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

Purpose: Health profession students may experience mental health issues during training, and clinical educators report that they don't feel confident in supporting students with these issues. This study explored whether a customized Mental Health First Aid (MHFA) training programme changed the knowledge, perceptions, intentions, and confidence of clinical educators in supporting students with mental health issues in the workplace. Method: Twenty-four allied health clinical educators from a tertiary health service attended a two-day customized MHFA course. The educators completed assessments before (n = 21) and after (n = 23) the course. Quantitative data was analyzed using independent t-tests. Qualitative data was thematically analyzed using content analysis. Results: Knowledge improved significantly (p = <0.001). The confidence to manage students with mental health issues increased significantly (p < 0.001). A significant change in perception was only found with respect to a character in a scenario being dangerous or unpredictable. Intentions to assist co-workers and students with mental health issues improved for all items but not necessarily significantly. Conclusions: This programme improved educators' knowledge of mental health, perceptions of people with mental health issues, intentions of providing help, and confidence to support people with mental health issues.

Objectif: les étudiants dans les professions de la santé peuvent éprouver des troubles de santé mentale pendant leur formation, et les éducateurs cliniques déclarent qu'ils ne se sentent pas à l'aise de soutenir les étudiants aux prises avec ces problèmes. La présente étude explore si un programme de formation personnalisé de premiers soins en santé mentale (PSSM) modifiait les connaissances, les perceptions, les intentions et la confiance des éducateurs cliniques à l'égard du soutien des étudiants éprouvant des troubles de santé mentale en milieu de travail. Méthodologie: au total, 24 éducateurs cliniques en santé paramédicale d'un service de soins tertiaires ont suivi un cours de deux jours du PSSM adapté. Les éducateurs ont rempli des évaluations avant (n = 21) et après (n = 23) le cours. Les chercheurs ont analysé les données quantitatives à l'aide de tests de Student indépendants. Ils ont recouru à l'analyse de contenu pour les analyser par thèmes. Résultats: les connaissances ont augmenté de manière significative (p = <0,001). Leur confiance à gérer les étudiants ayant des troubles de santé mentale s'est accrue de manière significative (p < 0,001). Un changement important de perception n'était observé qu'à l'égard du personnage d'un scénario dangereux ou imprévisible. Les intentions d'aider leurs collègues et les étudiants ayant des troubles de santé mentale se sont améliorées à l'égard de tous les points, mais pas nécessairement de manière significative. Conclusions: ce programme a amélioré les connaissances des éducateurs en santé mentale, leurs perceptions des personnes ayant des troubles de santé mentale, leurs intentions de les aider et leur confiance à soutenir les personnes ayant des problèmes de santé mentale.

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

BACKGROUND: Substance use problems have a major impact on the physical and mental health of individuals, families and communities. Early intervention may have a positive effect on recovery and treatment outcomes for those with substance use problems, reducing related risk and harm. Separate mental health first aid guidelines on how a member of the public could assist someone experiencing or developing alcohol use and drug use problems in high income Western countries were developed using Delphi expert consensus in 2009 and 2011, respectively. This study aimed to synthesise and update these two original guidelines to reflect current evidence and best practice. METHODS: The Delphi expert consensus method was used to determine the inclusion of statements in the redeveloped guidelines. A questionnaire was developed using previously endorsed helping statements from the original guidelines on alcohol and drug use problems, as well as relevant content identified in systematic searches of academic and grey literature. Three panels of experts (people with lived experience, support people and professionals) rated statements over three consecutive online survey rounds to determine the importance of their inclusion in the guidelines. Statements endorsed by at least 80% of each panel were included. RESULTS: 103 panellists completed all three survey rounds. They rated 469 statements and endorsed 300 of these for inclusion in the redeveloped guidelines. CONCLUSIONS: This study has developed a broader and more comprehensive set of guidelines for how to support a person experiencing or developing a substance use problem. The redeveloped guidelines provide more detail on knowledge about and recognition of substance use problems, approaching and assisting people who want to change or are not ready to change, harm reduction, community-based supports and professional help, but have less on physical first aid actions. Mental Health First Aid International will use these guidelines in future updates of their training courses.

