Search results

The literature search identified 2367 non-duplicated references (Fig. 1), including two additional examples from Google Scholar. One reference was identified through forward citation searching. Sixty full-text articles were assessed for eligibility, of which 26 met eligibility criteria. Reasons for exclusion are detailed in Supplementary Table 1.

Fig. 1

Preferred Reporting Items for Systematic Reviews and Meta-Analysis flow diagram. MHFA, Mental Health First Aid.

Interrater agreement

Interrater agreement was high for MMERSQI scores (ICC = 0.847), with both reviewers independently in agreement on all overall Cochrane RoB II assessments.

Study characteristics

Of the 26 studies, 12 were from the USA, ^{Reference Dulellari, Vesey, Mason, Marshall and Bostwick20–Reference McKeirnan, MacCamy, Robinson, Colorafi and Willson31} 8 from Australia, ^{Reference Bond, Jorm, Kitchener and Reavley32–Reference Wadsworth, Warren-James, Duncan and Clegg39} 2 from Hong Kong ^{Reference Hung, Chow, Chien and Wong40,Reference Hung, Lam and Chow41} and 1 each from the UK, ^{Reference Davies, Beever and Glazebrook42} France, ^{Reference Sibeoni, Ellul, Bubola, Debiche and Piot43} Canada ^{Reference McGregor, Boyd, Collins, Mcdonald and Pereira-Edwards44} and Portugal. ^{Reference de Jesus Loureiro and da Costa LM45} MHFA was translated into a different language in four studies: Portuguese, ^{Reference de Jesus Loureiro and da Costa LM45} Cantonese ^{Reference Hung, Chow, Chien and Wong40,Reference Hung, Lam and Chow41} and French. ^{Reference Sibeoni, Ellul, Bubola, Debiche and Piot43} Four studies were RCTs. ^{Reference Ostrowski, Sampson, McGoldrick, Karabin and Shields28,Reference Burns, Crawford, Hallett, Hunt, Chih and Tilley33,Reference Hung, Chow, Chien and Wong40,Reference Davies, Beever and Glazebrook42} Three studies were purely qualitative, utilising semi-structured interviews, ^{Reference O’Reilly, Moles, Boukouvalas and El-Den37,Reference Hung, Lam and Chow41,Reference Sibeoni, Ellul, Bubola, Debiche and Piot43} and five quantitative questionnaire studies captured qualitative data through open-ended responses. ^{Reference Forbes, Noller, Henriquez, Scantamburlo, Ward and Lee21,Reference Frick, Osae, Ngo, Anksorus, Williams and Rodgers22,Reference Witry, Karamese and Pudlo26,Reference Edgar and Connaughton34,Reference Wadsworth, Warren-James, Duncan and Clegg39}

Fourteen studies included pharmacy students, ^{Reference Dulellari, Vesey, Mason, Marshall and Bostwick20,Reference Frick, Osae, Ngo, Anksorus, Williams and Rodgers22–Reference Witry, Fadare and Pudlo27,Reference Habba, Frond, Burghardt and Stewart30,Reference McKeirnan, MacCamy, Robinson, Colorafi and Willson31,Reference El-Den, Chen, Moles and O’Reilly35,Reference O’Reilly, Bell, Kelly and Chen36,Reference Ung, O’Reilly, Moles, Collins, Ng and Pham38} seven included nursing students, ^{Reference Bond, Jorm, Kitchener and Reavley32,Reference Burns, Crawford, Hallett, Hunt, Chih and Tilley33,Reference Hung, Chow, Chien and Wong40,Reference Hung, Lam and Chow41,Reference Sibeoni, Ellul, Bubola, Debiche and Piot43–Reference de Jesus Loureiro and da Costa LM45} three included medical students, ^{Reference Bond, Jorm, Kitchener and Reavley32,Reference Davies, Beever and Glazebrook42,Reference Sibeoni, Ellul, Bubola, Debiche and Piot43} three included physiotherapy students, ^{Reference Murphy, Klug and Kasimatis29,Reference Edgar and Connaughton34,Reference Sibeoni, Ellul, Bubola, Debiche and Piot43} two included physician assistant students, ^{Reference Forbes, Noller, Henriquez, Scantamburlo, Ward and Lee21,Reference Murphy, Klug and Kasimatis29} two included occupational therapy students ^{Reference Ostrowski, Sampson, McGoldrick, Karabin and Shields28,Reference Murphy, Klug and Kasimatis29} and one included paramedic students. ^{Reference Wadsworth, Warren-James, Duncan and Clegg39}

