Mental Health First Aid is an effective public health intervention for improving knowledge, attitudes, and behaviour: a meta-analysis

A randomized clinical trial testing a health literacy intervention to reduce disparities in access to care among Justice-Impacted Adults (JIA)

BACKGROUND

Low health literacy is costly and observed among justice-impacted adults (JIA), a group that often faces numerous barriers in accessing healthcare and a disproportionate burden of illness. Health literacy interventions for JIA are critically needed to improve healthcare access and related outcomes.

METHODS

This manuscript describes the protocol for a longitudinal mixed-methods randomized clinical trial that assesses the effectiveness of a coach-guided health literacy intervention on JIA's healthcare access. The intervention was previously piloted with justice impacted adults. We will recruit 300 JIA ages 18 + in San Diego, California. Participants will be randomized 1:1 to the Treatment Group (i.e., coach-guided intervention providing 12 sessions of individualized health coaching and service navigation over 6 months) or the Control Group (i.e., self-study of the health coaching program, and brief service navigation support). We will quantitatively assess JIA's healthcare access defined as: use of healthcare, health insurance status, and regular source of care at 6-months as the primary outcomes. Participants will also be surveyed at 12-months. Statistical analyses will incorporate the intent-to-treat (ITT) principle and we will estimate mixed-effects logistic regression for the primary outcomes. We will also conduct qualitative interviews at 6 and 12-months with 40 purposively sampled participants, stratified by study arm, who reported healthcare access barriers at baseline. Interviews will explore participants' satisfaction with the intervention, healthcare attitudes, self-efficacy for and barriers to healthcare access over time, perceived contribution of the intervention to health and well-being, and diffusion of intervention-related information within participants' social networks. We will conduct deductive thematic analyses of qualitative data.

DISCUSSION

Low health literacy among JIA is a foundational challenge requiring tailored intervention strategies. Findings from this trial may inform policies and the structure of service delivery models to build health literacy among JIA in institutional and community settings throughout the United States and elsewhere.

TRIAL REGISTRATION

This study is registered with the United States' ClinicalTrials.gov registry under protocol # 161,903.

Evaluating Mental Health First Aid for Illinois Agricultural Communities

Introduction. Mental Health First Aid (MHFA) was created to teach individuals how to identify, understand, and respond to signs of mental illnesses and substance use disorders. Programs like this may be essential for agricultural communities where suicide rates have increased, and mental health stigma has been a barrier to this population. This study evaluated how effective MHFA and Youth MHFA were for participants from agricultural communities. Methods. Participants completed the MHFA (N = 38) and Youth MHFA (N = 66) programs in 2021-2022, and Extension educators offered both programs as a part of outreach efforts within agricultural contexts. Participants completed pre-, post-, and post-only evaluations as standardized by the National Council for Mental Wellbeing. Results. After completing the MHFA and Youth MHFA training, participants increased their knowledge, confidence, and skills in various mental health topics. This includes early indicators of mental health challenges, the ability to have supportive conversations, and how to provide resources to others. For example, most participants felt they became more knowledgeable about MHFA (69%) and the ability to recognize the signs and symptoms of mental health or substance use challenges (65%). Conclusion. This research has implications for supporting agricultural workers through additional mental health training, managing farm stress, and understanding mental health stigma within this community.

Universal mental health training for frontline professionals: evaluation of pilot trial in Ukraine

Background

Increasing accessibility of mental health services and expanding universal health coverage is possible worldwide by using a task-shifting approach as partial delegation of some mental health support tasks to trained non-mental health service providers in order to use the available workforce more efficiently. The Universal Mental Health Training (UMHT), which is dedicated to this aim, was developed and piloted in Ukraine. The UMHT is an educational program for frontline professionals on high-quality and evidence-based responses to the mental health needs of the population they serve.

Methods

The pilot trial of UMHTs' effectiveness was conducted with 307 frontline professionals divided into 24 training groups. The control group included 211 persons with the same occupation background who participated in training later (waiting list). All the groups took part in eight-hour training, which includes one introductory module that introduces the mental health topic alongside a five-step model of UMHT, two disorders-focused modules with the steps adjusted to work with specific disorders, and the final module that considers possible difficulties frontline professionals might experience. Three effectiveness measurements were used in the outcome assessment: readiness to interact with people with mental health issues at work, mental health awareness and mental health proficiency.

Results

Analysis of the outcome data for the frontline professionals who underwent the UMHT revealed a moderate effect size related to the knowledge of mental health conditions, mental health awareness, and increasing the readiness to interact with people with mental health issues in comparison to the control group.

Conclusions

High-level utilisation of the UMHT at work by trained professionals confirms the effectiveness of the developed intervention. Obtained results favour the continuation of the development of the UMHT and future implementation research in this field in Ukraine and potentially in other low- and middle-income countries.

Impact of a psychoeducational intervention on willingness to seek help for depression among African American young adults

Despite the success of psychoeducational interventions at improving willingness to seek professional help for mental illness, limited research explores the effect of culturally tailored psychoeducational interventions on African American (AA) college students. The objective of this study was to determine if exposure to a culturally relevant psychoeducational intervention impacted AA young adult attitudes, subjective norms, perceived behavioral control, depression stigma, disclosure and willingness to seek help for depression. We conducted a one-group pre- and post-test intervention study of AA college students (N = 75). The 2.5-h intervention featured presentations, large-group discussions, videos, and active learning exercises and was guided by applying a cultural adaptation framework to an existing psychoeducational intervention. The self-administered surveys were created using the Theory of Planned Behavior as a guide. Data were analyzed using paired t-tests. A total of 70 participants completed both pre- and post-test surveys. Overall, willingness, attitude, and disclosure significantly increased after the intervention (p < .001). Additionally, depression stigma significantly decreased after the intervention, indicating fewer stigmatizing beliefs about depression (p < .001). Willingness to seek help for depression among AA college students can be improved through culturally relevant and interactive psychoeducational interventions. These interventions can also improve negative attitudes and perceived behavioral control toward seeking help and decrease stigmatizing beliefs. More research is needed to explore the longitudinal impact of culturally relevant psychoeducational interventions and how they may affect actual help-seeking behavior among AA college students.

What do carers of people with high-grade glioma perceive could improve their preparedness to care, and what additional support do they require?

Background

Concerning levels of stress, strain, and poorer mental health are observed in family carers of patients diagnosed with high-grade glioma (HGG). Understanding the reported unmet needs of these carers will enable future interventions to address such needs to improve their preparedness for care and well-being. In this secondary analysis, we aimed to explore: (i) what carers of people with HGG perceive could improve their preparedness to care; and (ii) what needs carers reported they required additional support with.

Methods

Responses from 188 carers of patients with HGG participating in a randomized controlled trial of the Care-IS intervention were analyzed to identify reported unmet needs. Of this larger sample, 92 participants answered a qualitative question seeking to identify perceived unmet needs in carer preparedness over 12 months. These responses comprised the data for the current secondary analysis. Content analysis was used to analyze the qualitative data and observe trends across participant responses.

Results

Five overarching themes were identified: carer needs, providing emotional and practical care, coping with uncertainty, coping with the consequences of illness progression, and processing and supporting end-of-life care. Notably, the content analysis identified differences in response numbers between groups in the Care-IS trial, particularly with the control group having more needs regarding illness progression and end-of-life care.

Conclusions

Future interventions aimed at improving the well-being and preparedness of carers of people with HGG should consider providing better support centered on carer needs, their changed circumstances, living with uncertainty, and care transition.

