B R I T I S H J O U R N A L O F P S YC H I AT RY ( 2 0 0 0 ) , 1 7 7, 3 9 6 ^ 4 0 1 REVIEW ARTICLE

Mental health literacy reduction in disabling symptoms and also

a change in mental health literacy. In this
framework, the person affected by the
Public knowledge and beliefs about mental disorders symptoms (either personally or through
close contact) is seen as the primary agent
A. F. JORM
in symptom management, with professional
help being one of a range of strategies he or
she might try. This perspective is important
because it leads to a greater emphasis on
increasing public (rather than professional)
knowledge and skills about mental health
and on empowering the person ex-
Background Although the benefits of Health literacy has been defined as ``the periencing disabling symptoms. The need
public knowledge of physical diseases are ability to gain access to, understand, and for the public to have greater mental health
use information in ways which promote literacy is highlighted by the high lifetime
widely accepted, knowledge about mental
and maintain good health'' (Nutbeam et prevalence of mental disorders (up to
disorders (mentalhealthliteracy)
(mentalhealth literacy) has been al,
al, 1993). In the area of physical health, 50%, according to Kessler et al, al, 1994),
comparatively neglected. examples of health literacy would include which means that virtually everyone will
knowledge and use of a healthy diet, taking either develop a mental disorder or have
Aims To introduce the concept of actions to prevent skin cancer, performing close contact with someone who does.
mental health literacy to a wider audience, breast self-examination, having first aid
to bring together diverse research skills and knowing how to look up health
relevantto the topic and to identify gaps in information in a library or on the internet. RECOGNITION
While the importance of health literacy OF MENTAL DISORDERS
the area. for physical health is widely acknowledged,
the area of mental health literacy has been Many members of the public cannot
Method A narrative review within a
comparatively neglected. The purpose of correctly recognise mental disorders and
conceptual framework. this review is to introduce the concept to do not understand the meanings of psychi-
a wider audience, to bring together diverse atric terms. For example, when a represen-
Results Many members of the public
research relevant to mental health literacy tative sample of the Australian public was
cannot recognise specific disorders or and to identify gaps in the area. shown vignettes of a person suffering from
differenttypes of psychological distress. major depression or schizophrenia, most
They differ from mental health experts in recognised that there was some sort of
their beliefs aboutthe causes of mental DEFINITION AND mental health problem but depression was
CONCEPTUAL FRAMEWORK
FR AMEWORK correctly used as the label by only 39%
disorders and the most effective
and schizophrenia by 27% (Jorm et al, al,
treatments. Attitudes which hinder Jorm et al (1997a
(1997a) introduced the term 1997a
1997a). For the depression vignette, 11%
recognition and appropriate help-seeking `mental health literacy' and have defined thought the person had a physical disorder.
are common.Much of the mental health it as ``knowledge and beliefs about mental Similarly, European surveys have found
disorders which aid their recognition, lack of understanding of the terms schizo-
information most readily available to the
management or prevention''. Mental health phrenia and mania to be common (Bra (Brandli,
È ndli,
public is misleading.However, there is literacy consists of several components, 1999; Hillert et al,
al, 1999) and that `schizo-
some evidence that mental health literacy including: (a) the ability to recognise phrenia' is commonly associated with a split
can be improved. specific disorders or different types of personality (Angermeyer & Matschinger,
psychological distress; (b) knowledge and 1999). A US study found that the public
Conclusions If the public's mental beliefs about risk factors and causes; (c) are reasonably knowledgeable about the
health literacy is not improved, this may knowledge and beliefs about self-help inter- mood symptoms of depression, but less
ventions; (d) knowledge and beliefs about likely to know about somatic changes
hinder public acceptance of evidence-
professional help available; (e) attitudes (Regier et al,
al, 1988).
based mental health care. Also, many which facilitate recognition and appro- Is the inability to use a correct psychi-
people with common mental disorders priate help-seeking; and (f) knowledge of atric label and lack of knowledge of symp-
may be denied effective self-help and may how to seek mental health information. tomatology of any significance? These
not receive appropriate support from If people experience disabling psycho- failures of mental health literacy may cause
logical symptoms or have close contact problems of communication with health
others in the community.
with others who have such problems, they practitioners. It is well known that patients
Declaration of interest None. will attempt to manage those symptoms. with mental disorders are often missed by
People's symptom-management activities general practitioners (GPs). Aspects of the
will be influenced by their mental health GP interviewing style are known to be
literacy. If successful, these symptom- associated with rate of detection (Goldberg
management activities may lead to a & Huxley, 1992), but the patient's mode of

396

Downloaded from https://www.cambridge.org/core, subject to the Cambridge Core terms of use.

