- Email: [email protected]
How do mental health first aid ™ interventions influence patient help-seeking behaviours? A dilemma for pharmacist mental health first aid responders
Accepted Manuscript How do mental health first aid ™ interventions influence patient help-seeking behaviours? A dilemma for pharmacist mental health first aid responders Azmeta Chowdhary, Victoria Zlotnikova, Cherie Lucas, John M. Lonie PII:
S1551-7411(18)30102-5
DOI:
10.1016/j.sapharm.2018.02.010
Reference:
RSAP 1018
To appear in:
Research in Social & Administrative Pharmacy
Received Date: 18 February 2018 Accepted Date: 25 February 2018
Please cite this article as: Chowdhary A, Zlotnikova V, Lucas C, Lonie JM, How do mental health first aid ™ interventions influence patient help-seeking behaviours? A dilemma for pharmacist mental health first aid responders, Research in Social & Administrative Pharmacy (2018), doi: 10.1016/ j.sapharm.2018.02.010. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Title Page with Author details
How do Mental Health First Aid TM interventions influence patient help-seeking behaviours? A
Victoria Zlotnikova, BPS, (PharmD Cand.)1 Cherie Lucas, PhD, BPharm, GradCertEdSt (Higher Ed)2 John M. Lonie, R. Ph, EdD1 Corresponding Author
M AN U
1. Long Island University, College of Pharmacy 75 Dekalb Avenue Brooklyn, NY, 11201, USA
SC
Azmeta Chowdhary, BPS, (Pharm D Cand.) 1
RI PT
dilemma for pharmacist mental health first aid responders.
Corresponding Author: John M. Lonie, R.Ph, Ed.D
TE D
2. University of Technology Graduate School of Health (Pharmacy Discipline) 67 Thomas Street, Ultimo Sydney, Australia
75 Dekalb Avenue
EP
Long Island University, College of Pharmacy
AC C
Brooklyn, NY, 11201, USA 718-488-1259
[email protected]
ACCEPTED MANUSCRIPT
How do Mental Health First Aid TM interventions influence patient help-seeking behaviours? An
RI PT
opportunity for pharmacists as mental health first aid responders.
Abstract
In any given year approximately 34% of the 130 million adults in the United States suffer from a mental health condition or disorder. Anxiety and depressive disorders are the most common followed by
SC
substance use disorder. Many people who suffer from a mental illness do not seek help. Studies have shown that the stigma of being perceived as having a mental illness prevents many adults from seeking
M AN U
help. Mental Health First Aid TM (MHFA) is an educational program geared towards educating MHFA responders to assist those who may be experiencing a mental health condition or disorder. Pharmacists are the most accessible healthcare professionals, and many are trained in delivering MHFA. The literature on MHFA suggests that it is an effective educational program for those that take the training course. What is lacking is evidence that MHFA interventions positively affect help-seeking behaviours after an
TE D
intervention has occurred between a mental health first air responder and an individual requiring MHFA. This paper highlights this issue and provides suggestions for future research.
EP
1. INTRODUCTION
In the United States 43.8 million adults suffer from a mental illness in a given year.1 Sixty percent
AC C
of American adults living with a mental disorder did not seek treatment in 2016.1 Research has shown that a key barrier to seeking treatment is the stigma associated with mental illness.1,2 This stigma occurs in various healthcare settings including community pharmacy1 and may affect patient help-seeking behaviours.2 Research has shown that stigma towards patients with mental health conditions often stems from an unconscious bias, pessimistic views on treatment outcomes, or inadequate training in mental healthcare.3,4 A review of the epidemiology of mental health conditions across several countries identified substantial similarities in the onset and symptoms of common mental health disorders. For example, in
ACCEPTED MANUSCRIPT
most countries and cultures, females are more likely to experience a mood or anxiety disorder, and males were more likely to experience an alcohol or other substance use disorder.5 Anxiety and depressive disorders affect more than 16 million people in the United States and 350 million people worldwide each
RI PT
year.3,4,6 In addition to health care professionals, it is also important for individuals without formal health care or mental health training (i.e. lay public) to have access to the knowledge and skills needed to
address mental illness stigma in order to engage appropriately and provide support as mental health first
SC
aid responders with individuals experiencing a mental health problem or crisis .7 Once trained in MHFA, pharmacists are in a unique position to assist during their frequent interactions with their patients and
2. MENTAL HEALTH FIRST AID
M AN U
customers.
