Motivation and emotion/Book/2023/Mental health literacy

Mental health literacy:
What is mental health literacy, why does it matter, and how can it be fostered?

Multimedia presentation (3 min)

Overview

John Doe is a 23 year old University of Canberra student who is studying a Bachelor of Software Engineering. His first semester went very well, recently however John has found himself struggling to get out of bed in the mornings and finds it hard to focus on his assessment tasks and has started to fall behind as a result. He grew up in a family where mental health wasn't really talked about and where the mentality was that you just had to tough it out. As such John isn't aware that he might be experiencing the effects of declining mental health and possible depression and instead of seeking out help tries to push through. His problems only worsen however and it is only when he fails a unit and one of the tutors checks in on him that he finally opens up about his problems and is referred to a psychologist.

Figure 1. Mental health awareness poster display at a Minneapolis Health Fair, 1944.

Mental health literacy was first coined by Jorm et al (1997), who defined it as “knowledge and beliefs about mental disorders which aid their recognition, management or prevention”. Over the years it has expanded greatly with the focus of modern interpretations shifting to a more holistic approach to mental health. Mental health literacy is a complex concept with many factors that influence the development of it both in individuals and on a larger societal scale. The interaction of these factors is unclear with studies presenting contradictory accounts. However, the impacts of mental health literacy are more readily understood with evidence strongly supporting the benefits of good mental health literacy and the consequences of poor mental health literacy. Mental health literacy is increasingly more important given the increasing prevalence of mental health disorders in modern society with lifetime prevalence rates up to nearly 50%, which means it is highly likely nearly everyone will either contract a mental disorder or know someone who has (Jorm, 2018). This chapter explores mental health literacy; what it is, what impacts it, the consequences of poor MHL, the benefits of good MHL and the ways that it can be developed and fostered.

The case study of John demonstrates what might happen as a result of poor mental health literacy (MHL) and the stigmas that can come with it. John is lucky that he manages to find help for his problems but many are not so fortunate.

What is mental health literacy?

Figure 2. Mental disorders are complex and numerous

Mental health literacy is a concept that was originally introduced in 1997 by A. F. Jorm and was derived from the concept of health literacy. Health literacy as a concept is as defined by the World Health Organization, “gain access to, understand and use information in ways which promote and maintain good health” (Nutbeam, 1998) . Mental health literacy as a concept builds on this while also narrowing the specific focus to mental health. The concept in it's original iteration proposed by Jorm focused heavily mental health disorders and has since been refined and adjusted to expand to mental health as a whole rather than specifically mental ill health. While the original idea had six key components most modern variations of the idea are narrowed down to four key components;

• Understanding how to gain and maintain good mental health
• Understanding mental disorders and their treatments
• Decreasing stigma related to mental disorders
• Enhancing help-seeking efficacy

Mental health literacy is a relatively new concept and research into it has only just begun to pick up pace within developed countries. This is a factor worth considering in regard to all existing knowledge of mental health literacy. This is particularly worth considering regarding measurement tools as there is not yet a standardized test to assess MHL.

Understanding how to manage good mental health

The first of the components de-emphasizes the focus on mental ill-health that the original concept had and refocuses it on mental health. In particular, it focuses on the knowledge of how to improve one's mental health state and how to effectively maintain that state. The inherent difficulty in this component comes from the fact the conceptions of how to obtain and maintain good mental health are often highly individualized. However at least one attempt has been made at creating an effective measure to quantify this particular component, utilizing basic psychological needs theory (BPNT) to clarify three key factors:

• Competence, specifically mastering ones own environment
• Autonomy, specifically a sense of free will
• Relatedness, specifically the desire to interact and connect with others

These three factors are as per BPNT believed to be essential for developing and maintaining good mental health. This measure has found some success but needs greater research to refine and improve it (Bjornsen et al., 2017).

Understanding mental disorders

The second of the components is the one that remains closest to the original vision of MHL as proposed by Jorm. It is focused on the recognition of mental disorders, such as depression, PTSD and schizophrenia and awareness of appropriate treatment approaches for them. Studies have explored measures to assess MHL in specific regard to this component such as the three factor model of Jung et al., which utilized the factors of participants knowledge of mental disorders, beliefs about professional help and ratings of treatment options to assess participants MHL (Jung et al., 2016).

