Centre for Youth Mental Health - Theses
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ItemSocial inclusion and mental illness( 2014)Background: Social inclusion is increasingly recognised as an important contributor to good mental health and greater mental health outcomes, in particular for people with mental illness. Despite increased understanding of the positive impact that social inclusion can have, the potential to make progress has been slowed by some key limitations. The key, underlying problem regarding social inclusion, is the lack of a specific operationalised definition, with only some consensus regarding what it means to be socially included. This lack of specificity has made it difficult to accurately measure the impact of initiatives designed to improve social inclusion. Nonetheless, several attempts at developing measures of social inclusion have been made, in particular for use with people with mental illness. Psychometric testing has been conducted on some, but not all of the measures, and has not been completed on any of them. The overall aim of this thesis was to develop a measure of social inclusion for use with people with mental illness. The measure was designed in a series of studies ensuring the representative input of people with a lived experience of mental illness. The measure was titled the SIMI-LE, an abbreviation of a measure of Social Inclusion for people with Mental Illness – Long Edition. Method: The development of the SIMI-LE took place over three sequential studies. The first study involved a thematic analysis of literature regarding social inclusion to obtain the opinions of professionals regarding key contributors of social inclusion. Seventy-one pieces of literature were reviewed (academic literature regarding social inclusion in general n=25, academic literature regarding social inclusion and mental illness n=26, and organisational reports n=20). The second was a Delphi study, conducted to obtain a consensus between three groups regarding the importance or relevance of contributors identified in the first study. Participants included 32 consumers of a mental health service, 32 carers of a person with mental illness and 40 community members. The third study involved the construction of the measure, and preliminary testing with a sample of ninety participants (30 consumers, 30 family members of a person with mental illness and 30 community members). Results: A comprehensive list of contributors was compiled during the first study. A consensus across three groups regarding how important or relevant each of these contributors were, was obtained during the second study. Finally, the SIMI-LE was constructed and preliminary testing conducted. The measure was seen to have good face validity and was highly acceptable to participants. Preliminary findings demonstrated poorer outcomes for people with mental illness as compared to those without, with differences seen in each of the five categories. Discussion: Overall, the aim of developing a measure of social inclusion for use with people with mental illness was achieved. In the process of developing the measure, a greater understanding of social inclusion from the perspective of people with mental illness was obtained. The measure has demonstrated excellent preliminary psychometric properties and has displayed the ability to differentiate between groups, as expected. Implications for use and suggestions for future research are detailed.
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ItemDesign and refinement of the MATE program: Mindful Awareness Training and Education: how do young people understand and practise mindfulness?( 2012)Background and aims: Young people (aged 15-24) often experience difficulties regulating their emotions. This is thought to be a key mediator of distress and ill health. Improving emotion regulation is an important target for mental health promotion in this age group. Mindfulness practice includes cultivating awareness of emotions and developing skilful ways to deal with them. Mindfulness training has been shown to improve mental health in adults. Preliminary investigations have also been reported in children and adolescents. Few studies specific to young people are available and none have reported engaging young people themselves in the design process. Very little research has been reported into online delivery, and all of this work so far has involved adults. Using the Internet to provide mindfulness training has the potential to improve accessibility for young people. Very little research, all of which has involved adults, has been reported into online delivery. The aim in this project was to use a participatory, mixed methods approach to the design and preliminary evaluation of a mindfulness training program for young people in live and online editions. Methods: Initial design of the Mindful Awareness Training and Education program, MATE version 1, was informed by a review of the literature and discussion with experts. MATE v.2 was created after consultation with 13 mindfulness-naïve young people. The live edition of MATE v.2 was trialled with 11 participants. Evaluation included qualitative interviews, a focus group, written and online feedback, and quantitative measurement. The latter was conducted at commencement, immediately after the program and at six weeks’ follow-up. Qualitative data collection and analysis were informed by grounded theory. Results: Consultees on MATE v.1 described mindfulness training as a desirable activity for young people and offered valuable suggestions regarding program structure and content. Recruitment of participants for the pilot trial of MATE v.2 was difficult. Those enrolled showed a high level of engagement with both the program content and evaluation process: 73% completed all program stages, 88% of whom also attended either a focus group or interview. Benefits, in terms of improved emotion regulation and well-being, and reduction in symptoms of stress, anxiety and depression were suggested by qualitative and quantitative data. An explanatory model of participants’ experience was devised indicating that: (1) key initial benefits were a calmer mind and greater sense of agency; and (2) that with ongoing practice, additional benefits may occur. Greater understanding of their minds helped participants develop enhanced confidence and perceived competence in managing day-to-day challenges. Some participants reported transient increased distress in the middle weeks of the program. MATE v.3, the final version of the program, in live and online editions, resulted from an integration of findings. Conclusions: Mindfulness training appears to be acceptable to young people and a feasible strategy to enhance mental health and well-being in this age group. Participants in the live trial were able, within a short time, to develop a sophisticated understanding and application of mindfulness. The MATE program, as devised and refined in this project, is ready for large-scale face to face trial and for website development in its online edition.
