Provider Perceptions of Mental Health Literacy Among Youth

Provider Perceptions of Mental Health Literacy AmongYouth

Amy N. Mendenhall • Susan Frauenholtz •

Aislinn Conrad-Hiebner

� Springer Science+Business Media New York 2013

Abstract Approximately one in five children will have a mental health disorder at

some point in their lifetime (Merikangas et al. Pediatrics 125:75–81, 2010). Despite

this prevalence, many children are uninformed and unaware of how to recognize

and manage mental health disorders. Previous efforts to increase mental health

literacy focused on adults, not children. The purpose of this article is to begin filling

this gap by utilizing a survey to describe children’s mental health providers’ per-

ceptions of the amount, accuracy, and origin of mental health literacy in the children

and adolescents they treat and how mental health literacy impacts their work.

Eighty-seven mental health providers completed an online survey to explore per-

ceptions of children’s mental health literacy. Per providers’ reports, results dem-

onstrate that children’s mental health literacy is low, inaccurate, and inconsistent.

Consistent with previous research, providers reported that children primarily rely on

friends and peers for information about mental health disorders, with family as a

close second. Implications of these findings for social work practitioners,

researchers, and children are discussed.

Keywords Children � Youth � Adolescents � Mental health � Mental

health literacy � Mental health providers

Provider Perceptions of Mental Health Literacy Among Youth

Recent statistics indicate that mental health disorders remain prevalent among

children in the United States, creating enormous difficulties for both the children

themselves and their families (NIMH 2005). Approximately 20 % of children (or 1

A. N. Mendenhall (&) � S. Frauenholtz � A. Conrad-Hiebner

School of Social Welfare, University of Kansas, 1545 Lilac Avenue,

Lawrence, KS 66044-3184, USA

e-mail: [email protected]

123

Child Adolesc Soc Work J

DOI 10.1007/s10560-013-0321-5

in 5) currently or at some point in their lifetime will have a mental health disorder

(Merikangas et al. 2010). Yet in spite of the frequency with which children

experience mental health disorders, many remain uninformed and unaware of how

to recognize and manage them. In other words, they lack mental health literacy. The

term ‘‘mental health literacy’’, was first coined by the Australian researcher Anthony

Jorm and his colleagues in the late 1990s as an extension of the term ‘‘health

literacy,’’ and is defined as ‘‘knowledge and beliefs about mental health disorders

which aid their recognition, management or prevention’’ (Jorm et al. 1997, p. 182).

The initial mental health literacy survey conducted by Jorm et al. (1997) revealed

low levels of mental health literacy among Australian adults in the general public.

These striking results triggered a call by Jorm and his colleagues for efforts to raise

public levels of mental health literacy to increase mental health disorder recognition

and improve treatment utilization. The U. S. National Institute of Health (2000) has

also made research efforts to make mental health literacy a top priority.

In response, the topic of mental health literacy has garnered enthusiasm from

mental health researchers across the globe, spurring a substantial area of research

and the development of interventions to improve mental health literacy.

However, these efforts have predominately focused on adult populations and

have not given adequate consideration to the specialized concerns surrounding

the mental health literacy of children and adolescents. This is troubling, as the

initial onset of mental health disorders often occurs in childhood or adolescence

and early intervention might be helpful in reducing the severity and persistence

of early incipient mental health disorders (Kessler et al. 2007). Symptoms of

mental health disorders in children do not always present or manifest themselves

as they do in adults and certain disorders are diagnosed primarily in children

(American Psychiatric Association [DSM-IV-TR] 2000); hence the need for

mental health literacy research addressing the unique considerations of children

and youth.

