Mental health literacy

Mental health literacy has been defined as "knowledge and beliefs about mental disorders which aid their recognition, management or prevention. Mental health literacy includes the ability to recognize specific disorders; knowing how to seek mental health information; knowledge of risk factors and causes, of self-treatments, and of professional help available; and attitudes that promote recognition and appropriate help-seeking."[1] The concept of mental health literacy was derived from health literacy, which aims to increase patient knowledge about physical health, illnesses, and treatments.[2]

Framework

Mental health literacy has three major components: recognition, knowledge, and attitudes. A conceptual framework of mental health literacy illustrates the connections between components, and each is conceptualized as an area to target for measurement or intervention.[3][4][5] While some researchers have focused on a single component, others have focused on multiple and/or the connection between components. For example, a researcher may focus solely on improving recognition of disorders through an education program, whereas another researcher may focus on integrating all three components into one program.

Recognition

Recognition can be broken down into symptom or illness recognition. Symptom recognition is the ability to detect beliefs, behaviors, and other physical manifestations of mental illness, without knowing explicitly which disorder they link to. Specific illness recognition is the ability to identify the presentation of a disorder, such as major depressive disorder.

Knowledge

Knowledge is the largest component of mental health literacy, and is divided into four sub-components:

Attitudes

Attitudes are studied in two sub-components: attitudes about mental disorders, or persons with mental disorders, and attitudes about seeking professional help or treatment. Attitudes can vary greatly by individual, and can often be difficult to measure or target with intervention. Nonetheless, a large body of research literature exists on both sub-components, though not always explicitly tied to the mental health literacy.

Knowledge vs. attitudes

The differentiation between knowledge and attitudes is a crucial part of the mental health literacy framework. While some efforts have focused on promoting knowledge, other researchers have argued that changing attitudes by reducing stigma is a more prolific way of creating meaningful change in mental healthcare utilization. Overall, both approaches have benefits for improving outcomes.[6]

Of the public

Because of the high prevalence of mental disorders over the lifetime, it has been argued that everyone will either develop one of these disorders themselves or have close contact with someone else who does. Consequently, members of the public need to have some knowledge to allow them to recognize, prevent and seek early help for mental disorders. They also need to have the skills to support other people in their social network who develop a mental disorder.

Surveys of the public have been carried out in a number of countries to investigate mental health literacy.[7][8][9][10][11][12][13] These surveys show that recognition of mental disorders is lacking and reveal negative beliefs about some standard psychiatric treatments, particularly medications. On the other hand, psychological, complementary and self-help methods are viewed much more positively. Negative attitudes towards people with mental disorders have been found, such as viewing them as having a weak character. These beliefs and attitudes are potential barriers to seeking optimal professional help and being supportive of others.

Measures

Researchers have measured aspects of mental health literacy in several ways.[14][15] Popular methodologies include vignette studies and achievement tests. Vignette studies measure mental health literacy by providing a brief, detailed story of an individual (or individuals) with a mental health problem, and asks participants questions to identify what problem the individual is experiencing, and at times, additional questions about how the individual can help themselves.[16]

Achievement tests measure mental health literacy on a continuum, such that higher scores on a test indicate greater overall knowledge or understanding of a concept. Achievement tests can be formatted using multiple-choice, true/false, or other quantitative scales.

Various scales have been created to measure the various components of mental health literacy, though not all are validated.[14][15] Mental health literacy has been measured across several populations, varying in age range, culture, and profession. Most studies have focused on adult and young adult populations, though improving literacy in children has been a focus of prevention efforts.

