Laura M. Hart

Unmet need for treatment in the eating disorders: A systematic review of eating disorder specific treatment seeking among community cases

OBJECTIVE To systematically review the literature on the proportion of community cases with a diagnosable eating disorder who seek eating disorder specific treatment. METHOD CSA PsycInfo, Medline/PubMed and Scopus databases were searched for relevant articles that were written in English, published between January 1989 and January 2010, and satisfied three selection criteria: 1) recruited a representative sample of community cases; 2) used a standardized eating disorder screening instrument; 3) reported percentage of cases with eating disorders that sought appropriate (mental health or medical) treatment specifically for their eating disorder. Reference lists were also scanned for relevant articles. RESULTS Of 200 articles identified, 14 met inclusion criteria, comprising 1581 participants with a diagnosable eating disorder. The pooled proportion seeking treatment was 23.2% (95% CI=16.6, 31.4), however this estimate was associated with significant variability. The proportion seeking treatment for weight loss ranged from 30% to 73%, indicating that individuals with eating disorders are much more likely to receive treatment for a perceived problem with weight. DISCUSSION The literature provides a complex picture, as a minority receive appropriate mental health care, yet many receive treatment for weight loss. Significant gaps in the literature currently exist and future research needs to focus on treatment seeking in the young and elderly, males, and in countries outside of Australia and the United States. There is a need for interventions that assist community members, health professionals and treatment services to recognize eating disorders and understand their associated burden and the benefit of providing appropriate and timely treatment.

Mental health first aid for Indigenous Australians: using Delphi consensus studies to develop guidelines for culturally appropriate responses to mental health problems

BackgroundEthnic minority groups are under-represented in mental health care services because of barriers such as poor mental health literacy. In 2007, the Mental Health First Aid (MHFA) program implemented a cultural adaptation of its first aid course to improve the capacity of Indigenous Australians to recognise and respond to mental health issues within their own communities. It became apparent that the content of this training would be improved by the development of best practice guidelines. This research aimed to develop culturally appropriate guidelines for providing first aid to an Australian Aboriginal or Torres Strait Islander person who is experiencing a mental health crisis or developing a mental illness.MethodsA panel of Australian Aboriginal people who are experts in Aboriginal mental health, participated in six independent Delphi studies investigating depression, psychosis, suicidal thoughts and behaviours, deliberate self-injury, trauma and loss, and cultural considerations. The panel varied in size across the studies, from 20-24 participants. Panellists were presented with statements about possible first aid actions via online questionnaires and were encouraged to suggest additional actions not covered by the survey content. Statements were accepted for inclusion in a guideline if they were endorsed by ≥ 90% of panellists as essential or important. Each study developed one guideline from the outcomes of three Delphi questionnaire rounds. At the end of the six Delphi studies, participants were asked to give feedback on the value of the project and their participation experience.ResultsFrom a total of 1,016 statements shown to the panel of experts, 536 statements were endorsed (94 for depression, 151 for psychosis, 52 for suicidal thoughts and behaviours, 53 for deliberate self-injury, 155 for trauma and loss, and 31 for cultural considerations). The methodology and the guidelines themselves were found to be useful and appropriate by the panellists.ConclusionAboriginal mental health experts were able to reach consensus about culturally appropriate first aid for mental illness. The Delphi consensus method could be useful more generally for consulting Indigenous peoples about culturally appropriate best practice in mental health services.

Helping someone with problem drinking: mental health first aid guidelines - a Delphi expert consensus study