A lack of accurate information and stereotypes about mental health disorders

held by both adults and youth can act as obstacles preventing children with mental

health disorders from getting the care they need (Rickwood et al. 2005). Therefore,

increasing mental health literacy among children and adolescents could result in the

reduction of stigma among peers and greater utilization of quality mental health

care. In addition, increased mental health literacy can provide children and

adolescents with the knowledge and skills they need to manage their own mental

health and act as helpful social supports to peers experiencing mental health

disorders. This is critical because research has shown that children are more likely

to rely on informal supports such as friends and family for information and

assistance relating to mental health. So by improving mental health literacy among

children and adolescents, we may be able to close the gap between those with

mental illness and those who actually receive treatment and increase the likelihood

of early identification and treatment. In order for efforts to increase mental health

literacy to be most effective, researchers and practitioners must first be aware of the

current level of mental health literacy among children and adolescents and how that

literacy was acquired.

A. N. Mendenhall et al.

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Mental Health Literacy of Children and Youth

This section presents an overview of children’s mental health literacy related to the

prevention, identification, and treatment of mental health disorders and the

predictors of mental health literacy in children and adolescents. Because the field

of children’s mental health literacy is still developing, the literature remains

inconclusive but identifiable trends are emerging.

Children and Adolescents’ Mental Health Literacy Related to the Prevention,

Identification, and Treatment of Mental Health Disorders

Research indicates adolescents believe mental health disorders can be prevented by

having contact with friends and family and using self-help techniques such as

exercise, relaxation, and the avoidance of alcohol and drugs. Counter to clinical

wisdom, adolescents tend to believe that avoiding stressful situations is a helpful

prevention strategy (Jorm et al. 2010). Recent research suggests that mental health

disorder recognition among children and adolescents remains low, inconsistent, and

may vary by disorder (Wahl et al. 2012) although children and adolescents do

appear to be able to distinguish between peers with and without symptoms of

clinical disorders (Swords et al. 2011). In one study, Olsson and Kennedy (2010)

discovered that less than half of adolescents could correctly identify depression

(42.4 %) or anxiety (27.5 %), and Wright et al. (2005) observed poor recognition of

psychosis and depression among adolescents as well. However, it appears

adolescents may be more likely to recognize depression than other psychiatric

disorders (Leighton 2010; Olsson and Kennedy 2010), particularly if suicidal

ideation is present (Burns and Rapee 2006).

When considering treatment, the research indicates that children and adolescents

prefer informal sources of support such as friends, family and the internet over

specialized mental health services, and professionals with a general title such as

‘‘counselor’’ are viewed as more helpful than specialists such as psychologists or

psychiatrists (Jorm and Wright 2007; Wisdom and Agnor 2007; Wright et al. 2005).

Similarly, when responding to a peer with a mental health disorder, adolescents

identify informal interventions such as talking to and supporting a peer as their first

response before considering professional help (Jorm et al. 2007) and express

reluctance to engage the help of an adult (Kelly et al. 2006). Wahl et al.’s (2012)

recent study revealed that less than half of the middle school students they surveyed

believed medication could be helpful in treating a mental health disorder, and nearly

one-third thought that individuals with severe mental health disorders cannot get

better even with treatment.

Predictors of Mental Health Literacy in Children and Adolescents

Studies of mental health literacy among children and adolescents have identified

demographic characteristics that seem to impact mental health literacy. The findings

are not entirely consistent, but females generally demonstrate higher levels of

recognition of mental disorders (Cotton et al. 2006). Although further exploration is


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required, a child’s age appears to predict mental health literacy as well. Hennessy

et al. (2008) discovered children begin identifying mental health problems in their

peers as young as preschool, but demonstrate increased ability to identify a wider

range of disorders as they get older, with attribution to internal causes becoming

more common in adolescence (Boxer and Tisak 2003). A school-based study of

adolescents conducted by Leighton (2010) indicated that socioeconomic status and

low educational attainment may not be associated with mental health literacy.

Continued study is needed to clarify the predictors of mental health literacy in

children and adolescents.

These initial studies suggest that although children and adolescents have some

knowledge of mental health disorders, many appear to lack the ability to recognize

mental health disorders and seek out effective treatment. While continued mental

health literacy research employing samples of children, adolescents, and their

caregivers is needed, little attention has been paid to the observations of

professionals who work with children with mental health disorders on a daily

basis, creating a significant gap in the emerging mental health literacy literature.