Decreasing stigma

The third of the components much like the second is quite close to the conception of MHL by Jorm as it focuses on reducing the stigma and stereotypes around mental disorders and mental illness. There are no definitive measures to asses stigma but many other measures have assessed the attitudes toward mental health in various populations, such as O'Coonor and Casey's MHLS (O'Connor & Casey, 2015). It is worth differentiating from self stigma, which is internalized attitudes and beliefs about mental health, and public stigma, which is the general view and beliefs of mental health from the people around us. Both forms of stigma are significantly important toward the final component of Kutcher's model of MHL.

Enhancing help-seeking efficacy

The final of the components is also seen in Jorms original model and it puts the focus on behaviors and knowledge that enable the individual to seek appropriate care and aid when required. While no standardized measure has been designed to assess help-seeking specifically more generalized measures like O'Connor and Casey's Mental Health Literacy Scale (MHLS) have included this dimension alongside recognition of disorders and treatments. (O'Connor and Casey, 2015)

What influences development of mental health literacy?

There many factors that can influence mental health literacy and as previously stated the research on how they influence it is often contradictory. For example, some studies indicate that older participants present higher levels of mental health literacy while others indicate that younger participants present with high levels. Given the complexity of the concept and the number of potential factors involved, it is likely that there are other factors influencing the levels of mental health literacy in such cases. While it is not possible to cover every single possible influential factor and the potential interactions between each in the space of this chapter, it will aim to cover some of the more prominent factors as identified in the literature.

Age

The research on how age impacts mental health literacy is unclear. Some studies show evidence that higher age is linked to higher mental health literacy while other studies indicate the lower age is linked to higher mental health literacy. The WHO Mental Health surveys in 2014 indicate that older people generally perceived a lower need to their problems and as such were less likely to seek treatment for their problems (Andrade et al., 2014). However, other studies show an decrease in stigmatising beliefs and attitudes as people age (Bradbury, 2020). It is possible that some aspects of mental health literacy are positively affected by age while others are negatively affected which creates another complication in addressing mental health literacy that must be considered.

Gender

Studies have shown that gender can influence people's attitudes toward mental health and particularly toward help seeking behaviors. Most studies indicate that men as a whole have lower levels of mental health literacy than women and tend to seek help less frequently overall (Chatmon, 2020). Research indicates that MHL is higher among the LGBT community, likely as a result of the increased prevalence of mental disorders within the population (Brandt, et al., 2023)

Socioeconomic status

Someone's class or socioeconomic status is consistently shown within the literature to be positively linked to mental health literacy. Those of a higher class or greater levels of wealth are often shown to have correspondingly higher levels of mental health literacy than those of lower class or wealth. This factor can be easily linked to others such as education as greater levels of wealth reduces the barriers to education, both mental health specific education and higher education (Picholas Kian, 2023).

Exposure

Of all the factors expressed here, exposure or lived experience of a mental disorder, is perhaps one of the most impactful. It has been shown consistently throughout the literature that having a family, friend or other person in ones life with a mental disorder can have a strong positive impact on an individuals level of mental health literacy. This effect is also quite prominent in mental health workers and as such can experience crossover with education in how it can promote greater development of mental health literacy (Kutcher et al., 2015).

Education

A higher level of education is commonly associated with a greater level of mental health literacy. This applies to both general education level, such as if someone has attended university and any mental health specific training, such as mental health first aid courses (Reavley, et al., 2011).

Culture

Cultural values and beliefs can impact the development of mental health literacy quite significantly on both an individual and societal level. Much literature has shown views on mental health can differ dramatically between different nations and regions. Dependent on whether these beliefs and views are positive towards mental health this can result in a significant positive or negative shift in the level of mental health literacy in a population. For example, some cultures hold supernatural phenomena as a key part of the cause of mental illness and will often rely on traditional medicine and practitioners over medical assistance (Jorm, 2018).

Quiz 1 Which of the following factors is believed to positively influence mental health literacy: Exposure to someone with a mental health condition Sexuality Religion 2 Which of the following factors is believed to negatively influence mental health literacy: Race Lower socioeconomic status Occupation

What are the impacts of mental health literacy?

