Mental Health First Aid training and assessment among university students: A systematic review

Simulated psychosis care role-plays for pharmacy curricula: a qualitative exploration of student experiences

PURPOSE

Mental Health First Aid (MHFA) training is embedded in various tertiary healthcare curricula. However, opportunities for students to practise their newly acquired MHFA skills before entering the clinical practice workforce are lacking. The purpose of this study was to explore pharmacy students' experiences of MHFA training and post-MHFA simulated psychosis care role-plays.

METHODS

Final-year pharmacy students received MHFA training, after which they were invited to participate in simulated patient role-plays with trained actors, whilst being observed by peers, pharmacy tutors and mental health consumer educators (MHCEs). Immediately after each role-play, the role-playing student engaged in self-assessment, followed by performance feedback and debrief discussions with the tutor, MHCE and observing peers. All MHFA-trained students were invited to participate in audio-recorded focus groups to explore their experiences. Audio-recordings were transcribed verbatim and thematically analysed.

RESULTS

MHFA training was delivered to 209 students, of which 86 participated in a simulated patient role-play as a role-player and the remaining students observed. Seven focus groups were conducted with 36 students (mean duration 40 min, SD 11 min). Five themes emerged: scenario reactions, realistic but not real, mental health confidence, MHFA skills application, feedback and self-reflection.

CONCLUSION

Students enjoyed the post-MHFA simulated psychosis care role-plays, which provided opportunities to apply and reflect on their newly-acquired MHFA skills in a safe learning environment. These experiences enhanced students' confidence to support people in the community, experiencing mental health symptoms or crises, and could be an add-on to MHFA training in the future.

A mixed-methods project on the impact of the mental health first aid training on French university students' knowledge, attitudes and practices

AIM

University students are increasingly affected by mental health problems and need prompt support. The aim of this project was to assess the impact of the mental health first aid (MHFA) training on students' knowledge, attitudes and practices (KAP) concerning mental health in the short, mid and long-term.

METHODS

Three studies were conducted in Bordeaux, France, from May 2021 to March 2022. The first study collected data from 55 students 1 to 6 months after they had followed the training to examine its efficacy in the mid-long term. The second study collected data immediately before and after the training to evaluate the KAP of 52 students in the short-term (1 to 10 days). The third study consisted of 14 semi-structured interviews with students trained since 2020 to identify the training's long-term impact (3 to 18 months). Descriptive statistics were used for studies one and two, and framework analyses for study three.

RESULTS

Most participants reported that their KAP about mental health had improved after the training. In the first study, 94.2% of students reported being ready to intervene during a psychotic crisis in their peers. In the second study, 75.0% of students reported improved mental health-related knowledge and decreased stigma. All students in the third study reported that they had assisted at least one person after the training.

CONCLUSIONS

These were the first data on the impact of the French MHFA on KAP. While not exhaustive, findings suggest that deploying the training would be beneficial to French students.

Mental Health First Aid Training for Allied Health Clinical Educators: A Pre- and Post-Evaluation

Purpose

Health profession students may experience mental health issues during training, and clinical educators report that they don't feel confident in supporting students with these issues. This study explored whether a customized Mental Health First Aid (MHFA) training programme changed the knowledge, perceptions, intentions, and confidence of clinical educators in supporting students with mental health issues in the workplace.

Method

Twenty-four allied health clinical educators from a tertiary health service attended a two-day customized MHFA course. The educators completed assessments before (n = 21) and after (n = 23) the course. Quantitative data was analyzed using independent t-tests. Qualitative data was thematically analyzed using content analysis.

Results

Knowledge improved significantly (p = <0.001). The confidence to manage students with mental health issues increased significantly (p < 0.001). A significant change in perception was only found with respect to a character in a scenario being dangerous or unpredictable. Intentions to assist co-workers and students with mental health issues improved for all items but not necessarily significantly.

