Development of Chinese mental health first aid guidelines for psychosis: a Delphi expert consensus study

Background: Family and friends of a person developing a mental illness or in a mental health crisis can help the person until treatment is received or the crisis resolves. Guidelines for providing this 'mental health first aid' have been developed and disseminated in high-income countries. However, they may not be appropriate for use in China due to cultural and health care system differences. The aim of this study was to use the Delphi expert consensus method to develop culturally appropriate guidelines for a member of the public providing mental health first aid to someone with psychosis in mainland China. Methods: A Chinese-language survey, comprising statements about how to provide mental health first aid to a person with psychosis, was developed. This was based on the endorsed items from the first round of the English-language questionnaire for high-income countries. These statements were rated by two expert panels from mainland China - a mental health professional panel (N = 31) and a lived experience panel (N = 41) - on how important they believed each statement was for a member of the public providing first aid to a person with psychosis in China. There were three Delphi rounds, with experts able to suggest additional items in Round 1. Items had to have at least 80% endorsement from both panels for inclusion. Results: Out of 208 statements, 207 were endorsed for inclusion in the Chinese-language guidelines. Eight new statements were also included. Compared to the English-language guidelines, the importance of family involvement was emphasized in the development of the Chinese-language guidelines. Conclusions: While many of the actions in the English-language guidelines were endorsed by Chinese participants, a number of additional items point to the importance of developing culturally appropriate mental health first aid guidelines. These guidelines will form the basis for the development of Chinese Mental Health First Aid course aiming at training members of the public on how to provide first aid to someone with a mental health problem.Wenjing Li, Anthony F. Jorm, Yan Wang, Shurong Lu, Yanling He and Nicola Reavle

Cultural adaptation of the mental health first aid guidelines for depression used in English-speaking countries for China: a Delphi expert consensus study

Background: Most people who meet the criteria for a diagnosis of depression in China do not receive treatment. Family and friends can play a role in recognising the signs of depression and encouraging the person to seek treatment. However, many of them may lack the knowledge and skills to offer such help. The aim of this study was to culturally adapt the existing English-language mental health first aid (MHFA) guidelines for helping a person with depression to the Chinese context. Methods: A Delphi expert consensus study was conducted, in which two Chinese expert panels of mental health professionals (with experience in the field of clinical management of depression, n = 37) and consumers and carers (with lived experience, n = 30) rated the importance of actions that could be taken to help a person experiencing depression in mainland China. Results: Data were collected over 3 survey rounds. In the 1st round questionnaire, 175 statements translated into Chinese from the English-language guidelines were presented to the expert panels and 12 new statements were generated from panellists’ comments. Of these 187 statements, 173 were endorsed for inclusion in the adapted guidelines for China. Conclusions: Although the adapted guidelines were still quite similar to the guidelines for English-speaking countries, they also incorporated some new actions for the Chinese context, including those relating to different ways of respecting the autonomy of a person with depression and the role of their families. Further research is needed to explore the use of these guidelines by the Chinese public, including how they may be incorporated in Mental Health First Aid training.Shurong Lu, Wenjing Li, Brian Oldenburg, Yan Wang, Anthony F. Jorm, Yanling He and Nicola J. Reavle

Finite-state recall revealed by backward learning curves constructed from confidence ratings

Two experiments were carried out to show that the constancy of Type II d' in recall is not an artifact, but is due to finite-state processes as suggested by Bernbach (1967). The following conclusions were reached: (1) The constancy of Type II d' is not an artifact due to the inclusion of intralist intrusions in the class of incorrect responses; (2) backward learning curves constructed from confidence ratings gave clear evidence of all-or-none recall; (3) recall appeared to be all or none whether the subjects learned by rote or with a mnemonic; (4) the discriminability index derived from Luce's (1959) choice theory did not exhibit constancy over trials, unlike Type II d' and despite the fact that backward rating curves indicated all-or-none processes

Academic psychiatry - extinction or adaptation to a changing world: A view from clinical psychology

Henderson et al.’s Editorial contends that academic psychiatrists are now an endangered species, with potential impacts on undergraduate teaching, postgraduate training, research capacity and academic advice on health policy (Henderson et al., 2014). The Editorial identifies contributing factors, which include barriers to recruitment of trainee psychiatrists to academic careers due to demographic, financial and lifestyle factors, psychiatry’s ‘image problem’ within medicine (Lyons, 2013), the need for mentorship and the lack of career options offered by existing research fellowships. The Editorial predicts that, should the situation continue, psychiatrists will find their role in research replaced by ‘highly trained researchers from other professions’ and it urges far-reaching changes to avoid a looming extinction. The situation in academic psychiatry is very different from that in clinical psychology, where demand for postgraduate training places far outstrips supply, students are fully engaged with research as part of their training, and there is no shortage of aspiring clinical academics. In this commentary, we consider why the situation has evolved so differently for the two professions and what lessons might be learned for the survival of academic psychiatry..

Mental health nurses' and psychiatrists' views on the prognosis of schizophrenia and depression: an explanatory, qualitative investigation

The definitive version is available at www.blackwell-synergy.comThis study uses a qualitative methodology to explore mental health literacy, specifically perceptions of prognosis, which is typically investigated with a quantitative, questionnaire-based approach. Two vignettes – one of a person with schizophrenia and one with depression – were shown to three mental health nurses and three psychiatrists. During semi-structured, open-ended interviews, they were asked to discuss their thoughts about the prognosis for the patient presented in each vignette. Participants tended to use the terms ‘prognosis’ and ‘outcome’ interchangeably. Psychiatrists tended to be more guarded in determining a prognosis than nurses. Both groups emphasized the importance of clinical experience in formulating views. However, nurses also discussed the role of the multidisciplinary team, whilst psychiatrists emphasized their reliance upon the scientific literature in shaping opinions. Participants identified information relevant for incorporating into future vignettes, to allow more informed research into literacy. The results of quantitative mental health literacy research should be interpreted with caution. Simplifying responses to allow comparative analysis is necessary, but masks more complex and important interpretations. Further qualitative research is recommended, the results of which can inform more comprehensive quantitative studies in the area.A. Chur-Hansen, R. Taverner, R.J. Barrett and M. Hug

MJA policy on sponsored supplements - in reply

Dr Jureidini's response to the 'Early intervention in youth mental health' supplement is puzzling and idiosyncratic. He asserts some kind of impropriety on our behalf or that of the MJA - an assertion we strongly reject