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

BACKGROUND: Non-suicidal self-injury (NSSI) is a common mental health problem, with a 19% lifetime prevalence in Australian adolescents and 12% in adults. Though rates of professional help-seeking for NSSI are low, disclosure to family and friends is more common, providing opportunities for them to encourage professional support. Mental Health First Aid® Australia's Conversations about Non-Suicidal Self-Injury course provides evidence-based training for the general public to support a person engaging in NSSI. METHODS: This uncontrolled trial evaluated the effects of the Conversations about Non-Suicidal Self-Injury course on participants' knowledge, confidence, stigmatising attitudes, and intended and actual helping behaviours. Surveys were administered pre- and post-course, and at a six-month follow-up. A linear mixed-model analysis determined mean change over time, and effect sizes were estimated using Cohen's d. Course satisfaction was assessed using descriptive statistics and summative content analysis of qualitative data. RESULTS: The pre-course survey was completed by 147 Australian participants (77.5% female, mean age 45.8 years), 137 (93.2%) at post-course and 72 (49%) at follow-up. Knowledge, confidence, quality of intended helping behaviours, and quality of actual helping behaviours increased significantly at both time points. Social distance decreased significantly at all time points and stigma decreased significantly at post-course. The course was perceived to be highly acceptable by participants. CONCLUSIONS: There is initial evidence that the Conversations about Non-Suicidal Self-Injury course is effective and acceptable for members of the public who may support a person engaging in NSSI.

Development of the Mental Health Support Scale: A New Measure of Mental Health First Aid Behaviors.

Mental health first aid (MHFA) courses teach community members the knowledge and skills needed to recognize and respond to mental health problems until professional help is received or the crisis resolves. This study aimed to develop a reliable and valid measure of MHFA behaviors. A pool of actions that were recommended and not recommended were selected from MHFA guidelines and developed into two scales measuring either intended or provided support. Items were tested with a sample of 697 adults. Item response theory guided the selection of final items. The Mental Health Support Scale (MHSS) Intended version has 23 items across two subscales and the MHSS-Provided has 12 items across two subscales. These scales demonstrated convergent validity, discrimination between respondents with and without MHFA expertise, and acceptable measurement precision across a range of skill levels. Overall, findings suggest that the MHSS is a valid and useful measure of MHFA behaviors.

teen Mental Health First Aid: 12-month outcomes from a cluster crossover randomized controlled trial evaluation of a universal program to help adolescents better support peers with a mental health problem.

BACKGROUND: teen Mental Health First Aid (tMHFA) is a universal mental health literacy, stigma reduction, help-seeking, and suicide prevention program designed for adolescents in Years 10-12 of secondary school (16-18 years). tMHFA is delivered by trained instructors, in a regular classroom setting, to increase the knowledge, attitudes and behaviours that adolescents' require to better support peers with mental health problems or mental health crises. METHODS: To explore the efficacy of tMHFA, a cluster crossover randomised controlled trial was conducted with Year 10 students in four schools in Victoria, Australia, using physical first aid training as the control intervention. Of the 1942 eligible students, 1,624 completed baseline and 894 completed follow-up surveys. Online surveys, administered one week before training and again 12-months later, included vignettes depicting peers John (depression and suicide risk) and Jeanie (social anxiety/phobia), measures of mental health first aid (quality of first aid intentions, confidence, first aid behaviours provided, and first aid behaviours received), mental health literacy (beliefs about adult help, help-seeking intentions), and stigma (social distance, weak-not-sick, dangerous/unpredictable, and would not tell anyone). RESULTS: The primary outcome-quality of first aid intentions towards the John vignette-showed statistically significant group x time interactions, with tMHFA students reporting more helpful and less unhelpful first aid intentions, than PFA students did over time. Confidence in providing first aid also showed significant interactions. First aid behaviours-both those provided to a peer with a mental health problem and those received from a peer-showed null results. Ratings of both beliefs about adult help and help-seeking intentions were found to be significantly improved among tMHFA students at follow-up. A group x time interaction was found on one stigma scale (would not tell anyone). CONCLUSIONS: This trial showed that, one year after training, tMHFA improves first aid intentions towards peers with depression and suicide risk, confidence in helping peers with mental health problems, willingness to tell someone and seek help from an adult or health professional if experiencing a mental health problem. TRIAL REGISTRATION: This research was registered with Australia New Zealand Clinical Trials Registry: ACTRN12614000061639 .