Conclusions

This programme improved educators' knowledge of mental health, perceptions of people with mental health issues, intentions of providing help, and confidence to support people with mental health issues.

Pharmacy student attitudes to mental illness and the provision of mental health care: a repeated cross-sectional survey

BACKGROUND

Attitudes to mental illness are an important factor in the willingness of professionals to engage in mental health care.

AIM

The aim of this study was to understand attitudes of undergraduate pharmacy students in Ireland to severe mental illness and the provision of medicines optimisation services as well as the variation in these attitudes throughout the undergraduate course.

METHOD

A survey instrument was compiled using existing published research and validated questionnaires. The survey was distributed to students in their first, third and Master of Pharmacy years annually between 2014 and 2019. Although designed as a longitudinal study, following the matching process there were a limited number of students who completed more than one survey and therefore data were treated as independent samples.

RESULTS

The overall average response rate was 25% per survey (n = 191 participants) Notwithstanding generally positive attitudes, a sizeable proportion of students felt people with severe depression and schizophrenia were hard to talk to (n = 48, 25.3%; n = 54, 29.2%) Less than half of MPharm students expressed confidence and competence in caring for people with more severe mental illnesses such as bipolar disorder and schizophrenia and 29% (n = 60) of students would feel awkward asking someone about their antipsychotic medication. Almost two thirds (n = 120, 63.8%) expressed an interest in a career in mental health.

CONCLUSION

Irish pharmacy students have generally positive attitudes towards people with severe mental illness and provision of medicines optimisation services. There is an opportunity to improve pharmacy graduates perceived competence and confidence to provide mental health services.

Mental Health First Aid crisis role-plays between pharmacists and simulated patients with lived experience: a thematic analysis of debrief

PURPOSE

Healthcare professionals, including pharmacists, can recognise and assist people experiencing mental health crises. Despite this, little is known about how pharmacists assist and engage with people presenting with signs and symptoms of mental health crises. This study aimed to (i) examine pharmacists' mental health crisis assessment language during simulated patient role-plays (SPRPs) and (ii) explore participants' experiences of participating in SPRPs of Mental Health First Aid (MHFA) scenarios.

METHODS

Fifty-nine MHFA-trained pharmacy staff participated in audio-recorded SPRPs of three crisis scenarios enacted by a mental health consumer educator (MHCE). Post-SPRP, pharmacy staff members (including role-playing and observing participants), engaged in reflective debrief discussions with the facilitator and MHCEs. Debrief discussions were transcribed verbatim and analysed using inductive thematic analysis and suicide assessment language was explored.

RESULTS

The majority of role-playing pharmacists asked about suicidal ideation using appropriate, direct language (n = 8). Qualitative analyses of debrief discussions yielded four themes: (i) Relationship with the consumer, (ii) Verbal and non-verbal communication, (iii) Challenges with crisis assessment, which included difficulties associated with initiating conversations about suicide and mania, and (iv) Reflective learning.

CONCLUSION

While pharmacists demonstrated the appropriate suicide assessment language post-MHFA training, pharmacists felt uncomfortable initiating conversations around suicide and lacked confidence during crisis assessments. SPRPs provided pharmacists with opportunities to reflect on and practice MHFA skills in a safe learning environment. Future research exploring how MHFA training and SPRPs impact pharmacists' ability to provide MHFA in real-world settings is warranted.

Implementing Mental Health First Aid Training in a Doctor of Pharmacy Program

OBJECTIVE

In this study, we aimed to describe the implementation of Mental Health First Aid (MHFA) training as a required curricular component in a Doctor of Pharmacy (PharmD) program; and analyze the impact of MHFA training on student pharmacist's perceptions of stigma, comfort, confidence, and willingness to intervene when someone is experiencing a mental health issue.

