Abstract
Purpose:
Health profession students may experience mental health issues during training, and clinical educators report that they don’t feel confident in supporting students with these issues. This study explored whether a customized Mental Health First Aid (MHFA) training programme changed the knowledge, perceptions, intentions, and confidence of clinical educators in supporting students with mental health issues in the workplace.
Method:
Twenty-four allied health clinical educators from a tertiary health service attended a two-day customized MHFA course. The educators completed assessments before (n = 21) and after (n = 23) the course. Quantitative data was analyzed using independent t-tests. Qualitative data was thematically analyzed using content analysis.
Results:
Knowledge improved significantly (p = <0.001). The confidence to manage students with mental health issues increased significantly (p < 0.001). A significant change in perception was only found with respect to a character in a scenario being dangerous or unpredictable. Intentions to assist co-workers and students with mental health issues improved for all items but not necessarily significantly.
Conclusions:
This programme improved educators’ knowledge of mental health, perceptions of people with mental health issues, intentions of providing help, and confidence to support people with mental health issues.
Key Words: allied health, clinical education, curriculum, fitness to practise, mental health first aid
Résumé
Objectif :
les étudiants dans les professions de la santé peuvent éprouver des troubles de santé mentale pendant leur formation, et les éducateurs cliniques déclarent qu’ils ne se sentent pas à l’aise de soutenir les étudiants aux prises avec ces problèmes. La présente étude explore si un programme de formation personnalisé de premiers soins en santé mentale (PSSM) modifiait les connaissances, les perceptions, les intentions et la confiance des éducateurs cliniques à l’égard du soutien des étudiants éprouvant des troubles de santé mentale en milieu de travail.
Méthodologie :
au total, 24 éducateurs cliniques en santé paramédicale d’un service de soins tertiaires ont suivi un cours de deux jours du PSSM adapté. Les éducateurs ont rempli des évaluations avant (n = 21) et après (n = 23) le cours. Les chercheurs ont analysé les données quantitatives à l’aide de tests de Student indépendants. Ils ont recouru à l’analyse de contenu pour les analyser par thèmes.
Résultats :
les connaissances ont augmenté de manière significative (p = <0,001). Leur confiance à gérer les étudiants ayant des troubles de santé mentale s’est accrue de manière significative (p < 0,001). Un changement important de perception n’était observé qu’à l’égard du personnage d’un scénario dangereux ou imprévisible. Les intentions d’aider leurs collègues et les étudiants ayant des troubles de santé mentale se sont améliorées à l’égard de tous les points, mais pas nécessairement de manière significative.
Conclusions :
ce programme a amélioré les connaissances des éducateurs en santé mentale, leurs perceptions des personnes ayant des troubles de santé mentale, leurs intentions de les aider et leur confiance à soutenir les personnes ayant des problèmes de santé mentale.
Mots-clés : aptitude à exercer; enseignement clinique; premiers soins en santé mentale, programme; santé paramédicale
Fitness to practise (FTP) is a concept that underpins the safe, effective practice of the health professions. It relies on five factors: freedom from impairment (mental and physical health with or without additional support strategies to minimize the effect of these issues), professionalism, clinical competence, effective communication, and recognition of one's own limits.1–3 Health profession students may face issues that affect their FTP.4 A survey of 49 physiotherapy (PT) clinical educators in Australia found that in a 12-month period, the most prevalent issues impacting student FTP were clinical incompetence (76%), poor mental health (51%), unprofessional behaviour (47%), and poor physical health (36%).3 These FTP issues affected the clinical educator's teaching role, client management, and work satisfaction.3 Therefore, strategies to support student FTP may not only help students, but also clinical educators and patients.
It is known that when PT students experience a confronting situation in clinical practice, such as a client death, they approach their peers for support first and then their clinical educators.5 However, clinical educators report that they do not feel confident supporting students with mental health issues.3 A way of increasing confidence to support people with mental health issues in the community and workplace is to complete Mental Health First Aid (MHFA) training.6 MHFA is an accredited course designed to educate participants on how to help people with developing mental health issues or exacerbations of existing mental health issues.7 Although MHFA courses are primarily intended for members of the public who are not health professionals, the standard MHFA course has been evaluated in tertiary and other health care settings, including with nursing, medical, and pharmacy students.6,8–12
MHFA training is a recognized health and safety management tool that has the potential to be adapted for employee groups to make it more applicable to specific contexts.13 MHFA training teaches a five-step management plan (ALGEE). The five steps are: (1) Approach, assess, and assist with any crisis; (2) Listen and communicate non-judgmentally; (3) Give support and information; (4) Encourage the person to obtain appropriate professional help; and (5) Encourage other supports (e.g., family, friends).14 Participants learn about common mental health symptoms, risk factors, and resources for referring people for help. Educating clinical educators through MHFA training may address their lack of confidence in supporting students with mental health needs. To date, research evaluating the MHFA programme has focused on adults in the general population.7,15–17 A MHFA programme adapted for clinical educators has not been conducted. Therefore, the research question for this study was: Does an MHFA training programme customized for clinical educators increase their knowledge, perceptions, intentions, and confidence to support students impacted by mental health issues while on clinical placements in a workplace environment?
