Quality of helping behaviours of members of the public towards a person with a mental illness: a descriptive analysis of data from an Australian national survey

Redevelopment of mental health first aid guidelines for substance use problems: a Delphi study

BACKGROUND

Substance use problems have a major impact on the physical and mental health of individuals, families and communities. Early intervention may have a positive effect on recovery and treatment outcomes for those with substance use problems, reducing related risk and harm. Separate mental health first aid guidelines on how a member of the public could assist someone experiencing or developing alcohol use and drug use problems in high income Western countries were developed using Delphi expert consensus in 2009 and 2011, respectively. This study aimed to synthesise and update these two original guidelines to reflect current evidence and best practice.

METHODS

The Delphi expert consensus method was used to determine the inclusion of statements in the redeveloped guidelines. A questionnaire was developed using previously endorsed helping statements from the original guidelines on alcohol and drug use problems, as well as relevant content identified in systematic searches of academic and grey literature. Three panels of experts (people with lived experience, support people and professionals) rated statements over three consecutive online survey rounds to determine the importance of their inclusion in the guidelines. Statements endorsed by at least 80% of each panel were included.

RESULTS

103 panellists completed all three survey rounds. They rated 469 statements and endorsed 300 of these for inclusion in the redeveloped guidelines.

CONCLUSIONS

This study has developed a broader and more comprehensive set of guidelines for how to support a person experiencing or developing a substance use problem. The redeveloped guidelines provide more detail on knowledge about and recognition of substance use problems, approaching and assisting people who want to change or are not ready to change, harm reduction, community-based supports and professional help, but have less on physical first aid actions. Mental Health First Aid International will use these guidelines in future updates of their training courses.

Helping intentions toward suicidal people among young adults: Patterns, transitions, and influencing factors

BACKGROUND

Public involvement is an essential element of effective suicide prevention. However, few studies have investigated laypeople's intentions and behaviors in supporting suicidal people, especially within Chinese contexts. This study was conducted among young adults in Hong Kong to identify categories of helping intentions toward suicidal people, and to understand whether, and why, youth transitioned over time between helping intention categories.

METHODS

A total of 807 Hong Kong young adults (18-35 years) participated in this two-wave study across 2018 (W1) and 2019 (W2). Latent class analyses were conducted to identify categories of helping intentions toward suicidal people. A latent transition analysis was applied to explore the stability of the categories over time, and the factors that influenced stability.

RESULTS

Three categories were identified in both waves: 1) dedicated helpers (W1: 28.38 %, W2: 28.50 %), 2) willing helpers (W1: 30.24 %, W2: 33.83 %), and 3) inconsistent helpers (W1: 41.39 %, W2: 37.67 %). 73.48 % of the young adults stayed in the same category across two years. Gender, and attitudes toward suicide victims were related to category membership and transitions between categories.

LIMITATIONS

Measurement of helping intentions may not be thorough. Further studies are required to examine whether the findings can be generalized to the other population.

CONCLUSIONS

Effective community engagement is essential for suicide prevention. Young adults in Hong Kong exhibited different helping intentions toward suicidal people, that were moderately stable over a two-year period. Understanding how and why young adults behave differently toward suicidal people is important when planning effective suicide prevention programs.

Utilization of the mental health first aid ALGEE action plan: a longitudinal study

Purpose

Mental health training programs exist to assist the public with aiding people experiencing mental distress. This study aims to examine the five steps of the Mental Health First Aid (MHFA) ALGEE action plan to assess which steps were used most frequently and how personal characteristics were associated with utilization.

Design/methodology/approach

Individuals completing MHFA either at public schools with students ranging in age from 5 to 18 or at a university in the Northern central area of the USA were invited to participate. Prior to MHFA, participants completed an initial questionnaire, which included demographic questions and questions assessing the use of the MHFA ALGEE action plan, which is a plan to provide help to someone experiencing mental distress. Follow-up questionnaires were completed every quarter to assess the ALGEE action plan utilization at three-, six- and nine-months after completion of MHFA. A comparison group of individuals, not completing MHFA, was also included.

Findings

After completing MHFA, individuals demonstrated an increase in using the ALGEE action plan at three- and six-months, but by nine-months there was a reduction in utilization. In general, age, gender and race did not usually influence the usage of the ALGEE action plan.

Originality/value

Although other studies have measured the efficacy of MHFA, those studies have focused on participant predicted behaviors. The present study measured self-reported behavior and compared the behaviors to a comparison group over time.

Intentions and confidence as predictors of mental health first aid: Findings from a longitudinal study

BACKGROUND

Mental health first aid (MHFA) training can improve confidence and intention to help a person with a mental health problem, but there is limited research exploring whether this results in better support provided. This study aims to evaluate the relationship between a person's confidence and intention to help with the quality of support provided.

METHODS

Australian public servants who had received MHFA training or Physical First Aid training (n = 152) completed questionnaires exploring attitudes and skills for assisting someone at work with a mental health problem. Data on confidence and intention to help was used to predict quality of support provided at 1 and 2-year follow-up. Data were analysed using linear and logistic regression.

RESULTS

Intention to help predicted the quality of support for assisting someone at work at follow-up (rs=0.15-0.20, p < .0.05), while confidence in providing help only predicted quality of support 1-year later (rs = 0.42, p = .032). These relationships were significantly attenuated after controlling for personal stigma, desire for social distance, gender, age, language spoken at home, level of education and whether participant managed staff. Furthermore, there were some large associations between intentions to perform specific first aid actions and carrying out the same action at follow-up such as for encouraging professional help at 2-year follow-up (OR=8.20, p < 0.05).

CONCLUSION

Findings indicate that intended actions to support a person with a mental health problem can predict the quality of support provided up to 2 years later. Future research should clarify whether this support benefits the mental health of recipients.