METHODS

Student pharmacists completed an all-day MHFA training as a required element of the PharmD curriculum during the spring of 2022. Pre- and post-survey was completed by students during the in-person training. Questions included items from the Opening Minds to Stigma Scale for Healthcare Providers; question, persuade, refer gatekeeper training for suicide prevention; and questions developed by the authors to assess the impact of the training on participant-reported stigma, confidence, and willingness to provide care to those potentially experiencing a mental issue.

RESULTS

A total of 235 student pharmacists completed the MHFA training. A statistically significant reduction of stigma was seen for 9 of the 15 statements from Opening Minds to Stigma Scale for Healthcare Providers. Additionally, all responses related to comfort and willingness to provide care and confidence improved significantly after completing MHFA.

CONCLUSION

MHFA training was implemented as a mandatory requirement for all student pharmacists in the didactic portion of a PharmD program. This training led to reduced stigma around mental illness and improved confidence, comfort, and willingness to intervene among student pharmacists.

Mental Health First Aid training for paramedic students: An evaluation study

BACKGROUND

The combination of first-year placements, an increasing proportion of mental health callouts, and the high incidence of mental illness in health-professional tertiary students means standard curricula may not adequately prepare early-year paramedic students for mental health challenges.

METHODS

A retrospective online survey was used to explore the experiences of paramedic students who have completed Mental Health First Aid (MHFA) training within their undergraduate studies. The content-validated survey explored the relevance, appropriateness, and novelty of MHFA training, and invited participants to reflect on the course strengths and weaknesses.

RESULTS

The majority of 102 respondents, predominantly female first- and second-year paramedic students aged 18-24 years, agreed the content was relevant (86%) and appropriate (88%), with 73% agreeing they would recommend to other university students. Thematic analysis identified strengths of the course as perceived increases in mental health literacy and empowerment to act on mental health concerns. A weakness was students perceived the course did not prepare them adequately for clinical practice.

CONCLUSION

The inclusion of MHFA early in paramedic curricula is appropriate and relevant, increasing mental health literacy and empowering students to recognise and act upon mental health concerns. Application of practical scenarios may further enhance student learning experiences.

Mental health: "it is a subject where most pharmacists [or pharmacy] students have no more knowledge than the general public"

BACKGROUND

Mental health is a global health priority, and pharmacists have a valuable role in improving outcomes in all sectors of practice. This study sought to explore pharmacy students' views on teaching and learning of mental health and future practice.

METHODS

An anonymous online questionnaire was distributed to pharmacy students in the UK and Ireland in February 2020 via the Qualtrics™ platform and 232 students responded. The questionnaire was originally intended to explore the provision of Mental Health First Aid (MHFA) teaching and the quantitative analysis has been previously reported. Students were invited to comment on their views about MHFA. The open-ended question: 'Do you have any other comments about mental health teaching and learning in the MPharm degree?' was also included. The rich free-text data were analysed, and themes identified.

RESULTS

Three major themes were identified: (i) Mental Health is important; (ii) Pharmacist roles and (iii) So, Teach me. A fourth theme, Stigma, crosscut all the themes.

CONCLUSIONS

Pharmacy students appreciate the importance of mental health care. The majority recognise the role of the pharmacist in providing person-centred care and the potential to enhance this role. Students are keen to learn more, and acquire the confidence and skills to contribute in the future. They would like an integrated approach and have more opportunities to learn from patients. Addressing stigma is an important consideration for educators.

ANALYSIS OF THE WORLD'S BEST PRACTICES IN TRAINING PHARMACISTS FOR PROVIDING MENTAL HEALTH CARE TO PATIENTS

The article analyzes and systematizes international documents and research results, which reveal the experience of implementing the best practices in mental health into the educational process of training pharmacists at various levels of education. Available foreign educational programs were analyzed in terms of their form and content. According to the results of the research, it was found out that the practice of professional training of pharmacists on mental health issues is quite widespread at the world level and is presented in various scientific publications. The results of their analysis also indicate different forms of training process organization.