MHFA was mostly delivered face to face, with five studies taking a blended approach incorporating elements of virtual and classroom learning ^{Reference McKeirnan, MacCamy, Robinson, Ebinger and Willson24,Reference Ostrowski, Sampson, McGoldrick, Karabin and Shields28,Reference Murphy, Klug and Kasimatis29,Reference McKeirnan, MacCamy, Robinson, Colorafi and Willson31,Reference Wadsworth, Warren-James, Duncan and Clegg39} and two delivering virtual MHFA. ^{Reference Vickery, Wick and McKee25,Reference Davies, Beever and Glazebrook42} In ten studies, MHFA was embedded into the curriculum ^{Reference Frick, Osae, Ngo, Anksorus, Williams and Rodgers22,Reference McKeirnan, MacCamy, Robinson, Ebinger and Willson24,Reference Vickery, Wick and McKee25,Reference Murphy, Klug and Kasimatis29,Reference McKeirnan, MacCamy, Robinson, Colorafi and Willson31,Reference Edgar and Connaughton34,Reference El-Den, Chen, Moles and O’Reilly35,Reference O’Reilly, Moles, Boukouvalas and El-Den37–Reference Wadsworth, Warren-James, Duncan and Clegg39} ; in all others it was an optional course.

Study characteristics and findings are summarised in Supplementary Table 2. Where reported, effect sizes for statistically significant outcomes were generally small to moderate and are summarised in Supplementary Table 2.

Patterns in area of research focus differed by study design. Quantitative studies predominantly investigated measurable changes in mental health literacy, confidence and intentions to provide help, and stigma. Qualitative studies more broadly explored students’ experiences of MHFA training and their views on its relevance in their education. The distribution of research focus across study designs is summarised in Table 2.

Table 2

Distribution of research focus across outcome domains and study designs

Table 2 Long description

A table comparing the focus of quantitative and qualitative studies across various areas related to mental health and education. The table has six rows and four columns. The columns are labeled Area of focus, Quantitative studies, Qualitative studies, and Integrated summary. The rows are labeled Mental health literacy/knowledge, Confidence in supporting others, Intentions to provide help, Stigma, Self-care and well-being, Peer support, and Perceived relevance to education and practice. Row 1: Mental health literacy/knowledge, Dominant, Limited, Core outcome measured quantitatively; there is little qualitative exploration of how the wider impact of this and how this knowledge may be applied in practice. Row 2: Confidence in supporting others, Dominant, Dominant, Central to both quantitative and qualitative studies. Row 3: Intentions to provide help, Moderate, Dominant, Frequently measured quantitatively with richer exploration in qualitative studies; translation into behaviour was rarely assessed. Row 4: Stigma, Moderate, Moderate, Generally a secondary focus across study designs, with consistent but modest focus. Row 5: Self-care and well-being, Absent, Limited, Limited inclusion across study types; some exploration in qualitative studies. Row 6: Peer support, Absent, Limited, Mentioned incidentally in qualitative accounts, but not examined systematically or measured quantitatively. Row 7: Perceived relevance to education and practice, Absent, Moderate, Explored through qualitative accounts, but not measured quantitatively.

Categories reflect the relative prominence of outcome domains across the included studies, aligned with the review objectives. Dominant, identified as a primary or central outcome within the majority of studies; moderate, examined repeatedly across studies with variable emphasis; limited, noted descriptively or incidentally without systematic evaluation; absent, not addressed.

