Mental Health First Aid: Noticing, Listening, and Safe Referrals

45 min read Training Guide

The five-step ALGEE model, signs of crisis, and how non-clinical workers help without overstepping.

Table of contents

What the work looks like

Mental Health First Aid (MHFA) is a national 8-hour certification program (Mental Health First Aid USA, run by the National Council for Mental Wellbeing) that trains non-clinical workers to recognize signs of mental health or substance use crises, have a supportive conversation, and connect the person to professional help. It is the mental-health equivalent of physical first aid or CPR. CNAs, teachers, managers, childcare workers, landscapers, and HR reps all take it.

The core tool is ALGEE:

  1. Assess for risk of suicide or harm.
  2. Listen non-judgmentally.
  3. Give reassurance and information.
  4. Encourage appropriate professional help.
  5. Encourage self-help and other support strategies.

Job titles this skill supports: any customer-facing or caregiving role. In healthcare specifically: CNA, HHA, PCT, Receptionist, Community Health Worker, Peer Support Specialist. Pay follows the base role, but MHFA certification makes you hireable for roles with clients who have mental health needs (an IDD home, a recovery house, a memory-care facility).

Safety and tools

What to watch for:

  • Talking about wanting to die or kill oneself.
  • Looking for ways to kill oneself (asking about pills, guns).
  • Talking about being a burden, feeling trapped, unbearable pain.
  • Increasing alcohol or drug use.
  • Acting anxious, agitated, reckless.
  • Sleeping too little or too much.
  • Withdrawing, isolating.
  • Extreme mood swings.

What to do:

  • Ask directly: "Are you thinking about suicide?" This does not plant the idea. Research is clear: asking reduces risk by giving permission to talk.
  • Listen. Do not problem-solve, minimize, or change the subject.
  • Stay with them or arrange for someone to stay.
  • Remove access to means (guns, large stockpiles of medication) if you can do so safely.
  • Get professional help: 988 (Suicide and Crisis Lifeline, call or text), 911 for imminent danger, SAMHSA helpline (1-800-662-4357) for substance use.

What not to do: do not promise confidentiality for a suicide or harm disclosure (you must report). Do not argue the person out of feelings. Do not leave a person in imminent danger alone.

Safety for you: crisis calls can be heavy. Debrief with a supervisor or EAP counselor. Mental Health First Aid training includes self-care modules for exactly this reason.

Your first exercise

Memorize 988 (the national Suicide and Crisis Lifeline). It launched in 2022 and is free, confidential, and 24/7. Practice saying out loud: "I am worried about you. Have you had thoughts of suicide?" Practicing the words matters; the first time you say them to someone in crisis should not be the first time you have ever said them.

Where to go next

Build on Mental Health First Aid with CNA Fundamentals (Introduction to CNA Skills), Pediatric Home Care (Introduction to Pediatric Home Care), Diabetes Management (Introduction to Diabetes Management), Trauma-Informed Care, Substance Use Recovery Support, and Positive Behavior Guidance (Introduction to Positive Behavior Guidance - for childcare). Safety: HIPAA/PHI, Workplace Safety.