Young people - knowledge of mental health

Using knowledge of mental health as an evaluation criteria for young people

A recent snapshot survey of Australian COPMI programs for children of parents with a mental illness highlighted that 80 percent (15 out of 18 interventions) had increasing knowledge about mental illness as a goal.

Children often report not understanding their parent's mental illness and sometimes report feeling self-blame, guilt and/or social isolation. Many early intervention programs for young people provide an education component (psychoeducation) to address this lack of knowledge and develop understanding about mental illness. This education component commonly focuses upon:

  • what a mental illness is
  • signs and symptoms of mental illness
  • myths about mental illness.

To evaluate the psychoeducation component of a program or intervention, improvements in a young person's understanding of and knowledge about mental illness must be determined.

Click on the headings below to read more.

Knowledge of mental health - the concept

According to Australian program facilitators who include a knowledge component in their COPMI programs, the main rationale is that knowledge is empowering for young people. 'Another common rationale was that education gives young people the necessary language to communicate about their experiences and needs' and this is linked to 'a corresponding reduction in anxiety, confusion and isolation and an increase in coping strategies' (Reupert & Maybery, in press).

Psychoeducation can be defined as 'a specific form of education aimed at helping persons with a mental illness, or anyone with an interest in mental illness, to access the facts about a broad range of mental illnesses in a clear and concise manner. It is also a way of accessing and learning strategies to deal with mental illness and its effects' (Royal Brisbane and Women's Hospital, 2009).

This section focuses on the features of knowledge of mental health, and reviews some measures designed to assess this concept.

Theoretical background

The Paying Attention To Self (PATS) project highlighted the idea of 'mental health literacy' as the theoretical concept underpinning a young person's level of knowledge about mental illness, and suggested that improved knowledge is empowering. PATS assisted adolescents from families with a parental mental illness to identify problems (e.g. risks and causes) in themselves and others earlier, and raised their awareness of services and supports so that they could better seek assistance for themselves or others when needed. Increasing 'the young person's ability to seek mental health support' means that 'they are then in the position to help themselves should issues arise' (PATS Report, 2005, pp. 25-6).

Richter suggests that knowledge reduces emotional distress and self-blame and may increase resilience. Summarising previous literature, Richter suggests that 'talking about mental illness could strengthen family cohesion and lead to greater social connectedness' (2006, p.34). He also suggests that knowledge of mental illness might give young people the language to talk about mental illness and consequently process their lived experiences. He summarises: 'Overall, knowledge of mental illness may contribute to resilience by removing barriers that interfere with COPMI's ability to experience other protective factors' (2006, p. 34).

Definition of knowledge of mental health

The PATS Report perhaps comes closest to a definition of mental health knowledge for COPMI. Mental health knowledge 'relates to a person's primary knowledge and beliefs about risk factors, causes and types of professional help available' (PATS Report, 2005, pp. 25-6).

Measures of knowledge of mental health

A number of knowledge measures are available but, as far as is known at the time of writing, none have undergone rigorous psychometric evaluation or refereed publication. However, the COPMI SMILES Program employed a knowledge measure (outlined below) that was published in a peer-reviewed journal (Pitman & Matthey, 2004). The three measures reported here have been developed and used by program evaluators.

When choosing a scale to assess knowledge, it is important to consider the age of your audience and the level of cognitive ability they require to comprehend and complete the measure. Two of the measures reported were completed by participants between the ages of five and 15.

At present there are no subscales within the knowledge concept.

Goodyear, Maybery and Reupert Scale

Structure of the measure

This knowledge scale addresses some of the core components of psychoeducation interventions for children of parents with mental illness. Children report that:

  • they have a better understanding of what a mental illness is
  • not all disorders are the same
  • mental illness involves dysfunctional brain chemistry
  • a mental illness can be treated.

The measure asks children to indicate which of the eight items on the checklist are true and which are false. The measure includes statements such as 'A mental illness can be caught like a cold.' and 'I am probably the only person in my school who has a parent with a mental illness.'

