Share Public Health podcast transcript, Mental Health: Language Matters

Transcript: Season 1 Episode 1

Laurie Walkner Welcome to share public health the Midwestern public health training centers podcast connecting you to public health topics issues and colleagues throughout our region and the country highlighting that we all share in public health thank you for tuning in to the series focusing on mental health in this series we will explore mental health through the lenses of schools public safety and the business community. Be sure to check the notes to get links to resources mentioned in the podcast.

Suzanne Hawley Hello this is Dr.Suzanne Hawley and today I’m here with Dr. Amy Chesser. She is an associate professor at Wichita State University in the Department of Public Health Sciences in the College of Health Professions and today I’m really excited that we get to talk about mental health literacy just to remind you this is part of a podcast series on mental health and so today we’re going to talk about mental health literacy. I want to welcome you and I guess the first question I have for our listeners is what is mental health literacy and why does it matter?

Amy Chesser Thanks Suzanne, and thanks for inviting me to speak today. I’m really excited to discuss this topic of mental health literacy with you and the listeners. This is a new topic for me and I think we’ve kind of discussed that some of my research, and I’m learning quite a bit about the topic right now. So I’m not sure that most people even know this term so that was a great question. What is mental health literacy? So to begin from the research we know that mental health literacy is quote “the knowledge and beliefs about mental disorders which aid their recognition management or prevention.” So this definition along with some other very important research was created by Jorm from Australia in 1977. So let me say that again for the listeners just a little bit slower so mental health literacy is “the knowledge and beliefs about mental disorders which aid their recognition management or prevention” and what I think about when I hear this definition, Suzanne, is that it ranges from knowledge to beliefs and we have a chance to change with the recognition management and prevention the health of others. This can be at the individual level or an entire population of people who may be struggling themselves or know someone who is struggling with a mental health illness or disorder.

Suzanne Hawley You know this to me sounds so important, but if you want to just help explain to our listeners why does this matter?

Amy Chesser Right so I think it’s important for the listeners, from my understanding, who are mostly public health people is that this is an important topic for public health because it impacts a number of population related illnesses. So if we think about just even here in the United States today we have a big problem with anxiety and depression, and there are a lot of people who are fighting this today. So depression is one of the leading causes of years lived with disability. I’m sure you’ve heard that term before years lived with disability, and so that impacts people worldwide although it can be successfully treated. So seventy-five percent of Americans do not receive care for this one mental illness, and treatment has lower rates among non-immigrant Latinos and Hispanics in comparison to white, meaning there are continued opportunities for treatment for that population. Also, when thinking about anxiety disorders they represent the single largest mental health problem in the United States but most people never seek treatment. Therefore, the deficits and the ability to recognize and the beliefs about the disorder may contribute to low health seeking behaviors.

Suzanne Hawley So if people don’t understand and have mental health literacy, then what I’m hearing from you is I mean these are huge issues in our communities. It’s kind of like a silent issue some people will never even go to seek treatment. So we could, I mean, these are people listening today. This could be you or me. This could be people in your family, someone that’s a friend, or a colleague. And so it’s all around us, and that’s interesting. I mean anxiety disorders are the biggest problem in the U.S., and yet. You know I’m thinking an anxious person. When I feel anxious I don’t want to talk about it to anybody. I just want to fix the problem.

Amy Chesser Right, Yeah.

Suzanne Hawley Even if I don’t know how to, I just make up something.

Amy Chesser Right.

Suzanne Hawley So anyway, it’s just it’s amazing to think about the lack of treatment, and this is a crisis. This is an epidemic, and we’re not even trained as traditional public health people; or we’re in a helping profession; or in a school to deal with this at just a personal level or a community level. I mean that’s overwhelming to me, so I mean I’m glad we’re here today and talk about it.

Amy Chesser Yeah so good point, and at the end of this discussion I hope we’re going to be able to have some resources that we can provide and practices that would be helpful to kind of take the next step for those who are listening and working everyday in public health. So that they can kind of put their foot forward in addressing mental health literacy problems for the people that are in our community and our families etc.

