Re-development of mental health first aid guidelines for supporting Aboriginal and Torres Strait Islanders who are engaging in non-suicidal self-injury

Effects of an Aboriginal and Torres Strait Islander Mental Health First Aid training programme for non-suicidal self-injury on stigmatising attitudes, confidence in ability to assist, and intended and actual assisting actions: an uncontrolled trial with precourse and postcourse measurement and 6-month follow-up

OBJECTIVES

Non-suicidal self-injury (NSSI) is a complex issue affecting Aboriginal and/or Torres Strait Islander Peoples in Australia. We evaluated the effects of an Aboriginal and Torres Strait Islander Mental Health First Aid (AMHFA) training course on assisting an Aboriginal and/or Torres Strait Islander person engaging in NSSI, including the effects on stigmatising attitudes, confidence in ability to assist, and intended and actual assisting actions.

DESIGN

Uncontrolled trial with precourse and postcourse measurement (n=49) and 6-month follow-up (n=17).

SETTING

Participants attended courses that were run in Queensland and Victorian communities and through one national organisation.

PARTICIPANTS

Participants were 49 adults who worked directly with Aboriginal and/or Torres Strait Islander Peoples.

INTERVENTION

The 5-hour 'Talking About Non-Suicidal Self-Injury' course was delivered by accredited AMHFA instructors and teaches people how to support an Aboriginal and/or Torres Strait Islander person who is engaging in NSSI.

PRIMARY AND SECONDARY OUTCOME MEASURES

The outcome measures were stigmatising attitudes, confidence in ability to assist, and intended and actual actions to assist a person engaging in NSSI.

RESULTS

Improvements were observed in stigmatising attitudes, with significant changes from precourse in both the 'weak-not-sick' (postcourse p<0.0623; follow-up p=0.0058) and 'dangerous/unpredictable' (postcourse p<0.0001; follow-up p=0.0036) subscales. Participants' confidence in ability to assist increased significantly both postcourse (p<0.0001) and at follow-up (p<0.0001). Despite a high level of endorsement for the nine recommended assisting actions at precourse, significant improvements (p<0.05) were observed in endorsement for six and four of the assisting actions postcourse and at follow-up, respectively. Course content was rated as being somewhat (3.4%), mostly (13.8%) or very (82.7%) culturally appropriate by participants who identified as Aboriginal and/or Torres Strait Islander.

CONCLUSIONS

The results of this uncontrolled trial were encouraging, suggesting that the Talking About Non-Suicidal Self-Injury course was able to improve participants' attitudes, confidence and intended assisting actions.

Development of guidelines for school staff on supporting students who self-harm: a Delphi study

OBJECTIVE

Self-harm is a major public health issue that significantly impacts communities, making early intervention and prevention paramount in addressing this public health issue. This study aimed to develop evidence-based, culturally responsive, safe, and practical guidelines to assist school staff in effectively supporting students who self-harm.

METHODS

This Delphi study comprised of a five-step process, oversighted by a Rōpū Mātanga Māori (Māori clinical and cultural governance group), and drawing on the expertise and knowledge gained from existing literature, interviews with stakeholders, and two panels of experts (youth and stakeholders). The Rōpū Mātanga Māori ensured accountability to the principles of Te Tiriti o Waitangi (Treaty of Waitangi) and kept Māori processes central to the research aims. The panels completed two rounds of questionnaires, rating their endorsement of each statement. Statements rated as important or essential by 80% or more of both panels and Māori participants were included in the final guidelines. The Rōpū Mātanga Māori reviewed any remaining statements to determine inclusion.

RESULTS

Following the five-step process, 305 statements were included in the guidelines. These statements provided guiding actions that endorsed communication, collaborative responsibility, and wellbeing and a student-centred approach.

CONCLUSION

The guidelines provide guidance to all school staff that is culturally responsive and safe, consensus-based, and evidence-based. It is informed by the voices and experiences of young people and those who support them.