Mental Health First Aid™ (MHFA) is a unique mental health advocacy and training program that educates the lay public on how to respond and react to someone who may be experiencing a mental health condition or crisis. Mental Health First Aid was created in Australia in 2001 by Betty Kitchener, a nurse
TE D
specializing in health education, and Anthony Jorm, a mental health literacy professor.8 Since then it has become a popular training program in the United States and many other countries worldwide.8 In addition to providing mental health education and social support, MHFA teaches its participants to appropriately
EP
identify a mental illness, and then properly engage and encourage persons to seek appropriate resources or treatment. MHFA utilizes a specific action plan to assist the first aider in supporting someone
AC C
experiencing a mental health condition.8 For example, the action plan teaches MHFA students how to approach, listen nonjudgmentally, assess and assist the individual, provide support, information and encourage the individual to seek appropriate assistance.8 MHFA courses typically consists of 8-12 hours of face-to-face training, primarily intended for non-mental health professionals, as well as the general public.8 For example, in the United States MHFA is an 8-hour training program.8 Proponents of MHFA relate it to cardiopulmonary resuscitation (CPR) training. If a societal or healthcare goal is to train as
ACCEPTED MANUSCRIPT
many people in CPR in order to save lives, then society and the healthcare system should also be training people in mental health first aid skills. 2.1 The literature on MHFA
RI PT
There have been several studies examining the usefulness of MHFA as an educational program for the participants who take the training course. Examples include assessing MHFA training for its effects on knowledge, attitudes and helping behaviour of course participants,9,10,11 and the efficacy of MHFA
training as a public health intervention and what to consider when providing mental health first aid to
SC
minority populations.12-16 In a review, researchers evaluated mental health first aid (MHFA) training on
M AN U
trainees by evaluating three published trials. Researchers found that MHFA training improved trainee helping behaviours, greater confidence in providing help to others and decreased social distance from people with mental disorders.17 A recent study evaluated the trainee confidence and application of MHFA skills in a tertiary setting. Most study participants agreed that their mental health literacy and confidence improved as a result of the training. Although 60% of the respondents mentioned that they have had an
TE D
opportunity to apply their skills, it is not clear from this study how or if the recipients of MHFA sought help after the intervention.18 While these studies on MHFA trainees are important, there appears to be a gap in the literature assessing the effectiveness of MHFA as an intervention. Does sufficient empirical
EP
data exist regarding MHFA being an effective intervention in motivating help-seeking behaviours in adults exposed to a mental health first aider intervention?
AC C
3. APPROACH
To answer this question a computer search of databases was performed. Search terms were
selected with the assistance of a medical librarian. Studies were searched in EBSCO host databases [MEDLINE + CINAHL Complete + PsycINFO] as well as PubMed. Three researchers conducted the initial search and pooled their findings. The search strategy included the use of Medical Subject Headings (MeSH) terms. The term “mental health first aid” was chosen. The search term was purposely kept broad as to obtain as many articles as possible. The initial search strategy yielded 193 results. Duplicate articles were identified and excluded from further analysis. One hundred eighty-one articles were screened. Over
ACCEPTED MANUSCRIPT
90% of the articles retrieved focused on the educational benefits of the MHFA training program on the program participants not of the effectiveness of MHFA on the help-seeking behaviours of individuals who experienced an MHFA intervention. No studies were found which focused on the effectiveness of MHFA
RI PT
on patient help-seeking behaviours (Figure 1). Figure 1
SC
Records identified through database searching (n = 193)
M AN U
Identification
Flow diagram of study selection
TE D
Records after duplicates removed (n = 181)
Eligibility
EP AC C
Screening
Records screened (n = 181)
Full-text articles assessed for eligibility (n = 181)
Articles found focusing on the effectiveness of MHFA on patient help-seeking behaviours. (n = 0)
Full-text articles excluded, with reasons (n = 181)
ACCEPTED MANUSCRIPT
4. DISCUSSION AND FUTURE DIRECTIONS Based on these findings, it appears that MHFA training programs need to be “tested” for their patient help-seeking effectiveness using more rigorous methods. As mentioned, most of the research that currently exists involves the evaluation of how MHFA affects persons that take the MHFA course. For
RI PT
example, how MHFA addresses the stigma of individuals with mental illnesses and MHFA trainee
attitudes and perceptions of the training. It would be helpful if studies were initiated that evaluate the actual benefits to individuals who are exposed to MHFA interventions, with a possible “follow up” on these patients/participants, as recommended in most scenarios, particularly if the individual is a peer,
SC
friend, family member or regular community pharmacy patient/customer.