Providers’ first-hand observations of child and adolescent mental health literacy can

inform interventions designed to increase mental health literacy among children and

adolescents. Providers’ experiences can also enhance mental health treatment by

ensuring services are designed to appropriately address children and adolescents’

knowledge of and attitudes toward mental health disorders. The purpose of this

article is to begin filling the gap by utilizing a survey to describe children’s mental

health providers’ perceptions of the amount, accuracy and origin of mental health

literacy in the children and adolescents they treat and how mental health literacy

impact their work.

Method

Design and Procedures

This study is based on data collected from an online survey that was available from

July 2011 through September 2011. The target population was social workers in

Kansas or surrounding areas who work with children facing mental health

difficulties and their families. Participants were recruited by advertisements with a

direct link to the survey in e-newsletters or emails sent by the local NASW chapter,

the local school social workers association, and a children’s mental health

stakeholder’s group. The linked webpage included (1) additional details about the

purpose and methods of the study, (2) a link to start the survey, (3) and a place to

register for a $100 gift card drawing. Individuals who clicked the direct link from

the advertisement to find out more information about the study were eligible to

register for a $100 gift card drawing regardless of whether they actually completed

the survey. The anonymous survey did not collect personal identifying information

or link the participants’ email to their responses; the personal information for the

drawing was collected completely separate from the survey responses.


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Survey

The survey included 29 items, all of which were multiple choice or short answer,

and took approximately 10 min to complete. The survey items were derived from a

review of the literature and discussions with mental health professionals, and the

final survey was reviewed for content and readability by a panel of mental health

researchers and clinicians. Qualtrics Survey Software was utilized to create and

administer the survey.

The survey items were grouped into four categories: (1) demographic charac-

teristics (age, gender, race, educational background, practice setting, number of

years working with youth); (2) providers’ perceptions of the parent’s mental health

literacy (how much knowledge do they have, where do they get their knowledge,

how accurate is their knowledge); (3) providers’ perceptions of youth’s mental

health literacy (how much knowledge do they have, where do they get their

knowledge, how accurate is their knowledge); and (4) the impact of youth and

parent mental health literacy on the providers’ work with families (does parent

knowledge impact how you approach your work, does child knowledge impact how

you approach your work, do you provide education to improve mental health

literacy). This paper focuses on the data collected in the third section about provider

perceptions about the youth’s mental health literacy.

Participants

A total of 104 individuals accessed the initial website explaining the study. Of those

individuals, 87 completed or almost fully completed the survey (at least half of the

questions were answered), 5 completed the demographic questions but did complete

any additional questions, 12 read the introductory website but never started the

actual survey. It is estimated that up to 1,000 individuals may have received

information about the study through advertisements in e-newsletters and emails.

However, exact distribution numbers are not known and not all of the individuals

receiving the study information through these means were eligible as the study was

specifically geared towards professionals who work or have worked with children

and adolescents who have mental illness. As such, a response rate cannot be

calculated, and results should not be generalized to all social workers working with

youth. Analyses were run using responses from the 87 participants who fully

completed or completed at least half of the questions. 78 % of participants were

(n = 68) female and the average age was 46 years (SD = 13.18). Respondents

were predominantly white (92 %, n = 80). The majority of the respondents had a

master’s degree in social work (80.5 %, n = 70), and even though this survey was

developed for social workers, there was a small portion of non-social workers who

completed it (15 %, n = 13). Table 1 lists basic demographics, the populations the

respondents worked with, and the average number of years working with that

population.


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Analyses

SPSS Version 20 was used for all data analysis. Descriptive statistics were used to

summarize how providers characterized the mental health literacy of youth with

whom they worked. Spearman’s q and v2 analyses were conducted to test for the

relation between practitioner characteristics and their perceptions of the amount and

accuracy of child mental health literacy.

