Child mental health literacy: What is it and why is it important?

Australia is a world leader in research on mental health literacy

The term ‘mental health literacy’ refers to knowledge and beliefs about mental health problems that aid their recognition, management or prevention². Mental health literacy includes:

• the ability to recognise mental health problems
• knowledge and beliefs about risk factors and causes
• knowledge about self-help interventions
• knowledge and beliefs about professional help available
• attitudes that assist with recognition and appropriate help-seeking; and
• knowledge about how to seek appropriate mental health information².

Over the past 20 years, Australia has emerged as a leader in campaigns that have focused on increasing mental health literacy, particularly for adult/adolescent depression and anxiety disorders. For example, beyondblue has led population health education programs which have significantly increased community awareness of depression³. In addition, two recent review papers examining the effectiveness of Australian and international interventions to increase adult mental health literacy reported significant improvements in knowledge and attitudes about mental health^1,5.

Child mental health literacy has been overlooked

But what about child mental health literacy, which refers to adult knowledge and beliefs about mental health problems for children under 12 years of age? Aside from the recent work of the Emerging Minds: National Workforce Centre for Child Mental Health (NWCCMH) and beyondblue’s Be You initiative, there has been a noticeable lack of focus on child mental health literacy both in Australia and internationally.

The lack of focus on child mental health literacy has resulted in a need for common language to describe children’s mental health problems. It may also have fostered high levels of stigma towards children with mental health problems and their parents, as well as low levels of appropriate help-seeking by parents and caregivers. Low levels of child mental health literacy may also be one reason why the prevalence of children’s mental health problems in Australia has not decreased in the past 15 years⁶, despite the increased availability of effective early interventions.

Research suggests low levels of child mental health literacy in Australia

While there is a lack of research on child mental health literacy, the evidence available suggests low levels of parental knowledge about child mental health problems in Australia. For example, a survey of 2,000 Australian parents found that only 35% were confident that they could recognise signs of mental health problems in their child⁸.

Research also suggests low levels of help-seeking: a survey of 1,000 Australian fathers found that only 30% of fathers of children with high levels of behavioural problems reported seeking help⁹.

Parents not knowing where to get help also appears to be a common problem, with 40% of parents of 4-11 year olds with mental health difficulties identifying this as an issue in the Second Australian Survey of Child and Adolescent Wellbeing⁴. For those parents who have sought help for their child, they are more likely to seek informal help, such as advice from family and friends, rather than professional services⁷.

The need for research and new initiatives on child mental health literacy

The lack of research on child mental health literacy, coupled with the findings highlighted above, suggests that more needs to be done to better understand current levels of knowledge and beliefs about child mental health problems in Australia. There appears to be an urgent need to develop educational resources that could be distributed as part of a public health campaign. While parents should be key targets in any initiative to increase child mental health literacy, so too should schools, teachers and professionals who work with children and parents. In addition, other supportive adults (e.g. family members and friends) also play a key role in identifying and discussing child mental health difficulties. The Emerging Minds: National Workforce Centre for Child Mental Health (NWCCMH)¹⁰ aims to increase the child mental health literacy of professionals and organisations who work with children, parents and/or families, while beyondblue’s national Be You project¹¹ focuses on educators. However, with one in seven 4-11 year olds experiencing clinical level mental health difficulties in a 12 month period¹², more focus is required, especially for parents and the general community.

The existing findings seem to indicate three key areas that are particularly important for a child mental health literacy initiative to focus on:

• increasing the public’s knowledge about the signs and symptoms of child mental health problems, including how to differentiate emerging mental health problems from developmentally normal and transient issues
• providing appropriate explanations about risk factors for child mental health problems, as this information may help address the stigma directed towards parents and children. These explanations may also help foster positive perceptions about the effectiveness of interventions and treatments; and
• providing information about how to seek help and the effectiveness of different interventions. This should include information about the range of supports and services available, including self-help interventions and professional services.

