562120 research-article2014
RSH0010.1177/1757913914562120FeatureFeature
Feature
Mental Health First Aid: addressing mental health as a public health priority As mental health moves increasingly higher on the public health agenda, Heike Kroll from Mental Health First Aid (MHFA) sets out the current issues and explains the work MHFA are doing to address the widespread low levels of understanding of mental health problems and the effective treatments available in the wider community. Understanding The Current Issues
Would you know how to help a friend in the midst of a panic attack? Do you believe your manager has the skills to recognise when positive stress tips over into detrimental anxiety and offer appropriate support? Crucially, would you know how to help yourself or where to go for support if your mental health started taking a turn for the worse? Mental health is fast becoming a hotbutton issue in our ever-busier, fastpaced lives, particularly in major cities such as London, where there is often a propensity for a long-hours culture. However, evidence suggests that mental health is still the poor cousin to physical health, both in terms of society’s awareness around what constitutes good and bad mental health and the level of public spending allocated to the issue. When Deputy Prime Minister Nick Clegg called for waiting time standards to be applied to mental health services,1 he further cemented the argument for parity of esteem. And yet, with a Freedom of Information request by the BBC revealing real term funding cuts in mental health care of 2.36% from 2012 to 20142 and a recent report by mental health charity Mind highlighting that local authorities in England spend only 1.36% of their public health budget on mental health,3 the inequalities are stark.
the capital each year; yet, this figure is the tip of the iceberg, with a further 4.2% of Londoners (almost 300,000) having The disparity between public health contemplated suicide in the past year.5 spending on preventing physical health problems (over £1 billion combined) and These figures are alarming, especially in that dedicated to mental health light of the latest suicide statistics (£40 million) is huge, despite the showing an increase in deaths in line with overwhelming evidence that the two are the economic downturn.8 At the less 4 inextricably linked. But if we truly want extreme end of the spectrum, the impact is felt, too: nearly half of Londoners are to empower individuals to make healthy anxious, and almost one-third report low choices in their lives, addressing their levels of happiness, with life satisfaction mental health needs is paramount – precisely because the links between poor lagging behind the national average.5 The mental health and poor physical health Greater London Authority estimates the have been repeatedly proven. total cost of mental health to London at People with poor mental health are £26 billion each year, and £70 billion two to four times more likely to die across the United Kingdom which prematurely, and complex, long-term equates to 4.5% of the country’s gross health issues such as substance and/or domestic product.9 These figures do not alcohol misuse or smoking are more even begin to take into account the links frequently found in people with mental ill between complex public health issues health.5 The Royal College of such as sexual health, smoking or obesity with mental health, although Psychiatrists found that depression, for these are well established.6,10,11 If a high example, doubles the risk of developing coronary heart disease, and that ‘people proportion of people affected by these with a mental disorder smoke almost half physical health concerns have underlying of all tobacco consumed and account for and unaddressed mental health issues, it almost half of all smoking-related is questionable how much traction deaths’.6 Many people with mental ill government funded educational campaigns targeting these concerns health who are undiagnosed and would achieve. unaware of their mental With a clear gap health problems may strong argument between the need for self-medicate with drugs for increasing better mental health and/or alcohol, which in the focus on services and current turn exacerbates their prevention and funding, there is a strong mental health early argument for increasing the problems.7 intervention focus on prevention and The impact of these work. early intervention work. mental health problems With significantly lower on London – and England on the whole – is undeniable. An levels of funding needed to increase the nation’s mental health literacy, it is average of 579 people take their lives in
12 Perspectives in Public Health l January 2015 Vol 135 No 1 Downloaded from rsh.sagepub.com at UCSF LIBRARY & CKM on March 29, 2015
Feature (average increase of 3.5 points) in a total sample size of 11,502 participants.14 These results are echoed in findings by Westminster University supporting the effectiveness of Youth MHFA, a two-day course targeted at those working with, The Work Of Mental Health caring for or living with young people First Aid aged 11–18 years. This research noted In order to empower individuals to significant increases in median improve their own mental wellbeing and health by association, we must raise their knowledge and confidence ratings from 5 to 8 points.15 awareness of mental health problems first. Mental Health First Aid (MHFA) was MHFA increases mental health literacy created in order to address the lack of in participants,16–19 increases attendees’ understanding of mental health problems willingness to help someone experiencing and effective treatments in the wider mental ill health, helps reduce stigma and community12 and to reduce the impact of discrimination around mental ill health and, notably, enables participants to widespread stigma which can prevent improve their own wellbeing and find people from seeking help at an earlier their own coping strategies.17 This stage, delaying their recovery and also 13 significantly reducing quality of life. research is also reflected on an international scale and in minority