Table 3 Characteristics of training interventions

Compton et al. (2008) [13]

Crisis Intervention Team programs (CIT)

The CIT model is a specialised police-based program intended to enhance officers’ interactions with individuals with mental illnesses and improve the safety of all

No details or table of characteristics presented.

Not reported in this paper. Reference is made to other reports and reviews that explain the CIT model (Dupont and Cochran 2000; Cochran, Deane and Borum 2000; Munertz et al., 2006; Oliva et al., 2006; Oliva and Compton 2008)

No details or table of characteristics presented.

No details or table of characteristics presented.

MH providers, family advocates and MH consumer groups (Cochran, Deane and Borum, 2000)

40 h (Cochran, Deane and Borum, 2000)

Systematic review

Face-to-face

Parties involved in MH crises. Self-selected officers (usually volunteers selected after a review by a CIT coordinator or other senior officer) receive 40 h classroom and experiential de-escalation training in handling crises.

Cochran, Deane and Borum (2000) describe the program as teaching officers about mental illness, substance abuse, psychotropic medication, treatment modalities, patients’ rights, civil commitment law and techniques for intervening in crisis. It is also reported that ‘advocates of CIT’ state that the program promotes a philosophy of responsibility and accountability to consumers of MH services, their relatives and the community.

Team based

Mixed

Forni et al. (2009) [29] Non-comparative study

MH awareness training: developed in house.

To improve police officers’ knowledge and awareness of MH. Objectives included: improve overall communication; understand others roles and perspectives; explore common problems and discuss ways to overcome them; understand how the Unit functions; how MH staff handle violence and aggression and for Police to understand common MH problems.

Every police officer in the borough.

Tour of unit by MH Professionals explaining their work and answering questions.

Borough police officer for MH liaison and clinicians: two police trainers responsible for teaching section 136 procedures and prosecuting offenders with MH problems

Not reported

The Ladywell Mental Health Unit, South London and Maudsley NHS Foundation Trust, Lewisham

Assessing a mental state

‘Hearing voices’

Assaults by patients with MH problems

Face-to-face

Section 136 procedures

Team based

Mixed

One day training

Delivered over 4 months – groups of 12 to 20 each day

Hansson & Markstrom (2014) [27]

An anti-stigma course added on to the regular psychiatry course as part of officer training

To improve knowledge, behaviour and attitudes towards people with mental illness

Student police officers

The programme comprised of: an introductory lecture on attitudes towards people with mental illness; a video of people with lived experience telling their story (2 h); two lectures by people with mental health problems (schizophrenia and bipolar disorder) (2 h); six videotapes of people with MH problems including psychosis, anxiety disorder, depression, bipolar disorder, suicide, and children in families with a parent with mental illness (4 h); practical in vivo training module where feedback was provided on how best to respond to specific situations (4 h). The psychiatry course consisted of 14 h of lectures on causes, diagnosis and types of mental illnesses, legislation and a case study presented at a 2 h seminar.

Two lecturers with experience of MH problems

Lectures, videos, role play with professional actors

University

3 weeks full-time

Non-RCT

Face-to-face

Team-based

Mixed

Herrington & Pope (2013) [28]

Mental Health Intervention Team (MHIT)

To train uniformed officers to be specialist responders to individuals with an apparent MH concern

Front line police officers (constables, senior constables, sergeants)

Not reported in this paper. Reference is made to Crisis Intervention Teams developed in Memphis (Compton et al. 2008 and Canada et al. 2010) which MHIT is based on.

A central project team was responsible for the development and delivery of training, headed by a superintendent (commander) supported by an Education Development Officer, an analyst, and a Clinical Nurse Consultant

Not reported

Non-RCT

Not reported

Not reported

Not reported

Norris & Cooke (2000) [30]

MH awareness training: developed in house.

To acquire awareness, understanding and skills in order to aid management of mental disorder or mental illness and thereby assist police officers in their duties.

Police officers

Morning: Legal responsibilities of police. Tour of unit by MH Professionals explaining their work and answering questions.

MH professionals at the Hutton Centre and the Cleveland police training officer

Not reported

The Hutton Centre, Middlesborough, a medium secure unit

Afternoon: Assessing a mental state, emphasis on increasing awareness of signs and symptoms of MH problems rather than clinical diagnosis. Discussion of personal and professional experiences and interactive role plays and teaching.

Non-comparative study

Face-to-face

One day training

Has been delivered over last five years – 132 officers trained.

Team based

The training emphasised the “distinction between a ‘criminal’ and a ‘mentally disordered offender’”, and the “need for care and treatment as opposed to incarceration and punishment”

Mixed

Pinfold et al. (2003) [31]

Reducing psychiatric stigma and discrimination: developed in house

To communicate the ordinariness of mental ill-health and to address fear and misunderstanding surrounding experiences labelled ‘severe mental illness’. Raising participant awareness; increasing level of knowledge; changing views and affecting behaviour.