Mental health literacy

Thirteen quantitative studies ^{Reference Dulellari, Vesey, Mason, Marshall and Bostwick20,Reference Frick, Osae, Ngo, Anksorus, Williams and Rodgers22,Reference Ostrowski, Sampson, McGoldrick, Karabin and Shields28–Reference Habba, Frond, Burghardt and Stewart30,Reference Bond, Jorm, Kitchener and Reavley32,Reference Burns, Crawford, Hallett, Hunt, Chih and Tilley33,Reference O’Reilly, Bell, Kelly and Chen36,Reference Wadsworth, Warren-James, Duncan and Clegg39,Reference Hung, Chow, Chien and Wong40,Reference Davies, Beever and Glazebrook42,Reference McGregor, Boyd, Collins, Mcdonald and Pereira-Edwards44,Reference de Jesus Loureiro and da Costa LM45} examined the impact of MHFA on mental health literacy. ^{Reference Jorm12} This was a major area of focus across quantitative studies but a less prominent theme in qualitative studies. Methods of assessing mental health literacy were variable, ranging from multiple-choice questions on MHFA course content, ^{Reference Frick, Osae, Ngo, Anksorus, Williams and Rodgers22,Reference Bond, Jorm, Kitchener and Reavley32,Reference Davies, Beever and Glazebrook42} responses to case vignettes ^{Reference Burns, Crawford, Hallett, Hunt, Chih and Tilley33} and utilisation of the Mental Health Literacy Scale ^{Reference O’Connor and Casey46} or an adapted version for HCP students. ^{Reference Murphy, Klug and Kasimatis29,Reference Hung, Chow, Chien and Wong40} This methodological variability limits direct comparison across studies, but reflects the breadth of how mental health literacy has been conceptualised within HCP student education.

All quantitative studies except one ^{Reference Frick, Osae, Ngo, Anksorus, Williams and Rodgers22} reported significant improvements in mental health literacy following MHFA training. One high-quality RCT involving 358 nursing students (scoring 81 out of 100 on MMERSQI) reported significant gains in recognition of mental illness presentations between pre- and post-training, ^{Reference Hung, Chow, Chien and Wong40} and another RCT reported that pharmacy students demonstrated greater proficiency in recognising mental illness presentations and supporting evidence-based interventions following training. ^{Reference O’Reilly, Bell, Kelly and Chen36} These gains were echoed in the qualitative studies, which indicated that students felt that MHFA had meaningfully enhanced their theoretical knowledge of mental illness. ^{Reference Hung, Lam and Chow41}

However, the picture was not uniformly positive. One large study of 135 pharmacy students reported no significant differences in knowledge test scores following training, ^{Reference Frick, Osae, Ngo, Anksorus, Williams and Rodgers22} and another involving medical and nursing students found no improvements in recognition of depression. ^{Reference Bond, Jorm, Kitchener and Reavley32} The latter finding may be explained by a ceiling effect, with pre-course recognition of depression already at 92% in this sample. Qualitative findings suggested that, given HCP students’ prior mental health knowledge from their training, MHFA content could have been more detailed and challenging. ^{Reference Sibeoni, Ellul, Bubola, Debiche and Piot43} This convergence between quantitative ceiling effects and qualitative reports of insufficient depth suggests that standard MHFA content may not be sufficiently advanced for HCP student populations, highlighting an opportunity for tailored adaptation of the content for these students. Evidence on the retention of mental health literacy gains was limited but generally positive.