Results

The providers who completed the survey were asked how much knowledge children

typically have about mental illness the first time that they interact with the youth. Of

the providers, 85 % (n = 74) reported that the youth have ‘‘none’’ or ‘‘very little’’

knowledge about mental illness. When asked how they would characterize the

knowledge that the children did have, 62 % (n = 54) of the providers reported that

the knowledge that the youth do have is ‘‘inaccurate’’ or ‘‘very inaccurate,’’ whereas

the remaining providers (38 %, n = 32) reported the knowledge was a ‘‘mixture of

inaccuracy and accuracy.’’ None of the providers characterized the mental illness

knowledge level of the children they work with as ‘‘accurate’’ or ‘‘very accurate.’’

Table 1 Selected

demographics of mental health

providers (N = 86)

Variables Values

Age, M (SD) 46.8 (13.2)

Male, N, % 18, 21

White, N, % 80, 92

Educational background N, %

Bachelor’s social work 4, 4.6

Master’s social work 70, 80.5

Master’s psychology 2, 2.3

Master’s counseling 6, 6.9

Other 5, 5.7

Practice setting N, %

Schools 31, 35.6

Private practice 13, 15

Community mental health center 12,13.8

Social services agency 7, 8

Psychiatric hospital/residential treatment 6, 6.9

Other mental health setting 5, 5.7

Hospital/healthcare 4, 4.6

Other 9, 10.3

Number of years working with children with mental

illness, M (SD)

14.41

(11.9)


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Providers’ perception of the amount of knowledge children have was positively

correlated with the accuracy of the knowledge (spearman’s q = .504, p \ .000).

When asked whether the amount or accuracy of child knowledge about mental

illness affects the work (or treatment plan) with the family, 11 % (n = 9) of

respondents said ‘‘not at all’’, 49 % (n = 42) said ‘‘to some extent’’, 26 % (n = 22)

said ‘‘to a moderate extent’’, and 14 % (n = 12) said ‘‘to a great extent’’.

Symptoms (n = 58, 66.7 %) and the potential negative outcomes of illness

(n = 43, 49.4 %) were the areas of child knowledge endorsed by providers the

most, and the areas that were endorsed by providers the least were risk factors

(n = 2, 2.3 %) and services and resources (n = 2, 2.3 %). Providers were also

asked which areas of mental health that they wish children had knowledge about,

and the top three areas endorsed by these providers were the potential negative

outcomes of mental illness (n = 50, 57.5 %), treatment options other than

medications (n = 46, 52.9 %), and symptoms (n = 45, 51.7 %). Figure 1 shows

all of the areas that providers believe children have knowledge about versus the

areas that providers wish children had knowledge about.

Providers were also asked where they thought children were getting their

knowledge about mental illness. The sources that were most frequently selected

were friends/peers (n = 61, 70.1 %) and family (n = 60, 69 %), and the sources

selected the least were print media (n = 1, 1.1 %) and informational Internet

0%

10%

20%

30%

40%

50%

60%

70%

80%

Risk factors Symptoms Diagnosis Services &resources

Medications Treatmentother than

medications

Potentialnegativeoutcomes

Per

cent

of

Pro

vide

rs w

ho e

ndor

sed

this

Areas of mental health knowledge

Areas in which providers thinkchildren have knowledge

Areas in which providers thinkchildren need to have knowledge

are

a of

kno

wle

dge

Fig. 1 Mental health providers’ perceptions of children’s knowledge about mental health. Note Eachcategory represents a dichotomous variable. Respondents could select multiple answers, meaning that theresponses are not exclusive


123

sources (n = 8, 9.2 %). Table 2 lists frequencies for all possible sources. Providers

were also asked which factors they believe impact or influence the amount or type

of knowledge that children have. The most highly endorsed influential factors were

parents’ knowledge (n = 67, 77 %), prior treatment experiences of the child

(n = 59, 67.8 %), and having another family member with a mental illness (n = 51,

58.6 %), while the factors that were least frequently endorsed as influential were

child’s gender (n = 4, 4.6 %), number of children in the home (n = 10, 11.5 %),

and the child’s race or ethnicity (n = 10, 11.5 %). Table 3 shows the frequencies

for all potentially influencing factors.