Suzanne Hawley Great and I hope I can remember for all of us, you know, to ask you about those so we actually have something to take away. So let’s just start off with experts. Who are they? You know, what what’s some of the research in this area? As researchers ourselves and faculty we want the evidence, so give it to us.

Amy Chesser So let’s talk about the evidence for a little bit. Most of the researchers in this area have been primary care clinicians, as well as people in psychiatry, psychology, and the like, but the more majority of the work that’s been conducted has been in other countries. Other than the United States. So the early research was conducted in Australia by a team led by Jorm. So we heard his name just a little bit earlier with the definition he was the first to kind of get into this area in 1997, and he created a team that has done the bulk of the research. And their focus was in numerous studies have involved adolescents. So mental health literacy with adolescents, and there’s a variety of assessment tools that researchers use for mental health literacy. Many of them started with his team and we’ll talk a little bit about those tools here in a second. So just keep listening.

Suzanne Hawley So that’s kind of interesting that a lot of this really important work has been done outside of the United States. I think of, you know, all the mental health awareness or the crisis we have here, but yeah that. I find that interesting and I think about what we need to know. I’m wondering where are people using the tools? Like what are these tools?

Amy Chesser So again we look to the research and the evidence, and we see that people are currently using these tools to assess vulnerable individuals, such as adolescents or women with postpartum depression. Some with mental health providers themselves, and we’ve even seen public health students. So at the population level we see a lot of studies that are just assessing the general public. So just large population-based studies. A few of the studies have involved other populations, such as older adults or minorities. And very few looking at rural populations or rural areas. I think it’s noteworthy that several of the studies in international locations have specifically looked at culture and its impact on mental health literacy, which can impact an entire population.

Suzanne Hawley So really when they’re assessing people they’re looking at, what do they know? That this is a mental health problem, for example. When from my background as a clinician, I had learned in graduate school about anxiety not being a term that certain groups used. But they may talk about the physical symptoms like I have butterflies in my stomach, but I would never know that I’m anxious.

Amy Chesser Right, exactly.

Suzanne Hawley I have some physical reaction. So it’s what do they know? And then if they know it, like if they’re measuring it in the middle school adolescent kids. Then, you know, this can keep them if they kind of understand ‘what are my symptoms?’ because this is related to a mental health issue. Then I can actually talk to someone about it, a counsellor or whatever. Because you think about in the news, I mean the suicide rates, and all kinds of risk-taking behaviors of teenagers and young people. And suicide rates in the military. I mean really it’s great that they’re tracking kind of the rates, but you know this is different because this is about measuring what they know.

Amy Chesser Right.

Suzanne Hawley Not if they have it. So that puts the power into the the people, if they actually know the information.

Amy Chesser Right, exactly.

Suzanne Hawley Okay, I just want to make sure I’m tracking you. So what does a mental health literacy mean for like a community population perspective?

Amy Chesser Yeah. So it’s a little bit about what we’ve been mentioning all along, which is that mental health literacy starts with the individual. It can move quickly to the family impacting the entire family’s, or someone who is involved in a family, system. And then out to the community, and eventually to the entire public or population. And it’s having the knowledge of those preventive measures symptoms and treatment modalities, and the treatment locations for mental disorders that’s important. So it also includes being knowledgeable about the strategies to support yourself or others experiencing mental health conditions that are around you. Among those experiencing mental health condition. Mental health literacy includes knowing how to manage that illness, and so you’re thinking about maybe caregivers. And mental health literacy including having the knowledge or effective support rendered from the family for that person that has the mental health condition.

Suzanne Hawley So that’s helpful to hear. It’s not just okay I’m having these symptoms, or I’m noticing the population I work with may have symptoms but I know that there’s a treatment I can, you know, go to therapy. I might know that, but I don’t know where to go. So actually having a physical location. So if it’s the county mental health center; if it’s the school system; if it’s University Counseling Center; medical group in a military facility. But just knowing where to go.