While randomized control studies assessing the clinical effectiveness of MHFA may not be a practical methodological approach for this problem, there are other ways that the effectiveness of MHFA could be
M AN U
assessed. For example, individual case reports could be conducted to get a sense of what type of interventions were initiated and which interventions resulted in patient help-seeking behaviours. In addition, researchers could interview either the mental health first aider and/or the first aid recipient to examine the factors leading up to the MHFA intervention and the recipients help-seeking behaviours. Alternatively, case control studies and retrospective cohort studies on MHFA participants can be conducted to determine various factors that lead to individuals seeking help versus those that did not seek
TE D
help after a MHFA intervention.
Additional research involving pharmacists as mental health first aiders is warranted/ As highly accessible healthcare professionals, MHFA-trained pharmacists can make a significant impact in their communities. However, for pharmacists to truly make such an impact, research assessing pharmacists’ willingness and
EP
competence to serve as MHFA responders is necessary. Some pharmacists may view this as an additional professional liability and not take advantage of the training. Others may embrace this and view it as an
AC C
expansion of their professional responsibilities. Presently, health professionals receive the same MHFA certification as the general public. It is not unusual to expect pharmacists or other licensed health professionals to be held to a higher level of competence in MHFA. An adapted “professional” MHFA training could tap into the already extensive medical training that pharmacists currently have. Perhaps a more intensive MHFA training can be offered to pharmacists and other licensed health professionals. If an adapted MHFA were offered to pharmacists, it may be able to qualify as required continuing education credits. This may be an additional incentive for pharmacists to become certified.
ACCEPTED MANUSCRIPT
Given the high levels of public trust enjoyed by pharmacists, another avenue of potential research would be to assess how patients and other health care providers perceive pharmacists in the role of a MHFA responder. How would patients view pharmacists and for that matter even other professionals in delivering this type of care/service? Would potential patients avail themselves of their community
pharmacists would make in their communities could be momentous.
RI PT
pharmacist if they knew he or she were MHFA certified? If so, the positive impact MHFA-trained
The MHFA website is a valuable resource for persons requiring information about support groups to assist people with a mental health condition, to accessing MHFA accredited instructors.8 It would be treatment-seeking behaviours on this website.19
SC
helpful to see an anonymous repository or blog of MHFA individual interventions and follow-up
The impact of undiagnosed and untreated mental illness has become the focus of debate throughout the
M AN U
United States. As the number of people suffering from mental illnesses continues to rise, so does the need for evidence-based interventions by non-mental health professionals and the lay public. The results of this enquiry show a definite need for further study of MHFA as a viable intervention for individuals
AC C
EP
Conflicts of Interest- None
TE D
suffering from mental health conditions.
ACCEPTED MANUSCRIPT
REFERENCES 1. All Things Can Be Good. Learn more about mental health | NAMI: National Alliance on Mental Illness. https://www.nami.org/Learn-More. Accessed February 4, 2018.
RI PT
2. Boyd J, et al. Internalized Stigma of Mental Illness (ISMI) scale: a multinational review. Compr Psychiat. 2014; 55:221-231. 3. “Research & Evidence Base.” Mental Health First Aid, National Council for Behavioral Health, 18 Oct. 2013, www.mentalhealthfirstaid.org/about/research/. Accessed Jan 20, 2018.
SC
4. Dyrbye L, et al. The impact of stigma and personal experiences on the help-seeking behaviors of medical students with burnout. Acad Med.2015;90:9:61-969.
M AN U
5. Steel Z, Marnane C, Iranpour C, Chey T, Jackson J, Patel V, Silove D. The global prevalence of common mental disorders: a systematic review and meta-analysis 1980–2013. Int J Epidemiol. 2014;43(2):476-93. 6. Kaiser R, Andrews-Hanna J, Wager T, Pizzagalli D. Large-scale network dysfunction in major depressive disorder: a meta-analysis of resting-state functional connectivity. JAMA Psychiatry. 2015;72(6):603-11. 7. Public Policy. Learn more about mental health | NAMI: National Alliance on Mental Illness. https://www.nami.org/Learn-More/Public-Policy. Accessed February 4, 2018.