Redevelopment of mental health first aid guidelines for supporting someone experiencing a panic attack: a Delphi study

Background

Panic attacks and panic disorder can have a major impact on the mental health and wellbeing of those who experience them. People with recurrent panic attacks have increased odds of developing a mental disorder and of worsening the course of existing mental disorders. Early intervention efforts at the time that a panic attack occurs might reduce or prevent some of these associated negative outcomes. Expert consensus guidelines for high income Western countries on how to provide mental health first aid for panic attacks were published in 2009. The present study aims to redevelop these guidelines to ensure content reflects current evidence and best practice.

Methods

The Delphi consensus method was used to determine which helping strategies should be included in the redeveloped guidelines. A survey with items on how to assist someone who is having a panic attack was developed using the 2009 guidelines and a systematic search of grey and academic literature. Panellists with lived experience and professional experience rated these items to determine which helping statements should be included in the guidelines.

Results

Thirty panellists completed all three surveys. Panellists rated 158 statements, with 83 statements meeting the criteria for inclusion in the redeveloped guidelines. The endorsed statements covered: what the first aider should know about panic attacks, what they should do if they think someone is having a panic attack, what they should do if they are uncertain whether the person is having a panic attack, what they should say and do if they know the person is having a panic attack and what they should do when the panic attack has ended.

Conclusion

This study has resulted in a more comprehensive set of guidelines than the original version, with the endorsement of 83 helping actions, compared to 27 previously. The redeveloped guidelines provide greater detail on recognising the signs of a panic attack, providing initial assistance, communicating with someone experiencing a panic attack and supporting them to seek appropriate professional help if it is needed. The guidelines will be used in future updates of Mental Health First Aid training courses.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40359-022-00843-3.

Cultural adaptation of the mental health first aid guidelines for Brazilians with problem drinking: a Delphi expert consensus study

BACKGROUND

Harmful use of alcohol is highly prevalent around the world and results in a large disease burden. Most people who meet the criteria for an alcohol use disorder do not receive treatment. Those in a person's social network can be useful in recognizing a problem and encouraging the person to seek treatment. However, many people lack the knowledge and skills to do this effectively. This study reports on the cultural adaptation for Brazil of the 2009 English-language mental health first aid guidelines for helping someone with problem drinking.

METHODS

A Delphi expert consensus study with two expert panels, one comprising health professionals with experience in the treatment of problem drinking and the other comprising people with lived experience was conducted. Participants rated the importance of actions to be taken to help a person with problem drinking.

RESULTS

Over two rounds, 60 participants (30 professionals and 30 people with lived experience) rated 197 items. A total of 166 items were included in the final guidelines.

CONCLUSIONS

While there were many similarities with the English-language guidelines for high-income countries, the guidelines also incorporate actions of importance for Brazil, including compulsory treatment and different approaches to dealing with people with problem drinking. Further research is necessary to assess their impact.

Uncovering Blind Spots in the Intention to Provide Adequate Help to Suicidal Individuals

Background: An adequate reaction from families, friends, and colleagues who can provide help to suicidal individuals is a preventive factor. Despite the logical assumption that the mere presence of risk factors in individuals needing help may affect others' helping intentions, empirical evidence is lacking in this regard. Method: We tested whether the presence of various risk factors influences the intention to provide help to suicidal individuals. Individuals (N = 890) were exposed to a vignette in which they were asked to imagine meeting a distant acquaintance. Such persons talk about serious problems and suddenly use the word "suicide." In a one-factorial between-subjects design with 21 groups, we manipulated person-related attributes corresponding to risk factors for suicide. Results: Some attributes increased helping intentions: male gender, very young and old age, homosexuality and transsexuality, terminal illness, previous nonsuicidal self-injury, previous suicide attempt, and seeking out lethal means. However, some attributes did not: female gender, major depression, chronic pain, different stressful life events, previously experienced violence, a family history of suicide, and a cry for help. Limitations: We measured self-reported behavioral intentions. Conclusions: Although people seem to adapt their helping intentions in response to some attributes, there seem to be many blind spots.

Longer-term effectiveness of eLearning and blended delivery of Mental Health First Aid training in the workplace: 2-Year follow-up of a randomised controlled trial

INTRODUCTION

Evidence relating to long-term outcomes of online education programs is largely lacking and head-to-head comparisons of different delivery formats are very rare. The aims of the study were to test whether eLearning Mental Health First Aid (MHFA) or blended training (eLearning plus face-to-face course delivery), implemented in an Australian public sector workplace, were more effective than a control intervention at 1-year and 2-year follow-up, and whether blended MHFA training was more effective than eLearning alone.

MATERIAL AND METHODS

Australian public servants (n = 608 at baseline) were randomly assigned to complete an eLearning MHFA course, a blended MHFA course or Red Cross eLearning Provide First Aid (PFA) (the control) and completed online questionnaires pre- and post-training and one and two years later (n = 289, n = 272, n = 243 at post, 1- and 2-year follow-up respectively). The questionnaires were based on vignettes describing a person with depression or post-traumatic stress disorder (PTSD). Primary outcomes were mental health first aid knowledge, desire for social distance and quality of support provided to a person in the workplace. Secondary outcomes were recognition of mental health problems, beliefs about treatment, helping intentions and confidence, personal stigma, quality of support provided to a person outside the workplace, self-reported professional help seeking and psychological distress.

RESULTS

At 1-year follow-up, both eLearning and blended courses produced greater improvements than PFA training in knowledge, confidence and intentions to help a person with depression or PTSD, beliefs about dangerousness and desire for social distance. At 2-year follow-up, some of these improvements were maintained, particularly those relating to knowledge and intentions to help someone with PTSD. When eLearning and blended courses were compared at 1-year follow-up, the blended course led to greater improvements in knowledge and in confidence and intentions to help a person with depression. At 2-year follow-up, improvements in the quality of help provided to a person with a mental health problem outside the workplace were greater in participants in the blended course.

CONCLUSIONS

Both blended and eLearning MHFA courses led to significant longer-term improvements in knowledge, attitudes and intentions to help a person with a mental health problem. Blended MHFA training led to an improvement in the quality of helping behaviours and appears to be more effective than online training alone.Trial registrationACTRN12614000623695 registered on 13/06/2014 (prospectively registered).Trial registry record url: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366410&isReview=true.