A Framework for Protecting and Promoting Employee Mental Health through Supervisor Supportive Behaviors

The attention to workplace mental health is timely given extreme levels of burnout, anxiety, depression and trauma experienced by workers due to serious extraorganizational stressors - the COVID-19 pandemic, threats to climate change, and extreme social and political unrest. Workplace-based risk factors, such as high stress and low support, are contributing factors to poor mental health and suicidality (Choi, 2018; Milner et al., 2013, 2018), just as low levels of social connectedness and belonging are established risk factors for poor mental health (Joiner et al., 2009), suggesting that social support at work (e.g., from supervisors) may be a key approach to protecting and promoting employee mental health. Social connections provide numerous benefits for health outcomes and are as, or more, important to mortality as other well-known health behaviors such as smoking and alcohol consumption (Holt-Lundstad et al., 2015), and can serve as a resource or buffer against the deleterious effects of stress or strain on psychological health (Cohen & Wills, 1985). This manuscript provides an evidence-based framework for understanding how supervisor supportive behaviors can serve to protect employees against psychosocial workplace risk factors and promote social connection and belongingness protective factors related to employee mental health. We identify six theoretically-based Mental Health Supportive Supervisor Behaviors (MHSSB; i.e., emotional support, practical support, role modeling, reducing stigma, warning sign recognition, warning sign response) that can be enacted and used by supervisors and managers to protect and promote the mental health of employees. A brief overview of mental health, mental disorders, and workplace mental health is provided. This is followed by the theoretical grounding and introduction of MHSSB. Suggestions for future research and practice follow, all with the focus of developing a better understanding of the role of supervisors in protecting and promoting employee mental health in the workplace.

Development and Evaluation of Online Suicide Preventive Tool iAlive to Increase Competences in Engaging With a Suicidal Person

Background: Online implementation of suicide prevention interventions offers many advantages, facilitating the dissemination of large-scale suicide prevention interventions. An online tool iAlive aimed at raising awareness and increasing suicide prevention competences in lay people was developed and implemented in Slovenia. Aims: To develop, implement, and evaluate the iAlive tool. Method: Following the development and implementation of the tool, a nonrandomized controlled study with 310 participants was conducted. One hundred fifty-six of them fully completed the study [intervention group (used the iAlive tool): N = 85, control group (did not use the tool): N = 71]. Perceived competences in engaging with a suicidal person were assessed in both groups at baseline and at follow-up (3-4 weeks apart), which also represents the time of the intervention. Results: A significant effect of time and condition [F(1,149) = 6.62, p = .011, ηp2 = .043] showed that the intervention group assessed their perceived competences on intervention exposure more positively compared to the control group. Limitations: Additional data on different populations and people's engagement with the tool in relation to perceived competences are needed. Conclusion: The study suggests that the interactive online tool iAlive effectively increases perceived competences in engaging with a suicidal person. These results provide a background for further dissemination of the tool.

Hybrid-delivered community psychoeducation for people aged 50 and older: A mixed-method evaluation and lesson learned

Introduction

Hybrid training mode comprising in-person and teleconferencing sessions is effective and sustainable, yet no standardized principles guide its development for older people. This study aimed to develop a set of principles for hybrid-mode psychoeducation for older people from the experiences of middle-aged and older people in two folds: (1) examining the effects of hybrid-mode community psychoeducation and (2) identifying features that could enhance participants' experience.

Methods

We delivered 12-hour Older Person Mental Health First Aid and 3-hour late-life depression training to adults aged 50 and older in in-person and hybrid modes. Hybrid group participants received technology-related support, including in-advance training and on-site support. All participants completed assessments on depression literacy, depression stigma, meaning in life, social support, depressive symptoms, and anxiety pre-and post-intervention and evaluated the program in open-ended questions.

Results

A total of 471 in-person and 346 hybrid group participants completed the psychoeducation and post-assessment (80.4 % female, mean age = 64.73 years, SD = 7.29). Linear mixed models revealed improvements in depression literacy, depression stigma, meaning in life, social support, and anxiety (B = -1.43 to 0.13, all p < .001), with no significant difference between in-person and hybrid groups. Thematic analysis of open-ended questions identified three themes: (1) informational content with case studies, (2) hardcopy course handouts, and (3) interactive learning environment.

Discussion/conclusion

Hybrid-mode and in-person psychoeducation had comparable benefits on middle-aged and older people. The TORCH principles, an acronym for Technology provision, On-site technical support, Rehearsal, Connection with group members, and Hardcopy notes, was derived from practice wisdom and qualitative findings to support older people in online learning.

Effects of the Mental Health Supporter Training Program on mental health-related public stigma among Japanese people: A pretest/posttest study

Aim

The Mental Health Supporter Training Program is a national project conducted in Japan. This study aimed to determine the effects on mental health-related stigma, mental health literacy, and knowledge about mental health difficulties and support techniques among program participants.

Methods

The target population was local residents of a wide range of generations in Japan. Outcomes were assessed at baseline (T1), immediately postintervention (T2), and at the 6-month follow-up (T3). A mixed model for repeated-measures conditional growth model analyses were employed to examine the effects of the intervention over time (T1, T2, T3). We also calculated effect sizes using Cohen's d.

Results

The program had a significantly favorable pooled effect on the Japanese version of the Reported and Intended Behaviour Scale score after adjusting for covariates (reported behavior [t = 3.20, p = 0.001]; intended behavior [t = 8.04, p < 0.001]). However, when compared at each time point, only intended behavior from T1 to T2 showed a significant difference (t = 8.37, p < 0.001). Significant pooled effects were found for mental health literacy (knowledge: t = 19.85, p < 0.001; attitude: t = 15.02, p < 0.001), knowledge of mental health (t = 28.04, p < 0.001), and psychological distress (t = -2.41, p = 0.016).

Conclusion

The results suggest that the program might be effective for improving intended, but not reported, behavior in the short term and for improving mental health literacy, knowledge of mental health, and psychological distress.

Causal beliefs about mental illness: A scoping review

Research on causal beliefs about mental illness-the beliefs people hold about what causes a particular mental illness, or mental illnesses in general-is split across a number of theories and disciplines. Although research on this subject has provided a number of insights and practical applications, the diversity of theories, terminology, and keywords makes it challenging for a new reader to gain a comprehensive understanding. We sought to address this by conducting a systematic scoping review of research on causal beliefs. This review included English-language articles from any year that mentioned causal beliefs for mental illness in their title or abstract. We identified articles in two stages. In the first stage, we used a narrow set of search terms referring specifically to causal beliefs (1227 records identified, 417 included). In the second stage, we used a comprehensive set of terms relevant to research on causal beliefs (10,418 records identified, 3838 included). We analyzed articles qualitatively, organizing them into one of five theories or categories: the common-sense model of self-regulation, explanatory models, mental health literacy, biogenetic causal beliefs, and other research on causal beliefs. We provide a comprehensive summary of these literatures in terms of their history, typical research questions and study design, findings, and practical applications. These theories differ in their theoretical orientation towards causal beliefs, research methods, findings, and applications. However, they broadly share a view of causal beliefs as multifaceted, culturally determined, and relevant for additional psychosocial variables such as mental illness stigma and help-seeking. We conclude by making recommendations for researchers, clinicians, public health messaging, and for individuals with mental illness.

Effectiveness of educational interventions in reducing the stigma of healthcare professionals and healthcare students towards mental illness: A systematic review and meta-analysis

AIM

To examine the effectiveness of educational interventions in reducing stigma among healthcare professionals and students towards people with mental illness.

DESIGN

A systematic review and meta-analysis of randomized controlled trials (RCTs) and cluster RCTs.

DATA SOURCES

Articles published from database inception to October 2023 were systematically searched from seven databases (CINAHL, Embase, ProQuest Dissertations and Theses Global, PsycINFO, PubMed, Scopus, Web of Science), following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

METHODS

Random-effect meta-analyses were conducted. Heterogeneity was evaluated using the I2 statistics and Cochran's Q chi-squared test. A quality appraisal conducted at the study level used the Cochrane risk of bias tool and an outcome-level quality assessment utilized the Grades of Recommendation, Assessment, Development and Evaluation Approach. Publication bias was assessed using the funnel plot.

