An evaluation of participation in a schools-based youth mental health peer education training programme

The use of peer education has been well documented within the discipline of health promotion, but not within the youth mental health domain. This paper describes an evaluation of an innovative schools-based peer education training programme that involved preparing young people to deliver a mental health workshop to their peers. Participants (n = 30) were recruited from five post-primary schools in Ireland. After each training session (n = 4), participants completed a questionnaire assessing their reactions to training. Participants also completed measures of self-esteem, help-seeking, mental health knowledge and skills at their first and final training session, and at the end of the programme. Significant changes in participants’ presentation skills, mental health knowledge and beliefs about help-seeking were observed. Participants also reported that training was well facilitated and well timed. Overall, findings indicate participation in a schools-based mental health peer education training programme is enjoyable and beneficial for young people.     

Tensions along the path toward mental health literacy for new immigrant mothers: perspectives on mental health and mental illness

This study explored how mothers approach their own mental health literacy and that of their teenage children. The research used focus groups and questions based on the messaging of a community-based mental health awareness program called ‘Talking about Mental Illness’ (TAMI) to investigate the nature of mental health perceptions and attitudes of new immigrant mothers and illustrate how the program’s messaging can contribute to or build upon their levels of mental health literacy. A qualitative thematic assessment of the knowledge and perceptions of the study participants, all recent immigrants to Canada from India, Bangladesh, Iran, and Romania within the last three years and mothers of high school students, was undertaken. The findings show that participants appreciate the importance of fostering mental health understanding and discussion with their children at the same time that they encounter obstacles to the advancement of their mental health literacy.     

Review: School-based mental health literacy interventions to promote help-seeking – a systematic review

Background

School-based mental health literacy interventions aim to prevent mental disorders and promote mental wellbeing through improving the knowledge and understanding of mental health, mental disorders, and reducing stigma. Evidence suggests that good mental health literacy helps young people recognise mental health difficulties in themselves and in others, and seek help for mental health problems. Improved help-seeking can allow for early intervention, which prevents the progression of mental disorders and ultimately reduces the burden of mental disorders. The aim of this review is to identify and synthesise evidence on the effectiveness of school-based mental health literacy interventions in improving help-seeking outcomes.

Methods

We searched MEDLINE, Embase, PsycINFO, ERIC, Child Development and Adolescent Studies, British Education Index and ASSIA (June 2020). Additional searches were conducted a year later to identify any new publications (June 2021). We included randomised controlled trials (RCTs) assessing the effectiveness or cost-effectiveness of school-based interventions to improve help-seeking outcomes for children and young people aged 4–18 years. Included studies were critically appraised.

Results

We identified 11 studies investigating help-seeking outcomes of school-based mental health literacy interventions including a total of 7066 participants from 66 secondary schools. Overall, there is no strong evidence for the effectiveness of school-based mental health literacy interventions in improving help-seeking outcomes, including general attitudes towards help-seeking, personal intentions to seek help, knowledge of when and how to seek help for mental disorders, confidence to seek help, and actual help-seeking behaviours. None of the studies investigated the cost-effectiveness of the interventions.

Conclusion

The lack of standardised measures with established reliability and validity for help-seeking outcomes, and the incomprehensive consideration of the multi-faceted concepts of MH literacy and MH stigma have contributed to the scarcity of evidence for the effectiveness. Future research should focus on developing standardised measurement tools and including economic evaluations to understand pragmatic and financial aspects of school-based mental health literacy interventions.     

Recommendations of mental health professionals and the general population on how to treat mental disorders

Objective The objectives of the study are (1) to assess the mental health literacy of mental health professionals, (2) to determine whether there is agreement between different professional groups with respect to different psychopathological conditions and (3) to compare the professionals' knowledge with that of the general population. Methods Two representative samples of mental health professionals and laypersons were presented with a vignette depicting either a person with schizophrenia, major depression or without any psychiatric symptoms (‘non-case’). Out of 18 treatment proposals, the respondents were asked to indicate the proposals regarded as helpful and those considered as being harmful, respectively, for the person depicted. Results Mental health professionals view their profession and less often their treatment methods as helpful. Dealing with the situation alone, electroconvulsive therapy, hypnotics and sedatives are consistently regarded as harmful. For the individual with schizophrenia, mental health professionals agree about helpful treatments. Regarding depression, a lack of consensus is found about treatment proposals such as psychiatric hospitalisation, antidepressants and complementary and alternative medicine. An important part of mental health professionals suggests medical help (psychologists and general practitioners) for the non-case vignette. Fewer nurses, social workers, vocational workers and occupational therapists (‘other therapists’) as compared to psychiatrists and psychologists recommend standard treatment methods. Professionals and the general population significantly differ in their attitudes towards the treatment suggestions, especially regarding medication and alternative medicine. Conclusions To improve the treatment of mental disorders, various strategies must be considered. These include permanent education of all mental health professionals, especially nurses and other therapists. A special focus must be given to affective disorders and a potential (over-) treatment of normal behaviour.     

