Background: mental health problems (i.e. depression, burn-out, addiction) are common. To assist in early detection, adequate social support, and referral to professional help, the Belgian Red Cross is currently developing a first aid guideline and training manual specifically adapted to the Belgian context. The manual is designed to teach members of the public the skills to recognize and respond to mental problems. This project is a collaboration with the Flemish social care network Zorgnet-Icuro, and is funded by the Flemish Ministry of Welfare, Public Health and Family.
1) to develop an evidence-based mental health first aid guideline and training manual, adapted to the Belgian context;
2) to assess the impact of mental health experts and patient representatives in providing feedback to the draft first aid manual.
Methods: the PICO (patient, intervention, comparison, outcome) question is as follows: 'In people with mental health problems (P), are different forms of communication by laypeople (I) effective as compared to no communication (C), to reduce mental health problems (O)'. We conducted a search in Medline, Embase and PsychNet (October 2018) and screened a total of 27,729 references. We extracted data and used the GRADE approach to assess the certainty of evidence. A content expert translated the evidence into a draft manual, which we discussed with five patient representatives and 10 content experts in the form of written feedback, and during four expert meetings.
1) we included 16 experimental and 71 observational studies, including many cross-sectional studies. The certainty of evidence for all recommendations was low or very low. Recommendation example: to reduce the risk of self-injury, it is beneficial to talk about your problems with your parents, relatives, or teacher. Talking to a friend could not be demonstrated to reduce the risk of self-injury.
2) Patient representatives and mental health experts impacted on the first aid manual in different ways. The feedback of the experts generally (97%) focused on three topics: defining the mental health problem, describing the symptoms, and discussing the first aid interventions. In contrast, these topics involved less than 50% of the comments in patient representatives. Instead, they mostly emphasized stigma, sensitive wordings, and the impact of a mental health problem on work and family.
Conclusions: a limited body of evidence was available, and the certainty of the evidence was low or very low. When evidence is limited, the importance of the expert panel increases. The contribution of a multidisciplinary expert panel, including patient representatives, is essential in order to obtain a guideline that is relevant to the field.
Patient or healthcare consumer involvement: involving both mental health experts and patient representatives within an expert panel is important, and resulted in the development of an evidence-based mental health first aid manual, meaningful for practice.