Our hypothesis was that MHFA training would affect these factors in a positive manner. This research aimed to determine whether MHFA training can increase the mental health literacy of allied health clinical educators to indicate whether future research to investigate the feasibility of studying this approach as a potential strategy to support students’ FTP is warranted.
Methods
This research studied the knowledge, perceptions, intentions, and confidence of allied health clinical educators before and after a two-day, in-person MHFA education programme. It included quantitative and qualitative data gathered online and in a paper-based assessment. The data reporting was based on Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for reporting observational studies.18
The setting was a tertiary hospital in metropolitan Melbourne, Australia. The participants were clinical educators (primarily physiotherapists but also allied health assistants, exercise physiologists, occupational therapists, podiatrists, and social workers) interested in learning more about supporting students with mental health issues. Follow-up was immediately after the intervention. Data was collected in surveys.
All allied health clinical educators in a tertiary health service in Melbourne, Australia, were eligible for the course. Everyone who registered was enrolled in the course. Participation in the research was additional to enrolling in the course. All research participants gave informed written consent to participate in the study.
Content of the MHFA intervention
The programme was delivered by a trained MHFA facilitator using the curriculum proposed by Kitchener and Jorm.7 The content included information about the ALGEE management plan, common mental health problems in Australia, depression, how to talk to a person who is suicidal, anxiety disorders, trauma, and post-traumatic stress disorder (PTSD), panic attacks, schizophrenia, bipolar disorder, and substance use and misuse. The customization added student characters with mental health issues to the vignettes, student mental health management strategies, and appropriate university support services to the standardized MHFA content and objective measures. Participants were sent an article19 five days prior to the course that gave them background information on how educator, student, and health system issues can alter performance. At the workshop, they were also given an MHFA manual20 that had information on both the content of the workshop and mental health issues. Four vignettes were used (see Table 1).
Table 1.
Customized Student Focused Vignette Descriptions and Facilitatory Questions
| Vignette number | Customized Vignette | Facilitatory questions |
|---|---|---|
| 1 | You are working with a health professional student who is making mistakes, seems shaky and is not confident in communication. They miss client's cues and are not a flexible problem-solver. Responding to patients or staff in real-time is challenging. On receiving constructive criticism, they burst into tears because of fear of failing. | What are the signs and symptoms that concern you? What might be causing the issues? What is your role in this and ... what isn’t? What strategies might you use? If not confident, are you incompetent? |
| 2 | You are supervising a third year health professional student on a rural placement. They have not lived away from home before. Student is experiencing sleep disturbances affecting their ability to concentrate and perform on placement. They disclose that they have just been diagnosed with generalized anxiety disorder and have been prescribed new medications. You are concerned about the impact of the student taking new medications and potential side-effects. | What are the signs and symptoms you might be concerned about? How might a person with generalized anxiety disorder present? What strategies might you use? Are they fit to practise? |
| 3 | Your health professional student is often late to placement, saying they slept through their alarm. You have given them a professionalism warning about this already! They also seem to be having difficulty concentrating and making decisions. They seem tired and lacking energy particularly in the afternoon and have expressed that they aren’t sure if the course is for them. | What are the signs and symptoms that concern you? What might be causing their issues? What strategies might you use? (that address educator, learner and system issues)? What do you think is your role in this scenario and what isn’t...? Do they have a professionalism issue? Would you contact your registration body? |
| 4 | Your student has just found out that one of the clients they have been treating has passed away. The student is very upset and teary and has had to go to the bathroom to calm down. Your student discloses that their aunty has also just died from a heart attack. You handover their next patient (a cardiac event) and they begin to cry again. | What are the signs and symptoms that concern you? What might be causing their issues? What strategies might you use? (Consider educator, student and systems issues). Are they fit to practise? |
References to mindfulness21 and awareness of the present moment as a mental health first aid strategies were included because they have been found to be effective in managing health profession student stress22,23 and other mental health issues such as depression24 and anxiety.25 The workshop was delivered over two consecutive days from 9 a.m. to 4 p.m. with a 30-minute lunch break. The session concluded with an opportunity to ask questions and discuss the content of the student focused vignettes and how they related further to the participants’ own experiences with student mental health.
Data collection
The pre-course assessment was administered on the first day of the course before the course began. The post-course assessment was administered at the end of the last day of the course. Depending on participant preference, the assessments were conducted on paper or online.
Ethics approval was granted by Monash University Human Research Ethics Committee (No. 12015). Also, ethics approval was obtained from Monash Health Human Research Ethics Committee (No. RES-18-0000-149XL). To maintain confidentiality, the ethics approval did not permit the collection of the demographic variables of age, gender, or years since graduation.