 M E N TA L H E A LT H L I T E R A C Y

interacting with the GP is also important. causes was associated with a better outcome (McKeon & Carrick, 1991; Jorm et al, al,
Detection of a mental disorder is greater if in cognitive therapy (Addis & Jacobson, 2000a
2000a). For depression, psychiatrists and
the patient presents his or her symptoms 1996). psychologists are rated less highly than
as reflecting a psychological problem GPs, but are more likely to be seen as help-
(Herran et al,
al, 1999; Kessler et al,
al, 1999) ful for schizophrenia (Jorm et al, al, 1997a
1997a;
KNOWLEDGE AND BELIEFS
and explicitly raises the problem with the Angermeyer et al, al, 1999). These results
ABOUT SELF -HELP
GP (Bowers et al, al, 1990; Jacob et al,al, come from developed countries. Beliefs
1998). Although GP recognition may about professional help may be very differ-
Given that only a minority of people who
not be sufficient in itself to benefit the ent in developing countries. For example, in
meet diagnostic criteria for a mental dis-
patient (Goldberg et al,al, 1998; Simon et Ethiopia traditional sources of help, such as
order seek professional help (Regier et al, al,
al,
al, 1999), it is a first step towards effec- witchcraft, holy water and herbalists, were
1993; Lin et al, al, 1996; Andrews et al, al,
tive action. preferred over medical help for a range of
1999), self-help skills are of great import-
mental health problems (Alem et al, al,
ance. When the public were asked to rate
1999). By contrast, medical help was over-
a range of interventions for likely helpful-
KNOWLEDGE AND BELIEFS whelmingly preferred for physical health
ness, self-help interventions were found to
ABOUT CAUSES problems.
be at the top of the list in both Australia
When the public are asked about
and the UK (Rippere, 1979; Parker &
In Western countries depression and various therapies, a strikingly consistent
Brown, 1982; Jorm et al, al, 1997a
1997a). Among
schizophrenia are most often seen by the finding across many countries is very
the most popular self-help interventions
public as caused by the social environ- negative beliefs about medication for a
are seeking support from family and
ment, particularly recent stressors range of mental disorders (Regier et al, al,
friends, engaging in pleasurable activities,
(McKeon & Carrick, 1991; Matschinger 1988; Angermeyer et al, al, 1993; Priest et al,
al,
taking up new activities and physical exer-
& Angermeyer, 1996; Priest et al, al, 1996; 1996; Jorm et al,
al, 1997a
1997a; Fischer et al,
al, 1999;
cise. Unfortunately, there is much less
Jorm et al, al, 1997b
1997b; Link et al,al, 1999). Hillert et al,
al, 1999; Jorm et al, al, 2000a
2000a).
evidence on the effectiveness of self-help
While psychiatric epidemiologists would The public's belief about medication is in
interventions than on that of professional
concur about the importance of stressful sharp contrast to both the evidence from
ones, making it difficult to say which are
life events in depression, in schizophrenia randomised controlled trials and the views
likely to work. However, for milder states
life events are more of a trigger than a of mental health professionals that anti-
of depression, there is evidence for the
cause. Biological factors are seen by the depressant and antipsychotic medications
effectiveness of social support (Goldberg
public as less important than environ- are effective (Jorm et al, al, 1997c
1997c; Caldwell
& Huxley, 1992), physical exercise
mental ones (McKeon & Carrick, 1991; & Jorm, 2000). The public's negative views