TE D
8. Research & Evidence Base. Mental Health First Aid. https://www.mentalhealthfirstaid.org/about/research/. Published October 18, 2013. Accessed February 4, 2018. 9. Kitchener B, Jorm A. Mental health first aid training for the public: evaluation of effects on knowledge, attitudes and helping behavior. BMC Psychiatry. 2002;2(1):10.
EP
10. Kitchener B, Jorm A. Mental health first aid training: review of evaluation studies. Aust N Z J Psychiatry. 2006;40(1):6-8.
AC C
11. Jorm A, Kitchener B, O'Kearney R, Dear K. Mental health first aid training of the public in a rural area: a cluster randomized trial. BMC psychiatry. 2004;4(1):33. 12. Hadlaczky G, Hökby S, Mkrtchian A, Carli V, Wasserman D. Mental Health First Aid is an effective public health intervention for improving knowledge, attitudes, and behaviour: A metaanalysis. Int Rev Psychiatry. 2014;26(4):467-75. 13. Bond K, Jorm A, Kelly C, Kitchener B, Morris S, Mason R. Considerations when providing mental health first aid to an LGBTIQ person: a Delphi study. Adv Ment Health. 2017;19:1-5. 14. MHFA Course Evaluations. MHFA Australia Course Evaluations. https://mhfa.com.au/research/mhfa-course-evaluations. Accessed February 4, 2018. 15. PRISMA.” PRISMA 2009 Checklist Ottawa Hospital Research Institute, www.prismastatement.org/.
ACCEPTED MANUSCRIPT
16. Knaak S, Mantler E, Szeto A. Mental illness-related stigma in healthcare: Barriers to access and care and evidence-based solutions. Healthcare Management Forum. 2017;30(2):111-116.
17. Kitchener B, Jorm F. Mental health first aid training: review of evaluation studies. Aust N Z J Psychiatry. 2006;40(1):6-8.
RI PT
18. Albrecht KL, Giftakis E, Baxter C, Wylde T, Clifford R, Ashoorian D. Mental health first aid training and its application in a tertiary setting benefits staff and students. Res Social Adm Pharm. 2017;13(4):e30.
19. Evans-Lacko S, Brohan E, Mojtabai R, Thornicroft G. Association between public views of mental illness and self-stigma among individuals with mental illness in 14 European countries. Psychological Medicine. 2012;42(8):1741-1752.
AC C
EP
TE D
M AN U
SC
.
S1551-7411(18)30102-5
DOI:
10.1016/j.sapharm.2018.02.010
Reference:
RSAP 1018
To appear in:
Research in Social & Administrative Pharmacy
Received Date: 18 February 2018 Accepted Date: 25 February 2018
Please cite this article as: Chowdhary A, Zlotnikova V, Lucas C, Lonie JM, How do mental health first aid ™ interventions influence patient help-seeking behaviours? A dilemma for pharmacist mental health first aid responders, Research in Social & Administrative Pharmacy (2018), doi: 10.1016/ j.sapharm.2018.02.010. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Title Page with Author details
How do Mental Health First Aid TM interventions influence patient help-seeking behaviours? A
Victoria Zlotnikova, BPS, (PharmD Cand.)1 Cherie Lucas, PhD, BPharm, GradCertEdSt (Higher Ed)2 John M. Lonie, R. Ph, EdD1 Corresponding Author
M AN U
1. Long Island University, College of Pharmacy 75 Dekalb Avenue Brooklyn, NY, 11201, USA
SC
Azmeta Chowdhary, BPS, (Pharm D Cand.) 1
RI PT
dilemma for pharmacist mental health first aid responders.
Corresponding Author: John M. Lonie, R.Ph, Ed.D
TE D
2. University of Technology Graduate School of Health (Pharmacy Discipline) 67 Thomas Street, Ultimo Sydney, Australia
75 Dekalb Avenue
EP
Long Island University, College of Pharmacy
AC C
Brooklyn, NY, 11201, USA 718-488-1259
[email protected]
ACCEPTED MANUSCRIPT
How do Mental Health First Aid TM interventions influence patient help-seeking behaviours? An
RI PT
opportunity for pharmacists as mental health first aid responders.