Police officers

Workshop 1: ‘What are MH problems?’ Including hearing voices simulation exercise a session on recovery and talks by an individual explaining what it feels to be psychotic.

Developed by project team, police force, Rethink severe mental illness trainers.

Workshops supported by information packs

Two police areas in Kent

Non-comparative study

2 × 2 h workshops over 6 month period.

Workshop 2: ‘How can the police support people with MH problems?’ including case studies and talks from carers and service users highlighting best practice principles. Additionally, workshop two reviewed mental health act 1983 legislation, local service provision and officers own MH needs

Delivered by: service users, carers, social workers, voluntary sector staff

Face-to-face

Team based

Mixed

Rafacz (2012) [17]

An on-line anti-stigma program delivered in two different ways: personal experience vs information giving

The control condition aimed to increase general knowledge of specific MH conditions. The intervention condition aimed to change attitudes (reduced stigma and increased empathy)

Campus police officers

A 17 min long video in which the presenter disclosed his mental illness (schizo-affective disorder), and shared his initial experiences of the illness and treatment before discussing t where he is now and his successes, hopes and dreams for the future. He also discussed the interaction he had with police officers and their effect on the outcomes of his illness.

Videos presented by men with similar attributes to each other, however in the intervention group the presenter disclosed having a diagnosis of schizo-affective disorder

Video presentation delivered online

RCT

Online

17 min

Online/web-based

Self-directed

Didactic

Bailey et al. (2001) [26]

Awareness training on intellectual disabilities

Training aimed to raise the awareness of police officers to people with intellectual disabilities in general

Trainee Police officers (post foundation training)

Involved a role-played exercise where residents from a group home on a local housing estate attended a community meeting relating to a drug problem on the estate. Police officers within the treatment group were allocated a number of roles, including that of a person with intellectual disability resident in a group home. This was followed by a debrief session and exploration of stereotyped views held about people with intellectual disability.

One of the co-authors, a professional with a background in intellectual disability services.

Briefing, role play, plenary group. Other course materials not reported

Non-RCT

Not stated

Face-to-face Team-based Interactive

Not stated but appeared to be a single session

Teagardin et al. (2012) [15]

“Law Enforcement: Your Piece to the Autism Puzzle”: a video to educate law officers about Autism Spectrum Disorders (ASD)

To help the recognition and identification of and attitudes towards people with ASD.

‘In the field’ law enforcement officers.

The video covers topics included what is ASD, how to recognize persons with ASD, and how to respond to persons with ASD.

No trainer present, video only.

Video presentation

RCT

Law enforcement training venue

13 min

On-line/web based

Self-directed

Didactic

Dorsey et al. (2012) [25]

Project Focus’ a caseworker training and consultation model. Training followed by case-specific consultation.

To enhance the skills of case-workers through training and case-based consultations to enable better recognition of MH needs and link youth with effective MH treatment (EBP). Project focus was designed to explore whether an increase in caseworker capacity to identify commonly occurring MH problems and to refer to EBPs improves child well-being.

Child Welfare Caseworkers.

The training involved: building awareness of available EBPs in the community; common MH needs for youths in foster care screening to identify needs. Three main classes of MH problems were covered: internalising (depression and anxiety), externalising (disruptive behaviour) and attention-related issues. Screening strategies were discussed. Classes of disorders rather than specific diagnosis were covered. Overviews of ‘name brand’ approaches available locally were provided; short video modelling and demonstration of EBPs; and engagement training to involve foster parents and collaborate with clinicians. Consultation sessions involved reviewing screening data and discussing the implications, treatment options and developing action plans for each case.

None stated for training. Consultation sessions were delivered by three PhD-level psychologists and one M-level social worker with 30+ years-experience in MH.

Lectures (PowerPoint), small group activity (vignette and discussion). Short modelling and video demonstrations of available EBPs

RCT

Not specified.

Two 3-h training sessions and following training, caseworkers received 4 months of bi-weekly 1 h case specific consultation.

Face-to-face

Team based

Mixed.

Jorm et al. (2010) [23]

A modified version of the Youth MHFA course.