(Martinsen, 1994), self-help books based
Matschinger & Angermeyer, 1996; Wolff about psychotropic medication also con-
on cognitive±behavioural therapy (Cuij-
et al,
al, 1996; Jorm et al,al, 1997b
1997b; Link et trast with their own positive views about
pers, 1997) and for the herb St John's wort
al,
al, 1999), although relatives of people medication for common physical disorders
(Linde et al,
al, 1996). Rauwolfia serpentina is
with schizophrenia are more likely to see (Hillert et al,
al, 1999). The reasons given by
a traditional herbal remedy known to have
biological factors as important (Anger- the public for their negative views of
an antipsychotic effect (Bhatara et al, al,
meyer & Matschinger, 1996a 1996a). Providing psychotropic medication are perceived
1997). There is a clear need for further
the label `schizophrenia' to a vignette side-effects, such as dependence, lethargy
evaluation of self-help interventions, so that
has also been found to increase the likeli- or brain damage, and the belief that the
the public can be given appropriate advice.
hood that biological rather than psycho- treatments deal only with the symptoms
Knowledge of how to help others is a
social causes are seen as responsible and not the causes (Angermeyer et al, al,
related component of mental health
(Angermeyer & Matschinger, 1996b 1996b). In 1993; Priest et al, al, 1996; Fishcher et al, al,
literacy. Very little research has been done
some non-Western cultures, supernatural 1999). One interpretation of these findings
on the topic, but a Swiss survey found that
phenomena, such as witchcraft and is that the negative attributes of benzo-
the public have difficulty in dealing with
possession by evil spirits, are seen as diazepines have become generalised to
mental disorders, saying they do not know
important causes of mental disorders all types of psychotropic medication
how to behave, are afraid of making
(Razali et al,
al, 1996), although this is un- (Angermeyer et al, al, 1993). Indeed, the
mistakes and do not have sufficient know-
common in the West (Angermeyer & public do not seem to discriminate between
ledge (Bra
(Brandli,
È ndli, 1999).
Matschinger, 1999; Bra Brandli,
È ndli, 1999). different types of psychotropic medication,
Beliefs about causes may alter patterns in contrast to mental health professionals
of help-seeking and response to treatment. KNOWLEDGE AND BELIEFS who are quite specific in their recommenda-
For example, in Malaysia belief by psychi- ABOUT PROFESSIONAL HELP tions (Jorm et al, al, 1997c
1997c). An Australian
atric patients in supernatural causes was survey found that other treatments specifi-
associated with greater use of traditional A number of surveys have asked the public cally associated with psychiatrists, such as
healers and poorer compliance with medi- about various helping professions. General electroconvulsive therapy (ECT) and admis-
cation (Razali et al,
al, 1996). In a US con- practitioners are rated very highly in many sion to a psychiatric ward, are also viewed
trolled trial of psychotherapy for de- countries, particularly for depression (Priest very negatively by the public, with more
pression, belief in relationship causes was et al,
al, 1996; Wolff et al,
al, 1996; Jorm et al,
al, people believing they are harmful than help-
associated with a better outcome in behav- 1997a
1997a; Bra
Bradli,
È dli, 1999). The strong endorse- ful (Jorm et al,
al, 1997a
1997a). Anecdotal evidence
ioural therapy, while belief in existential ment of GPs is not, however, universal would support the conclusion that such

