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Mental Health First Aid is Unproven yet SAMHSA Subsidized

As part of his “Now is the Time” initiative in response to the shootings at Newtown, President Obama announced support for a  $15 million dollar Mental Health First Aid Program. Mental Health First Aid is a commercially available training program created in Australia and now sold by the National Council for Community Behavioral Healthcare, the Maryland Department of Health and Mental Hygiene, and the Missouri Department of Mental Health to non-profits in the United States. The training program teaches people to identify the symptoms of mental illness in others and connect them to help. It also licenses others to be trainers for a fee. Participants get a certificate saying they received the training.

SAMHSA maintains a National Registry of Evidence Based Practices (NREPP).  Several programs are identified as evidence based to help people with mental illness. Mental Health First Aid was recently added to the list. The three studies SAMHSA relied on to determine it was evidence based were all done by the owners/vendors of the program: Betty Kitchener or Anthony F. Jorm. The three studies SAMHSA relied on evaluated how those trained to identify symptoms of mental illness felt.  This research found that those who received the training, felt they could recognize symptoms of schizophrenia and depression, they learned about mental health support and treatment resources; they felt a reduce distance between themselves and individuals with mental health problems; they felt confident they could help someone with mental health issues; and their own mental health improved.

None of the studies evaluated outcomes for people with mental illness. 

There is not evidence Mental Health First Aid has an impact on persons with mental illness.

As the owners of the intervention pointed out

 Conclusions: Although MHFA training has been found to change knowledge, attitudes and helping behaviours, and even benefit the mental health of participants, there has not yet been an evaluation of the effects on those who are the recipients of the first aid. (Betty A. Kitchener, Anthony F. Jorm, “Mental health first aid training: review of evaluation studies”  Australian and New Zealand Journal of Psychiatry 2006; 40:6–8) (Footnote 4)

The studies only show that the program made those trained feel better, more informed, and have less stigmatizing attitudes. (Footnote 1) They did not show any benefits for persons with mental illness or increased referrals of persons with mental illness for treatment. A 2005 study acknowledged, “Perhaps the most important unanswered question is the benefits of being a recipient of MHFA.” In other words, does having people trained to identify mental illness benefit people with mental illness?  No research has yet been done on that question. Likewise the most recent study did not report benefits for persons with mental illness. (Footnote 2) There is no evidence Mental Health First Aid benefits people with mental illness.

SUPPORTERS

Mental Health First Aid USA is managed, operated, and disseminated by three national authorities all of whom receive funds from SAMHSA– the National Council for Community Behavioral Healthcare (Footnote 3) , the Maryland Department of Health and Mental Hygiene, and the Missouri Department of Mental Health. Only the national authorities can train and certify instructors to teach the 12-hour Mental Health First Aid USA course in local communities. They support Mental Health First Aid.

Additional Research

Mental Illness Policy Org looked deeper than SAMHSA did. We found 55 studies related to Mental Health First Aid. (3/2013 PubMed search below). But 36 were authored or co-authored by the founders and owners of the approach, Betty Kitchener or Anthony F. Jorm. All were consistent with those relied on by SAMHSA: they showed people who participated in the training felt better about themselves after receiving the training, but did not show benefits to people with mental illness.

For example, one study that does not appear to be connected with the vendors of the program was funded by NIMH:  “Mental Health First Aid for college students: A multi-campus randomized control trial” Daniel Eisenberg, Ph.D.,Nicole Speer, Ph.D., NIMH Grant 1RC1MH089757-01 (2011?).This grant was awarded on 09/23/2009 for the amount of $988,937.  It was funded out of Recovery Act funds.  It appears to have been completed by September 30, 2011.

 It trained “Resident Advisors” in college dormitories. Among the findings:

  • “There were no reported changes in referrals for mental health services from RAs, or reported increases in intereactions with RAs." 
  • “The preliminary results do not show any reported influence of the intervention on RAs’ interactions with students. Reports of interventions with students did not increase in treatment residence halls (referring students to the counseling center or other professionals); RAs in treatment halls were equally likely to help students with a crisis situation as those in control residence halls, and RAs in control and treatment halls reported a similar likelihood of approaching a student having significant mental health problems. ”

SAMHSA certified MHFA as an evidence based program in spite of lack of research showing it helps people with mental illness. As a result, states are spending money on this unproven program and proven programs like Asissted outpatient Treatment go unfunded.


Footnote 1: Jorm AF, et al. Mental health first aid training of the public in a rural area: a cluster randomized trial [ISRCTN53887541]. BMC Psychiatry. 2004;4(33):1-9. Kitchener BA, et al. Mental health first aid training in a workplace setting: A randomized and controlled trial [ISRCTNI3249129]. BMC Psychiatry. 2004;4(23):1-8.

Footnote 2: “Mental Health First Aid for college students: A multi-campus randomized control trial” Daniel Eisenberg, Ph.D.,Nicole Speer, Ph.D., NIMH Grant 1RC1MH089757-01 (2011?).

Footnote 3: Mental Illness Policy Org. does not know why President Obama singled out the program for funding. We think it may have been suggested to him by the National Council for Community Behavioral Healthcare one of the USA licensees of the program and/or SAMHSA which has historically supported non-evidence based interventions.

Footnote 4: In one study those who received training said there own mental health improved, but the goal of the program is to get others into treatment. There is no data on mental illness.


Mental Health First Aid (MHFA) Related Studies

36 of the of the 55 following studies were conducted by the vendors of MHFA, Betty A. Kitchener and Anthony F. Jorm. The program ostensibly teaches people to identify symptoms of depression and schizophrenia that those without training can not. Completing the course gets you a certificate. Research does not show that training people to identify those so asymptomatic others may not recognize the problem, leads to any different outcomes for those with mental illness. Put another way, the trainers feel better, but that is the only outcome. In spite of that, MHFA is certified by SAMHSA as an evidence based program.

1. Seishin Shinkeigaku Zasshi. 2012;114(11):1284-90.

Supporting caregivers for people with alcohol-related problems ways to listen, support, and link with care.

Aoyama-Uehara K.[Article in Japanese] Kanagawa Psychiatric Center Serigaya Hospital.

Local caregivers such as psychiatric service providers, mental health welfare workers, and nursing-care staff have a major role to play in the long-term support of survivors of the Great Eastern Japan Earthquake of March 11th, 2011.

Alcohol-related problems often cause various problems mentally, physically, economically, and socially. Alcoholics tend to show violent behavior, deny their own alcoholism, cause codependency in significant others, and occasionally relapse. Local caregivers bear the burden of caring for them and feel responsible for their relapse. This leads to exhaustion and discomfort with caring for them.

In order to provide continuous and effective support for people with alcohol-related problems, it is important for caregivers to know the nature of the illness, the means and stages of recovery, effective support strategies, and how to enjoy providing support. A Leadership Training course on "Mental Health First Aid (MHFA)" was held in November 2011 for caregivers in Iwate Prefecture.

MHFA provides help for people suffering from a mental health problem or in a mental health crisis, developed in Australia by Betty A. Kitchener and Anthony F. Jorm.

In 2006, the MHFA-Japan (MHFA-J) Project Team translated the program and modified it to fit Japanese culture. The action plan consists of 5 part: 1) Approach the person, assess and assist with any crises, 2) Listen non-judgmentally, 3) Give support and information, 4) Encourage the person to get appropriate, professional help, 5) Encourage other support/self-help. During the leadership training course, MHFA for anxiety disorder, depression, suicidal thoughts, and alcohol-related problems was introduced, as well as how to train caregivers in experience-based and participatory approaches. The session for alcohol-related problems focused on the process of recovery, including how to deal with relapse, how to listen, how to motivate patients, and how to enjoy being a caregiver. There was also a role-play with two different scenarios: one with a confrontational interview and one with an MHFA-styled interview using a motivational approach.

In February 2012, two other seminars focused on alcohol-related problems among the elderly and how to organize a case conference to incorporate requests from participants of the leadership training course. In order to provide long-term support to local caregivers, it is important to convey strategies that focus on caring for others comfortably.

PMID: 23367838  [PubMed - in process]

 

2. J Nepal Health Res Counc. 2012 Sep;10(22):258-60.

Mental health first aid programme in Nepal.

Jha A, Kitchener BA, Pradhan PK, Shyangwa P, Nakarmi B.

Nepalese Doctors' Association (UK), Hertfordshire, UK. arunjha@hotmail.co.uk

Mental Health First Aid is a relatively new concept conceived in Australia about 10 years ago and by 2010 it has spread to 15 other countries including Nepal. It is designed to deal with mental health emergencies as well as to help people with developing mental health problems to get to appropriate help before a crisis occurs. This programme was launched in Kathmandu by SAF-Nepal in November 2010 when the Australian experts ran a workshop for over 22 delegates from various mental health organisations. The MHFA Nepal course is being evaluated and adapted to suit Nepalese context. New conditions including hysteria and epilepsy have been added in the Nepalese version. The programme is expected to raise mental health awareness and reduce stigmatising attitudes amongst the selected members of the general public and health professionals.

PMID: 23281463  [PubMed - in process]

 

3. CMAJ. 2012 Nov 20;184(17):E891-2. doi: 10.1503/cmaj.109-4298. Epub 2012 Oct 22.

The boundaries of mental health first aid.

Monette M.

PMCID: PMC3503918
PMID: 23091177  [PubMed - indexed for MEDLINE]

 

4. BMC Psychiatry. 2012 Aug 2;12:98. doi: 10.1186/1471-244X-12-98.

Mental health first aid for eating disorders: pilot evaluation of a training program for the public.

Hart LM, Jorm AF, Paxton SJ.

Melbourne School of Population Health, University of Melbourne, Parkville, VIC, Australia. lhart@unimelb.edu.au

BACKGROUND: Eating disorders cause significant burden that may be reduced by early and appropriate help-seeking. However, despite the availability of effective treatments, very few individuals with eating disorders seek treatment.

Training in mental health first aid is known to be effective in increasing mental health literacy and supportive behaviours, in the social networks of individuals with mental health problems. Increases in these domains are thought to improve the likelihood that effective help is sought. However, the efficacy of mental health first aid for eating disorders has not been evaluated. The aim of this research was to examine whether specific training in mental health first aid for eating disorders was effective in changing knowledge, attitudes and behaviours towards people with eating disorders.

METHODS: A repeated measures, uncontrolled trial was conducted to establish proof of concept and provide guidance on the future design of a randomised controlled trial. Self-report questionnaires, administered at baseline, post-training and 6-month follow-up, assessed the effectiveness of the 4-hour, single session, mental health first aid training.

RESULTS: 73 participants completed the training and all questionnaires. The training intervention was associated with statistically significant increases in problem recognition and knowledge of appropriate mental health first aid strategies, which were maintained at 6-month follow-up. Sustained significant changes in attitudes and behaviours were less clear. 20 participants reported providing assistance to someone with a suspected eating disorder, seven of whom sought professional help as a result of the first aid interaction. Results provided no evidence of a negative impact on participants or the individuals they provided assistance to.

CONCLUSIONS: This research provides preliminary evidence for the use of training in mental health first aid as a suitable intervention for increasing community knowledge of and support for people with eating disorders to seek appropriate help.

TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12611001181998.

PMCID: PMC3549729
PMID: 22856517  [PubMed - in process]

 

5. Int J Ment Health Nurs. 2013 Feb;22(1):85-92. doi: 10.1111/j.1447-0349.2012.00844.x. Epub 2012 Jul 12.

Evaluation of mental health first aid training in a diverse community setting.

Morawska A, Fletcher R, Pope S, Heathwood E, Anderson E, McAuliffe C.

