Mental Health First Aid in Camden. An Evaluation

Transcription

1 Mental Health First Aid in Camden An Evaluation The National Programme Mental Health First Aid (MHFA) is exactly what you might think a first aid approach to mental health. Originally founded and developed by Betty Kitchener and Professor Tony Jorm in Australia, MHFA has been successfully introduced around the world, in countries as widespread as Hong Kong, Singapore, Finland, Canada, USA and Scotland. Usually taught over two days, MHFA is evidence-based and has been developed and regulated by the National Institute for Mental Health in England (NIMHE). The course teaches people to recognise the signs and symptoms of common mental health problems, provide help on a first aid basis and signpost towards support services. The course aims to give participants the knowledge and confidence to encourage someone to seek the right help, and to reduce the stigma around mental illness. The key message is Mental Health is everybody s business, and the course is aimed at those with no previous training or experience in the field. MHFA training has been recognised in a number of policy documents i as a contributor in reducing stigma and raising awareness around mental illness and in encouraging people to seek help earlier. Previous Research A number of previous trials ii have shown that participants increase their knowledge and confidence about mental illness following the training and that they make use of the skills learned on the course. Some also report a positive impact on the mental health of those participating in the course. The Programme in Camden NHS Camden introduced MHFA courses to the borough in March 2009 as indicated by the local Mental Health Promotion Strategy. Since its inception over 70 courses iii have been delivered and over 800 participants trained by a range of instructors both within Public Health and in a number of partner organisations within the borough. Delivery has focused on staff in posts that interface with the public, particularly the more vulnerable, or staff involved with relevant policy and planning. What Did We Evaluate And How? Between January and March 2010, 6 MHFA courses were delivered and evaluated by NHS Camden. Three of these courses were to mixed groups of workers in the borough and 3 were courses for the Metropolitan police service in Camden. Self-report questionnaires were completed by attendees both before, 1 month and 6 months after attending the courses. The return rate for these questionnaires was high: 87% (60) completed the pre-course, 65% (45) the 1 month post-course and 64% (44) the 6 month post-course questionnaires. The evaluation aimed to determine: Quality of the training Changes in mental health literacy Changes in confidence when dealing with people with mental health problems

2 Changes in opinions about people with mental illness Practical implementation of the training Influence of the training on participants own mental health Who Came on the Courses? There were 69 trainees in total on these 6 courses. 36 were police officers, 12 Local Authority employees, 9 NHS employees, 11 from the voluntary and community sector and 1 from the private sector. 34 were male and 35 female, the majority evenly spread through the age groups. The ethnicity of the participants was predominantly white British (61%); other participants included white Irish, black African, black Caribbean, white and Asian and Asian British. Very few (6) of the participants had any prior formal training in mental health. This usually consisted of short courses (1/2 day or less) within a work setting which included some mental health material. How Did They Rate The Training? All participants complete a standard assessment form for MHFA England asking about the quality and content of the training. 94% of trainers and 97% of the training was rated very good or excellent. OUTCOMES 1) Improvements in Knowledge Course participants were asked to selfassess (Q1) their knowledge of mental health issues in general, (Q2) symptoms of illness and (Q3) resources for people with mental illness. There was a substantial increase in participants selfassessed knowledge in all areas that was well-maintained at 6 months post-course. 100% 80% 60% 40% 20% Participants self-assessment of knowledge about mental health 0% Pre 1m Post 6m Post Q1 Q2 Q3 Participants were also asked to rate as true or false a series of 10 statements about mental illness, first aid and other treatment options, all from areas covered in the course (appendix 1). These results also showed an increase in correct responses to all questions, although in some areas there were relatively high levels of initial knowledge. Some important principals were taken on board by the participants, for example that asking about suicidal feelings does not encourage suicide: The statement: It is not a good idea to ask someone if they are feeling suicidal in case you put the idea in their head was rated as false by 69% pre-course and 93% 6-months postcourse. The statement: There is clear evidence that anxiety disorders are better treated with counselling and psychological techniques than medication was rated as true by 37% pre-course and by 76% at 6 months, showing increased awareness of effective treatment. Participants were also asked to rate the life-time incidence of mental illness amongst the general population. Pretraining, 38% of participants gave the correct answer of 1 in 4. Immediately post-training this showed some improvement to 69%, but this figure had dropped to 48% at 6 months. Instructors