RESULTS

Twenty-five articles were included in this review. Meta-analysis reported statistically significant medium and small effect sizes for attitudes towards mental illness and attitudes towards people with mental illness respectively, showing the association between educational interventions and improved attitudes among healthcare professionals and students. However, a statistically non-significant effect was reported for knowledge of mental illness. Subgroup analyses indicated that face-to-face and contact-based interventions were particularly effective at reducing stigma. Notably, single-session interventions were just as effective as multiple sessions, suggesting a potential for resource-efficient approaches.

CONCLUSION

Educational interventions demonstrate promise in fostering more positive attitudes towards mental health issues. Future research should aim to determine the long-term effects of these interventions and include patient feedback on the stigmatizing behaviours of healthcare professionals and students, to holistically evaluate the effect of interventions.

NO PATIENT OR PUBLIC CONTRIBUTION

This study is a secondary review and does not require relevant contributions from patients or the public. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: Face-to-face contact-based educational sessions have proven to be the most effective. Reinforcing learning may be achieved through a series of repeated single-session interventions.

Brief video training for suicide prevention in veterans: A randomized controlled trial of VA S.A.V.E

INTRODUCTION

VA S.A.V.E. (Signs; Ask; Validate; Encourage/Expedite) is a gatekeeper training developed by the Department of Veterans Affairs (VA) that teaches individuals to identify and assist veterans at risk for suicide. Although VA S.A.V.E. has been widely disseminated, rigorous evaluation is lacking.

METHODS

In a pilot randomized controlled trial of a brief, video-based version of VA S.A.V.E., individuals were recruited through Facebook, randomized to VA S.A.V.E. versus an attention control condition, and completed 6-month follow-up. A subgroup (n = 15) completed interviews. We used a mixed methods framework to integrate quantitative and qualitative findings.

RESULTS

Among 214 participants, 61% were spouses/partners of veterans and 77% had prior suicide exposure. Sixty-seven percent (n = 68) of VA S.A.V.E. participants watched the entire video, and satisfaction and usability were highly rated. At 6-month follow-up, compared to the control group, the VA S.A.V.E. group had a higher proportion of participants use each gatekeeper behavior (66.7%-84.9% vs. 44.4%-77.1%), and used significantly more total gatekeeper behaviors (2.3 ± 0.9 vs. 1.8 ± 1.0; p = 0.01). Interviews supported positive reactions, learning, and behavior change from VA S.A.V.E.

CONCLUSION

VA S.A.V.E. merits further investigation into its effectiveness as a brief, scalable gatekeeper training for suicide prevention in veterans.

What Do We Know About Depression Among Youth and How Can We Make Progress Toward Improved Understanding and Reducing Distress? A New Hope

This paper summarizes many findings about depression among children and adolescents. Depression is prevalent, highly distressing, and exerts considerable burden worldwide. Rates surge from childhood through young adulthood and have increased over the last decade. Many risk factors have been identified, and evidence-based interventions exist targeting mostly individual-level changes via psychological or pharmacological means. At the same time, the field appears stuck and has not achieved considerable progress in advancing scientific understanding of depression's features or delivering interventions to meet the challenge of youth depression's high and growing prevalence. This paper adopts several positions to address these challenges and move the field forward. First, we emphasize reinvigoration of construct validation approaches that may better characterize youth depression's phenomenological features and inform more valid and reliable assessments that can enhance scientific understanding and improve interventions for youth depression. To this end, history and philosophical principles affecting depression's conceptualization and measurement are considered. Second, we suggest expanding the range and targets of treatments and prevention efforts beyond current practice guidelines for evidence-based interventions. This broader suite of interventions includes structural- and system-level change focused at community and societal levels (e.g., evidence-based economic anti-poverty interventions) and personalized interventions with sufficient evidence base. We propose that by focusing on the FORCE (Fundamentals, Openness, Relationships, Constructs, Evidence), youth depression research can provide new hope.

COVID-19 and coping: Absence of previous mental health issues as a potential risk factor for poor wellbeing in females

COVID-19 has caused unprecedented disruption to everyday life. Unsurprisingly, this has resulted in increased prevalence of poor mental wellbeing. While previous mental health issues have been consistently flagged as a risk factor, the absence of these may also leave individuals vulnerable due to a lack of psychological coping strategies. This study explored the change in symptoms of anxiety, depression, and trauma in 167 females who provided data at four timepoints over the course of the first year of the pandemic. There was a significant effect of time on the extent of the change in depression but, for all wellbeing measures, those with current or previous mental health issues experienced a similar magnitude of change as those with no previous issues. This suggests that low-risk individuals may be faring worse, relatively. Ensuring that this group is not overlooked will be imperative in protecting and re-building the wellbeing of the nation.

Validation of a French questionnaire assessing knowledge of suicide

OBJECTIVES

The objective of this study was to develop and validate the Knowledge of Suicide Scale (KSS), elaborated to assess adherence to myths about suicide.

METHODS

The KSS is a self-questionnaire including 22 statements relating to myths about suicide for which the respondent is asked to rate his degree of adherence on a scale ranging from 0 ("strongly disagree") to 10 ("completely agree"). Using the script concordance test scoring method, the respondents' scores were compared with those of experts to obtain, for each item, a score between 0 (maximum deviation with the experts) and 1 (minimum deviation with the experts). One thousand and thirty-five individuals (222 psychiatric interns, 332 medical interns in the first semester excluding psychiatry and 481 journalism students) were included.

RESULTS

According to the exploratory factor analysis, the KSS is a two-dimensional scale: the first subscale includes 15 items and the second seven items. The tool showed excellent face validity, correct convergent and divergent validities (multi-method multi-feature analyzes), and good internal consistency (Cronbach's alpha coefficient between 0.66 and 0.83 for scales and subscales). The KSS is moderately and negatively correlated with the Stigma of Suicide Scale (r=-0.3). It significantly discriminates groups with different expected levels of knowledge regarding suicide (P<0.001).

CONCLUSIONS

The KSS demonstrated good psychometric properties to measure adherence to myths about suicide. This tool could be useful in assessing the effectiveness of suicide prevention literacy improvement programs.

Effectiveness of teen Mental Health First Aid in Improving Teen-to-Teen Support Among American Adolescents

BACKGROUND

teen Mental Health First Aid (tMHFA) is an Australian school-based universal program for grade 10 to 12 students. tMHFA teaches teens how to recognize and respond to a peer in crisis or experiencing mental health concerns.

METHODS

Schools implementing tMHFA in 2019 and 2020 were propensity score matched, yielding a sample of instructors (n = 130) and students (n = 1915) in 44 high schools in 24 American states. Effectiveness and acceptability were assessed with student surveys at baseline and after implementation.

RESULTS

There were significant findings for primary outcomes, including improved helpful first aid intentions (Cohen ds = 0.57 to 0.58), confidence supporting a peer (ds = 0.19 to 0.31); the number of adults rated as helpful (ds = 0.37 to 0.44); and reductions in stigmatizing beliefs (ds = 0.21 to 0.40) and "harmful first aid intentions" (ds = 0.11 to 0.42). Instructors and students rated the program favorably with students sharing improvements on their recognition and responses to mental health problems and crises.

CONCLUSION

tMHFA is an effective, feasible, and scalable training program for increasing mental health literacy and decreasing mental health stigma in adolescents in the short term, consistent with trials of tMHFA in Australian adolescents.

Mental Health of Brazilian Immigrant Women: The Role of Discrimination, Social Support, and Community Strengths

Little is known about the mental health status of Brazilians living in the U.S. We assessed the prevalence and correlates of depression to guide the development of culturally relevant community-based mental health interventions. An online survey was conducted between July and August 2020 among a sample of Brazilian women living in the U.S. (age 18 and over, born in Brazil, English or Portuguese speaking) recruited through Brazilian social media pages and community organizations. The survey assessed depression using the Center for Epidemiological Study Depression Scale (CES-D-10), the Everyday Discrimination Scale (EDS), the Oslo Social Support Scale (OSSS), and community strengths (CS). We first assessed the correlation between CES-D-10 scores and EDS, OSSS, and CS. We found that half of the participants (52.2%) had CES-D-10 scores of 10 or greater, indicating the presence of depressive symptomatology. In a multivariable model controlling for significant covariates (age, time lived in U.S.), EDS was positively associated with CES-D-10 scores (β = 0.64, 95% CI = 0.45, 0.83), while OSSS was negatively associated with CES-D-10 scores (β = -0.53, 95% C I= -0.80, -0.27). No statistically significant relationship was observed between CES-D-10 and CS scores. In this sample of Brazilian immigrant women, depressive symptomatology was highly prevalent, and experiences of discrimination were associated with increased symptoms of depression. There is a need to understand and address mental health in Brazilian immigrant women.

