Mind the gap: Person-centred delivery of mental health information to post-secondary students

The burden of mental illness is increasing in society and limitations in treatment resources available do not adequately account for this increase ( Burns & Rapee, 2006; Michael & Crowley, 2002 ). Deficits in mental health knowledge, or “mental health literacy,” are now proposed as a major contributing factor to both stigma and low service access (e.g., Canadian Alliance on Mental Illness and Mental Health, 2007 ). Mental health literacy was a term first coined by Jorm et al. (1997, p. 187) to refer to “knowledge and beliefs about mental disorders which aid their recognition, management or prevention.” Mental health literacy includes the ability to accurately recognize specific disorders, knowledge about how to seek mental health information, attitudes that facilitate problem recognition and help-seeking, as well as knowledge and beliefs about risk factors and causes for mental illness, self-help interventions, and available professional help ( Canadian Alliance on Mental Illness and Mental Health, 2007; Jorm et al., 1997 ). Some mental health literacy research has been conducted with youth to date.

Research has found that youth, including post-secondary students, often have difficulty identifying mental illnesses presented in case vignettes ( Burns & Rapee, 2006; Cotton et al., 2006; Mond et al., 2007 ). Moreover, regarding the definition of mental health, research with over 10,000 youth in focus groups has found that only a minority of young people (20%) define mental health in a positive manner ( Youth Net, 1998 ). Youth also hold negative attitudes toward treatment, with many believing that problems will continue despite treatment and that evidence-based treatments may not be beneficial or may even be harmful ( Burns & Rapee, 2006; Goldney, Fisher, & Wilson, 2001; Mond et al., 2007 ). Thus, youth indicate that they are skeptical of the value of mental health specialists, as well as medications, and note that they would be more likely to pursue alternative self-help interventions, such as getting out and about more, taking vitamins and minerals, and pursuing special diets ( Burns & Rapee, 2006; Mond et al., 2007 ). Such interventions may not always represent healthy or even beneficial alternatives. These findings highlight that youth are indeed in need of greatly enhanced mental health knowledge.

Group differences have also been found in youth mental health literacy. Female youth appear to be significantly more likely than young males to identify specific mental illnesses, such as depression, presented in vignettes ( Burns & Rapee, 2006; Cotton et al., 2006 ). Male youth are also less likely than females to say that they would see a physician, psychologist, or counsellor for mental illness ( Cotton et al., 2006 ). Given these findings, it would appear that gender may play an important role in mental health literacy and associated help-seeking behaviour. However, little research exists in this area, with no research for first year post-secondary students.

There is no published research to date concerning what youth want to know about mental health and how best to disseminate mental health knowledge. A needs assessment of what youth want to know, and not just what they appear to need to know, is an essential component of knowledge mobilization ( Health Canada, 2002 ) – a component which has been ignored in youth mental health literacy research. It is also important to examine preferences concerning knowledge mobilization, as the method through which knowledge is disseminated is thought to only have a positive impact and maximize utilization of knowledge if it is consistent with the receivers’ preferences ( Cunningham et al., 2008 ). Therefore, post-secondary students’ preferences for knowledge mobilization methods must be assessed in order for mental health awareness efforts to effectively reach their targets.

Assessing mental health literacy, what youth want to know about mental health, and knowledge mobilization preferences will aid in the development of a framework to address the significant gap in the mental health needs of first year post-secondary students.

Given the gaps in the existing literature, the goal of the present study was to assess: 1) mental health literacy, 2) what youth want to know about mental health, and 3) preferences concerning knowledge mobilization.

The present research is the first to explore knowledge mobilization needs among youth, which should help to maximize utilization of information by the target audience. Moreover, the measure used in this study was the first to involve youth input in development of a mental health literacy questionnaire, which should enhance research reliability and the resultant service improvement ( Armstrong, 2009; Young & Armstrong, 2012 ). It is also the first to examine mental health literacy for a higher risk transition population for mental health concerns: first year post-secondary students. Moreover, the current research is also the first to examine what youth want to know about mental health so that we may determine what types of knowledge certain youth may be receptive to. In the longer term, the present study acts as a springboard to provide a rationale for a national study. In the shorter term, this research provides some initial insight concerning mental health literacy and knowledge mobilization in first year post-secondary students.

The Mental Illness Awareness and Transfer of Information Preferences Survey (MIAtips; Armstrong, Robertson, Young, & Tahir, 2012 ) was used in the present research. The questionnaire is an internet-based survey designed collaboratively with youth, but heavily grounded in literature and DSM-IV-TR ( APA, 2004 ) diagnostic criteria. Both open-ended and closed-ended forced choice questions are included in this measure.

Like past mental health literacy research (e.g., Jorm, 1997), youth are also presented with scenarios about a “friend” meeting diagnostic criteria for Major Depression, an Anxiety Disorder, an Eating Disorder, and Psychosis. Following each scenario, participants are then given an open-ended question: “What, if anything, is going on with your friend?” Responses can be categorized into: 1) correct identification of the specific presented mental illness, 2) identification that the person has a mental illness (general response), or 3) no reference to mental illness. Attitudes and stigma toward mental illness are also measured and can be examined in relation to correct identification of mental illnesses and youth knowledge preferences. Specifically, following each scenario, participants are presented with a series of five items, measuring stigma or inaccurate attitudes that are common myths, assessed from strongly disagree to strongly agree . For example, “This is a sign of personal weakness;” “Most people our age experience this.” Internal consistency reliability in the standardization sample for these 5 items was averaged at .72 for each of the scenarios (ranging from .71 to .73), which is considered to be adequate, based on Hunsley and Mash (2008) criteria. In the standardization sample, correct identification of mental illnesses and low stigma or accurate attitudes also demonstrated convergent validity with having a close friend or family member who has been diagnosed with a mental illness ( Young & Armstrong, 2012).