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

BACKGROUND: Panic attacks and panic disorder can have a major impact on the mental health and wellbeing of those who experience them. People with recurrent panic attacks have increased odds of developing a mental disorder and of worsening the course of existing mental disorders. Early intervention efforts at the time that a panic attack occurs might reduce or prevent some of these associated negative outcomes. Expert consensus guidelines for high income Western countries on how to provide mental health first aid for panic attacks were published in 2009. The present study aims to redevelop these guidelines to ensure content reflects current evidence and best practice. METHODS: The Delphi consensus method was used to determine which helping strategies should be included in the redeveloped guidelines. A survey with items on how to assist someone who is having a panic attack was developed using the 2009 guidelines and a systematic search of grey and academic literature. Panellists with lived experience and professional experience rated these items to determine which helping statements should be included in the guidelines. RESULTS: Thirty panellists completed all three surveys. Panellists rated 158 statements, with 83 statements meeting the criteria for inclusion in the redeveloped guidelines. The endorsed statements covered: what the first aider should know about panic attacks, what they should do if they think someone is having a panic attack, what they should do if they are uncertain whether the person is having a panic attack, what they should say and do if they know the person is having a panic attack and what they should do when the panic attack has ended. CONCLUSION: This study has resulted in a more comprehensive set of guidelines than the original version, with the endorsement of 83 helping actions, compared to 27 previously. The redeveloped guidelines provide greater detail on recognising the signs of a panic attack, providing initial assistance, communicating with someone experiencing a panic attack and supporting them to seek appropriate professional help if it is needed. The guidelines will be used in future updates of Mental Health First Aid training courses.

Evaluation of the Conversations About Gambling Mental Health First Aid course: effects on knowledge, stigmatising attitudes, confidence and helping behaviour.

BACKGROUND: The effects of problem gambling are wide-ranging, affecting many aspects of health and negatively impacting the person who gambles, their family and friends, and their community. People experiencing problem gambling have low rates of help-seeking and perceive many barriers to treatment, although evidence suggests that encouragement and support from friends and family can increase rates of help-seeking. Mental Health First Aid Australia's Conversations About Gambling course aims to teach members of the public evidence-based strategies for recognising and responding to signs of problem gambling in a person they know. METHODS: This research evaluated the effects of the Conversations About Gambling course on participants' knowledge, confidence, stigmatising attitudes, intended helping behaviour and actual helping behaviour towards a person experiencing problem gambling. Participants from Australia completed surveys before the course, immediately after the course and six months later. Changes over time (pre-course to post-course, and pre-course to 6-month follow-up) were assessed with linear mixed models. Descriptive statistics and content analyses of open-ended questions pertaining to participants' satisfaction with the course were also produced. RESULTS: Between 2018 and 2020, 166 participants were recruited into this study. At 6-month follow-up 87 participants (52.4%) provided data. Participants' knowledge about gambling and gambling problems, confidence, desire for social distance and intentions to help a person experiencing problem gambling significantly improved from pre-course to post-course, and from pre-course to 6-month follow-up. The quality of some actions taken to support a person they knew who was experiencing problem gambling also improved from pre-course to 6-month follow-up, in line with the teachings of the course. Participants perceived the course to be highly acceptable. CONCLUSIONS: The results of this initial evaluation of Mental Health First Aid Australia's Conversations About Gambling course suggest that it is an effective and acceptable educational intervention for those who wish to support a person experiencing problem gambling.

Reasons for not providing initial support to a colleague, friend, or family member experiencing a mental health problem or crisis.

AIM: To investigate reasons for not helping a person experiencing a mental health problem, and explore factors associated with not offering help. METHODS: Data were collected as part of a randomized controlled trial evaluating Mental Health First Aid (MHFA) in the workplace conducted with 608 Australian adults. Participants were asked if a colleague, friend, or family member had any mental health problem in the last 12 months, whether they had tried to help them, and reasons for not helping. These reasons were content analysed and predictors of not helping were explored with logistic regression. RESULTS: A minority of participants did not offer help, with reasons for not helping (n = 107) related to the recipient already being helped, characteristics of the recipient such as perceived illness type, the type of relationship between helper and recipient, distance or time barriers, and a lack of skills or knowledge. CONCLUSIONS: Some reasons for not helping cannot be modified but others could be used to inform the curricula of MHFA or other gatekeeper training.