397

Downloaded from https://www.cambridge.org/core, subject to the Cambridge Core terms of use.

 JOR M

beliefs are widespread in other countries as because they feared a negative impact on frequently portrayed as violent or having
well. their employment situation (Regier et al, al, other undesirable characteristics in fictional
`Natural' remedies, such as vitamins 1988). Stigmatising attitudes also extend accounts in the cinema and on television
and herbs, are viewed much more positively to approaching professionals. In the UK, a (Hyler et al,
al, 1991; Wilson et al, al, 1999).
by the public (Angermeyer & Matschinger, majority of the public reported that they Although violence is a problem in a small
1996c
1996c; Jorm et al,al, 1997a
1997a) and are not gen- would be embarrassed to consult a GP for proportion of people suffering from severe
erally seen as sharing the negative attributes depression, primarily because the GP would mental disorders (Torrey, 1994), the public
of psychotropics (Fischer et al,
al, 1999). see them as unbalanced or neurotic (Priest clearly overestimate this risk, on the basis
Another consistent finding across a et al,
al, 1996), and in India patients with of media reports and dramatic portrayals
range of countries is very positive views stigmatising attitudes have been found to (Wolff et al,
al, 1996; Link et al,
al, 1999).
about psychological treatments such as present their distress in somatic rather than Finally, there are sources of knowledge,
counselling (McKeon & Carrick, 1991; psychological terms (Raguram et al, al, 1996). such as books, libraries, the internet and
Priest et al,
al, 1996; Jorm et al, al, 1997a
1997a, courses of study, available to those with
2000a
2000a) and psychotherapy (Angermeyer better education and resources. While it is
& Matschinger, 1996c 1996c; Hillert et al, al, KNOWLEDGE OF HOW known that some self-help books are best-
1999). Indeed, the public's views tend to TO SEEK MENTAL HEALTH sellers and that some mental health web-
be more positive than those of professionals INFORMATION sites receive a large number of hits, the
(Furnham et al,al, 1992; Jorm et al,
al, 1997c
1997c). overall impact of such sources on mental
What is most surprising is that psycho- We know very little about how people health literacy is unknown. There is a need
logical interventions are seen by the public acquire knowledge and beliefs about for greater quality control of such sources
as highly effective for psychotic disorders mental health. It is likely that personal to ensure that the public gets accurate
(Angermeyer & Matschinger, 1996c 1996c; Jorm experiences and anecdotal evidence from information. For example, a recent study
et al,
al, 1997c
1997c, 2000a
2000a) and even, according family and friends are an important source. of the top 20 depression websites found
to an Austrian survey, for dementia (Jorm A UK study found that 33% of respondents the overall quality of the information was
et al,
al, 2000a
2000a). cited personal experience of someone with poor when evaluated against clinical
What are the consequences of the a mental disorder as their main source of practice guidelines (K. Griffiths, personal
public's beliefs about treatment? The most information, while a further 10% cited communication, 2000; further details avail-
obvious is that negative beliefs about medi- friends and relatives (Wolff et al,al, 1996). able from the author upon request).
cation may lead to failure to seek medical Indeed, personal experience or contact has
help and lack of compliance with any medi- been found to be associated with beliefs
cation recommended (Fischer et al, al, 1999). about causes (Angermeyer & Matschinger, COGNITIVE ORGANISATION
It has been proposed that greater account 1996b
1996b), with more favourable attitudes OF MENTAL HEALTH
should be taken of patients' views in nego- (Angermeyer & Matschinger, 1996d1996d; Wolff LITER ACY
tiating the treatment approach. In this et al,
al, 1996), with treatment preferences
regard, the term `concordance', which (Angermeyer & Matschinger, 1996a 1996a) and There is a clear gulf between public and
implies a two-way negotiation between with greater understanding of the term professional beliefs about mental disorders
doctor and patient, is more appropriate schizophrenia (Hillert et al,
al, 1999). (Jorm et al,
al, 1997c
1997c). One interpretation of
than `compliance' (Mullen, 1997). Public Other important influences are journal- this finding is that there is a continuum of
beliefs about professional help may also ists' reports and television and cinema mental health literacy running from lay
affect the help-seeking of others. It has been dramas depicting mental disorders. In the beliefs to professional knowledge. The pro-
found that professional help for depression UK, 32% cited the media as their main fessionals have expert knowledge which is
is more likely to occur when another person source of information (Wolff et al,al, 1996). to a large extent based on scientific
recommends that help be sought (Dew et al, al, Unfortunately, these media often tend to evidence and expert consensus, while the
1991), so the views of significant others report on the negative aspects. In a survey public have a range of beliefs based on
about treatment may also be influential. of the German public, 64% said that they personal experience, anecdotes, media
had read about a person with a mental ill- reports and more formal sources of know-
ness who had committed a violent crime ledge. However, factor analysis of public
AT TITUDES THAT and 50% about someone who became beliefs reveals not a general factor corres-
FACILITATE RECOGNITION addicted to prescribed drugs, but only ponding to mental health literacy, but a
AND HELP-SEEKING 17% had read about persons with mental number of factors representing general
illnesses who became able to lead a normal belief systems that illness is best handled
There is a stigma associated with mental life by taking their medication (Hillert et al,
al, by medical, psychological or lifestyle inter-
disorders and this may hinder seeking 1999). It is clear that such negative report- ventions (Jorm et al,
al, 1997d
1997d). It may be that
help. For example, the German public ing has an impact. Another German study when people are confronted by a health
report much greater reluctance to discuss was able to show that two attempts on problem they know little about, they fall
mental disorders with relatives and friends the lives of prominent politicians by back on their general belief systems about
than to discuss physical disorders (Hillert persons with a mental disorder led to a health (Jorm et al,
al, 2000b
2000b). For example, if
et al,
al, 1999), while in the USA many marked increase in negative attitudes a person has no specific knowledge about
members of the public reported an unwill- (Angermeyer & Matschinger, 1995). depression, they might fall back on a
ingness to seek treatment for depression People with mental disorders are also general belief system that health problems

398

Downloaded from https://www.cambridge.org/core, subject to the Cambridge Core terms of use.