Approaches to improving literacy

A number of approaches have been tried to improve mental health literacy, many of which have evidence of effectiveness. These include:

  1. Whole of community campaigns. Examples are beyondblue[17] and the Compass Strategy[18] in Australia, the Defeat Depression Campaign[19] in the United Kingdom, and the Nuremberg Alliance Against Depression[20] in Germany.
  2. School-based interventions. These include MindMatters[21] and Mental Illness Education[22] in Australia.
  3. Individual training programs. These include mental health first aid training[23] and training in suicide prevention skills.[24]
  4. Websites and books aimed at the public. There is evidence that both websites and books can improve mental health literacy.[25][26] However, the quality of information on websites can sometimes be low.[27]

Notes and references

  1. ↑ Jorm, A.F., Korten, A.E., Jacomb, P.A., Christensen, H., Rodgers, B. & Pollitt, P. (1997). "Mental health literacy": a survey of the public's ability to recognise mental disorders and their beliefs about the effectiveness of treatment. Medical Journal of Australia, 166, 182-186.
  2. ↑ Jorm, Anthony F.; Korten, Ailsa E.; Jacomb, Patricia A.; Christensen, Helen; Rodgers, Bryan; Pollitt, Penelope (1997-01-01). "Mental health literacy: a survey of the public's ability to recognise mental disorders and their beliefs about the effectiveness of treatment". Medical Journal of Australia. 166 (4). ISSN 0025-729X.
  3. ↑ Jorm, Anthony F.; Korten, Ailsa E.; Jacomb, Patricia A.; Christensen, Helen; Rodgers, Bryan; Pollitt, Penelope (1997-01-01). "Mental health literacy: a survey of the public's ability to recognise mental disorders and their beliefs about the effectiveness of treatment". Medical Journal of Australia. 166 (4). ISSN 0025-729X.
  4. ↑ Jorm, Anthony F. (2000). "Mental health literacy: Public knowledge and beliefs about mental disorders" (PDF). British Journal of Psychiatry.
  5. ↑ O'Connor, Matt; Casey, Leanne; Clough, Bonnie (2014-08-01). "Measuring mental health literacy – a review of scale-based measures". Journal of Mental Health. 23 (4): 197–204. doi:10.3109/09638237.2014.910646. ISSN 0963-8237.
  6. ↑ Corrigan, Patrick W.; Morris, Scott B.; Michaels, Patrick J.; Rafacz, Jennifer D.; Rüsch, Nicolas. "Challenging the Public Stigma of Mental Illness: A Meta-Analysis of Outcome Studies". Psychiatric Services. 63 (10): 963–973. doi:10.1176/appi.ps.201100529.
  7. ↑ Angermeyer, M.C. & Matschinger, H. (2005). Have there been any changes in the public's attitudes towards psychiatric treatment? Results from representative population surveys in Germany in the years 1990 and 2001. Acta Psychiatrica Scandinavica, 111, 68-73.
  8. ↑ Jorm, A.F., Nakane, Y., Christensen, H., Yoshioka, K., Griffiths, K.M. & Wata, Y. (2005). Public beliefs about treatment and outcome of mental disorders: a comparison of Australia and Japan. BMC Medicine, 3, 12.
  9. ↑ Jorm, A.F., Angermeyer, M. & Katschnig, H. (2000). Public knowledge of and attitudes to mental disorders: A limiting factor in the optimal use of treatment services. In G. Andrews & A.S. Henderson (Eds.) Unmet Need in Psychiatry. (pp. 399-413). Cambridge: Cambridge University Press.
  10. ↑ Lauber, C., Nordt, C., Falcato, L., & Rössler, W. (2003). Do people recognise mental illness? Factors influencing mental health literacy. European Archives of Psychiatry and Clinical Neuroscience, 253, 248-251.
  11. ↑ Magliano, L., Fiorillo, A., De Rosa, C., Malangone, C., & Maj, M. (2004). Beliefs about schizophrenia in Italy: A comparative nationwide survey of the general public, mental health professionals, and patients' relatives. Canadian Journal of Psychiatry, 49, 322-330.