Frequency and quality of first aid offered by older adolescents: a cluster randomised crossover trial of school-based first aid courses.

BACKGROUND: Research indicates that school-based first aid programmes appear to improve students' knowledge and skills. However, evidence for their effectiveness is limited by a lack of rigorously designed studies. This research used a cluster randomised crossover trial to assess the effects of two different types of first aid training on the frequency and appropriateness of older adolescents' first aid behaviours towards their peers 12 months after training. METHODS: Schools eligible to participate were government funded and able to accommodate first aid training and survey time for two consecutive Year 10 student cohorts. Four Australian public schools were matched in two pairs and randomly assigned to receive either physical first aid (PFA) or teen mental health first aid (tMHFA) training for their Year 10 student cohort (mean age 16 years). In the second year, the new Year 10 cohort received the other intervention. Four cohorts were randomised to receive PFA and four were randomised to receive tMHFA. Online surveys were administered at baseline and 12 months after training, measuring whether students had encountered a peer needing PFA, whether they had provided PFA, what actions they performed and, if applicable, why they had been unable to help the person. Only research staff analysing the data could be blinded to measurement occasion, school identity and condition. RESULTS: Four cohorts received PFA and four received tMHFA. The results indicated that there were no differences between groups regarding the frequency of appropriate first aid actions performed 12 months after training. The most common types of PFA provided to a peer were sending for help and wound care. Students most commonly mentioned someone else attending to their peer or lacking skills or experience as reasons for not performing PFA actions. CONCLUSIONS: More research that examines first aid behaviours using rigorous, longitudinal study designs is needed to establish the effectiveness of school-based first aid training for older adolescents.

Confidence and Intentions to Help a Person at Risk of Suicide.

OBJECTIVE: We aimed to identify Australian adults' current level of confidence and intentions to help a person close to them in distress or at risk of suicide to inform the content and targeting of suicide prevention messages aimed at family and friends of those at risk. METHODS: We conducted a nationally representative computer-assisted telephone survey of confidence and intentions to help someone in distress or at risk of suicide (n = 3,002). We used logistic regression to determine whether sociodemographic and exposure variables predicted confidence and intentions to help. RESULTS: Confidence to help was high. About half of the respondents had intentions inconsistent with best practice. Listening and talking, and encouraging the person to seek professional help were the most common types of intended helping actions. Intentions to ask suicide risk assessment questions were least common. Men were more likely than women to have intentions to carry out nonrecommended actions, and less likely to have intentions to carry out recommended actions. CONCLUSIONS: Suicide prevention messaging aimed at family and friends could encourage them to ask direct questions about suicide risk and could include messages about "what not to do." Suicide prevention messages aimed specifically at men are indicated.

Teen Mental Health First Aid for years 7-9: a description of the program and an initial evaluation.

BACKGROUND: A teen Mental Health First Aid training course for high school students in years 10-12 (tMHFA 10-12) has previously been evaluated in uncontrolled and randomized controlled trials and found to improve Mental Health First Aid intentions, mental health literacy and to reduce stigma. This 3 × 75-min course has more recently been adapted for younger students in years 7-9 (tMHFA 7-9). The present study reports an initial uncontrolled trial of this new training course which aimed to assess feasibility and acceptability of the course and test effects on knowledge, attitudes and behaviour. METHODS: An uncontrolled trial was carried out in five schools with measures taken at pre-test, post-test and 3-month follow-up. The outcomes measured were: quality of first aid intentions to help peers, confidence in helping, stigmatising attitudes, recognition of anxiety disorder, number of adults thought to be helpful, help-seeking intentions, quality of support provided to a peer, quality of support received, and psychological distress. Questions were also asked about satisfaction with the course. RESULTS: There were 475 students (mean age 13.86 years) who provided data at baseline, with 76% of these providing data at post-test and 75% at follow-up. Sustained changes at follow-up were found for: number of adults thought to be helpful, some components of stigma, recognition of anxiety disorder, and quality of support provided to a peer. However, there was an unexpected decline in willingness to tell others about a mental health problem. Most students found the information presented to be new, easy to understand, and useful. CONCLUSIONS: The tMHFA 7-9 training course produced some positive changes that were sustained over 3 months. However, the changes were not as strong as previously found for older high school students, suggesting the need for further refinement of the course.