Effects of the Mental Health First Aid for the suicidal person course on beliefs about suicide, stigmatising attitudes, confidence to help, and intended and actual helping actions: an evaluation

BACKGROUND

Suicide is a significant concern in Australia and globally. There is a strong argument for training community gatekeepers in how to recognise and support suicidal people in their social network. One such training course is the Mental Health First Aid for the Suicidal Person course. This course was developed using suicide prevention best practice guidelines based on expert opinion (determined using the Delphi Method).

METHODS

We evaluated the impact of attending the Mental Health First Aid for the Suicidal Person course on suicide literacy and stigma, confidence in and quality of intended and actual helping behaviours towards a person who is suicidal, and course satisfaction. Surveys were administered before and immediately after the course, and at 6-month follow-up. Data were analysed to yield descriptive statistics (percentages, means, standard deviations), with linear mixed models and generalized linear mixed models being used to test the statistical significance of changes over occasions of measurement.

RESULTS

We recruited 284 participants from workplaces and general community networks. The mean age was 41 years and 74% were female. 85% of people undertook the course as part of professional development, and almost half (44%) did the course because they had contact with a suicidal person. The majority (59%) of participants had previous mental health and suicide prevention training. The majority of participants held knowledge (suicide literacy) before undertaking the course. The major effect of training was to strengthen this knowledge. There was a significant improvement from pre-course (M = 1.79, SD 0.56) to post-course (M = 1.48, SD 0.82, p < 0.0001), which was maintained at follow-up (M = 1.51, SD 0.49, p < 0.0001). Confidence in gatekeeper skills significantly improved after the course and at follow-up (M = 3.15, SD 0.95 before the course to M = 4.02, SD 0.68 afterward and 3.87, SD 0.77 at follow-up, p < 0.0001 and p < 0.0001, respectively). The quality of intended helping behaviours significantly improved from pre-course (intended actions M = 4.28, SD 0.58) and to post-course (M = 4.70, SD 0.50, p < 0.0001) and were maintained at follow-up (M = 4.64, SD 0.41, p < 0.0001). There was significant improvement in some of the actions taken by participants to help a suicidal person from pre-course to post-course (e.g. asking about suicidal thoughts and plan, contacting emergency services). The course was highly acceptable to participants.

CONCLUSION

These results indicate that this course is an acceptable intervention that delivers a broad spectrum of beneficial outcomes to community and workplace gatekeepers.

Offering mental health first aid to a person experiencing psychosis: a Delphi study to redevelop the guidelines published in 2008

Background

Psychotic illnesses can have a major impact on those who experience them. Timely treatment for psychosis is important and friends, family members and the public can be a facilitating factor in social support and professional help-seeking. Expert consensus guidelines on how to provide mental health first aid to a person experiencing psychosis were developed in 2008. This Delphi study aimed to redevelop the guidelines to reflect current evidence.

Methods

The Delphi consensus method was used to determine which helping strategies should be included in the redeveloped guidelines. A systematic search of grey and academic literature was undertaken to identify strategies on how a member of the public can assist someone experiencing psychosis. These strategies were organised into questionnaire statements. Two expert panels—one comprising people with lived experience (Carers and Consumers) and one of professionals—completed three consecutive rounds of online survey questionnaires to rate the importance of each helping statement for inclusion in the guidelines. Statements were included in the guidelines if they were endorsed by at least 80% of each panel.

Results

The expert panels rated 515 statements across three rounds of surveys, with 325 statements meeting the criteria for inclusion in the redeveloped guidelines. 59 panel participants completed all three surveys.

Conclusions

The redeveloped guidelines outline a general set of strategies for providing initial assistance to a person who is experiencing psychosis. Compared to the original guidelines, these redeveloped guidelines provide more detailed instruction for members of the public on how to provide mental health first aid to assist a person experiencing psychosis. The guidelines are available to the public and will be used to update the Mental Health First Aid courses.

Offering mental health first aid to a person after a potentially traumatic event: a Delphi study to redevelop the 2008 guidelines

BACKGROUND

Trauma has a major impact on the mental health and wellbeing of people globally. Friends, family and members of the public are often well positioned to provide initial assistance if someone is experiencing extreme distress following a potentially traumatic event. Expert consensus guidelines for high income, Western countries on how to do this were published in 2008. The aim of the current study was to re-develop these guidelines to ensure they are current and reflect best practice.

METHODS

The Delphi consensus method was used to determine which helping statements should be included in the guidelines. Helping statements were derived from a systematic search of literature that considered how a member of the public could help someone experiencing extreme distress following a potentially traumatic event. Two expert panels, comprising 28 mental health professionals with expertise in managing trauma and 26 consumer advocates, rated each statement. Statements were accepted for inclusion in the guidelines if they were endorsed by at least 80% of each panel.

RESULTS

Out of 183 statements, 103 were endorsed as appropriate helping actions in providing assistance to someone experiencing extreme distress following a potentially traumatic event. These statements were used to form the re-developed guidelines.

CONCLUSION

This study has resulted in a more comprehensive set of guidelines than the original version, with the endorsement of 103 helping actions, compared to 65 previously. The updated guidelines better represent the complexities of experiencing trauma and the considered approach required when providing first aid after a potentially traumatic event. The additional guidance on providing initial assistance, talking about the trauma, offering short-term assistance and seeking appropriate professional help reflects current knowledge. A notable addition is the inclusion of content on how a first aider can assist after a disclosure of abuse. The guidelines are available to the public and will inform future updates of Mental Health First Aid training courses.

Long-term effects of Youth Mental Health First Aid training: randomized controlled trial with 3-year follow-up

BACKGROUND

Mental Health First Aid (MHFA) training teaches community members how to provide initial support to someone with a mental health problem. Key gaps in the evidence base supporting the training are the longevity of effects beyond 6 months, effects on mental health first aid behavior, and the impact of support on the recipient of aid. This study aimed to evaluate the effect of the Youth MHFA course 3 years after training.