Mental health knowledge
The mental health knowledge component was assessed using a previously developed questionnaire.26 It was originally used to evaluate an intervention known as WorkplaceAid that included both MHFA training and a traditional first-aid component (first aid focused on physical illness or injury assistance). The original questionnaire had 16 questions but we removed the two questions referring to traditional first-aid interventions as first aid was not a component of our course. Therefore, 14 questions were asked regarding educators’ knowledge of mental health issues. For example, “Half of all people who experience a mental illness have their first episode by age 18.” The answer options were “Disagree,” “Agree,” and “Don’t know.” One point was awarded for each correct answer and the score summed across all items. Therefore, the maximum points awarded was 14.
Perceptions: personal and perceived stigma
Stigma was assessed by using the personal and perceived stigma scale developed by Griffiths and colleagues.27 Personal stigmatizing attitudes towards and perceptions of stigmatizing beliefs others would hold about people who seek treatment for a mental health issues are both assessed by this scale. There were nine questions for each personal and perceived stigma. An example of a perceived stigma facilitatory question is: “Most people believe that people with depression could snap out of it if they wanted.” Scores on each of the nine-item sub-scales were marked out of 18 with higher scores indicating increased stigma.
Social distance
Social distance was defined as the self-reported degree of willingness to have contact or interaction with a vignette character, either John or Paula, described in a vignette.28 The 5-item scale we used was developed by Link and colleagues.29 The items rated the person's willingness to: (1) move next door to John/Paula; (2) spend an evening socializing with John/Paula; (3) make friends with John/Paula; (4) work closely with John/Paula on a job; and (5) have John/Paula marry into their family. Each item was rated on a 4-point scale ranging from “definitely willing” to “definitely unwilling.” Scores were summed (range 5–20), with higher scores indicating a greater desire for social distance. (Of note, this does not describe the social distancing that was recommended during the COVID-19 pandemic. The study was performed before the pandemic.)
Intentions to help a vignette character
Two vignettes from the standard MHFA training program were presented. One vignette described John who has a diagnosis of depression with associated suicidal ideation. The other vignette described Paula who has PTSD and generalized anxiety disorder (GAD). The help giving intentions were established for two scenarios: if John/ Paula was a co-worker, and for the purposes of this research (with permission), participants were also asked how they would respond if instead John/Paula was a student. This resulted in four scenarios being considered in total. Participants were asked to “describe all the things you would do to help your co-worker John/Paula” and then asked the same question substituting ‘student’ for ‘coworker’. The open ended responses were assessed and awarded one point for any component of the ALGEE action plan14 mentioned and given an additional point when specific details were given. For example, “Encourage the person to see a psychologist” received two points for encouraging appropriate professional help.6 The ALGEE action plan coding was based on previous publications.30 Intention to help was assessed on a 7-point Likert scale (1 = strongly disagree; 7 = strongly agree).
Confidence
There was one stand-alone confidence question.7 Educators’ confidence to support students with mental health issues was assessed on a 7-point Likert scale (1 = not very confident; 7 = very confident).
Disorder identification
The ability of educators to identify particular mental health issues in the vignette was assessed by the question: “What, if anything, do you think is the matter with John/ Paula?” The vignettes were written to meet the minimum requirements for DSM-IV-TR.
Experience with mental health issues and intention to provide help
The participants’ experience with people who have mental health issues was assessed with a number of questions including: “Over the last 12 months, has anyone that you work with/any students you have supervised/any family or friends had any sort of mental health problem? What do you think the mental health problem was? Over the last 12 months, did you try to help the person with this problem? Describe all the things you did to help.” These questions were taken from the outcome measure by Reavley and colleagues31 who found that mental health literacy scores increased in the general public when they knew a person with a mental health issue. Note that this was the participants’ best educated guess as they might not have known the actual diagnosis.
Keep, stop, start
Educators were asked to write down two actions that they would keep doing, stop doing, and start doing as a result of attending the MHFA education programme. This technique is commonly used in education.32
Statistical methods
Responses to the vignettes in the pre- and post-assessments regarding diagnosis identification and management were scored by a blinded assessor with extensive experience in coding this type of data. The facilitator was not involved in data analysis. All quantitative data including vignette scores were analyzed using Graph pad PRISM 5 (GraphPad Software, Inc., California, US) with pre- and post-data analyzed by independent t-testing with Welch correction.33 It has been noted that parametric tests are appropriate for analyzing Likert scale responses.34 An alpha level of 0.05 was used. Two researchers independently analyzed the qualitative data for the “keep, stop, start” questions by using content analysis.35
Results
Twenty-four allied health clinical educators were invited to participate in this study, and then attended all of the two-day MHFA course. Completion of research data collection was not mandated as part of attending the training. Twenty-one of the 24 clinical educators provided pre-intervention data, and 23 provided post-intervention data. Participants were clinical educators from nutrition and dietetics, exercise physiology, music therapy, occupational therapy, PT, podiatry, social work, and speech pathology. One to six educators from each discipline were represented; the median (IQR) was 3 (2, 5). See Table 2 for the outcome measures.