Parenting and Family Support Centre, School of Psychology, The University of Queensland, Australia. alina@psy.uq.edu.au

Mental health first aid (MHFA) training has been disseminated in the community and has yielded positive outcomes in terms of increasing help-seeking behavior and mental health literacy. However, there has been limited research investigating the effectiveness of this programme in multicultural communities. Given the increasing levels of multiculturalism in many countries, as well as the large number of barriers presented to these groups when trying to seek help for mental illnesses, the present study aimed to investigate the effectiveness of MHFA in these settings. A total of 458 participants, who were recruited from multicultural organizations, participated in a series of MHFA training courses.

Participants completed questionnaires pre and post the training course, and 6-month follow-up interviews were conducted with a subsample of participants. Findings suggested that MHFA training increased participant recognition of mental illnesses, concordance with primary care physicians about treatments, confidence in providing first aid, actual help provided to others, and a reduction in stigmatizing attitudes. A 6-month follow up also yielded positive long-term effects of MHFA. The results have implications for further dissemination and the use of MHFA in diverse communities. In addition, the results highlight the need for mental health training in health-care service providers.

© 2012 The Authors. International Journal of Mental Health Nursing © 2012
Australian College of Mental Health Nurses Inc.

PMID: 22783922  [PubMed - in process]

 

6. Early Interv Psychiatry. 2012 Nov;6(4):399-406. doi: 10.1111/j.1751-7893.2012.00345.x. Epub 2012 Mar 1.

Mental health first aid guidelines: an evaluation of impact following download from the World Wide Web.

Hart LM, Jorm AF, Paxton SJ, Cvetkovski S.

Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria,
Australia. lhart@unimelb.edu.au

AIM: Mental health first aid guidelines provide the public with consensus-based information about how to assist someone who is developing a mental illness or experiencing a mental health crisis. The aim of the current study was to evaluate the usefulness and impact of the guidelines on web users who download them.

METHOD: Web users who downloaded the documents were invited to respond to an initial demographic questionnaire, then a follow up about how the documents had been used, their perceived usefulness, whether first-aid situations had been encountered and if these were influenced by the documents.

RESULTS: Over 9.8 months, 706 web users responded to the initial questionnaire and 154 responded to the second. A majority reported downloading the document because their job involved contact with people with mental illness. Sixty-three web users reported providing first aid, 44 of whom reported that the person they were assisting had sought professional care as a result of their suggestion.  Twenty-three web users reported seeking care themselves. A majority of those who provided first aid reported feeling that they had been successful in helping the person, that they had been able to assist in a way that was more knowledgeable, skilful and supportive, and that the guidelines had contributed to these outcomes.

CONCLUSIONS: Information made freely available on the Internet, about how to provide mental health first aid to someone who is developing a mental health problem or experiencing a mental health crisis, is associated with more positive,empathic and successful helping behaviours.

© 2012 Wiley Publishing Asia Pty Ltd.

PMID: 22379952  [PubMed - in process]
 
7. Psychiatry Res. 2012 Apr 30;196(2-3):315-9. doi: 10.1016/j.psychres.2011.10.004.  Epub 2012 Feb 28.

Young people's mental health first aid intentions and beliefs prospectively predict their actions: findings from an Australian National Survey of Youth.

Yap MB, Jorm AF.

University of Melbourne, Parkville, Australia. mbhy@unimelb.edu.au

Little is known about whether mental health first aid knowledge and beliefs of young people actually translate into actual behavior. This study examined whether young people's first aid intentions and beliefs predicted the actions they later  took to help a close friend or family member with a mental health problem.

Participants in a 2006 national survey of Australian youth (aged 12-25 years) reported on their first aid intentions and beliefs based on one of four vignettes: depression, depression with alcohol misuse, psychosis, and social phobia. At a two-year follow-up interview, they reported on actions they had taken to help any family member or close friend with a problem similar to the vignette character since the initial interview. Of the 2005 participants interviewed at follow-up, 608 reported knowing someone with a similar problem.

Overall, young people's first aid intentions and beliefs about the helpfulness of particular first aid actions predicted the actions they actually took to assist a close other. However, the belief in and intention to encourage professional help did not predict subsequent action. Findings suggest that young people's mental health first aid intentions and beliefs may be valid indicators of their subsequent actions.

Copyright © 2012 Elsevier Ltd. All rights reserved.

PMID: 22377574  [PubMed - indexed for MEDLINE]

 

8. J Pak Med Assoc. 2012 Jan;62(1):77-8.

Mental health first aid: need for grass root approach?

Gadit AA.

Discipline of Psychiatry, Memorial University of Newfoundland, Canada.

PMID: 22352113  [PubMed - indexed for MEDLINE]
   

9. Early Interv Psychiatry. 2012 Aug;6(3):229-38. doi: 10.1111/j.1751-7893.2011.00331.x. Epub 2012 Jan 13.

Development of key messages for adolescents on providing basic mental health first aid to peers: a Delphi consensus study.

Ross AM, Hart LM, Jorm AF, Kelly CM, Kitchener BA.

Orygen Youth Health Research Centre, Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia. anross@unimelb.edu.au

AIM: Most young people fail to receive professional treatment for mental disorders; however, they do indicate a preference for sharing problems with peers. This article describes key messages about knowledge and actions to form the basis of a basic mental health first aid (MHFA) course for adolescents to increase recognition of and help seeking for mental health problems by teaching the best knowledge and helping actions a young person can undertake to support a peer with a mental health problem.

METHODS: The Delphi method was used to achieve consensus among Australian and Canadian youth mental health experts regarding the importance of statements that describe helping actions a young person can take, and information they should have, to support a friend with a mental health problem. There were two expert panels, one consisting of 36 youth mental health consumer advocates and the other of 97 Youth MHFA instructors.

Panellists rated each statement according to how appropriate it would be as a basic mental health first aid message for both a junior adolescent (12-15 years) and a senior adolescent (16-18 years).

RESULTS: Out of 98 statements, 78 were endorsed as key basic MHFA messages for junior adolescents and 81 were endorsed for senior adolescents.

CONCLUSION: The study has identified key messages for adolescents on how they can help a peer. These messages will form the basis of the curriculum for an MHFA course for adolescents, which will aim to facilitate early recognition of and help seeking for mental health problems in adolescents.

© 2012 Blackwell Publishing Asia Pty Ltd.

PMID: 22240091  [PubMed - indexed for MEDLINE]

 

10. J Affect Disord. 2012 Feb;136(3):430-42. doi: 10.1016/j.jad.2011.11.006. Epub 2011 Dec 2.

Intentions and helpfulness beliefs about first aid responses for young people with mental disorders: findings from two Australian national surveys of youth.

Yap MB, Reavley NJ, Jorm AF.

Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia. mbhy@unimelb.edu.au

BACKGROUND: Youths are important sources of first aid for people close to them who are experiencing mental health problems, but their skills are not optimal. A better understanding of predictors of young people's first aid intentions and beliefs will facilitate future efforts to improve their mental health first aid skills.

METHODS: Young people's first aid intentions and beliefs were assessed by a national telephone survey of 3746 Australian youth aged 12-25 years in 2006. A similar survey was repeated in 2011 with 3021 youths aged 15-25 years. In both surveys, youths were presented with a vignette portraying depression, psychosis, social phobia, or depression with alcohol misuse in a young person. The 2011survey also included depression with suicidal thoughts and post-traumatic stress disorder. Respondents reported on any past-year experience of mental health problems and treatment, exposure to beyondblue and mental health information at school or work.

RESULTS: The potential value of encouraging professional treatment was not universally recognized, although young people were mostly aware of and reported the intention to take supportive actions. Respondent age, sex, experience of mental health problems, type of mental disorder, and exposure to mental health information at school, work, or beyondblue all predicted some intentions and beliefs. Some improvements in beliefs were observed between surveys.

LIMITATIONS: Actual first aid actions and their helpfulness were not measured.

CONCLUSIONS: Future efforts should target adolescents, males and those with recent mental health problems who had not received help. Beyondblue and schooland work settings may be promising avenues for these efforts.

Copyright © 2011. Published by Elsevier B.V.

PMID: 22137764  [PubMed - indexed for MEDLINE]

 

11. Am Psychol. 2012 Apr;67(3):231-43. doi: 10.1037/a0025957. Epub 2011 Oct 31.

Mental health literacy: empowering the community to take action for better mental health.

Jorm AF.

Orygen Youth Health Research Centre, University of Melbourne, Parkville, Victoria, Australia. ajorm@unimelb.edu.au

For major physical diseases, it is widely accepted that members of the public will benefit by knowing what actions they can take for prevention, early intervention, and treatment. However, this type of public knowledge about mental disorders (mental health literacy) has received much less attention. There is evidence from surveys in several countries for deficiencies in (a) the public's knowledge of how to prevent mental disorders, (b) recognition of when a disorder is developing, (c) knowledge of help-seeking options and treatments available,(d) knowledge of effective self-help strategies for milder problems, and (e)first aid skills to support others affected by mental health problems.

Nevertheless, there is evidence that a range of interventions can improve mental health literacy, including whole-of-community campaigns, interventions in educational settings, Mental Health First Aid training, and information websites.
There is also evidence for historical improvements in mental health literacy in some countries. Increasing the community's mental health literacy needs to be a focus for national policy and population monitoring so that the whole communityis empowered to take action for better mental health.

PMID: 22040221  [PubMed - indexed for MEDLINE]

 

12. J Psychiatr Ment Health Nurs. 2011 Oct;18(8):677-86. doi: 10.1111/j.1365-2850.2011.01719.x. Epub 2011 Mar 13.

Delivering a basic mental health training programme: views and experiences of Mental Health First Aid instructors in Wales.

Terry J.

College of Human and Health Sciences, Swansea University, Carmarthenshire, UK.

j.terry@swansea.ac.uk

Originating in Australia, 'Mental Health First Aid' (MHFA) is a way of providing support to someone who is experiencing a mental health problem before professional help is obtained. Positive evaluations have shown that it both increases confidence while decreasing stigmatizing attitudes. However, the evidence base surrounding the delivery of basic mental health programmes remains  underdeveloped. This descriptive qualitative study explored the views and experiences of 14 MHFA instructors from across Wales through semi-structured interviews, as a means to identify the experience of course delivery from their perspective. Data were collected between January and April 2009. The study found individuals benefited from being an MHFA instructor through increased confidence and self-development.

However, instructors encountered logistical difficulties in course delivery and noted that as attendees related to the course material, they wished to discuss their own mental health problems during the course. This created considerable challenges for instructors, who noted both positive and negative impacts on themselves, and on their expectations of the role of becomingMHFA instructors.

In conclusion, basic mental health training courses must build a clear infrastructure, ongoing quality assurance processes and reliable support  structures to train, support and monitor those delivering them.

© 2011 Blackwell Publishing.

PMID: 21896110  [PubMed - indexed for MEDLINE]

 

 

13. Aust N Z J Psychiatry. 2011 Oct;45(10):808-13. doi: 10.3109/00048674.2011.594785.
Epub 2011 Aug 10.

Noting a landmark achievement: Mental Health First Aid training reaches 1% of Australian adults.

Jorm AF, Kitchener BA.

PMID: 21827342  [PubMed - indexed for MEDLINE]

 

14. Aust N Z J Psychiatry. 2011 Jul;45(7):549-57. doi: 10.3109/00048674.2011.585454.

Impact of mental health first aid training on pharmacy students' knowledge, attitudes and self-reported behaviour: a controlled trial.

O'Reilly CL, Bell JS, Kelly PJ, Chen TF.

Faculty of Pharmacy, Building A15, University of Sydney, New South Wales 2006, Australia. claire.oreilly@sydney.edu.au

OBJECTIVE: The aim of this study was to assess the impact of delivering Mental Health First Aid (MHFA) training for pharmacy students on their mental health literacy and stigma towards mental illness.