 M E N TA L H E A LT H L I T E R A C Y

are caused by lifestyle and that the solution the duration of untreated psychosis by of important consequences of this poor
is to be found in natural remedies and life- encouraging early help-seeking (Johannes- knowledge. First, it may place a limit on
style changes. These general belief systems sen, 1998). As well as targeting the public, the implementation of evidence-based
then become a scaffold onto which specific this campaign was aimed at health care mental health care. Attempts to make
knowledge (mental health literacy) is providers, educators and treatment centres. clinical practice more evidence-based, such
grafted. It involved radio, newspaper, cinema and as the Cochrane Collaboration (Adams,
television advertisements. Public surveys 1995), are founded on the assumption that
carried out before and after the campaign meta-analyses of randomised controlled
IMPROVING MENTAL HEALTH showed a large increase in knowledge of trials and the dissemination of clinical
LITERACY
LITER ACY the terms psychosis and schizophrenia. practice guidelines are sufficient to improve
There is also early evidence that help-seeking clinical practice. This approach is very much
Efforts to improve public knowledge of behaviour has changed and that the duration a top-down one in which it is assumed that
mental disorders have been much less of untreated psychosis has decreased. the benefits of research will be realised if
common than for cancer and heart disease. Another approach is to target specific clinicians can be won over to use evidence-
Nevertheless, a number of approaches have subgroups of the public. This approach is based treatments. However, this approach
been tried. One is an information campaign exemplified by the work of Wolff et al fails to take account of the views of the
targeted at the general population. In the (1999), who educated the public in a neigh- public, who are the potential consumers of
late 1980s, the Americans instituted the bourhood where a group house for those services. If evidence-based treatments do
Depression Awareness, Recognition and with mental illnesses was being established. not accord with public views, people who
Treatment Program, which aimed to inform In this study, one such neighbourhood develop mental disorders may be unwilling
both the public and health professionals received an education campaign, while to seek those treatments or to adhere to
that depressive disorders are common, another acted as a control. The campaign advice given by clinicians (Jorm et al, al,
serious and treatable (Regier et al,
al, 1988). consisted of an educational package with 2000a
2000a). Furthermore, they may burden the
This campaign involved a broad range of information sheets and a video, social health care system by seeking inappropriate
educational materials, including television, events to establish contact with the group services and unnecessary investigations.
radio and print advertisements, bookmarks house, a formal reception and informal dis- A second consequence of poor mental
and brochures. This national campaign cussion sessions. Pre- and post-surveys in health literacy is that the task of preventing
was coordinated with action in local the experimental and control neighbour- and helping mental disorders is largely
communities. Its effects are unknown. hoods showed only a small effect on public confined to professionals. However, the
Another US campaign, begun in the early knowledge, but revealed less fear and more prevalence of mental disorders is so high that
1990s, is the National Depression Screening social contact with the group house the mental health workforce cannot help
Day (Jacobs, 1995). The aims of this day are residents in the experimental neighbour- everyone affected and tends to focus on
to call public attention to depression, to hood. Another targeted population sub- those with more severe and chronic prob-
educate the public about symptoms and group is high-school students. Fairly brief lems. If there are to be greater gains in pre-
treatments and to identify individuals who classroom instruction has been found to vention, early intervention, self-help and
may be unaware they are clinically improve willingness to seek professional support of others in the community, then
depressed. This day has resulted in wide- help (Battaglia et al,al, 1990; Esters et al,
al, we need a `mental health literate' society in
spread media publicity and screening of a 1998). which basic knowledge and skills are more
large number of people. Finally, there are attempts to improve widely distributed.
In the UK there was the Defeat Depres- the quality of information presented in the
sion Campaign run by the Royal College of media through expert input. Although ACKNOWLEDGEMENTS
Psychiatrists and the Royal College of mental health experts frequently make
General Practitioners from 1992 to 1996 themselves available for media comment, Suggestions for improving the paper were provided
(Paykel et al,
al, 1998). This campaign aimed there is virtually no research on the effects by Betty Kitchener,Kathy Griffiths, Scott Henderson,
to educate the public about depression of doing so. However, in an analysis of four Jo Medway and Bryan Rodgers.
and its treatment, to encourage earlier media items derived from lay sources and
treatment-seeking and to reduce the stigma three from psychiatrists, Nairn (1999) found REFERENCES
of depression. It included use of radio, tele- that the psychiatrists presented mental dis-
vision and print media. National surveys orders in a less negative manner, but the
Adams, C. E. (1995) A systematic approach to
carried out at the beginning, middle and journalists tended to undermine their evaluation of care: the Cochrane Collaboration. Journal
end of the campaign showed small but message to produce a more newsworthy of Psychosomatic Research,
Research, 39,
39, 927^931.
significant changes in the percentage of story.
the public who believe that antidepressants Addis, M. E. & Jacobson, N. S. (1996) Reasons for
depression and the process and outcome of cognitive ^
are effective and who would be willing to behavioural psychotherapies. Journal of Consulting and
seek professional help. It is impossible to IMPLICATIONS FOR MENTAL Clinical Psychology,
Psychology, 64,
64, 1417^1424.
say whether these changes were solely due HEALTH CARE
to the campaign, but the results are Alem, A., Jacobsson, L., Araya, M., et al (1999) How
certainly encouraging. The evidence reviewed here makes it clear are mental disorders seen and where is help sought in a
rural Ethiopian community? A key informant study in
In Norway, there has recently been a that the public in many countries have poor Butajira, Ethiopia. Acta Psychiatrica Scandinavica,
Scandinavica, 100,
100,
campaign in one county aimed at reducing mental health literacy. There are a number 40^47.

399

Downloaded from https://www.cambridge.org/core, subject to the Cambridge Core terms of use.