Table 2.
Independent T-Testing of Pre-And Post-Assessments to Determine if Change in Scores Before and After MHFA Training was Statistically Significant
| Question | Pre-MHFA Mean (SD) | Post-MHFA Mean (SD) | P-value |
|---|---|---|---|
| 1. Mental health knowledge (Higher scores = more correct answers) Maximum score = 14 | |||
| 5.38 (2.25) | 9.35 (1.56) | <0.001* | |
| 2. Perceptions: Personal stigma on a 5-point Likert scale (1 = strongly disagree; 5 = strongly agree) | |||
| John/Paula could snap out of it if he/she wanted. | John 1.62 (0.81) Paula 1.24 (0.44) |
John 1.35 (0.57) Paula 1.26 (0.54) |
John 0.21 Paula 0.88 |
| John's/Paula's problem is a sign of personal weakness. | John 1.28 (0.46) Paula 1.10 (0.30) |
John 1.13 (0.34) Paula 1.09 (0.29) |
John 0.22 Paula 0.93 |
| John's/Paula's problem is not a real medical illness. | John 1.38 (0.50) Paula 1.14 (0.36) |
John 1.44 (0.90) Paula 1.17 (0.49) |
John 0.80 Paula 0.81 |
| John/Paula is dangerous. | John 2.05 (1.07) Paula 1.57 (0.81) |
John 1.30 (0.64) Paula 1.13 (0.34) |
John 0.009* Paula 0.028* |
| It is best to avoid John/Paula so you don’t develop the problem yourself. | John 1.19 (0.40) Paula 1.10 (0.30) |
John 1.13 (0.34) Paula 1.09 (0.29) |
John 0.60 Paula 0.93 |
| John's/Paula's problem makes him/her unpredictable. | John 2.76 (0.89) Paula 2.29 (1.10) |
John 1.91 (1.13) Paula 1.65 (0.71) |
John 0.008* Paula 0.032* |
| I would not tell anyone if I had a problem like John's/Paula's. | John 1.91 (1.09) Paula 1.52 (0.68) |
John 1.61 (0.78) Paula 1.61 (0.89) |
John 0.31 Paula 0.72 |
| I would not employ someone if I knew they had a problem like John's/Paula's. | John 2.00 (1.10) Paula 1.48 (0.68) |
John 1.78 (0.90) Paula 1.48 (0.67) |
John 0.48 Paula 0.99 |
| I would not vote for a politician if I know they had suffered a problem like John's/Paula's. | John 1.91 (1.04) Paula 1.52 (0.81) |
John 1.74 (1.01) Paula 1.61 (0.89) |
John 0.60 Paula 0.74 |
| 3. Perceptions: Social distance (Higher score = participants wanted to have less contact with the person with a mental health issue) Maximum score = 28 | |||
| John 10.95 (4.60) Paula 7.62 (3.03) |
John 7.48 (4.26) Paula 7.30 (2.90) |
John 0.013* Paula > 0.99 |
|
| 4. Intentions: To use ALGEE action plan and provide helpful behaviour. Maximum score = 12 (Higher score = increased likelihood or increased confidence to use ALGEE strategies to address mental health issues as indicated by question wording “I would help…” and “How confident…” respectively | |||
| John co-worker 4.43 (1.73) John student 2.09 (1.95) Paula co-worker 3.43 (2.09) Paula student 2.35 (2.25) |
John co-worker 6.08 (2.65) John student 3.83 (3.35) Paula co-worker 5.96 (2.61) Paula student 3.25 (3.31) |
John co-worker 0.007* John student 0.019* Paula co-worker < 0.001* Paula student 0.151 |
|
| If John/Paula was a co-worker, I would help him/her. | John 5.71 (1.55) Paula 5.91 (1.22) |
John 6.56 (0.66) Paula 6.60 (0.66) |
John 0.028* Paula 0.025* |
| How confident do you feel in helping a co-worker with a problem like John's/Paula's? | John 2.62 (0.97) Paula 2.43 (0.98) |
John 3.81 (0.50) 3.86 (0.64) |
John < 0.001* Paula < 0.001* |
| If John/Paula was a student, I would help him/her. | John 6.10 (1.26) Paula 6.00 (1.05) |
John 6.69 (0.56) Paula 6.59 (0.59) |
John 0.055 Paula 0.031* |
| How confident do you feel in helping a student with a problem like John's/Paula's? | John 2.52 (0.87) Paula 2.35 (0.93) |
John 3.78 (0.67) Paula 3.85 (0.73) |
John < 0.001* Paula < 0.001* |
| 5. Confidence: Confidence and help giving intentions (Higher score = more confidence/help). Highest score is 7. How confident do you feel to support students with mental health challenges? | |||
| 3.81 (1.33) | 5.82 (0.89) | < 0.001* | |
| 6. Correct identification of disorder portrayed in each vignette | |||
| 20 identified John's depression 8 recognized John's suicidal thoughts 17 recognized Paula's PTSD 10 recognized Paula's GAD |
20 identified John's depression 7 recognized John's suicidal thoughts 17 recognized Paula's PTSD 9 recognized Paula's GAD |
||
Statistically significant results.