Mental health first aid USA implementation: Trainee reported quality and impact of training

This study investigated the association of training implementation factors (Quality, Impact, Usefulness) with Mental Health First Aid (MHFA)-targeted outcomes (e.g., increased knowledge, confidence helping someone). Trainees who completed MHFA USA training in 2016 (N = 1003) were surveyed post training about its influence on their thoughts and behaviors, and about implementation factors. Some trainees completed 3- and 6-month follow-ups (N = 430, N = 276, respectively). Training Quality, Impact and Usefulness were rated highly. Differences in Quality and Impact across demographic groups were found; trainees from racially and ethnically marginalized backgrounds, and trainees with lower education levels, reported greater effect. Quality and Impact predicted positive changes in MHFA-targeted constructs such as self-efficacy, stigma and trainee perceived positive effect of MHFA strategies for those in crisis. Impact predicted positive change in mental health knowledge; this association strengthened over time. Results provide information about acceptability and perceived Impact of MHFA USA training and lead to recommendations for future evaluation and implementation.

Cultural adaptation of the mental health first aid guidelines for assisting a person at risk of suicide for Sri Lanka: a Delphi expert consensus study

BACKGROUND

Approximately 3000 people die by suicide each year in Sri Lanka. As family and friends may play a role in supporting a person at risk of suicide to get appropriate help, there is a need for evidence-based resources to assist with this. The aim of this study was to culturally adapt the existing English-language mental health first aid guidelines for helping a person at risk of suicide to the Sri Lankan context.

METHODS

A Delphi expert consensus study was conducted, involving mental health professionals and consumers (people with lived experience) and caregivers, who were identified by purposive and snowball sampling methods. Participants were recruited from a wide variety of professional roles and districts of Sri Lanka in order to maximize diversity of opinion. The original questionnaire was translated into Sinhala and participants were requested to rate each item according to the importance of inclusion in the guidelines.

RESULTS

Data were collected over two survey rounds. Altogether, 148 people participated in the study (130 health professionals and 18 consumers). A total of 165 items were included in the final guidelines, with 153 adopted from the guidelines for English-speaking countries and 12 generated from the comments of panellists.

CONCLUSIONS

The adapted guidelines were similar to the English-language guidelines. However, new items relating to the involvement of family members were included and some items were omitted because they were not considered appropriate to the Sri Lankan context (particularly those relating to explicit mention of suicide). Further research is warranted to explore the use of these guidelines by the Sri Lankan public, including how they may be incorporated in Mental Health First Aid training.

A Delphi yarn: applying Indigenous knowledges to enhance the cultural utility of SMART Recovery Australia

BACKGROUND

Mutual support groups are a popular treatment for substance use and other addictive behaviours. However, little is known about the cultural utility of these programmes for Indigenous peoples.

METHODS

A three-round Delphi study, utilising Indigenous research yarning methods was conducted to: (1) Obtain expert opinion regarding the cultural utility of an Indigenous SMART Recovery handbook; (2) Gain consensus on areas within the SMART Recovery programme that require cultural modification and; (3) Seek advice on how modifications could be implemented in future programme design and delivery. The panellists were 11 culturally, geographically, and professionally diverse Indigenous Australian health and wellbeing experts. A group consensus level of 80% was set prior to each survey round.

RESULTS

There was 100% participant retention across all three Delphi rounds. The panel reached consensus on five key programme modifications (composition of a separate facilitator and group member handbook; culturally appropriate language, terminology, and literacy level; culturally meaningful programme activities; supplementary storytelling resources; and customisation for diverse community contexts). The panel also developed a series of practical implementation strategies to guide SMART Recovery through a modification process.

CONCLUSION

The findings highlight the importance of involving Indigenous peoples in the design, delivery and validation of mainstream mutual support programmes. Indigenous-led programme modifications could help improve accessibility and usefulness of mutual support groups for Indigenous peoples worldwide. This study is an example of how Indigenous research methods can be used alongside the Delphi technique. This approach demonstrated a way that Indigenous peoples from culturally and geographically diverse locations can participate in research anonymously, autonomously and without added burden on personal, community or professional obligations.

Talking about suicide: An uncontrolled trial of the effects of an Aboriginal and Torres Strait Islander mental health first aid program on knowledge, attitudes and intended and actual assisting actions

OBJECTIVE

Suicide is a leading cause of death among Aboriginal and Torres Strait Islander people. Friends, family and frontline workers (for example, teachers, youth workers) are often best positioned to provide initial assistance if someone is at risk of suicide. We developed culturally appropriate expert consensus guidelines on how to provide mental health first aid to Australian Aboriginal and Torres Strait Islander people experiencing suicidal thoughts or behaviour and used this as the basis for a 5-hour suicide gatekeeper training course called Talking About Suicide. This paper describes the outcomes for participants in an uncontrolled trial of this training course.