Observed behaviours and suicide assessment language post-Mental Health First Aid training in Australia and the United States: a mixed methods study using discourse analysis

BACKGROUND

Mental Health First Aid (MHFA) training teaches participants how to respond to mental health crises, including suicide. Little is known about the impact of training on participants' observed MHFA behaviours. This exploratory study aimed to compare MHFA-trained Australian and US student pharmacists' performance and suicide assessment language during simulated patient role-play (SPRP) assessments.

METHODS

Student pharmacists (n = 265) completed MHFA training and participated (n = 81) in SPRPs with simulated patients (SP) who were people with lived experience of mental illness. Each SPRP was marked by three raters (student, tutor and SP). One-way ANOVA, chi-squared tests and independent samples t-tests were used to compare scores and pass/fail rates, where appropriate. Transcribed audio-recordings of suicide assessments underwent discourse analysis. A chi-squared test was conducted to investigate the differences in how suicide assessment language was coded across six discursive frames ('confident'/'timid', 'empathetic'/'apathetic', and 'direct'/'indirect').

RESULTS

Three raters assessed 81 SPRPs, resulting in quantitative analysis of 243 rubrics. There were no significant differences between student pharmacists' mean scores and pass/fail rates across countries. Overall, both cohorts across Australia and the US performed better during the mania scenario, with a low failure rate of 13.9 and 19.0%, respectively. Most students in both countries passed their SPRP assessment; however, 27.8% did not assess for suicide or used indirect language during suicide assessment, despite completing MHFA training. Australian student pharmacists demonstrated, more direct language (76.9% versus 67.9%) and empathy (42.3% versus 32.1%) but less confidence (57.7% versus 60.7%) compared to US student pharmacists, during their suicide assessment; however, these differences were not statistically significant.

CONCLUSIONS

Findings indicate most MHFA-trained student pharmacists from Australia and the US can provide MHFA during SPRPs, as well as assess for suicide directly, empathetically and confidently. This exploratory study demonstrates the importance of practicing skills post-training and the need for further research exploring participants' hesitance to assess for suicide, despite training completion.

Public Health Approaches to Promoting University Students' Mental Health: A Global Perspective

PURPOSE OF REVIEW

Provide a critical overview of recent global advances in student mental health from a public health perspective, highlighting key challenges and gaps in the literature.

RECENT FINDINGS

Mental disorders and suicidality are common among university students globally. However, there is a significant treatment gap even though evidence-based treatments are available. To overcome barriers to treatment, public health interventions should be conceptualized within a developmental paradigm that takes cognizance of the developmental tasks of young adulthood. Traditional one-on-one treatment approaches will not be a cost-effective or sustainable way to close the treatment gap among students. A range of evidence-based interventions is available to promote students' mental health; however, novel approaches are needed to scale up services and adapt intervention delivery to suit student specific contexts. Digital interventions and peer-to-peer interventions could be a cost-effective way to scale-up and expand the range of services.

Mental health training programs for community pharmacists, pharmacy staff and students: A systematic review

BACKGROUND

Primary care is often the first point of contact for people living with mental disorders. Community pharmacists, pharmacy staff and students are increasingly being trained to deliver mental health care. However, there is still a gap in the literature exploring the characteristics of all available mental health training programs and their components and their influence on pharmacists, pharmacy staff and students' outcomes.

OBJECTIVES

To summarize the evidence evaluating mental health training programs completed by community pharmacists, pharmacy staff and students. More specifically, to explore the components of mental health training programs and identify those that facilitate significant improvements in outcomes.

METHODS

A systematic review was conducted following the Cochrane handbook and reported according to PRISMA guidelines. A search for published literature was conducted in three databases (PubMed, Scopus, and Web of Science) in July 2021. Eligible studies were included if they described and evaluated the impact of mental health training programs delivered to community pharmacists, pharmacy staff and pharmacy students regardless of design or comparator. The methodological quality of included studies was appraised using both the NIH quality assessment, to evaluate studies with an uncontrolled pre-post design, and the Cochrane EPOC risk of bias assessment, to evaluate studies with a controlled (randomized and non-randomized) study design.

