Children of Patients Undergoing Psychiatric Treatment: An Investigation of Statutory Support Services After Referrals to Child Protection Services.

AIMS: Preventive interventions for children of parents with mental illness are widely recommended. Mental health services entrust concern for patients' children by referrals to child protection services. We investigated service coverage for children following referrals. METHODS: Data from referrals regarding 376 children of adult psychiatry patients over 2008-2012 was linked to information from municipal records and Danish national registers. We conducted Cox regression and used Kaplan-Meier curves to show time to intervention and cumulative incidence of any child and family support services with one-year follow-up from referral date. RESULTS: At follow-up, 32% of children were provided with a child and family support service on average 73.4 days after referral. The most common services were family treatment (18%) and family counseling (11%). A statutory child assessment was conducted for 21% of children. Contents of the referrals suggested that 60% of children experienced adverse home environments and/or acute situations due to parents' psychiatric illness. Predictors of initiation of support services included a child living alone with the patient, hazard ratio 2.09 (1.41-3.08), the patient being the mother, hazard ratio 1.72 (1.11-2.65), and an adverse home environment presenting an acute situation specified in referral, hazard ratio 1.89 (1.01-3.51). CONCLUSION: Our finding that only one third of children receive support after referrals from psychiatry within an average of three months suggests an underserved population of at-risk children. These findings warrant reconsideration of resource allocation and creation of more efficient intervention strategies to protect at-risk children and prevent development of mental illness and adversity.

Effectiveness of Mental Health First Aid training in Denmark: a randomized trial in waitlist design.

PURPOSE: To examine the effect of the Australian educational intervention Mental Health First Aid (MHFA) in a Danish context. Primary outcome was improvement concerning confidence in help-giving behavior towards people suffering from mental illness. Secondary outcomes were increased knowledge and ability to recognize mental illness and improved positive attitudes towards people suffering from mental health problems. METHOD: Study design was a randomized trial with a waitlist control group. The intervention group was compared with the control group at 6-month follow-up. Both groups completed at baseline and at 6-month follow-up. RESULTS: A significant difference was found between employees trained in the intervention group compared to the control group at 6-month follow-up on the items of confidence in making contact to (Cohen's d 0.17), talking to (Cohen's d 0.18) and providing help to (Cohen's d 0.31) people suffering from a mental health illness. Further, participants improved in knowledge (Cohen's d depression vignette 0.40/Cohen's d schizophrenia vignette 0.32) and in the ability to recognize schizophrenia OR = 1.75 (95 % CI 1.00-3.05), p = 0.05. A significant difference between the intervention group and control group at follow-up concerning actual help offered was not found. Changes in attitudes were limited. CONCLUSION: The MHFA training was effective in a Danish context.

The effect of the mental health first-aid training course offered employees in Denmark: study protocol for a randomized waitlist-controlled superiority trial mixed with a qualitative study.

BACKGROUND: Studies show a high and growing prevalence of mental disorders in the population worldwide. 25% of the general population in Europe will during their lifetime experience symptoms related to a mental disorder. The Mental Health First Aid concept (MHFA) was founded in 2000 in Australia by Kitchener and Jorm, in order to provide the population with mental health first aid skills. The aim of the concept is, through an educational intervention (course), to increase confidence in how to help people suffering from mental health problems. Further, secondary aims are to increase the mental health literacy of the public by increasing knowledge, reduce stigma and initiate more supportive actions leading towards professional care. An investigation of the effect of MHFA offered a Danish population is needed. METHODS: The design is a randomized waitlist-controlled superiority trial, in which 500 participants will be allocated to either the intervention group or the control group. The control group will attend the course six months later, hence waiting list design. From fall 2013 to spring 2014 participants will be educated to be "mental health first-aiders" following a manualized, two days MHFA course. All the participants will answer a questionnaire at base-line and at 6 months follow-up. The questionnaire is a back-translation of the questionnaire used in Australian trials. The trial will be complemented by a qualitative study, in which focus groups will be carried out. DISCUSSION: Outcomes measured are sensitive to interpretation, hence a challenge to uniform. This trial will add to the use of a mixed-methods design and exemplify how it can strengthen the analysis and take up the challenge of a sensitive outcome. TRIAL REGISTRATION: https://clinicaltrials.gov identifier NCT02334020.