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." The concept of mental health literacy was derived from health literacy, which aims to increase patient knowledge about physical health, illnesses, and treatments.
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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. 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.
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. 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. 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.
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. 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:
- Whole of community campaigns. Examples are beyondblue and the Compass Strategy in Australia, the Defeat Depression Campaign in the United Kingdom, and the Nuremberg Alliance Against Depression in Germany.
- School-based interventions. These include MindMatters and Mental Illness Education in Australia.
- Individual training programs. These include mental health first aid training and training in suicide prevention skills.
- Websites and books aimed at the public. There is evidence that both websites and books can improve mental health literacy. However, the quality of information on websites can sometimes be low.