Abstract
In any given year approximately 34% of the 130 million adults in the United States suffer from a mental health condition or disorder. Anxiety and depressive disorders are the most common followed by
SC
substance use disorder. Many people who suffer from a mental illness do not seek help. Studies have shown that the stigma of being perceived as having a mental illness prevents many adults from seeking
M AN U
help. Mental Health First Aid TM (MHFA) is an educational program geared towards educating MHFA responders to assist those who may be experiencing a mental health condition or disorder. Pharmacists are the most accessible healthcare professionals, and many are trained in delivering MHFA. The literature on MHFA suggests that it is an effective educational program for those that take the training course. What is lacking is evidence that MHFA interventions positively affect help-seeking behaviours after an
TE D
intervention has occurred between a mental health first air responder and an individual requiring MHFA. This paper highlights this issue and provides suggestions for future research.
EP
1. INTRODUCTION
In the United States 43.8 million adults suffer from a mental illness in a given year.1 Sixty percent
AC C
of American adults living with a mental disorder did not seek treatment in 2016.1 Research has shown that a key barrier to seeking treatment is the stigma associated with mental illness.1,2 This stigma occurs in various healthcare settings including community pharmacy1 and may affect patient help-seeking behaviours.2 Research has shown that stigma towards patients with mental health conditions often stems from an unconscious bias, pessimistic views on treatment outcomes, or inadequate training in mental healthcare.3,4 A review of the epidemiology of mental health conditions across several countries identified substantial similarities in the onset and symptoms of common mental health disorders. For example, in
ACCEPTED MANUSCRIPT
most countries and cultures, females are more likely to experience a mood or anxiety disorder, and males were more likely to experience an alcohol or other substance use disorder.5 Anxiety and depressive disorders affect more than 16 million people in the United States and 350 million people worldwide each
RI PT
year.3,4,6 In addition to health care professionals, it is also important for individuals without formal health care or mental health training (i.e. lay public) to have access to the knowledge and skills needed to
address mental illness stigma in order to engage appropriately and provide support as mental health first
SC
aid responders with individuals experiencing a mental health problem or crisis .7 Once trained in MHFA, pharmacists are in a unique position to assist during their frequent interactions with their patients and
2. MENTAL HEALTH FIRST AID
M AN U
customers.
Mental Health First Aid™ (MHFA) is a unique mental health advocacy and training program that educates the lay public on how to respond and react to someone who may be experiencing a mental health condition or crisis. Mental Health First Aid was created in Australia in 2001 by Betty Kitchener, a nurse
TE D
specializing in health education, and Anthony Jorm, a mental health literacy professor.8 Since then it has become a popular training program in the United States and many other countries worldwide.8 In addition to providing mental health education and social support, MHFA teaches its participants to appropriately
EP
identify a mental illness, and then properly engage and encourage persons to seek appropriate resources or treatment. MHFA utilizes a specific action plan to assist the first aider in supporting someone
AC C
experiencing a mental health condition.8 For example, the action plan teaches MHFA students how to approach, listen nonjudgmentally, assess and assist the individual, provide support, information and encourage the individual to seek appropriate assistance.8 MHFA courses typically consists of 8-12 hours of face-to-face training, primarily intended for non-mental health professionals, as well as the general public.8 For example, in the United States MHFA is an 8-hour training program.8 Proponents of MHFA relate it to cardiopulmonary resuscitation (CPR) training. If a societal or healthcare goal is to train as
ACCEPTED MANUSCRIPT
many people in CPR in order to save lives, then society and the healthcare system should also be training people in mental health first aid skills. 2.1 The literature on MHFA
RI PT
There have been several studies examining the usefulness of MHFA as an educational program for the participants who take the training course. Examples include assessing MHFA training for its effects on knowledge, attitudes and helping behaviour of course participants,9,10,11 and the efficacy of MHFA
training as a public health intervention and what to consider when providing mental health first aid to
SC
minority populations.12-16 In a review, researchers evaluated mental health first aid (MHFA) training on
M AN U
trainees by evaluating three published trials. Researchers found that MHFA training improved trainee helping behaviours, greater confidence in providing help to others and decreased social distance from people with mental disorders.17 A recent study evaluated the trainee confidence and application of MHFA skills in a tertiary setting. Most study participants agreed that their mental health literacy and confidence improved as a result of the training. Although 60% of the respondents mentioned that they have had an
TE D
opportunity to apply their skills, it is not clear from this study how or if the recipients of MHFA sought help after the intervention.18 While these studies on MHFA trainees are important, there appears to be a gap in the literature assessing the effectiveness of MHFA as an intervention. Does sufficient empirical
EP
data exist regarding MHFA being an effective intervention in motivating help-seeking behaviours in adults exposed to a mental health first aider intervention?