METHODS

384 Australian parents of an adolescent aged 12-15 were randomized to receive either the 14-h Youth MHFA course or the 15-h Australian Red Cross Provide First Aid course. This paper reports outcomes at baseline and 3 years later. Primary outcomes were cases of adolescent mental health problems, and parental support towards their adolescent if they developed a mental health problem, rated by the parent and adolescent. Secondary outcomes included parent knowledge about youth mental health problems, intentions and confidence in supporting a young person, stigmatizing attitudes, and help-seeking for mental health problems. Data were analyzed with mixed-effects models with group by measurement occasion interactions.

RESULTS

3-year follow-up data was obtained from 149 parents and 118 adolescents, who were aged 16.5 years on average. Between baseline and 3-year follow-up, there was a non-significant reduction in adolescent cases of mental health problems relative to the control group (odds ratios (OR) 0.16-0.17), a non-significant improvement in parental support reported by adolescents with a mental health problem (OR 2.80-4.31), and a non-significant improvement in the quality of support that parents reported providing to their adolescents with a mental health problem (d = 0.38). Secondary outcomes that showed significant improvements relative to the control group were parental knowledge about youth mental health problems (d = 0.31) and adolescent perceptions of general social support from their parents (d = 0.35).

CONCLUSIONS

This paper reports on the longest follow-up of Mental Health First Aid training in a controlled trial. Three years after training, participants had maintained their improved knowledge about mental health problems. There were some indications of other positive effects, but the study was underpowered to clearly show benefits to mental health first aid skills and recipients of aid.

TRIAL REGISTRATION

ACTRN 12612000390886 , registered retrospectively 5/4/2012, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=347502.

What responses do people at risk of suicide find most helpful and unhelpful from professionals and non-professionals?

BACKGROUND

People at risk of suicide frequently communicate suicidal thoughts to professionals and non-professionals. These groups, therefore, need to be aware of how best to respond.

AIMS

We aimed to identify helpful and unhelpful responses to communications of suicide risk from the perspective of those at risk to inform suicide prevention messaging and education.

METHOD

We conducted an online survey (n = 141) of members of an online reference group for an Australian mental health organisation with a history of suicide risk.

RESULTS

Most respondents had repeatedly considered and attempted suicide. Indirect suicide communications were more common than direct communications. Listening without judgement was the most common helpful response and "minimizing" responses to suicidal thoughts and feelings, the most common unhelpful responses.

CONCLUSION

We make recommendations for suicide prevention messages and professional education content based on these findings.

Confidence and Intentions to Help a Person at Risk of Suicide

OBJECTIVE

We aimed to identify Australian adults' current level of confidence and intentions to help a person close to them in distress or at risk of suicide to inform the content and targeting of suicide prevention messages aimed at family and friends of those at risk.

METHODS

We conducted a nationally representative computer-assisted telephone survey of confidence and intentions to help someone in distress or at risk of suicide (n = 3,002). We used logistic regression to determine whether sociodemographic and exposure variables predicted confidence and intentions to help.

RESULTS

Confidence to help was high. About half of the respondents had intentions inconsistent with best practice. Listening and talking, and encouraging the person to seek professional help were the most common types of intended helping actions. Intentions to ask suicide risk assessment questions were least common. Men were more likely than women to have intentions to carry out nonrecommended actions, and less likely to have intentions to carry out recommended actions.

CONCLUSIONS

Suicide prevention messaging aimed at family and friends could encourage them to ask direct questions about suicide risk and could include messages about "what not to do." Suicide prevention messages aimed specifically at men are indicated.

The Portrayal of Suicidal Behavior in Police Television Series

Fictional suicidal behavior can affect the public as a risk or a protective factor, and it may reflect how suicide is perceived in a society. However, surprisingly little is known of how suicidal behavior is portrayed in television series. The aim of this study was to investigate the characteristics of televised fatal and non-fatal suicidal behavior, preventative interventions, and the portrayal of people bereaved by suicide. All episodes (N = 475) of four Belgian police series were screened against inclusion and exclusion criteria, and 87 episodes with a total of 54 suicides, 13 attempted suicides, 13 suicide threats, and 20 characters bereaved by suicide were included in a quantitative and qualitative analysis. Televised suicidal behavior was primarily motivated by external motives, such as social/relational issues or the death of a significant other, and to a lesser extent, by internal motives, such as mental or physical health related issues. Interventions were likely to prevent suicide. People bereaved by suicide were mostly portrayed as individuals seeking justice. Shame, revenge, and escape were the major qualitative themes associated with suicidal behavior. Two prototypes emerged: a ruthless, "psychopath" type criminal, who kills him/herself before being arrested, and a suicidal individual struggling with devastating life events. The study provided unique insights in how suicidal behavior is televised in Belgian police series. Though some characteristics were portrayed adequately, mental health related issues were overlooked, spectacular suicide methods were overrepresented, and the bereaved characters were mostly unidimensional revengers. Strategies for improving the accuracy of televised suicidal behavior should be studied.