Mental health literacy can have significant impacts on the overall wellbeing of people, even those who do not suffer from mental disorders or have poor mental health. The ability to recognize mental disorders, identify warning signs of mental ill health and knowledge of appropriate treatments are invaluable skills to anyone in modern society.

Impacts of strong mental health literacy

Good mental health literacy provides multiple significant benefits such as an increase in help-seeking behaviors, better coping strategies and greater levels of psychological resilience (Jia-Yuan et al., 2023). Higher levels of mental health literacy can also result in better capacity to filter out negative information which further contributes to increasing mental health literacy by reducing the amount of stigmatizing information an individual takes in (Fleary, et al., 2022).

Impacts of weak mental health literacy

Poor mental health literacy on the individual level can result in a reduction of help-seeking behaviors and increased psychological distress (Jones, 2022). On the societal level however, it can result in an unwillingness for the public to adopt evidence based practices if they differ from public opinion. Low societal levels of mental health literacy also place a greater level of stress on professionals as the sole source of dealing with mental ill-health which can be better addressed through a mental health literate society where basic skills and knowledge are commonplace (Jorm, 2018).

Quiz 1 What is a potential consequence of poor mental health literacy: Decreased likelihood of seeking help Increased risk of developing mental disorders Greater stress on health providers Lower life expectancy 2 What is a potential benefit of good mental health literacy: Higher life expectancy Developing more effective coping strategies Improved psychological resilience Increased mood

How can mental health literacy be improved?

Figure 2. Logo for the World Health Organization.

Mental health literacy must be fostered on an individual level before it can be developed on a societal scale. To this end, there are many existing programs and organizations that work to promote mental health and mental health literacy with the single most prominent being the World Health Organization (see Figure 2). Other services and organizations such as Beyond Blue in Australia, the National Alliance on Mental Illness in the United States of America, MentalHealthUK in the UK and many others in countries across the globe work to provide information through readily available online resources and through providing training. Online programs have shown to be particularly effective at enhancing the mental health literacy of participants and this particularly notable for adolescents and children who are particularly at risk of mental health disorders and conditions. However, mental health literacy is approached it is important to consider cultural differences as these can have a significant shift on the views people have toward mental health and can lead to less effective results if not taken into consideration.

Conclusion

Mental health literacy is a relatively new concept which builds upon health literacy. It provides a framework with which to approach mental health promotion and decision making on policies or legislation that affect relevant issues. It also serves to provide a framework for development and growth on a personal level, allowing the use of the four core components as a way to direct personal learning and development on the topic of mental health. While the factors that can influence people's levels of mental health literacy are complex and often contradictory anyone can choose to take the step to start developing their mental health literacy further. With the increasing prevalence of mental disorders in the modern world, it is integral that we have a mental health literate society to help ease the burden on service providers and ensure that as many people as possible are capable of helping others effectively. In order to achieve this vision however, we need to ensure we integrate mental health literacy education into the curriculum to not only help protect adolescents and children from mental ill health, as they are uniquely vulnerable in that many mental disorders emerge within adolescence, but to ensure that they have a framework to develop their skills and knowledge as early as possible. We must take into account different cultural beliefs and values about mental health and adjust programs and educational approaches to better fit the cultures they are designed for. Mental health is a complex and confusing things but we can all do our part to help make it a little easier for both us and those around us by developing our knowledge and skills to enhance our mental health literacy.

See also

• Mental Health Literacy (Wikipedia)
• Psychological resilience (Book chapter, 2011)

References

Jorm, A. F. (2000). Mental health literacy: Public knowledge and beliefs about mental disorders. The British Journal of Psychiatry, 177(5), 396-401. doi:https://doi.org/10.1192/bjp.177.5.396

Joseph, P. L., Gonçalves, C., Somogie, J., & Angeles, J. (2022). The relationship between health literacy and mental health attitudes and beliefs. Health Literacy Research and Practice, 6(4), e270-e279. doi:https://doi.org/10.3928/24748307-20221018-01

Jia-Yuan, Z., Xiang-Zi Ji, & Yu-Qiu, Z. (2023). The mediating effect of mental health literacy on psychological resilience and psychological distress of medical college students. Perspectives in Psychiatric Care, 2023 doi:https://doi.org/10.1155/2023/3461121

