Improving the Mental Health Literacy of the Australian Public

1
Improving the Mental Health Literacy of the
Australian Public

• Tony Jorm
• ORYGEN Research Centre
• Dept of Psychiatry
• University of Melbourne

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Overview of this Talk

• Concept of Mental Health Literacy
• Survey data showing mental health literacy has
  improved in Australia
• What led to this improvement?
• What needs to be done next for mental health
  literacy?
• Some current and future research projects

3
What is Mental Health Literacy?

• Knowledge and beliefs about mental disorders
  which aid the recognition, management or
  prevention of these disorders

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Mental health literacy includes

• Ability to recognize mental disorders
• Knowing how to seek information
• Knowledge of risk factors and causes
• Knowledge of professional help available
• Knowledge of self-treatments
• Attitudes that promote recognition and
  help-seeking

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Why Mental Health Literacy is Important

• Mental health literacy places a limit on the
  implementation of evidence-based health care.
• Poor mental health literacy means that the task
  of preventing and helping mental disorders is
  largely confined to professionals.

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Australian National Survey of Mental Health
Literacy

• Carried out in 1995
• 2031 respondents aged 18-74
• Half respondents given depression vignette and
  half a schizophrenia vignette
• Questions on recognition, treatment, outcome,
  causes and risk factors, and stigmatizing
  attitudes

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Surveys of Australian Professionals

• 872 GPs
• 1128 psychiatrists
• 454 clinical psychologists
• 673 mental health nurses

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Depression Vignette

• John is 30 years old. He has been feeling
  unusually sad and miserable for the last few
  weeks. Even though he is tired all the time, he
  has trouble sleeping nearly every night. John
  doesnt feel like eating and has lost weight. He
  cant keep his mind on his work and puts off
  making decisions. Even day-to-day tasks seem too
  much for him. This has come to the attention of
  Johns boss who is concerned about his lowered
  productivity.

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Public Recognition of Depression

• Most recognized some sort of mental health
  problem
• 39 mentioned depression
• 22 mentioned stress
• 11 mentioned a physical disorder

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Depression Summary of Public Beliefs About
Treatment

• Most helpful were
• GPs, counselors, close friends, physical
  activity, getting out more, relaxation etc.
• Antidepressants were more often rated as harmful
  than helpful

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Professional Beliefs About Treatment for
Depression

• Two-thirds or more of each group agreed that the
  following would be helpful
• GPs, psychiatrists, clinical psychologists,
  antidepressants, counseling and
  cognitive-behavioral therapy

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Schizophrenia Vignette

• John is 24 and lives at home with his parents.
  He has had a few temporary jobs since finishing
  school but is now unemployed. Over the last six
  months he has stopped seeing his friends and has
  begun locking himself in his bedroom and refusing
  to eat with the family or to have a bath. His
  parents also hear him walking about his bedroom
  at night while they are in bed. Even though they
  know he is alone, they have heard him shouting
  and arguing as if someone else is there. When
  they try to encourage him to do more things, he
  whispers that he wont leave home because he is
  being spied upon by the neighbour. They realise
  he is not taking drugs because he never sees
  anyone or goes anywhere.

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Public Recognition of Schizophrenia

• Most recognized some sort of mental health
  problem
• 27 mentioned schizophrenia
• 26 mentioned depression

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Schizophrenia Summary of Public Beliefs About
Treatment

• Most helpful were
• Counselors, GPs, psychiatrists, physical
  activity, getting out more, relaxation etc,
  self-help books
• Antipsychotics and admission to a psychiatric
  ward were more often rated as harmful than
  helpful

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Professional Beliefs About Treatment for
Schizophrenia

• Two-thirds or more of each group agreed that the
  following would be helpful
• Seeing a GPs, psychiatrists, clinical
  psychologists, antipsychotic medication and
  admission to a psychiatric ward

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Second National Survey of Mental Health Literacy

• 4000 adults surveyed in 2003-04
• Given vignette of either depression, depression
  with suicidal thoughts, early schizophrenia, or
  chronic schizophrenia
• Survey involved the same questions as the earlier
  survey, plus some new ones
• Allowed assessment of changes over 8 years

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Percent Saying John is Depressed
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Would Antidepressants be Helpful?
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Would Psychotherapy Be Helpful?
20
Would Dealing With it Alone Be Helpful?
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John Has Schizophrenia or Psychosis
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Would Antipsychotic Medication Be Helpful?
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Would Admission to a Psychiatric Ward Be Helpful?
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South Australian Data Percent Recognizing
Depression
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South Australian Data Percent Believing in
Helpfulness of Antidepressants
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How Has Australia Achieved This Change?

• Some contributing factors
• A national depression initiative
• Other national information campaigns Mind
  Matters, Australian Rotary Health Research Fund
  community forums
• Specific interventions for particular groups
  Compass Strategy, web sites, Mental Health First
  Aid

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beyondblue the national depression initiative

• Priorities of beyondblue
• Increase community awareness and reduce stigma
• Providing information to consumers and carers
• Prevention and early intervention
• Training of GPs
• Applied research

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Has beyondblue Worked?

