4. Discussion
NSSI, self-injury
The present uncontrolled trial used a pre-course, post-course, and six-month follow-up survey to evaluate the effects of Mental Health First Aid Australia’s Participant knowledge about NSSI was moderate before the course and showed sustained improvement over time, with mastery being achieved by over three quarters of participants at post-course and follow-up. This was reflected in the participant satisfaction data where participants rated the content as mostly new (see Similar sustained improvements were demonstrated for confidence in intended help and confidence in actual help provided to a person who had engaged in NSSI. Confidence in intended help showed greater mean improvements from pre-course to six-month follow-up than confidence in actual helping situations. This discrepancy may be influenced by additional factors, such as the participant’s relationship to the person they are helping, which are present in real-world interactions and difficult to simulate in roleplay scenarios as taught in the course [The quality of intended helping behaviours significantly increased at post-course and six-month follow-up. Concordance with non-recommended actions showed the greatest improvement, with participants’ reducing the number of non-recommended actions endorsed at the post-course assessment. However, mastery for intended recommended actions was higher at all time points than mastery for non-recommended actions, which may suggest that appropriate actions to take when supporting someone engaging in NSSI are clearer or more memorable than actions to avoid. Furthermore, some non-recommended actions (for example, telling them to stop) may reflect intuitive responses which could be related to participants’ lack of knowledge or confidence. Future iterations of the Interestingly, of the participants who reported that they had provided support to someone who engaged in NSSI after undertaking the course, the proportions for mastery were higher for non-recommended actions than recommended actions. These results may indicate that, although participants knew what actions they should take, there may be barriers present in real-life situations that are not measured in this study that prevent them from taking appropriate action, for example, the participant’s relationship to the person they are supporting or the context in which NSSI was disclosed or discovered [There are several possible explanations for why the non-recommended item “Ask Alicia about why she is injuring herself” was consistently incorrectly endorsed as both an intended and actual behaviour. First, the action may not have been appropriately distinguished from a similarly worded recommended action included in the guidelines that informed the course: “Ask the person questions about their self-injury, but avoid pressuring them to talk about it” [