For teachers, to improve: knowledge and attitudes towards MH; confidence in helping students; knowledge of school policies and procedures for dealing with students with MH problems. Training also aimed to improve teachers ability to support colleagues with MH problems seek information about MH problems and their own MH

Teachers

How to apply the MHFA action plan “ALGEE”: Assess the risk of suicide or harm; Listen non-judgementally; Give reassurance and information; Encourage to get appropriate professional help; Encourage self-help strategies

MHFA trainers who had previously worked as teachers. Each course was taught by two instructors, one from the Department of Education and Children’s Services and the other from the Child and Adolescent Mental Health Service. Instructors got a one-week training program in how to conduct this modified Youth MHFA course. They were trained by two experienced trainers, including the person who devised the MHFA course

A lesson plan for each session, the existing Youth MHFA manual and a set of MH factsheets

Participants’ school

RCT

Two parts, taught over two days, seven hours each day

Face-to-face

Part 1 (for all education staff) covered departmental policy on MH issues, common mental disorders in adolescents and how to use the MH action plan

Team based

Mixed

Part 2 (for teachers with special responsibility for student welfare) provided information about first aid approaches for crises that require a more comprehensive response and about responses for less common MH problems

For students to improve their MH and increase information provided about MH

Lipson et al. (2014) [21]

MHFA

For Resident Advisors and Residents trained in MHFA to have improved attitudes, knowledge and self-efficacy to manage MH issues in their residential communities. This should lead to more contact with residents about MH issues, leading to increased knowledge and attitudes at the population level. Ultimately, training aimed to increase residents’ service utilization, so improving MH.

University Resident Advisors

The five course modules were on: depression, anxiety, psychosis, substance abuse and eating disorders. Each module had information about signs and symptoms, appropriate responses, and interactive activities. The cornerstone for MHFA is a five-step gatekeeper action plan ALGEE (as above). MHFA emphasises that self-help does not replace professional care in potential crises.

Instructors were certified by the National Council on Behavioral Healthcare. Most of the instructors (10 of 14) were behavioural health clinicians.

Slides, demonstrations, and case examples.

RCT

Face-to-face

Not specified.

Team based

Interactive

12 h (since reduced to 8 h but still retaining breadth of content)

Svensson & Hansson (2014) [16]

MHFA translated and modified to suit the Swedish context

To improve MH literacy among the general public and give the public the skills to be able to provide initial help to people with MH problems.

Public sector staff (social insurance agencies, employment agencies, social services, schools, police departments, correctional treatment units, rescue services, recreation centres).

The course was taught in five steps (as in ALGEE above). The steps were then applied to depression, anxiety disorders, psychosis and substance use disorder. Attendees were taught how to help a suicidal person, a person having a panic attack, a person who has experienced a traumatic event and a psychotic person threatening violence.

An Australian team taught three Swedish main instructors, who then taught 18 instructors who implemented the training program. All the instructors had experience of MH work in some form, such as health care staff and volunteers in user organisations.

An MHFA manual in Swedish

RCT

Face-to-face

Team based

Interactive

Training was given at worksites or local colleges localities in classes

12 h (equally spread over 2 days)

Thombs et al. (2015) [14]

Peer Hero Training Program: uses a story-based approach to emphasise Resident Assistants (RAs) need to show courage in carrying out their responsibilities as MH & alcohol/other drug first-aid providers.

Improve skills, knowledge and confidence in managing their ‘First-aid’ response in relation to MH and alcohol/other drug situations for students living in university residences. Address the RA’s four critical attitudes which affect their ability to manage these ‘first-aid’ situations: perceived referral barriers, referral self-efficacy, referral anticipatory anxiety, and perceived referral norms.

University RAs

Program has three components, all in video format. 1) 3 dramatisations of a situation which RAs may face relating to alcohol, other drug, MH, and academic problems and methods for referring students for help. Interactive decision points require the RA to select 1 of 4 answers. The actor RA then dramatises the selected answer before feedback is given about the selected answer. 2) two-part counselling session: a student referred by an RA meeting with a counsellor, the story line flows from videos above to illustrate what students referred to counselling may encounter. 3) a series of interviews with actual parents of students and senior residence life professionals on: what is expected of RAs; not ignoring or overlooking students’ needs; how to approach students with an observed behavioural problem; need for RAs to be sincere, empathic and maintain confidentiality.

Developed by team of campus residence professional staff, RA supervisors, RAs campus MH professionals, student affairs professionals and health behaviour researchers.

Interactive videos

Not specified

RCT

Three separate training sessions which each took between 15 and 25 min to complete.

Delivered on line.

On-line/web-based

Self-directed

Interactive

Hart & More (2013) [24]

Information relating to Autism Spectrum Disorder (ASD).

Improve knowledge of ASD by comparing two methods of information delivery.

Trainee teachers

The ASD-related content was based on information on the Centers for Disease Control website and the course text, included: early warning signs and current prevalence and definition of ASD. Content used reflected the local cultural and linguistic diversity and that seen in ASD: this focused on potential underservice of ethnic and linguistic minority populations and teacher strategies for developing cultural competence and collaborative relationships with families.