It is also important that any initiative examines the potential unintended negative effects of increasing child mental health literacy, such as increased parental anxiety, unwarranted help-seeking and overburdening of child mental health services.

Summary and conclusions

Despite increasing research suggesting that mental health literacy programs and interventions can help improve knowledge and attitudes regarding adolescent/adult mental health problems, the area of mental health literacy for children under 12 years of age has been largely overlooked. While the work of the Emerging Minds: National Workforce Centre for Child Mental Health (NWCCMH) and beyondblue’s Be You has aimed to increase the levels of child mental health literacy of professionals and educators in Australia, it is important to recognise that there continues to be a noteworthy lack of research on child mental health literacy both in Australia and internationally. Despite this lack of research on child mental health literacy^4,7,8,9, there is nevertheless some evidence of low levels of such literacy in Australia. Further research on child mental health literacy and new initiatives could increase the likelihood of Australian children accessing evidence-based early interventions for mental health problems. This in turn may help to reduce the prevalence and burden of child mental health problems in the Australian community.

References

^1. Brijnath B, Protheroe J, Mahtani KR, et al. (2016) Do web-based mental health literacy interventions improve the mental health literacy of adult consumers? Results from a systematic review. Journal of Medical Internet Research 18, e165.

^2. Jorm AF, Korten A, Jacomb P, et al. (1997) “Mental health literacy”: A survey of the public’s ability to recognise mental disorders and their beliefs about the effectiveness of treatment. Medical Journal of Australia 166, 182-186.

^3. Jorm AF, Christensen H and Griffiths KM (2006) Changes in depression awareness and attitudes in Australia: the impact of beyondblue: the national depression initiative. Australian and New Zealand Journal of Psychiatry 40, 42-46.

^4. Lawrence D, Johnson S, Hafekost J, et al. (2015) The Mental Health of Children and Adolescents. Report on the second Australian Child and Adolescent Survey of Mental Health and Wellbeing. Canberra, Australia. Available at: http://www.health.gov.au/internet/main/publishing.nsf/Content/mental-pubs-m-child2 (accessed 10 January 2018)

^5. Morgan, A.J., Ross, A. and Reavley, N. (2018). Systematic review and meta-analysis of Mental Health First Aid training: Effects on knowledge, stigma, and helping behaviour. PLOS One 13. Advance online publication. doi: 10.1371/journal.pone.0197102

^6. Sawyer, M.G., Reece, C.E., Sawyer, A.C., et al. (2018). Has the prevalence of child and adolescent mental disorders in Australia changed between 1998 and 2013-14? Journal of the American Academy of Child & Adolescent Psychiatry 5, 343-350.

^7. Tapp, B., Gandy, M., Fogliati, V.J., et al. (2017). Psychological distress, help‐seeking, and perceived barriers to psychological treatment among Australian parents. Australian Journal of Psychology 70, 113-121.

^8. The Royal Children’s Hospital. (2017). RCH National Child Health Poll. Poll 8. Child mental health problems: Can parents spot the signs? Available at: https://www.rchpoll.org.au/wp-content/uploads/2017/10/RCH-National-Child-Health-Poll-Report_Poll-8_Final.pdf (accessed 1 October 2018)

^9. Tully, L.A., Piotrowska, P.J., Collins, D.A., et al. (2017). Optimising child outcomes from parenting interventions: fathers’ experiences, preferences and barriers to participation. BMC public health, 17, 550.

^10. Emerging Minds: The National Workforce Centre for Child Mental Health (NWCCMH) was established to assist professionals and organisations who work with children and/or parents/families to have the skills to identify, assess and support children at risk of mental health conditions.

^11. Beyond Blue’s Be You is a national initiative for educators, aimed at promoting and protecting positive mental health in children and young people.

^12. The Mental Health of Child and Adolescents Report on the second Australian Child and Adolescent Survey of Mental Health and Wellbeing (2015)