Organizational capacity building in childcare: promoting children's mental health

Mental health promotion is not included in core childcare training or in intervention programmes for family day care (FDC). The aim of this study was to identify key FDC strategies for a children's social and emotional well-being intervention. Three focus groups and five individual interviews were conducted with FDC educators, as well as one focus group with FDC fieldworkers. Content analysis guided data analysis and issues were mapped onto a health promotion capacity-building framework. Capacity-building strategies in the key areas of workforce development, resource allocation, and enhancing leadership and creating partnerships were identified. Issues to be managed included lack of resources and time and unclear role delineation for educators and fieldworkers. Worker insight into capacity-building strategies and potential barriers are essential to shape much needed and timely mental health promotion programmes in FDC.     

Perceptions of teacher preparation and attitudes regarding students' mental health in Kenya

This study was conducted to identify whether high school teachers in Kenya perceive themselves as well prepared to effectively work with students who present with mental health concerns. The study also assessed teachers' attitudes toward the importance of mental health training as it relates to teaching success in the classroom. Gender and teaching experience differences on teachers' perception and attitudes were assessed as well as areas of need. Data were collected from 121 secondary school teachers in Kenya. Results of statistical analyses indicated that while the majority of teachers in Kenya rate their preparation positively, there are differences between male and female teachers, and teachers at different levels of teaching experience. The findings highlight the need for strengthening pre-service and in-service training for teachers in Kenya to increase teachers' ability to identify and manage mental health issues in schools.     

An integrated approach to workplace mental health: an Australian feasibility study

We developed and implemented an integrated workplace mental health promotion intervention combining job stress reduction with a workplace mental health literacy program. The intervention was evaluated using an uncontrolled design, with organizationorganisation-wide census employee surveys of working conditions and mental health literacy pre-intervention, followed by a 1-year action planning and intervention period, then a post-intervention survey. All employees were invited to be surveyed, and all respondents were included in analysis, independent of participation in intervention activities or employment status (44% response rate at baseline, 37% at final). No significant changes were observed in the targeted psychosocial working conditions – job control, job demands, and social support at work. In contrast, significant improvements in some aspects of mental health literacy were observed, particularly in helping behaviours. Acknowledging the limitations of this being an uncontrolled pilot study, our results suggest that it is feasible to integrate job stress and mental health literacy intervention, as well as evidence of sustained improvements in mental health literacy and the need for more intensive and sustained efforts to improve psychosocial working conditions.     

Attitudes toward mental health services: Age-group differences in Korean American adults

The present study examined the attitudes toward mental health services held by younger (aged 20–45, n = 209) and older (aged 60 and older, n = 462) groups of Korean Americans. Following Andersen's (1968; A behavioral model of families’ use of health service, Center for Health Administration Studies) behavioral health model, predisposing (age, gender, marital status and education), need (anxiety and depressive symptoms) and enabling (acculturation, health insurance coverage and personal experience and beliefs) variables were considered. In the mean-level assessment, younger and older adults were found to hold a similar level of positive attitudes toward mental health services. In the multivariate analysis, culture-influenced beliefs were shown to have a substantial contribution to the model of attitudes toward mental health services in both age groups. The belief that depression is a medical condition was found to be a common predictor of positive attitudes across the groups. In the older adult sample, more negative attitudes were observed among those who believed that depression is a sign of personal weakness and that having a mentally ill family member brings shame to the whole family. Our findings show that older adults are not only more subject to cultural misconceptions and stigma related to mental disorders, but also their attitudes toward service use are negatively influenced by the cultural stigma. The findings provide important implications for interventions targeted to improve access to mental health care among minority populations. Based on the similarities and differences found between young and old, both general and age-specific strategies need to be developed in order to increase effectiveness of these programs.     

Teachers' beliefs about mental health needs in inner city elementary schools

OBJECTIVE: To survey teachers' beliefs about mental health service needs in inner city elementary schools. METHOD: A total of 119 teachers from six elementary schools in a major city in the midwestern United States were surveyed to assess their beliefs about the major mental health problems facing their schools, the major barriers to surmounting those problems, their preferences for mental health topics for in-service education, and their education, experience, knowledge, attitudes, and self-efficacy pertaining to mental health issues. RESULTS: Disruptive behavior was endorsed by approximately 50% of teachers as the largest mental health problem facing their schools, and lack of information/training was endorsed as the greatest barrier to surmounting mental health problems. The highest-rated topics for in-service education were disruptive behavior disorders and implementing behavior plans. Although most teachers had taught students with mental health problems, most had had little education in mental health and little consultation with mental health professionals. Correspondingly, teachers' knowledge about mental health issues was limited, and they did not feel confident about their ability to manage mental health problems in their classrooms. CONCLUSIONS: Teachers would benefit from education, training, and consultation from mental health professionals if they serve as effective gatekeepers to mental health services.     