METHODS

We undertook an uncontrolled trial of the Talking About Suicide course, delivered by Aboriginal and Torres Strait Islander Mental Health First Aid instructors to 192 adult (i.e. 18 years of age or older) Aboriginal and Torres Strait Islander (n = 110) and non-Indigenous (n = 82) participants. Questionnaires capturing self-report outcomes were self-administered immediately before (n = 192) and after attending the training course (n = 188), and at four-months follow-up (n = 98). Outcome measures were beliefs about suicide, stigmatising attitudes, confidence in ability to assist, and intended and actual actions to assist a suicidal person.

RESULTS

Despite a high level of suicide literacy among participants at pre-course measurement, improvements at post-course were observed in beliefs about suicide, stigmatising attitudes, confidence in ability to assist and intended assisting actions. While attrition at follow-up decreased statistical power, some improvements in beliefs about suicide, stigmatising attitudes and intended assisting actions remained statistically significant at follow-up. Importantly, actual assisting actions taken showed dramatic improvements between pre-course and follow-up. Participants reported feeling more confident to assist a suicidal person after the course and this was maintained at follow-up. The course was judged to be culturally appropriate by those participants who identified as Aboriginal and/or Torres Strait Islanders.

IMPLICATIONS

The results of this uncontrolled trial were encouraging, suggesting that the Talking About Suicide course was able to improve participants' knowledge, attitudes, and intended assisting actions as well as actual actions taken.

A Systematic Review of the Antecedents and Prevalence of Suicide, Self-Harm and Suicide Ideation in Australian Aboriginal and Torres Strait Islander Youth

Suicide and self-harm represent serious global health problems and appear to be especially elevated amongst indigenous minority groups, and particularly amongst young people (aged 24 years or younger). This systematic review investigates for the first time the antecedents and prevalence of suicide, self-harm and suicide ideation among Australian Aboriginal and Torres Strait Islander youth. Web of Science, PubMed, PsychINFO, CINAHL databases and grey literature were searched from earliest records to April 2019 for eligible articles. Twenty-two empirical articles met the inclusion criteria. The data confirmed that indigenous youth in Australia have elevated rates of suicide, self-harm and suicidal ideation relative to the nonindigenous population. Risk factors included being incarcerated, substance use and greater social and emotional distress. Notably, though, information on predictors of suicide and self-harm remains scarce. The findings support and justify the increasing implementation of public health programs specifically aimed at tackling this crisis. Based on the review findings, we argued that Aboriginal communities are best positioned to identify and understand the antecedents of youth self-harm, suicide ideation and suicide, and to take the lead in the development of more effective mental health preventive strategies and public policies within their communities.

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.

Re-development of mental health first aid guidelines for supporting Aboriginal and Torres Strait islanders who are experiencing suicidal thoughts and behaviour

BACKGROUND

Suicide is a leading cause of death among Indigenous Australians. Friends, family and frontline workers (for example, teachers, youth workers) are often best positioned to provide initial assistance if someone is suicidal. Culturally appropriate expert consensus guidelines on how to provide mental health first aid to Australian Aboriginal and Torres Strait Islander persons who are experiencing suicidal thoughts or behaviour were developed in 2009. This study describes the re-development of these guidelines to ensure they contain the most current recommended helping actions.

METHODS

The Delphi consensus method was used to elicit consensus on potential helping statements to be included in the guidelines. These statements describe helping actions that Indigenous community members and non-Indigenous frontline workers can take, and information they should have, to help someone who is experiencing suicidal thoughts or displaying suicidal behaviour. A panel was formed, comprising 27 Aboriginal and Torres Strait Islander people who have expertise in Indigenous suicide prevention. The panellists were presented with the helping statements via online questionnaires and were encouraged to suggest re-wording of statements and any additional helping statements that were not included in the original questionnaire. Statements were only accepted for inclusion in the guidelines if they were endorsed by ≥90% of panellists as essential or important.

RESULTS

From a total of 301 statements shown to the expert panel, 172 were endorsed as helping statements to be including in the re-developed guidelines.

CONCLUSIONS

Aboriginal and Torres Strait Islander suicide prevention experts were able to reach consensus on appropriate strategies for providing mental health first aid to an Aboriginal or Torres Strait Islander person experiencing suicidal thoughts or behaviour. The re-development of the guidelines has resulted in more comprehensive guidance than the earlier version, for which the panel had rated 166 helping statements and had endorsed 52. These re-developed guidelines can be used to inform Indigenous suicide gatekeeper training courses.

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).