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Table 3 Changes in the adapted mental health first aid guidelines of trauma for China

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

Changes(n) Statements
Section 1. Background information(6 statements in the English version)
Added (new statements developed based on comments from panellists, n = 2) The first aider should be aware that for most people, their responses to a potentially traumatic event may be “normal reactions in an abnormal situation”, do not necessarily mean “being mentally ill”.
The first aider should be aware that they can also be influenced by the potentially traumatic event.
Section 2. Actions to be taken at the site of a potentially traumatic event(39 statements in the English version)
Endorsed (statements endorsed for inclusion in the Chinese guidelines but rejected in the English-language guidelines, n = 7) The first aider should find out what the person’s immediate needs are (e.g. food, clothing, shelter, medical help or emotional support) and attempt to meet them.
The first aider should try to minimise the person’s exposure to potentially upsetting sights and sounds, e.g. injured people or flashing lights.
If the person has been a victim of crime, the first aider should consider the possibility that forensic evidence may need to be collected (e.g. evidence on clothing or skin) and should encourage the person to preserve such evidence.
The first aider should discourage the person from making any impulsive decisions because they may not be thinking clearly.
If the person’s loved ones or friends are not present, the first aider should offer to contact them.
If the person has been separated from loved ones during the potentially traumatic event and wants to be reconnected with them, the first aider should try to help them do so.
If the person is asking for information, the first aider should find out from professional helpers what information they are allowed to pass on to the person.
Added (n = 2) If the person shows aggressive behaviors like suicide and self-harm, the first aider should try to keep calm and try to comfort the person.
If the person hurts someone or destroy something, the first aider should ensure his own safety and then call the police or a professional to help.
Section 3. Talking about the trauma(53 statements in the English version)
Endorsed (n = 8) If the person begins a sensitive conversation and the first aider does not think it is the ideal place to talk to the person, the first aider should suggest finding an environment likely to be safe, comforting and free of distractions.
The first aider should encourage the person to talk about their feelings, but only if the person feels ready to do so.
If the person talks repetitively about the potentially traumatic event, the first aider should listen.
The first aider should tell the person that what happened was not their fault, but only if they know this to be true.
The first aider should not avoid talking about the person’s experiences.
If the person wants to tell their whole story about the potentially traumatic event, the first aider should give the person enough time to do so.
If the person seems to be ‘spaced out’, ‘shuts down’ or is struggling to communicate, the first aider should encourage the person to move a little, e.g. change their posture, do some stretches.
If the person seems to be ‘spaced out’, ‘shuts down’ or is struggling to communicate, the first aider should offer to talk to the person at another time.
Added (n = 1) The first aider should remind the person that there are people who care about him and love him.
Excluded (statements rejected for inclusion in the Chinese guidelines but endorsed in the English-language guidelines, n = 3) The first aider should not probe for details of the potentially traumatic event.
The first aider should not offer religious solace by saying things like “God has reasons”.
If the person wants to talk about the potentially traumatic event but this is too distressing for the first aider, they should find someone else for the person to talk to.
Section 4. Providing support in the weeks & months following a potentially traumatic event(38 statements in the English version)
Endorsed (n = 5) The first aider should discourage the person from making any major life decisions or big life changes, if at all possible.
The first aider should encourage the person to talk about how the trauma has affected their relationships.
The first aider should encourage the person to share their reactions with people who they think will be supportive.
The first aider should encourage the person to share their memories with people who they think will be supportive.
The first aider should encourage the person to seek help from a professional who treats people who have experienced trauma.
Added (n = 1) If the person appears to suddenly return to their normal routine and behaviours after experiencing the trauma, you should still continue to keep an eye on them.
Excluded (n = 2) The first aider should tell the person about any sources of information available for survivors, e.g. information sessions, fact sheets and phone numbers for information lines.
The first aider should encourage the person to seek professional help if they misuse alcohol or other drugs to deal with the trauma at any time.
Section 5. Experiences of abuse(36 statements in the English version)
Endorsed (n = 10) If the person discloses any abuse associated with criminal activity, the first aider should report it to the police, if it is safe to do so.
If the person discloses any abuse associated with criminal activity, the first aider should encourage the person to report it to the police, if it is safe to do so.
If the person discloses that they are being abused, the first aider should encourage the person to tell the perpetrator to stop, if it is safe to do so.
If the person discloses that they are being abused, the first aider should encourage the person to tell the perpetrator how it is affecting them, if it is safe to do so.
If the first aider is concerned that the person is at risk of harm from someone else, they should offer to call the police and report the situation.
If the first aider is concerned that the person is at risk of harm from someone else, they should encourage the person to call the police and report the situation.
If the first aider is concerned that the person is at risk of harm from someone else, they should offer to call an appropriate helpline on behalf of the person, e.g. family violence helpline.
If the person asks the first aider not to tell anyone about the abuse they have experienced, the first aider should respect their wishes, unless they are at risk of immediate harm.
If the person asks the first aider not to tell anyone about the abuse they have experienced, the first aider should respect their wishes, unless the abuse is likely to be a criminal offence.
If the person discloses abuse that happened in the past, the first aider should tell the person that they believe them.
Excluded (n = 3) If the person discloses abuse, the first aider should listen to them and not feel that they have to provide solutions or advice.
If the first aider expresses their concerns about signs of physical abuse and the person dismisses them and becomes angry, the first aider should explain they only asked out of concern and will continue to be there if the person needs someone to talk to.
If the person begins to relate details of the abuse that the first aider finds distressing, the first aider should ask the person if they would like assistance finding someone else they can talk to.
Section 6. Adolescents(11 statements in the English version)
Endorsed (n = 3) If appropriate to the relationship, the first aider should contact the adolescent’s school about any additional support they may need.
The first aider should encourage the adolescent to use face-to-face contact with friends rather than through social media.
If the adolescent does not want to talk about what has occurred, the first aider should encourage the adolescent to talk about their feelings rather than about what has occurred.