Youth preferences about receiving certain types of mental health knowledge and the methods through which young people want that information delivered to them are also assessed. Assessing what youth want to know about mental illness and how they want that information shared with them is the key way in which this survey differs from past research. More specifically, young people are asked whether they would like to know about symptoms of mental illness, how to cope with stress, community mental health services, different options for therapy, self-help techniques, and how to help someone who might be suicidal. The MIAtips also includes an open-ended opinion question about “good ways to share mental health knowledge” with young people. A closed-ended question follows in which young people can endorse preferred ways to learn about mental health, mental illness, and mental health services. Young people rank order these means of knowledge mobilization from 1 to 13, with 1 being perceived as the most helpful : online, health promotion campaigns, community health services, books, classes, friends, family, public presentations by professionals, presentations by people who have a mental illness, through music, through television, through billboard ads, through print media.

Data screening and cleaning, and all statistical analyses, were carried out with SPSS-PSAW 19.0 Statistical Package. SPSS Frequencies were used to calculate percentages of youth endorsing the various mental health literacy and knowledge mobilization items. A one-way Analysis of Variance (ANOVA) by gender and correlational analyses were also carried out. Results were considered to be significant at p < .05.

What youth want to know about mental health is presented in Figure 2 . Questions were asked in a Yes/No format. “Yes” responses are presented in the figure. The majority of youth respondents wanted to know about how to cope with stress, symptoms of mental illness, and how to talk to someone who is suicidal. The majority of respondents expressed that they do not want to learn about mental health services in the community, different options for therapy, how to talk to someone with a mental illness, and self-help techniques for symptoms of mental illness.

Figure 2

Youth Want to Know about: % of Youth Reporting What They Want to Know about Mental Health & Illness (“Yes” Reponses).

Respondents were asked an open-ended question concerning the method by which they would like to learn mental health information. Youth indicated that they wanted to learn about mental health through: large-group/classroom presentations by professionals or those with lived experience (21%), small-group interactive presentations (20%), online (14%), music lyrics or video material (13%), and books or other print material (7%). The remainder of the youth suggested a variety of alternate knowledge mobilization methods or did not provide a suggestion.

With the exception of depressive symptoms, first year post-secondary youth were fairly poor at recognizing symptoms of common mental illnesses, such as anxiety, eating disorders, and psychosis. In particular, males had more difficulty identifying mental illnesses than females. Likely given poor recognition of symptoms, first year youth do not express an interest in learning about community mental health resources or self-help techniques: they potentially do not believe such services are helpful for, or targeted at, them. In fact, those who did not recognize symptoms of common mental illnesses generally held stigmatized and inaccurate attitudes toward those with mental illness. They also did not hold beliefs in favour of self or other help-seeking.

Prochaska's Transtheoretical Model of Behavioural Change suggests that before a person contemplates healthy change, they have to recognize that there is a problem ( Prochaska & DiClemente, 2005 ). In the “precontemplation” phase of their model, people have no intention of taking action and may not recognize that there is a problem. This theory fits the present findings. Consistent with previous mental health literacy research, a lack of service access in post-secondary students is particularly associated with a lack of perceived need ( Eisenberg et al., 2007 ). Before one can teach youth about available mental health services, the present research findings extend beyond the existing mental health literacy literature to suggest that youth need to learn about symptoms of common mental illnesses first. Myths and inaccurate attitudes also need to be countered. Teaching about symptoms of common mental illnesses is fortunately consistent with first year post-secondary students’ stated knowledge learning preferences. Only after first year post-secondary students learn about symptoms of common mental illnesses and recognize that they themselves may be experiencing these concerns, might they move to the “contemplation” phase of Prochaska's model – Should I seek help? Following this self-awareness, it would be time to share knowledge about available community mental health services or self-help techniques.

To share mental health information with first year post-secondary youth, it is helpful to present information in a way that is consistent with the receivers’ preferences ( Cunningham et al., 2008 ). In the current study, youth suggest that they would prefer information to be shared with them through both traditional and non-traditional methods. More specifically, they would primarily appreciate classroom-based presentations or information presented through the Internet or other media (e.g., music, video).

The present research suggests the need for an awareness and acknowledgement among policy-makers of first year post-secondary students’ knowledge gaps and youth-appropriate knowledge sharing. Expert, stakeholder, and post-secondary institution partnerships would be beneficial in the development of appropriate knowledge mobilization protocols. If stakeholders are not involved in designing services that affect them, resultant services can fail to meet their needs ( Amsden & VanWynsberghe, 2005 ). As resources for mental health education are limited within the funding system, it is imperative that protocols be appropriate and effective. Acknowledging limitations that this is the first study to explore mental health knowledge needs and mobilization preferences with a single sample, the current findings suggest youth-friendly knowledge sharing mediums and topics that may meet first year post-secondary students’ mental health literacy needs.

Given the existing knowledge gaps, myths or inaccurate beliefs, and attitudes not in favour of help-seeking found in the present study, it would appear that there is an urgent need to enhance mental health literacy in first year post-secondary students. This group of students is particularly vulnerable to mental health concerns and, compounding the problem, the majority of those with symptoms do not seek help ( Eisenberg et al., 2007; Lu, 1994 ). With enhanced knowledge shared in a person-centred manner, and likely resultant increased help-seeking, we can hope to decrease the risk for academic, future career, and interpersonal problems due to untreated symptoms of mental illness.

The authors of this article declare no conflict of interest.

The authors would like to acknowledge the Ontario Mental Health Foundation and the Provincial Centre of Excellence for Child & Youth Mental Health for supporting this research.