Nordic region suicide trends 2000-2018; sex and age groups

BACKGROUND AND AIM

Overall, suicide rates in the Nordic region, Denmark, Finland, Iceland, Norway and Sweden, have declined in the past 40 years. The aim of this study was to determine trends in suicide mortality from 2000 to 2018.

METHODS

Data were obtained from official suicide statistics for men and women, 15 years and older. Gender and age groups in four calendar periods were analyzed using Joinpoint Estimated Regression Coefficient.

RESULTS

The crude regional suicide rate was 17.1, 2000-2004, decreased to 14.1 per 100,000 inhabitants in 2015-2018. Age-standardized rates are 13.6-11.3. The crude rate decreased by 19.5% (16.3% age-standardized), 19.3% for males and 20.5% for females. The largest decrease was found in Finland (34.9%), the smallest in Norway (1.4%). In males, the exception was an increased suicide rate among all Icelandic except 15-24-year olds, and in 45-64 year-old Norwegians. Among females, an increase was seen among 15-24-year olds in all countries except Iceland, in all age groups in Norway, and in 25-44-year olds in Sweden. In males, a decline of the suicide rated lower than 10% was noted in 25-44 olds in Norway and in 15-64 year-olds in Sweden.

DISCUSSION

A robust decrease was observed in the overall regional suicide rate in recent years. Exceptions are rising rates in Icelandic males, in Norwegian females, and the youngest female groups in all except Iceland. The small decline among middle-aged males in Norway and Sweden is of concern.

Encouraging "Positive Views" of Mental Illness in High Schools: An Evaluation of Bring Change 2 Mind Youth Engagement Clubs

"Bring Change 2 Mind" (BC2M) high school clubs may destigmatize mental illness among club members, but clubs' (1) reach and impact on non-club members at the same school, (2) connection to student help-seeking attitudes, and (3) mechanisms by which they destigmatize mental illness, are unknown. This community-partnered evaluation involved pre/post surveys of predominantly Latino (72%) students at three urban public schools and focus groups and interviews with a sample of club members (n = 26/65, 40%) and all club staff (n = 7, 100%). Multivariate regressions tested relationships between variables. In 84% of the student body responded in the Fall (n = 1,040) and Spring (n = 1,031). Non-club member engagement in BC2M (reach) increased from 25% (Fall) to 44% (Spring) (p < .01). Engagement with BC2M clubs was associated with decreased stigma among members (p < .05) but not non-members (p = .19). Decreased stigma was associated with help-seeking attitudes (p < .01). Possible BC2M mechanisms identified by students and staff include the following: (1) fostering a positive campus climate, (2) normalizing mental health discussions, (3) increasing peer support and help-seeking, and (4) increasing awareness of positive coping behaviors. While BC2M clubs likely reduce stigma for members, effects did not reach non-members, challenging the potential of BC2M clubs as a schoolwide strategy to destigmatize mental health services. Future projects could investigate how to reach non-BC2M members, complement BC2M with other school climate interventions to increase impact, and measure BC2M impact alongside other outcomes relevant to schools, such as academic achievement.

Mental Health First Aid as a tool for improving mental health and well-being

BACKGROUND

The prevalence of mental health problems is high, and they have a wide-ranging and deleterious effect on many sectors in society. As well as the impact on individuals and families, mental health problems in the workplace negatively affect productivity. One of the factors that may exacerbate the impact of mental health problems is a lack of 'mental health literacy' in the general population. This has been defined as 'knowledge and beliefs about mental disorders, which aid their recognition, management, or prevention'. Mental Health First Aid (MHFA) is a brief training programme developed in Australia in 2000; its aim is to improve mental health literacy and teach mental health first aid strategies. The course has been adapted for various contexts, but essentially covers the symptoms of various mental health disorders, along with associated mental health crisis situations. The programmes also teach trainees how to provide immediate help to people experiencing mental health difficulties, as well as how to signpost to professional services. It is theorised that improved knowledge will encourage the trainees to provide support, and encourage people to actively seek help, thereby leading to improvements in mental health. This review focuses on the effects of MHFA on the mental health and mental well-being of individuals and communities in which MHFA training has been provided. We also examine the impact on mental health literacy. This information is essential for decision-makers considering the role of MHFA training in their organisations.

OBJECTIVES

To examine mental health and well-being, mental health service usage, and adverse effects of MHFA training on individuals in the communities in which MHFA training is delivered.

SEARCH METHODS

We developed a sensitive search strategy to identify randomised controlled trials (RCTs) of MHFA training. This approach used bibliographic databases searching, using a search strategy developed for Ovid MEDLINE (1946 -), and translated across to Ovid Embase (1974 -), Ovid PsycINFO (1967 -), the Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Common Mental Disorders Group's Specialised Register (CCMDCTR). We also searched online clinical trial registries (ClinicalTrials.gov and WHO ICTRP), grey literature and reference lists of included studies, and contacted researchers in the field to identify additional and ongoing studies. Searches are current to 13th June 2023.

SELECTION CRITERIA

We included RCTs and cluster-RCTs comparing any type of MHFA-trademarked course to no intervention, active or attention control (such as first aid courses), waiting list control, or alternative mental health literacy interventions. Participants were individuals in the communities in which MHFA training is delivered and MHFA trainees. Primary outcomes included mental health and well-being of individuals, mental health service usage and adverse effects of MHFA training. Secondary outcomes related to individuals, MHFA trainees, and communities or organisations in which MHFA training has been delivered DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. We analysed categorical outcomes as risk ratios (RRs) and odds ratios (ORs), and continuous outcomes as mean differences (MDs) or standardised mean differences (SMDs), with 95% confidence intervals (CIs). We pooled data using a random-effects model. Two review authors independently assessed the key results using the Risk of Bias 2 tool and applied the GRADE criteria to assess the certainty of evidence MAIN RESULTS: Twenty-one studies involving a total of 22,604 participants were included in the review. Fifteen studies compared MHFA training with no intervention/waiting list, two studies compared MHFA training with an alternative mental health literacy intervention, and four studies compared MHFA training with an active or an attention control intervention. Our primary time point was between six and 12 months. When MHFA training was compared with no intervention, it may have little to no effect on the mental health of individuals at six to 12 months, but the evidence is very uncertain (OR 0.88, 95% CI 0.61 to 1.28; 3 studies; 3939 participants). We judged all the results that contributed to this outcome as being at high risk of bias. No study measured mental health service usage at six to 12 months. We did not find published data on adverse effects. Only one study with usable data compared MHFA training with an alternative mental health literacy intervention. The study did not measure outcomes in individuals in the community. It also did not measure outcomes at our primary time point of six to 12 months. Four studies with usable data compared MHFA training to an active or attention control. None of the studies measured outcomes at our primary time point of six to 12 months.

AUTHORS' CONCLUSIONS

We cannot draw conclusions about the effects of MHFA training on our primary outcomes due to the lack of good quality evidence. This is the case whether it is compared to no intervention, to an alternative mental health literacy intervention, or to an active control. Studies are at high risk of bias and often not sufficiently large to be able to detect differences.