Amy Chesser Got it.

Suzanne Hawley So, you know, I think about my father that is elderly and has health issues, and I take it for granted that I’m a psychologist. So I might be thinking about these things, but when you’re in the situation it’s hard to assess these things because he has all these other health conditions. You know, having pain can make him more irritable, or, you know, just he’s not as mobile. So that can, you know, change his mood and, you know, when to really be worried about it.

Amy Chesser Right.

Suzanne Hawley That’s hard for anybody I think.

Amy Chesser Right. Now as we think about depression, dementia, and old age. I mean they are all kind of blending together with mental health issues. And then you do something like take away someone’s car keys. Before you know it, you know. It’s really impacting. Now we’re talking about an older adult population, which I think is interesting for us to talk about in the context of mental health literacy because this is an interesting population in a couple of ways that are pertinent to our discussion. First, that population continues to grow, as you know, at an exponential rate. We’re looking at the stats right now that say 2030 one in every five people in the United States will be age 65 and older. Just thinking about that and letting that resonate for a minute. The next step would be looking out at, so just 30 years later in the U.S. we’re saying that 65 and older population will be 98 million people. So that’s a lot of people to be considering when we’re thinking about the older generation in their mental health literacy skills. Second, we think about what’s known about this population. Again, going back to the evidence and the research I started looking at mental health literacy for older adults, and there’s a lack of understanding about the differences among cognitive decline and dementia and Alzheimer’s disease. So when you’re researching you have to take all these things into consideration. There are multiple factors when you’re thinking about mental health in older adults and mental health literacy, so it’s an exciting time. There’s a lot of potential for new research in this area. We are certainly going to have the population and the numbers in order to conduct research, and we can look at it from the public health and population perspectives in the future.

Suzanne Hawley So basically you’re telling us that there’s this silver tsunami. I mean the older adult population is growing and growing no matter what area of health or community work you’re involved, and you need to know about older adults. And that this is probably the most vulnerable one of the most vulnerable groups.

Amy Chesser Right.

Suzanne Hawley Because they might have cognitive conditions like dementia that interfere with kind of understanding or diagnosing. They have not been raised in their childhood in life to talk about this or know what this is. They’re at risk for suicide.

Amy Chesser Yeah, they are. Yeah, right.

Suzanne Hawley I mean all these things, right? And so it’s never too late, I think.

Amy Chesser And changing that cultural norm for this large population, as you’re saying, is a big issue. As we were looking at earlier, you know, looking at culture. Well we have that right here at home with a whole generation. Like you said not necessarily thinking it’s normal, acceptable, or desirable to go to a therapist or any kind of clinician in order to fix what they may or may not see as a problem. And it just reminds me of this book I’m reading now The Power of Habit. And I just realized they were talking about, how do we build new habits? You cue it with a habit that already exists. Something you’re comfortable with. I can’t buy into something that’s totally foreign. So if an older adult is used to going to physicians and their primary care doc. and those kinds of physical health issues, that’s where they’re going to be and that’s who is going to need to also be have mental health literacy.

Suzanne Hawley A physician to even ask the questions. To know if their patient has that literacy. To then even have that comfort level. To make a referral or to even have somebody come in the office and do a behavioral health consult or whatever. But I mean you need to find those people where they’re at, not where you want them to go.

Amy Chesser Right.

Suzanne Hawley So I’m not actually sure how common the term mental health literacy is for everybody. I mean when I think about it it’s another way to say it is mental health awareness. Mental health 101. It’s very specifically defined like you said which is great. The symptoms, you know, the treatment and where can you actually go. So like all the actual steps. So how does this fit into health literacy? You know, I know you’re an expert in health literacy. I think that’s a pretty common concept, but can you say something about the connection?