METHODS: A non-randomized controlled design was used, with all third year pharmacy students at the University of Sydney (n = 272) in 2009 invited to participate in one of two MHFA training courses, each of 12 hours duration. Of these, 174 students applied for MHFA training, of whom 60 were randomly selected and offered MHFA training. Outcome measures that were completed by all participants in the MHFA and non-MHFA groups before and after the MHFA training included an evaluation of mental health literacy, the 7-item social distance scale, and 16 items related to self-reported behaviour.

RESULTS: The survey instrument was completed by 258 participants at baseline (59 MHFA and 199 non-MHFA) and 223 participants at follow up (53 MHFA and 170 non-MHFA). The MHFA training improved the participants' ability to correctly identify a mental illness (p = 0.004). There was a significant mean decrease in total social distance of 2.18 (SD 3.35) p <0.001 for the MHFA group, indicating less stigmatizing attitudes. There were improvements in recognition of helpful interventions with participants' views becoming more concordant with health professional views about treatments for depression (p = 0.009) and schizophrenia (p = 0.08), and participants were significantly more confident (p < 0.01) to provide pharmaceutical services to consumers with a mental illness following the training.

CONCLUSION: This study demonstrated that MHFA training can reduce pharmacy students' mental health stigma, improve recognition of mental disorders and improve confidence in providing services to consumers with a mental illness in the pharmacy setting.

PMID: 21718124  [PubMed - indexed for MEDLINE]

 

15. J Affect Disord. 2011 Nov;134(1-3):473-7. doi: 10.1016/j.jad.2011.05.039. Epub 2011 Jun 12.

The influence of stigma on first aid actions taken by young people for mental health problems in a close friend or family member: findings from an Australian national survey of youth.

Yap MB, Jorm AF.

Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Australia.

BACKGROUND: Young people are an important source of first aid for mental health problems in people they are close to, but their first aid skills remain inadequate. Research into the factors that influence mental health first aid skills are required to reveal targets for improving these skills. This study examined the influence of stigma on first aid actions taken by young people to help someone close to them with a mental health problem.

METHODS: Participants in a national telephone survey of Australian youth (aged 12-25 years) reported on their stigmatising attitudes based on one of three disorders in vignettes: depression, depression with alcohol misuse, and social phobia. At a two-year follow-up interview, they were asked if they knew a family member or close friend with a problem similar to the vignette character since the initial interview, and those who did reported on the actions taken to help the person.

RESULTS: Of the 1520 participants interviewed at follow up, 507 reported knowing someone with a similar problem. Young people's stigmatising attitudes (weak-not-sick, social distance and dangerousness/unpredictability) influenced their first aid actions.

LIMITATIONS: Social desirability could have affected the assessment of stigma, we could not assess the severity of the first aid recipient's problem or the benefit derived from the first aid provided, and the proportion of variance explained was modest.

CONCLUSIONS: Reducing stigma may help to improve the first aid that people with mental health problems can receive from young people who are close to them.

Copyright © 2011 Elsevier B.V. All rights reserved.

PMID: 21658776  [PubMed - indexed for MEDLINE]

16. Int J Ment Health Syst. 2011 May 19;5:12. doi: 10.1186/1752-4458-5-12.

Mental Health First Aid guidelines for helping a suicidal person: a Delphi consensus study in Japan.

Colucci E, Kelly CM, Minas H, Jorm AF, Suzuki Y.

Centre for International Mental Health, Melbourne School of Population Health, The University of Melbourne, Parkville, Victoria 3010, Australia. ecolucci@unimelb.edu.au.

BACKGROUND: This study aimed to develop guidelines for how a member of the Japanese public should provide mental health first aid to a person who is suicidal.

METHODS: The guidelines were produced by developing a questionnaire containing possible first aid actions and asking an expert panel of 32 Japanese mental health professionals to rate whether each action should be included in the guidelines. The content of the questionnaire was based on a systematic search of the relevant evidence and claims made by authors of consumer and carer guides and websites. The panel members were asked to complete the questionnaire by web survey. Three rounds of the rating were carried and, at the end of each round, items that reached the consensus criterion were selected for inclusion in the guidelines. During the first round, panel members were also asked to suggest any additional actions that were not covered in the original questionnaire (to include items that are relevant to local cultural circumstances, values, and social norms). Responses to these open-ended questions were used to generate new items.

RESULTS: The output from the Delphi process was a set of agreed upon action statements. The Delphi process started with 138 statements, 38 new items were written based on suggestions from panel members and, of these 176 items, 56 met the consensus criterion. These statements were used to develop the guidelines appended to this article.

CONCLUSIONS: There are a number of actions that are considered to be useful for members of the Japanese public when they encounter someone who is experiencing suicidal thoughts or engaging in suicidal behaviour. Although the guidelines are designed for members of the public, they may also be helpful to health professionals working in health and welfare settings who do not have clinical mental health training.

PMCID: PMC3108941 PMID: 21592409  [PubMed]

 

17. J Behav Health Serv Res. 2011 Apr;38(2):143-5. doi: 10.1007/s11414-011-9236-0.

Mental health first aid: a "radical efficiency" in health promotion.

Rosenberg L.

National Council for Community Behavioral Healthcare, Washington DC, USA. MeenaD@thenationalcouncil.org

Comment on     J Behav Health Serv Res. 2011 Apr;38(2):159-69.

PMID: 21373964  [PubMed - indexed for MEDLINE]
   

18. Psychiatry Res. 2011 Jun 30;188(1):123-8. doi: 10.1016/j.psychres.2011.01.014.
Epub 2011 Feb 16.

First aid actions taken by young people for mental health problems in a close friend or family member: findings from an Australian national survey of youth.

Yap MB, Wright A, Jorm AF.

Orygen Youth Health Research Centre, University of Melbourne, Parkville, Victoria, Australia. mbhy@unimelb.edu.au

This study examined the first aid actions taken by young people to help someone they know and care about who was experiencing a mental health problem and the characteristics of the first aid provider (respondent) and recipient which influence these first aid actions. Participants in a national survey of Australian youth (aged 12-25 years) completed a two-year follow-up phone interview based on one of the following disorders in vignettes: depression, depression with alcohol misuse, social phobia and psychosis.

Participants were asked if they knew a family member or close friend who had experienced a similar problem to the vignette character since the initial interview and those who did reported on any actions taken to help the person. Of the 2005 participants interviewed, 609 (30%) reported knowing someone with a similar problem, with depression (with or without alcohol misuse) being the most common problem.

Respondent age and gender, recipient gender, and type of mental health problem, all influenced first aid actions. Findings indicate that peers are a major source of support for young people with mental health problems and underscore some important areas and subgroups of young people to target for interventions to improve young people's mental health first aid skills.

Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

PMID: 21324529  [PubMed - indexed for MEDLINE]

 

19. Int J Ment Health Syst. 2011 Jan 27;5(1):4. doi: 10.1186/1752-4458-5-4.

Youth mental health first aid: a description of the program and an initial evaluation.

Kelly CM, Mithen JM, Fischer JA, Kitchener BA, Jorm AF, Lowe A, Scanlan C.

Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia. ckel@unimelb.edu.au.

BACKGROUND: Adolescence is the peak age of onset for mental illness, with half of all people who will ever have a mental illness experiencing their first episode prior to 18 years of age. Early onset of mental illness is a significant predictor for future episodes. However, adolescents and young adults are less likely than the population as a whole to either seek or receive treatment for a mental illness. The knowledge and attitudes of the adults in an adolescent's life may affect whether or not help is sought, and how quickly. In 2007, the Youth Mental Health First Aid Program was launched in Australia with the aim to teach adults, who work with or care for adolescents, the skills needed to recognise the early signs of mental illness, identify potential mental health-related crises, and assist adolescents to get the help they need as early as possible. This paper provides a description of the program, some initial evaluation and an outline of future directions.

METHODS: The program was evaluated in two ways. The first was an uncontrolled trial with 246 adult members of the Australian public, who completed questionnaires immediately before attending the 14 hour course, one month later and six months later. Outcome measures were: recognition of schizophrenia or depression; intention to offer and confidence in offering assistance; stigmatising attitudes; knowledge about adolescent mental health problems and also about the Mental Health First Aid action plan. The second method of evaluation was to track the uptake of the program, including the number of instructors trained across Australia to deliver the course, the number of courses they delivered, and the uptake of the YMHFA Program in other countries.

RESULTS: The uncontrolled trial found improvements in: recognition of schizophrenia; confidence in offering help; stigmatising attitudes; knowledge about adolescent mental health problems and application of the Mental Health First Aid action plan. Most results were maintained at follow-up. Over the first  3 years of this program, a total of 318 instructors were trained to deliver the course and these instructors have delivered courses to 10,686 people across all states and territories in Australia. The program has also spread to Canada, Singapore and England, and will spread to Hong Kong, Sweden and China in the near future.

CONCLUSIONS: Initial evaluation suggests that the Youth Mental Health First Aid course improves participants' knowledge, attitudes and helping behaviour. The program has spread successfully both nationally and internationally.

TRIAL REGISTRATION: ACTRN12609000033246.

PMCID: PMC3041764 PMID: 21272345  [PubMed]

 

20. BMC Psychiatry. 2011 Jan 5;11:3. doi: 10.1186/1471-244X-11-3.

Helping someone with problem drug use: a Delphi consensus study of consumers, carers, and clinicians.

Kingston AH, Morgan AJ, Jorm AF, Hall K, Hart LM, Kelly CM, Lubman DI.

Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Victoria, Australia.

BACKGROUND: Problem use of illicit drugs (i.e. drug abuse or dependence) is associated with considerable health and social harms, highlighting the need for early intervention and engagement with health services. Family members, friends and colleagues play an important role in supporting and assisting individuals with problem drug use to seek professional help, however there are conflicting views about how and when such support should be offered. This paper reports on the development of mental health first aid guidelines for problem drug use in adults, to help inform community members on how to assist someone developing problem drug use or experiencing a drug-related crisis.

METHODS: A systematic review of the scientific and lay literature was conducted to develop a 228-item survey containing potential first-aid strategies to help someone developing a drug problem or experiencing a drug-related crisis. Three panels of experts (29 consumers, 31 carers and 27 clinicians) were recruited from Australia, Canada, New Zealand, the United Kingdom, and the United States. Panel members independently rated the items over three rounds, with strategies reaching consensus on importance written into the guidelines.

RESULTS: The overall response rate across three rounds was 80% (86% consumers,81% carers, 74% clinicians). 140 first aid strategies were endorsed as essential or important by 80% or more of panel members. The endorsed strategies provide information and advice on what is problem drug use and its consequences, how to approach a person about their problem drug use, tips for effective communication, what to do if the person is unwilling to change their drug use, what to do if the person does (or does not) want professional help, what are drug-affected states and how to deal with them, how to deal with adverse reactions leading to a medical emergency, and what to do if the person is aggressive.

CONCLUSIONS: The guidelines provide a consensus-based resource for community members who want to help someone with a drug problem. It is hoped that the guidelines will lead to better support and understanding for those with problem drug use and facilitate engagement with professional help.

PMCID: PMC3022807 PMID: 21208412  [PubMed - indexed for MEDLINE]

 

21. Int J Ment Health Syst. 2010 Dec 21;4:33. doi: 10.1186/1752-4458-4-33.

Where there is no evidence: use of expert consensus methods to fill the evidence gap in low-income countries and cultural minorities.

Minas H, Jorm AF.

Centre for International Mental Health, Melbourne School of Population Health, University of Melbourne, Parkville, Victoria 3010, Australia. h.minas@unimelb.edu.au.

