By using experts in the field, this research aimed to produce guidelines for providing culturally appropriate mental health first aid to an Australian Aboriginal or Torres Strait Islander adolescent. The expert panel reached consensus on a range of first aid techniques, from how to initially engage the adolescent to discussing mental health problems with them. There were a number of notable findings.
Understanding culture when providing help
The open-ended responses provided in Round 1 highlighted that culture is not static and will vary between regions, families and individuals. The findings make clear that being culturally appropriate when providing first aid includes recognising that views on mental health differ between communities. Panellists stated that the first aider should avoid making assumptions because of the adolescent’s culture (e.g. automatically assuming that unusual or out-of-character behaviours are related to culture or adopting communication styles based on cultural stereotypes). Endorsed statements also reflected the problem of relying on cultural assumptions, for example, when helping the adolescent get professional help:and
The first aider should be aware that the adolescent may not be comfortable using Aboriginal-controlled health services because of concerns about confidentiality and ‘shame jobs’ if it involves a personal problem.
The first aider should be aware of the way shame affects the behaviour of Aboriginal people; for instance, some Aboriginal people may be afraid of attending a mainstream hospital because, historically, being admitted to a hospital with a mental illness caused shame on family and community.
The open-ended responses indicated that although cultural knowledge is important when providing mental health first aid to an Aboriginal adolescent, any help is better than none, especially in a crisis situation. One participant’s comments read:
A first aider ideally will have some knowledge of the Aboriginal culture before stepping in and offering first aid to an Aboriginal person, however, this should not be a barrier to supporting a young person. Never be afraid to ask a young person to clarify or learn what you don’t know about them or their culture. All individuals, including young persons, are the experts on their own lives and culture.
Comments like this were similar to feedback in a past Delphi study with Aboriginal people where panel members suggested that a person providing first aid to an Aboriginal adult need not be so focused on cultural awareness that they lose sight of the physical and emotional needs of the person they are assisting [
14]. Panellists in the current study were adamant that although it is important to be sensitive to cultural differences when having a discussion, individual differences should also be considered in the first aider’s approach (e.g. adapting communication with the adolescent to their age, level of maturity and favoured style rather than relying on any preconceptions based on culture). This meant that the present study was consistent with past findings that showed the importance of providing culturally appropriate first aid whilst having equal consideration for the individual needs of the person, regardless of their cultural identity [
14].
The findings indicated that when providing help, the first aider should consider the other challenges that an Aboriginal adolescent may be facing, for example, social problems due to racism or discrimination, many deaths or losses of family or friends or anger from past injustices. A caveat to this idea was that the first aider should not assume that an adolescent is facing particular problems, for example one participant noted:
It is important to recognise historical factors that may lead to shame but essential that the first aider takes the adolescent on face value without pushing previous trauma upon them.
Importance of autonomy
A strong theme throughout the panel feedback was the importance of giving the adolescent autonomy and choice. For example, panel members discussed the need for the first aider to ask the adolescent before involving family or community members, giving the adolescent the opportunity to answer questions even if their family members are present, empowering the adolescent to make decisions, and allowing the adolescent to drive the discussion.
Similarities with a previous study on helping an adolescent
There were several commonalities between items endorsed in the present study and those endorsed in a previous study on communicating with Australian adolescents about sensitive issues [
50]. There were items that were endorsed in both studies, for example, asking the adolescent where they feel comfortable and safe to talk, taking the time to build rapport and trust, being reliable and consistent, listening without interrupting, being genuine, talking calmly, awareness of body language, how to discuss problems and offering courses of action. These commonalities show that Aboriginal adolescents have much in common with other Australian adolescents, even though there are specific considerations to take into account as well.
Panel member feedback
Panel member feedback at the end of Round 3 was similar to that of a past Delphi study with Aboriginal experts to develop mental health first aid guidelines [
14]. For example, in both the present study and the previous study, all panel members responded with either
Strongly agree or
Agree to the statement,
I thought participating in this research was worthwhile. Statements regarding the appropriateness of the Delphi research method also received a high level of agreement, with 73% of participants in the present study responding with either
Strongly agree or
Agree to the statement
I would recommend the Delphi method for other research projects for Aboriginal people. This was similar to the 83% of participants in the previous study responding with either
Strongly agree or
Agree to that same statement.
When given the opportunity to provide feedback on the research project, participants gave reasons why they liked the methodology, including that they appreciated the community consultation and that they wished more organisations would take such an approach. Participants also stated that the combination of multiple surveys and the results report, provided to them after each round, ensured all the necessary content was considered. Participants also made suggestions for future studies, for example that consumers, parents, elders and both Aboriginal and non-Aboriginal mental health experts might be included as participants. Another common response was a justification of why Don’t know/depends was selected for many survey statements. This included the acknowledgement that often the mental health first aid strategies used will depend on the individual adolescent’s personality, geographical area, severity of illness, access to services and the availability of other supports.
Dissemination of guidelines
To have a direct impact on Aboriginal adolescents and their communities, the developed guidelines must be disseminated throughout Australia. The guidelines will inform a Youth Aboriginal and Torres Strait Islander MHFA Supplementary Booklet, which will supplement both the Aboriginal and Torres Strait Islander MHFA training program and the Youth MHFA training program.
Mental Health First Aid courses are widely disseminated in Australia, with over 1,000 instructors offering courses and over 200,000 people having received the training, which is more than 1% of the adult population [
5]. In addition, there are 164 Aboriginal and Torres Strait Islander instructors and over 13,500 people have completed the Aboriginal and Torres Strait Islander MHFA course. Thus, there is a ready means of national dissemination for the newly developed guidelines, supplementary workbook and updated courses.
In addition, the guidelines will be available from the Mental Health First Aid website [
52] and will be submitted to the NHMRC Clinical Practice Guidelines Portal [
53]. Copies of MHFA guidelines are downloaded very frequently from the Mental Health First Aid website. The guidelines web page has attracted an average of 45 visits per day. A recent evaluation found that the information in the guidelines led to more positive, empathic and successful helping behaviours [
54]. These findings suggest that the newly developed guidelines might also be practically useful when made available online.
The guidelines received provisional support from the experts involved in this study. Despite this, and the widespread dissemination plan outlined, only further evaluation of the first aid outcomes will confirm whether or not the information developed by this research is effective in increasing support provided to Aboriginal Australian youth with mental health problems.