ALGEE action plan
The ability to address mental health issues with the ALGEE action plan improved significantly for all of the scenarios. When the vignette was described as a co-worker, educators tended to describe more personal involvement with their co-workers and to follow up on a more regular basis. When the vignette was framed as a student, educators described more limitations their personal involvement with the student, and described their involvement as a “one-off” rather than “ongoing support,” and more likely to appropriately refer the student to university resources.
The types of support that clinical educators described having provided for co-workers, students, and family/friends with mental health issues prior to attending the MHFA training are shown in Table 3.
Table 3.
Qualitative Analysis of the Types of Support that the Participants Had Given to Co-Workers, Students, and Family/Friends (pre-MHFA)
| Strategies adopted | Co-worker | Student | Family/friend |
|---|---|---|---|
| Spend time with them/talk/ask open questions | ✓ | ✓ | ✓ |
| Allow person to identify issue/identify needs | ✓ | ✓ | |
| Discuss how symptoms affect performance | ✓ | ✓ | |
| Suggest strategies for work-life balance/self-care (e.g., diet, exercise, sleep) | ✓ | ✓ | ✓ |
| Recommend appointment with a health professional | ✓ | ✓ | ✓ |
| Suggest family/friends who could support | ✓ | ✓ | ✓ |
| Speak with manager | ✓ | ||
| Decrease caseload | ✓ | ||
| Increase supervision time/provide feedback | ✓ | ||
| Speak to student coordinator/university | ✓ | ||
| Suggest reflective journaling | ✓ | ||
| Provide peer supervision | ✓ | ||
| Discuss plans to keep them safe/make them feel safe | ✓ | ||
| Offer for them to stay at your house | ✓ | ||
| Include person and invite to social events | ✓ | ||
| Discuss job options | ✓ | ||
| Maintain regular phone contact | ✓ | ||
| Acknowledge what they are feeling | ✓ | ||
| Reinforce the positives, rationalize the negative thinking | ✓ |
Keep, stop, start
The top three actions that educators wanted to keep doing as a result of completing the MHFA course were: talking to students/talking about mental health (7 responses), asking questions (6 responses), and providing support (3 responses). The top three actions they intended to stop doing were: being judgmental/unaware of unconscious biases (12 responses); stigmatizing/formulating an image based on a diagnosis/making assumptions (5 responses); and automatically referring the person to their family physician, particularly if their family physician does not specialize in mental health (4 responses). The most common actions educators intended to start doing after the course were: feeling at ease having discussions/ asking difficult questions (13 responses); considering their own mental health/self-care (6 responses); and practising mindfulness (4 responses).
Discussion
The overall interpretation of results is that a customized MHFA intervention positively impacted knowledge, perceptions, intentions, and confidence in supporting students with mental health issues. As with other studies, mental health knowledge improved significantly with MHFA training.6,7,16,17,36
Of the personal stigma items, only the items regarding John/Paula as either a co-worker or student being dangerous and unpredictable changed significantly. Although positive changes in all items of personal stigma have been seen in other studies,6 some studies have not shown any statistically significant changes in stigma.37,38 The differences might be due to health professionals having a greater awareness than the general public that mental health issues are not a sign of weakness.
There was a statistically significant reduction in social distance scores for the vignette about John (which described depression with suicidal ideation) but not the vignette about Paula (describing GAD). We hypothesize that clinicians may be more confident supporting people experiencing anxiety as it is a commonly experienced and recognizable emotion. In contrast, suicidal ideation is less commonly encountered and more complex to address. Clinicians may therefore have desired less contact with people experiencing suicidal thoughts before the MHFA course because they perceived the situation as more serious or threatening, and themselves as unequipped to support the person in the vignette.
Before MHFA training, the clinical educators were less inclined to want contact with a person with a mental health issue but after the intervention, the outcome was quite similar for both co-workers and students. This may be explained by health care workers being more used to seeing individuals with mental health issues.
