YouthREX Research Summaries ask Just Six Questions of research publications on key youth issues. These summaries get at what the youth sector needs to know in two pages or less!

1. What was this research about?
Young people who live in rural areas show poorer mental health outcomes and higher rates of suicide than those who live in urban centres. Cultural and societal differences between regions mean that mental health issues are both expressed and addressed differently. Therefore, training for mental health literacy should take into account these differences when providing training to individuals in rural areas.

This research is an evaluation of the Better Todays/Better Tomorrows for Children’s Mental Health/Youth Suicide Prevention training program. This program was developed in 2009 to educate adults who interact with children and youth in rural communities on the signs and symptoms of mental health disorders in children and youth. This program was adapted from an earlier program to meet the unique needs of youth living in rural communities. The intervention is based on the belief that “every adult in a rural community who touches a child’s life – not just the few mental health professionals – should be equipped to help” (p. 16).

The evaluation aimed to determine if the training increased the mental health literacy of adults, as well as their ability to proactively respond to youth in early stages of distress. Mental health literacy is a person’s understanding of mental health issues and suicide. This includes the ability to recognize risk and protective factors, and warning signs. The Better Todays/Better Tomorrows program provides a customizable training curriculum on the following topics:

• statistics on rates of mental illness and suicide
• mental health stigma and how it can be addressed
• causes of mental illness
• warning signs of mental illness and suicide
• protective factors and resilience
• cultural implications for addressing mental illness and suicide

2. Where did the research take place?
This study took place in a remote area of Idaho, United States, where “mountains, harsh winter conditions, and sheet distance serve as barriers to seeking and obtaining health care” (p. 17).

3. Who is this research about?
This research is about the changes in mental health literacy that adults in rural America experience through attending the Better Todays training course.

“Increasing mental health literacy provides the opportunity to develop a circle of care that can reach youth at their point of need, whether at school or in community activities. Most importantly it is implied that mental health and suicide disparities can decrease when individuals are supplied with knowledge and resources that honor the customs and values of their community” (p. 23).

4. How was this research done?
The researchers conducted an outcome evaluation of the Better Todays program. They reviewed program documentation from 19 trainings that occurred between 2007 and 2009, attended by 1,122 individuals. All program participants were invited to anonymously complete two surveys: one prior to training and the other upon completion of training. Eighty-nine percent of those who took the training completed the pre-training survey and 50% of participants completed the post-training survey. The survey was designed to determine the participant’s knowledge of four areas, which would be an indication of their mental health literacy. The survey asked participants to describe the their understanding of the following:

a) knowledge of protective factors
b) knowledge of risk factors for suicide
c) knowledge about youth suicide in Idaho
d) knowledge about suicide rates for Native American male youth

Upon completion of the Better Days training, participants were asked the same questions. The surveys were compared to test for differences between pre- and post-training mental health literacy.

5. What are the key findings?
The research indicated that participation in Better Todays did result in increased mental health literacy.

The training increased participants’ understandings of protective factors for suicide, risk factors for suicide, as well as the specific risk factors for children and youth in Idaho. Participants also demonstrated increased understanding of the unique risks Native American youth face with regards to suicide.

6. Why does it matter for youth work?
Better Todays has demonstrated success in teaching participants the warning signs of suicide and increasing mental health literacy for adults in rural areas. This training is especially important for adults in rural areas who have multiple roles and interact with youth in multiple capacities not necessarily seen in urban areas. Training for these adults that equips them to identify mental health issues and be aware of appropriate interventions and resources is important in rural contexts where more traditional supports may be lacking.

Customized and accessible mental health literacy programs for rural communities that take into account social and cultural differences hold promise for improving the mental health outcomes of rural youth.