This review sought to compare Mental Health First Aid (MHFA) to alternative training; understand the implementation issues within 81 organisations through survey data from those who had attended an MHFA course; and gain insight into the implementation, use and utility of MHFA by interviewing participants. The review included 25 mental health awareness courses and 14 suicide awareness courses. Success of MHFA training was found to be enhanced by a clear rationale for the introduction of MHFA, motivated MHFA co-ordinators and MHFA organisational networks. Barriers to implementation included challenges with measuring the impact, lack of clear boundaries for the MHFA role and inconsistent strategies to identify trained MHFA persons and promote this role. Other specific issues around the MHFA course are discussed (e.g. course length, ability to evaluate MHFA and refresher training opportunities). Overall, findings suggest participants were positive towards MHFA, while it was acknowledged that barriers to the success of the MHFA role included: challenges in measuring impact, having clear role boundaries within the MHFA role and inconsistencies with selecting and promoting individuals for the role.