 JOR M

Andrews, G., Hall,W., Teesson, M., et al (1999) The

Mental Health of Australians.
Australians. Canberra: Commonwealth
Department of Health and Aged Care. CLINICAL IMPLICATIONS
Angermeyer, M. C. & Matschinger, H. (1995) Violent
attacks on public figures by persons suffering from & The public does not share many of the core beliefs of clinicians with regard to
psychiatric disorders: their effect on the social distance treatment and aetiology of mental disorders.
towards the mentally ill. European Archives of Psychiatry
and Clinical Neuroscience,
Neuroscience, 245,
245, 159^164. & Clinicians may have difficulty in implementing evidence-based mental health care if
_ (1996a) Relatives' beliefs about the causes of
& _ (1996a patients do not believe in the interventions offered.
schizophrenia. Acta Psychiatrica Scandinavica,
Scandinavica, 93,199^204.
93,199^204.
_ (1996b) The effect of diagnostic labelling on the
& _ (1996b & An increase in mental health literacy in the population may assist prevention, early
lay theory regarding schizophrenic disorders. Social intervention, effective self-help and support of others in the community.
Psychiatry and Psychiatric Epidemiology,
Epidemiology, 31,
31, 316^320.
_ (1996c) Public attitude towards psychiatric
& _ (1996c LIMITATIONS
treatment. Acta Psychiatrica Scandinavica,
Scandinavica, 94,
94, 326^336.
_ (1996d) The effect of personal experience with
& _ (1996d & The concept of mental health literacy assumes the superiority of expert
mental illness on the attitude towards individuals psychiatric knowledge over lay beliefs.
suffering from mental disorders. Social Psychiatry and
Psychiatric Epidemiology,
Epidemiology, 31,
31, 321^326. & The concept could be criticised for seeing the sufferer's interpretation of his or her
_ & _ (1999) Social representations of mental illness condition as less valid.
among the public. In The Image of Madness: The Public
Facing Mental Illness and Psychiatric Treatment (eds J.
Guimon,W. Fischer & N. Sartorius), pp. 20^28. Basel:
Karger.
_ , Da« umer, R. & Matschinger, H. (1993) Benefits
Daumer,
and risks of psychotropic medication in the eyes of the A. F. JORM, DSc, Centre for Mental Research, The Australian National University, Canberra 0200, Australia
general public: results of a survey in the Federal
Republic of Germany. Pharmacopsychiatry,
Pharmacopsychiatry, 26,
26, 114^120.
(First received 4 February 2000, final revision 12 May 2000, accepted 15 May 2000)
_ , Matschinger, H. & Riedel-Heller, S. G. (1999)
Whom to ask for help in case of a mental disorder?
Preferences of the lay public. Social Psychiatry and
Psychiatric Epidemiology,
Epidemiology, 34,
34, 202^210.
Furnham, A.,Wardley, Z. & Lillie, F. (1992) Lay Jorm, A. F., Korten, A. E., Jacomb, P. A., et al (1997a
(1997a)
Battaglia, J., Coverdale, J. H. & Bushong, C. P. (1990) theories of psychotherapy, III: Comparing the ratings of `Mental health literacy': a survey of the public's ability to
Evaluation of a mental illness awareness week program lay persons and clinical psychologists. Human Relations,
Relations, recognise mental disorders and their beliefs about the
in public schools. American Journal of Psychiatry,
Psychiatry, 147,
147, 45,
45, 839^858. effectiveness of treatment. Medical Journal of Australia,
Australia,
324^329. 166,
166, 182^186.
Goldberg, D. & Huxley, P. (1992) Common Mental
Bhatara,V. S., Sharma, J. N., Gupta, S., et al (1997) Disorders: A Bio-Social Model.
Model. London & New Y
York:
ork: _ (1997b) Public beliefs about causes and
, _ , _ , et al (1997b
Rauwolfia serpentina:
serpentina: the first herbal antipsychotic. Routledge. risk factors for depression and schizophrenia. Social
American Journal of Psychiatry,
Psychiatry, 154,
154, 894. Psychiatry and Psychiatric Epidemiology,
Epidemiology, 82,
82, 143^148.
_ , Privett, M., Ustun, B., et al (1998) The effects of
Bowers, J., Jorm, A. F., Henderson, S., et al (1990)
detection and treatment on the outcome of major _ (1997c) Helpfulness of interventions
, _ , _ , et al (1997c
General practitioners'
practitioners'detection
detection of depression and
depression in primary care: a naturalistic study in 15 for mental disorders: beliefs of health professionals