Helping actions given and received in response to suicide risk: Findings from an Australian nationally representative telephone survey

We conducted a nationally representative telephone survey of 3000 Australian adults. We assessed helping responses toward people in severe distress and experiencing suicidal thoughts by asking whether respondents had undertaken 15 specified helping actions (10 recommended and 5 non-recommended actions) to support such a person. We also asked respondents who had experienced suicidal ideation in the last 12 months whether the most helpful person at that time had undertaken the 15 specified helping actions. We weighted the data to represent the Australian adult population, calculated percentage frequencies for the helping actions and used logistic regression to analyse whether sociodemographic and exposure variables related to helping actions taken. Recommended supportive actions consistent with best practice were most commonly undertaken (e.g., listened to their problems without judgement: 96.5%, 95% CI 94.6–97.7); however, some non-recommended actions (e.g., reminded the person what they have they going for them: 91.6%, 95% CI 89.1–93.5) were also very common. Suicide risk assessment actions such as asking if they had a plan for suicide (39.8%; 95% CI 35.0–44.9), and encouraging professional help (e.g., helped make an appointment with a health professional: 61.3%, 95% CI 57.4–65.2) were relatively uncommon. Age, gender, level of education, language spoken at home, own suicidal ideation and suicide prevention training were shown to affect the odds of carrying out various helping actions. Australian adults need to be educated to ask direct questions about suicide risk and to encourage others in distress to seek professional help. There may also be a place for discouraging certain behaviours that oppose best practice in suicide prevention. While most previous studies have assessed intentions to help a person at risk of suicide, this study makes a unique contribution to the literature by assessing ‘real-world’ helping behaviour, including the occurrence of helping actions undertaken that oppose best practice in suicide prevention.

•

Surveys a nationally representative sample of Australian adults (n = 3000).

•

Identifies helping actions from non-professionals toward people at risk of suicide.

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Finds that actions opposing suicide prevention best practice are common.

•

Finds that asking questions to assess suicide risk is uncommon.

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Actions taken predicted by sociodemographics, suicidal ideation and training.

Offering mental health first aid to a person with depression: a Delphi study to re-develop the guidelines published in 2008

BACKGROUND

Depressive disorder is ranked as the largest contributor to non-fatal health burden. However, with prompt treatment, outcomes can improve. Family and friends are well placed to recognise the signs of depression and encourage early help seeking. Guidelines about how members of the public can provide mental health first aid to someone who is experiencing depression were developed in 2008. A Delphi study was conducted to re-develop these guidelines to ensure they are current and reflect best practice.

METHODS

A survey was developed using the 2008 depression mental health first aid guidelines and a systematic search of grey and academic literature. The questionnaire contained items about providing mental health first aid to a person with depression. These items were rated by two international expert panels - a lived experience panel (consumers and carers) and a professional panel.

RESULTS

Three hundred and fifty-two items were rated by 53 experts (36 with lived experience and 17 professionals) according to whether they should be included in the revised guidelines. There were 183 items that met the criteria to be included in the updated guidelines.

CONCLUSIONS

This re-development has added detail to the previous version of the guidelines, giving more guidance on the role of the first aider and allowing for a more nuanced approach to providing first aid to someone with depression. These guidelines are available to the public and will be used to update the Mental Health First Aid courses.

Quality of assistance provided by members of the Australian public to a person at risk of suicide: associations with training experiences and sociodemographic factors in a national survey

BACKGROUND

Members of the public can potentially take action to assist someone in their social network who is distressed and at risk of suicide. The present study used data from a community survey to examine training experiences and sociodemographic factors associated with the quality of assistance provided in such situations.

METHODS

A national telephone survey using random digit dialing was carried out with Australian adults on attitudes and intentions toward helping someone in severe distress or at risk of suicide, as well as actions taken. Participants were asked open-ended questions about their intentions to assist a hypothetical person in a vignette and about any actions they took to assist a family member or friend in distress over the previous 12 months. Each participant randomly received 1 of 6 vignettes which varied by gender and degree of suicidality portrayed. 3002 participants provided data on intentions and 932 on actions taken. Quality of Intentions and Quality of Actions were scored on 12-point scales.

RESULTS

Quality of Intentions and Quality of Actions correlated 0.28. Quality of Intentions was associated with more overt suicidality in the vignette, age 31-59 years, female gender, university education, speaking English at home, being non-Indigenous and all forms of suicide training (professional, Mental Health First Aid and other). Quality of Actions was associated with female gender, university education and other suicide training.

CONCLUSIONS

Training on suicide prevention is associated with better quality of intentions and actions to help a person at risk of suicide. There are sub-groups in the population who are in greater need of such training because they have poorer quality of intentions to help and are less likely to have received training. These include males, less educated people and people from non-English speaking backgrounds.

Guidelines for the public on how to provide mental health first aid: narrative review

BACKGROUND

Expert-consensus guidelines have been developed for how members of the public should assist a person with a mental health problem or in a mental health crisis.

AIMS

This review aimed to examine the range of guidelines that have been developed and how these have been implemented in practice.

METHOD

A narrative review was carried out based on a systematic search for literature on the development or implementation of the guidelines.

RESULTS

The Delphi method has been used to develop a wide range of guidelines for English-speaking countries, Asian countries and a number of other cultural groups. The primary implementation has been through informing the content of training courses.

CONCLUSION

Further work is needed on guidelines for low- and middle-income countries.

DECLARATION OF INTEREST

A.F.J. is an unpaid member of the Board of Mental Health First Aid International (trading as Mental Health First Aid Australia), which is a not-for-profit organisation.

Depression literacy and help-seeking in Australian police

OBJECTIVE

To assess depression literacy, help-seeking and help-offering to others in members of the police force in the state of Victoria, Australia.

METHODS

All staff in police stations involved in a cluster randomised controlled trial of an integrated workplace mental health intervention were invited to participate. Survey questions covered sociodemographic and employment information, recognition of depression in a vignette, stigma, treatment beliefs, willingness to assist co-workers with mental health problems, help-giving and help-seeking behaviours, and intentions to seek help. Using the baseline dataset associated with the trial, the paper presents a descriptive analysis of mental health literacy and helping behaviours, comparing police station leaders and lower ranks.

RESULTS

Respondents were 806 staff, comprising 618 lower-ranked staff and 188 leaders. Almost 84% of respondents were able to correctly label the problem described in the vignette. Among those who had helped someone with a mental health problem, both lower ranks and leaders most commonly reported 'talking to the person' although leaders were more likely to facilitate professional help. Leaders' willingness to assist the person and confidence in doing so was very high, and over 80% of leaders appropriately rated police psychologists, general practitioners, psychologists, talking to a peer and contacting welfare as helpful. However, among both leaders and lower ranks with mental health problems, the proportion of those unlikely to seek professional help was greater than those who were likely to seek it.