ethnic Originating in Australia in 2000, MHFA groups which are more likely to access has become an international training mental health services via the criminal programme and is now active in 23 justice system.20–23 countries and counting. The two-day MHFA course equips Compared to the £3,210 estimated delegates with the skills to recognise spend on mental health per person per the early warning signs of mental ill year in London alone, MHFA is a health (in themselves or remarkably cost-effective others, for example, tool in helping people and MHFA is a co-workers, family or remarkably cost- communities help friends) and to provide effective tool in themselves. By building help to someone on a more empathetic helping people first aid basis, directing and communities communities where them to appropriate help themselves. individuals are more willing sources of professional and able to support one or self-help to improve another, MHFA strengthens their chances of recovery. community resources and resilience. It Numerous independent evaluations also works to change business cultures demonstrate that MHFA is effective at towards openness and holistic meeting its aims. A recent study by management policies which create Coventry and Birmingham University, environments in which people feel more presented at Public Health England’s able to disclose mental health problems conference in Birmingham, noted and address them productively at an statistically significant increases in both early stage. knowledge and understanding of mental The London Health Commission has health issues (average increase of 3.8 recently recognised this in its points) and confidence in helping recommendations to the Mayor of someone experiencing a problem London to address health inequality in possible to bridge the gap while access and funding issues are addressed by future governments.
the capital. Recommendation 9 states that ‘The Mayor should encourage all employers to promote the health of Londoners through workplace health initiatives. The NHS should lead the way by introducing wellbeing programmes, including having a mental health first aider for every NHS organisation’.24 MHFA England’s work with the City Mental Health Alliance (CMHA) and major employers such as EY, Lend Lease and Unilever also shows that businesses are waking up to the importance of increasing the mental health literacy of their workforce and equipping them with right tools and expertise to improve wellbeing. We believe this is a good start. Yet, with the United States investing $15 million in 2014 to roll out MHFA to frontline workers such as police officers, first responders, primary care professionals, social workers and university staff, the United Kingdom has a long way to go before true parity of esteem exists between mental and physical health. Based on the evidence outlined in this article, it is our view that equal value should be placed on protecting and supporting people’s mental and physical health. We therefore propose that government funding for MHFA shouldn’t just be limited to our capital city or one organisation such as the National Health Service, but should be made available to our nation as a whole. Only then will we have made the necessary first steps to building empathetic and compassionate communities which form the bedrock of a resilient society. More information about MHFA can be found online, http://www.mhfaengland. org or by emailing [email protected]. Heike Kroll Communications Team, MHFA England CIC
References 1.
2.
Department of Health. Achieving Better Access to Mental Health Services by 2020, 8th October 2014. Available online at: https://www.gov.uk/ government/publications/mental-healthservices-achieving-better-access-by-2020 (Last accessed 10th November 2014). BBC News. Funds Cut for Mental Health in England. BBC News, 12th December 2013.
3 .
Available online at: http://www.bbc.co.uk/ news/health-25331644 (Last accessed 10th November 2014). BBC News. Public Mental Health Spending in England Too Low, Says Mind. BBC News, 28th October 2014. Available online at: http://www. bbc.co.uk/news/health-29792386 (Last accessed 10th November 2014).
4.
Department for Communities and Local Government. Local Authority Revenue Expenditure and Financing 2014–15 Budget, England (revised), 22nd October 2014. Available online at: https://www.gov.uk/government/uploads/ system/uploads/attachment_data/file/365581/ RA_Budget_2014-15_Statistical_Release.pdf
January 2015 Vol 135 No 1 l Perspectives in Public Health 13 Downloaded from rsh.sagepub.com at UCSF LIBRARY & CKM on March 29, 2015
Feature (Last accessed 10th November 2014). 5. Greater London Authority. London Mental Health – The Invisible Costs of Mental Ill Health, January 2014. Available online at: https://www.london.gov.uk/priorities/health/ publications/london-mental-health-theinvisible-costs-of-mental-ill-health (Last accessed 10th November 2014). 6. Royal College of Psychiatrists. No Health without Public Mental Health – A Case for Action, 2010. Available online at: http://www.rcpsych.ac.uk/ pdf/Position%20Statement%204%20website. pdf (Last accessed 10th November 2014). 7. Department of Health. No Health without Mental Health: A Cross-Government Mental Health Outcomes Strategy for People of All Ages, 2011. Available online at: https://www. gov.uk/government/publications/no-healthwithout-mental-health-a-cross-governmentmental-health-outcomes-strategy-for-peopleof-all-ages-a-call-to-action (Last accessed 10th November 2014). 8. HM Government. Preventing Suicide in England: One Year On, January 2014. Available online at: https://www.gov.uk/ government/uploads/system/uploads/ attachment_data/file/278119/Annual_Report_ FINAL_revised.pdf (Last accessed 10th November 2014). 9 . Organisation for Economic Co-operation and Development. Mental Health and Work: United Kingdom, 2014. Available online at: http://www.oecd.org/ employment/emp/mentalhealthandworkunitedkingdom.htm (Last accessed 10 th November 2014). 0. National Obesity Observatory. Obesity and 1 Mental Health, March 2011. Available online at: http://www.noo.org.uk/uploads/doc/
11.