Analyses were run to determine whether provider characteristics impacted their

perception of the amount or accuracy of children’s mental health literacy. The

gender of the providers was not significantly related to their perception of the

amount of mental health knowledge children have (X2 = 10.63, p = .22) or the

accuracy of the knowledge (X2 = 4.83, p = .31). Provider’s age was not

significantly correlated to level of accuracy of knowledge (spearman’s q = -.12,

p = .30) but provider’s age did have a small significant negative correlation with

how much mental health knowledge providers believed children had (spearman’s

q = -.25, p = .02). The number of years that the provider had been working with

children was also not significantly correlated with level of accuracy of knowledge

(spearman’s q = -.09, p = .40) nor with amount of knowledge providers believe

children had (spearman’s q = -.069, p = .528). Since 92 % of the sample was

white, analyses looking at race were not conducted.

Discussion

This article contributes to the limited amount of children’s mental health literacy

research conducted thus far by exploring providers’ perceptions of children’s mental

health literacy through the use of a survey. Providers report low levels of mental

Table 2 Frequencies of mental health providers who believed their youth clients receive mental health

information from various sources (N = 86)

Sources of information n %

Informational internet sources (e.g., agency website) 8 9.30

Other internet sources (e.g., chat room) 18 20.90

Print media 1 1.20

Audio/visual media 20 23.30

Family 60 69.80

Friends/peers 61 70.90

School 37 43.00

Health/mental health professionals 34 39.50

Note Each source of information represents a dichotomous variable for the question, ‘‘Where do you think

children are getting their knowledge about mental illness’’? Respondents could select multiple answers,

meaning that the responses are not exclusive


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health literacy in the children they treat, with a substantial number of providers

indicating children have very limited knowledge or none at all. In addition,

providers describe much of the mental health knowledge children have as inaccurate

and inconsistent. These results support previous findings (e.g. Olsson and Kennedy

2010; Wahl et al. 2012) and highlight even further the need for targeted efforts to

improve mental health literacy among children. Overall, results of the survey are

congruent with the limited research available regarding children’s mental health

literacy, indicating providers’ perceptions are likely reflective of the level of mental

health literacy of the children they serve.

When asked about where children receive information about mental health

disorders, providers reported friends and peers as the most significant source of

information, with family following as a very close second. These results reinforce

the findings of Jorm and Wright (2007) and others (Wisdom and Agnor 2007;

Wright et al. 2005) that children appear most likely to rely on informal sources of

support, such as friends and family, for information about and assistance with

managing mental health disorders. Providers identified schools as the third most

likely location where their child clients learn about mental health. Results from this

survey illustrate the importance of raising mental health literacy among not only

children, but also their key supports such as parents and caregivers, teachers,

coaches, and others who children frequently encounter and may turn to for help with

a mental health disorder. Additionally, because children are likely to turn to

informal social supports, such as friends, for information about and assistance with

mental health disorders, it is crucial that efforts to raise mental health literacy

target all children and not only those previously diagnosed with a mental health

disorder; thereby better preparing age-related peers to identify signs of a disorder in

others and intervene if a friend turns to them for assistance. An increased focus and

further development of school-based mental health literacy interventions hold

promise as a potentially effective way to universally increase the mental health

literacy of all children and adolescents (Pinto-Foltz et al. 2011; Schacter et al.

2008).

Table 3 Frequencies of mental

health providers who believed

their youth clients’ mental

health literacy was influenced or

impacted by various factors

(N = 86)

Note Each source of information

represents a dichotomous

variable for the question, ‘‘What

factors do you think impact or

influence the amount or

accuracy of children’s

knowledge of mental illness’’?