Improvements persisted for up to 6 months post-training for both nursing ^{Reference Hung, Chow, Chien and Wong40} and pharmacy students. ^{Reference McKeirnan, MacCamy, Robinson, Colorafi and Willson31} Notably, gains were amplified when MHFA was supplemented by additional learning activities; occupational therapy and physician assistant students showed greater gains in mental health literacy when MHFA was supplemented with simulation-based learning. ^{Reference Murphy, Klug and Kasimatis29} Additionally, pharmacy students who participated in a community depression screening programme following MHFA demonstrated greater knowledge retention at 8-week follow-up compared with those who received MHFA alone. ^{Reference Habba, Frond, Burghardt and Stewart30} This highlights the value of supplementing MHFA with opportunities for applied learning.

Confidence in providing MHFA

Twenty quantitative studies ^{Reference Dulellari, Vesey, Mason, Marshall and Bostwick20–Reference Frick, Osae, Ngo, Anksorus, Williams and Rodgers22,Reference McKeirnan, MacCamy, Robinson, Ebinger and Willson24–Reference Witry, Karamese and Pudlo26,Reference Ostrowski, Sampson, McGoldrick, Karabin and Shields28,Reference Habba, Frond, Burghardt and Stewart30–Reference O’Reilly, Bell, Kelly and Chen36,Reference Ung, O’Reilly, Moles, Collins, Ng and Pham38–Reference Hung, Chow, Chien and Wong40,Reference Davies, Beever and Glazebrook42,Reference McGregor, Boyd, Collins, Mcdonald and Pereira-Edwards44,Reference de Jesus Loureiro and da Costa LM45} examined the impact of MHFA training on self-rated confidence in providing MHFA. This was a dominant area of focus across both quantitative and qualitative studies. Assessment methods included scoring of self-rated confidence to provide MHFA for a case vignette on a four-point Likert scale, ^{Reference Bond, Jorm, Kitchener and Reavley32,Reference Davies, Beever and Glazebrook42} rating confidence in applying subsets of MHFA skills on a five-point Likert scale ^{Reference Forbes, Noller, Henriquez, Scantamburlo, Ward and Lee21,Reference Witry, Karamese and Pudlo26} and through open-ended questions. All studies reported that, following MHFA training, students had significantly increased self-reported confidence in providing support. Similarly, qualitative studies suggested that students had improved communication skills following MHFA training and greater confidence initiating conversations about mental health. ^{Reference Hung, Lam and Chow41} However, this did not apply universally, with some students feeling that they were ‘not ready to intervene’ due to limited practical opportunities in the MHFA course. ^{Reference Sibeoni, Ellul, Bubola, Debiche and Piot43}

Two studies ^{Reference O’Reilly, Moles, Boukouvalas and El-Den37,Reference Ung, O’Reilly, Moles, Collins, Ng and Pham38} involving pharmacy students described additional increases in self-reported confidence in utilising MHFA skills following classroom learning was reinforced by simulation. Improvements were noted in confidence in asking directly about suicide and encouraging self-help. ^{Reference Ung, O’Reilly, Moles, Collins, Ng and Pham38} Furthermore, pharmacy students who participated in community pharmacy-based depression screening following MHFA training reported significantly higher levels of confidence in applying these skills compared with those who underwent MHFA training alone, ^{Reference Habba, Frond, Burghardt and Stewart30} highlighting the value of experiential learning in reinforcing confidence in applying skills.

Interestingly, two studies focusing on skill proficiency following MHFA training suggested that self-rated confidence may not be an accurate reflection of actual skills. ^{Reference El-Den, Chen, Moles and O’Reilly35,Reference Ung, O’Reilly, Moles, Collins, Ng and Pham38}

In a study by El-Den et al, ^{Reference El-Den, Chen, Moles and O’Reilly35} 36 pharmacy students participating in simulated scenarios tended to underestimate their ability to approach an individual, and to overestimate their ability to encourage appropriate professional support; although 96% expressed confidence in providing directions for professional support, only 50% actually took the appropriate steps during simulation. Ung et al ^{Reference Ung, O’Reilly, Moles, Collins, Ng and Pham38} also investigated pharmacy students’ skills in simulated patient encounters following MHFA training, finding that students rated their performance lower than tutors and simulated patients. This suggests a disparity between self-rated confidence and assessed performance, and that confidence does not necessarily equate to skill proficiency. Although self-rated confidence in providing support generally improved following training, this did not always translate into skilled responses and some students felt hesitant to intervene following MHFA training.