RESULTS

Thirty-three studies were included. Most of the identified mental health training programs contained knowledge-based components and active learning activities. Changes in participants' attitudes, stigma, knowledge, confidence and skills were frequently assessed. An extensive range of self-assessment and observational instruments used to evaluate the impact of the training programs were identified. Positive improvements in participants' attitudes, knowledge and stigma were frequently identified following participation in training programs.

CONCLUSIONS

This systematic review highlights the importance of mental health training programs in increasing pharmacists', pharmacy staff and pharmacy students' skills and confidence to deliver mental health care in community pharmacy. Future research should build upon this basis and further focus on finding the most efficient measures to evaluate these training programs and assess their long-term effectiveness, allowing comparison between programs.

Professor Hippo-on-Campus: Developing and evaluating an educational intervention to build mental health literacy among university faculty and staff

Objective: The development and evaluation of the Professor Hippo-on-Campus Student Mental Health Education Program, a mental health literacy intervention for post-secondary faculty and staff, is described. It includes 3-hour virtual, asynchronous e-modules and an optional 2-hour, synchronous workshop. Participants: All faculty and staff in a single university were invited to participate (February 2020-January 2021). Methods: Pre-and post-module and post-workshop surveys were conducted, assessing knowledge, attitudes, stigma, behavioral intentions, and confidence. Paired t-tests and regressions assessed change. Satisfaction was assessed through closed and open-ended questions, analyzed descriptively and through qualitative content analysis. Results: Four hundred and fifty staff and faculty completed the pre-survey, 262 completed the post-survey, and 122 completed a workshop survey. Participation resulted in improvements in knowledge, attitudes, stigma, and confidence with high levels of satisfaction. Conclusion: The program provides tailored student mental health training to post-secondary staff and faculty, which appears to increase their mental health literacy.

Pharmacist-led interventions for people living with severe and persistent mental illness: A systematic review

OBJECTIVE

People living with severe and persistent mental illness experience poorer physical health, often due to medication and preventable lifestyle factors, and exacerbated by barriers to accessing healthcare services. Pharmacists are well-positioned to improve the physical and mental health of this population. However, little is known about pharmacists' current practices when providing services to this population nor the impact of pharmacist-led interventions on consumer health outcomes. We undertook a systematic review to identify, describe and assess the effectiveness of pharmacist-led interventions for supporting people living with severe and persistent mental illness and the impact on consumer outcomes.

METHODS

MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, Scopus, Cochrane Library, International Pharmaceutical Abstracts and ProQuest Dissertations and Theses were searched between January 1990 and April 2020. Full-text studies exploring pharmacist-led interventions in any setting for people living with severe and persistent mental illness were included. A risk of bias assessment was conducted.

RESULTS

A total of 37 studies were included. More than half of the pharmacist interventions were multifaceted. The most common components of pharmacist-led interventions included education and/or patient counselling, providing recommendations to healthcare professionals and conducting medication reviews. Multifaceted interventions demonstrated improvements in clinical outcomes, whereas single interventions focused mostly on consumer-reported outcomes. The methodological quality of included studies was moderate-to-high risk of bias and there was considerable heterogeneity in the study design, interventions described, and outcomes reported.

CONCLUSION

There is evidence that pharmacist-led interventions improve consumer-reported and clinical outcomes for people living with severe and persistent mental illness. Pharmacists are capable and have a role in supporting people living with severe and persistent mental illness, either individually or as interprofessional collaborators with other healthcare professionals. Future research should attempt to better understand which particular intervention components have the greatest impact and also evaluate the implementation and long-term sustainability of such interventions.