Mental health and help-seeking among college students during the COVID-19 pandemic: Roles of campus mental health climate and institutional support

Objective: This study aimed to examine college students' perceived mental health and help-seeking behaviors during the COVID-19 pandemic, as well as to determine the roles of campus mental health climate and institutional support on students' help-seeking behaviors and well-being. Participants: The sample included 123 students from a Northeastern United States University. Methods: Using a web-based survey and convenience sampling, data were collected in late 2021. Results: Most participants retrospectively reported a perceived decline in their mental health during the pandemic. Sixty-five percent of the participants reported that they did not receive professional help at a time when they needed it. Both campus mental health climate and institutional support were negatively related to anxiety symptoms. Greater institutional support predicted less social isolation. Conclusions: Our findings highlight the importance of campus climate and support on students' well-being during the pandemic and the need for increasing students' access to mental health care.

Mental health first aid improves mental health literacy among college students: A meta-analysis

OBJECTIVES

Mental health first aid (MHFA) may have beneficial effects on the public's knowledge, attitude, and behavior; however, its effectiveness in increasing mental health literacy on college students remains unknown.

METHODS

We systematically searched the PubMed, EMBASE, and Cochrane Library databases from inception to January 2020. We included trials that compared the effect between the MHFA program group and control group on the knowledge, stigmatizing attitudes, confidence, and intention of college students. A random-effects model was used.

RESULTS

We analyzed five trials involving 1134 participants and found that the MHFA program could significantly increase the student's knowledge (SMD: 0.49, 95% CI: [0.28-0.70]) and confidence (SMD: 0.71, 95% CI: 0.24-1.19).

CONCLUSIONS

Overall, the MHFA program could increase college students' knowledge regarding mental health and confidence to support people with mental health problems. However, well-designed control trials are required to investigate the program's effect on mental health literacy in college students.

ABBREVIATIONS

MHFA, Mental health first aid; GPs, General Practioners; CI, confidence interval; SMD, standardized mean24difference.

Structured exercise programs for higher education students experiencing mental health challenges: background, significance, and implementation

The incidence of mental illness is greatest among young adults, and those enrolled in higher education may be particularly vulnerable compared to the general young adult population. Many higher education institutions employ student support staff tasked with implementing strategies to improve student wellbeing and mental illness. However, these strategies tend to be focused on clinical therapies and pharmacological interventions with limited lifestyle approaches. Exercise is an effective method for addressing mental illness and promoting wellbeing, yet widespread provision of structured exercise services to support treatment options for students with mental health challenges has not been fully realized. In an effort to guide exercise strategies for student mental health, we synthesize considerations for developing and delivering exercise programs in higher education settings. We draw directly from the evidence base on existing exercise programs in higher education; and the broader behavior change, exercise adherence, health psychology, implementation science, and exercise prescription literatures. Our broad considerations cover issues regarding program engagement and behavior change, exercise 'dose' and prescription, integration with other on-campus services, and robust research and evaluation. These considerations may provide impetus for widespread program development and implementation, as well as informing research focused on protecting and improving student mental health.

Global Advancement in Pharmacy Services for Mental Health: A Review for Evidence-Based Practices

The symptoms of psychiatric infirmities have variability, and selected drug regimens for mental illness are comparatively complex and individualized; therefore, pharmacy services vary with respect to patients, diseases, healthcare settings, community structures, and countries. Clinical pharmacy services for mental health (MH) are continuously being upgraded. A structured search of the literature was performed in the Cochrane, PubMed (Medline), PsycINFO, Google scholar, Scopus, Science Direct, and Springer Links databases. The title and abstract of each retrieved article were evaluated for relevance. To remove uncertainty and ambiguity, the full-text articles were retrieved and examined for relevance. The articles were further assessed on the basis of inclusion and exclusion criteria. Narrative synthesis was performed, creating new categories and relevant subcategories and further subsections. The articles and the results were assessed for quality and bias. Pharmacists have a range of expertise in psychiatric care. The services can be classified as conventional, extended, and advanced pharmacy services. Conventional services include the quality use of medicines in healthcare settings and medication support services in communities that ensure medication adherence. Pharmacists perform extended roles in collaborative medication therapy management, multidisciplinary community mental health teams, collaborative care, patient education, home medication review, hospital-to-home transit, and screening services. In the USA, the role of pharmacists was advanced by prescribing as collaborative and interim prescribers. Australia launched an accredited program for psychiatric first-aid pharmacists. Pharmacists can provide mental care to rural populations using health technology. The role of pharmacists in MH is appreciated either independently or as a team member. Patients and healthcare providers rank the services of pharmacists in MH highly. Still, there is a margin for improvement in the training of pharmacists. Pharmacists cannot provide sufficient time to their patients. Public awareness about the role of pharmacists in MH needs more attention. Moreover, the training of psychiatric pharmacists should be standardized around the world.

The Effectiveness of Online Mental Health First Aid Training in Community Rugby: A Mixed-Methods Approach

Mental Health First Aid (MHFA) training exists to improve supportive behaviours towards peers, increase mental health literacy, and reduce stigma. Community sport clubs have potential to successfully deliver mental health programs. This study investigated the effectiveness of online MHFA training undertaken by members of the rugby community and evaluated the feasibility and usefulness of the online delivery mode and users' engagement with it. A mixed-methods approach was used to provide depth of understanding through qualitative analysis, combined with quantitative outcomes. Online surveys examining participants' knowledge and perceptions were administered pre- and post-MHFA training. Significant improvements (p < 0.05) across all assessed domains were observed post- compared to pre-MHFA training. A large effect size was identified in relation to advice giving and sign and symptom identification. A moderate effect size pre- to post-improvement was identified for users' perceptions of therapy's effectiveness, the ability of people with severe mental health conditions to recover, and benefit of a healthcare professional. Participants endorsed the MHFA program to improve mental health literacy, advance non-technical skills, and improve confidence. MHFA training can increase the awareness and knowledge of mental health issues in key individuals in community sport clubs and enable them to aid people with mental health concerns. Online MHFA training is associated with improved mental health literacy and may be a suitable and economically sustainable model for community sport.

The effectiveness of mental illness stigma-reduction interventions: A systematic meta-review of meta-analyses

The high prevalence of stigma toward mental illnesses contributes to the worsened health and quality of life for people with mental illnesses. Different stigmas (e.g., public, self) lead to social discrimination, social isolation, and reduce the likelihood that people with mental illnesses receive adequate treatment for their conditions. In response to this, numerous social interventions have been developed to help combat the spread of stigma. Subsequently, researchers have conducted meta-analyses to determine the effectiveness of different interventions for reducing stigma toward mental illness. To date, no efforts have been made to synthesize these meta-analyses to identify gaps in the stigma-reduction literature, assess the quality of extant literature, and to identify trends in programming efforts. The present study conducted a systematic meta-review of 19 meta-analyses, drawing from the Health Stigma and Discrimination Framework, to address these gaps. Results showed that the included meta-analyses were of relatively poor quality and that interventions primarily addressed either public or self-stigma, while overlooking other stigmas. Further, meta-analyses primarily assessed the effects of contact-promotion or educational intervention strategies. There was little evidence to suggest that interventions were effective longitudinally. Implications for future research and intervention development are discussed.

Cross-sectional study of factors affecting the receipt of mental health education in older migrants in China

BACKGROUND

Population migration in China has increasingly included middle-aged and older populations. Relatedly, the lack of mental health education among China's older migrants is still an important but neglected problem. This study aimed to understand the current situation of mental health education received by the older migrant population in China and to explore related influencing factors.

METHODS

This cross-sectional study included 5729 older migrants who participated in the 2017 China Migrants Dynamic Survey. The independent variables included four components: demographic and socioeconomic characteristics, migration factors, public health service utilization, and social integration factors. Data were analyzed using the chi-square test for single factors and a binary logistic regression model for multiple factors.

RESULTS

A total of 1749 older migrants received mental health education, for a receipt rate of 30.53%. Regression analysis showed that older migrant individuals who had an average monthly household income > 3000 CNY, self-rated their health as healthy, had chronic diseases, had heard of National Basic Public Health Services, had established health records, received ≥2 types of health education were willing to integrate into the local population, and were highly involved in the community were more likely to receive mental health education. Older migrants who were ≥ 70 years old, had an elementary school education or below, had difficulties in the local community, had migrated ≥11 years prior, moved for their offspring, and moved across provinces were less likely to receive mental health education.