BACKGROUND: In both developing countries and in relation to cultural minorities there have been calls to scale up mental health services and for evidence-informed policy and practice. EVIDENCE BASED MEDICINE: The evidence based medicine movement has had a major influence in improving practice. However, implementation of this approach has some major difficulties. One that has been neglected is the situation where there is no relevant evidence. This situation is more likely to occur for healthcare decisions in developing countries or for cultural minorities within developed countries, because resources do not exist for expensive research studies.

CONSENSUS METHODS: Consensus methods, such as the Delphi process, can be useful in providing an evidence base in situations where there is insufficient evidence. They provide a way of systematically tapping the  expertise of people working in the area and give evidence that is readily applicable for a particular country and culture. Although consensus methods are often thought of as low in the hierarchy of evidence, consensus is central to the scientific process. We present four examples where the Delphi method was used to assess expert consensus in situations where no other evidence existed: estimating the prevalence of dementia in developing countries, developing mental health first aid guidelines in Asian countries, mental health first aid guidelines for Australian Aboriginal people, and modification of the concept of 'recovery' for Australian immigrant communities.

CONCLUSION: Consensus methods can provide a basis for decision-making and considered action when there is no evidence or when there are doubts about the applicability of evidence that has been generated from other populations or health system settings.

PMCID: PMC3016371  PMID: 21176157  [PubMed]

 

22. Int J Ment Health Syst. 2010 Dec 20;4:32. doi: 10.1186/1752-4458-4-32.

Mental Health First Aid guidelines for helping a suicidal person: a Delphi consensus study in the Philippines.

Colucci E, Kelly CM, Minas H, Jorm AF, Nadera D.

Centre for International Mental Health, Melbourne School of Population Health,The University of Melbourne, Parkville, Victoria 3010, Australia. ecolucci@unimelb.edu.au.

BACKGROUND: This study aimed to develop guidelines for how a member of the Filipino public should provide mental health first aid to a person who is suicidal.

METHODS: The guidelines were produced by developing a questionnaire containing possible first aid actions and asking an expert panel of 34 Filipino mental health clinicians to rate whether each action should be included in the guidelines. The content of the questionnaire was based on a systematic search of the relevant evidence and claims made by authors of consumer and carer guides and websites. The panel members were asked to complete the questionnaire by web survey. Three rounds of the rating were carried and, at the end of each round, items that reached the consensus criterion were selected for inclusion in the guidelines. During the first round, panel members were also asked to suggest any additional actions that were not covered in the original questionnaire (to include items that are relevant to local cultural circumstances, values, and social norms). Responses to these open-ended questions were used to generate new items.

RESULTS: The output from the Delphi process was a set of agreed upon action statements. The Delphi process started with 138 statements, 48 new items were written based on suggestions from panel members and, of these 186 items, 102 met the consensus criterion. These statements were used to develop the guidelinesappended to this paper. The guidelines are currently being translated into local languages.
CONCLUSIONS: There are a number of actions that are considered to be useful for members of the public when they encounter someone who is experiencing suicidal thoughts or engaging in suicidal behaviour. Although the guidelines are designed for members of the public, they may also be helpful to non-mental health professionals working in health and welfare settings.

PMCID: PMC3017011 PMID: 21167076  [PubMed]

 

23. Rural Remote Health. 2010 Oct-Dec;10(4):1593. Epub 2010 Nov 24.

Value of mental health first aid training of advisory and extension agents in supporting farmers in rural Queensland.

Hossain D, Gorman D, Eley R, Coutts J.

Centre for Rural and Remote Area Health, University of Southern Queensland, Toowoomba, Queensland, Australia. delwar.hossain@usq.edu.au

INTRODUCTION: This study was a pilot project responding to the increasing levels of stress, depression and other mental health issues in Australian rural areas resulting from prolonged drought and a changing economic and social environment.

METHODS: Thirty-two Advisory and Extension Agents (AEAs) attended a training course held in 2007 and 2008 in Queensland, Australia. A year after the training, data was collected to determine its value. Interviews were conducted with course participants and their supervisors and focus groups were held with stakeholders (farmers, agency staff and health professionals).

RESULTS: The findings show that Mental Health First Aid training improved the participants' confidence level and their knowledge of mental health issues and increased their empathy toward persons with mental health problems. Furthermore, providing training on mental health issues to AEAs was perceived by stakeholders to be beneficial to both farmers and AEAs.

CONCLUSION: This study demonstrated that stakeholders and course participants see this type of training as very much needed and highly beneficial. Further, providing training in mental health issues to rural service providers can be very beneficial to their farmer clients and their social network.

PMID: 21105751  [PubMed - indexed for MEDLINE]

 

24. Aust N Z J Psychiatry. 2010 Dec;44(12):1072-81. doi: 10.3109/00048674.2010.516426.

Mental health first aid training by e-learning: a randomized controlled trial.

Jorm AF, Kitchener BA, Fischer JA, Cvetkovski S.

Orygen Youth Health Research Centre, University of Melbourne, Parkville, Victoria, Australia. ajorm@unimelb.edu.au

OBJECTIVE: Mental Health First Aid training is a course for the public that teaches how to give initial help to a person developing a mental health problem or in a mental health crisis. The present study evaluated the effects of Mental Health First Aid training delivered by e-learning on knowledge about mental disorders, stigmatizing attitudes and helping behaviour.

METHOD: A randomized controlled trial was carried out with 262 members of the Australian public. Participants were randomly assigned to complete an e-learning CD, read a Mental Health First Aid manual or be in a waiting list control group. The effects of the interventions were evaluated using online questionnaires pre- and post-training and at 6-months follow up. The questionnaires covered mental health knowledge, stigmatizing attitudes, confidence in providing help to others, actions taken to implement mental health first aid and participant mental health.

RESULTS: Both e-learning and the printed manual increased aspects of knowledge, reduced stigma and increased confidence compared to waiting list. E-learning also improved first aid actions taken more than waiting list, and was superior to the printed manual in reducing stigma and disability due to mental ill health.

CONCLUSIONS: Mental Health First Aid information received by either e-learning or printed manual had positive effects, but e-learning was better at reducing stigma.

PMID: 21070103  [PubMed - indexed for MEDLINE]

 

25. BMC Psychiatry. 2010 Oct 8;10:78. doi: 10.1186/1471-244X-10-78.

Development of mental health first aid guidelines for Aboriginal and Torres Strait Islander people experiencing problems with substance use: a Delphi study.

Hart LM, Bourchier SJ, Jorm AF, Kanowski LG, Kingston AH, Stanley D, Lubman DI.

Orygen Youth Health Research Centre, University of Melbourne, Parkville, Victoria, Australia.

BACKGROUND: Problems with substance use are common in some Aboriginal
communities. Although problems with substance use are associated with significant mortality and morbidity, many people who experience them do not seek help. Training in mental health first aid has been shown to be effective in increasing knowledge of symptoms and behaviours associated with seeking help. The current study aimed to develop culturally appropriate guidelines for providing mental health first aid to an Aboriginal or Torres Strait Islander person who is experiencing problem drinking or problem drug use (e.g. abuse or dependence).

METHODS: Twenty-eight Aboriginal health experts participated in two independent Delphi studies (n = 22 problem drinking study, n = 21 problem drug use; 15 participated in both). Panellists were presented with statements about possible first aid actions via online questionnaires and were encouraged to suggest additional actions not covered by the content. Statements were accepted for inclusion in the guidelines if they were endorsed by ≥ 90% of panellists as either 'Essential' or 'Important'. At the end of the two Delphi studies, participants were asked to give feedback on the value of the project and their participation experience.

RESULTS: From a total of 735 statements presented over two studies, 429 were endorsed (223 problem drinking, 206 problem drug use). Statements were grouped into sections based on common themes (n = 7 problem drinking, n = 8 problem drug use), then written into guideline documents. Participants evaluated the Delphi method employed, and the guidelines developed, as useful and appropriate for Aboriginal and Torres Strait Islander people.

CONCLUSIONS: Aboriginal health experts were able to reach consensus about culturally appropriate first aid for problems with substance use. Many first aid actions endorsed in the current studies were not endorsed in previous international Delphi studies, conducted on problem drinking and problem drug use in non-Indigenous people, highlighting the need for culturally specific first aid strategies to be employed when assisting Aboriginal or Torres Strait Islander people.

PMCID: PMC2964528 PMID: 20932326  [PubMed - indexed for MEDLINE]

 

26. Int J Ment Health Syst. 2010 Sep 8;4:25. doi: 10.1186/1752-4458-4-25.

Improving responses to depression and related disorders: evaluation of a innovative, general, mental health care workers training program.

Graham AL, Julian J, Meadows G.

Faculty of Medicine, Nursing and Health Sciences, Department of Psychological Medicine, Southern Synergy, Monash University, Notting Hill Campus, Clayton, Vic,3800, Australia. annette.graham@med.monash.edu.au.

BACKGROUND: Australian General Practitioners have been beneficiaries of extensive training in mental health care delivery over the last few years but less so other workers who support those with mental illness. Training is needed as it is widely recognised that the most effective interventions to prevent and treat mental disorders are often not readily available. The Mental Health Aptitudes into Practice (MAP) training package is a broad, innovative, interdisciplinary, general mental health training aimed at improving responses to individuals with depression and related disorders. The modular structure of this training program meant that such training could be targeted at those with varied backgrounds. Two hundred and seventy one days of free MAP training was delivered across Victoria in 2004/2005. The evaluation reported here assessed whether changes occurred in the trainees' confidence, mental health literacy, attitudes towards effective treatments, mental health knowledge and skills and community mental health ideology following training.

METHODS: These elements were assessed using pen and paper tests prior, immediately following, 6 months after and then 12 months after the training. Trainees' confidence, mental health literacy and social distance were measured using scales that have been used in evaluations of Mental Health First Aid Training. Community mental health ideology was measured using a sub-scale of the Community Attitudes to the Mentally Ill (CAMI) scale. The trainees' knowledge and skills were accessed using instrumentation specifically designed for this evaluation.
RESULTS: Following training, participants had more confidence in their ability to work with those who have mental health issues and less desire for social distance from them. Participants' knowledge and skills in relation to the treatment of mental disorders increased. These changes were observed immediately after training. The limited existing evidence suggests these changes were sustained six and twelve months later.

CONCLUSIONS: MAP training can be used to develop the capacity and capabilities of mental health workers.

PMCID: PMC2944816 PMID: 20822546  [PubMed]

 

27. J Okla State Med Assoc. 2010 Jul;103(7):263-5.

Prevention and mental illness: a new era for a healthier tomorrow.

Buck S.

Deputy Commissioner, Prevention and Communications, Oklahoma Department of Mental Health and Substance Abuse Services Oklahoma City, OK 73152, USA. sbuck@odmhsas.org

The Department of Mental Health and Substance Abuse Services strives to provide the best possible care for Oklahoma communities through preventative programs and approaches such as QPR, Mental Health First Aid and mental health screenings. All of these techniques have been proven in providing adequate knowledge of risk factors in Oklahoma communities for mental health disorders and help to prevent those predisposed to mental illness from experiencing an onset of the disorder.

PMID: 20821925  [PubMed - indexed for MEDLINE]

 

28. Psychiatry Clin Neurosci. 2010 Oct;64(5):531-40. doi: 10.1111/j.1440-1819.2010.02114.x. Epub 2010 Aug 19.

Development of 2-hour suicide intervention program among medical residents: first pilot trial.

Kato TA, Suzuki Y, Sato R, Fujisawa D, Uehara K, Hashimoto N, Sawayama Y, HayashiJ, Kanba S, Otsuka K.

Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. takahiro@npsych.med.kyushu-u.ac.jp

AIM: Suicide is associated not only with primary psychiatric disorders but also with physical disorders. Physicians' education on suicide prevention contributes to reducing suicide. Therefore, medical residents, who contact patients daily and who eventually become primary physicians in each specialty, might be the most appropriate candidates for intervention. In this article, we introduce our newly developed suicide intervention program among medical residents.

