Mental Health Literacy in Canada

Phase One Report

Mental Health Literacy Project

May 2007

For a PDF of this report, click here.

Executive Summary:

Canadian Alliance on Mental Illness and Mental Health (CAMIMH)

CAMIMH was established in 1998 and serves as the only national coalition representing the mental health sector across the continuum of non-governmental stakeholders. The core purpose of CAMIMH is to put mental illness and mental health on the national health and social policy agendas. CAMIMH has been highly effective in forging collaborative national leadership on mental illness and mental health policy through four pillars of public education, research, data collection and reporting, and policy frameworks.

[Note: The Schizophrenia Society of Canada is a member of CAMIMH]

Mental Health Literacy Project
Mental health literacy has been defined as the knowledge, beliefs and abilities that enable the recognition, management or prevention of mental health problems. Enhanced mental health literacy appears to confer a range of benefits: prevention, early recognition and intervention, and reduction of stigma associated with mental illness. The Mental Health Literacy (MHL) project is the first of its kind in Canada, funded by Health Canada under the Population Health Fund (PHFN) as a response to the Chronic Disease - Integrated Approaches to Chronic Disease funding priority. It is a three-year project, which commenced in the fall of 2005. The report represents the conclusion of the first phase of the MHL project, which included a review of existing data, a national survey on MHL and follow-up focus group discussions. The next steps in the project involve sharing project findings and engaging with prospective partners across sectors and developing an Integrated National Strategy for Canada on Mental Health Literacy.

Data Sources and Areas of Investigation
Data sources for the MHL project included an extensive review of the research literature pertaining to mental health literacy, preliminary focus group discussions with Canadian seniors and youth, a national survey of Canadians and an Aboriginal survey, and followup focus group discussions across Canada. The sample sizes were not large and the focus groups may not have been representative of all Canadians however, in the opinion of the authors, triangulation of results lends credibility to the project findings. For the most part, the results from the surveys and focus groups are mutually confirming and consistent with research findings from the literature review.

Section two of the report includes summaries of the results of each of these investigations and implications for enhancing mental health literacy. The knowledge domains reviewed include prevalence, recognition, perceived causes, attitudes about interventions and recovery, conceptions of mental illness, stigmatizing attitudes and perceptions of dangerousness, beliefs about protecting and promoting mental health, and perceived linkages between mental and physical health.

Section three of the report provides an overview of an integrated model for enhancing mental health literacy, possible strategies and next steps.

KEY FINDINGS

Perceived Prevalence and Recognition of Mental Disorders
Canadians appear to have reasonably good MHL regarding prevalence, awareness of warning signs, and ability to identify a mental disorder as such. These capacities would likely enhance the ability to identify a mental health problem and to intervene early. There is room for some improvement of general knowledge of mental health problems: many people underestimate the prevalence of mental disorders and many, especially youth, confuse other types of disorders with mental disorders.

Perceived Causes
Like people in other countries, Canadians are inclined to prefer psychosocial explanations for mental health problems, although they are more apt to identify biomedical causes for serious mental illness. It is debatable to what extent these tendencies represent an area for intervention. There is strong evidence for psychosocial causal influences especially prolonged stress, for common mental disorders. In addition, biomedical, particularly genetic, explanations can increase stigma and reduce optimism about recovery.

Attitudes about Treatment and Recovery
Compared to those studied in other research, Canadians are more inclined to recommend medical help for symptoms of mental disorders. However, they are still somewhat ambivalent about medical care, especially for common mental health problems and with regard to psychiatric medications, as found in other studies. Focus group results show that many people would like access to a range of treatment options, but many have a poor understanding of the different options available.

Canadians are generally optimistic about the prospect of recovery from mental disorders, but more so for common mental health problems compared to serious disorders.

Conceptions of Mental Illness, Stigma and Perceptions of Dangerousness
Stigma and discrimination toward persons with mental disorders remain somewhat problematic in Canada, although more so for serious mental illness. Canadians know that stigma and discrimination towards mental disorders exist, and they exhibit some reluctance about disclosing mental health problems especially in the workplace, for fear of stigma and discrimination.

Public education about mental disorders may help to reduce stigma. Because Canadians prefer to maintain a distinction between common mental health problems and serious disorders, targeted anti-stigma campaigns may be most effective. For less serious mental disorders, initiatives that emphasize the commonness of mental health problems appear to be helpful. As fear of stigma can deter treatment seeking, access to self-help interventions represents a promising practice. Workplace initiatives are needed to manage people’s concerns about disclosing mental health problems at work. Community development and self-help initiatives including training in communication and advocacy, would support mutual empowerment for social action to reduce stigma, end discriminatory practices, and improve services.

Beliefs about Protecting/Promoting Mental Health
Canadians appear to have good knowledge of prevention strategies and many of the strategies they recommended such as social support, physical exercise and stress reduction, are indeed protective factors. The focus group participants who attributed mental illness to genetic causes expressed more pessimism about prevention; this finding calls for careful construction of key messages for educational initiatives.

Perceived Linkages between Mental and Physical Health
Canadians show a good intuitive understanding of the mind/body connection. A significant body of research investigating how the relationship works has emerged in recent years, and people could benefit from this information, to protect their mental and physical health. Raising public awareness about the connections between stress, depression and chronic disease represents a good opportunity for intersectoral collaboration, which is itself integral to effective health promotion.

TOWARDS A NATIONAL STRATEGY FOR MENTAL HEALTH LITERACY

Assessing the degree of mental health literacy in a population depends on how mental health literacy is defined. The existing definition of mental health literacy, knowledge and beliefs about mental disorders that aid their recognition, management or prevention, does not specify which knowledge and beliefs represent good mental health literacy. There is a tendency among professionals to assume the mental health literacy of the public will increase as it comes into alignment with professional thinking and an expectation that this will result in stigma reduction, improvements in help seeking and better treatment outcomes. However, there are limitations and risks to this approach.

Mental health literacy could be more broadly defined as the range of cognitive and social skills and capacities that support mental heath promotion. This includes the capacity to act on social as well as individual determinants of mental health and mental illness. An expanded definition could serve as the basis for a comprehensive, population health model for enhancing mental health literacy, at all levels.

The next stage of this project will be to share project findings with prospective partners across sectors, including existing health prevention/promotion coalitions and alliances, the media, youth, seniors, health care providers, the private sector, other NGOs. Consultations will focus what the findings mean to prospective partners, the potential benefits of an integrated approach, identification of barriers, solutions and proposed contributions to a integrated plan to enhance mental health literacy in Canada.

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Cartoon courtesy of Merinda Epstein.