  12. ↑ Wang, J.L., Adair, C., Fick, G., Lai, D., Evans, B., Perry, B.W., Jorm, A. & Addington, D. (2007). Depression literacy in Alberta: Findings from a general population sample. Canadian Journal of Psychiatry, 52, 442-449.
  13. ↑ Marie, D., Forsyth, D. & Miles, L.K. (2004). Categorical ethnicity and mental health literacy in New Zealand. Ethnicity and Health, 9(3), 225-252.
  14. 1 2 O'Connor, Matt; Casey, Leanne; Clough, Bonnie (2014-08-01). "Measuring mental health literacy – a review of scale-based measures". Journal of Mental Health. 23 (4): 197–204. doi:10.3109/09638237.2014.910646. ISSN 0963-8237.
  15. 1 2 Wei, Yifeng; McGrath, Patrick J.; Hayden, Jill; Kutcher, Stan (2015-01-01). "Mental health literacy measures evaluating knowledge, attitudes and help-seeking: a scoping review". BMC Psychiatry. 15: 291. doi:10.1186/s12888-015-0681-9. ISSN 1471-244X. PMC 4650294Freely accessible. PMID 26576680.
  16. ↑ Jorm, Anthony F.; Korten, Ailsa E.; Jacomb, Patricia A.; Christensen, Helen; Rodgers, Bryan; Pollitt, Penelope (1997-01-01). "Mental health literacy: a survey of the public's ability to recognise mental disorders and their beliefs about the effectiveness of treatment". Medical Journal of Australia. 166 (4). ISSN 0025-729X.
  17. ↑ Jorm, A.F., Christensen, H. & Griffiths, K.M. (2005). The impact of beyondblue: the national depression initiative on the Australian public's recognition of depression and beliefs about treatments. Australian and New Zealand Journal of Psychiatry, 39, 248-254.
  18. ↑ Wright, A., McGorry, P.D., Harris, M.G., Jorm, A.F. & Pennell, K. (2006). Development and evaluation of a youth mental health community awareness campaign: The Compass Strategy. BMC Public Health, 6, 215.
  19. ↑ Paykel, E.S., Hart, D., & Priest, R.G. (1998). Changes in public attitudes to depression during the Defeat Depression Campaign. British Journal of Psychiatry, 173, 519-522.
  20. ↑ Hegerl, U., Althaus, D., & Stefanek, J. (2003). Public attitudes towards treatment of depression: Effects of an information campaign. Pharmacopsychiatry, 36, 288-291.
  21. ↑ MindMatters Evaluation Consortium (2000). Report of the MindMatters (National Mental Health in Schools Project) Evaluation Project, vols 1-4. Newcastle: Hunter Institute of Mental Health.
  22. ↑ Rickwood, D., Cavanagh, S., Curtis, L. & Sakrouge, R. (2004). Educating young people about mental health and illness: Evaluating a school-based programme. International Journal of Health Promotion, 6, 23-32.
  23. ↑ Kitchener, B.A. & Jorm, A.F. (2006). Mental Health First Aid training: review of evaluation studies. Australian and New Zealand Journal of Psychiatry, 40, 6-8.
  24. ↑ Pearce, K., Rickwood, D. & Beaton, S. (2003). Preliminary evaluation of a university-based suicide intervention project: Impact on participants. Australian e-Journal for the Advancement of Mental Health, 2, www.auseinet.com/journal/vol2iss1/Pearce.pdf.
  25. ↑ Christensen, H., Griffiths, K.M., & Jorm, A.F. (2004). Delivering interventions for depression by using the internet: randomised controlled trial. British Medical Journal, 328, 265.
  26. ↑ Jorm, A.F., Griffiths, K.M., Christensen, H., Korten, A.E., Parslow, R.A. & Rodgers, B. (2003). Providing information about the effectiveness of treatment options to depressed people in the community: A randomized controlled trial of effects on mental health literacy, help-seeking and symptoms. Psychological Medicine, 33, 1071-1087.
  27. ↑ Griffiths, K.M. & Christensen, H. (2002). The quality and accessibility of Australian depression sites on the World Wide Web. Medical Journal of Australia, 176, S97-S104.
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