METHODS: We developed a 2-hour suicide intervention program among medical residents, based on the Mental Health First Aid (MHFA), which had originally been developed for the public. The program contains a 1-hour lecture and a 1-hour role-play session. As the first pilot trial, we conducted the program among 44 first-year medical residents at a university hospital and evaluated its effectiveness. Changes in confidence, attitudes and behavior toward suicidal people were evaluated using self-reported questionnaires before, immediately after, and 6 months after the program.

RESULTS: Participants' confidence and attitudes significantly improved after the program. The total mean score (standard deviation) of the Suicide Intervention Response Inventory improved from 18.4 (2.0) before the intervention to 19.4 (2.0) immediately after the intervention. However, the effectiveness was limited after 6 months. In the course of 6 months, the participants learned to apply the MHFA principles in their daily clinical practice.

CONCLUSION: Our newly developed brief suicide intervention program demonstrating its effectiveness among medical residents should be modified in order to be more effective in the long term. The next trial with a control group ought to be conducted to evaluate our developed program.

© 2010 The Authors. Journal compilation © 2010 Japanese Society of Psychiatry and Neurology.

PMID: 20727109  [PubMed - indexed for MEDLINE]

 

29. J Psychiatr Ment Health Nurs. 2010 Sep;17(7):594-602. doi: 10.1111/j.1365-2850.2010.01557.x.

Experiences of instructors delivering the Mental Health First Aid training programme: a descriptive qualitative study.

Terry J.

Mental Health Nurse Tutor, School of Human & Health Sciences, Swansea University, Carmarthen, UK. j.terry@swansea.ac.uk

Mental health literacy among the public is often poor, and although people frequently encounter others experiencing mental distress in their workplace, families and communities, they may be ill-equipped to provide appropriate support. 'Mental Health First Aid' (MHFA), a 12-h mental health promotion programme seeks to address this, training people in the knowledge and skills needed to engage with someone experiencing mental health problems. Research relating to the MHFA programme has centred on course attendees, with a paucity of research surrounding the delivery of basic mental health training programmes. Understanding experiences of instructors delivering such programmes is key to the success of future delivery. This study sought to identify the views and experiences of instructors delivering the MHFA programme in Wales. Fourteen MHFA instructors participated in semi-structured audio-recorded interviews, with the transcripts analysed to identify key themes. This paper explores two of the identified themes namely prerequisite skills and support required by instructors. The study highlighted that because of the ensuing emotional labour experienced by instructors, universal mental health training programmes must put in place a clear infrastructure to train, support and monitor those delivering them, for programme roll-out to be effective.

PMID: 20712682  [PubMed - indexed for MEDLINE]

 

30. BMC Psychiatry. 2010 Jun 24;10:51. doi: 10.1186/1471-244X-10-51.

Mental health first aid training for high school teachers: a cluster randomized trial.

Jorm AF, Kitchener BA, Sawyer MG, Scales H, Cvetkovski S.

Orygen Youth Health Research Centre, University of Melbourne, Locked Bag 10, Parkville, Victoria, Australia. ajorm@unimelb.edu.au

BACKGROUND: Mental disorders often have their first onset during adolescence. For this reason, high school teachers are in a good position to provide initial assistance to students who are developing mental health problems. To improve the skills of teachers in this area, a Mental Health First Aid training course was modified to be suitable for high school teachers and evaluated in a cluster randomized trial.

METHODS: The trial was carried out with teachers in South Australian high schools. Teachers at 7 schools received training and those at another 7 were wait-listed for future training. The effects of the training on teachers were evaluated using questionnaires pre- and post-training and at 6 months follow-up.

The questionnaires assessed mental health knowledge, stigmatizing attitudes, confidence in providing help to others, help actually provided, school policy and procedures, and teacher mental health. The indirect effects on students were evaluated using questionnaires at pre-training and at follow-up which assessed any mental health help and information received from school staff, and also the mental health of the student.

RESULTS: The training increased teachers' knowledge, changed beliefs about treatment to be more like those of mental health professionals, reduced some aspects of stigma, and increased confidence in providing help to students and colleagues. There was an indirect effect on students, who reported receiving more mental health information from school staff. Most of the changes found were sustained 6 months after training. However, no effects were found on teachers' individual support towards students with mental health problems or on student mental health.

CONCLUSIONS: Mental Health First Aid training has positive effects on teachers' mental health knowledge, attitudes, confidence and some aspects of their behaviour.

TRIAL REGISTRATION: ACTRN12608000561381.

PMCID: PMC2908569 PMID: 20576158  [PubMed - indexed for MEDLINE]
 

31. Int J Ment Health Syst. 2010 Jun 24;4:18. doi: 10.1186/1752-4458-4-18.

Mental health first aid training for the Chinese community in Melbourne, Australia: effects on knowledge about and attitudes toward people with mental illness.

Lam AY, Jorm AF, Wong DF.

The Centre for Cognitive Behavioural Therapy Education and Training for Chinese People, Department of Social Work and Social Administration, Faculty of Social Science, The University of Hong Kong, Pokfulam, Hong Kong SAR. anguslyk@hku.hk.

BACKGROUND: The aim of this study was to investigate in members of the Chinese community in Melbourne the impact of Mental Health First Aid (MHFA) training on knowledge about mental disorders and on attitudes to people with mental illness.

The hypotheses were that at the end of the training participants would have increased knowledge of mental disorders and related treatments, and decreased negative attitudes towards people with mental disorders.

METHODS: Respondents were 108 participants of three MHFA training workshops for the Chinese community in Melbourne conducted by a qualified MHFA trainer. Participants completed the research questionnaire prior to the commencement of the training (pre-test) and at its completion (post-test). The questionnaires assessed participants' ability to recognize a mental disorder (depression and schizophrenia) described in the vignettes, knowledge about the professional help and treatment, and negative attitudes towards people with mental illness.

RESULTS: Between pre- and post-test there was significant improvement in the recognition of mental disorders, beliefs about treatment became more concordant with health professionals, and negative attitudes reduced.

CONCLUSION: The MHFA training course for general members of the Chinese community in Melbourne produced significant positive change in the level of mental health literacy and reductions in stigmatizing attitudes. The evidence from this study, together with the accumulated evidence of the benefits of MHFA training in the general Australian community, suggests that this approach should be scaled up to a level where it can have an impact on the whole of the Chinese community in Australia.

PMCID: PMC2904712 PMID: 20576137  [PubMed]

 

32. BMC Psychiatry. 2010 Jun 21;10:49. doi: 10.1186/1471-244X-10-49.

Development of mental health first aid guidelines on how a member of the public can support a person affected by a traumatic event: a Delphi study.

Kelly CM, Jorm AF, Kitchener BA.

Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Australia. ckel@unimelb.edu.au

BACKGROUND: People who experience traumatic events have an increased risk of developing a range of mental disorders. Appropriate early support from a member of the public, whether a friend, family member, co-worker or volunteer, may help to prevent the onset of a mental disorder or may minimise its severity. However, few people have the knowledge and skills required to assist. Simple guidelines may help members of the public to offer appropriate support when it is needed.

METHODS: Guidelines were developed using the Delphi method to reach consensus in a panel of experts. Experts recruited to the panels included 37 professionals writing, planning or working clinically in the trauma area, and 17 consumer or carer advocates who had been affected by traumatic events. As input for the panels to consider, statements about how to assist someone who has experienced a traumatic event were sourced through a systematic search of both professional and lay literature. These statements were used to develop separate questionnaires about possible ways to assist adults and to assist children, and panel members answered either one questionnaire or both, depending on experience and expertise.

The guidelines were written using the items most consistently endorsed by the panels across the three Delphi rounds.

RESULTS: There were 180 items relating to helping adults, of which 65 were accepted, and 155 items relating to helping children, of which 71 were accepted.  These statements were used to develop the two sets of guidelines appended to this paper.

CONCLUSIONS: There are a number of actions which may be useful for members of the public when they encounter someone who has experienced a traumatic event, and it is possible that these actions may help prevent the development of some mental health problems in the future. Positive social support, a strong theme in these guidelines, has some evidence for effectiveness in developing mental health problems in people who have experienced traumatic events, but the degree to which it helps has not yet been adequately demonstrated. An evaluation of the effectiveness of these guidelines would be useful in determining their value.

These guidelines may be useful to organisations who wish to develop or revise curricula of mental health first aid and trauma intervention training programs and policies. They may also be useful for members of the public who want immediate information about how to assist someone who has experienced a potentially traumatic event.

PMCID: PMC2904289 PMID: 20565918  [PubMed - indexed for MEDLINE]

 

33. Int J Ment Health Syst. 2010 May 19;4:10. doi: 10.1186/1752-4458-4-10.

Australian rural football club leaders as mental health advocates: an investigation of the impact of the Coach the Coach project.

Pierce D, Liaw ST, Dobell J, Anderson R.

Rural Health Academic Centre, Melbourne Medical School, The University of Melbourne, 806 Mair Street, Ballarat, Victoria 3350, Australia. d.pierce@unimelb.edu.au.

BACKGROUND: Mental ill health, especially depression, is recognised as an important health concern, potentially with greater impact in rural communities.

This paper reports on a project, Coach the Coach, in which Australian rural football clubs were the setting and football coaches the leaders in providing greater mental health awareness and capacity to support early help seeking behaviour among young males experiencing mental health difficulties, especially depression. Coaches and other football club leaders were provided with Mental Health First Aid (MHFA) training.

METHOD: Pre-post measures of the ability of those club leaders undertaking mental health training to recognise depression and schizophrenia and of their knowledge of evidence supported treatment options, and confidence in responding to mental health difficulties were obtained using a questionnaire. This was supplemented by focus group interviews. Pre-post questionnaire data from players in participating football clubs was used to investigate attitudes to depression, treatment options and ability to recognise depression from a clinical scenario. Key project stakeholders were also interviewed.

RESULTS: Club leaders (n = 36) who were trained in MHFA and club players (n = 275) who were not trained, participated in this evaluation. More than 50% of club leaders who undertook the training showed increased capacity to recognise mental illness and 66% reported increased confidence to respond to mental health difficulties in others. They reported that this training built upon their existing skills, fulfilled their perceived social responsibilities and empowered them. Indirect benefit to club players from this approach seemed limited as minimal changes in attitudes were reported by players. Key stakeholders regarded the project as valuable.

CONCLUSIONS: Rural football clubs appear to be appropriate social structures to promote rural mental health awareness. Club leaders, including many coaches, benefit from MHFA training, reporting increased skills and confidence. Benefit to club players from this approach was less obvious. However, the generally positive findings of this study suggest further research in this area is desirable.

PMCID: PMC2889859 PMID: 20482809  [PubMed]

 

34. Perspect Public Health. 2010 Mar;130(2):61-2.

Mental Health First Aid--a life skill we should all have?

Zilnyk A.

PMID: 20455481  [PubMed - indexed for MEDLINE]

 

   35. Int J Ment Health Syst. 2010 Feb 19;4:4. doi: 10.1186/1752-4458-4-4.

Mental Health First Aid guidelines for helping a suicidal person: a Delphi consensus study in India.

Colucci E, Kelly CM, Minas H, Jorm AF, Chatterjee S.

Centre for International Mental Health, The University of Melbourne, Parkville, Victoria, Australia. ecolucci@unimelb.edu.au

BACKGROUND: This study aimed to develop guidelines for how a member of the Indian public should provide mental health first aid to a person who is suicidal.

METHODS: The guidelines were produced by developing a questionnaire containing possible first aid actions and asking an expert panel of Indian mental health clinicians to rate whether each action should be included in the guidelines. The content of the questionnaire was based on a systematic search of the relevant evidence and claims made by authors of consumer and career guides and websites.