CONCLUSIONS

The older migrant population does not receive sufficient mental health education. Mental health interventions should be tailored to the characteristics of older migrants to increase their mental health literacy and meet their psychological needs.

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.

Evaluation of the Conversations about Non-Suicidal Self-Injury Mental Health First Aid Course: Effects on Knowledge, Stigmatising Attitudes, Confidence and Helping Behaviour

BACKGROUND

Non-suicidal self-injury (NSSI) is a common mental health problem, with a 19% lifetime prevalence in Australian adolescents and 12% in adults. Though rates of professional help-seeking for NSSI are low, disclosure to family and friends is more common, providing opportunities for them to encourage professional support. Mental Health First Aid® Australia's Conversations about Non-Suicidal Self-Injury course provides evidence-based training for the general public to support a person engaging in NSSI.

METHODS

This uncontrolled trial evaluated the effects of the Conversations about Non-Suicidal Self-Injury course on participants' knowledge, confidence, stigmatising attitudes, and intended and actual helping behaviours. Surveys were administered pre- and post-course, and at a six-month follow-up. A linear mixed-model analysis determined mean change over time, and effect sizes were estimated using Cohen's d. Course satisfaction was assessed using descriptive statistics and summative content analysis of qualitative data.

RESULTS

The pre-course survey was completed by 147 Australian participants (77.5% female, mean age 45.8 years), 137 (93.2%) at post-course and 72 (49%) at follow-up. Knowledge, confidence, quality of intended helping behaviours, and quality of actual helping behaviours increased significantly at both time points. Social distance decreased significantly at all time points and stigma decreased significantly at post-course. The course was perceived to be highly acceptable by participants.

CONCLUSIONS

There is initial evidence that the Conversations about Non-Suicidal Self-Injury course is effective and acceptable for members of the public who may support a person engaging in NSSI.

Web-Based Mind-Body Tactical Resilience Training Program for First Responders: Pre-Post Study Assessing Feasibility, Acceptability, and Usability

BACKGROUND

First responders report elevated rates of mental disorders, including posttraumatic stress disorder (PTSD), yet many are reluctant to seek care. Preventative resilience training programs attempt to proactively address this issue, and there is evidence showing promise for programs targeting cognitive processes. However, these programs rarely address the physical health conditions associated with PTSD. There is emerging evidence of mind-body exercise training improving PTSD symptoms as well as its associated physical health symptoms. However, the feasibility and acceptability of delivering a web-based mind-body resilience training among first responders are not yet known.

OBJECTIVE

This study aimed to evaluate the feasibility, usability, and acceptability of a web-based mind-body tactical resilience training program designed for first responders. In addition, we explored the preliminary effectiveness of the training program on mental health outcomes, adaptive cognitive strategies, and work productivity.

METHODS

A total of 42 first responders based in the United States enrolled in the web-based training program. Participants were administered web-based surveys before enrolling in the 6-week web-based program and at the end of the program. The primary outcomes of feasibility were measured using the number of training hours, program adherence rates, and self-reported data on frequency of practice. Acceptability and usability were measured using self-reported data. Secondary outcomes were symptoms of PTSD, psychological distress, emotion regulation, stress mindset, psychological preparedness, and work performance.

RESULTS

Overall, the training program was feasible based on the median number of training hours spent on the web-based program (7.57 hours out of an expected total of 6 to 9 hours), and 55% (23/42) of the enrolled participants completed more than half of the program. Although acceptability, usability, and frequency of practice were rated as high, this was based on only 29% (12/42) of the respondents who provided follow-up data. Secondary outcomes showed a significant improvement in the adaptive cognitive strategy of the stress mindset, with a mean difference of -5.42 (SD 4.81; 95% CI -8.475 to -2.358; t₁₁=-3.898; P=.002). All other secondary outcomes were not significant. However, the secondary outcomes were exploratory only, and this study was neither designed nor powered to adequately assess efficacy.

CONCLUSIONS

These findings suggest that a mind-body tactical resilience training program delivered in a web-based format is feasible and acceptable among first responders; however, further refinements may be required to improve adherence rates. Further research using a larger, more rigorous trial design is warranted to examine the effectiveness of this type of training as a possible prevention or treatment strategy for this population.

Evaluation of a training program to support the implementation of a community pharmacist-led support service for people living with severe and persistent mental illness

BACKGROUND

With appropriate training, community pharmacists can support people living with severe and persistent mental illness (SPMI) by identifying and managing medication-related issues and physical health concerns. The Bridging the Gap between Physical and Mental Illness in Community Pharmacy (PharMIbridge) randomized controlled trial (RCT) tested the impact of an individualized, pharmacist-led support service for people living with SPMI.

OBJECTIVE(S)

To evaluate the impact of the PharMIbridge training program on pharmacy participants' knowledge and confidence, as well as stigma and attitudes, in relation to supporting, and providing services to, people living with SPMI; compared to Mental Health First Aid (MHFA) training alone.

METHODS

Pharmacy staff (n = 140) from 55 community pharmacies across four RCT regions attended face-to-face training. Both intervention group (IG) and comparator group (CG) participants received MHFA training while IG participants received additional PharMIbridge training, involving role-plays and mental health consumer educators (MHCEs). A questionnaire including validated instruments was administered at baseline, after training and after 12 months. Comparative analyses included paired t tests and mixed between/within analysis of variance (ANOVA).

RESULTS

Pre and post-training surveys were completed by 136 participants, most of which were pharmacists. Both IG and CG participants had significant reductions in stigma (P < 0.001) post-training. IG participants' confidence and knowledge regarding metabolic monitoring significantly improved compared to CG (P < 0.001). IG participants were significantly more confident and comfortable in providing medication counseling, compared to CG participants (P < 0.05).

CONCLUSION

MHFA training reduced participants' stigma toward mental health. However, the purpose-designed PharMIbridge training program provided pharmacists with additional knowledge and skills to confidently support the physical health care needs of people living with SPMI. The inclusion of role-plays and MHCEs allowed pharmacists to self-reflect and practice skills in safe, supportive environments. Future studies should continue to involve MHCEs in pharmacy training and explore whether these improvements are sustainable.

The Effectiveness of Mental Health First Aid Training among Undergraduate Students in Switzerland: A Randomized Control Trial

Half to three-fourths of mental disorders appear during adolescence or young adulthood, and the treatment gap is mainly due to lack of knowledge, lack of perceived need, and the stigmatization of mental illness. The aims of this study were to implement and evaluate a Mental Health First Aid (MHFA) training program among undergraduates. Participants were second-year students from two universities in the French-speaking region of Switzerland (N = 107), who were randomly assigned to an intervention group (n = 53) or control group (n = 54). The intervention group received a 12-h MHFA course. Online questionnaires were completed before the intervention (T0), and both 3 months (T1) and 12 months (T2) after the intervention in order to evaluate the participants' mental health knowledge, recognition of schizophrenia, and attitudes and behaviors towards mental illness. We used Generalized Estimating Equations (GEE) to examine the effects of intervention over time. After the MHFA course, the intervention group showed significantly increased basic knowledge and confidence helping others with mental illness and reduced stigmatization at both T1 and T2 compared to their baseline scores and compared to control groups. This suggests that the MHFA training program is effective and has significant short-term and long-term impacts, in terms of enhancing basic knowledge about mental health and improving attitudes towards mental illness among undergraduate students.

