Sample
In the Philippines, 34 panel members were involved in Round 1 (i.e. 54% of the experts who were invited to participate), 29 in Round 2 and 28 in Round 3. All panel members were currently working in the Philippines. The majority were psychiatrists (N = 15) and psychologists (N = 9). Six participants were counselors or counselor advocates, two were social workers and one was a psychiatric nurse. Two of the participants indicated that they were also priests. The panel was comprised of 13 males and 21 females. The majority of the participants were in the age range 40-49 years (N = 12) and 50-59 years (N = 12), two participants were aged 18-29 years, five were aged 30-39 years, and three were aged 60 years or over.
Some information was also collected on the clinical experience of the panel members. On average, participants reported that they had practiced in mental health/psychiatry for 15 years (the shortest time was 1 year and the longest 31 years). Less than half of the participants (N = 14) received some formal education related to their profession overseas (mainly in USA, Canada and other Asian countries). Slightly over a third of the participants (N = 12) reported having received a formal training specifically on suicide prevention/intervention. However, when asked to state how well prepared they felt to assist a suicidal person, 16 answered "somewhat prepared", 12 "mostly prepared" and 6 "very prepared". No one reported being "not all prepared". Although participants generally felt prepared to assist a suicidal person, in their opinion most people in the Philippines are not at all prepared (N = 17) or somewhat prepared (N = 17). No participant believed others are mostly or very prepared to assist.
Item endorsement
After three Delphi rounds, there were 102 items that were rated as "essential" or "important" by 80% or more of the panel members.
At Round 2, 48 new items suggested by participants were added to the questionnaire. The following are examples of such items:
• An important warning sign for suicide is if a person expresses in words or actions the desire or hope that they will die (including praying that God may take their life).
• An important warning sign for suicide is if a person is not doing usual important tasks, such as household chores, going to work or school.
• The first aider should be aware that the absence of a belief in a God may increase the risk of suicide.
• The first aider should ask the suicidal person if they have experienced a change in their spiritual/religious practices or beliefs (e.g. an increase or decrease in prayer or church attendance).
• The first aider should take the suicidal person in the nearest safe place (e.g. church, hospital, or police station).
• The first aider should ask the suicidal person if they would like the first aider to contact someone for them, such as a friend, family member or trusted religious leader.
• The first aider should consider the suicidal person's spiritual/religious beliefs and refer to these to try to prevent the person from taking their life.
• During the suicidal crisis, the first aider should encourage the suicidal person to spend time with their significant others (e.g. family, friends or religious leader).
A number of responses to the Round 1 open-ended questions did not meet criteria for creation of a new item (e.g. they did not fit the definition of first aid or did not suggest a clear action) or were comments/suggestions. The following are examples of the comments and suggestions that did not generate new items:
• The area where I work is highly multicultural (Christians, Muslims, Indigenous people, other ethnic groups). Mental Health First Aid should consider this aspect as truly essential.
• Suicide is something that needs to be taken seriously. I think everybody should be trained on how to deal with this case as we don't know when it can happen.
• Religious organizations in the Philippines should be oriented and trained on the Mental Health First Aid for Suicide since they serve as powerful influence on the mindset and lifestyle of their followers. Each also has its own idea/perception on suicide.
• There are so many myths about suicide in the Philippines, perpetuated to a great extent by the church and an uneducated field of professionals. A focused training/orientation program for the churches and the helping professions might be a good starting point.
• Local government officials at the community level and the local law enforcement agency are usually called immediately during emergencies, I think they will benefit most with this kind of training.
• (...) will we be given a copy of the guidelines once all data have been gathered and finalized? Will you be conducting a formal training course on the prevention of suicide in Australia? That, I think, would be a very big help to teach experts on the mental health field to put to exercise this paper and put it to a "field test" later on. I am interested to participate and train for such course if this will be considered in the future. Thank you for letting me participate in this study [name deleted].
See the Additional File
1 for a complete list of rated statements, including the percentage of panel members endorsing each item.
At the end of the survey, participants were asked their opinions about the likely effectiveness of suicide first aid, using a 5-point Likert scale (from "definitely yes" to "definitely no"). All the participants who answered the question (N = 32) believed that if the first aider does the right thing the risk of suicide can be reduced. An overwhelming majority of the respondents (N = 29) thought that if the first aider does the wrong thing the risk of suicide can be increased.
The longer-term goal of the project is to use the guidelines to develop, implement and evaluate a training program on suicide first aid in the Philippines. This goal reflects the opinion of the expert panel. When asked if they thought members of the public should receive such training, 25 participants responded "definitely yes" and 4 "probably yes". Only two respondents answered "don't know/depends" and one "probably no".