Experts were recruited by SC, EC and HM. The panel members were asked to complete the questionnaire by web survey. Three rounds of the rating were carried and, at the end of each round, items that reached the consensus criterion were selected for inclusion in the guidelines. During the first round, panel members were also asked to suggest any additional actions that were not covered in the original questionnaire (to include items that are relevant to local cultural circumstances, values, and social norms.). Responses to the open-ended questions were used to generate new items.

RESULTS: The output from the Delphi process was a set of agreed upon action statements. The Delphi process started with 138 statements, 30 new items were written based on suggestions from panel members and, of these 168 items, 71 met the consensus criterion. These statements were used to develop the guidelines appended to this paper. Translated versions of the guidelines will be produced and used for training.

CONCLUSIONS: There are a number of actions that are considered to be useful for members of the public when they encounter someone who is experiencing suicidal thoughts or engaging in suicidal behaviour. Although the guidelines are designed for members of the public, they may also be helpful to non-mental health professionals working in health and welfare settings.

PMCID: PMC2847966 PMID: 20167125  [PubMed]

 

36. BMC Psychiatry. 2009 Dec 7;9:79. doi: 10.1186/1471-244X-9-79.

Helping someone with problem drinking: mental health first aid guidelines - a Delphi expert consensus study.

Kingston AH, Jorm AF, Kitchener BA, Hides L, Kelly CM, Morgan AJ, Hart LM, Lubman DI.

Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, 35 Poplar Rd (Locked Bag 10), Parkville, Victoria 3052, Australia.  kingston.anna@gmail.com

BACKGROUND: Alcohol is a leading risk factor for avoidable disease burden. Research suggests that a drinker's social network can play an integral role in addressing hazardous (i.e., high-risk) or problem drinking. Often however, social networks do not have adequate mental health literacy (i.e., knowledge about mental health problems, like problem drinking, or how to treat them). This is a concern as the response that a drinker receives from their social network can have a substantial impact on their willingness to seek help. This paper describes the development of mental health first aid guidelines that inform community members on how to help someone who may have, or may be developing, a drinking problem (i.e., alcohol abuse or dependence).
 
METHODS: A systematic review of the research and lay literature was conducted to develop a 285-item survey containing strategies on how to help someone who may have, or may be developing, a drinking problem. Two panels of experts (consumers/carers and clinicians) individually rated survey items, using a Delphi process. Surveys were completed online or via postal mail. articipants were 99 consumers, carers and clinicians with experience or expertise in problem drinking from Australia, Canada, Ireland, New Zealand, the United Kingdom, and the United  States. Items that reached consensus on importance were retained and written into guidelines.

RESULTS: The overall response rate across all three rounds was 68.7% (67.6% consumers/carers, 69.2% clinicians), with 184 first aid strategies rated as essential or important by > or =80% of panel members. The endorsed guidelines provide guidance on how to: recognize problem drinking; approach someone if there is concern about their drinking; support the person to change their drinking; respond if they are unwilling to change their drinking; facilitate professional help seeking and respond if professional help is refused; and manage an alcohol-related medical emergency.

CONCLUSION: The guidelines provide a consensus-based resource for community members seeking to help someone with a drinking problem. Improving community awareness and understanding of how to identify and support someone with a drinking problem may lead to earlier recognition of problem drinking and greater facilitation of professional help seeking.

PMCID: PMC2799400 PMID: 19968868  [PubMed - indexed for MEDLINE]

 

 37. Int J Ment Health Syst. 2009 Sep 7;3(1):19. doi: 10.1186/1752-4458-3-19.

Evaluation of mental health first aid training with members of the Vietnamese community in Melbourne, Australia.

Minas H, Colucci E, Jorm AF.

Centre for International Mental Health, The University of Melbourne, Parkville, Victoria, Australia. h.minas@unimelb.edu.au

BACKGROUND: The aim of this project was to investigate in members of the Vietnamese community in Melbourne the impact of Mental Health First Aid (MHFA)training on attitudes to people with mental illness and on knowledge about mental disorders. Our hypotheses were that at the end of the training participants would have increased knowledge of mental disorders and their treatments, and decreased negative attitudes towards people with mental disorders.

METHODS: Respondents were 114 participants in two-day MHFA training workshops for the Vietnamese community in Melbourne conducted by two qualified MHFA trainers. Participants completed the research questionnaire prior to the commencement of the training (pre-test) and at its completion (post-test). The questionnaires assessed negative attitudes towards people with mental illness (as described in four vignettes), ability to recognise the mental disorders described in the vignettes, and knowledge about how to assist someone with one of these disorders.

Responses to open-ended questions were content analysed and coded. To evaluate the effect of the training, answers to the structured questions and to the coded open-ended questions given at pre- and post-test were compared using McNemar tests for dichotomous values and Wilcoxon tests for other scores.

RESULTS: Between pre- and post-test there was significant improvement in recognition of mental disorders; more targeted and appropriate mental health first aid responses, and reduction in inappropriate first aid responses; and negative attitudes to the people described in the vignettes declined significantly on many items of the stigma scale.

CONCLUSION: A two-day, MHFA training course for general members of the Vietnamese community in Melbourne demonstrated significant reductions in stigmatizing attitudes, improved knowledge of mental disorders and improved knowledge about appropriate forms of assistance to give to people in the community with mental disorder. There is sufficient evidence to scale up to a population level program  for the Vietnamese community, and a need for longitudinal evaluation of such a scaled up program.

PMCID: PMC2745360 PMID: 19735575  [PubMed]

 

      38. BMC Psychiatry. 2009 Aug 10;9:49. doi: 10.1186/1471-244X-9-49.

Development of mental health first aid guidelines for panic attacks: a Delphi study.

Kelly CM, Jorm AF, Kitchener BA.

ORYGEN Research Centre, University of Melbourne, Australia. ckel@unimelb.edu.au

BACKGROUND: Panic attacks are common, and while they are not life-threatening events, they can lead to the development of panic disorder and agoraphobia. Appropriate help at the time that a panic attack occurs may decrease the fear associated with the attack and reduce the risk of developing an anxiety disorder. However, few people have the knowledge and skills required to assist. Simple first aid guidelines may help members of the public to offer help to people who experience panic attacks.

METHODS: The Delphi method was used to reach consensus in a panel of experts. Experts included 50 professionals and 6 people who had experience of panic attacks and were active in mental health advocacy. Statements about how to assist someone who is having a panic attack were sourced through a systematic search of both professional and lay literature. These statements were rated for importance as first aid guidelines by the expert and consumer panels and guidelines were written using the items most consistently endorsed.

RESULTS: Of 144 statements presented to the panels, 27 were accepted. These statements were used to develop the guidelines appended to this paper.

CONCLUSION: There are a number of actions which are considered to be useful for members of the public to do if they encounter someone who is having a panic attack. These guidelines will be useful in revision of curricula of mental health first aid programs. They can also be used by members of the public who want immediate information about how to assist someone who is experiencing panic attacks.

PMCID: PMC2739201 PMID: 19664244  [PubMed - indexed for MEDLINE]

 

39. BMC Psychiatry. 2009 Aug 3;9:47. doi: 10.1186/1471-244X-9-47.

Mental health first aid for Indigenous Australians: using Delphi consensus studies to develop guidelines for culturally appropriate responses to mental health problems.

Hart LM, Jorm AF, Kanowski LG, Kelly CM, Langlands RL.

Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia. lhart@unimelb.edu.au

BACKGROUND: Ethnic minority groups are under-represented in mental health care services because of barriers such as poor mental health literacy. In 2007, the Mental Health First Aid (MHFA) program implemented a cultural adaptation of its first aid course to improve the capacity of Indigenous Australians to recognize and respond to mental health issues within their own communities. It became apparent that the content of this training would be improved by the development of best practice guidelines. This research aimed to develop culturally appropriate guidelines for providing first aid to an Australian Aboriginal or Torres Strait Islander person who is experiencing a mental health crisis or developing a mental illness.

METHODS: A panel of Australian Aboriginal people who are experts in Aboriginal mental health, participated in six independent Delphi studies investigating depression, psychosis, suicidal thoughts and behaviours, deliberate self-injury, trauma and loss, and cultural considerations. The panel varied in size across the studies, from 2024 participants. Panellists were presented with statements about possible first aid actions via online questionnaires and were encouraged to suggest additional actions not covered by the survey content. Statements were accepted for inclusion in a guideline if they were endorsed by > or = 90% of panellists as essential or important. Each study developed one guideline from the outcomes of three Delphi questionnaire rounds. At the end of the six Delphi studies, participants were asked to give feedback on the value of the project and their participation experience.

RESULTS: From a total of 1,016 statements shown to the panel of experts, 536 statements were endorsed (94 for depression, 151 for psychosis, 52 for suicidal thoughts and behaviours, 53 for deliberate self-injury, 155 for trauma and loss, and 31 for cultural considerations). The methodology and the guidelines themselves were found to be useful and appropriate by the panellists.

CONCLUSION: Aboriginal mental health experts were able to reach consensus about culturally appropriate first aid for mental illness. The Delphi consensus method could be useful more generally for consulting Indigenous peoples about culturally appropriate best practice in mental health services.

PMCID: PMC2729076 PMID: 19646284  [PubMed - indexed for MEDLINE]

 

40. Australas Psychiatry. 2009 Aug;17 Suppl 1:S116-20. doi: 10.1080/10398560902948365.

Enhancing the knowledge and skills of Advisory and Extension Agents in mental health issues of farmers.

Hossain D, Gorman D, Eley R.

Centre for Rural and Remote Area Health, University of Southern Queensland, Toowoomba, QLD, Australia. hossain@usq.edu.au

OBJECTIVES: The aim of this study was to increase knowledge and skills of Advisory and Extension Agents (AEAs) in recognizing the symptoms of mental disorders, providing initial help, and offering the referral pathway for appropriate professional help.

METHOD: Mental Health First Aid (MHFA) training was provided to AEAs and knowledge and skills pre-training were compared to 6-months post-training.

RESULTS: The MHFA training improved the AEAs' ability to recognize a mental disorder, it increased their confidence level in providing help to someone with a mental health problem, it decreased social distances and positively changed their beliefs about treatment.

CONCLUSION: MHFA training is effective in enhancing the mental health knowledge and skills of AEAs. The agents, who are a main line of contact of farmers, are able to recognize mental disorders of people and help them appropriately. They are more willing to work with stigmatized people and know who to refer people to for help.

PMID: 19579123  [PubMed - indexed for MEDLINE]

 

41. Int J Ment Health Syst. 2009 Jun 3;3(1):10. doi: 10.1186/1752-4458-3-10.

A mental health first aid training program for Australian Aboriginal and Torres Strait Islander peoples: description and initial evaluation.

Kanowski LG, Jorm AF, Hart LM.

ORYGEN Youth Health Research Centre, University of Melbourne, Parkville, Victoria, Australia. len.kanowski@mh.org.au <len.kanowski@mh.org.au>

BACKGROUND: Mental Health First Aid (MHFA) training was developed in Australia to teach members of the public how to give initial help to someone developing a mental health problem or in a mental health crisis situation. However, this type of training requires adaptation for specific cultural groups in the community.

This paper describes the adaptation of the program to create an Australian Aboriginal and Torres Strait Islander Mental Health First Aid (AMHFA) course and presents an initial evaluation of its uptake and acceptability.
METHODS: To evaluate the program, two types of data were collected: (1) quantitative data on uptake of the course (number of Instructors trained and courses subsequently run by these Instructors); (2) qualitative data on strengths, weaknesses and recommendations for the future derived from interviews with program staff and focus groups with Instructors and community participants.