Needs assessment and impact of mental health training among doctor of pharmacy students

INTRODUCTION

Mental illness is extremely prevalent, yet many pharmacy students get little exposure to mental health training. The majority of studies assessing mental health training and Mental Health First Aid (MHFA) are focused on undergraduate programs. This study critically evaluated the impact of MHFA on pharmacy students' knowledge, confidence, and perceptions as they pertain to mental health, as well as the appropriateness of MHFA as a training course for pharmacy students.

METHODS

There were two parts to this study: (1) a pre-/post-survey that assessed the impact of MHFA on pharmacy students as well as the appropriateness of MHFA for students at this level of education and training and (2) a college-wide survey that assessed the impact of mental health training of any type on confidence in mental health-related skills and the perceived usefulness of mental health training for pharmacy students.

RESULTS

Participants of the MHFA portion of the study demonstrated a statistically significant improvement in knowledge of mental health-related topics and confidence to interact with someone experiencing mental illness (P < .05) after completing the MHFA course. Perceptions of mental illness did not improve significantly following a single training. The college-wide survey (N = 275) revealed a significantly higher confidence level among students who had previously completed any mental health training program compared to those who had not (P < .05).

CONCLUSIONS

MHFA training significantly increased students' knowledge and confidence in approaching and interacting with persons experiencing mental illness.

A qualitative exploration of mental health services provided in community pharmacies

The burden of mental health problems continues to grow worldwide. Community pharmacists’, as part of the primary care team, optimise care for people living with mental illness. This study aims to examine the factors that support or hinder the delivery of mental health services delivered in Australian community pharmacies and proposes ideas for improvement. A qualitative study was conducted comprising focus groups with community pharmacists and pharmacy staff across metropolitan, regional, and rural areas of New South Wales, Australia. Data were collected in eight focus groups between December 2020 and June 2021. Qualitative data were analysed using thematic analysis. Thirty-three community pharmacists and pharmacy staff participated in an initial round of focus groups. Eleven community pharmacists and pharmacy staff participated in a second round of focus groups. Twenty-four factors that enable or hinder the delivery of mental health services in community pharmacy were identified. Participant’s perception of a lack of recognition and integration of community pharmacy within primary care were identified as major barriers, in addition to consumers’ stigma and lack of awareness regarding service offering. Suggestions for improvement to mental health care delivery in community pharmacy included standardised practice through the use of protocols, remuneration and public awareness. A framework detailing the factors moderating pharmacists, pharmacy staff and consumers’ empowerment in mental health care delivery in community pharmacy is proposed. This study has highlighted that policy and funding support for mental health services is needed that complement and expand integrated models, promote access to services led by or are conducted in collaboration with pharmacists and recognise the professional contribution and competencies of community pharmacists in mental health care. The framework proposed may be a step to strengthening mental health support delivered in community pharmacies.

Mental Health First Aid training and assessment in Australian medical, nursing and pharmacy curricula: a national perspective using content analysis

BACKGROUND

Suicide is among the leading causes of death among people aged 15 to 29 worldwide. Healthcare professionals interact with people at risk of suicide regularly, yet mental health and crisis first aid training is lacking in curricula. Mental Health First Aid (MHFA) training teaches crucial communication and crisis first aid skills and is increasingly recognised as integral to healthcare education. This study aimed to explore the extent of, as well as barriers and enablers to MHFA training delivery and assessment in Australian medical, nursing and pharmacy curricula.

METHODS

All accredited Australian medical, nursing and pharmacy program providers were identified through Australian Health Practitioner Regulation Agency and National Boards websites and invited to participate in a semi-structured interview. A purpose-designed interview guide explored if and how MHFA training was delivered and assessed in curricula, as well as perceptions of and barriers and enablers to MHFA training. Interview recordings were transcribed verbatim, allowing for deductive content analysis to compare MHFA training provision across programs.

RESULTS

Of 75 invited program providers, 36 (48%; 13 medical, 13 nursing and 10 pharmacy) participated, of which 15 representatives (42%; six medical, two nursing and six pharmacy) reported providing MHFA training to students. Differences in mandating training, year level of students completing training, type of training delivered and source of MHFA instructors were identified. Barriers to MHFA implementation included perceived adequacy of existing curricula, lack of funding and time, while facilitators included perceived benefit and availability of funding.