AC C
3. APPROACH
To answer this question a computer search of databases was performed. Search terms were
selected with the assistance of a medical librarian. Studies were searched in EBSCO host databases [MEDLINE + CINAHL Complete + PsycINFO] as well as PubMed. Three researchers conducted the initial search and pooled their findings. The search strategy included the use of Medical Subject Headings (MeSH) terms. The term “mental health first aid” was chosen. The search term was purposely kept broad as to obtain as many articles as possible. The initial search strategy yielded 193 results. Duplicate articles were identified and excluded from further analysis. One hundred eighty-one articles were screened. Over
ACCEPTED MANUSCRIPT
90% of the articles retrieved focused on the educational benefits of the MHFA training program on the program participants not of the effectiveness of MHFA on the help-seeking behaviours of individuals who experienced an MHFA intervention. No studies were found which focused on the effectiveness of MHFA
RI PT
on patient help-seeking behaviours (Figure 1). Figure 1
SC
Records identified through database searching (n = 193)
M AN U
Identification
Flow diagram of study selection
TE D
Records after duplicates removed (n = 181)
Eligibility
EP AC C
Screening
Records screened (n = 181)
Full-text articles assessed for eligibility (n = 181)
Articles found focusing on the effectiveness of MHFA on patient help-seeking behaviours. (n = 0)
Full-text articles excluded, with reasons (n = 181)
ACCEPTED MANUSCRIPT
4. DISCUSSION AND FUTURE DIRECTIONS Based on these findings, it appears that MHFA training programs need to be “tested” for their patient help-seeking effectiveness using more rigorous methods. As mentioned, most of the research that currently exists involves the evaluation of how MHFA affects persons that take the MHFA course. For
RI PT
example, how MHFA addresses the stigma of individuals with mental illnesses and MHFA trainee
attitudes and perceptions of the training. It would be helpful if studies were initiated that evaluate the actual benefits to individuals who are exposed to MHFA interventions, with a possible “follow up” on these patients/participants, as recommended in most scenarios, particularly if the individual is a peer,
SC
friend, family member or regular community pharmacy patient/customer.
While randomized control studies assessing the clinical effectiveness of MHFA may not be a practical methodological approach for this problem, there are other ways that the effectiveness of MHFA could be
M AN U
assessed. For example, individual case reports could be conducted to get a sense of what type of interventions were initiated and which interventions resulted in patient help-seeking behaviours. In addition, researchers could interview either the mental health first aider and/or the first aid recipient to examine the factors leading up to the MHFA intervention and the recipients help-seeking behaviours. Alternatively, case control studies and retrospective cohort studies on MHFA participants can be conducted to determine various factors that lead to individuals seeking help versus those that did not seek
TE D
help after a MHFA intervention.
Additional research involving pharmacists as mental health first aiders is warranted/ As highly accessible healthcare professionals, MHFA-trained pharmacists can make a significant impact in their communities. However, for pharmacists to truly make such an impact, research assessing pharmacists’ willingness and
EP
competence to serve as MHFA responders is necessary. Some pharmacists may view this as an additional professional liability and not take advantage of the training. Others may embrace this and view it as an
AC C
expansion of their professional responsibilities. Presently, health professionals receive the same MHFA certification as the general public. It is not unusual to expect pharmacists or other licensed health professionals to be held to a higher level of competence in MHFA. An adapted “professional” MHFA training could tap into the already extensive medical training that pharmacists currently have. Perhaps a more intensive MHFA training can be offered to pharmacists and other licensed health professionals. If an adapted MHFA were offered to pharmacists, it may be able to qualify as required continuing education credits. This may be an additional incentive for pharmacists to become certified.
ACCEPTED MANUSCRIPT
Given the high levels of public trust enjoyed by pharmacists, another avenue of potential research would be to assess how patients and other health care providers perceive pharmacists in the role of a MHFA responder. How would patients view pharmacists and for that matter even other professionals in delivering this type of care/service? Would potential patients avail themselves of their community
pharmacists would make in their communities could be momentous.
