Pharmacists and Mental Health First Aid training: A comparative analysis of confidence, mental health assistance behaviours and perceived barriers.

BACKGROUND: Pharmacists are aptly positioned to provide first aid-level assistance to patients experiencing a mental health problem or crisis, yet often lack confidence or perceive barriers to intervention. One potential solution is Mental Health First Aid (MHFA) training-an evidence-based psycho-educational programme. This study evaluates MHFA training within pharmacy by (1) assessing pharmacists' perceptions of the prevalence of patients experiencing a mental health-related problem or crisis, (2) investigating whether MHFA is associated with increased confidence, intervention and assistance quality and (3) examining perceived intervention barriers. METHODS: Pharmacists working in Australia were surveyed. The survey included validated measures and research objectives were assessed using descriptives and ANOVAs. RESULTS: One hundred sixty-one pharmacists were included; 90 MHFA trained and 71 untrained. Overall, 86% of reported encountering at least one patient perceived to be experiencing a mental health problem or crisis in the last year. MHFA trained pharmacists reported being more confident, with notable differences in their confidence to recognize signs, approach and ask someone about suicide. Pharmacists did not intervene ~25% of the time in which a problem/ crisis was identified. When they did intervene, results suggest the assistance was similar in content. Intervention barriers were reported to impede MHFA trained pharmacists significantly less than untrained pharmacists. CONCLUSION: Results suggest pharmacists frequently encounter patients experiencing a mental health problem or crisis and that MHFA training may support pharmacists in helping these patients. Future research can utilize experimental methods to provide causal evidence as to the utility of MHFA training for pharmacists and patients.

Shared decision making for psychiatric medication management: a summary of its uptake, barriers and facilitators.

The model of shared decision making with mental health patients and clinicians (doctors and pharmacists) harnesses the benefits of patients becoming partners in their own recovery through improved communication and greater self-advocacy. Shared decision making in mental health services is an emerging model of care which has not been well investigated, however it is seen as the way forward to achieving improved health outcomes for non-pharmacological and pharmacological therapy. Successful implementation of this model requires supporting the process through provision of information and training, use of decision aids, coaching in communication skills and inclusion of family and carers in the decision making process. This summary examines the application of the shared decision making model for psychiatric medication management, including barriers and facilitators.

Mental health first aid by Australian tertiary staff: Application rates, modes, content, and outcomes.

AIM: Mental health problems are a growing challenge in tertiary institutions warranting psycho-educational intervention programmes such as mental health first aid (MHFA) that provide training to identify and support affected individuals. The present study assesses the impact of MHFA interventions on tertiary students and staff. Specifically, we examine (1) MHFA application rates and the types of mental health issues encountered, (2) how MHFA was provided, (3) application of the MHFA action plan, and (4) perceived outcomes of MHFA. METHODS: MHFA-trained staff within a tertiary institution were electronically surveyed. Quantitative data were analysed using descriptive statistics, whereas abductive coding yielded qualitative themes. RESULTS: Ninety participants completed the questionnaire (26%). Fifty-seven percentage of respondents had applied MHFA within the tertiary context. All participants reported applying MHFA in response to anxiety or depression at least once. Anxiety (37%) and depression (27%) were the most frequently encountered mental health issues. All participants had administered MHFA face-to-face, with telephone calls (35%) and text messaging (33%) also frequently employed. On average, participants reported completing 4.2 (out of 5) MHFA action plan actions, with 47% completing all actions. Most participants believed that their intervention was helpful (88%) with 65% of recipients seeking professional assistance. Recipients experienced perceived positive affective responses, which were also associated with approach strategies. CONCLUSIONS: MHFA is widely applied in the tertiary context through a variety of modes. Most interventions featured at least four of the recommended MHFA action plan actions. The outcomes of MHFA were largely positive, suggesting that MHFA is an effective early intervention in the tertiary context.

Evaluation of Mental Health First Aid skills in an Australian university population.

AIM: University students have high rates of mental health problems; however, most delay or fail to seek help altogether. Tertiary settings can offer educational and social programmes to increase mental health awareness and in turn increase the number of students seeking help for their problems. This study aimed to explore students' and staffs' knowledge of mental health issues, confidence to intervene and application of skills following Mental Health First Aid (MHFA) training. METHODS: Students and staff at an Australian university who had completed MHFA training in the previous 24 months were invited to complete a validated online questionnaire. RESULTS: Of the 566 eligible participants, 107 (19%) completed the questionnaire. The majority (65%) had applied their skills to someone in need, with the highest number applying it to students. Notably, of those who had applied their skills 23 participants (33%) had applied them in a crisis situation, the most common being panic attacks followed by suicidal thoughts. Although most (98%) applied their skills in a face-to-face capacity, 53% also reported assisting someone via electronic mediums and social media. The mean score for the literacy test was considered high, 12/16 (SD = 1.7) for students and 13/16 (SD = 2.5) for staff. The majority (94%) reported more confidence in providing support following training. CONCLUSION: This study demonstrated that MHFA training on a university campus is associated with a high level of knowledge, confidence to intervene and apply MHFA skills to assist a student or friend in need, potentially impacting their long-term health outcomes and future professional careers.

Development of the My Medicines and Me (M3Q) side effect questionnaire for mental health patients: a qualitative study.