12.
13.
14.
15.
16.
17.
1 8.
vid_10266_Obesity%20and%20mental%20 health_FINAL_070311_MG.pdf (Last accessed 10th November 2014). NICE Guidelines. CG9: Eating Disorders, January 2004. Available online at: http://www. nice.org.uk/guidance/cg9 (Last accessed 10th November 2014). Jorm AF, Korten AE, Jacomb PA, Christensen H, Rodgers B, Pollitt P. Mental health literacy: A survey of the public’s ability to recognise mental disorders and their beliefs about the effectiveness of treatment. Medical Journal of Australia 1997; 166(4): 182–6. Time to Change. Stigma Shout, 2008. Available online at: http://www.time-to-change. org.uk/sites/default/files/Stigma%20Shout.pdf (Last accessed 10th November 2014). Patterson P, Pearson L. Mental Health First Aid England: is improving the mental health literacy of the population contributing to a public health priority? Presented at Public Health England annual conference, September 2013. Borrill J, Kuczynska P. Evaluation of Youth Mental Health First Aid Training in the North-East of England, December. 2013. Available online at: http://mhfaengland.org/files/1813/9057/6593/ NE_Youth_2013_Evaluation.pdf (Last accessed 10th November 2014). Brett-Jones J. NHS Camden MHFA Audit, 2011. Available online at: http://mhfaengland. org/files/8613/9031/3780/NHS_Camden_ MHFA_Review.pdf (Last accessed 10th November 2014). Zilnyk A. Mental Health First Aid – A life skill we should all have? Perspectives in Public Health 2010; 130: 61–2. Robson J. Evaluation of MHFA Training for Flood Recovery Workers, 2008. Available online at: http://mhfaengland. org/files/3513/9031/4235/
14 Perspectives in Public Health l January 2015 Vol 135 No 1 Downloaded from rsh.sagepub.com at UCSF LIBRARY & CKM on March 29, 2015
19.
20.
21.
22.
23.
24.
northumberland-flood-recovery-workersevaluation1.pdf (Last accessed 10 th November 2014). Brandling J, McKenna S. Evaluating Mental Health First Aid Training for Line Managers Working in the Public Sector, 2010. Available online at: http://www.harp-project.org/ docsupload/Bath%20University%20-%20 MHFA%20Evaluation%20Report.pdf (Last accessed 10th November 2014). Day A, Francisco A. Social and emotional wellbeing in Indigenous Australians: Identifying promising interventions. Australian and New Zealand Journal of Public Health 2013; 37: 350–5. National Health Service (NHS). Mental Health: National Service Frameworks. London: NHS, 1999, p. 77. Available online at: https://www. gov.uk/government/uploads/system/uploads/ attachment_data/file/198051/National_ Service_Framework_for_Mental_Health.pdf (Last accessed 10th November 2014). Healthcare Commission. Count Me In: Results of a National Census of Inpatients in Mental Health Hospitals and Facilities in England and Wales, 2005. Available online at: https://www. nacro.org.uk/data/files/nacro-2005121604332.pdf (Last accessed 10th November 2014). Khaliq F. NHS Report from Bristol on MHFA Training in BME Communities, 2012. Available online at: http://mhfaengland.org/evaluationand-research/nhs-report-bristol-mhfa-trainingbme-communities/ (Last accessed 10th November 2014). London Health Commission. Better Health for London, 15th October 2014. Available online at: http://www.londonhealthcommission.org. uk/wp-content/uploads/London-HealthCommission_Better-Health-for-London.pdf (Last accessed 10th November 2014).