Respondents could select

multiple answers, meaning that

the responses are not exclusive

Factors n %

Child’s age 59 67.8

Child’s race/ethnicity 10 11.5

Child’s level of education 37 42.5

Child’s symptom severity 38 43.7

Child’s diagnosis 27 31

Child’s gender 4 4.7

Parents’ knowledge 67 77

Prior treatment experiences of the child 59 67.8

Area where they live 20 23

Number of children in the home 10 11.5

Having another family member with mental illness 51 58.6

The media 22 25.3


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Providers identified parent knowledge of mental health disorders as the most

influential factor impacting the amount or accuracy of children’s mental health

knowledge. This result seems logically consistent, given that the providers in this

survey and children themselves both report family as one of the top resources for

mental health support and information. This finding also supports the work of Jorm

et al. (2008), which discovered that parents and children are more likely to share

mental health attitudes with each other than with professional clinicians. Providers’

perceptions that children with previous treatment experiences or another family

member with a mental health disorder increase mental health literacy are similar to

previous findings in the literature (Leighton 2010). It seems plausible that children

will acquire more accurate information about mental health disorders while in

treatment or, similarly, will obtain second-hand information by observation of a

parent or sibling’s experience with a mental health disorder and related treatment.

These findings support the need for and potential benefits of further integrating a

psychoeducational component into mental health disorder interventions with all

children and families.

Startlingly, 60 % of providers stated that the children’s level of mental health

knowledge impacted their work with the child ‘‘not at all’’ or only ‘‘to some extent’’.

It appears that some providers may not be adequately assessing the mental health

knowledge and attitudes of the children they treat and using that information to

inform their practice. Given that treatment experiences appear to increase children’s

knowledge of mental health disorders, providers themselves must be further

educated about the importance of addressing mental health literacy in their work

with children. By incorporating interventions and activities to increase child mental

health literacy, and adapting those interventions to the child’s current level of

mental health knowledge, providers could hone their treatment approach to meet the

unique needs of the individual child being served and potentially improve the

quality of treatment outcomes.

Surprisingly, given the popularity of the internet and other forms of social media

among children and adolescents, providers identified them as less likely sources of

mental health information in the children and adolescents they treat than

interpersonal resources. When children utilize web-based resources, according to

the providers surveyed, it appears they are more likely to access informal sources,

such as chat rooms, instead of informational resources such as the National Institute

of Mental Health’s website or other agency-based resources. This result is

concerning, as the quality of the mental health information provided on informal

sites is not reliable and could be inaccurate. Although it is impossible to know if

providers’ perceptions are representative of children’s online actions, this finding

demonstrates the need to further develop and refine readily available, legitimate

internet resources that are visually appealing and designed specifically for children

and adolescents. Such initiatives could prove fruitful in improving mental health

literacy in children and initial research indicates online interventions hold promise

(Oh et al. 2009).

Although directionality could not be assessed from the survey, providers did

report a child’s age substantially influences the amount or accuracy of a child’s

mental health knowledge, echoing the results of Boxer and Tisak (2003) and


123

Hennessy et al. (2008). Although previous research has indicated that girls may have

higher levels of mental health literacy than their male counterparts (Cotton et al.

2006), the providers in this survey did not report similar observations in their practice.

In addition, race and ethnicity were not identified by providers as significantly

influencing children’s mental health literacy. A variety of factors could account for

these results. Providers’ perceptions could be accurate, revealing that factors such as

race and sex are not key predictors of mental health literacy. Conversely, it is also

possible that providers themselves are not fully aware of the role that socio-

demographic factors play in influencing mental health literacy in children or that these

providers’ client populations lack diversity. Finally, perhaps additional factors, such

as personal and family experience with mental health disorders, are more salient

regardless of a child’s socio-demographic status. Much work remains to be done in

parceling out the role of socio-demographics as predictors of mental health literacy.

The responses of providers also revealed valuable information that can be used to

refine and focus current efforts underway to increase children’s mental health

literacy. Providers expressed the desire for more children to know about the

potentially negative outcomes of mental health disorders if left untreated, as well as

increased child knowledge about available treatments, an area where children

consistently demonstrate a lack of knowledge and inaccurate understanding in the

literature (Jorm et al. 2010; Wahl et al. 2012). Given the significant discrepancy

between those diagnosed with mental health disorders and those who access the

growing number of evidence-based treatments now available, increased focus on

information about treatment options should be a top priority of mental health

literacy interventions. In addition, although providers indicated children are most

likely to have knowledge regarding the symptoms of mental health disorders, they

also expressed the need for further education regarding symptom identification.