Amy Chesser Yeah. So yes. I have done a lot of research and my passion has actually been health literacy itself for almost 20 years now. And when we think about that definition, again there are like 24 definitions of health literacy out there in the literature, but I always look to the institutes of medicine because they were kind of the first that said that health literacy. And I’m going to quote: “… is the degree to which individuals have the capacity to obtain, process, and understand basic health information and the services needed to make appropriate health decisions.” So in a lot of ways when you listen to that the first word I think of is the individual having that capacity to do these things. In general we think about health literacy as that individual’s ability to know what is going on with his, her, or their own health. And where to find that reliable information of what he, she, or they should do next. So it’s an individual’s ability to help themselves navigate through that health care system. Mental health literacy is similar in that individuals are supposed to be able to recognize and manage their illness. And although health literacy is similar. And that providers often work to communicate effectively about that person’s health issues and provide that appropriate and useful information. Mental health literacy is different in that some of the measures that we use to include expert understanding and the ability to manage health issues as the provider of the care measure the same thing as you would for the general populace. So to date we have just a few instruments other than plain language, and the patient-centered observation form often used in medical education that assess a provider skill of health literacy and more generally for mental health literacy. It’s just the exact same tool.

Suzanne Hawley Okay. So to kind of just further get us back to the bottom line. How does recognizing that people have different understandings and abilities related to mental health help us in our work? I mean even in our personal lives.

Amy Chesser Right. So first and foremost I think it’s important for people to begin to recognize and talk about mental health issues, and this includes general accurate knowledge of the very most common illnesses. And the removal of that stigma around mental health. Some of the linguistics that I think of just kind of walking around in my daily life is when I hear somebody calling somebody else a person crazy or not. It’s not necessarily a situation but an actual person. “Oh he’s really nuts.” I think that we need to recognize that right away, and think about the ways that we use language in the way we talk in reflection to mental health issues. And recognizing that people have different understandings and capacities related to mental health literacy. That allows us to provide education in those areas for people in the general population. Patients themselves, their family, their providers, their caregivers. Kind of all of us, which will allow for understanding about the need for care and the continued support for the people with these acute or chronic mental health issues.

Suzanne Hawley So I think when I think about that I think about just we just need to keep talking about this, whether, you know. It’s not that we have to overshare about our own lives, you know. If we have a loved one or ourselves, or struggling with mental health. I mean that can help reduce stigma in a lot of ways, but it’s interesting when I share information about working with people who may need mental health services. And how it was so helpful for them. Whether it was for student services and things like that. And then they kind of know that I know information. I know where to go. I know just basic things, and I’m comfortable with that this is theirs. I don’t have feeling of stigma about it, but then just people kind of come out of the woodwork. Hey, you know, do you have a referral for this? Do you have a, you know? Because they don’t even know who to ask. And I’m thinking well there’s a clinic right there next door, but the thing is is they don’t want to go to a bunch of strangers.

Amy Chesser Absolutely.

Suzanne Hawley I mean, you know, just talking about it, you know, even at an individual level is kind of breaking down that that stigma. You know, not saying “crazy” or “nuts.” There was a crazy day dress up at one of my kids preschool. And it was like we asked, can you not use that? I mean I don’t want to be like the mean boring parent, but just how do we just make it like Wacky Wednesday or something?

Amy Chesser Yes. Right.

Suzanne Hawley I don’t know if that’s better, but anyway. Sorry. I’m just.

Amy Chesser No I think it’s good. I think it’s important that we talk about language in the, you know, the silliness of it. Maybe, I think some people think I’m over-the-top about this, but I’m really serious about mental health issues just in my daily walking around life. Because I think probably two of three people that I will run into on a daily basis may have a mental health issue, and it’s important that we keep helping that not be a stigma.

Suzanne Hawley Exactly. So I mean with that said, why is it important for people working with groups and communities to really know about this topic here a mental health literacy?

