Because of the high prevalence of mental disorders in the community, every person will either develop a disorder themselves or have close contact with someone who does. For this reason, it has been argued that members of the public need some degree of knowledge about the recognition, management and prevention of these disorders – what has been termed "mental health literacy" [1
]. However, surveys in a number of countries have found deficits in public knowledge, including inability to recognize mental disorders, negative views about some standard psychiatric treatments, particularly medications, and positive views about some non-evidence-based interventions [2
An important aspect of mental health literacy, which has received comparatively little attention, is the initial response of those in the social network when someone is developing a mental disorder. When a person develops a mental disorder, they will often not receive any professional help or there may be delays before they get this help [9
]. Nevertheless, the changes in the person's behaviour and functioning are likely to be apparent to family, friends and others in their social network. Indeed, family and friends are seen as important sources of help for mental disorders by both adults and adolescents [8
]. These people are in a position to provide first aid to the person with the mental disorder and to facilitate professional help-seeking. Mental health first aid
can be defined as the help provided to a person developing a mental health problem or in a mental health crisis. The first aid is given until appropriate professional treatment is received or until the crisis resolves.
A number of community surveys have examined the mental health first aid skills of the public. In a national survey of Australian adults, Jorm et al. [13
] presented participants with a vignette of a person with a mental disorder and asked what they would do if that person was someone they had known for a long time and cared about. The responses to this open-ended question were coded into categories. The most common responses were to encourage professional help-seeking and to listen to and support the person, although significant minorities did not give these responses. Other first aid responses were mentioned by only a minority. Of particular concern was the low percentage assessing the risk of harm for a vignette which portrayed a depressed person with suicidal thoughts.
More recently, Jorm et al. [14
] have reported a similar survey of young Australians aged 12–25 years and their parents. The young people were presented with a vignette and asked how they would respond to a peer with the problem. Parents were given the same vignettes and asked how they would respond if this was their child. Only a minority of young people mentioned that they would encourage professional help, even when the vignette portrayed a psychotic person. However, most parents said they would encourage professional help-seeking, although there was a minority who did not mention it. Only a minority of both young people and parents mentioned listening to the person's problems and few mentioned asking about suicidal thoughts.
In a survey of high school students, Kelly et al. [15
] asked how they would respond to a peer portrayed in a vignette of either depression or conduct disorder. Around half the sample gave positive social support as their response, but only a minority would engage the help of an adult such as a parent, teacher or school counsellor. Other research has examined how young adults would respond to a suicidal peer and found that many would not tell a responsible adult about it [16
While these surveys indicate that the public's first aid skills may not be optimal, there is a difficulty judging the adequacy of their responses, because there is no evidence-base or guidelines on what is appropriate first aid for mental disorders. It is not feasible to carry out controlled trials on first aid responses of the public. In this situation, the best guide is probably expert consensus. Here we report the findings from surveys of a range of health professionals on the likely helpfulness or harmfulness of 10 first aid strategies for young people. These strategies were rated for vignettes depicting four disorders: depression, depression with alcohol misuse, social phobia and psychosis. The vignettes focussed on young people because mental disorders often have first onset during youth [17
]. Furthermore, young people show a strong preference for getting initial help from their family and friends [11
] who are therefore a potential source of first aid. Because health professionals vary in the sorts of disorders they have experience with and in the interventions they are trained to use, we sought the views of a range of professions (GPs, psychiatrists, psychologists and mental health nurses) and looked for consensus across these groups. The consensus views of these professionals can then give guidance on what the public should be advised to do. The questions used in these surveys were also included in an earlier national survey of Australian youth and their parents [14
], allowing an examination of any discrepancies between professional consensus and public beliefs.