These results parallel the literature, which indicates children have some ability to

identify the symptoms of mental health disorders but lack full and consistent

knowledge (Olsson and Kennedy 2010; Wahl et al. 2012). Increased symptom

identification can also play a critical role in ensuring more children diagnosed with a

mental health disorder are referred for treatment.

The primary limitation of this survey study is its reliance upon a relatively small

convenience sample of providers who responded to an advertisement. Therefore, it

is not possible to assess the response rate, and the viewpoints of those providers

choosing to respond may differ and not be representative of the larger pool of

potential respondents who did not complete the survey. Further, survey respondents

were generally quite homogeneous with regards to sex, race, age and educational

background. In addition, social workers in school settings accounted for more than

one-third of respondents and were overrepresented. This lack of diversity among

respondents could also have contributed to bias in the survey results. Because this

survey investigated the self-reported perceptions of providers and not the first-hand

responses of children themselves, it is possible that the providers’ perceptions

contained inaccuracies and additional unknown bias. Finally, the perceptions of

children’s mental health literacy identified by providers were informed by their

observations of children whom they see in clinical practice. While these perceptions

provide valuable information, it is important to consider that the mental health


123

literacy of those children may not be generalizable and could differ from that of

their peers who have mental health disorders but have not accessed treatment, as

well as children without mental health disorders.

However, in spite of the limitations noted above, this article provides a

significant contribution to the mental health literacy literature because of its focus

on children’s literacy, an area frequently overlooked in current mental health

literacy research. In particular, this paper’s focus on providers’ perceptions, even

with the unavoidable limitations, provides another perspective regarding how

providers view and use the mental health knowledge of the children they serve. The

inclusion of this viewpoint is essential to discern how provider perceptions may be

consistent or differ from other findings related to children’s mental health literacy.

Indeed, although providers’ perceptions may be biased, they also bring a unique

strength not found in surveys which rely on child and adolescent self-report, given

that children are likely unable to accurately report and describe knowledge they do

not have. Areas of congruence and potential discrepancy between provider and child

self-report surveys can be used to deepen our understanding of children’s mental

health literacy and develop more effective mental health literacy interventions.

While significant progress has been made in the growing area of children’s mental

health literacy research to inform practice and improve outcomes for children with

mental health disorders, much more remains to be discovered.

Acknowledgments This research was supported by a Grant from the University of Kansas New Faculty

General Research Fund.

References

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th

ed.). Washington, DC: American Psychiatric Association.

Boxer, P., & Tisak, M. (2003). Adolescents’ attributions about aggression: An initial investigation.

Journal of Adolescence, 26, 559–573.

Burns, J. R., & Rapee, R. M. (2006). Adolescent mental health literacy: Young people’s knowledge of

depression and help seeking. Journal of Adolescence, 29(2), 225–239.

Cotton, S. M., Wright, A., Harris, M. G., Jorm, A. F., & McGorry, P. D. (2006). Influence of gender on

mental health literacy in young Australians. Australian and New Zealand Journal of Psychiatry,

40(9), 790–796.

Hennessy, E., Swords, L., & Heary, C. (2008). Children’s understanding of psychological problems

displayed by their peers: A review of the literature. Child: Care, Health and Development, 34, 4–9.

Jorm, A. F., Korten, A. E., Jacomb, P. A., Christensen, H., Rodgers, B., & Pollitt, P. (1997). ‘‘Mental

health literacy’’: A survey of the public’s ability to recognize mental disorders and their beliefs

about the effectiveness of treatment. Medical Journal of Australia, 166, 182.

Jorm, A. F., Morgan, A. J., & Wright, A. (2008). Interventions that are helpful for depression and anxiety

in young people: A comparison of clinicians’ beliefs with those of youth and their parents. Journal

of Affective Disorders, 111(2/3), 227–234.

