their generous support
throughout the research project. This research was developed through the training and support
provided by the MLA Research Training Institute (RTI) and funded in part by the Institute of
Museum and Library Services (IMLS).

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https://www.inthelibrarywiththeleadpipe.org/2024/conversations-about-libraries/
https://doi.org/10.5860/crl.80.5.638
https://doi.org/10.5860/crl.80.5.638
https://doi.org/10.1080/0963823031000118221
https://doi.org/10.1080/01616846.2017.1275772
https://www.libraryjournal.com/story/Mental-Wellness
https://www.apa.org/monitor/2020/04/libraries-health-hubs
https://americanlibrariesmagazine.org/2017/03/01/mental-health-first-aid/
https://doi.org/10.1037/a0025957
https://www.homelesstraining.com/