Amy Chesser All right. So my base answer to that would be because we can do something about it. Many professionals have the chance to improve the overall health of the individual community and population by educating themselves about the variety of mental health illnesses. You know, the things that we’ve talked about depression, anxiety, and we haven’t mentioned bipolar or obsessive-compulsive. They’ve definitely been studied as well as you know that post-traumatic stress disorder has been well studied in the past few years. As you mentioned before in the veterans kind of military service population, but also with other populations as well. So we’re starting to have a glimpse of how we can take action and improve.

Suzanne Hawley So yeah there’s a lot of important things that are going on that we might not understand in terms of the specific diagnosis, but really, you know, just talking about it. Just talking about mental health in general to make it just a more comfortable topic. If we’re able to assess this mental health literacy, how can it improve mental health in our population?

Amy Chesser Right. So if we look at low mental health literacy, which has been shown to be important contributor and that mental health treatment gap. So what I’m saying is that we identify those people with low mental health literacy. We’re also be able to identify providers and services as you were kind of mentioning earlier. About hey people come out and seek you because they know maybe you have the resources. And when I think about this I go back to the adolescent studies because what we know is that with early recognition and intervention that the trajectories of that person can be altered for their future mental health. And in by altering the trajectory for that individual later years they will affect an entire community. For the future of that community and identification is the key to that gap. So higher mental health literacy improves health seeking and it eventually improves the quality of life at the individual and the family level.

Suzanne Hawley So I love that we’re talking about this today. I love that I’m just spending this time with you. Makes me want to say mental health literacy as much as possible. Say that word and to say what it means because it’s more than just one. I mean it’s more than 101. It’s specifically, you know, knowing the symptoms. Knowing there’s treatments. Knowing there’s someone, a place to go. What you know, where you can go for that information, and all of us can do that. And we can answer that question for somebody who comes up to us. Who and, you know, I don’t give. I don’t any more provide therapy for anybody, and I don’t have to because I can, you know, just cover that very basic level and offer support to give them a referral. But if all of us know that and if community members know that that’s great. And I’m just trying to imagine if this is the first time I’m learning about this, and I really want to know where I can go that third part. Where do I go for more resources? What are your suggestions?

Amy Chesser Right. So we did remember, which is great at the end of the talk. We were going to say what can we do? So this is great. One of the valuable tools that I’ve seen is called the mental health first aid. And you can look that up, you know, through any a search engine and get all the details about that. But they attempt to improve mental health through this intervention. It’s an eight-hour course, and it gives people skills to help someone who is developing a mental health problem or may be experiencing a mental health crisis, which is key. And the evidence behind the program has demonstrated that it does build mental health literacy by helping the public identify, understand, and respond to the signs of mental illness. As stated on the website, and I’m just gonna quote here that “It’s intended for all people and organizations that make up the fabric of the community.” I love that. And the course is presented in the Chamber of Commerce, professional associations, hospitals and nurses, rotary clubs. So, you know, they have a large variety of people out in the community that they’re presenting to, as well as professionals who regularly interact with a lot of people in their communities. Their faith communities, friends, and family. Anybody who are dealing with mental illness or addiction, or anyone learning more about a mental illness. So you can see that there’s just a vast variety of people that are able to be impacted by this eight-hour course.

Suzanne Hawley That sounds great.

Amy Chesser Yeah there’s also a mental health curriculum from New York State Education Department. Again, you can kind of look that up through a search engine. Just search ‘mental health literacy‘ or ‘the New York State Education Department‘ and the link will come right up. And that curriculum is really focused in that they look at school climates and educating young people about mental health. So back to those adolescents who we can intervene with early. That maybe we can make a difference for their adulthood. For their future communities.

Suzanne Hawley So mental health first aid is a specific resource. And MentalHealthFirstAid.org. And then ‘mental health literacy‘ is just a good search term to find things. And that the New York example. So now that you talk about this, so let’s say I want to measure, you know, I’m working with communities or I’m working with a school. What screening tools are available?

