Development of Chinese mental health first aid guidelines for problem drinking: a Delphi expert consensus study

Abstract

Background Alcohol use disorders have become the second leading cause of death for mental and substance use disorders in China. However, with early diagnosis and timely treatment, the burden can be mitigated. Family and friends of a person with alcohol use problems are well placed to recognize the signs, encourage professional help-seeking and help the person until treatment is received. We aimed to use the Delphi consensus methodology to develop guidelines about how members of the public can provide this “mental health first aid” to someone with problem drinking in China. Methods A Chinese-language questionnaire was developed, comprising statements that were endorsed for inclusion in the English-language problem drinking first aid guidelines for high-income countries. Participants were also encouraged to suggest new statements. These statements were evaluated by two Chinese expert panels – a professional panel and a lived experience panel – on how important they believed each statement was for members of the public providing mental health first aid to a person with problem drinking in China. Three survey rounds were conducted. To be included in the final guidelines, statements had to receive a “very important” or “important” rating from at least 80% of participants from each of the panels. Results The majority of statements were rated in the first survey round by 30 mental health professionals and 25 lived experience panel members. One hundred and eighty-one statements met the inclusion criteria and were used to form the guidelines. Compared to the English-language guidelines, the importance of family involvement and mutual support were highlighted by both Chinese expert panels, while a number of statements relating to low-risk drinking were rejected by the lived experience panel. Conclusions The Chinese-language problem drinking first aid guidelines cover a variety of first aid strategies that members of the public can use when providing initial help to a person with problem drinking, such as how to communicate with the person and what to do if the person is intoxicated. These guidelines will be used as a stand-alone document will also inform the content of Mental Health First Aid training in China.

Development of mental health first aid guidelines for problem drinking: a Delphi expert consensus study in Argentina and Chile

“…While 72% of the items included in the English-language guidelines were endorsed, there were some notable differences, particularly those related to abstinence. These differences were greater than the guidelines for problem drinking culturally adapted for China [ 42 ] and Brazil [ 43 ], where 86% and 84% of English-language items were endorsed, respectively. While there was a relatively high level of agreement between health professionals and people with lived experience, some divergence of opinion was seen, particularly in commitment to recovery as a condition for help.…”

“…The health professional panel members were also unlikely to endorse items related to low-risk drinking. Moreover, many of the lived experience participants, who were influenced by AA tenets, endorsed these items on average 10% less often than professionals, possibly due to the belief that suggesting low-risk drinking may make the person believe that they are authorized to drink [ 42 , 46 ].…”

“…They also allow each participant an equal voice in the process and thus do not prioritise the views of one person or group over another, which is particularly important in capturing the views of people with lived experience of mental health or substance use problems. This method has been successfully used to culturally adapt guidelines for problem drinking in China [ 42 ] and Brazil [ 43 ],…”

Cultural Adaptation of the teen Mental Health First Aid (tMHFA) Program from Australia to the USA

“…While an important step, the body of research on gatekeeper training programs as a public health approach to suicide prevention shows that many adults do not feel comfortable talking with young people in crisis about their risk and that most suicidal adolescents do not feel comfortable talking to an adult about the problems they are experiencing (Torok et al, 2019 ; Wyman et al, 2008 ). Systematic reviews reveal that suicide prevention gatekeeper school-based education programs targeting adults in schools did not find an impact on suicidal behaviors in young people (Mann et al, 2021 ; Torok et al, 2019 ). Recent research supports the benefits of directly training adolescents in addition to training adults in school settings (Torok et al, 2019 ).…”

Development of Chinese mental health first aid guidelines for assisting a person affected by a traumatic event: a Delphi expert consensus study

“…However, most of the guideline development studies have been done in high-income English-speaking countries [ 28 – 30 ], with only a few, on how to assist a person at risk of suicide, carried out in middle-income countries, including the Philippines, Sri Lanka, India and China [ 31 – 34 ]. The research team have previously conducted studies to develop guidelines on providing mental health first aid to a Chinese person developing depression, psychosis, problem drinking or at risk of suicide [ 34 – 37 ]. No cultural adaptation studies of trauma-related guidelines have been conducted.…”