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

BACKGROUND: Members of the public can potentially take action to assist someone in their social network who is distressed and at risk of suicide. The present study used data from a community survey to examine training experiences and sociodemographic factors associated with the quality of assistance provided in such situations. METHODS: A national telephone survey using random digit dialing was carried out with Australian adults on attitudes and intentions toward helping someone in severe distress or at risk of suicide, as well as actions taken. Participants were asked open-ended questions about their intentions to assist a hypothetical person in a vignette and about any actions they took to assist a family member or friend in distress over the previous 12 months. Each participant randomly received 1 of 6 vignettes which varied by gender and degree of suicidality portrayed. 3002 participants provided data on intentions and 932 on actions taken. Quality of Intentions and Quality of Actions were scored on 12-point scales. RESULTS: Quality of Intentions and Quality of Actions correlated 0.28. Quality of Intentions was associated with more overt suicidality in the vignette, age 31-59 years, female gender, university education, speaking English at home, being non-Indigenous and all forms of suicide training (professional, Mental Health First Aid and other). Quality of Actions was associated with female gender, university education and other suicide training. CONCLUSIONS: Training on suicide prevention is associated with better quality of intentions and actions to help a person at risk of suicide. There are sub-groups in the population who are in greater need of such training because they have poorer quality of intentions to help and are less likely to have received training. These include males, less educated people and people from non-English speaking backgrounds.

Perceptions of positive treatment and discrimination towards people with mental health problems: Findings from the 2017 Attitudes to Mental Illness survey.

Anti-stigma programme evaluations primarily measure knowledge and attitudes, and rarely assess behaviour. This study describes perceived and self-reported avoidance, discrimination and positive treatment using data from the 2017 Attitudes to Mental Illness survey. A nationally representative quota sample of 1720 English participants were interviewed about mental health-related knowledge and attitudes, reported and intended contact with people with mental health problems, awareness of the Time to Change anti-stigma programme and knowledge of anyone with a mental health problem. Participants who knew someone were asked how they thought the person was treated in different life areas, and whether they had avoided the person, treated them unfairly or treated them more positively. 30.1% of respondents knew someone with a mental health problem. Most believed the person had been treated fairly across various life domains. 5.1% of participants reported avoiding the person, 2.1% reported unfair treatment, and 58.1% reported positive treatment. Less stigmatising attitudes were associated with reduced avoidance and discrimination. Greater knowledge and reported contact were associated with positive treatment. Anti-stigma campaigns can reduce discrimination or increase positive treatment by targeting knowledge, attitudes and awareness of people with mental health problems. Evaluations should measure discrimination and positive treatment to fully assess behavioural change.

Suicide Prevention Media Campaigns: A Systematic Literature Review.

Suicide prevention media campaigns are gaining traction as a means of combatting suicide. The current review set out to synthesize information about the effectiveness of these campaigns. We searched four electronic databases for studies that provided evidence on the effectiveness of media campaigns. We focused on studies that described an evaluation of the effectiveness of an entire campaign or a public service announcement explicitly aimed at suicide prevention. We identified 20 studies of varying quality. Studies that looked at whether campaign exposure leads to improved knowledge and awareness of suicide found support for this. Most studies that considered whether campaign materials can achieve improvements in attitudes toward suicide also found this to be the case, although there were some exceptions. Some studies found that media campaigns could boost help-seeking, whereas others suggested that they made no difference or only had an impact when particular sources of help or particular types of help-seeking were considered. Relatively few studies had sufficient statistical power to examine whether media campaigns had an impact on the ultimate behavioral outcome of suicides, but those that did demonstrated significant reductions. Our review indicates that media campaigns should be considered in the suite of interventions that might be used to prevent suicide. Evidence for their effectiveness is still amassing, but there are strong suggestions that they can achieve positive results in terms of certain suicide-related outcomes. Care should be taken to ensure that campaign developers get the messaging of campaigns right, and further work is needed to determine which messages work and which ones do not, and how effective messages should be disseminated. There is an onus on those developing and delivering campaigns to evaluate them carefully and to share the findings with others. There is a need for evaluations that employ rigorous designs assessing the most pertinent outcomes. These evaluations should explore the nature of given campaigns in detail - in particular the messaging contained within them - in order to tease out which messages work well and which do not. They should also take into account the reach of the campaign, in order to determine whether it would be reasonable to expect that they might have their desired effect.