RI PT
pharmacist if they knew he or she were MHFA certified? If so, the positive impact MHFA-trained
The MHFA website is a valuable resource for persons requiring information about support groups to assist people with a mental health condition, to accessing MHFA accredited instructors.8 It would be treatment-seeking behaviours on this website.19
SC
helpful to see an anonymous repository or blog of MHFA individual interventions and follow-up
The impact of undiagnosed and untreated mental illness has become the focus of debate throughout the
M AN U
United States. As the number of people suffering from mental illnesses continues to rise, so does the need for evidence-based interventions by non-mental health professionals and the lay public. The results of this enquiry show a definite need for further study of MHFA as a viable intervention for individuals
AC C
EP
Conflicts of Interest- None
TE D
suffering from mental health conditions.
ACCEPTED MANUSCRIPT
REFERENCES 1. All Things Can Be Good. Learn more about mental health | NAMI: National Alliance on Mental Illness. https://www.nami.org/Learn-More. Accessed February 4, 2018.
RI PT
2. Boyd J, et al. Internalized Stigma of Mental Illness (ISMI) scale: a multinational review. Compr Psychiat. 2014; 55:221-231. 3. “Research & Evidence Base.” Mental Health First Aid, National Council for Behavioral Health, 18 Oct. 2013, www.mentalhealthfirstaid.org/about/research/. Accessed Jan 20, 2018.
SC
4. Dyrbye L, et al. The impact of stigma and personal experiences on the help-seeking behaviors of medical students with burnout. Acad Med.2015;90:9:61-969.
M AN U
5. Steel Z, Marnane C, Iranpour C, Chey T, Jackson J, Patel V, Silove D. The global prevalence of common mental disorders: a systematic review and meta-analysis 1980–2013. Int J Epidemiol. 2014;43(2):476-93. 6. Kaiser R, Andrews-Hanna J, Wager T, Pizzagalli D. Large-scale network dysfunction in major depressive disorder: a meta-analysis of resting-state functional connectivity. JAMA Psychiatry. 2015;72(6):603-11. 7. Public Policy. Learn more about mental health | NAMI: National Alliance on Mental Illness. https://www.nami.org/Learn-More/Public-Policy. Accessed February 4, 2018.
TE D
8. Research & Evidence Base. Mental Health First Aid. https://www.mentalhealthfirstaid.org/about/research/. Published October 18, 2013. Accessed February 4, 2018. 9. Kitchener B, Jorm A. Mental health first aid training for the public: evaluation of effects on knowledge, attitudes and helping behavior. BMC Psychiatry. 2002;2(1):10.
EP
10. Kitchener B, Jorm A. Mental health first aid training: review of evaluation studies. Aust N Z J Psychiatry. 2006;40(1):6-8.
AC C
11. Jorm A, Kitchener B, O'Kearney R, Dear K. Mental health first aid training of the public in a rural area: a cluster randomized trial. BMC psychiatry. 2004;4(1):33. 12. Hadlaczky G, Hökby S, Mkrtchian A, Carli V, Wasserman D. Mental Health First Aid is an effective public health intervention for improving knowledge, attitudes, and behaviour: A metaanalysis. Int Rev Psychiatry. 2014;26(4):467-75. 13. Bond K, Jorm A, Kelly C, Kitchener B, Morris S, Mason R. Considerations when providing mental health first aid to an LGBTIQ person: a Delphi study. Adv Ment Health. 2017;19:1-5. 14. MHFA Course Evaluations. MHFA Australia Course Evaluations. https://mhfa.com.au/research/mhfa-course-evaluations. Accessed February 4, 2018. 15. PRISMA.” PRISMA 2009 Checklist Ottawa Hospital Research Institute, www.prismastatement.org/.
ACCEPTED MANUSCRIPT
16. Knaak S, Mantler E, Szeto A. Mental illness-related stigma in healthcare: Barriers to access and care and evidence-based solutions. Healthcare Management Forum. 2017;30(2):111-116.
17. Kitchener B, Jorm F. Mental health first aid training: review of evaluation studies. Aust N Z J Psychiatry. 2006;40(1):6-8.
RI PT
18. Albrecht KL, Giftakis E, Baxter C, Wylde T, Clifford R, Ashoorian D. Mental health first aid training and its application in a tertiary setting benefits staff and students. Res Social Adm Pharm. 2017;13(4):e30.
19. Evans-Lacko S, Brohan E, Mojtabai R, Thornicroft G. Association between public views of mental illness and self-stigma among individuals with mental illness in 14 European countries. Psychological Medicine. 2012;42(8):1741-1752.
AC C
EP
TE D
M AN U
SC
.