Jorm, A. F., Morgan, A. J., & Wright, A. (2010). Actions that young people can take to prevent

depression, anxiety and psychosis: Beliefs of health professionals and young people. Journal of

Affective Disorders, 126, 278–281.

Jorm, A. F., & Wright, A. (2007). Beliefs of young people and their parents about the effectiveness of

interventions for mental disorders. Australian and New Zealand Journal of Psychiatry, 41, 656–666.

Jorm, A. F., Wright, A., & Morgan, A. J. (2007). Beliefs about appropriate first aid for young people with

mental disorders: Findings from an Australian national survey of youth and parents. Early

Intervention Psychiatry, 1, 61–70.


123

Kelly, C. M., Jorm, A. F., & Rodgers, B. (2006). Adolescents’ responses to peers with depression or

conduct disorder. Australian and New Zealand Journal of Psychiatry, 40(63), 63–66.

Kessler, R. C., Amminger, G. P., Aguilar-Gaxiola, S., Alonso, J., Lee, S., & Ustun, T. B. (2007). Age of

onset of mental disorders: A review of recent literature. Current Opinion Psychiatry, 20(4), 359–364.

Leighton, S. (2010). Using a vignette-based questionnaire to explore adolescents’ understanding of

mental health issues. Clinical Child Psychology and Psychiatry, 15(2), 231–250.

Merikangas, K. R., He, J. P., Brody, D., Fisher, P. W., Bourdon, K., & Koretz, D. S. (2010). Prevalence

and treatment of mental disorders among US children in the 2001–2004 NHANES. Pediatrics,

125(1), 75–81.

National Institute of Mental Health. (2005). Mental illness exacts heavy toll, beginning in youth. Retrieved from

http://www.nimh.nih.gov/science-news/2005/mental-illness-exacts-heavy-toll-beginning-in-youth.shtml.

Oh, W., Jorm, A. F., & Wright, A. (2009). Perceived helpfulness of websites for mental health

information: A national survey of young Australians. Social Psychiatry and Psychiatric

Epidemiology, 44(4), 293–299.

Olsson, D. P., & Kennedy, M. G. (2010). Mental health literacy among young people in a small US town:

Recognition of disorders and hypothetical helping responses. Early Intervention in Psychiatry, 4(4),

291–298.

Pinto-Foltz, M. D., Logsdon, M. C., & Myers, J. A. (2011). Feasibility, acceptability, and initial efficacy

of a knowledge-contact program to reduce mental illness stigma and improve mental health literacy

in adolescents. Social Science and Medicine, 72, 2011–2019.

Rickwood, D., Deane, F. P., Wilson, C. J., & Ciarrochi, J. (2005). Young people’s help-seeking for

mental health problems. Advances in Mental Health, 4(3), 218–251.

Schacter, H. M., Giradi, A., Ly, M., Lacroix, D., Lumb, A. B., van Berkom, J., et al. (2008). Effects of

school-based interventions on mental health stigmatization: A systematic review. Child and

Adolescent Psychiatry and Mental Health, 2, 18.

Swords, L., Hennessy, E., & Heary, C. (2011). Adolescents’ beliefs about sources of help for ADHD and

depression. Journal of Adolescence, 34(3), 485–492.

Wahl, O., Susin, J., Lax, A., Kaplan, L., & Zatina, D. (2012). Knowledge and attitudes about mental

illness: A survey of middle school students. Psychiatric Services, 63(7), 649–654.

Wisdom, J. P., & Agnor, C. (2007). Family heritage and depression guides: Family and peer views

influence adolescent attitudes about depression. Journal of Adolescence, 30(2), 333–346.

Wright, A., Harris, M. G., Wiggers, J. H., Jorm, A. F., Cotton, S. M., & McGorry, P. D. (2005).

Recognition of depression and psychosis by young Australians and their beliefs about treatment.

Medical Journal of Australia, 183, 18–23.


123

http://www.nimh.nih.gov/science-news/2005/mental-illness-exacts-heavy-toll-beginning-in-youth.shtml

Documents

Provider Perceptions of Mental Health Literacy Among Youth