The impact of mental health literacy,stigma, and social support on attitudes toward mental health help-seeking

Guided by the theory of reasoned action, this study built a model to examine the ways in which mental health literacy (MHL), personal stigma, self-stigma, and social support collectively influence attitudes toward mental health help-seeking. A sample of 211 participants (age range 22–64; 67.62% females) from a cross-sectional survey that examined MHL of local public housing staffs in Texas were included in a structural equation modeling analysis. MHL directly influenced attitudes. Personal and self-stigma did not mediate the relationship between MHL and attitudes. Yet, self-stigma was significantly associated with attitudes. Social support positively predicted attitudes. Findings suggest the need for improving MHL and strengthening social support to promote positive attitudes toward mental health help-seeking. Mental health education to those who are at risk for mental illness and to families who are likely to influence help-seeking attitudes of those with mental illness could be useful.     

Teachers' role breadth and perceived efficacy in supporting student mental health

Teachers are considered well placed to identify issues concerning students' mental health and well-being and can play a critical role in the helping process for their concerns. However, little is known about the views of teachers regarding their role in supporting student mental health and how well-equipped they feel to fulfil it. The aim of this study was to investigate teachers' perceived role breadth and perceived self-efficacy in supporting students' mental health. Interviews were conducted with 21 teachers from Canberra, Australia. Teachers viewed supporting student mental health as part of their role, though perceived a lack of knowledge and skills in mental health-related areas. They clearly emphasized the need to work within a well-coordinated pastoral care system. Additional training in mental health and clear role delineation within the school may assist teachers to feel better prepared to effectively and appropriately support student mental health.     

A mental health training program for community health workers in India: impact on knowledge and attitudes

Background

Unmet needs for mental health treatment in low income countries are pervasive. If mental health is to be effectively integrated into primary health care in low income countries like India then grass-roots workers need to acquire relevant knowledge and skills to be able to recognise, refer and support people experiencing mental disorders in their own communities. This study aims to provide a mental health training intervention to community health workers in Bangalore Rural District, Karnataka, India, and to evaluate the impact of this training on mental health literacy.

Methods

A pre-test post-test study design was undertaken with assessment of mental health literacy at three time points; baseline, completion of the training, and three month follow-up. Mental health literacy was assessed using the interviewer-administered Mental Health Literacy Survey. The training intervention was a four day course based on a facilitator's manual developed specifically for community health workers in India.

Results

70 community health workers from Doddaballapur, Bangalore Rural District were recuited for the study. The training course improved participants' ability to recognize a mental disorder in a vignette, and reduced participants' faith in unhelpful and potentially harmful pharmacological interventions. There was evidence of a minor reduction in stigmatizing attitudes, and it was unclear if the training resulted in a change in participants' faith in recovery following treatment.

Conclusion

The findings from this study indicate that the training course demonstrated potential to be an effective way to improve some aspects of mental health literacy, and highlights strategies for strengthening the training course.     

Investigating the impact of masculinity on the relationship between anxiety specific mental health literacy and mental health help-seeking in adolescent males

BackgroundPoor mental health literacy and greater alignment with norms of hegemonic masculinity are established barriers to mental health help-seeking in men. However, little is known about how these variables influence adolescent male help-seeking and in particular, help-seeking for anxiety disorders. This study investigated the relationship between i) anxiety mental health literacy, ii) alignment with traditional masculinity norms and iii) help-seeking attitudes, intentions and behaviour in a sample of adolescent males.Methods1732 adolescent males (aged 12–18 years) participated online whilst at school.ResultsParticipant attitudes towards formal help-seeking, intentions to seek help from a family member and from an online source were found to predict professional help-seeking behaviour by the adolescent and/or by their parents on the adolescents’ behalf. In adolescents with a low or average personal alignment with norms of hegemonic masculinity, greater anxiety mental health literacy was positively associated with more favourable attitudes towards formal and informal help-seeking. However, this relationship was not found in adolescent males with a greater alignment with norms of hegemonic masculinity.LimitationsThe study had a correlational research design and used self-report measures.ConclusionsMental health initiatives which consider the impact of masculinity and gender stereotypes have the potential to significantly improve help-seeking in this population.     