RESULTS: 199 Aboriginal people were trained as Instructors in a five day Instructor Training Course. With sufficient time following training, the majority of these Instructors subsequently ran 14-hour AMHFA courses for Aboriginal people in their community. Instructors were more likely to run courses if they had prior teaching experience and if there was post-course contact with one of the Trainers of Instructors. Analysis of qualitative data indicated that the Instructor Training Course and the AMHFA course are culturally appropriate, empowering for Aboriginal people, and provided information that was seen as highly relevant and important in assisting Aboriginal people with a mental illness. There were a number of recommendations for improvements.

CONCLUSION: The AMHFA program is culturally appropriate and acceptable to Aboriginal people. Further work is needed to refine the course and to evaluate its impact on help provided to Aboriginal people with mental health problems.

PMCID: PMC2694763 PMID: 19490648  [PubMed]

 

42. Aust J Rural Health. 2008 Dec;16(6):343-8. doi: 10.1111/j.1440-1584.2008.01014.x.

Mental health of farmers in Southern Queensland: issues and support.

Hossain D, Eley R, Coutts J, Gorman D.

Centre for Rural and Remote Area Health, University of Southern Queensland, Australia.

OBJECTIVE: To inform the development of an initiative designed to support the mental well-being of farmers in Queensland.

DESIGN: Interactive focus groups.

SETTING: Rural and remote Queensland.

PARTICIPANTS: Health professionals, farmers and representatives of oganisations and agencies working with farmers.

MAIN OUTCOME MEASURES: Determination of factors contributing to the declining mental health of rural landholders. Content material for inclusion into mental health first aid programs held for field officers.

RESULTS: Key areas identified to contribute to the decline in mental health of farmers were: increasing isolation in its varying forms, the ongoing drought, increased government regulations and widening of the schism between urban and rural Australians. The issues that affect farmers are recognised to have a 'knock-on' effect on the people who interact with them. In particular, rural support organisations are concerned for the well-being of their staff, prompting some to begin to put protocols in place to address their staff need for mental health support. Additional mental health training of field officers that involves awareness, recognition, communication skills, understanding and empathy was recognised by participants to be beneficial.

CONCLUSION: Training of field officers was considered to be of benefit to the support of farmers. An understanding of the various and diverse issues that rural landholders face should be a fundamental component of that training.

PMID: 19032206  [PubMed - indexed for MEDLINE]

 

43. Aust J Rural Health. 2008 Oct;16(5):313-8. doi: 10.1111/j.1440-1584.2008.01005.x.

Improving mental health capacity in rural communities: mental health first aid delivery in drought-affected rural New South Wales.

Sartore GM, Kelly B, Stain HJ, Fuller J, Fragar L, Tonna A.

Centre for Rural and Remote Mental Health, The University of Newcastle, Orange,NSW, Australia. khill@rfdsqld.com.au

OBJECTIVE: To assess the effectiveness of mental health first aid (MHFA) training in drought-affected rural and remote Australia, as part of a strategy to improve capacity among farming communities to provide early intervention for mental health problems.

METHODS: Data were obtained from 99 participants recruited across 12 New South Wales towns, before and after delivery of MHFA seminars emphasising the role of front-line workers from agricultural-related services. Surveys assessed knowledge of, confidence in dealing with, and attitude towards people experiencing mental illness, along with the impact of training on response to mental health problems among target population of farmers and farming families.

RESULTS: Rural support workers and community volunteers attended MHFA seminars because of perceived mental health needs in the workplace. A majority of responses reflect a concern with giving appropriate advice and support well outside narrow job definitions. Participants' ability to identify high prevalence disorders and endorse evidence-based interventions for both high and low prevalence disorders increased following MHFA training, as did their confidence in their ability to provide appropriate help.

CONCLUSIONS: MHFA training can form an effective part of a strategy to improve systems of care and pathways to early intervention in rural communities by using local networks to provide mental health support.

PMID: 18808491  [PubMed - indexed for MEDLINE]

 

44. BMC Psychiatry. 2008 Jul 23;8:62. doi: 10.1186/1471-244X-8-62.

Development of mental health first aid guidelines for deliberate non-suicidal self-injury: a Delphi study.

Kelly CM, Jorm AF, Kitchener BA, Langlands RL.

ORYGEN Research Centre, University of Melbourne, Australia. ckel@unimelb.edu.au

BACKGROUND: It is estimated that around 4% of the population engages, or has engaged, in deliberate non-suicidal self-injury. In clinical samples, the figures rise as high as 21%. There is also evidence to suggest that these figures may be increasing. A family member or friend may suspect that a person is injuring themselves, but very few people know how to respond if this is the case. Simple first aid guidelines may help members of the public assist people to seek and receive the professional help they require to overcome self-injury.

METHODS: This research was conducted using the Delphi methodology, a method of reaching consensus in a panel of experts. Experts recruited to the panels included 26 professionals, 16 people who had engaged in self-injurious behaviour in the past and 3 carers of people who had engaged in self-injurious behaviour in the past. Statements about providing first aid to a person engaged in self-injurious behaviour were sought from the medical and lay literature, but little was found. Panel members were asked to respond to general questions about first aid for NSSI in a variety of domains and statements were extracted from their responses. The guidelines were written using the items most consistently endorsed by the consumer and professional panels.

RESULTS: Of 79 statements rated by the panels, 18 were accepted. These statements were used to develop the guidelines appended to this paper.

CONCLUSION: There are a number of actions which are considered to be useful for members of the public when they encounter someone who is engaging in deliberate, non-suicidal self-injury. These guidelines will be useful in revising curricula for mental health first aid and NSSI first aid training programs. They can also be used by members of the public who want immediate information about how to assist a person who is engaging in such behaviour.

PMCID: PMC2518920 PMID: 18647420  [PubMed - indexed for MEDLINE]

 

45. BMC Psychiatry. 2008 Mar 18;8:17. doi: 10.1186/1471-244X-8-17.

Development of mental health first aid guidelines for suicidal ideation and behaviour: a Delphi study.

Kelly CM, Jorm AF, Kitchener BA, Langlands RL.

ORYGEN Research Centre, University of Melbourne, Australia. ckel@unimelb.edu.au

BACKGROUND: Suicide is a statistically rare event, but devastating to those left behind and one of the worst possible outcomes associated with mental illness. Although a friend, family member or co-worker may be the first person to notice that a person is highly distressed, few have the knowledge and skills required to assist. Simple guidelines may help such a person to encourage a suicidalindividual to seek professional help or decide against suicide.

METHODS: This research was conducted using the Delphi methodology, a method of reaching consensus in a panel of experts. Experts recruited to the panels included 22 professionals, 10 people who had been suicidal in the past and 6 carers of people who had been suicidal in the past. Statements about how to assist someone who is thinking about suicide were sourced through a systematic search of both professional and lay literature. The guidelines were written using the items most consistently endorsed by all three panels.

RESULTS: Of 114 statements presented to the panels, 30 were accepted. These statements were used to develop the guidelines appended to this paper.

CONCLUSION: There are a number of actions which are considered to be useful for members of the public when they encounter someone who is experiencing suicidal thoughts or engaging in suicidal behaviour. These guidelines will be useful in revision of curricula of mental health first aid and suicide intervention training programs. They can also be used by members of the public who want immediate information about how to assist a suicidal person.

PMCID: PMC2324091 PMID: 18366657  [PubMed - indexed for MEDLINE]

 

46. Am J Disaster Med. 2007 Nov-Dec;2(6):307-20.

Primary intervention for memory structuring and meaning acquisition (PIMSMA):
study of a mental health first-aid intervention in the ED with injured survivors of suicide bombing attacks.

Schreiber S, Dolberg OT, Barkai G, Peles E, Leor A, Rapoport E, Heinik J, Bloch M.

Department of Psychiatry, Tel Aviv Sourasky Medical Center, Israel.

OBJECTIVE: To assess the impact of a structured intervention, the "primary intervention for memory structuring and meaning acquisition" (PIMSMA) performed randomly in the emergency department with survivors of suicide bombing attacks,on their medium-term mental health outcome.

DESIGN: Follow up and assessment 3-9 months postinjury, and 24 months thereafter.

SETTING: A tertiary referral general hospital in Tel Aviv, Israel.

PARTICIPANTS: Injured survivors of 9 suicide bombing and suicide shooting, men and women aged 16-72 at the time of the incident.

MAIN OUTCOME MEASURES: Diagnosis of posttraumatic stress disorder (PTSD) was made using the Hebrew validated version of the DSM-IV SCID-PTSD rating scale. Other psychiatric symptoms were assessed using the following rating scales: impact of event scale (IES), Hamilton rating scale for depression (HAM-D) and for anxiety (HAM-A), and the Pittsburgh sleep quality index (PSQI). Effects of PIMSMA and PTSD level of psychological distress were analyzed using ANOVA and for change over time for continuous variables repeated measured multivariate analyses was performed, and for categorical variables nonparametric-related sample McNemar. Logistic regression for variable associated with PTSD was performed.

RESULTS: Out of 213 eligible injured survivors evacuated to our ER, 129 were retrieved 3-9 months after the incident, and 53 were available for assessment 2 years later. Multivariate analyses for being PTSD vs non-PTSD at the first
evaluation, being hospitalized OR = 5.6 (95 percent CI 1.1-27.6) and treated OR = 24.5 (95 percent CI 2.8-200) were the only predictors, with no effect (p = 0.9) for PIMSMA vs other supportive intervention. Predictor for PTSD at the second evaluation were IES severity score at first evaluation OR = 1.1 (95 percent CI 1.04-1.2).

CONCLUSION: The PIMSMA approach is as good as the nonspecific supportive treatment performed routinely in the ED with all survivors of traumatic events of any origin. Further studies are needed to establish valid, evidence-based treatment approaches for the acute aftermath of exposure to severe potentially traumatic events.

PMID: 18297951  [PubMed - indexed for MEDLINE]

    47. Early Interv Psychiatry. 2008 Feb;2(1):55-61. doi: 10.1111/j.1751-7893.2007.00056.x.

Mental Health First Aid: an international programme for early intervention.

Kitchener BA, Jorm AF.

ORYGEN Research Centre, University of Melbourne, Victoria, Australia. bettyk@unimelb.edu.au

AIM: To describe the development of the Mental Health First Aid (MHFA) programme in Australia, its roll-out in other countries and evaluation studies which have been carried out.

METHODS: A description of the programme's development and evaluation, its cultural adaptations and its dissemination in seven countries.

RESULTS: The programme was developed in Australia in 2001. By the end of 2007, there were 600 instructors and 55,000 people trained as mental health first aiders. A number of evaluations have been carried out, including two randomized controlled trials that showed changes in knowledge, attitudes and first aid behaviours. Special adaptations of the course have been rolled out for Aboriginal and Torres Strait Islander peoples and some non-English speaking immigrant groups. The course has spread to seven other countries with varying degrees of penetration. In all countries, the programme has been initially supported by government funding. Independent evaluations have been carried out in Scotland and Ireland.

CONCLUSIONS: The concept of first aid by the public for physical health crises is familiar in many countries. This has made it relatively easy to extend this approach to early intervention by members of the public for mental disorders and crises. Through MHFA training, the whole of a community can assist formal mental health services in early intervention for mental disorders.

© 2008 The Authors.

PMID: 21352133  [PubMed - indexed for MEDLINE]

 

48. Aust J Rural Health. 2007 Apr;15(2):99-106.

Use of social network analysis to describe service links for farmers' mental health.

Fuller J, Kelly B, Sartore G, Fragar L, Tonna A, Pollard G, Hazell T.

University Department of Rural Health (Northern Rivers), University of Sydney and Southern Cross University, Lismore, New South Wales, Australia. jeffreyfuller@nrahs.nsw.gov.au

OBJECTIVE: The primary mental health care needs of farmers require that service innovations incorporate rural support workers into a local service network. This  component of the FarmLink pilot sought to develop a social network analysis method that would describe local mental health-related human service networks. The purpose is to inform improvements in this network and to serve as a baseline against which such improvements can be evaluated.