The content of the training was developed by the authors: no details provided. Delivery was online.

For both groups material was located on a university Blackboard Course Management Learning System which students were asked to log onto via a laptop. Those allocated to the podcast also used headphones.

Classroom

RCT

20 min

On-line/web-based

Self-directed

Didactic

Kolko et al. (2012) [22]

Alternatives for Families: A Cognitive–Behavioral Therapy (AF-CBT)

Provide practitioners with skills to use AF-CBT when working with families with physical forces, aggression or abuse of children.

Community practitioners (clinicians)

Initial training based on the AF-CBT Session Guide: included didactic and experiential activities, case examples, group discussion, videotape reviews, and behavioural rehearsal/ challenge exercises. The session guide provides clinicians with an outline and examples for presenting the three phases of AF-CBT: engagement and psycho-education, individual skill-building, and family applications. Follow-up training: Each consultation began with a review of one or more AF-CBT topics, followed by two case presentations, feedback from consultants and the group, and problem solving to address the needs of the presenting clinicians. Booster training: Sessions focused on case conceptualisation, review of a skill topic, exploration of treatment adaptations and use of handouts, and implementation challenges.

Three experienced, ‘second generation’ trainers either alone or in tandem (1 trainer to 8–15 practitioners).

Treatment book; AF-CBT session guide; clinician-friendly handouts; two children’s books

RCT

Initial training: conducted at the site of each participating agency, repeated for each cohort. Follow-up: at agency site; Booster: not stated.

Face-to-face

Experienced AF-CBT clinicians, trainers, and developers generated the initial training content based on the AF-CBT Session Guide.

Team based

Interactive

Initial training: 4 × 8 h weekly workshops for 1 month; Followed by 10 × 90 mins bi-weekly group case consultations.

Annual booster sessions offered (1.5–2 h) from 6 to 12 months after initial training.

McVey et al. (2008) [20]

An online programme called “The student body: promoting health at any size an online programme”

Help teachers and public health practitioners prevent the onset of disordered eating through the promotion of positive body image in children before they reach adolescence. Inform adult role models about the various factors influencing children’s body image.

Teachers and public health professionals

Six modules: media and peer pressure, healthy eating, active living teasing, adult role models and school climate. Steps in each module for the facilitator: 1) a case study introducing the topic using an animated cartoon; 2) background information providing topic information and its significance to disordered eating prevention; 3) instructions on how to conduct a classroom activity with students; 4) topic-related supplementary resources.

Online

Case study script for role-play, PDF of background information, true or false game, comic strip with game answers, parents’ handout and an optional evaluation. Topic related resources

RCT

Online for participants – for delivery in classroom.

Online-curriculum available for delivery to students during classroom time for 60 day period.

On-line/web-based

Self-directed

Didactic

Moor et al. (2007) [19]

Educational package on adolescent depression

Not explicitly specified but intervention designed to help the recognition, identification of and attitudes towards adolescent depression.

Teachers

The training was delivered in three parts. 1) An introduction to adolescent depression and the importance and challenges of early detection; emphasising the role of teachers. Followed by a video of actors on ways that the signs of depression may show in school settings and standardising information on the signs and symptoms of depression. 2) Case vignettes illustrating a range of difficulties that schools may encounter were presented to teachers in small groups for discussion. All depressive disorders in the community such as co-morbidity of depression with school refusal, drug and alcohol abuse and conduct disorder were included. Management strategies appropriate for teachers to use in school were covered, including problem solving approaches. 3). Discussion of issues specific to each staff group’s local triage procedures and referral of hypothetical at-risk pupils.

Each training session was delivered by the same pair of trainers-details of trainers not provided.

An educational video and case vignettes

Not specified

RCT

2 h

Face-to-face

Team based

Mixed

Ostberg & Rydell (2012) [18]

A modified version of Barkley’s parent training programme-adapted to setting and for use with teachers

To better equip teachers and parents with the ‘tools’ they need and “strategies in Everyday life” to help children with ADHD

Teachers and parents

Sessions from Barkley’s parent training included information about neuropsychiatric problems, teaching participants to use reinforcements, problem solving and communication with the children. Adaptations to the programme included: removal of ‘time-out’ for unwanted behaviour, home assignments were based on the problems parents and teachers experienced and reported on. Problem-solving aspect of the training was extended. A structure for co-operation between home and school was formed.

Two “well-trained” group-leaders per group

Home assignments based on problems reported by parents and teachers

Child and adolescent psychiatry clinic.

RCT

Parents 10 weekly 2 h sessions, teachers 8 sessions.

Face-to-face

Team based

Mixed