Discrimination in health care against people with mental illness

This paper discusses factors associated with low rates of help-seeking and poorer quality of physical healthcare among people with mental illnesses. Evidence is reviewed on the associations between low rates of mental health literacy, negative attitudes towards people with mental illness, and reluctance to seek help by people who consider that they may have a mental disorder. People with mental illness often report encountering negative attitudes among mental health staff about their prognosis, associated in part with ‘physician bias’. ‘Diagnostic overshadowing’ appears to be common in general health care settings, meaning the misattribution of physical illness signs and symptoms to concurrent mental disorders, leading to underdiagnosis and mistreatment of the physical conditions.     

Active ingredients in anti-stigma programmes in mental health

This paper draws upon a review of the relevant literature and the results of the recent Mental Health Awareness in Action (MHAA) programme in England to discuss the current evidence base on the active ingredients in effective anti-stigma interventions in mental health. The MHAA Programme delivered educational interventions to 109 police officers, 78 adults from different community groups whose working lives involved supporting people with mental health problems but who had received no mental health training and 472 schools students aged 14–15. Each adult target group received two intervention sessions lasting two hours. The two school lessons were 50 minutes each. Knowledge, attitudes and behavioural intent were assessed at baseline and follow-up. In addition focus groups were held with mental health service users to explore the impact of stigma on their lives and facilitators of educational workshops were interviewed to provide expert opinion on ‘what works' to reduce psychiatric stigma. Personal contact was predictive of positive changes in knowledge and attitudes for the school students but not the police officers or community adult group. The key active ingredient identified by all intervention groups and workshop facilitators were the testimonies of service users. The statements of service users (consumers) about their experience of mental health problems and of their contact with a range of services had the greatest and most lasting impact on the target audiences in terms of reducing mental health stigma.     

Mental health literacy among young people in a small US town: recognition of disorders and hypothetical helping responses

Aim: Mental health literacy may be a factor in early detection and prompt treatment for mental, emotional and behavioural disorders among young people. Building on previous research in Australia, this study assessed aspects of mental health literacy among adolescents in classrooms in a small town in the eastern USA. Methods: The students were provided brief, hypothetical, gender-matched scenarios about adolescents experiencing negative emotions and exhibiting related behaviours; some scenarios depicted diagnosable disorders. The respondents were asked to characterize each scenario as describing a mental health problem or other teen problem and indicate how they would respond to a peer who had such a problem. Results: Overall levels of recognition of mental disorders were low (27.5% identified anxiety and 42.4% identified depression as ‘a mental health problem or illness’). However, the respondents who recognized a disorder were three to four times more likely than those who did not to say they would take some helping action, such as telling an adult about the problem (depression: odds ratio 3.27; CI 1.43–7.46, anxiety: OR 4.43; CI 2.23–8.79). Few students (27.7%) remembered in-class discussions of mental health, a mandated health topic for schools in their area. Conclusions: There appears to be substantial room for improvement in mental health literacy among young people, and the development of interventions to enhance mental health literacy among students may be justified.     

Helping older adults to help themselves: the role of mental health literacy in family members

Objectives: Family members may play an important role in the health and well-being of older adults. However, little is known about the factors that influence the likelihood of family members supporting older relatives to seek help from mental health professionals for mental health concerns. Mental health literacy is associated with people's help-seeking intentions regarding their own mental health concerns, and some studies have suggested it may play a role in help-seeking on behalf of others. The purpose of this study was to investigate whether mental health literacy is associated with adults’ likelihood of supporting an older relative to seek professional help for mental health concerns.

Method: Two hundred and sixty-three participants completed a measure of mental health literacy and responded to a hypothetical scenario by indicating their likelihood of supporting an older relative experiencing mental health problems to seek help from various sources.

Results: Mental health literacy was positively associated with intentions to support older relative's help-seeking.

Conclusions: Interventions to increase the mental health literacy of the relatives of older adults may lead to additional support for older adults’ help-seeking for mental health concerns.     

Building mental health promotion capacity in health care: results from Phase I of a workforce development project

The development of mental-health-promoting health care systems is dependent on having a skilled and informed workforce to effectively integrate mental health promotion (MHP) into programme and service delivery. This paper describes Phase I (September 2009-July 2010) of Health Compass, an innovative, multi-phased project that aims to transform health care practice and shift organizational culture by enhancing the capacity of health care providers to further promote patient, client and family mental well-being. Phase I of Health Compass examined the current state of MHP within British Columbia's Provincial Health Service Authority health care services. The findings, based on group discussions and key informant interviews, examined health care providers' current understanding and knowledge of MHP; identified existing strategies, facilitators and barriers that help or hinder the incorporation of MHP into health care practice and services; and identified preferred learning modalities for development and piloting of future MHP resources in Phases II and III.