The significant differences in mean ALGEE scores from pre- to post-training suggests that educators were better able to apply the ALGEE principles to co-workers and students with depression. These changes were greater than those found in a sample of medical and nursing students.6 While educators were more likely to provide help to students than co-workers, they appeared to offer more personal support outside of work to co-workers; for example, ringing them to see if they were okay. For students, they recommended speaking to their clinical placement support team at university for support. Lower scores for the student vignettes may have been a sign of respondent fatigue, given that several responses to the Paula as student vignette were brief or cursory, resulting in low scores. Respondent fatigue has also been found in other studies.39 Participants may also have felt it was more appropriate to refer students to professional help and provide more personalized support to co-workers. It might be helpful to discuss with educators the need to continue to monitor students with mental health issues and liaise with the university accordingly as educators would be more aware of how the students were coping given their contact with them on a daily basis. It is also important that university staff are aware of what to do when students have mental health issues, and we encourage academics to undertake MHFA training.
The intent to assist co-workers and students with mental health issues improved for all items but not necessarily significantly. The course also improved participants’ confidence to support co-workers and students with mental health issues. The participants’ confidence to help a person with a mental health issue showed statistically significant increases. This was beneficial given that the research question stemmed from the issue of clinical educators not feeling confident to support students with mental health issues.3 Other studies have also found that MHFA training resulted in statistically significant increases in the participants’ confidence to provide help. 6,7,15–17,36
After the training, there was minimal to no change in the ability of educators to identify different mental health diagnoses. In fact, the educators were less likely to identify the problem as a specific diagnosis and more likely to explain the problem in terms of stressors/risk factors after the intervention. This may have been due to potential assessment ceiling effects and the fact that health professionals may have had additional experience, so their baseline scores were quite high.6 There is also a possibility that the media has raised awareness of mental health issues, particularly of depression.
In our study, after completing the training all of the educators were more likely to provide help; however, the difference was not statistically significant for the student with depression/suicidal thoughts. This may have been because the pre-scores were high, leaving less room for improvement. Statistically significant increases in providing help have been seen in two other studies.16,38 Of note, clinical educators were more likely to help a student than a colleague with a mental health issue.
All of the participants had previous experience with mental health issues and offered insights into their management of these situations. It has been found that having a friend or family member with a problem similar to that described in the vignette is significantly associated with higher scores of recognizing the diagnosis, knowing what strategies are helpful or harmful, and mental health literacy. It is also associated with reduced levels of stigmatizing attitudes.31
The limitations of this study include the small sample size, which reduces the generalizability of the results. In addition, this study used a convenience sample which means a potential confounder associated with our sample is that participants had expressed interest in learning about how to support students experiencing a mental health issue.
While the cohort was multidisciplinary, they were from one tertiary metropolitan hospital. All of the participants had a co-worker/student or family/friend with a mental health issue, and this experience may have influenced their decision to apply for the course and their high pre-intervention scores. This prior knowledge and experience with a person with a mental health issue may have positively contributed to the results of this study; that is, it may explain why a number of the participants could identify the mental health issues in the vignettes before the course. The research was also limited by it being a pre- and immediately post-study, so we cannot comment on whether participants had long-term behaviour changes. Another source of bias that may have positively influenced the results was that the participants had an interest in improving their confidence in supporting students with a mental health issue.
This is the first study that we are aware of that examines the effects of customized MHFA training for allied health clinical educators. Although additional studies with larger samples are needed, this research suggests that MHFA training positively changes health educators’ approaches to supporting students and co-workers experiencing mental health problems, and would be suitable for scale-up in clinical and teaching settings. The study results could be generalized to all allied health profession educators particularly in tertiary health services.
Conclusion
This study advances the understanding of the utility of MHFA training for clinical educators. In answer to our research question, a MHFA training programme customized for clinical educators increases their knowledge, perceptions, intentions, and confidence to support students impacted by mental health issues while on clinical placements in the workplace environment.
Key Messages
What is already known on this topic
Students have reported experiencing mental health issues while on clinical placement and clinical educators have also reported reduced confidence and increased stress when faced with students experiencing mental health issues while on clinical placements. Mental Health First Aid training has been successful adapted for different employ groups and situational contexts.
What this study adds
Clinical educators and student placement coordinators demonstrated improved mental health first aid knowledge and confidence to enact mental health first aid strategies with their co-workers and students after completing a two-day training workshop that had been adapted to include the student education context of their workplace. This study indicates that MHFA training as an intervention may be a worthwhile investment to support clinical educators in the workplace.