• Some states funded beyondblue and others did not
• There was more exposure to its messages in the
  states that provided funding

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Change in Belief that Antidepressants are Helpful
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Change in Belief That Dealing With Depression
Alone Helpful
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Other National Information Campaigns

• Examples include Mind Matters, Rotary Community
  Forums, SANE Stigma Watch
• These may have had an impact, but have not been
  rigorously evaluated

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Some Specific Interventions That Have Been
Rigorously Evaluated

• Compass Strategy
• Web sites on depression
• Mental Health First Aid

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The Compass Strategy

• Run by ORYGEN in Melbourne and Barwon
• Targetted young people and their supporters
• Aimed to increase help-seeking and reduce delays
  in treatments

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Compass Strategies Include

• Media campaign aimed at youth
• Telephone info line
• Website
• Information to service providers
• Videos to trigger classroom discussion

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Evaluation of Compass Strategy

• Western region of Melbourne received the
  intervention and eastern region served as control
• There were greater changes in the intervention
  region in a number of aspects of mental health
  literacy and help-seeking

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Change in Reported Exposure to Mental Health
Issues in the Media
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Web Sites on Depression

• BluePages an information site providing high
  quality information
• http//bluepages.anu.edu.au
• MoodGYM a site providing cognitive-behaviour
  therapy in an educational format aimed at young
  people
• http//moodgym.anu.edu.au

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BlueMood Trial for Evaluating Web Sites

• Randomized controlled trial comparing BluePages
  and MoodGYM with an attention-placebo control
• Outcomes were mental health literacy and
  depressive symptoms

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Improvement in Depressive Symptoms
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The Mental Health First Course

• Follows the model that has been successful with
  conventional first aid
•  
• Trains members of the public to give early help
  to developing mental health problems and
  assistance in crisis situations
• The course currently involves 12-hours of
  training, typically over 4 sessions

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MHFA Course Content

• Mental health problems in Australia
• Steps of mental health first aid
• Depression
• Anxiety disorders
• Psychosis
• Substance use disorders

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The Five Basic Steps

• Assess the risk of suicide or harm
• Listen non-judgmentally
• Give reassurance and information
• Encourage person to get appropriate
• professional help
• 5. Encourage self-help strategies

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Crisis Situations Covered

• Suicidal person
• 2. Person having a panic attack
• 3. Person who has experienced a traumatic event
• Psychotic person who is perceived to be
  threatening
• 5. Person who has overdosed

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Manual and Web Site

• There is a MHFA manual available for sale or can
  be downloaded as a PDF for free.
•  
• The web site provides information on first aid
  strategies and on the course.
• www.mhfa.com.au

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Dissemination of Mental Health First Aid

• There are currently 1000 instructors employed by
• Health services
• Non-government organizations (e.g. Red Cross)
• Places of employment (e.g. university, defence
  department)
• Private practice

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Evaluation of Mental Health First Aid

• Two randomized controlled trials have been
  completed
• One was in a workplace and the other with the
  public in a rural area
• Changes were found in mental health literacy,
  stigmatizing attitudes, helping behaviour and
  participant mental health

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Some Conclusions So Far

• Mental health literacy can be changed
• Hard to single out specific influences, but some
  have been shown to have an effect
• Need for population monitoring of mental health
  literacy
• Need for rigorous evaluation of specific programs

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What Should Australia Do Next to Improve Mental
Health Literacy?

• We need to go beyond awareness raising and give
  people specific useful skills
• Convey key messages about (a) prevention, (b)
  self-help and (c) first aid to the whole
  population
• Train all community service workers in MHFA
• Offer patient self-management education to all
  consumers (and their carers) during the first
  episode of a mental disorder

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1(a). Prevention Messages for the Whole Population

• We need campaigns like those to reduce cancer and
  heart disease
• What can I do to reduce my risk of developing a
  mental disorder?
• What can I do to reduce my childrens risk?
• An example Parents who fight in front of their
  children are harming their mental health

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1(b). Self-Help Messages for the Whole Population

• People commonly use self-help methods
• Some of these may be harmful (e.g. nicotine,
  cannabis, alcohol)
• We need to promote awareness of those that are
  helpful
• An example Exercise is good for your mood

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Top 16 Interventions Used for Anxiety and
Depression
1. Occasional drink (55) 2. Pain relievers
(55) 3. Physical activity (50) 4. Close friends
(50) 5. Family (46) 6. Vitamins (43) 7. Time
off work (40) 8. Get out more (35) 9. GP
(35) 10. Cut commitments (33)
11. Massage (30) 12. Meditation/Prayer (30) 13.
Read about problem (26) 14. Special diet
(22) 15. Sex to relax (21) 16. Antidepressants
(20) .. 24. Psychologist (5) .. 29.
Psychiatrist (3)
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1(c). Supportive Action Messages for the Whole
Population

• Everyone has contact with people suffering from
  mental disorders
• How they are treated by others can make a
  difference
• We need to promote awareness of some basic
  supportive actions
• An example Criticism only makes it worse

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2. Train All Community Services Workers in MHFA

• Community services workers have a high
  probability of close contact with people
  experiencing mental disorders
• They need to have more knowledge than the general
  public
• MHFA training needs to be required for
  professional practice

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3. Patient Self-Management Education for All
Consumers

• Consumers (and carers) need a high level of
  knowledge
• Patient self-management education is standard
  practice for chronic physical diseases
• Mental disorders have a high risk of relapse and
  need a similar approach
• Patient self-management education needs to become
  standard at first onset

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The Public Want It, Even Though It Does Not Exist!
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Work Currently Underway on First Aid to Achieve
These Aims

• We are using expert consensus to develop key
  messages for what the public needs to know about
  first aid
• We will use this information to develop standards
  for MHFA and to get accreditation
• We are developing tailored training for relevant
  professions (e.g. Schools MHFA)

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More Work Currently Underway on Prevention

• Indicated prevention We are using systematic
  reviews and expert consensus to develop key
  messages for self-help for depressive symptoms
• Universal prevention We have applied for funding
  to use the same methods to develop key messages
  on prevention of depression that can be used by
  families, educational institutions and young
  people