Developing a model of help giving towards people with a mental health problem: a qualitative study of Mental Health First Aid participants.

BACKGROUND: Members of the public frequently perform mental health first aid actions in daily life, and people with mental health problems often cite informal supports as motivators of professional treatment seeking. However, a thorough understanding of how, when and why these actions are undertaken is lacking. This research aimed to investigate the helping experiences of community members trained in Mental Health First Aid, understand the factors that might facilitate and deter helping behaviours, and develop a preliminary model that outlines the process of providing help to someone with a mental health problem. METHODS: Community members who had received Mental Health First Aid training (n = 16) were recruited from an urban Australian university and completed an in-depth, semi-structured interview about their experiences of helping someone with a mental health problem. Data were analysed using thematic analysis. Member checking was used to assess the accuracy and transferability of the findings. RESULTS: The results suggested that several common elements were present in participants' narratives, including recognising a recipient in distress, considering reasons to intervene or not, choosing a course of action, and noting the outcomes of help. These themes were collated to form the main stages of a preliminary model of helping. CONCLUSIONS: The findings of this study highlight the many considerations involved in deciding whether and how to assist a person with a mental health problem, and the complex, dynamic nature of the helping process itself. The preliminary model of helping may be used to enhance the content of educational programs and public health messages.

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

BACKGROUND: When a person is in severe distress, people in their social network can potentially take action to reduce the person's suicide risk. The present study used data from a community survey to examine whether people who had received training in how to assist a person at risk of suicide had higher quality intentions and actions to provide support. METHODS: A national telephone survey was carried out with 3002 Australian adults on attitudes and intentions toward helping someone in severe distress or at risk of suicide as well as actions taken. Participants were asked about their intentions to assist a hypothetical person in a vignette and about any actions they took to assist a family member or friend in distress over the previous 12 months. Participants were also asked whether they had received professional training, Mental Health First Aid training or other training in how to assist a person at risk of suicide. RESULTS: Responses covered ten intentions/actions that were recommended in guidelines for the public on how to support a suicidal person and 5 that were recommended against in the guidelines. Scales were created to measure positive and negative intentions to act and positive and negative actions taken. All three types of training were associated with greater positive intentions and actions, and with lesser negative intentions. These associations were largely due to a greater willingness of those trained to talk openly about suicide with a person in distress. CONCLUSIONS: Training in how to support a person at risk of suicide is associated with better quality of support. Such training merits wider dissemination in the community.

Importance of Messages for a Suicide Prevention Media Campaign.

BACKGROUND: A suicide prevention media campaign aimed at family members and friends may be one useful population-level suicide prevention strategy for Australia. However, currently there is limited evidence of what messages would be acceptable and appropriate for inclusion. AIMS: This expert consensus study aimed to identify messages that experts with lived experience of suicide risk and suicide prevention professionals believed were most important to include in such a suicide prevention campaign. METHOD: Using an online survey method, 127 participants with lived experience (lived experience group) and 33 suicide prevention professionals (suicide prevention professionals group) rated 55 statements, drawn from an earlier Delphi study, from very low priority to very high priority for inclusion in a suicide prevention campaign. RESULTS: There was significant agreement within and between the two participant groups on the most highly rated messages for inclusion. The mostly highly rated messages were that family members or friends should ask directly about suicidal thoughts and intentions, listen to responses without judgment, and tell the person at risk that they care and want to help. LIMITATIONS: We restricted ratings to just one round and may therefore have limited the level of consensus achieved. Use of a predefined set of suicide prevention messages might also have prevented us from identifying other important messages. Lived experience participants were drawn from one source and this might bias their responses through exposure to common suicide prevention messages that influence their points of view. CONCLUSION: There is substantial agreement between professionals and people with lived experience on the most important messages to include in a suicide prevention campaign. These most highly rated messages could be adopted in a suicide prevention media campaign.

Helping adolescents to better support their peers with a mental health problem: A cluster-randomised crossover trial of teen Mental Health First Aid.