dementia in elderly patients. Medical Journal of Australia,
Australia,
cities. British Journal of General Practice,
Practice, 48,
4 8, 1840^1844. compared with the general public. British Journal of
153,
153, 192^196.
Psychiatry,
Psychiatry, 171,
171, 233^237.
« ndli, H. (1999) The image of mental illness in
Bra
Brandli, Herran, A.,Väzquez-Barquero,
A.,Vazquez-Barquero, J. L. & Dunn, G.
Switzerland. In The Image of Madness: The Public Facing (1999) Patients'attributional style is important factor. _ (1997d) Belief systems of the general
, _ , _ , et al (1997d
Mental Illness and Psychiatric Treatment (eds. J. Guimon, British Medical Journal,
Journal, 318,
318, 1558. public concerning the appropriate treatments for mental
W. Fischer & N. Sartorius), pp. 29^37. Basel: Karger. disorders. Social Psychiatry and Psychiatric Epidemiology,
Epidemiology,
Hillert, A., Sandmann, J., Ehmig, S. C., et al (1999)
32,
32, 468^473.
Caldwell, T. M. & Jorm, A. F. (2000) Mental health The general public's cognitive and emotional perception
nurses' beliefs about interventions for schizophrenia and of mental illnesses: an alternative to attitude-research. In
_ , Angermeyer, M. & Katschnig, H. (2000a(2000a) Public
depression: a comparison with psychiatrists and the The Image of Madness: The Public Facing Mental Illness
knowledge of and attitudes to mental disorders: a
public. Australian and New Zealand Journal of Psychiatry,
Psychiatry, and Psychiatric Treatment (eds J.J.Guimon,W
Guimon,W. Fischer
limiting factor in the optimal use of treatment services.
in press. & N. Sartorius), pp. 56^71. Basel: Karger.
In Unmet Need in Psychiatry (eds G. Andrews & S.
Cuijpers, P. (1997) Bibliotherapy for unipolar Hyler, S. E., Gabbard, G. O. & Schneider, L. (1991) Henderson), pp. 399^413. Cambridge: Cambridge
depression: a meta-analysis. Journal of Behavior Therapy Homicidal maniacs and narcissistic parasites: University Press.
and Experimental Psychiatry,
Psychiatry, 28,
28, 139^147. stigmatization of mentally ill persons in the movies.
_ (2000b) Public
, Christensen, H., Medway, J., et al (2000b
Dew, M. A., Bromet, E. J., Schulberg, H. C., et al Hospital and Community Psychiatry,
Psychiatry, 42,
42, 1044^1048.
belief systems about the helpfulness of interventions for
(1991) Factors affecting service utilization for depression depression: associations with history of depression and
Jacob, K. S., Bhugra, D., Lloyd, K. R., et al (1998)
in a white collar population. Social Psychiatry and professional help-seeking. Social Psychiatry and
Common mental disorders, explanatory models and
Psychiatric Epidemiology,
Epidemiology, 26,
26, 230^237. Psychiatric Epidemiology,
Epidemiology, in press.
consultation behaviour among Indian women living in
Esters, L. G., Cooker, P. G. & Ittenbach, R. F. (1998) the UK. Journal of the Royal Society of Medicine,
Medicine, 91,
91, 66^71.
Kessler, D., Lloyd, K., Lewis, G., et al (1999) Cross
Effects of a unit of instruction in mental health on rural
adolescents' conceptions of mental illness and attitudes Jacobs, D. G. (1995) National Depression Screening sectional study of symptom attribution and recognition
about seeking help. Adolescence,
Adolescence, 33,
33, 469^476. Day: educating the public, reaching those in need of of depression and anxiety in primary care. British
treatment, and broadening professional understanding. Medical Journal,
Journal, 318,
318, 436^440.
Fischer,W.,
Fischer, W., Goerg, D., Zbinden, E., et al (1999) Harvard Review of Psychiatry,
Psychiatry, 3, 156^159.
Determining factors and the effects of attitudes towards Kessler, R. C., McGonagle, K. A., Zhao, S., et al
psychotropic medication. In The Image of Madness: The Johannessen, J. O. (1998) Early intervention and (1994) Lifetime and 12-month prevalence of DSM ^ III ^ R
Public Facing Mental Illness and Psychiatric Treatment (eds prevention in schizophrenia: experiences from a study in psychiatric disorders in the United States: results from
J.Guimon,W. Fischer & N. Sartorius), pp. 162^186. Basel: Stavanger, Norway. Seishin Shinkeigaku Zasshi. Psychiatria the National Comorbidity Survey. Archives of General
Karger. et Neurologia Japonica,
Japonica, 100,
100, 511^522. Psychiatry,
Psychiatry, 51,
51, 8^19.