RSH0010.1177/1757913914562120FeatureFeature
Feature
Mental Health First Aid: addressing mental health as a public health priority As mental health moves increasingly higher on the public health agenda, Heike Kroll from Mental Health First Aid (MHFA) sets out the current issues and explains the work MHFA are doing to address the widespread low levels of understanding of mental health problems and the effective treatments available in the wider community. Understanding The Current Issues
Would you know how to help a friend in the midst of a panic attack? Do you believe your manager has the skills to recognise when positive stress tips over into detrimental anxiety and offer appropriate support? Crucially, would you know how to help yourself or where to go for support if your mental health started taking a turn for the worse? Mental health is fast becoming a hotbutton issue in our ever-busier, fastpaced lives, particularly in major cities such as London, where there is often a propensity for a long-hours culture. However, evidence suggests that mental health is still the poor cousin to physical health, both in terms of society’s awareness around what constitutes good and bad mental health and the level of public spending allocated to the issue. When Deputy Prime Minister Nick Clegg called for waiting time standards to be applied to mental health services,1 he further cemented the argument for parity of esteem. And yet, with a Freedom of Information request by the BBC revealing real term funding cuts in mental health care of 2.36% from 2012 to 20142 and a recent report by mental health charity Mind highlighting that local authorities in England spend only 1.36% of their public health budget on mental health,3 the inequalities are stark.
the capital each year; yet, this figure is the tip of the iceberg, with a further 4.2% of Londoners (almost 300,000) having The disparity between public health contemplated suicide in the past year.5 spending on preventing physical health problems (over £1 billion combined) and These figures are alarming, especially in that dedicated to mental health light of the latest suicide statistics (£40 million) is huge, despite the showing an increase in deaths in line with overwhelming evidence that the two are the economic downturn.8 At the less 4 inextricably linked. But if we truly want extreme end of the spectrum, the impact is felt, too: nearly half of Londoners are to empower individuals to make healthy anxious, and almost one-third report low choices in their lives, addressing their levels of happiness, with life satisfaction mental health needs is paramount – precisely because the links between poor lagging behind the national average.5 The mental health and poor physical health Greater London Authority estimates the have been repeatedly proven. total cost of mental health to London at People with poor mental health are £26 billion each year, and £70 billion two to four times more likely to die across the United Kingdom which prematurely, and complex, long-term equates to 4.5% of the country’s gross health issues such as substance and/or domestic product.9 These figures do not alcohol misuse or smoking are more even begin to take into account the links frequently found in people with mental ill between complex public health issues health.5 The Royal College of such as sexual health, smoking or obesity with mental health, although Psychiatrists found that depression, for these are well established.6,10,11 If a high example, doubles the risk of developing coronary heart disease, and that ‘people proportion of people affected by these with a mental disorder smoke almost half physical health concerns have underlying of all tobacco consumed and account for and unaddressed mental health issues, it almost half of all smoking-related is questionable how much traction deaths’.6 Many people with mental ill government funded educational campaigns targeting these concerns health who are undiagnosed and would achieve. unaware of their mental With a clear gap health problems may strong argument between the need for self-medicate with drugs for increasing better mental health and/or alcohol, which in the focus on services and current turn exacerbates their prevention and funding, there is a strong mental health early argument for increasing the problems.7 intervention focus on prevention and The impact of these work. early intervention work. mental health problems With significantly lower on London – and England on the whole – is undeniable. An levels of funding needed to increase the nation’s mental health literacy, it is average of 579 people take their lives in
12 Perspectives in Public Health l January 2015 Vol 135 No 1 Downloaded from rsh.sagepub.com at UCSF LIBRARY & CKM on March 29, 2015
Feature (average increase of 3.5 points) in a total sample size of 11,502 participants.14 These results are echoed in findings by Westminster University supporting the effectiveness of Youth MHFA, a two-day course targeted at those working with, The Work Of Mental Health caring for or living with young people First Aid aged 11–18 years. This research noted In order to empower individuals to significant increases in median improve their own mental wellbeing and health by association, we must raise their knowledge and confidence ratings from 5 to 8 points.15 awareness of mental health problems first. Mental Health First Aid (MHFA) was MHFA increases mental health literacy created in order to address the lack of in participants,16–19 increases attendees’ understanding of mental health problems willingness to help someone experiencing and effective treatments in the wider mental ill health, helps reduce stigma and community12 and to reduce the impact of discrimination around mental ill health and, notably, enables participants to widespread stigma which can prevent improve their own wellbeing and find people from seeking help at an earlier their own coping strategies.17 This stage, delaying their recovery and also 13 significantly reducing quality of life. research is also reflected on an international scale and in minority ethnic