References
- 1.Parker M. Assessing medical students’ professional development and behaviours: a theoretical foundation. Focus Health Prof Educ. 2000;2(2):28–38. https://search.informit.org/doi/10.3316/aeipt.118717 [Google Scholar]
- 2.Parker M. Assessing professionalism: theory and practice. Med Teach. 2006;28(5):399–403. 10.1080/01421590600625619. Medline: [DOI] [PubMed] [Google Scholar]
- 3.Lo K, Curtis H, Keating JL, et al. Physiotherapy clinical educators’ perceptions of student fitness to practise. BMC Med Educ. 2017;17(1):16. 10.1186/s12909-016-0847-2. Medline: [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Lo K, Maloney S, Bearman M, et al. Proactive student engagement with fitness to practise. J Biomed Educ. 2014;2014:8. 10.1155/2014/578649. [DOI] [Google Scholar]
- 5.Lo K, Storr M. Physiotherapy Students’ Exposure to Confronting Clinical Situations-A Qualitative Review. Journal of Allied Health. 2020. Nov 27;49(4):153E–60E. https://www.ingentaconnect.com/contentone/asahp/jah/2020/00000049/00000004/art00013. [PubMed] [Google Scholar]
- 6.Bond KS, Jorm AF, Kitchener BA, et al. Mental health first aid training for Australian medical and nursing students: an evaluation study. BMC Psychol. 2015;3(1):(11). 10.1186/s40359-015-0069-0. Medline: [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Kitchener BA, Jorm AF. Mental health first aid training for the public: evaluation of effects on knowledge, attitudes and helping behavior. BMC Psychiatry. 2002;2(1):(10). 10.1186/1471-244x-2-10. Medline: [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Davies B, Beever E, Glazebrook C. The mental health first aid eLearning course for medical students: a pilot evaluation study. Eur Health Psychol. 2016;18(S):861. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Kitchener BA, Jorm AF. Mental health first aid training: review of evaluation studies. Aust N Z J Psychiatry. 2006;40(1): 6–8. 10.1080/j.1440-1614.2006.01735.x. Medline: [DOI] [PubMed] [Google Scholar]
- 10.O’Reilly CL, Bell JS, Kelly PJ, et al. Impact of mental health first aid training on pharmacy students’ knowledge, attitudes and self-reported behaviour: a controlled trial. Aust N Z J Psychiatry. 2011;45(7):549–57. 10.3109/00048674.2011.585454. Medline: [DOI] [PubMed] [Google Scholar]
- 11.Janusonyte G, Lawani K, Hare B, et al. Eds. Evaluating the impact of Mental Health First Aid (MHFA) training for UK construction workers. The International Council for Research and Innovation in Building and Construction (CIB) World Building Congress Constructing Smart Cities; 17–21 June 2019. The Hong Kong Polytechnic University. [Google Scholar]
- 12.El-Den S, Moles R, Choong H-J, et al. Mental Health First Aid training and assessment among university students: a systematic review. J Am Pharm Assoc. 2020;60(5):e81–95. 10.1016/j.japh.2019.12.017. Medline: [DOI] [PubMed] [Google Scholar]
- 13.Reavley NJ, Morgan AJ, Fischer J-A, et al. Effectiveness of eLearning and blended modes of delivery of Mental Health First Aid training in the workplace: randomised controlled trial. BMC Psychiatry. 2018;18(1):1–14. 10.1186/s12888-018-1888-3. Medline: [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Kitchener BA, Jorm AF, Kelly CM. Mental Health First Aid manual. 4th ed. Mental Health First Aid, Melbourne; 2017. [Google Scholar]
- 15.Jorm AF, Kitchener BA, Fischer J-A, et al. Mental Health First Aid training by e-learning: a randomized controlled trial. Aust N Z J Psychiatry. 2010;44(12):1072–81. 10.3109/00048674.2010.516426. Medline: [DOI] [PubMed] [Google Scholar]
- 16.Jorm AF, Kitchener BA, O’ Kearney R, et al. Mental Health First Aid training of the public in a rural area: a cluster randomized trial [ISRCTN53887541]. BMC Psychiatry. 2004;4(1):(33). 10.1186/1471-244x-4-33. Medline: [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Kitchener BA, Jorm AF. Mental Health First Aid training in a workplace setting: a randomized controlled trial [ISRCTN13249129]. BMC Psychiatry. 2004;4(1):(1). 10.1186/1471-244x-4-23. Medline: [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Bull World Health Organ. 2007;85(11):867–72. 10.2471/blt.07.045120. Medline: [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.Steinert Y. The “problem” learner: whose problem is it? AM EE Guide No. 76. Med Teach. 2013;35(4):e1035–45. 10.3109/0142159x.2013.774082. Medline: [DOI] [PubMed] [Google Scholar]
- 20.Kitchener B, Jorm A. Mental health manual 2021. https://mhfa.com.au/shop. [Google Scholar]
- 21.Kabat-Zinn J. Mindfulness-based interventions in context: past, present, and future. Clin Psychol: Sci Pract. 2003;10(2):144–56. 10.1093/clipsy.bpg016 [DOI] [Google Scholar]