Intentions to provide MHFA

There was a moderate focus on the impact of MHFA training on intentions to provide support to others; eight quantitative studies ^{Reference McKeirnan, MacCamy, Robinson, Ebinger and Willson24,Reference Witry, Karamese and Pudlo26,Reference Witry, Fadare and Pudlo27,Reference McKeirnan, MacCamy, Robinson, Colorafi and Willson31–Reference Burns, Crawford, Hallett, Hunt, Chih and Tilley33,Reference Hung, Chow, Chien and Wong40,Reference Davies, Beever and Glazebrook42} examined the impact of MHFA on students’ intentions to provide help in real-world situations, and qualitative studies also explored this. All reported that, following MHFA training, students expressed high levels of willingness to provide help, with limited evidence suggesting that this continued for 6 months post-training for pharmacy students. ^{Reference McKeirnan, MacCamy, Robinson, Colorafi and Willson31}

Furthermore, several studies demonstrated that MHFA training translated into actual helping behaviours, which is promising for an educational intervention; one large RCT involving nursing students reported that, 6 months post-training, 95% in the intervention group (n = 86) who encountered an individual in need of mental health support provided help, versus 85% of controls (n = 39). ^{Reference Hung, Chow, Chien and Wong40} Similarly, 71% (n = 72) of paramedic students who had completed MHFA up to 18 months previously reported using skills to support people in their social networks suffering from mental health difficulties, or professionally as first responders. ^{Reference Wadsworth, Warren-James, Duncan and Clegg39}

Willingness to provide support was reflected in the qualitative studies, with MHFA equipping students with the skills and confidence to initiate difficult conversations around mental health that they may previously have avoided. Nursing students described using their training to open conversations about mental illness within their own families, with one participant describing MHFA as a ‘bridge’ between themselves and a parent living with depression, ^{Reference Hung, Lam and Chow41} capturing the role of MHFA in reducing the interpersonal distance that stigma and uncertainty can create. French HCP students also described assisting others with mental health crises following training. ^{Reference Sibeoni, Ellul, Bubola, Debiche and Piot43} Pharmacy students expressed willingness to provide support despite acknowledging the practical challenges of doing so within the community pharmacy setting, ^{Reference Witry, Karamese and Pudlo26} reflecting a deep sense of responsibility towards others.

Overall, these findings across different HCP disciplines suggest that MHFA may function as more than a knowledge-based intervention, promoting actual helping behaviour across both personal and professional contexts.

Stigma

There was a moderate focus on the impact of MHFA training on stigmatising attitudes, which was explored in roughly half of the studies. Quantitative studies explored changes in standardised rating scales for stigma, and qualitative studies evaluated shifts in perceptions of individuals with mental illness following MHFA training. Results were conflicting, with ten quantitative studies reporting significant decreases in stigmatising attitudes ^{Reference McCormack, Gilbert, Ott and Plake23–Reference Vickery, Wick and McKee25,Reference Bond, Jorm, Kitchener and Reavley32–Reference Edgar and Connaughton34,Reference O’Reilly, Bell, Kelly and Chen36,Reference Ung, O’Reilly, Moles, Collins, Ng and Pham38,Reference Hung, Chow, Chien and Wong40,Reference Davies, Beever and Glazebrook42} following training, but four ^{Reference Dulellari, Vesey, Mason, Marshall and Bostwick20,Reference Frick, Osae, Ngo, Anksorus, Williams and Rodgers22,Reference Ostrowski, Sampson, McGoldrick, Karabin and Shields28,Reference McKeirnan, MacCamy, Robinson, Colorafi and Willson31} describing no significant impact. Qualitative studies reported reduced fear and judgement towards people with mental illness following MHFA training, including among nursing students in Hong Kong ^{Reference Hung, Lam and Chow41} and French HCP students, who attributed this to improved understanding of psychotic disorders. ^{Reference Sibeoni, Ellul, Bubola, Debiche and Piot43}