Evaluation and/or research that has used this measure

This measure was designed for evaluation of Australian Northern Kids Care - On Track (NSW): an early intervention and preventative support program for children or young people aged up to 18 years who have a parent with a mental illness.

Availability of the scale

Contact Melinda Goodyear for availability of the scale, email: M.Goodyear@latrobe.edu.au

Kids Knowledge Scale

The Kids Knowledge Scale was designed by Gordon Richter to evaluate the British Columbia Kids in Control Support Group Program.

Thirty three participants - 22 boys and 11 girls aged between 7 and 14 (mean age 10) - completed the measure in Richter's evaluation, which included 16 experimental and 17 control condition participants.

Structure of the measure

The 20-item measure asks the respondent to circle either 'True' or 'False' and includes items such as 'People who have a mental illness can learn ways to take care of their symptoms' and 'Having a phobia of rabbits means that you really like them'.

Construct validity

The scale's total score has been shown to have a positive correlation (r=.28) with the general scale of the Coopersmith Self-Esteem Scale. In addition a positive correlation has been shown between age and knowledge of r=.31.

Reliability

Richter reports a Cronbach alpha of .56 for the total 20 items.

Evaluation and/or research that has used this measure

Richter used the measure to evaluate the Kids in Control Support Group Program.

Availability of the scale

The measure is available as an appendix to Gordon Richter's thesis (see 'Other references').

Measure used to evaluate the SMILES Program

The peer-reviewed evaluation of the SMILES Program used a nine-item measure of knowledge about mental illness. The measure asks general questions about what a mental illness is and what causes it plus questions about what specific types of illness are and the signs of these types of illness. The measure includes schizophrenia, depression and bipolar disorder. Equivalent findings are reported in an external review of programs offered through Carers NSW's Carers Mental Health Project 2001-2004.

The 25 children who completed this measure in the Pitman and Matthey (2004) evaluation were aged between 5 and 15 (mean age 10.8 years).

Structure of the measure

The measure was constructed specifically for the SMILES Program evaluation. The child or adolescent selected whether 'he or she felt confident of the answer to the question on a 10-point scale (from 1 - I know nothing at all to 10 - I know everything there is to know)' (Pitman & Matthey, 2004).

Evaluation and/or research that has used this measure

This measure was specifically designed for the SMILES Program by Erica Pitman.

Availability of the scale

For availability, please contact the SMILES Program.

Programs and interventions

Eastern Health FaPMI (Families where a Parent has a Mental Illness): This group runs CHAMPS which is a suite of peer support programs for children aged 8-12 years in families where a parent has a mental illness.

Kids in Control Support Group Program: This program gives information, education and support to children 8-13 years of age who have a parent with a serious mental illness.

On Track - Northern Kids Care: This early intervention and preventative support program for children and young people aged up to 18 years recognises that they may require support around understanding mental illness and medication.

Paying Attention to Self (PATS): this program was developed in response to an identified lack of support and resources for adolescents whose parents have a mental illness. See the 'Prevention services and helplines' section of the COPMI website for information on individual PATS program listings.

SMILES Program: this program for children aged 8-12 aims to provide age-appropriate education about mental illness and life skills.

Key readings

Beardslee, W.R. (2004). When a parent is depressed: how to protect your children from the effects of depression in the family. New York: Little, Brown and Company.

Paying Attention to Self (PATS) Report. (2005). Available for download.

Reupert, A. & Maybery, D. (in press) 'Knowledge is power': educating children about their parent's mental illness.

Other references

Pitman, E. & Matthey, S. (2004). The SMILES Program: a Group Program for Children With Mentally Ill Parents or Siblings. American Journal of Orthopsychiatry, 74, 3, 383-88, July.

Richter, G. (2006). Fostering resilience: evaluating the effectiveness of Kids in Control. Master of Arts Thesis, Trinity Western University, British Columbia Canada.

Royal Brisbane and Women's Hospital. (2009). What is Psychoeducation? Topics - Living With Mental Illness.