Originating in Australia in 2000, MHFA groups which are more likely to access has become an international training mental health services via the criminal programme and is now active in 23 justice system.20–23 countries and counting. The two-day MHFA course equips Compared to the £3,210 estimated delegates with the skills to recognise spend on mental health per person per the early warning signs of mental ill year in London alone, MHFA is a health (in themselves or remarkably cost-effective others, for example, tool in helping people and MHFA is a co-workers, family or remarkably cost- communities help friends) and to provide effective tool in themselves. By building help to someone on a more empathetic helping people first aid basis, directing and communities communities where them to appropriate help themselves. individuals are more willing sources of professional and able to support one or self-help to improve another, MHFA strengthens their chances of recovery. community resources and resilience. It Numerous independent evaluations also works to change business cultures demonstrate that MHFA is effective at towards openness and holistic meeting its aims. A recent study by management policies which create Coventry and Birmingham University, environments in which people feel more presented at Public Health England’s able to disclose mental health problems conference in Birmingham, noted and address them productively at an statistically significant increases in both early stage. knowledge and understanding of mental The London Health Commission has health issues (average increase of 3.8 recently recognised this in its points) and confidence in helping recommendations to the Mayor of someone experiencing a problem London to address health inequality in possible to bridge the gap while access and funding issues are addressed by future governments.
the capital. Recommendation 9 states that ‘The Mayor should encourage all employers to promote the health of Londoners through workplace health initiatives. The NHS should lead the way by introducing wellbeing programmes, including having a mental health first aider for every NHS organisation’.24 MHFA England’s work with the City Mental Health Alliance (CMHA) and major employers such as EY, Lend Lease and Unilever also shows that businesses are waking up to the importance of increasing the mental health literacy of their workforce and equipping them with right tools and expertise to improve wellbeing. We believe this is a good start. Yet, with the United States investing $15 million in 2014 to roll out MHFA to frontline workers such as police officers, first responders, primary care professionals, social workers and university staff, the United Kingdom has a long way to go before true parity of esteem exists between mental and physical health. Based on the evidence outlined in this article, it is our view that equal value should be placed on protecting and supporting people’s mental and physical health. We therefore propose that government funding for MHFA shouldn’t just be limited to our capital city or one organisation such as the National Health Service, but should be made available to our nation as a whole. Only then will we have made the necessary first steps to building empathetic and compassionate communities which form the bedrock of a resilient society. More information about MHFA can be found online, http://www.mhfaengland. org or by emailing [email protected]. Heike Kroll Communications Team, MHFA England CIC
References 1.
2.
Department of Health. Achieving Better Access to Mental Health Services by 2020, 8th October 2014. Available online at: https://www.gov.uk/ government/publications/mental-healthservices-achieving-better-access-by-2020 (Last accessed 10th November 2014). BBC News. Funds Cut for Mental Health in England. BBC News, 12th December 2013.
3 .
Available online at: http://www.bbc.co.uk/ news/health-25331644 (Last accessed 10th November 2014). BBC News. Public Mental Health Spending in England Too Low, Says Mind. BBC News, 28th October 2014. Available online at: http://www. bbc.co.uk/news/health-29792386 (Last accessed 10th November 2014).
4.
Department for Communities and Local Government. Local Authority Revenue Expenditure and Financing 2014–15 Budget, England (revised), 22nd October 2014. Available online at: https://www.gov.uk/government/uploads/ system/uploads/attachment_data/file/365581/ RA_Budget_2014-15_Statistical_Release.pdf
January 2015 Vol 135 No 1 l Perspectives in Public Health 13 Downloaded from rsh.sagepub.com at UCSF LIBRARY & CKM on March 29, 2015
Feature (Last accessed 10th November 2014). 5. Greater London Authority. London Mental Health – The Invisible Costs of Mental Ill Health, January 2014. Available online at: https://www.london.gov.uk/priorities/health/ publications/london-mental-health-theinvisible-costs-of-mental-ill-health (Last accessed 10th November 2014). 6. Royal College of Psychiatrists. No Health without Public Mental Health – A Case for Action, 2010. Available online at: http://www.rcpsych.ac.uk/ pdf/Position%20Statement%204%20website. pdf (Last accessed 10th November 2014). 7. Department of Health. No Health without Mental Health: A Cross-Government Mental Health Outcomes Strategy for People of All Ages, 2011. Available online at: https://www. gov.uk/government/publications/no-healthwithout-mental-health-a-cross-governmentmental-health-outcomes-strategy-for-peopleof-all-ages-a-call-to-action (Last accessed 10th November 2014). 8. HM Government. Preventing Suicide in England: One Year On, January 2014. Available online at: https://www.gov.uk/ government/uploads/system/uploads/ attachment_data/file/278119/Annual_Report_ FINAL_revised.pdf (Last accessed 10th November 2014). 9 . Organisation for Economic Co-operation and Development. Mental Health and Work: United Kingdom, 2014. Available online at: http://www.oecd.org/ employment/emp/mentalhealthandworkunitedkingdom.htm (Last accessed 10 th November 2014). 0. National Obesity Observatory. Obesity and 1 Mental Health, March 2011. Available online at: http://www.noo.org.uk/uploads/doc/
11.