400

Downloaded from https://www.cambridge.org/core, subject to the Cambridge Core terms of use.

 M E N TA L H E A LT H L I T E R A C Y

Lin, E., Goering, P., Offord, D. R., et al (1996) The use Nutbeam, D.,Wise,
D., Wise, M., Bauman, A., et al (1993) _ , Narrow,W. E., Rae, D. S., et al (1993) The de facto
of mental health services in Ontario: epidemiologic Goals and Targets for Australia's Health in the Year 2000 US mental and addictive disorders service system.
findings. Canadian Journal of Psychiatry,
Psychiatry, 41,
41, 572^577. and Beyond.
Beyond. Canberra: Australian Government Epidemiologic catchment area prospective 1-year
Publishing Service. prevalence rates of disorders and services. Archives of
Linde, K., Ramirez, G., Mulrow, C. D., et al (1996) St
General Psychiatry,
Psychiatry, 50,
50, 85^94.
John's wort for depression ^ an overview and meta- Parker, G. B. & Brown, L. B. (1982) Coping behaviors
analysis of randomised controlled trials. British Medical that mediate between life events and depression. Rippere,V. (1979) Scaling the helpfulness of
Journal,
Journal, 313,
313, 253^258. Archives of General Psychiatry,
Psychiatry, 39,
39, 1386^1391. antidepressive activities. Behaviour Research and Therapy,
Therapy,
17,
17, 439^449.
Link, B. G., Phelan, J. C., Bresnahan, M., et al (1999)
Paykel, E. S., Hart, D. & Priest, R. G. (1998) Changes
Public conceptions of mental illness: labels, causes, Simon, G. E., Goldberg, D., Tiemens, B. G., et al
in public attitudes to depression during the Defeat
dangerousness, and social distance. American Journal of (1999) Outcomes of recognized and unrecognized
Depression Campaign. British Journal of Psychiatry,
Psychiatry, 173,
173,
Public Health,
Health, 89,
89, 1328^1333. depression in an international primary care study.
519^522.
Martinsen, E. W. (1994) Physical activity and General Hospital Psychiatry,
Psychiatry, 21,
21, 97^105.
depression: clinical experience. Acta Psychiatrica Priest, R. G.,Vize, C., Roberts, A., et al (1996) Lay
Torrey, E. F. (1994) Violent behavior by individuals with
Scandinavica,
Scandinavica, 377 (suppl.), 23^27. people's attitudes to treatment of depression: results of
serious mental illness. Hospital and Community Psychiatry,
Psychiatry,
opinion poll for Defeat Depression Campaign just
Matschinger, H. & Angermeyer, M. (1996) Lay beliefs 45,
45, 653^662.
before its launch. British Medical Journal,
Journal, 313,
313, 858^859.
about the causes of mental disorders: a new Wilson, C., Nairn, R., Coverdale, J., et al (1999)
methodological approach. Social Psychiatry and Raguram, R.,Weiss, M. G., Channabasavanna, S. M., Mental illness depictions in prime-time drama:
Psychiatric Epidemiology,
Epidemiology, 31,
31, 309^315. et al (1996) Stigma, depression, and somatization in south identifying the discursive resources. Australian and New
India. American Journal of Psychiatry,
Psychiatry, 153,
153, 1043^1049. Zealand Journal of Psychiatry,
Psychiatry, 33,
33, 232^239.
McKeon, P. & Carrick, S. (1991) Public attitudes to
depression: a national survey. Irish Journal of Psychological Razali, S. M., Khan, U. A. & Hasanah, C. I. (1996) Wolff, G., Pathare, S., Craig,T., et al (1996) Community
Medicine,
Medicine, 8, 116^121. Belief in supernatural causes of mental illness among knowledge of mental illness and reaction to mentally ill
Mullen, P. D. (1997) Compliance becomes concordance. Malay patients: impact on treatment. Acta Psychiatrica people. British Journal of Psychiatry,
Psychiatry, 168,
168, 191^198.
British Medical Journal,
Journal, 314,
314, 691^692. Scandinavica,
Scandinavica, 94,
94, 229^233.
_ , _ , _ , et al (1999) Public education for
Nairn, R. (1999) Does the use of psychiatrists as Regier, D. A., Hirschfeld, R. M. A., Goodwin, F. K., et community care: a new approach. In The Image of
sources of information improve media depictions of al (1988) The NIMH depression awareness, recognition, Madness: The Public Facing Mental Illness and Psychiatric
mental illness? A pilot study. Australian and New Zealand and treatment program: structure, aims, and scientific Treatment (eds J.Guimon,W
J. Guimon,W. Fischer & N. Sartorius),
Journal of Psychiatry,
Psychiatry, 33,
33, 583^589. basis. American Journal of Psychiatry,
Psychiatry, 145,
145, 1351^1357. pp. 105^117. Basel: Karger.

4 01

Downloaded from https://www.cambridge.org/core, subject to the Cambridge Core terms of use.