Increasing early help seeking and support for people experiencing mental illness: exploring and modelling helping behaviours in members of the public

© 2015 Dr. Alyssia RossettoBackground: People with mental illnesses are encouraged to seek professional help as soon as possible to improve their long-term outcomes. However, only a minority of people utilise mental health services in any given 12-month period. Evidence suggests that the social networks of people with a mental illness can facilitate help seeking and recovery for the ill person. However, little literature exists on how, when and why people decide to provide help to individuals experiencing mental illnesses. This thesis recognises the need for a different approach to the problem of how to facilitate early treatment seeking and long-term support for mental illness and aims to: 1. elucidate the factors that motivate adults to give help to people experiencing a mental illness or mental health crisis; 2. understand how intention translates into behaviour in these situations; 3. develop a model of help giving which describes the process of providing help; and 4. explore ways to increase the likelihood of effective help giving, and improve outcomes for people with mental illness. Method: Three studies were undertaken to fulfil these aims. The first study focused on establishing the current help giving knowledge of the Australian public, using data from the 2011 National Survey of Mental Health Literacy and Stigma to compare the helping responses of 6,019 members of the general public with current best practice, in the form of the Mental Health First Aid (MHFA) action plan. It also investigated factors that were associated with good quality helping scores for different mental illnesses, and examined predictors of harmful responses towards people with mental illnesses, using linear and logistic regressions. The second study surveyed 820 participants at two time points six months apart, adapting questions from the 2011 National Survey of Mental Health Literacy and Stigma. It assessed whether a participant’s intention to help a hypothetical person at baseline predicted their behaviour towards a real-life person at follow-up. The final study investigated the helping experiences of 16 people who had received MHFA training using semi-structured interviews. It aimed to develop a model of help giving towards people with mental illnesses using thematic analysis techniques. Results: The first study found that the mental health first aid knowledge of the general, untrained public requires substantial improvement. Participants frequently mentioned basic actions, for example, listening to the person, but lacked more specific and effective helping skills, such as listening non-judgementally, and assessing and assisting with crisis, even when the vignette presented a person at risk of suicide. Regressions indicated that the factors associated with respondents’ helping depended on the disorder presented in the vignette, with the only consistent predictor of good quality helping scores being female gender of the respondent. Stigmatising attitudes, especially perceiving the person with the illness to be weak, rather than sick, were associated with harmful responses and poorer helping actions. The results of the second study supported previous research which suggested that the intention to perform specific mental health first aid actions, and the overall quality of helping responses towards a hypothetical person, predicted respondents’ actual behaviour at follow-up. These associations were generally small but significant; however, the finding that people who mentioned assessing for the risk of suicide were five times more likely to perform this action at follow-up, has notable implications for suicide intervention and mental health first aid programs. The study also found that past behaviour was a significant predictor of future behaviour, independent of other variables. The third study’s analysis noted that, despite the complexity of helping situations involving a recipient with mental illness, there were several common elements and stages underlying participants’ experiences of helping people with mental illnesses. The model of helping developed from these data involves recognising a problem exists; considering reasons that might motivate or deter helping; taking an action according to a spectrum of helping; and assessing both the immediate and long- term effects of the helping action on the recipient and the helper. Additional themes were also derived from the information provided by participants. These related to issues they perceived as important when helping, and assisted in contextualising parts of the model. Discussion: Overall, the results of this research suggest that while the mental health first aid knowledge of the general public is minimal, existing capabilities can be built upon by public health campaigns and educational programs such as MHFA. Increasing knowledge about mental illnesses, appropriate mental health first aid actions and confidence is likely to have positive effects on helping behaviours. Likewise, although participants provided many reasons for choosing not to help a person experiencing a mental illness, several of these reasons could be modified with further education and open and sensitive public discussions about mental health and mental illness. In terms of future research, the model of helping, which integrates the results from each of the studies that comprise the thesis, also reflects the findings of the literature to date and provides a basis for continuing research into helping. This research suggests that campaigns and programs which focus on educating the social networks of people with mental illnesses on how to help appropriately would both increase opportunities for early intervention and complement existing help-seeking approaches for people with mental illnesses