3 felt that the overall incidence was obscured in the training by more complex statistics around different types of mental illness. It is clear that the participants had both actually increased their literacy around mental illness, and also perceived themselves as more knowledgeable. 2) Improvements in Confidence Participants were asked 7 questions (see appendix 2) about their confidence to identify mental illness, assess risk, and provide first-aid support, advice and signposting to people in mental distress. Precourse confidence (quite or very confident) around these areas ranged from 20% - 68% and 1 month post-course from 93% - 100%. There was only a small drop in confidence at 6 months to 84% - 100%. Participants confidence around mental health identification and intervention percentage of particpants quite or very confident 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Q1 Q2 Q3 Q4 Q5 Q6 Q7 Pre 1m post 6m post 3) Less stigmatising views post-course Course participants were asked 5 questions about their own attitudes and their perception of other people s attitudes to mental illness. In general participants were already a relatively enlightened group although their views still shifted in a positive way. (See appendix 3 for full results). This was the only area in which the police officers differed significantly from other participants. For example regarding self-disclosure, the question: If I was suffering from mental health problems I would not want people knowing about it was agreed with (strongly or slightly) by 53% of non-police participants before the course, and by 52% after 6 months (i.e. little change). However, of the police officers, 94% agreed before the course and 59% after the course, indicating a substantial increase in those willing to self-disclose. For the question: The public should be better protected from people who have mental health problems, of non-police participants only 23% agreed pre-course, and this did not change at 6 months. Of the police participants, 57% agreed precourse and this also changed little at 62% post-course. These differences are not surprising given the nature of police work. With regard to self-disclosure, police officers made it clear that they felt disclosure of mental illness would reflect badly on their personnel record and might influence future job prospects. It is heartening that there was an increase in willingness to self-disclose after the course. In relation to protecting the public, this is a police officer s duty. Police contact with violence is much greater than that of the general public, and their experience of people with mental health problems is likely to be skewed by this contact. They are far more likely than the general public to come into contact with the very small percentage of those with a mental illness who commit violent offences, and might well feel that the public should be better protected from this group.

4 4) Impact of Training on Participants Own Mental Health Previous studies have all shown an unexpected effect of participation in the course: a perception that the course has had a positive impact on the participants own mental health. It can be seen from the diagram below that this evaluation had a similar finding: At 6 months posttraining, over 50% of participants felt that the course had a moderate or substantial positive impact on their own mental health. Only 14% felt the course had had no impact. What was the impact of the course on participants mental health? with someone with a mental health problem. Of these, 29 participants (88%) had offered help or advice. Many of these 29 participants had offered help to more than one person, so there were 48 instances of mental health first-aid being applied. The chart illustrates that there were benefits in the workplace and within the wider community, with first-aiders offering help or advice to friends and family, colleagues, customers and members of the public. First-aiders were able to use their skills in multiple settings.. Who did course participants offer help or advice to? Relative 21% 15% 19% 13% Friend Colleague 25% 8% Client/Custo mer Member of Public Other 5) Putting the Training into Practice We were keen to see whether or not participants actually used the knowledge and awareness that they had gained on the course. In the 6 months follow-up, participants were asked: Whether they had come into contact with someone with a mental health problem If so; o had they offered help or advice? o Who did they help? o What help did they offer? Forty-three participants answered this question, and of those, 34 (79%) recognised that they had been in contact The participants were also asked what kind of first-aid they had offered. Often this took more than one form, and a total of 109 interventions showed that each person helped was offered a good spread of the five core interventions taught within the course. What kind of help or advice was offered? In virtually all instances the first-aider reported listening to the person in distress. They were also encouraged to seek professional help (in 86% of cases) and to adopt self-help approaches, given information and reassurance and in over 50% of cases, the first-aider was able to give direct information about an appropriate support group. These are