CONCLUSION

MHFA training is provided to more than one third of medical, nursing and pharmacy students in Australia. Increased funding may facilitate the integration of MHFA as a minimum standard of mental health training for future healthcare professionals. Further research exploring the effectiveness of MHFA in improving behaviours and its impact on patient outcomes is warranted.

TRIAL REGISTRATION

This study was approved by the University of Sydney Human Research Ethics Committee [Project number: 2020/087].

Exploring the impact of suicide care experiences and post-intervention supports sought among community pharmacists: a cross-sectional survey

BACKGROUND

There is a need to appropriately train, support and remunerate pharmacists for their expanding roles in mental healthcare. Pharmacists often care for people experiencing mental health crises, including suicidal thoughts and behaviours, but little is known about pharmacists' suicide care experiences.

AIM

This cross-sectional study aimed to explore the impact of professional experiences with people at risk of suicide and support accessed, among community pharmacists.

METHOD

A survey exploring pharmacists' experiences with people at risk of suicide and post-intervention support-seeking was disseminated through Australian and Canadian professional associations, conferences and social media (June 2016-May 2017). Quantitative data were analysed using Chi-squared, Fisher's exact and independent t-tests, where appropriate. Qualitative data exploring the impact of these experiences were thematically analysed, and reasons for not seeking help post-intervention were identified.

RESULTS

Among 378 respondents, 84% had encountered patients at risk of suicide and 28% had lost patients to suicide. Some were negatively affected personally and/or professionally (11%), of which 88% did not seek professional support, mainly due to uncertainty about available services. Pharmacists were significantly more negatively affected if they had a personal mental health diagnosis (p = 0.017) and previous suicide care experiences (p = 0.001). Qualitative themes included: expanding knowledge and skills, role limitation and emotional impact and response.

CONCLUSION

A large proportion of pharmacists have interacted with suicidal patients and are impacted by these experiences, yet few seek help due to lack of awareness and access. There is a need to recognize pharmacists' roles in suicide care, and develop pharmacist-specific post-intervention support.

UK and Ireland survey of MPharm student and staff experiences of mental health curricula, with a focus on Mental Health First Aid

Background

One in four people experience a mental health problem every year and improving mental health care is an international priority. In the course of their work, pharmacists frequently encounter people with mental health problems. The experience of mental health teaching, including Mental Health First Aid (MHFA) training, in undergraduate pharmacy (MPharm) students in the UK and Ireland is not well documented. Students’ viewpoints, contextualised with curricular overviews provided by staff, were analysed to understand their experience.

Methods

An anonymous, online questionnaire was distributed to MPharm students and staff in the UK and Ireland. Students were asked closed questions regarding their course and exposure to MHFA, which were analysed using descriptive statistics. Open questions were included to enable explanations and these data were used to contextualise the quantitative findings. One member of staff from each university was invited to answer a modified staff version of the questionnaire, to provide a curriculum overview and staff perspective.

Results

232 students and 13 staff, from 22 universities, responded. Three-quarters of students did not agree with the statement that ‘mental health was embedded throughout the MPharm’. Most students (80.6%) stated that they were taught neuropharmacology whilst 44.8% stated that their course included communicating with people about their mental health. One-third (33.2%) of students stated that their degree ‘adequately prepared them to help people with their mental health’. Twenty-six students (11.6%) had completed MHFA training of which 89% would endorse inclusion of this within the MPharm. Of those who had not completed the training, 81% expressed a desire to do so. Those who completed MHFA training self-reported greater preparedness than those who did not, but student numbers were small.