Understanding the Association Between Mental Health Knowledge and Mental Health Service Utilization Among Black Adults

Mental health knowledge limitations may contribute to the treatment gap among Black adults. We conducted an online cross-sectional study of Black adults in the United States (n = 262, aged 18-65 years) from diverse ethnic backgrounds (African-Americans, African immigrants, Afro-Caribbean immigrants). Gamma regression using generalized linear models was used to estimate the associations between mental health knowledge and willingness to seek help from mental health professionals. After adjusting for age, education and ethnicity, participants with higher specific knowledge about mental health (such as recognition of schizophrenia as a mental illness) were 26% more likely to report willingness to seek help from a mental health professional for personal and emotional problems (RR = 1.26, CI 1.12-1.41, p < 0.001). Knowledge building interventions (such as psychoeducation) that seek to increase specific knowledge (rather than general knowledge) may correlate more strongly with utilization of mental health services among Black adults.

Implementation and evaluation of a juvenile mental health training for law enforcement in a medium-sized jurisdiction

The need for specialized training programs that are focused on youth mental health needs, awareness of community-based services, and de-escalation skills is growing across law enforcement agencies due to calls for service that involve youth in mental health crisis. The current study evaluates a juvenile mental health training for law enforcement that was developed based on agency needs. The training was completed by 159 officers and a pre-/post-test design was used. Findings suggest that officers were satisfied with the training and improvements were seen across several training constructs (confidence, preparedness, stigma, resource awareness, and de-escalation skills). Satisfaction with the training predicted change in confidence and preparedness. Recommendations for future research and the implementation of juvenile mental health trainings are discussed.

Behavioral Crisis and First Response: Qualitative Interviews with Chicago Stakeholders

Improving interactions between first responders and individuals experiencing behavioral crisis is a critical public health challenge. To gain insight into these interactions, key informant qualitative interviews were conducted with 25 Chicago stakeholders. Stakeholders included directors and staff of community organizations and shelters that frequently engage first responders. Interviews included granular depictions related to the expectations and outcomes of 911 behavioral crisis calls, and noted areas requiring improved response. Stakeholders called 911 an average of 2 to 3 times per month, most often for assistance related to involuntary hospitalization. Engagements with first responders included unnecessary escalation or coercive tactics, or conversely, refusal of service. While stakeholders lauded the value of police trained through the city's Crisis Intervention Team program, they emphasized the need for additional response strategies that reduce the role of armed police, and underscored the need for broader social and behavioral health services for individuals at-risk of such crises.

"Decoding MH"-A de-stigmatization campaign in the Hong Kong Police Force

Police officers are under high level of stress given the intense and emergent work nature. If left untreated, their mental wellbeing would be at risk and work performance compromised. However, mental health stigma is common among police officers and is perpetuated by factors like police cultures emphasizing toughness and self-reliance. In view of this, since 2016, the Hong Kong Police Force had launched a holistic campaign for Force members which was the first among law enforcement organizations in Hong Kong, aiming to reduce stigma, by enhancing mental health knowledge and decreasing negative attitudes and behaviors towards mental health issues. The programme incorporated standardised trainings of the Mental Health First Aid course with examples modified to the local police context, and psychoeducation via the use of digital medium and sharing by public figures. Positive feedback was received. It was foreseen that the campaign effects would increase Force members' awareness of their mental health, encourage help-seeking and facilitate officers' decision making when encountering crises in the community.

Examining mental health knowledge, stigma, and service use intentions among Royal Canadian Mounted Police cadets

Background

Royal Canadian Mounted Police (RCMP) officers experience an elevated risk for mental health disorders due to inherent work-related exposures to potentially psychologically traumatic events and occupational stressors. RCMP officers also report high levels of stigma and low levels of intentions to seek mental health services. In contrast, very little is known about the levels of mental health knowledge and stigma of RCMP cadets starting the Cadet Training Program (CTP). The current study was designed to: (1) obtain baseline levels of mental health knowledge, stigma against peers in the workplace, and service use intentions in RCMP cadets; (2) determine the relationship among mental health knowledge, stigma against peers in the workplace, and service use intentions among RCMP cadets; (3) examine differences across sociodemographic characteristics; and (4) compare cadets to a sample of previously surveyed serving RCMP.

Methods

Participants were RCMP cadets (n = 772) starting the 26-week CTP. Cadets completed questionnaires assessing mental health knowledge, stigma against coworkers with mental health challenges, and mental health service use intentions.

Results

RCMP cadets reported statistically significantly lower levels of mental health knowledge (d = 0.233) and stigma (d = 0.127), and higher service use intentions (d = 0.148) than serving RCMP (all ps < 0.001). Female cadets reported statistically significantly higher scores on mental health knowledge and service use and lower scores on stigma compared to male cadets. Mental health knowledge and service use intentions were statistically significantly positively associated. For the total sample, stigma was inversely statistically significantly associated with mental health knowledge and service use intentions.

Conclusion

The current results indicate that higher levels of mental health knowledge were associated with lower stigma and higher intention to use professional mental health services. Differences between cadets and serving RCMP highlight the need for regular ongoing training starting from the CTP, designed to reduce stigma and increase mental health knowledge. Differences between male and female cadets suggest differential barriers to help-seeking behaviors. The current results provide a baseline to monitor cadet mental health knowledge and service use intentions and stigma as they progress throughout their careers.

Feasibility of recruitment and retention in a remote trial of gatekeeper training for close supports of military veterans: Mixed methods study

Background

VA S.A.V.E. (Signs; Ask; Validate; Encourage/Expedite) is a gatekeeper training, designed to teach individuals how to identify and assist military veterans at risk for suicide. The aim of this pilot was to determine feasibility, barriers, and facilitators of recruitment and retention in a remote trial of VA S.A.V.E.

Methods

We recruited close supports (family and friends) of veterans through Facebook sponsored ads, automatically randomized them to VA S.A.V.E. or an unrelated video training, and followed them for six months. A subgroup completed interviews, and we used a mixed methods framework to integrate quantitative and qualitative findings.

Results

Of 214 participants, 61% were spouses or partners of veterans and 48% knew at least one veteran who had died by suicide. Of the three a priori feasibility benchmarks, two were achieved (enrollment, on average, of twenty participants per week and less than 50% loss to follow-up at the 6-month study endpoint) and one was not (enrollment of at least 50% of eligible individuals). There were three barriers (generic ads, ad text referring to "research," and Facebook as an ad platform) and five facilitators (audience segmentation focused on veterans' family members and friends, an urgent call to action to help a veteran, prior exposure to suicide, emphasizing the benefit of receiving training, and using a university as the campaign messenger) to study participation.

Conclusion

A fully remote trial of VA S.A.V.E. gatekeeper training was feasible in a population of close supports of veterans. Several strategies may further enhance study participation.

Assessing the Utility of Mental Health First Aid Training for Physician Assistant Students

INTRODUCTION

Physician assistant (PA) students are at increased risk for anxiety and depression compared with the general population. The demands of studying medicine can contribute to a decline in mental health, which may impede a student's ability to progress in his or her PA program. Mental Health First Aid (MHFA) is one strategy that can be used to increase mental health literacy, promote help-seeking behavior, reduce stigma, and improve confidence in providing help to individuals showing signs of a mental health disorder. The aim of this outcomes assessment was to assess PA students' satisfaction with the MHFA course and their posttraining confidence in using the skills learned.

METHODS

Participants were PA students (N = 435) across 9 PA programs in their didactic year of training who had completed an MHFA course through the PA Foundation's Mental Health Outreach Fellowship. MHFA postcourse evaluations, completed by the PA students, were analyzed to determine PA students' satisfaction with the course and their posttraining confidence in using the skills learned to help both themselves as well as the general population.

RESULTS

The mean of the MHFA course evaluation items corresponding to satisfaction with the course was 4.82 (maximum score of 5), and the mean of the items corresponding to posttraining confidence in using the skills learned was 4.74 (maximum score of 5). When asked, "Would you recommend this course to others?" 99.3% of the PA students trained in MHFA answered "yes," indicating a high level of satisfaction with the training they had received.

DISCUSSION

PA students who received MHFA training from the PA Foundation's Mental Health Outreach fellows showed high levels of satisfaction with the MHFA course and posttraining confidence in using the skills learned.

