Dear Editor 
Traumatic events may result in upsetting experiences that are typically fatal or seriously endanger physical or mental health. They include accidents, assaults, and natural disasters. Without prompt assistance, people are less likely to experience self-harm, anxiety, sadness, sleeplessness, or other psychological and behavioral problems following a traumatic event. Affected people may develop acute or post-traumatic stress disorder [1]. The negative effect of traumatic events on mental health has been the subject of several studies conducted in Iran. 
Iran is one of the world’s ten most earthquake-prone countries [2]. The 2003 Bam earthquake in Iran killed over 40,000 people and affected about 30,000 people. The survivors of the earthquake experienced a significant degree of mental distress. It is important to reduce the destructing effects of earthquakes on medical centers and provide timely mental health treatments to the victims [3]. Also, after the 2016 earthquake with 7.3-magnitude 5 km from Azgole County in Kermanshah Province of Iran, 20.61% of the survivors experienced poor sleep quality, 60.5% severe stress, 41.5% severe depression, and 74% moderate anxiety [4]. An online survey conducted during the COVID-19 outbreak in Iran revealed that about 15.1% and 20.1% of the participants experienced clinically significant symptoms of anxiety and sadness, respectively [5]. The results of another study in 2022 showed that almost half of the participants (52.2%) reported symptoms of mental health disorders during the pandemic [6]. Getting prompt and adequate care after a traumatic experience can lower the risk of developing a mental health problem [7]. Even in cases where services are provided, many individuals at risk need to receive special assistance or care. There is evidence that friends and family are important sources of support for people who need specialized treatment, but they lack the confidence, expertise, or knowledge to assist [8]. 
Different educational materials and guidelines have been developed to deal with traumatic events. One of these guidelines is the 2011 World Health Organization (WHO)’s guide for psychological first aid, which offers broad recommendations for different countries [9]. The mental health first aid (MHFA) training program, founded in Australia in 2001, is another educational program that can be utilized to enhance people’s abilities to respond to traumatic events [10]. This program’s goal is to teach nurses how to identify mental health problems in people experiencing traumatic experiences and how to assist them. The MHFA is “the help you give to someone developing a mental health problem, experiencing a worsening of a mental health problem or in a mental health crisis “; we can give this first aid “until the person has received appropriate professional treatment or the crisis is resolved” [11]. According to a recent meta-analysis of 18 randomized clinical trials, the MHFA program can reduce negative attitudes and enhance knowledge of first aid for mental health problems, recognition of psychological diseases, views about effective treatments, self-confidence, and intention to serve [12].
High-income countries have mostly been involved in developing the above-mentioned guidelines by surveying mental health professionals and the lived experience of people [13]. The MHFA program has been translated in some high-risk countries such as Brazil [8] and China [1] using the Delphi technique. In this technique, a panel of experts rates their level of agreement with a set of principles in a confidential, unbiased manner [14]. This expert consensus method has been used to establish several mental health first aid guidelines, including the original trauma guidelines [15]. It offers a systematic way to survey the knowledge of experts in a given field [16]. It is a practical method that enables the collection of practice-based evidence from experts. Therefore, considering that Iran is prone to traumatic events and disasters with high complications, and according to the promising results of MHFA, this program can be used by the general public of Iran. It is recommended that the MHFA instructions be translated into Persian and localized according to Iranian culture using the Delphi technique. Then, by social media, these instructions should be made available to the public.




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