BackgroundAlcohol is a leading risk factor for avoidable disease burden. Research suggests that a drinkers social network can play an integral role in addressing hazardous (i.e., high-risk) or problem drinking. Often however, social networks do not have adequate mental health literacy (i.e., knowledge about mental health problems, like problem drinking, or how to treat them). This is a concern as the response that a drinker receives from their social network can have a substantial impact on their willingness to seek help. This paper describes the development of mental health first aid guidelines that inform community members on how to help someone who may have, or may be developing, a drinking problem (i.e., alcohol abuse or dependence).MethodsA systematic review of the research and lay literature was conducted to develop a 285-item survey containing strategies on how to help someone who may have, or may be developing, a drinking problem. Two panels of experts (consumers/carers and clinicians) individually rated survey items, using a Delphi process. Surveys were completed online or via postal mail. Participants were 99 consumers, carers and clinicians with experience or expertise in problem drinking from Australia, Canada, Ireland, New Zealand, the United Kingdom, and the United States. Items that reached consensus on importance were retained and written into guidelines.ResultsThe overall response rate across all three rounds was 68.7% (67.6% consumers/carers, 69.2% clinicians), with 184 first aid strategies rated as essential or important by ≥80% of panel members. The endorsed guidelines provide guidance on how to: recognize problem drinking; approach someone if there is concern about their drinking; support the person to change their drinking; respond if they are unwilling to change their drinking; facilitate professional help seeking and respond if professional help is refused; and manage an alcohol-related medical emergency.ConclusionThe guidelines provide a consensus-based resource for community members seeking to help someone with a drinking problem. Improving community awareness and understanding of how to identify and support someone with a drinking problem may lead to earlier recognition of problem drinking and greater facilitation of professional help seeking.

Helping someone with problem drug use: a Delphi consensus study of consumers, carers, and clinicians.

BackgroundProblem use of illicit drugs (i.e. drug abuse or dependence) is associated with considerable health and social harms, highlighting the need for early intervention and engagement with health services. Family members, friends and colleagues play an important role in supporting and assisting individuals with problem drug use to seek professional help, however there are conflicting views about how and when such support should be offered. This paper reports on the development of mental health first aid guidelines for problem drug use in adults, to help inform community members on how to assist someone developing problem drug use or experiencing a drug-related crisis.MethodsA systematic review of the scientific and lay literature was conducted to develop a 228-item survey containing potential first-aid strategies to help someone developing a drug problem or experiencing a drug-related crisis. Three panels of experts (29 consumers, 31 carers and 27 clinicians) were recruited from Australia, Canada, New Zealand, the United Kingdom, and the United States. Panel members independently rated the items over three rounds, with strategies reaching consensus on importance written into the guidelines.ResultsThe overall response rate across three rounds was 80% (86% consumers, 81% carers, 74% clinicians). 140 first aid strategies were endorsed as essential or important by 80% or more of panel members. The endorsed strategies provide information and advice on what is problem drug use and its consequences, how to approach a person about their problem drug use, tips for effective communication, what to do if the person is unwilling to change their drug use, what to do if the person does (or does not) want professional help, what are drug-affected states and how to deal with them, how to deal with adverse reactions leading to a medical emergency, and what to do if the person is aggressive.ConclusionsThe guidelines provide a consensus-based resource for community members who want to help someone with a drug problem. It is hoped that the guidelines will lead to better support and understanding for those with problem drug use and facilitate engagement with professional help.

First aid for eating disorders

The objective of this study was to develop first aid guidelines, based on expert consensus, that provide members of the community with information on how to assist someone who is thought to be developing or experiencing an eating disorder. An online Delphi study was carried out with expert panels consisting of 36 clinicians, 27 care-givers and 22 consumers. The panel members rated statements that described potential first aid actions. If between 80 and 100 percent of all three panels rated a statement as either Essential or Important, the statement was endorsed as a guideline. Three rounds were conducted before consensus was reached. From a total of 456 statements, 200 were endorsed as guidelines. A cohesive guideline document was developed by writing the endorsed statements into sections of prose based on common themes. Clinicians, care-givers and consumers were able to reach consensus about guidelines for eating disorder first aid. Further research is needed to evaluate their efficacy.

Parenting strategies for reducing adolescent alcohol use: a Delphi consensus study

BackgroundInternational concern regarding the increase in preventable harms attributed to adolescent alcohol consumption has led to growing political and medical consensus that adolescents should avoid drinking for as long as possible. For this recommendation to be adopted, parents and guardians of adolescents require information about strategies that they can employ to prevent or reduce their adolescents alcohol use that are supported by evidence.MethodsThe Delphi method was used to obtain expert consensus on parenting strategies effective in preventing and reducing adolescent alcohol consumption. A literature search identified 457 recommendations for parents to reduce their adolescent childs alcohol use. These recommendations were presented to a panel of 38 Australian experts who were asked to rate their importance over three survey rounds.ResultsThere were 289 parenting strategies that were endorsed as important or essential in reducing adolescent alcohol use by ≥90% of the panel. These strategies were categorised into 11 sub-headings: things parents should know about adolescent alcohol use, delaying adolescents introduction to alcohol, modelling responsible drinking and attitudes towards alcohol, talking to adolescents about alcohol, establishing family rules, monitoring adolescents when unsupervised, preparing adolescents for peer pressure, unsupervised adolescent drinking, what to do when an adolescent has been drinking without parental permission, hosting adolescent parties, and establishing and maintaining a good parent-child relationship. The endorsed strategies were written into a document suitable for parents.ConclusionsA comprehensive set of parenting strategies for preventing or reducing adolescent alcohol consumption were identified. These strategies can be promoted to parents to help them implement national recommendations for use of alcohol by young people.