CONCLUSION

Knowledge about evidence-based interventions for depression was lower in this police sample than surveys in the general population, pointing to the need for education and training to improve mental health literacy. Such education should also aim to overcome barriers to professional help-seeking. Interventions that aim to improve mental health literacy and help-seeking behaviour appear to be suitable targets for better protecting police member mental health.

Effectiveness of eLearning and blended modes of delivery of Mental Health First Aid training in the workplace: randomised controlled trial

BACKGROUND

The aim of the WorkplaceAid study was to compare the effects of eLearning or blended (eLearning plus face-to-face course delivery) Mental Health First Aid (MHFA) courses on public servants' knowledge, stigmatising attitudes, confidence in providing support and intentions to provide support to a person with depression or post-traumatic stress disorder (PTSD).

METHODS

A randomized controlled trial was carried out with 608 Australian public servants. Participants were randomly assigned to complete an eLearning MHFA course, a blended MHFA course or Red Cross eLearning Provide First Aid (PFA) (the control). The effects of the interventions were evaluated using online questionnaires pre- and post-training. The questionnaires centred around vignettes describing a person meeting the criteria for depression or PTSD. Primary outcomes were mental health first aid knowledge and desire for social distance. Secondary outcomes were recognition of mental health problems, beliefs about treatment, helping intentions and confidence and personal stigma. Feedback on the usefulness of the courses was also collected.

RESULTS

Both the eLearning MHFA and blended MHFA courses had positive effects compared to PFA eLearning on mental health first aid knowledge, desire for social distance, beliefs about professional treatments, intentions and confidence in helping a person and personal stigma towards a person with depression or PTSD. There were very small non-significant differences between the eLearning MHFA and blended MHFA courses on these outcome measures. However, users were more likely to highly rate the blended MHFA course in terms of usefulness, amount learned and intentions to recommend the course to others.

CONCLUSIONS

The blended MHFA course was only minimally more effective than eLearning MHFA in improving knowledge and attitudes. However, course satisfaction ratings were higher from participants in the blended MHFA course, potentially leading to greater benefits in the future. Longer-term follow-up is needed to explore this.

TRIAL REGISTRATION

ACTRN12614000623695 registered on 13/06/2015 (prospectively registered).

Suicide literacy predicts the provision of more appropriate support to people experiencing psychological distress

Mental health literacy has been hailed as a public health priority to reduce stigma and increase help seeking. We examined the effect of suicide literacy on the type of help provided to those experiencing suicidal ideation. A community sample of 363 Australians were randomly assigned to read one of three messages from a member of their social network (the target). The target reported symptoms consistent with either (1) subclinical distress, (2) clinical depression, or (3) suicidal ideation. Participants were most likely to recommend social support and least likely to recommend professional help. Suicide literacy interacted with the target's presentation, such that participants with higher suicide literacy who considered a suicidal target were less likely to recommend self-help or no action, and more likely to recommend professional help. Suicide literacy was also associated with lower suicide stigma, and unexpectedly, this indirectly predicted more reluctance to recommend professional help. Overall, results indicated that the relationship between mental health literacy, stigma, and provision of help is not straightforward. While suicide literacy was associated with greater sensitivity to a person's risk of suicide, it also predicted fewer recommendations for professional help overall, partly due to the stigma associated with seeking professional help.

Systematic review and meta-analysis of Mental Health First Aid training: Effects on knowledge, stigma, and helping behaviour

OBJECTIVE

To provide an up-to-date assessment of the effectiveness of the Mental Health First Aid (MHFA) training program on improving mental health knowledge, stigma and helping behaviour.

DESIGN

Systematic review and meta-analysis.

METHODS

A systematic search of electronic databases was conducted in October 2017 to identify randomised controlled trials or controlled trials of the MHFA program. Eligible trials were in adults, used any comparison condition, and assessed one or more of the following outcomes: mental health first aid knowledge; recognition of mental disorders; treatment knowledge; stigma and social distance; confidence in or intentions to provide mental health first aid; provision of mental health first aid; mental health of trainees or recipients of mental health first aid. Risk of bias was assessed and effect sizes (Cohen's d) were pooled using a random effects model. Separate meta-analyses examined effects at post-training, up to 6 months post-training, and greater than 6 months post-training.

RESULTS

A total of 18 trials (5936 participants) were included. Overall, effects were generally small-to-moderate post-training and up to 6 months later, with effects up to 12-months later unclear. MHFA training led to improved mental health first aid knowledge (ds 0.31-0.72), recognition of mental disorders (ds 0.22-0.52) and beliefs about effective treatments (ds 0.19-0.45). There were also small reductions in stigma (ds 0.08-0.14). Improvements were also observed in confidence in helping a person with a mental health problem (ds 0.21-0.58) and intentions to provide first aid (ds 0.26-0.75). There were small improvements in the amount of help provided to a person with a mental health problem at follow-up (d = 0.23) but changes in the quality of behaviours offered were unclear.

CONCLUSION

This review supports the effectiveness of MHFA training in improving mental health literacy and appropriate support for those with mental health problems up to 6 months after training.

TRIAL REGISTRATION

PROSPERO (CRD42017060596).

Associations of training to assist a suicidal person with subsequent quality of support: results from a national survey of the Australian public

BACKGROUND

When a person is in severe distress, people in their social network can potentially take action to reduce the person's suicide risk. The present study used data from a community survey to examine whether people who had received training in how to assist a person at risk of suicide had higher quality intentions and actions to provide support.

METHODS

A national telephone survey was carried out with 3002 Australian adults on attitudes and intentions toward helping someone in severe distress or at risk of suicide as well as actions taken. Participants were asked about their intentions to assist a hypothetical person in a vignette and about any actions they took to assist a family member or friend in distress over the previous 12 months. Participants were also asked whether they had received professional training, Mental Health First Aid training or other training in how to assist a person at risk of suicide.

