Background Approximately 3000 people die by suicide each year in Sri Lanka. As family and friends may play a role in supporting a person at risk of suicide to get appropriate help, there is a need for evidence-based resources to assist with this. The aim of this study was to culturally adapt the existing English-language mental health first aid guidelines for helping a person at risk of suicide to the Sri Lankan context. Methods A Delphi expert consensus study was conducted, involving mental health professionals and consumers (people with lived experience) and caregivers, who were identified by purposive and snowball sampling methods. Participants were recruited from a wide variety of professional roles and districts of Sri Lanka in order to maximize diversity of opinion. The original questionnaire was translated into Sinhala and participants were requested to rate each item according to the importance of inclusion in the guidelines. Results Data were collected over two survey rounds. Altogether, 148 people participated in the study (130 health professionals and 18 consumers). A total of 165 items were included in the final guidelines, with 153 adopted from the guidelines for English-speaking countries and 12 generated from the comments of panellists. Conclusions The adapted guidelines were similar to the English-language guidelines. However, new items relating to the involvement of family members were included and some items were omitted because they were not considered appropriate to the Sri Lankan context (particularly those relating to explicit mention of suicide). Further research is warranted to explore the use of these guidelines by the Sri Lankan public, including how they may be incorporated in Mental Health First Aid training.

Background Family and friends can play a key role in supporting a person with depression to seek professional help. However, they may lack the knowledge to do so. English-language guidelines for high-income countries have been developed to assist with this. The aim of this study was to adapt the English mental health first aid guidelines for helping a person with depression to the Sri Lankan context. Methods A Delphi expert consensus study involving mental health professionals and people with lived experience (either their own or as carers) was conducted. Participants were recruited from inpatient, outpatient and community care settings. The English-language questionnaire was translated into Sinhala and participants were asked to rate the importance of each item for inclusion in the guidelines for Sri Lanka. Results Data were collected over two survey rounds. A total of 115 panellists (23% male) consisting of 92 mental health professionals and 23 consumers and carers completed the Round 1 questionnaire. A total of 165 items were included in the final guidelines, with 156 adopted from the guidelines for English-speaking countries and 9 generated from the comments of panellists. Conclusions The adapted guidelines were similar to the English-language guidelines. However, new items reflecting culturally relevant approaches to autonomy-granting, communication and culture-specific manifestations of depression were reflected in the adapted version. Further research should explore the use of the adapted guidelines, including their incorporation into Mental Health First Aid Training.

Introduction Deliberate Self-Harm (DSH) has emerged as an important health issue in Sri Lanka. It is one of the strongest risk factors for completed suicides. Methods: A questionnaire based descriptive cross-sectional study with a qualitative component was done in three hospitals in Galle district, in Southern Sri Lanka. Selection of variables was done by reviewing selected literature and curricula of basic training of medical officers. A series of in depth interviews were conducted to supplement the findings by using purposive sampling. Multivariate analysis was done to determine factors associated with satisfactory level of performances. Qualitative data analysis was done for in depth interviews. Results: Overall knowledge and practices were shown to be satisfactory but deficiencies were noted in certain aspects. Male gender (OR 3.560) and having a work experience of <5 years (OR 6.184) showed significantly higher level of knowledge while age<30 years (OR 4.497) showed satisfactory level of practices. Lack of priority given for psychiatric care stood as the main barrier in delivering satisfactory care. Excess work load, lack of competency and inadequate training appeared to be contributory factors. Conclusions: More training opportunities on psychiatric management DSH patients should be included. Competencies on preliminary risk assessments and providing basic psychological support should be improved.