Conclusions

Mental health teaching for pharmacy undergraduates is more focussed on theoretical aspects rather than applied skills. MHFA was viewed by students as one way to enhance skill application. The association of the increased self-reported preparedness of those who completed MHFA could be confounded by a positive environmental cultural. MPharm programmes need sufficient focus on real-world skills such as communication and crisis response, to complement the fundamental science.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40545-021-00364-1.

Simulated Patient Role-Plays with Consumers with Lived Experience of Mental Illness Post-Mental Health First Aid Training: Interrater and Test Re-Test Reliability of an Observed Behavioral Assessment Rubric

Mental Health First Aid (MHFA) training teaches participants how to assist people experiencing mental health problems and crises. Observed behavioral assessments, post-training, are lacking, and the literature largely focuses on self-reported measurement of behaviors and confidence. This study explores the reliability of an observed behavioral assessment rubric used to assess pharmacy students during simulated patient (SP) role-play assessments with mental health consumers. Post-MHFA training, pharmacy students (n = 528) participated in SP role-play assessments (n = 96) of six mental health cases enacted by consumers with lived experience of mental illness. Each assessment was marked by the tutor, participating student, and consumer (three raters). Non-parametric tests were used to compare raters' means scores and pass/fail categories. Interrater reliability analyses were conducted for overall scores, as well as pass/fail categories using intra-class correlation coefficient (ICC) and Fleiss' Kappa, respectively. Test re-test reliability analyses were conducted using Pearson's correlation. For interrater reliability analyses, the intra-class correlation coefficient varied from poor-to-good to moderate-to-excellent for individual cases but was moderate-to-excellent for combined cases (0.70; CI 0.58-0.80). Fleiss' Kappa varied across cases but was fair-to-good for combined cases (0.57, p < 0.001). For test re-test reliability analyses, Pearson's correlation was strong for individual and combined cases (0.87; p < 0.001). Recommended modifications to the rubric, including the addition of barrier items, scoring guides, and specific examples, as well as the creation of new case-specific rubric versions, may improve reliability. The rubric can be used to facilitate the measurement of actual, observed behaviors post-MHFA training in pharmacy and other health care curricula.

Pharmacy professionals' preparedness to use Mental Health First Aid (MHFA) behaviors

Background:

There is a need to train healthcare professionals to provide first aid to people experiencing a mental health crisis. Research testing the association between Mental Health First Aid (MHFA) training and the use of MHFA behaviors could provide evidence of program effectiveness in the pharmacy setting.

Objectives:

The objectives of this study were to measure the preparedness of pharmacy professionals to function in a MHFA role, and compare preparedness and the use of MHFA behaviors based on demographic characteristics.

Methods:

Pharmacists and student pharmacists attended MHFA training under a multi-state pharmacy initiative in 2018. An anonymous electronic survey was administered to 227 participants using 4 contacts in May to June, 2019. The survey evaluated if participants had recommended MHFA to others, their preparedness to engage in MHFA behaviors (13 items), and their frequency of performing a set of MHFA behaviors (7 items). Descriptive statistics, bivariate analysis, and ANOVA were used to describe the sample and compare these variables across groups.

Results:

The analysis was based on 96 responses (42.3%). Almost all respondents (96%) had recommended MHFA training to others. Respondents reported that the training program prepared them to provide a range of MHFA behaviors for multiple mental health conditions, particularly for depression and anxiety. Participants most often reported asking about a distressed mood and listening non-judgmentally. Almost half of participants had asked someone if they were considering suicide and a similar percent had referred someone considering suicide to resources. Those reporting the highest levels of preparedness engaged in significantly more MHFA behaviors than those with lower levels of preparedness (p=0.017). Preparedness and use of MHFA behaviors were not significantly associated with respondent demographic characteristics.

Conclusion:

These data suggest that pharmacy professionals who had MHFA training felt prepared to engage in MHFA and many used behaviors like asking about suicide and making referrals since being trained in MHFA. Research is warranted to better understand what makes someone feel maximally prepared to use MHFA behaviors compared to lower feelings of preparedness.