12.
13.
14.
15.
16.
17.
1 8.
vid_10266_Obesity%20and%20mental%20 health_FINAL_070311_MG.pdf (Last accessed 10th November 2014). NICE Guidelines. CG9: Eating Disorders, January 2004. Available online at: http://www. nice.org.uk/guidance/cg9 (Last accessed 10th November 2014). Jorm AF, Korten AE, Jacomb PA, Christensen H, Rodgers B, Pollitt P. Mental health literacy: A survey of the public’s ability to recognise mental disorders and their beliefs about the effectiveness of treatment. Medical Journal of Australia 1997; 166(4): 182–6. Time to Change. Stigma Shout, 2008. Available online at: http://www.time-to-change. org.uk/sites/default/files/Stigma%20Shout.pdf (Last accessed 10th November 2014). Patterson P, Pearson L. Mental Health First Aid England: is improving the mental health literacy of the population contributing to a public health priority? Presented at Public Health England annual conference, September 2013. Borrill J, Kuczynska P. Evaluation of Youth Mental Health First Aid Training in the North-East of England, December. 2013. Available online at: http://mhfaengland.org/files/1813/9057/6593/ NE_Youth_2013_Evaluation.pdf (Last accessed 10th November 2014). Brett-Jones J. NHS Camden MHFA Audit, 2011. Available online at: http://mhfaengland. org/files/8613/9031/3780/NHS_Camden_ MHFA_Review.pdf (Last accessed 10th November 2014). Zilnyk A. Mental Health First Aid – A life skill we should all have? Perspectives in Public Health 2010; 130: 61–2. Robson J. Evaluation of MHFA Training for Flood Recovery Workers, 2008. Available online at: http://mhfaengland. org/files/3513/9031/4235/
14 Perspectives in Public Health l January 2015 Vol 135 No 1 Downloaded from rsh.sagepub.com at UCSF LIBRARY & CKM on March 29, 2015
19.
20.
21.
22.
23.
24.
northumberland-flood-recovery-workersevaluation1.pdf (Last accessed 10 th November 2014). Brandling J, McKenna S. Evaluating Mental Health First Aid Training for Line Managers Working in the Public Sector, 2010. Available online at: http://www.harp-project.org/ docsupload/Bath%20University%20-%20 MHFA%20Evaluation%20Report.pdf (Last accessed 10th November 2014). Day A, Francisco A. Social and emotional wellbeing in Indigenous Australians: Identifying promising interventions. Australian and New Zealand Journal of Public Health 2013; 37: 350–5. National Health Service (NHS). Mental Health: National Service Frameworks. London: NHS, 1999, p. 77. Available online at: https://www. gov.uk/government/uploads/system/uploads/ attachment_data/file/198051/National_ Service_Framework_for_Mental_Health.pdf (Last accessed 10th November 2014). Healthcare Commission. Count Me In: Results of a National Census of Inpatients in Mental Health Hospitals and Facilities in England and Wales, 2005. Available online at: https://www. nacro.org.uk/data/files/nacro-2005121604332.pdf (Last accessed 10th November 2014). Khaliq F. NHS Report from Bristol on MHFA Training in BME Communities, 2012. Available online at: http://mhfaengland.org/evaluationand-research/nhs-report-bristol-mhfa-trainingbme-communities/ (Last accessed 10th November 2014). London Health Commission. Better Health for London, 15th October 2014. Available online at: http://www.londonhealthcommission.org. uk/wp-content/uploads/London-HealthCommission_Better-Health-for-London.pdf (Last accessed 10th November 2014).