DESIGN: A pilot survey of rural human service providers who deal with mental health-related issues among farmers about their self-reported links between each other.

SETTING: Service delivery agencies associated with a small rural town in New South Wales.

PARTICIPANTS: Twenty-five agents from a range of human services involved in rural human support services to farmers, such as from agricultural and drought support,welfare, primary health care and education.

INTERVENTION: Telephone interview prior to the conduct of a Mental Health First Aid seminar and a Farmers Mental Health and Wellbeing workshop.

MAIN OUTCOME MEASURES: Agent self-reported service links over the past three months for information exchange, client referrals and working together in relation to helping farmers for mental health, emotional health or stress-related problems. Analysis trialled on the 'made referrals' link shows the network influence, prominence and intermediary status of the rural financial counsellor.

CONCLUSIONS: Within the limitations of recalled self-report data, social network analysis provides a useful network description for informing and evaluating service network improvements.

PMID: 17441818  [PubMed - indexed for MEDLINE]

 

49. Early Interv Psychiatry. 2007 Feb;1(1):61-70. doi: 10.1111/j.1751-7893.2007.00012.x.

Beliefs about appropriate first aid for young people with mental disorders: findings from an Australian national survey of youth and parents.

Jorm AF, Wright A, Morgan AJ.

ORYGEN Research Centre, University of Melbourne, Melbourne, Victoria, Australia.  ajorm@unimelb.edu.au

OBJECTIVE: To determine the mental health first-aid knowledge and beliefs of young people and their parents.

METHODS: A national telephone survey was carried out with 3746 people aged 12-25 years. Interviews were also carried out with 2005 co-resident parents. First-aid knowledge was assessed in response to one of four randomly presented vignettes covering depression, depression with alcohol misuse, social phobia and psychosis (schizophrenia). Young people were asked about first aid in relation to a peer and parents in relation to a child.

RESULTS: The potential value of encouraging professional help-seeking was not universally recognized by either young people or adults. In general, positive social interactions were endorsed as likely to be helpful and negative ones as not, but again there is considerable room for improvement. Adolescents had less sophisticated first-aid knowledge and beliefs than young adults, but were paradoxically more confident about providing help to a peer.

CONCLUSIONS: These findings show that there is a continuing need for further community education about the potential benefits of early professional treatment of young people developing mental disorders.

PMID: 21352109  [PubMed - indexed for MEDLINE]

 

50. Aust N Z J Psychiatry. 2006 Jan;40(1):6-8.

Mental health first aid training: review of evaluation studies.

Kitchener BA, Jorm AF.

Centre for Mental Health Research, Australian National University, Canberra, Australian Capital Territory 0200, Australia. bettyk@unimelb.edu.au

OBJECTIVE: To review studies evaluating mental health first aid (MHFA) training.

METHOD: Review of three published trials: one uncontrolled with members of the public in a city, one randomized controlled efficacy trial in a workplace setting and one cluster randomized effectiveness trial with the public in a rural area.

RESULTS: Most mental health first aiders tend to be middle-aged women whose work involves people contact. All trials found the following statistically significant benefits 5-6 months post-training: improved concordance with health professionals about treatments, improved helping behaviour, greater confidence in providing help to others and decreased social distance from people with mental disorders. Only one trial evaluated the mental health benefits to participants and this found positive effects.

CONCLUSIONS: Although MHFA training has been found to change knowledge, attitudes and helping behaviours, and even benefit the mental health of participants, there has not yet been an evaluation of the effects on those who are the recipients of the first aid.

PMID: 16403032  [PubMed - indexed for MEDLINE]

 

51. BMC Psychiatry. 2005 Nov 9;5:43.

Experiences in applying skills learned in a Mental Health First Aid training course: a qualitative study of participants' stories.

Jorm AF, Kitchener BA, Mugford SK.

ORYGEN Research Centre, University of Melbourne, Locked Bag 10, Parkville, Victoria 3052, Australia. ajorm@unimelb.edu.au

BACKGROUND: Given the high prevalence of mental disorders and the comparatively low rate of professional help-seeking, it is useful for members of the public to have some skills in how to assist people developing mental disorders. A Mental Health First Aid course has been developed to provide these skills. Two randomized controlled trials of this course have shown positive effects on participants' knowledge, attitudes and behavior. However, these trials have provided limited data on participants' subsequent experiences in providing first aid. To remedy this, a study was carried out gathering stories from participants in one of the trials, 19-21 months post-training. METHODS: Former course participants were contacted and sent a questionnaire either by post or via the internet. Responses were received from 94 out of the 131 trainees who were contacted. The questionnaire asked about whether the participant had experienced a post-training situation where someone appeared to have a mental health problem and, if so, asked questions about that experience.

RESULTS: Post-training experiences were reported by 78% of respondents. Five key points emerged from the qualitative data: (1) the majority of respondents had had some direct experience of a situation where mental health issues were salient and the course enabled them to take steps that led to better effects than otherwise might have been the case; (2) positive effects were experienced in terms of increased empathy and confidence, as well as being better able to handle crises; (3) the positive effects were experienced by a wide range of people with varied expectations and needs; (4) there was no evidence of people over-reaching themselves because of over-confidence and (5) those who attended were able to identify quite specific benefits and many thought the course not only very useful, but were keen to see it repeated and extended.

CONCLUSION: The qualitative data confirm that most members of the public who receive Mental Health First Aid training subsequently provide support to people with mental health problems and that this support generally has positive effects.

PMCID: PMC1308824 PMID: 16280088  [PubMed - indexed for MEDLINE]

 

52. BMC Psychiatry. 2005 Feb 6;5:9.

Mental health first aid responses of the public: results from an Australian national survey.

Jorm AF, Blewitt KA, Griffiths KM, Kitchener BA, Parslow RA.

Centre for Mental Health Research, Australian National University, Canberra, ACT 0200, Australia. anthony.jorm@anu.edu.au

BACKGROUND: The prevalence of mental disorders is so high that members of the public will commonly have contact with someone affected. How they respond to that person (the mental health first aid response) may affect outcomes. However, there is no information on what members of the public might do in such circumstances.

METHODS: In a national survey of 3998 Australian adults, respondents were presented with one of four case vignettes and asked what they would do if that person was someone they had known for a long time and cared about. There were four types of vignette: depression, depression with suicidal thoughts, early schizophrenia, and chronic schizophrenia. Verbatim responses to the open-ended question were coded into categories.

RESULTS: The most common responses to all vignettes were to encourage professional help-seeking and to listen to and support the person. However, a significant minority did not give these responses. Much less common responses were to assess the problem or risk of harm, to give or seek information, to encourage self-help, or to support the family. Few respondents mentioned contacting a professional on the person's behalf or accompanying them to a professional. First aid responses were generally more appropriate in women, those with less stigmatizing attitudes, and those who correctly identified the disorder in the vignette.

CONCLUSIONS: There is room for improving the range of mental health first aid responses in the community. Lack of knowledge of mental disorders and stigmatizing attitudes are important barriers to effective first aid.

PMCID: PMC549043 PMID: 15694008  [PubMed - indexed for MEDLINE]

 

53. BMC Psychiatry. 2004 Oct 23;4:33.

Mental health first aid training of the public in a rural area: a cluster randomized trial [ISRCTN53887541].

Jorm AF, Kitchener BA, O'Kearney R, Dear KB.

Centre for Mental Health Research, Australian National University, Canberra, ACT 0200, Australia. anthony.jorm@anu.edu.au

BACKGROUND: A Mental Health First Aid course has been developed which trains members of the public in how to give initial help in mental health crisis situations and to support people developing mental health problems. This course has previously been evaluated in a randomized controlled trial in a workplace setting and found to produce a number of positive effects. However, this was an efficacy trial under relatively ideal conditions. Here we report the results of an effectiveness trial in which the course is given under more typical conditions.

METHODS: The course was taught to members of the public in a large rural area in Australia by staff of an area health service. The 16 Local Government Areas that made up the area were grouped into pairs matched for size, geography and socio-economic level. One of each Local Government Area pair was randomised to receive immediate training while one served as a wait-list control. There were 753 participants in the trial: 416 in the 8 trained areas and 337 in the 8 control areas. Outcomes measured before the course started and 4 months after it ended were knowledge of mental disorders, confidence in providing help, actual help provided, and social distance towards people with mental disorders. The data were analysed taking account of the clustered design and using an intention-to-treat approach.

RESULTS: Training was found to produce significantly greater recognition of the disorders, increased agreement with health professionals about which interventions are likely to be helpful, decreased social distance, increased confidence in providing help to others, and an increase in help actually provided. There was no change in the number of people with mental health problems that trainees had contact with nor in the percentage advising someone to seek professional help.

CONCLUSIONS: Mental Health First Aid training produces positive changes in knowledge, attitudes and behaviour when the course is given to members of the public by instructors from the local health service.

PMCID: PMC526774 PMID: 15500695  [PubMed - indexed for MEDLINE]

 

54. BMC Psychiatry. 2004 Aug 15;4:23.

Mental health first aid training in a workplace setting: a randomized controlled  trial [ISRCTN13249129].

Kitchener BA, Jorm AF.

Depression & Anxiety Consumer Research Unit, Centre for Mental Health Research, Australian National University, Canberra, Australia. betty.kitchener@anu.edu.au

BACKGROUND: The Mental Health First Aid training course was favorably evaluated in an uncontrolled trial in 2002 showing improvements in participants' mental health literacy, including knowledge, stigmatizing attitudes, confidence and help provided to others. This article reports the first randomized controlled trial of this course.

METHODS: Data are reported on 301 participants randomized to either participate immediately in a course or to be wait-listed for 5 months before undertaking the training. The participants were employees in two large government departments in Canberra, Australia, where the courses were conducted during participants' work time. Data were analyzed according to an intention-to-treat approach.

RESULTS: The trial found a number of benefits from this training course, including greater confidence in providing help to others, greater likelihood of advising people to seek professional help, improved concordance with health professionals about treatments, and decreased stigmatizing attitudes. An additional unexpected but exciting finding was an improvement in the mental health of the participants themselves.
CONCLUSIONS: The Mental Health First Aid training has shown itself to be not only an effective way to improve participants' mental health literacy but also to improve their own mental health. It is a course that has high applicability across the community.

PMCID: PMC514553 PMID: 15310395  [PubMed - indexed for MEDLINE]

 

55. BMC Psychiatry. 2002 Oct 1;2:10.

Mental health first aid training for the public: evaluation of effects on knowledge, attitudes and helping behavior.

Kitchener BA, Jorm AF.

Centre for Mental Health Research, Australian National University, Canberra, Australia. betty.kitchener@anu.edu.au

BACKGROUND: Many members of the public have poor mental health literacy. A Mental Health First Aid training course was developed in order to improve this. This paper describes the training course and reports an evaluation study looking at changes in knowledge, stigmatizing attitudes and help provided to others.

METHODS: Data are reported on the first 210 participants in public courses. Evaluation questionnaires were given at the beginning of courses, at the end and at 6 months follow-up. Data were analyzed using an intention-to-treat approach.

RESULTS: The course improved participants' ability to recognize a mental disorder in a vignette, changed beliefs about treatment to be more like those of health professionals, decreased social distance from people with mental disorders, increased confidence in providing help to someone with a mental disorder, and increased the amount of help provided to others.

CONCLUSIONS: Mental Health First Aid training appears to be an effective method of improving mental health literacy which can be widely applied.

PMCID: PMC130043 PMID: 12359045  [PubMed - indexed for MEDLINE]

 

Analysis by Mental Illness Policy Org (3/18/12)

 

 

 

 


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