5 exactly the responses taught within the course. What kind of first-aid was offered? spoke to them about how they were feeling and, with their permission; I made enquiries on their behalf and put them in touch with an appropriate organisation, sending them all the details. I continue to talk to this person regularly. A member of my team appeared to be suffering from, I believed, stress and anxiety, personally spoken to, line manager involved and with her agreement referred to OH and she is also receiving external counselling. 0% 50% 100% Listen to them Encourage them to get professional help Give reassurance and information Put them in contact with an appropriate support group Encourage them to adopt a self-help approach Other Anecdotal details of the first-aid episodes give a flavour of the broad and positive impact that MHFA training had on participants work and home lives: I dealt with a Member of the Public who had a diagnosed mental illness and was deteriorating, having not taken his medication. I spoke to him and offered reassurance, then I helped him to get professional help from the local hospital. Several service users at work experience mental health issues and I was able to give the advice from a more informed perspective than prior to attending the course. Police incidents, dealing with various individuals clearly displaying MH issues. A softer, gentler approach was adopted upon initial meeting in order to best gauge the situation. The individual I had been speaking to for a while, told me how they had been feeling depressed for some time and were on medication for bipolar disorder. They also said that they had spells of feeling suicidal. I Partner with anxiety - off sick with stress. Encouraged him to try MH services offered by GP and to keep himself active. Family with depression - talked about having a review of medications possibly asking about CBT. Friend with depression/eating disorder - encouraged to take depression as seriously as physical health problem and take time off work if needed. Also talked about treatment options for eating disorder and how I could best support her with this and when she returned to work. Some of these comments have been superficially edited for the purposes of clarity. 6) Discussion This evaluation supports existing studies that show that MHFA training increases knowledge and confidence around mental health issues, decreases stigmatising attitudes and most importantly, that trainees put their training to good effect by offering first-aid to people suffering from mental distress in workplaces, at home and in the community. Early intervention, and signposting to appropriate services is in line with NICE guidance iv and improves outcomes, but the stigma of mental illness is often a barrier to people seeking help. MHFA training addresses these issues and is a very effective mental health promotion tool, supporting early recognition, tackling stigma and improving wellbeing.

6 Appendix 1 Knowledge: statements about mental illness % of respondents giving correct answer Question Answer Precourse 1 month postcourse 6 months postcourse 1. It is not a good idea to ask someone if they are feeling suicidal in case you put the idea in their head 2. If someone has a severe traumatic experience, it is important to make them talk about it as soon as possible 3. The best way of helping someone who is having a panic attack is to make them breathe into a paper bag 4. A mental health first aider can distinguish a panic attack from a heart attack 5. Exercise can help relieve depressive and anxiety disorders 6. It is best not to reason with people having delusions 7. People who talk about suicide do not commit suicide Incorrect 69% 89% 93% Incorrect 42% 52% 56% Incorrect 35% 82% 79% Correct 42% 64% 63% Correct 83% 100% 98% Correct 14% 56% 50% Incorrect 65% 89% 84% 8. Psychosis is a lifelong illness Incorrect 32% 76% 63% 9. A depressed person is likely to feel better under the influence of alcohol 10. There is clear evidence that anxiety disorders are better treated with counselling and psychological techniques than medication Incorrect 85% 89% 95% Correct 37% 82% 76%

7 Appendix 2 Questions used to assess changes in confidence How confident do you feel about your ability around the following mental health issues? Precourse 1m Postcourse 6m Postcourse 1. Ability to recognise if someone is experiencing a mental health problem 65% 100% 100% 2. Ability to help someone with a mental health problem in your job or workplace 48% 96% 93% 3. Ability to help a member of your family or a close personal friend if they have a mental health problem 4. Ability to identify if someone is at risk of attempting suicide or harming themselves 5. Ability to assess how high the risk is of someone attempting suicide or harming themselves 6. Ability to guide a person with a mental health problem to appropriate professional help or services 7. Ability to advise someone with a mental health problem about steps they could take themselves 68% 98% 93% 31% 98% 89% 20% 93% 84% 52% 100% 91% 35% 98% 91% Appendix 3 Questions used to assess changes in confidence Views/attitudes about mental illness % agree with statement Question Pre-course 1 m postcourse 6 m postcourse 1. If I was suffering from mental health problems I would not want people knowing about it 68% 64% 55% 2. I would find it hard to talk to someone with a mental health problem 23% 14% 93% 3. People are generally caring and sympathetic to people with mental health problems 27% 31% 33% 4. The public should be better protected from people who have mental health problems 40% 30% 42% 5. The majority of people who experience a mental illness recover 68% 86% 81% i Boorman Review: Staff Health and Well-being Case Studies November 2009, ( Sainsbury Centre for Mental Health briefing 36: The police and Mental Health 2008 ( ii Kitchener, B.A. and Jorm, A.F., 2006

8 Scottish evaluation (Steven, R. & Elvy, N.) 2007 ( RE037FinalReport0506.pdf) Hull evaluation (Macdonald, K.M., Cosquer, C., Flockton, A.) 2008 ( NE England (Dr Borrill, J.) 2010 ( iii 77 courses were delivered between March 2009 and March 2011 iv NICE guidance CG123: Common Mental Health Disorders: identification and pathways to care, May 2011