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

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.

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

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.

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

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.

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

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 suicidal individual 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.

First aid for depression: a Delphi consensus study with consumers, carers and clinicians.

BACKGROUND: It is unclear how members of the public can best support individuals who are developing a depressive episode before appropriate professional help is received. METHODS: To assess expert consensus, we used the Delphi Method. An expert panel consisting of 167 mental health consumers, carers and clinicians was recruited from developed English-speaking countries. A 99-item questionnaire about how to help someone with depression was developed from a variety of resources. The panel members rated each item according to whether they believed the statement should be included in the first aid recommendations. The results were analysed by comparing consensus rates across the three groups. Three rounds were required to consolidate consensus levels. RESULTS: Sixty-four items were endorsed by > or =80% of panel members from all three groups as essential or important. These items were grouped under the following headings: recognising and acknowledging depression; approaching someone who may be depressed; how to be supportive; what is not helpful for a person who may have depression; whether to encourage the person to seek professional help; whether to encourage the person to use self-help strategies; what to do if the person does not want help. LIMITATIONS: These recommendations may not be applicable outside developed English-speaking countries. CONCLUSIONS: By informing the content of training courses, these recommendations will improve the provision of first aid to individuals who are developing a depressive episode and facilitate the uptake of appropriate professional help.

First aid recommendations for psychosis: using the Delphi method to gain consensus between mental health consumers, carers, and clinicians.

BACKGROUND: Members of the general public often lack the knowledge and skills to intervene effectively to help someone who may be developing a psychotic illness before appropriate professional help is received. METHODS: We used the Delphi method to determine recommendations on first aid for psychosis. An international panel of 157 mental health consumers, carers, and clinicians completed a 146-item questionnaire about how a member of the public could help someone who may be experiencing psychosis. The panel members rated each questionnaire item according to whether they believed the statement should be included in the first aid recommendations. The results were analyzed by comparing consensus rates across the 3 groups. Three rounds of ratings were required to consolidate consensus levels. RESULTS: Eighty-nine items were endorsed by >or=80% of panel members from all 3 groups as essential or important for psychosis first aid. These items were grouped under the following 9 headings: how to know if someone is experiencing psychosis; how to approach someone who may be experiencing psychosis; how to be supportive; how to deal with delusions and hallucinations; how to deal with communication difficulties; whether to encourage the person to seek professional help; what to do if the person does not want help; what to do in a crisis situation when the person has become acutely unwell; what to do if the person becomes aggressive. CONCLUSIONS: These recommendations will improve the provision of first aid to individuals who are developing a psychotic disorder by informing the content of training courses.

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

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.

Protocol for a randomised controlled trial of a web-based healthy relationship tool and safety decision aid for women experiencing domestic violence (I-DECIDE)

BACKGROUND: Domestic violence is a serious problem affecting the health and wellbeing of women globally. Interventions in health care settings have primarily focused on screening and referral, however, women often may not disclose abuse to health practitioners. The internet offers a confidential space in which women can assess the health of their relationships and make a plan for safety and wellbeing for themselves and their children. This randomised controlled trial is testing the effectiveness of a web-based healthy relationship tool and safety decision aid (I-DECIDE). Based broadly on the IRIS trial in the United States, it has been adapted for the Australian context where it is conducted entirely online and uses the Psychosocial Readiness Model as the basis for the intervention. METHODS/DESIGN: In this two arm, pragmatic randomised controlled trial, women who have experienced abuse or fear of a partner in the previous 6 months will be computer randomised to receive either the I-DECIDE website or a comparator website (basic relationship and safety advice). The intervention includes self-directed reflection exercises on their relationship, danger level, priority setting, and results in an individualised, tailored action plan. Primary self-reported outcomes are: self-efficacy (General Self-Efficacy Scale) immediately after completion, 6 and 12 months post-baseline; and depressive symptoms (Centre for Epidemiologic Studies Depression Scale, Revised, 6 and 12 months post-baseline). Secondary outcomes include mean number of helpful actions for safety and wellbeing, mean level of fear of partner and cost-effectiveness. DISCUSSION: This fully-automated trial will evaluate a web-based self-information, self-reflection and self-management tool for domestic violence. We hypothesise that the improvement in self-efficacy and mental health will be mediated by increased perceived support and awareness encouraging positive change. If shown to be effective, I-DECIDE could be easily incorporated into the community sector and health care settings, providing an alternative to formal services for women not ready or able to acknowledge abuse and access specialised services. TRIAL REGISTRATION: Trial registered on 15(th) December 2014 with the Australian New Zealand Clinical Trials Registry ACTRN12614001306606.

A climate-compatible approach to development practice by international humanitarian NGOs

If current climate-change predictions prove accurate, non-linear change, including potentially catastrophic change, is possible and the environments in which international humanitarian NGOs operate will change figuratively and literally. This paper proposes that a new approach to development is required that takes changing climate into account. This 'climate-compatible approach' to development is a bleak shift from some of the current orthodox positions and will be a major challenge to international humanitarian NGOs working with the most vulnerable. However, it is necessary to address the challenges and context such NGOs face, and the need to be resilient and adaptive to these changes.

Assessing the impact of foreign aid: value for money and aid for trade

 Assessing the Impact of Foreign Aid: Value for Money and Aid for Trade provides updated information on how to improve foreign aid programs, exploring the concept and practice of impact assessment within the sometimes-unproblematic approaches advocated in current literature of value for money and aid for trade.
Contributors from multi-lateral agencies and NGOs discuss the changing patterns of Official Development Assistance and their effects on impact assessment, providing theoretical, political, structural, methodological, and practical frameworks, discussions, and a theory-practice nexus.
With twin foci of economics and policy this book raises the potential for making sophisticated and coherent decisions on aid allocation to developing countries.

Innovative delivery mechanisms: Australian aid partnership with churches in Papua New Guinea

The Australian Aid programme is currently valued at AUD5 billion. The majority of this aid flows to the Asia Pacific region with Papua New Guinea and Indonesia being the largest recipients. In addition to traditional delivery mechanisms-bilateral and multilateral-the Australian Government has piloted a small partnership activity with Churches in Papua New Guinea. This paper will consider this model and the benefit it brings. Possible extension of this partnership model to non-Christian religious faiths in other countries, such as Islamic nationwide organisations in Indonesia, is also discussed.

Delivering mental health first aid training in Australian workplaces: exploring instructors' experiences

 The impact of common mental illnesses in the workplace can be reduced by encouraging support from co-workers and promoting early professional help-seeking. The Mental Health First Aid (MHFA) course is an evidence-based effective program designed to encourage social support and early help-seeking in the general community. However, little is known about whether the course meets the needs of workplaces. The current study aimed to gain a better understanding of how the course is being delivered in Australian workplaces and invite feedback on how it could be tailored for this delivery setting. This study used a purpose-designed survey to explore 120 MHFA instructors’ experiences of delivering the course in workplaces. The results indicated that MHFA is most commonly deployed in the human service and education sectors to assist workers with helping clients, rather than helping co-workers. The results also suggest ways in which the MHFA course could be tailored for workplaces, as well as further support instructors require to deliver courses in workplace settings.