OBJECTIVE: The objective of this study was to assess the acceptability, content validity and usability of the My Medicines and Me (M3Q) self-report side effect questionnaire. METHODS: Eight focus groups consisting of mental health patients, carers, general practitioners, psychiatrists, mental health nurses and pharmacists were conducted, involving 78 participants. Two researchers independently examined the transcriptions and analysed the data thematically using an inductive method. RESULTS: The findings supported changes to the formatting, length and phrasing of questions in the original version of the questionnaire. Although the groups provided differing views on the usability of the M3Q in clinical practice, the patient and carer groups were unconditionally in favour of such a tool to be used systematically to describe patients' subjective experiences with side effects. CONCLUSION: The differing contribution made by all groups involved in the administration and completion of the M3Q assisted with content validity of the questionnaire. The acceptability and usability of this novel side effect questionnaire was also explored, with many participants agreeing it was a necessary tool for a patient centred approach to treatment. Following implementation of the changes to the current format of the questionnaire, investigation into the uptake and use in clinical practice should be carried out.

A clinical communication tool for the assessment of psychotropic medication side effects.

The primary aim was to assess usability of the My Medicines and Me Questionnaire (M3Q) as a self-reported questionnaire for mental health patients to subjectively express side effects experienced with their psychotropic medications. The secondary aim was to evaluate patients' attitudes towards treatment and psychotropic medications following dialogue with their clinicians about side effects. Questionnaires were administered at six adult mental health facilities. A total of 205 participants were divided into intervention (facilitated dialogue) and non-intervention groups (no facilitated dialogue). The mean completion time for the M3Q was 15min (SD=6.5) with only 11 (5%) patients requiring assistance. The most commonly reported side effect was sedation (77%) and weight gain was ranked as the most bothersome (23%). The previously validated M3Q provided patients with the opportunity to express the impact these effects had on their lives. Side effects were the most common reason given for non-adherence. There were no significant changes in patient attitudes towards treatment and medications in the intervention group, mainly due to the logistical challenges in the clinicians' ability to view the questionnaire for the subsequent meeting with the patient. The M3Q demonstrated its usability in allowing patients to easily express their subjective experiences with side effects.

Construction and validation of the My Medicines and Me Questionnaire for assessment of the self-reported side effects of psychotropic medication.

We aimed to construct and assess the psychometric properties of the My Medicines and Me Questionnaire (M3Q), a self-report side-effect questionnaire for mental health patients. Thirty individuals taking a psychotropic medication completed the M3Q side-effect checklist along with the Liverpool University Neuroleptic Side Effect Rating Scale. Thirty healthy comparison individuals also completed the M3Q checklist. Data were analyzed using factorial analysis. Psychometric evaluations including validity and reliability testing were carried out on the questionnaire's checklist. The original 54-item checklist of the M3Q was shortened to include only those items found to be significant in the factorial analysis. The revised 32-item checklist of the M3Q was found to be valid and reliable. The M3Q is a simple, valid and reliable questionnaire that can be used routinely in clinical practice for detecting bothersome side effects of a range of psychotropic medications. This will provide a platform for improved communication between the clinician and the patient.

A review of self-report medication side effect questionnaires for mental health patients.

Side effects of psychotropic medications are important determinants of adherence to treatment. Discussion between the patient and clinician facilitated through the use of a side effect self-report questionnaire (SRQ) could lead to improved communications and treatment adherence. The aim of this review was to 1) identify all currently available side effect SRQs used in the assessment of mental health patients' subjective experiences, 2) evaluate the characteristics of the studies and 3) assess the psychometric properties of each of the questionnaires. Eight electronic databases were searched for peer-reviewed published articles. Six side effect SRQs were identified. Two independent reviewers assessed the quality of the study designs and psychometric properties of the identified SRQs. All questionnaires consisted of closed questions relating to antipsychotic side effects and completion times ranged from 5 to 20 min. Five questionnaires had undergone some form of psychometric testing, ranging from basic to comprehensive. There is a need in everyday clinical practice for a side effect communication tool applicable to all psychotropic medications, which allows the patient to express their subjective beliefs about their medications. This could provide an important contribution to the working relationship between patients and clinicians leading to informed decision-making and improved adherence.

The use of Enhancing Quality Use of Medication Self-Reported Questionniare (EQUIM-SRQ) among mental health consumers: a pilot study.

OBJECTIVE: To assess the applicability, interpretability and potential limitations of an adverse event screening questionnaire (the Enhancing Quality Use of Medication Self-Reported Questionnaire [EQUIM-SRQ]) in an Australian mental health outpatient population. METHOD: Questionnaires were distributed amongst two Australian adult mental health clinics for completion either at the clinic (onsite), or externally (postal option), during March-May 2011. Assistance was offered to participants completing the questionnaire onsite. Clients who were visited in their homes by clinic staff were invited to participate as external participants. RESULTS: Of 160 questionnaires distributed, 29 (18%) were completed. Of those, 22 were completed onsite, and seven were completed externally. Of the questionnaires completed onsite, 11 were fully completed, with 4 participants requiring assistance. A further 11 questionnaires were partially completed, with 2 participants requiring assistance. Of the questionnaires completed externally, 5 were fully completed. CONCLUSION: Although the response rate was low, the EQUIM-SRQ was applicable, interpretable and acceptable when completed or partially completed questionnaires were assessed. The potential exists to apply the EQUIM-SRQ in further research, and thereafter, clinical practice.