Developing a mental health literacy model and measurement scale for children
Justine Bale and Christine Grové, Australia, October 2020
This article has been adapted from a paper recently released in Children and Youth Services Review: ‘Building a mental health literacy model and verbal scale for children: Results of a Delphi study’.
Mental health literacy refers to knowledge and beliefs about mental health that seek to promote recognition, management or prevention of mental health problems for oneself and others (Jorm, 2012). Mental health literacy aims to provide accurate information about mental health, with a focus on wellness and positive coping (Kutcher et al., 2016).
In an Australian context, research has shown that mental health difficulties can be evident in children as early as four years of age (Lawrence et al., 2015), with early markers of mental health challenges seen in infants and toddlers (Moore et al., 2017). If not addressed, these challenges can develop into serious mental health issues in the teenage years (Lawrence et al., 2015).
Mental health literacy can enable children and young people to seek help for mental health problems (Rickwood et al., 2005; Rickwood et al., 2007). Equipping children with mental health knowledge early in life (including how to ask for help and how to cope) and improving their attitudes about mental health may help to prevent the development of serious mental health problems. A focus on younger children in particular can support prevention and early intervention with regards to emotional difficulties (Jorm et al., 1997; Jorm, 2000; Jorm, 2012).
A child-focused model of mental health literacy can guide those working in child mental health services to create intervention programs that are best suited to the specific needs of younger children. Information and content about mental health literacy should be adapted to suit children, who have different needs to adults (Kutcher, Wei, & Coniglio, 2016). For this reason, a child-specific mental health literacy model is necessary.
In addition, there appears to be a need for scientifically validated scales that measure children’s mental health literacy. These scales would help to inform and evaluate mental health literacy interventions, thus contributing to better mental health outcomes. A current lack of measures that can be administered in a spoken form makes it difficult to evaluate mental health literacy in children, who may not have the necessary literacy skills to complete written measures (Bale et al., 2018).
The study aimed to develop a mental health literacy model and a verbally administered (i.e. spoken) measure of mental health literacy for children aged 8 to 12 years.
Following a literature review, which identified that little was known regarding younger children’s (i.e. aged 12 years and under) mental health literacy knowledge and needs (Bale et al., 2018), an expert consensus study was conducted. This study aimed to clarify the needs of children and to develop verbal items for a mental health literacy scale.
Thirty-five experts responded to three rounds of online surveys. Experts in the study were psychologists, teachers, researchers, and academics with experience working with children.
In round 1 of the online surveys, experts responded to seven open-ended questions about important mental health literacy content needs for children. These questions were informed by past research with adults (Jorm, 1997; Jorm, 2000; Jorm, 2012). Round 1 resulted in qualitative data that was analysed for themes related to children’s mental health literacy, which led to a model for children. These themes also informed the initial set of verbal scale items that were quantitatively rated by experts in rounds 2 and 3.
The results led to the development of the first child mental health literacy model, which has five subscales (Bale et al., 2020). The model and subscales include five key areas of mental health literacy that children need (Figure 1):
Figure 1: Child specific mental health literacy model and subscales for Children’s Verbal Mental Health Literacy Scale (CVMHLS).
The findings were also used to develop the Children’s Verbal Mental Health Literacy Scale (CVMHLS).
Implications for practice and research
This child-focused mental health literacy model will help inform the development, design, implementation, and evaluation of future education programs for children that aim to promote social-emotional learning, mental health, and wellbeing.
Schools could potentially have a key role in developing mental health literacy programs, including through the involvement of teachers and wellbeing teams in the delivery of school-wide mental health approaches for children and young people (Graham et al., 2011; Grové & Laletas, 2020; Laletas et al., 2017).
The proposed mental health literacy scale for children could serve as a practical tool for researchers, psychologists, policy makers, and program developers, by offering a scale that can be used to:
- evaluate education programs with a mental health focus
- support the development and funding of interventions; and
- assist practitioners with identifying weak areas in children’s learning to better inform psychoeducation about mental health concepts.
Previously, little was known about younger children’s mental health literacy needs (Bale et al., 2018). This study shows that children have specific understandings and needs regarding mental health literacy that are different to those of adults. These specific features should be prioritised when developing programs and child-focused measurement scales.
Bale, J., Grové, C., & Costello, S. (2018). A narrative literature review of child-focused mental health literacy attributes and scales. Mental Health & Prevention, 12, 26-35.
Bale, J., Grové, C., & Costello, S. (2020). Building a MHL model and verbal scale for children: Results of a Delphi study. Children and Youth Services Review, 109, 104667.
Graham, A., Phelps, R., Maddison, C., & Fitzgerald, R. (2011). Supporting children’s mental health in schools: Teacher views. Teachers and Teaching, 17(4), 479–496.
Grové, C., & Laletas, S. (2020). Promoting student wellbeing and mental health throughsocial and emotional learning. In L. J. Graham (Ed.), Inclusive Education for the 21st Century: Theory, Policy and Practice (1st ed., pp. 317-335). Crows Nest, NSW: Allen & Unwin.
Grové, C & Trainer, L. (2020). ‘The Youth Booth’: Youth strengths and challenges in education. Monash University. Collection.
Jorm, A. F. (2012). Mental health literacy: Empowering the community to take action for better mental health. American Psychologist, 67(3), 231–243.
Jorm, A. F. (2000). Mental health literacy: Public knowledge and beliefs about mentaldisorders. British Journal of Psychiatry, 177, 396-401.
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 recognise mental disorders and their beliefs about the effectiveness of treatment. Medical Journal of Australia, 166(4), 182-186.
Kutcher, S., Wei, Y., & Coniglio, C. (2016). Mental health literacy: Past, present, and future. The Canadian Journal of Psychiatry, 61(3), 154–158.
Lawrence, D., Johnson, S., Hafekost, J., Boterhoven De Haan, K., Sawyer, M., Ainley, J., & Zubrick, S. R. (2015). The mental health of children and adolescents: Report on the second Australian Child and Adolescent Survey of Mental Health and Wellbeing. Canberra, ACT: Commonwealth Department of Health.
Laletas, S., Reupert, A., & Goodyear, M. (2017). “What do we do? This is not our area”: Child care providers’ experiences when working with families and preschool children living with parental mental illness. Children and Youth Services Review, 74(C), 71–79.
Moore, T. G., Arefadib, N., Deery, A., & West, S. (2017). The first thousand days: An evidence paper. Parkville: Centre for Community Child Health, Murdoch Children’s Research Institute.
Rickwood, D., Deane, F. P., Wilson, C. J., & Ciarrochi, J. (2005). Young people’s helpseeking for mental health problems. Australian e-journal for the Advancement of Mental health, 4(3), 218-251.
Rickwood, D. J., Deane, F. P., & Wilson, C. J. (2007). When and how do young people seek professional help for mental health problems? Medical Journal of Australia, 187(7), S35.
The United Nations (1989). Convention on the Rights of the Child. Treaty Series, 1577, 3.
Wei, Y., Hayden, J. A., Kutcher, S., Zygmunt, A., & McGrath, P. (2013). The effectiveness ofschool MHL programs to address knowledge, attitudes and help seeking among youth. Early Intervention in Psychiatry, 7(2), 109-121.