RESULTS

Responses covered ten intentions/actions that were recommended in guidelines for the public on how to support a suicidal person and 5 that were recommended against in the guidelines. Scales were created to measure positive and negative intentions to act and positive and negative actions taken. All three types of training were associated with greater positive intentions and actions, and with lesser negative intentions. These associations were largely due to a greater willingness of those trained to talk openly about suicide with a person in distress.

CONCLUSIONS

Training in how to support a person at risk of suicide is associated with better quality of support. Such training merits wider dissemination in the community.

A pilot randomised controlled study of the mental health first aid eLearning course with UK medical students

BACKGROUND

Medical students face many barriers to seeking out professional help for their mental health, including stigma relating to mental illness, and often prefer to seek support and advice from fellow students. Improving medical students' mental health literacy and abilities to support someone experiencing a mental health problem could reduce barriers to help seeking and improve mental health in this population. Mental Health First Aid (MHFA) is an evidence-based intervention designed to improve mental health literacy and ability to respond to someone with a mental health problem. This pilot randomised controlled trial aims to evaluate the MHFA eLearning course in UK medical students.

METHODS

Fifty-five medical students were randomised to receive six weeks access to the MHFA eLearning course (n = 27) or to a no-access control group (n = 28). Both groups completed baseline (pre-randomisation) and follow-up (six weeks post-randomisation) online questionnaires measuring recognition of a mental health problem, mental health first aid intentions, confidence to help a friend experiencing a mental health problem, and stigmatising attitudes. Course feedback was gathered at follow-up.

RESULTS

More participants were lost follow-up in the MHFA group (51.9%) compared to control (21.4%). Both intention-to-treat (ITT) and non-ITT analyses showed that the MHFA intervention improved mental health first aid intentions (p = <.001) and decreased stigmatising attitudes towards people with mental health problems (p = .04). While ITT analysis found no significant Group x Time interaction for confidence to help a friend, the non-ITT analysis did show the intervention improved confidence to help a friend with mental health problems (p = <.001), and improved mental health knowledge (p = .003). Medical students in the intervention group reported a greater number of actual mental health first aid actions at follow-up (p = .006). Feedback about the MHFA course was generally positive, with participants stating it helped improve their knowledge and confidence to help someone.

CONCLUSION

This pilot study demonstrated the potential for the MHFA eLearning course to improve UK medical students' mental health first aid skills, confidence to help a friend and stigmatising attitudes. It could be useful in supporting their own and others' mental health while studying and in their future healthcare careers.

TRIAL REGISTRATION

Retrospectively registered ( ISRCTN11219848 ).

Self-reported discriminatory and positive behaviours towards people with mental health problems: findings from an Australian national survey

OBJECTIVE

The aim of the study was to explore self-reported avoidance, discrimination, and positive treatment by members of the public towards people with mental health problems.

METHODS

In 2014, telephone interviews were carried out with 5220 Australians aged 18 +. Respondents were asked if they had known an adult with a mental health problem over the previous 12 months. If they had, they were asked further questions about the person's age, gender, relationship to the respondent, and their mental health problem. Respondents were then asked if they had avoided, discriminated against or treated the person more positively and, if so, some details about what happened.

RESULTS

19.9% of respondents reported avoiding someone with a mental health problem, with the most common reasons being difficulty tolerating the person's behaviour and needing time out. However, respondents were more likely to report treating the person with mental health problems more positively (73.0%) than avoiding or discriminating against them (4.7%). The most common positive behaviours were non-specific support and maintaining or increasing contact. Avoidance was less likely from friends and those aged 60 +. Discrimination was more likely from family members and spouses and less likely from respondents aged 60 +. Positive treatment was more likely from people who had experienced a mental health problem.

CONCLUSIONS

This study provides insight into the reasons why people avoid others with mental health problems. The results can provide input into the design of anti-discrimination interventions and further empower people with mental health problems as they advocate for change in the area of discrimination.

Helping intentions of undergraduates towards their depressed peers: a cross-sectional study in Sri Lanka

BACKGROUND

Despite showing high rates of depression, university students prefer to seek assistance for their depression from informal sources, such as their friends, rather than seeking professional assistance. Therefore, the helping behaviours of those who provide informal help to these students need examination. This study examines the helping intentions of undergraduates in Sri Lanka towards their depressed peers and the correlates of their helping intentions.

METHOD

The undergraduates were presented with a vignette of a hypothetical depressed undergraduate. A total of 4442 undergraduates responded to an open-ended question about how the person in the vignette should be helped if this person was someone they knew well. Their responses were coded in reference to established mental health first aid guidelines. Logistic and linear regression models were used to examine the predictors of their helping intentions.

RESULTS

The undergraduates' most common helping intentions were to listen/talk and support their peer. Only around a third considered the need for professional help. The overall quality of their helping intentions was poor, but better among those who recognised the problem as depression and those who had less stigmatising attitudes. There was some evidence that certain helping intentions of the undergraduates which were person-oriented or social network-related were better among females, those in higher years of study and among certain non-medical student groups. Intentions to encourage professional help were better among those who recognised the problem, but poorer among those with personal experiences of this problem and among those who perceived this problem to be a weakness and not a sickness.

CONCLUSIONS

Although the undergraduates may attempt to support their distressed peers, they may not show appropriate helping actions and may not encourage the use of professional assistance. Hence, they need to be educated on how best to respond to their distressed peers. Those with higher levels of stigma and inability to recognise the problem may be at greater risk of showing poorer helping responses towards their distressed peers.

Expanding a measure of mental health literacy: Development and validation of a multicomponent mental health literacy measure

Mental health literacy (MHL) is an important factor in mental health care. However, few measures are available that assess multiple components of MHL and that are applicable to lay community people. A valid, comprehensive measure is needed to adequately identify the level of MHL and need for mental health education. This study presents the development of a multicomponent MHL measure and its psychometric properties. Participants (n=211) were recruited from a local public housing authority in Texas. A series of an exploratory factor analysis, a confirmatory factor analysis, an independent sample t-test, and a correlation analysis were used to assess construct, known-groups, and concurrent validity. Internal consistency reliability was examined by Kuder-Richardson Formula 20. The result suggested a second-order factor model by three first-order factors: knowledge-oriented MHL; beliefs-oriented MHL; resource-oriented MHL. This measure was a valid tool to assess MHL among public housing staff. This measure can be useful in examining lay community members' levels of MHL.