In a study involving delivery of compulsory MHFA to 209 final-year pharmacy students, there was a statistically significant reduction in stigmatising attitudes assessed using the Social Distance Scale immediately post-training. Further reductions in stigmatising attitudes were reported in 86 students who participated in simulation training following MHFA. ^{Reference Ung, O’Reilly, Moles, Collins, Ng and Pham38} Pharmacy students’ self-reported empathy towards individuals with mental illness improved following MHFA training, ^{Reference Frick, Osae, Ngo, Anksorus, Williams and Rodgers22} as rated by the Kiersma–Chen Empathy Scale. ^{Reference Kiersma, Chen, Yehle and Plake47} Although data on the longevity of changes in stigma were limited, nursing students were reported to have further reductions in stigma 2 months post-training compared with immediately afterwards. ^{Reference Burns, Crawford, Hallett, Hunt, Chih and Tilley33}

Three studies did not report significant shifts in stigmatising attitudes immediately post-training, ^{Reference Dulellari, Vesey, Mason, Marshall and Bostwick20,Reference Frick, Osae, Ngo, Anksorus, Williams and Rodgers22,Reference Ostrowski, Sampson, McGoldrick, Karabin and Shields28} which the authors suggested may reflect positive baseline attitudes and the influence of social desirability bias in answering questions related to stigma. An additional study involving pharmacy students ^{Reference McKeirnan, MacCamy, Robinson, Colorafi and Willson31} found that, although there were immediate post-training improvements in stigma, this was not retained at 6-month follow-up. Psychotic illnesses were still perceived as more stigmatising than other mental health conditions following training. ^{Reference McKeirnan, MacCamy, Robinson, Colorafi and Willson31}

Overall, the evidence suggests that MHFA has potential to reduce stigma among HCP students, particularly if supplemented by experiential learning. However, the variability in findings and limited evidence on the longevity of changes indicate that MHFA as a standalone intervention may not produce lasting shifts in attitudes, especially towards more stigmatising mental health conditions.

Self-care

No quantitative studies examined the impact of MHFA on students’ self-care as a primary outcome. However, two questionnaire-based studies reported increased willingness to seek help for personal mental health difficulties following training; this included an increase in nursing students’ intentions to seek help for their own mental health (from 71.9 to 91.3%), ^{Reference de Jesus Loureiro and da Costa LM45} and 65 of 235 pharmacy students ^{Reference McKeirnan, MacCamy, Robinson, Ebinger and Willson24} reporting proactive help-seeking following MHFA training. One qualitative study provided further insight into self-care-related outcomes among nursing students, who described improved awareness of their own mental health needs and greater willingness to seek support. They also described an impact on resilience, including the use of adaptive coping strategies such as reframing negative situations and communicating more openly with their support networks. ^{Reference Hung, Lam and Chow41}

Peer support and student well-being

This area was not directly addressed in any of the included studies. McGregor et al ^{Reference McGregor, Boyd, Collins, Mcdonald and Pereira-Edwards44} assessed nursing students’ self-rated confidence in providing MHFA to a peer experiencing a panic attack before and after a simulated scenario; confidence scores increased significantly following simulation. Qualitative data from semi-structured interviews with French HCPs ^{Reference Sibeoni, Ellul, Bubola, Debiche and Piot43} suggested that MHFA fostered a sense of kinship within the group, and students proactively offered to support one another if needed in the future. In a further qualitative study, nursing students described being more able to recognise the pressures of their training, and becoming more vigilant for signs of emerging mental health problems in their peers following MHFA training. ^{Reference Hung, Lam and Chow41}

Impact of MHFA in different HCP student disciplines

Although MHFA produces broadly consistent benefits across HCP student populations, limited cross-disciplinary evidence suggests that its impact and relevance vary by student HCP discipline and their anticipated future clinical role.