- 22.O’Driscoll M, Byrne S, Mc Gillicuddy A, et al. The effects of mindfulness-based interventions for health and social care undergraduate students: a systematic review of the literature. Psychol Health Med. 2017;22(7):851–65. 10.1080/13548506.2017.1280178. Medline: [DOI] [PubMed] [Google Scholar]
- 23.Lo K, Water land J, Todd P, et al. Group interventions to promote mental health in health professional education: a systematic review and meta-analysis of randomised controlled trials. Adv Health Sci Educ. 2017;23(2):1–35. 10.1007/s10459-017-9770-5. Medline: [DOI] [PubMed] [Google Scholar]
- 24.Piet J, Hougaard E. The effect of mindfulness-based cognitive therapy for prevention of relapse in recurrent major depressive disorder: a systematic review and meta-analysis. Clin Psychol Rev. 2011;31(6):1032–40. https://doi.org/10.1016Aj.cpr.2011.05.002. Medline: [DOI] [PubMed] [Google Scholar]
- 25.V⊘llestad J, Nielsen MB, Nielsen GH. Mindfulness-and acceptance based interventions for anxiety disorders: a systematic review and meta-analysis. Br J Clin Psychol. 2012;51(3):239–60. 10.1111/j.20448260.2011.02024.x. Medline: [DOI] [PubMed] [Google Scholar]
- 26.Reavley NJ, Morgan AJ, Fischer J-A, et al. Effectiveness of eLearning and blended modes of delivery of Mental Health First Aid training in the workplace: randomised controlled trial. BMC Psychiatry. 2018;18(1):(312). 10.1186/s12888-018-1888-3. Medline: [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27.Griffiths KM, Christensen H, Jorm AF, et al. Effect of web-based depression literacy and cognitive-behavioural therapy interventions on stigmatising attitudes to depression. Br J Psychiatry. 2004;185(4):342–9. 10.1192/bjp.185.4.342. Medline: [DOI] [PubMed] [Google Scholar]
- 28.Jorm AF, Oh E. Desire for social distance from people with mental disorders. Aust N Z J Psychiatry. 2009;43(3):183–200. 10.1080/00048670802653349. Medline: [DOI] [PubMed] [Google Scholar]
- 29.Link BG, Phelan JC, Bresnahan M, et al. Public conceptions of mental illness: labels, causes, dangerousness, and social distance. Am J Public Health. 1999;89(9):1328–33. 10.2105/ajph.89.9.1328. Medline: [DOI] [PMC free article] [PubMed] [Google Scholar]
- 30.Yap MBH, Wright A, Jorm AF. First aid actions taken by young people for mental health problems in a close friend or family member: findings from an Australian national survey of youth. Psychiatry Res. 2011;188(1):123–8. 10.1016/j.psychres.2011.01.014. Medline: [DOI] [PubMed] [Google Scholar]
- 31.Reavley NJ, Morgan AJ, Jorm AF. Development of scales to assess mental health literacy relating to recognition of and interventions for depression, anxiety disorders and schizophrenia/psychosis. Aust NZ J Psychiatry. 2014;48(1):61–9. 10.1177/0004867413491157. Medline: [DOI] [PubMed] [Google Scholar]
- 32.Beck C, D’Elia P, Lamond MW. Easy and effective professional development: the power of peer observation to improve teaching. Abingdon, U.K.: Routledge; 2014. [Google Scholar]
- 33.Welch BL. The generalization of student's problem when several different population variances are involved. Biometrika. 1947;34(1–2):28–35. 10.2307/2332510. [DOI] [PubMed] [Google Scholar]
- 34.Norman G. Likert scales, levels of measurement and the “laws” of statistics. Adv Health Sci Educ. 2010;15(5):625–32. 10.1007/s10459-010-9222-y. Medline: [DOI] [PubMed] [Google Scholar]
- 35.Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004;24(2):105–12. 10.1016/j.nedt.2003.10.001. Medline: [DOI] [PubMed] [Google Scholar]
- 36.Morgan AJ, Ross A, Reavley NJ. Systematic review and meta-analysis of Mental Health First Aid training: effects on knowledge, stigma, and helping behaviour. PLoS One. 2018;13(5):e0197102. 10.1371/journal.pone.0197102. Medline: [DOI] [PMC free article] [PubMed] [Google Scholar]
- 37.Gulliver A, Griffiths KM, Christensen H, et al. Internet-based interventions to promote mental health help-seeking in elite athletes: an exploratory randomized controlled trial. J Med Internet Res. 2012;14(3):e69. 10.2196/jmir.1864. Medline: [DOI] [PMC free article] [PubMed] [Google Scholar]
- 38.Svensson B, Hansson L. Effectiveness of mental health first aid training in Sweden: a randomized controlled trial with a six-month and two-year follow-up. PLoS One. 2014;9(6):e100911. 10.1371/journal.pone.0100911. Medline: [DOI] [PMC free article] [PubMed] [Google Scholar]
- 39.Mason RJ, Hart LM, Rossetto A, et al. Quality and predictors of adolescents’ first aid intentions and actions towards a peer with a mental health problem. Psychiatry Res. 2015;228(1):31–8. 10.1016/j.psychres.2015.03.036. Medline: [DOI] [PubMed] [Google Scholar]