Mental health literacy

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.^[1][2][3] 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 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.

The recognition of difference 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.^[4]

Public knowledge about physical disease and health are often recognized and widely accepted but knowledge about mental health literacy is comparably neglected.^[5] Many people cannot recognize mental health disorders or different psychological distress. If mental health literacy doesn't improve, it may continue to neglect mental health care, and feeling denied of self-help and support from community.

Knowledge is the largest component of mental health literacy, and important topics in mental health include:

• How to get information: the networks and systems individuals use to get information about mental disorders. This may include friends, family, educators, or broader sources, such as entertainment or social media.
• Risk factors: what factors put individuals at greatest risk for specific mental health disorders? Risk factors can be unemployment, low income, lack of education, discrimination, and violence.^[6]
• Self-treatment or self-help: what are the best things individuals can do to help themselves recover without consulting with professionals, including the use of self-help books and media? However, many self-treatments are quite ineffective and even harmful due to a lack of knowledge.^[7]

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.^[7]

Recent research recognizes the varying attitudes across mental health professionals towards prognosis, long-term outcomes and likelihood of discrimination as more negative than those of the public. The attitudes of mental health professionals also differ towards interventions, but this variability is usually related to professional orientation.^[8]

Surveys of the public have been carried out in a number of countries to investigate mental health literacy.^{[9][10][11][12][13][14][15]} These surveys demonstrate that the 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. The public tends to prefer self-help and lifestyle interventions, opposed to medical, and psychopharmacological interventions.^[8]

Implications surrounding public attitudes towards mental disorders include negative Stereotypes, Prejudice, or Stigma. As a result, this can influence help-seeking behavior or failure to seek treatment.^[8] In Canada, a national survey found that young adult males tend to manage their problems individually and are less likely to seek formal help.^[16] Media influence plays a huge role in perpetuating negative mindsets towards mental illness, such as prescribing menacing qualities. A recent study highlights how the majority of participants note the media as the primary source of their beliefs about mental illness being associated with violence, and how this attitude is more prevalent towards serious mental illnesses.^[8] Fear and perceptions of danger related to mental illness have increased over the past few decades, largely due to serious mental illness such as schizophrenia being associated as potentially violent and harmful to others.^[8] These beliefs and attitudes are potential barriers to seeking individual professional help, and being supportive of others.

Additionally, the negative stigma against mental health may impede the ability of some to get help. When a caregiver avoids seeking mental health treatment due to fear of the stigma surrounding the label of a mental illness, it is seen as affiliate stigma.^[17] This phenomenon is exacerbated in scenarios where children who present with signs of mental illness have parents who hold negative beliefs about mental illness. Studies found that individuals that have a negative impression of mental health labels might refuse seeking treatment for themselves or their children in order to avoid mental illness label.^[18] A study in 2015 found that affiliate stigma decreases a parent's willingness to pursue mental health treatment for their children, which can lead to decreases in overall well-being for children.^[19] It is also found that suicide is the third leading cause of death for ages 15 to 19.^[20] This same study found that some parents fear that general practitioners will judge them as bad parents if their children are diagnosed with ADHD.

Along with schizophrenia, PTSD is also a highly stigmatized mental disorder that is often misunderstood, especially among the military community. Studies have found that there are various barriers to treatment that prevent many veterans from seeking treatment for PTSD and other mental disorders^[21][22] such as concerns that others will see them as "crazy", beliefs that treatment is ineffective or is simply not worth it, and beliefs that those with mental health problems cannot be relied upon.^[23] These beliefs about mental health and mental health treatment is more prevalent in the military community due to the culture of the military that places a strong emphasis on emotional toughness, self-control and stoicism.^[24] Though these values are useful in combat scenarios, they can serve as barriers to seeking treatment and treatment adherence.^[25]

Researchers have measured aspects of mental health literacy in several ways.^[3][26] 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 ask participants questions to identify what problem the individual is experiencing, and at times, additional questions about how the individual can help themselves.^[1]

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.^{[citation needed]}

Various scales have been created to measure the various components of mental health literacy, though not all are validated.^[3][26] 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.

Parental label avoidance can be measured by the Self-Stigma of Seeking Help Scale (SSOSH).^[27]

Family empowerment is measured by the Family Empowerment Scale (FES).^[28]

The three levels of development^[29]

• Measure development
  • Seven attributes of MHL were developed using clinical psychology
  • Clinical results reveal insufficient level of knowledge in the field to enable differentiation of risk factors for mental illness and the causes.
• Item testing
  • Items are generated of the attributes by the research team and clinical panel
• psychometrics and methodology quality
  • Results for the ability to recognize mental disorders