Amy Chesser Right. So let’s talk about that a little bit. The first thing I noticed when I was looking at the screening tools is, wow did I have high literacy skills were needed in order to implement those measurement tools. So first of all becoming familiar with terminology. So maybe you know the term ‘Akathisia.’ That’s not something I use in my everyday walking around language. So really thinking about Dysthymia. Is that a word I even know? So some of these tools, these measurement tools actually are asking those kind of words and a fill-in-the-blank scenario. So thinking about that. Taking care in choosing the tool that you’re going to use to measure and assess mental health literacy is very important. There are also some really good multiple screenings that are comprised of vignettes. So these are used for non expert people in the general population, as well as professionals not in mental health but people working with and people who have mental health illnesses. So again non-experts, but impacting and working with people with mental health illness in their short cases. And they describe a person with some type of mental health issue. And the respondent or the person taking the assessment indicates the illness. So, for example, depression and then the severity of that problem from that vignette or case study. And they read several of those and respond and they’re scored on that. So that’s one way to assess. There’s also another tool called the mental health literacy scale. You can look that up on the internet and take a look at it’s kind of long. It measures a variety of mental health issues, such as and again we’re going depression, schizophrenia, personality disorders and what mental health provider reporting requirements are. And then some assessment of that help seeking knowledge. So it should be noted that general literacy again on all of these tools needs to be pretty high in order to use these assessments.

Suzanne Hawley So thank you for clarifying that in terms of, you know, some having really high technical knowledge information and those terms that we don’t use every day to cases. And then that mental health literacy scale. I was just going to be nice, you know, if we all take that scale then we, you know, share with people that we know that can have that level of understanding. Because, you know, when I think about the everyday work environment or schools. Public health does a really good job of this for flu. This might be flu-like symptoms and this is when you should stay home and not infect other people.

Amy Chesser Right.

Suzanne Hawley And so we kind of, I think, are doing a pretty good job with that even though not everybody does stay home when they should stay home. So I’m not gonna say whether I have done that or not myself, since it’s being recorded. But we should have that level of knowledge of mental health issues, you know. I mean have you been sad and not able to function fully for, you know, a day? You know, yeah that’s life and that’s very normal. But if it’s for weeks at a time, or, you know, there’s certain specific symptoms. So how do we know how to even react to that? We need to have that mental health literacy.

Amy Chesser Exactly.

Suzanne Hawley That’s awesome. So is there any? I just really appreciate this time with you and talking to me about all of your wonderful, wonderful expertise and knowledge. Is there anything else for us?

Amy Chesser So just thinking of the summary statement of our talk. And again I thank you for letting me be a part of this talk. I’m so excited about mental health literacy now that I’ve learned more. I really want to get into this topic as much as I can in the future. But kind of at the bottom line I want to say to everybody out there, if nothing else, know that people with mental health literacy there’s promise. And we can help even if it’s just saying to that person there is promise. And we can help together. We can find you a resource and there’s a positive future for your future. I’m just saying that one statement may be the difference for that individual, which could impact the community and therefore the population. And I’d also add that as we seek to identify lower rates of various mental health illnesses that we’ve described before. We need to continue to think about mental health literacy as an important factor for providing the first step for that identification for those who are in need. And the ways to intervene for our population. Its mental health literacy is foundation for mental health promotion, mental health prevention, and all the stigmas that we have seen. And even within our culture today. Even right here in the United States in our communities. And providing care and information and knowledge so that we can improve mental health literacy. Suzanne, thanks again. I really appreciate it.

Suzanne Hawley Thank you. I appreciate it too. Take care.

Laurie Walkner Thank you for joining us today. Special thanks to our guests and members of our planning committee Sonja Armbruster, Katie Brandert, Stacey Coleman, Brandon Grimm, Suzanne Hawley, Abigail Menke, Melissa Richlen, Hannah Shultz, Laurie Walkner, and Kristen Wilson for guidance in creating this series. And Maya Chilese for guidance as well as hosting this series. Theme music was composed and produced by Dave Hoing and Roger Hileman. Funding for this webinar is provided by the Health Resources and Services Administration. Please see the podcast notes for an evaluation and transcript.

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