Pharmacy students were the group studied most frequently ^{Reference Dulellari, Vesey, Mason, Marshall and Bostwick20,Reference Frick, Osae, Ngo, Anksorus, Williams and Rodgers22–Reference Witry, Fadare and Pudlo27,Reference Habba, Frond, Burghardt and Stewart30,Reference McKeirnan, MacCamy, Robinson, Colorafi and Willson31,Reference El-Den, Chen, Moles and O’Reilly35–Reference Ung, O’Reilly, Moles, Collins, Ng and Pham38,Reference Sibeoni, Ellul, Bubola, Debiche and Piot43} and the evidence was consistently positive, with significant improvements reported across mental health knowledge, confidence, intentions to provide support and stigmatising attitudes. Pharmacists have a front-line role, interacting regularly with individuals experiencing mental health difficulties yet typically receiving limited formal mental health training as part of their professional curriculum. The convergence of positive outcomes with a clearly identified professional need makes pharmacy one of the most promising contexts for MHFA implementation identified in this review.

Studies involving medical students similarly reported improvements across multiple outcome domains, including mental health knowledge, confidence, stigma and intentions to provide help. Online and face-to-face courses were similarly effective in this group, ^{Reference Bond, Jorm, Kitchener and Reavley32,Reference Davies, Beever and Glazebrook42} with data from one qualitative study suggesting that medical students would value more detailed information about mental disorders. ^{Reference Bond, Jorm, Kitchener and Reavley32} The combination of positive outcomes but insufficiently advanced content suggests that medical students may benefit from a tailored version of MHFA that better aligns with the depth of clinical knowledge required for their training.

Seven studies ^{Reference Bond, Jorm, Kitchener and Reavley32,Reference Burns, Crawford, Hallett, Hunt, Chih and Tilley33,Reference Hung, Chow, Chien and Wong40,Reference Hung, Lam and Chow41,Reference Sibeoni, Ellul, Bubola, Debiche and Piot43–Reference de Jesus Loureiro and da Costa LM45} involving nursing students described similar benefits of MHFA training, with one ^{Reference McGregor, Boyd, Collins, Mcdonald and Pereira-Edwards44} reporting increased confidence in supporting a nursing student peer with anxiety and patients with depression following MHFA training. This underscores the dual role of MHFA in helping with professional practice and peer support in this group. Notably, two nursing studies were RCTs with high-quality assessment scores, lending greater methodological weight to the positive findings in this discipline. ^{Reference Burns, Crawford, Hallett, Hunt, Chih and Tilley33,Reference Hung, Chow, Chien and Wong40}

The evidence base for allied HCP students was considerably thinner, with only one or two studies per discipline for paramedic, ^{Reference Wadsworth, Warren-James, Duncan and Clegg39} physiotherapy, ^{Reference Murphy, Klug and Kasimatis29,Reference Edgar and Connaughton34} occupational therapy ^{Reference Ostrowski, Sampson, McGoldrick, Karabin and Shields28,Reference Murphy, Klug and Kasimatis29} and physician assistant ^{Reference Forbes, Noller, Henriquez, Scantamburlo, Ward and Lee21,Reference Murphy, Klug and Kasimatis29} students. Outcomes were broadly positive, although paramedic students felt that MHFA did not address de-escalation in emergency situations, which would have been of particular relevance to them. ^{Reference O’Reilly, Bell, Kelly and Chen36} Paramedic students are trained to respond to acute crises, often in high-pressure and unpredictable environments, which MHFA is not designed to address.

Taken together, the cross-disciplinary evidence suggests that the standardised MHFA course may not fully address the profession-specific mental health training needs of students across the full spectrum of healthcare disciplines, and that tailoring of MHFA to different disciplines may be beneficial.