Parents and prevention: A systematic review of interventions involving parents that aim to prevent body dissatisfaction or eating disorders

OBJECTIVE To systematically review the literature on interventions involving parents that aim to prevent body dissatisfaction or eating disorders in children, and provide directions for future research by highlighting current gaps. METHOD The literature was searched for articles using key concepts: parents, prevention and eating disorders or disordered eating or body dissatisfaction. All English language publications between 1992 and 2013 were searched across a range of academic databases. Studies were reviewed if they: (i) delivered an intervention designed to reduce eating disorders or body dissatisfaction or their risk factors, in children or adolescents; (ii) provided some intervention component for parents; and (iii) included some outcome measure of intervention effectiveness on disordered eating or body dissatisfaction. A scoring matrix based on the Critical Appraisal Skills Program (CASP) screening questions was used to assess each studys sample representativeness, relevance and data quality. RESULTS From 647 novel records uncovered by the search, 20 separate studies met inclusion criteria. The CASP scoring matrix revealed eight studies provided no relevant data, four relevant and eight highly relevant data on the effects of involving parents in prevention programs. Two of four high-quality studies reported that parental involvement significantly improved child outcomes on measures of body dissatisfaction or disordered eating. DISCUSSION Although a greater focus on engaging and retaining parents is needed, this review demonstrates that a small number of prevention studies with parents have led to significant reductions in risk of body image and eating problems, and future research is indicated.

A mental health first aid training program for Australian Aboriginal and Torres Strait Islander peoples: description and initial evaluation

BackgroundMental Health First Aid (MHFA) training was developed in Australia to teach members of the public how to give initial help to someone developing a mental health problem or in a mental health crisis situation. However, this type of training requires adaptation for specific cultural groups in the community. This paper describes the adaptation of the program to create an Australian Aboriginal and Torres Strait Islander Mental Health First Aid (AMHFA) course and presents an initial evaluation of its uptake and acceptability.MethodsTo evaluate the program, two types of data were collected: (1) quantitative data on uptake of the course (number of Instructors trained and courses subsequently run by these Instructors); (2) qualitative data on strengths, weaknesses and recommendations for the future derived from interviews with program staff and focus groups with Instructors and community participants.Results199 Aboriginal people were trained as Instructors in a five day Instructor Training Course. With sufficient time following training, the majority of these Instructors subsequently ran 14-hour AMHFA courses for Aboriginal people in their community. Instructors were more likely to run courses if they had prior teaching experience and if there was post-course contact with one of the Trainers of Instructors. Analysis of qualitative data indicated that the Instructor Training Course and the AMHFA course are culturally appropriate, empowering for Aboriginal people, and provided information that was seen as highly relevant and important in assisting Aboriginal people with a mental illness. There were a number of recommendations for improvements.ConclusionThe AMHFA program is culturally appropriate and acceptable to Aboriginal people. Further work is needed to refine the course and to evaluate its impact on help provided to Aboriginal people with mental health problems.

Development of key messages for adolescents on providing basic mental health first aid to peers: a Delphi consensus study

Aim: Most young people fail to receive professional treatment for mental disorders; however, they do indicate a preference for sharing problems with peers. This article describes key messages about knowledge and actions to form the basis of a basic Mental Health First Aid (MHFA) course for adolescents to increase recognition of and help seeking for mental health problems by teaching the best knowledge and helping actions a young person can undertake to support a peer with a mental health problem.

Mental health first aid guidelines: an evaluation of impact following download from the World Wide Web.

Aim: Mental health first aid guidelines provide the public with consensus‐based information about how to assist someone who is developing a mental illness or experiencing a mental health crisis. The aim of the current study was to evaluate the usefulness and impact of the guidelines on web users who download them.