Predictors of adults' helping intentions and behaviours towards a person with a mental illness: A six-month follow-up study

Little is known about the relationship between adults' intentions to assist a hypothetical person experiencing a mental illness and their subsequent first aid actions in reality. This study examines whether the quality of respondents' stated first aid intentions predicts the quality of their helping behaviour towards a person they know in real life. A convenience sample of 820 Australian adults completed two surveys six months apart which asked questions about a hypothetical person experiencing depression with suicidal thoughts, and how they had assisted someone with a similar problem in their lives. The quality of helping intentions at baseline predicted the quality of mental health first aid behaviours at follow-up, as did the quality of past behaviours. In particular, people who intended to assess and assist with the crisis situation in the vignette were five times more likely to perform the same action when helping someone they knew. The quality of past intentions and behaviour, and confidence in helping, were the most significant predictors of behaviour at follow-up. These findings suggest that adults' mental health first aid intentions can be used to predict their subsequent behaviours, therefore, educating communities about effective first aid responses may increase future rates of appropriate help.

An experimental study exploring the impact of vignette gender on the quality of university students' mental health first aid for peers with symptoms of depression

Background

University students have high rates of depression, and friends are often the most commonly-used source of support for emotional distress in this population. This study aimed to explore students’ ability to provide effective support for their peers with depressive symptoms and the factors influencing the quality of their mental health first aid (MHFA) skills, including students’ gender, course of study, and gender of student experiencing depression.

Methods

Via an online survey, students at two British universities (N = 483) were quasi-randomly allocated to view a video vignette of either a male or female student depicting symptoms of depression. An open-ended question probed MHFA actions they would take to help the vignette character, which were rated using a standardised scoring scheme based on MHFA guidelines.

Results

Students reported low MHFA scores (mean 2.89, out of possible 12). The most commonly reported action was provision of support and information, but only eight (1.6 %) students stated an intention to assess risk of harm. Those studying clinically non-relevant degrees with limited mental health content reported poorer MHFA (p = <0.001) and were less confident about their ability to support a friend with depression (p = 0.04). There was no main effect of vignette gender, but within the group of students on non-relevant courses the male vignette received significantly poorer MHFA than the female vignette (p = 0.02). A significant three-way interaction found that male participants studying non-relevant degrees who viewed a male vignette had poorer MHFA compared to females studying non-relevant degrees who viewed the female vignette (p = 0.005).

Conclusions

Most students lack the necessary MHFA skills to support friends suffering from symptoms of depression, or to help them get appropriate support and prevent risk of harm. Students on courses which do not include mental health related content are particularly ill-equipped to support male students, with male students receiving the poorest quality MHFA from fellow male students on these courses. MHFA training has the potential to improve outcomes for students with depression, and could have a valuable role in reducing the excess risk of harm seen in male students.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-2887-2) contains supplementary material, which is available to authorized users.

Resident assistant training program for increasing alcohol, other drug, and mental health first-aid efforts

In college and university residence halls, resident assistants (RAs) are expected to serve as first-aid providers to students who may have alcohol, other drug, mental health, and academic problems. Despite this responsibility, evidence-based, first-aid programs have not been developed and tested for the RA workforce. The current study examined effects of an investigational first-aid program designed specifically for RAs. The online Peer Hero Training program is a novel approach to RA training in its use of interactive video dramatizations of incidents involving substance-using or distressed residents. A 9-month randomized trial conducted on eight US campuses compared RAs who participated in the Peer Hero Training program to RAs who received training-as-usual. Participation in the Peer Hero Training program significantly increased RA first-aid efforts for residential students who may have had alcohol, other drug, mental health, or academic problems 6 months after baseline. Compared with those in the training-as-usual condition, RAs in the Peer Hero Training program made more than 10 times as many first-aid efforts for possible alcohol problems, almost 14 times the number of first-aid efforts for possible drug use, almost 3 times the number of first-aid efforts for possible mental health problems, and 3 times the number of first-aid efforts for academic problems. There was no evidence that measured RA attitudes mediated the effects of the intervention. Results of this preliminary evaluation trial suggest that online training using interactive video dramatizations is a viable approach to strengthening RAs' ability to provide alcohol, other drugs, and mental health first-aid to undergraduates.

Quality and predictors of adolescents' first aid intentions and actions towards a peer with a mental health problem

While peers are a common source of informal help for young people with a mental health problem, evidence suggests that the help they provide is inadequate. By examining predictors of the quality of mental health first aid provided by adolescents to their peers, future interventions can be targeted to adolescents most at risk of providing poor help. Students (n = 518) from Australian secondary schools were presented with two vignettes, depicting persons experiencing depression with suicidal thoughts, and social phobia. Participants were asked what they thought was wrong with the person, and how they would help them. Stigma towards the person was also assessed. Additionally, participants were asked if they had recently helped anyone in their own lives with a mental health problem, and, if so, what they did. The overall quality of help reported in response to the vignettes or an actual person was low; a particular inadequacy was the low rate of engaging the help of an adult. Being female, and believing that the person is sick rather than weak, consistently predicted better help-giving.

Why We Need the Concept of "Mental Health Literacy"

In this issue, Mackert and colleagues argue for the benefits of a general health literacy focus, which can be applied across health domains. Using the concept of mental health literacy as an example, this article argues that there are also major advantages of a domain-specific approach. The concept of mental health literacy has had policy impacts and led to the development of interventions, which might not have otherwise occurred. It has also led to the development of assessments specifically targeted at intervention goals. It is concluded that while a general concept of health literacy might be appropriate for some purposes, it does not meet the specific needs of the mental health area.