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ItemMental health first aid for eating disorders: the development of first aid guidelines and interventions for the public( 2010)Background: Eating disorders are a significant health issue. They commonly affect young women, create considerable disability and impose great burden on individuals, their family and community. Despite the availability of effective treatments, very few people with a diagnosable eating disorder seek appropriate treatment and public knowledge of symptoms and their effects is poor. If the considerable burden caused by eating disorders is to be reduced, interventions that increase the public’s knowledge, and the likelihood of help-seeking by individuals with eating disorders, are needed. Interventions that target the social network appear to be the most promising because of the important role family and friends can play in recognising an eating disorder, reducing stigmatising attitudes and facilitating engagement with treatment. One promising community-based intervention is mental health first aid training. Mental health first aid is defined as the help provided to a person developing a mental health problem or experiencing a mental health crisis. The first aid is given until appropriate professional treatment is received, or the crisis resolves. Mental health first aid training courses provide information to the public about how to assist those with mental illness to seek appropriate help, and are known to be effective in increasing mental health literacy, the provision of assistance, and in decreasing stigmatising attitudes. The development of mental health first aid interventions for eating disorders provides a promising avenue for increasing appropriate help-seeking and ultimately decreasing the burden they cause. This research aimed to establish which strategies should be used by members of the public when providing mental health first aid for eating disorders, and to explore how providing interventions, which describe and encourage the provision of appropriate mental health first aid strategies, affects mental health literacy and help-seeking behaviours. Method: This research involved three separate studies. The first was a Delphi consensus study, which used three different expert panels consisting of 14 consumers, 24 carers and 27 clinicians, to develop a guideline document describing how members of the public can best provide mental health first aid to someone who is developing or experiencing an eating disorder. The second study was an online evaluation of the usefulness and impact of the previously developed guideline document, on web-users’ first aid behaviours. This involved providing web-users who downloaded the document with two consecutive, self-report questionnaires, to assess how the information had been received and utilised. The third study was an uncontrolled evaluation trial of a mental health first aid training intervention, designed to teach young adults in contact with those at risk of developing an eating disorder, how to provide appropriate mental health first aid strategies for eating disorders. The evaluation, which aimed to assess the effectiveness of the training in changing knowledge, attitudes and behaviours towards eating disorders, involved a series of self-report questionnaires administered at baseline, post-training and six month follow-up. Results: In the first study, 200 first aid strategies, from a total of 456 gleaned from a systematic literature search, were endorsed by 80% or more of expert participants as essential or important to the provision of mental health first aid for eating disorders. These strategies were used to develop the document Eating Disorders: First aid guidelines. The inclusion of experts from clinical, carer and consumer backgrounds ensured that the developed guidelines covered broad content pertinent to providing assistance specifically for eating disorders. In the second study, 362 participants reported downloading the eating disorders guideline document over a 10 month period. These web-users ranged widely in age and country of residence, though a very large majority were women. The most common reason for accessing the guideline document was because of contact with individuals with eating disorders in the workplace. Ninety-six participants completed the second questionnaire and provided data about the utility and impact of the guidelines. This showed that web-users who access the guidelines pay careful attention to content and regard the information as helpful and relevant for the future. Twenty-two participants reported trying to assist someone with an eating disorder after reading the guidelines. Although it was found that only a small number of web-users changed their first aid behaviours, the guidelines appeared to play a role in increasing help-seeking in a number of instances where first aid was provided. The guidelines were also reported to be associated with more understanding and support, as offered by web-users providing first aid. In the third study, 85 participants were presented with a four hour, single session, eating disorders mental health first aid training intervention. Of those, 73 participants completed the questionnaires at all time points. Results for the items assessing knowledge showed that the training was associated with an immediate and sustained improvement in eating disorder problem recognition, knowledge of effective treatments and appropriate first aid strategies. However, changes to a number of other areas of knowledge were not maintained over time. Results for the items assessing attitudes towards eating disorders indicated that the sample at baseline were already very empathic and it was therefore difficult to produce any further change. Findings from measures of behavior suggested that there were not statistically significant changes over time, however, information provided in open-ended responses showed some limited evidence for a change in first aid behaviours, and an increase in appropriate help-seeking, albeit among a small number of participants. Of the 73 participants, 20 had provided assistance to someone with a suspected eating disorder, seven of whom reported that professional help had been sought as a result of their first aid interaction. Furthermore, many participants reported feeling more understanding and supportive towards individuals with eating disorders, as a result of the training, irrespective of whether they had an opportunity to provide mental health first aid. The results also provided no evidence that the training had a negative impact on the mental health of participants or the individuals they provided assistance to. Many of the findings from this third study concurred with those of previous mental health first aid training evaluations employing a six month follow-up period. Discussion: This research established that there are appropriate mental health first aid strategies which members of the public can use when providing assistance to someone developing or experiencing an eating disorder. These strategies were used to create the document Eating Disorders: First aid guidelines. This research also established that these guidelines can be usefully implemented and are associated with the provision of appropriate mental health first aid strategies to those with eating disorders and with subsequent, appropriate help-seeking. Although the third study provided some preliminary evidence that the training intervention was associated with increases in some aspects of mental health literacy, future research is needed to elucidate the optimal duration of the training to achieve sustained increases in knowledge and attitudes, and to assess whether statistically significant changes in first aid behaviour emerge over time. The current investigation, however, can confirm that the concept of mental health first aid can be usefully applied to improve mental health literacy and help-seeking behaviours for the eating disorders.