BACKGROUND: teen Mental Health First Aid (tMHFA) is a classroom-based training programme for students aged 15-18 years to improve supportive behaviours towards peers, increase mental health literacy and reduce stigma. This research evaluated tMHFA by comparing it to a matched emergency Physical First Aid (PFA) training programme. METHODS: A cluster-randomised crossover trial matched four public schools in two pairs and then randomised each to first receive tMHFA or PFA for all Year 10 students. In the subsequent calendar year, the new Year 10 cohort received the opposite intervention, giving eight cohorts. Online surveys were administered at baseline and 1 week post-training, measuring quality of first aid intentions, mental health literacy, problem recognition and stigmatising beliefs, towards fictional adolescents with depression and suicidality (John) and social anxiety (Jeanie). RESULTS: A total of 1942 students were randomised (979 received tMHFA, 948 received PFA), 1605 (84%) analysed for the John vignette at baseline and 1116 (69% of baseline) provided post-training data. The primary outcomes, 'helpful first aid intentions' towards John/Jeanie, showed significant group-by-time interactions with medium effect sizes favouring tMHFA ( ds = 0.50-0.58). Compared to PFA, tMHFA students also reported significantly greater improvements in confidence supporting a peer ( ds = 0.22-0.37) and number of adults rated as helpful ( ds = 0.45-0.46) and greater reductions in stigmatising beliefs ( ds = 0.12-0.40) and 'harmful first aid intentions' towards John/Jeanie ( ds = 0.15-0.41). CONCLUSIONS: tMHFA is an effective and feasible programme for increasing supportive first aid intentions and mental health literacy in adolescents in the short term. tMHFA could be widely disseminated to positively impact on help seeking for adolescent mental illness.

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

OBJECTIVE: The aim of the study was to explore self-reported avoidance, discrimination, and positive treatment by members of the public towards people with mental health problems. METHODS: In 2014, telephone interviews were carried out with 5220 Australians aged 18 +. Respondents were asked if they had known an adult with a mental health problem over the previous 12 months. If they had, they were asked further questions about the person's age, gender, relationship to the respondent, and their mental health problem. Respondents were then asked if they had avoided, discriminated against or treated the person more positively and, if so, some details about what happened. RESULTS: 19.9% of respondents reported avoiding someone with a mental health problem, with the most common reasons being difficulty tolerating the person's behaviour and needing time out. However, respondents were more likely to report treating the person with mental health problems more positively (73.0%) than avoiding or discriminating against them (4.7%). The most common positive behaviours were non-specific support and maintaining or increasing contact. Avoidance was less likely from friends and those aged 60 +. Discrimination was more likely from family members and spouses and less likely from respondents aged 60 +. Positive treatment was more likely from people who had experienced a mental health problem. CONCLUSIONS: This study provides insight into the reasons why people avoid others with mental health problems. The results can provide input into the design of anti-discrimination interventions and further empower people with mental health problems as they advocate for change in the area of discrimination.

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

BACKGROUND: Despite showing high rates of depression, university students prefer to seek assistance for their depression from informal sources, such as their friends, rather than seeking professional assistance. Therefore, the helping behaviours of those who provide informal help to these students need examination. This study examines the helping intentions of undergraduates in Sri Lanka towards their depressed peers and the correlates of their helping intentions. METHOD: The undergraduates were presented with a vignette of a hypothetical depressed undergraduate. A total of 4442 undergraduates responded to an open-ended question about how the person in the vignette should be helped if this person was someone they knew well. Their responses were coded in reference to established mental health first aid guidelines. Logistic and linear regression models were used to examine the predictors of their helping intentions. RESULTS: The undergraduates' most common helping intentions were to listen/talk and support their peer. Only around a third considered the need for professional help. The overall quality of their helping intentions was poor, but better among those who recognised the problem as depression and those who had less stigmatising attitudes. There was some evidence that certain helping intentions of the undergraduates which were person-oriented or social network-related were better among females, those in higher years of study and among certain non-medical student groups. Intentions to encourage professional help were better among those who recognised the problem, but poorer among those with personal experiences of this problem and among those who perceived this problem to be a weakness and not a sickness. CONCLUSIONS: Although the undergraduates may attempt to support their distressed peers, they may not show appropriate helping actions and may not encourage the use of professional assistance. Hence, they need to be educated on how best to respond to their distressed peers. Those with higher levels of stigma and inability to recognise the problem may be at greater risk of showing poorer helping responses towards their distressed peers.