Jones, A. (2022). Postpartum help-seeking: The role of stigma and mental health literacy. Maternal and Child Health Journal, 26(5), 1030-1037. doi:https://doi.org/10.1007/s10995-022-03399-1

Picholas Kian, A. P., Razak, A. A., Hue, S. K., Anis, K. G., Rahman, A. A., Husain, M., . . . Firdaus, A. G. (2023). Predictors of mental health literacy among parents, guardians, and teachers of adolescents in west malaysia. International Journal of Environmental Research and Public Health, 20(1), 825. doi:https://doi.org/10.3390/ijerph20010825

Sampaio, F., Gonçalves, P., & Sequeira, C.(2022) Mental Health Literacy: It Is Now Time to Put Knowledge into Practice. Int J Environ Res Public Health. doi: 10.3390/ijerph19127030. PMID: 35742278; PMCID: PMC9222847.

Lam, L.T. (2014) Mental health literacy and mental health status in adolescents: a population-based survey. Child Adolesc Psychiatry Ment Health 8, 26. https://doi.org/10.1186/1753-2000-8-26

Kutcher S, Wei Y, Coniglio C. (2016) Mental Health Literacy: Past, Present, and Future. The Canadian Journal of Psychiatry.61(3):154-158. doi:10.1177/0706743715616609

Nutbeam, D. 1998. “Health promotion glossary.” Health Promot. Int., 13 (4): 349-364. doi: 10.1093/heapro/13.4.349

Andrade, L. H., Alonso, J., Mneimneh, Z., Wells, J. E., Al-Hamzawi, A., Borges, G., . . . Kessler, R. C. (2014). Barriers to mental health treatment: Results from the WHO world mental health surveys. Psychological Medicine, 44(6), 1303-17. doi:https://doi.org/10.1017/S0033291713001943

Jorm, A. (2000). Mental health literacy: Public knowledge and beliefs about mental disorders. The British Journal of Psychiatry, 177(5), 396-401. doi:10.1192/bjp.177.5.396

Bjørnsen, H.N., Eilertsen, M.B., Ringdal, R., Espnes, G.A., & Moksnes, U.K. (2017) Positive mental health literacy: development and validation of a measure among Norwegian adolescents. BMC Public Health 17, 717. https://doi.org/10.1186/s12889-017-4733-6

Jung, H., von Stenberg, K., & Davis, K. (2016). Expanding a measure of mental health literacy: Development and validation of a multicomponent mental health literacy measure. Psychiatry Research, 243, 278 - 286. https://doi.org/10.1016/j.psychres.2016.06.034

O'Connor, M., & Casey, L. (2015). The Mental Health Literacy Scale (MHLS): A new scale-based measure of mental health literacy. Psychiatry Research, 229 (1-2), 511 - 516. https://doi.org/10.1016/j.psychres.2015.05.064

Kutcher, S., Bagnell, A., & Wei, Y. (2015). Mental Health Literacy in Secondary Schools. Child and Adolescent Psychiatric Clinics of North America, 24(2), 233 -244. http://dx.doi.org/10.1016/j.chc.2014.11.007

Brandt, S. A., Miles, R., Krishnan, A., & Rabin, L. A. (2023). Mental Health Literacy and Its Relation to Sexual and Gender Minority Identity in a Diverse Sample of Undergraduate College Students. Journal of Prevention and Health Promotion, 4(1), 87-111. https://doi-org.ezproxy.canberra.edu.au/10.1177/26320770221123538

Chatmon BN. Males and Mental Health Stigma. American Journal of Men’s Health. 2020;14(4). doi:10.1177/1557988320949322

Reavley, N.J., McCann, T.V. and Jorm, A.F. (2012), Mental health literacy in higher education students. Early Intervention in Psychiatry, 6: 45-52. https://doi.org/10.1111/j.1751-7893.2011.00314.x

External links

• Mental Health Fact Sheets (Lifeline)
• Mental Health Literacy Development Guidelines (NSW Mental Health Commission)
• WHO Mental Health (World Health Organization)
• Book Chapter on Mental Health Literacy (Bristol University Press)