Pharmacists and Mental Health First Aid training: A comparative analysis of confidence, mental health assistance behaviours and perceived barriers

BACKGROUND

Pharmacists are aptly positioned to provide first aid-level assistance to patients experiencing a mental health problem or crisis, yet often lack confidence or perceive barriers to intervention. One potential solution is Mental Health First Aid (MHFA) training-an evidence-based psycho-educational programme. This study evaluates MHFA training within pharmacy by (1) assessing pharmacists' perceptions of the prevalence of patients experiencing a mental health-related problem or crisis, (2) investigating whether MHFA is associated with increased confidence, intervention and assistance quality and (3) examining perceived intervention barriers.

METHODS

Pharmacists working in Australia were surveyed. The survey included validated measures and research objectives were assessed using descriptives and ANOVAs.

RESULTS

One hundred sixty-one pharmacists were included; 90 MHFA trained and 71 untrained. Overall, 86% of reported encountering at least one patient perceived to be experiencing a mental health problem or crisis in the last year. MHFA trained pharmacists reported being more confident, with notable differences in their confidence to recognize signs, approach and ask someone about suicide. Pharmacists did not intervene ~25% of the time in which a problem/ crisis was identified. When they did intervene, results suggest the assistance was similar in content. Intervention barriers were reported to impede MHFA trained pharmacists significantly less than untrained pharmacists.

CONCLUSION

Results suggest pharmacists frequently encounter patients experiencing a mental health problem or crisis and that MHFA training may support pharmacists in helping these patients. Future research can utilize experimental methods to provide causal evidence as to the utility of MHFA training for pharmacists and patients.

Selected Texan K-12 Educators' Perceptions of Youth Suicide Prevention Training

K-12 school personnel may be frontline responders for youth contemplating suicide or other harmful behaviors. Therefore, the purpose of this preliminary study was to determine selected K-12 educators' perceptions of youth suicide prevention (YSP) training. A longitudinal trend survey with repeated measures and proportionally stratified random samples of K-12 personnel from nine Texas independent school districts provided data. Participants' perceived knowledge of the YSP content showed significant appreciative gains between pre- and follow-up post-tests. Likewise, their confidence levels for helping students at risk of suicide and approaching other adults to talk about students at risk of suicide rose significantly between pretests and follow-up post-tests. This preliminary study reinforces the value of training educators to acquire content knowledge and confidence boosting opportunities for engagement in difficult dialogue about suicidality. YSP training helped improve educators' confidence to engage with others about students' mental health concerns, calling attention to the importance of identifying early warning signs that may aid in early support and prevention of youth mental health concerns.

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.

Overview of a Pilot Health-focused Reentry Program for Racial/Ethnic Minority Probationers ages 18 to 26 in Southern California

There is a significant gap in reentry programming that is tailored to the needs of young adults ages 18 to 26 who are in a unique developmental life stage that involves ongoing maturity in their neurobiology, cognitive development, and social and financial transitions to adulthood and independence. This article describes the structure and approach of a 6-month health-focused reentry program designed for racial/ethnic minority young adult (YA) probationers in Southern California. The UCSD RELINK program includes service navigation and an optional psychoeducation health coaching program to build health literacy, problem-solving, and executive functioning skills relevant across multiple life domains. We describe participant characteristics and service needs at intake. Between 2017 and 2019, 122 YA probationers ages 18 to 26 responded to interviewer-administered baseline surveys. Participants needed basic services including housing, nutrition assistance, employment, and educational/vocational training. Depression and anxiety symptoms, Adverse Childhood Events, trauma, and unmet physical and mental health care needs were pervasive. Given the dearth of research on reentry programming for YA, this article documents the approaches taken in this multi-pronged health-focused reentry program to ensure that the program was tailored to YA reentrants' comprehensive needs. These data serve to concretely illustrate the range of needs and how YA reentrants view their own health and social needs in the context of multiple competing demands; such data may be useful for program planners and policymakers seeking to advance service delivery for YA minority reentrants.

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.

Trauma Functioning and Well-Being in Children Who Receive Mental Health Aid after Natural Disaster or War

Background: There is worldwide consensus that providing secondary prevention to promote resilience and prevent mental health concerns after a disaster is important. However, data supporting this kind of intervention is largely lacking. The current study evaluates the effectiveness of OperationSAFE, an early intervention for children after community-wide trauma. Methods: Secondary data analyses of data collected during 158 OperationSAFE camps (a five day camp with a curriculum focused on coping with stressors) in five countries and ten disasters between 2015 and 2020 were performed. Data on child trauma-related functioning/well-being were collected by an OperationSAFE in-house developed symptom checklist and completed by counselors about children on the first and last day of the 5-day camp. Results: A total of 16,768 children participated in the camps (mean age 9.4 ± 2.36; 50% male). Trauma-related functioning/well-being improved from day 1 to day 5 (b = 8.44 ± 0.04; p < 0.0001). Older children improved more (b = 0.22 ± 0.01; p < 0.0001). Children in man-made ongoing trauma (war/refugees) situations responded stronger than those after natural disasters (b = 2.24 ± 0.05; p < 0.0001). Negligible effects for gender and the number of days between a traumatic event and the start of camp were found. Conclusions: This is the first study to show in a large and diverse sample that secondary prevention to promote resilience and prevent mental health concerns after a disaster for children is associated with improvements in trauma-related functioning/well-being. Delaying delivery of the intervention did not affect outcomes. Given the uncontrolled nature of the study and lack of long-term outcomes, more studies are needed to corroborate the current findings.

Evolution of Therapeutic Patient Education: A Systematic Scoping Review and Scientometric Analysis

Therapeutic patient education (TPE) aims to empower the patients and their caregivers to effectively care for and manage their conditions. Such educational programs have been shown to improve health behaviors, disease outcomes, and quality of life among different patient populations. The field of TPE has evolved extensively over decades, owing to interdisciplinary research. No study so far has been done to map this field, to identify the stakeholders and gaps requiring future research. By leveraging the theory of co-citation, CiteSpace was used to visualize the bibliographic data pertaining to TPE research. A total of 54,533 articles published in English language were analyzed to identify influential funders, regions, and institutes contributing to this field. Besides these, significant theoretical and empirical contributions that shaped this field were mapped. Our analysis revealed several important insights. Most of the important theories that helped shape TPE were inspired from the social sciences. Five important research themes were identified: disorders, study designs utilized in TPE research, the scope of the TPE literature and outcomes, and populations. The research focused on improving perceptions, behaviors, and attitudes toward health promotion, reducing stigma, self-management and medication adherence. Most of the research was developed in the context of high-income countries. Future research should involve patients and use digital technology. Meta-analytical studies need to be done to identify the effectiveness and moderators of TPE interventions across different disorders. Further research should involve low and middle-income countries (LMIC) to ensure knowledge and technology transfer.

A comparison of knowledge and attitude toward mental illness among secondary school students and teachers

Aim

The current study aimed to assess and compare the level of knowledge and attitude towards mental illness between secondary school students and their teachers in Oman.

Methods

An online survey was carried out to collect data from 400 students and 411 teachers about their knowledge and attitudes toward people with mental illness. Two independent case studies about depression and schizophrenia were also tested.

Results

Students have a poor knowledge of mental illness compared with their teachers, as more than half scored less than 60% compared with 16.5% of the teachers. More than two-thirds of the students (80%) and teachers (76.4%) have a low or minor positive attitude toward people with mental illness. The study identified significant differences in knowledge in favour of teachers, although the opposite was found regarding attitudes.

Conclusions

Since students spend a significant amount of time in school, bridging the gap between teachers' and students’ knowledge and attitudes toward mental illness is an essential part in enhancing the knowledge and attitudes of the students. In addition, knowledgeable teachers with positive attitude can assist in early identification of mental illnesses and help students when needed. In turn, students who possess knowledge and positive attitude toward mental illness can share their concerns with their teachers. In the presence of such accepting and cooperative environment, the stigma can be decreased and early detection of mental illness and help-seeking behaviour can be promoted.

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.