Increasing early help seeking and support for people experiencing mental illness: exploring and modelling helping behaviours in members of the public

© 2015 Dr. Alyssia RossettoBackground: People with mental illnesses are encouraged to seek professional help as soon as possible to improve their long-term outcomes. However, only a minority of people utilise mental health services in any given 12-month period. Evidence suggests that the social networks of people with a mental illness can facilitate help seeking and recovery for the ill person. However, little literature exists on how, when and why people decide to provide help to individuals experiencing mental illnesses. This thesis recognises the need for a different approach to the problem of how to facilitate early treatment seeking and long-term support for mental illness and aims to: 1. elucidate the factors that motivate adults to give help to people experiencing a mental illness or mental health crisis; 2. understand how intention translates into behaviour in these situations; 3. develop a model of help giving which describes the process of providing help; and 4. explore ways to increase the likelihood of effective help giving, and improve outcomes for people with mental illness. Method: Three studies were undertaken to fulfil these aims. The first study focused on establishing the current help giving knowledge of the Australian public, using data from the 2011 National Survey of Mental Health Literacy and Stigma to compare the helping responses of 6,019 members of the general public with current best practice, in the form of the Mental Health First Aid (MHFA) action plan. It also investigated factors that were associated with good quality helping scores for different mental illnesses, and examined predictors of harmful responses towards people with mental illnesses, using linear and logistic regressions. The second study surveyed 820 participants at two time points six months apart, adapting questions from the 2011 National Survey of Mental Health Literacy and Stigma. It assessed whether a participant’s intention to help a hypothetical person at baseline predicted their behaviour towards a real-life person at follow-up. The final study investigated the helping experiences of 16 people who had received MHFA training using semi-structured interviews. It aimed to develop a model of help giving towards people with mental illnesses using thematic analysis techniques. Results: The first study found that the mental health first aid knowledge of the general, untrained public requires substantial improvement. Participants frequently mentioned basic actions, for example, listening to the person, but lacked more specific and effective helping skills, such as listening non-judgementally, and assessing and assisting with crisis, even when the vignette presented a person at risk of suicide. Regressions indicated that the factors associated with respondents’ helping depended on the disorder presented in the vignette, with the only consistent predictor of good quality helping scores being female gender of the respondent. Stigmatising attitudes, especially perceiving the person with the illness to be weak, rather than sick, were associated with harmful responses and poorer helping actions. The results of the second study supported previous research which suggested that the intention to perform specific mental health first aid actions, and the overall quality of helping responses towards a hypothetical person, predicted respondents’ actual behaviour at follow-up. These associations were generally small but significant; however, the finding that people who mentioned assessing for the risk of suicide were five times more likely to perform this action at follow-up, has notable implications for suicide intervention and mental health first aid programs. The study also found that past behaviour was a significant predictor of future behaviour, independent of other variables. The third study’s analysis noted that, despite the complexity of helping situations involving a recipient with mental illness, there were several common elements and stages underlying participants’ experiences of helping people with mental illnesses. The model of helping developed from these data involves recognising a problem exists; considering reasons that might motivate or deter helping; taking an action according to a spectrum of helping; and assessing both the immediate and long- term effects of the helping action on the recipient and the helper. Additional themes were also derived from the information provided by participants. These related to issues they perceived as important when helping, and assisted in contextualising parts of the model. Discussion: Overall, the results of this research suggest that while the mental health first aid knowledge of the general public is minimal, existing capabilities can be built upon by public health campaigns and educational programs such as MHFA. Increasing knowledge about mental illnesses, appropriate mental health first aid actions and confidence is likely to have positive effects on helping behaviours. Likewise, although participants provided many reasons for choosing not to help a person experiencing a mental illness, several of these reasons could be modified with further education and open and sensitive public discussions about mental health and mental illness. In terms of future research, the model of helping, which integrates the results from each of the studies that comprise the thesis, also reflects the findings of the literature to date and provides a basis for continuing research into helping. This research suggests that campaigns and programs which focus on educating the social networks of people with mental illnesses on how to help appropriately would both increase opportunities for early intervention and complement existing help-seeking approaches for people with mental illnesses

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

Abstract 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

Additional file 2: of Helping intentions of undergraduates towards their depressed peers: a cross-sectional study in Sri Lanka

Correlation between ALGEE components. (XLSX 10 kb

Additional file 1: of Helping intentions of undergraduates towards their depressed peers: a cross-sectional study in Sri Lanka

Correlations between descriptive coding categories. (XLSX 9 kb

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

Abstract 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

Exploring adolescents’ causal beliefs about depression: A qualitative study with implications for prevention

Objective This study qualitatively explored adolescents’ causal beliefs about depression. Method Semi-structured focus groups were conducted with 38 Australian secondary students (25 females, 13 males) aged 15–17 years. Adolescents were asked an open-ended question about the causes of depression, followed by a series of prompts about common causes of illness. A deductive thematic analysis was conducted to identify themes within the data set. Results Participants emphasised potentially mutable psychosocial causes of depression (e.g., exposure to stressors, lifestyle) over biogenetic factors (e.g., genetics, chemical imbalance). Stigmatising explanations of depression were rare, although a minority gave explanations broadly consistent with a ‘weak not sick’ stigmatising attitude. Conclusion The findings suggest that adolescents perceived depression causation to be complex and multifactorial. Understanding the causal beliefs that are most salient amongst adolescents can inform messaging in relation to efforts to prevent depression at this time

Additional file 1: of Associations of training to assist a suicidal person with subsequent quality of support: results from a national survey of the Australian public

Full interview schedule. (DOCX 51 kb