Mental Health Literacy

Mental health literacy (MHL) is a construct that has arisen from the domain of health literacy (HL) and must be understood in that context. The development of HL was initially informed by observations that low functional literacy was associated with numerous poor health outcomes. In its early definition, HL was considered primarily within the health care environment, focusing on the ability of people to be able to understand and make effective use of medical information, particularly to better understand and better adhere to medication treatments. For example, the American Medical Association defined HL as the ‘‘ability to read and comprehend prescription bottles, appointment slips and other essential health-related materials required to successfully function as a patient. ’’ In 1998, the World Health Organization (WHO) expanded the definition of HL to include ‘‘the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand, and use information in ways which promote and maintain good health. ’’ The Canadian Public Health Association has used these historical developments to inform their own and more expanded HL definition, noting that HL is ‘‘the ability to access, understand, evaluate and communicate information as a way to promote, maintain and improve health in a variety of settings across the life-course. ’’ More recently, understanding of HL has evolved into a broader construct that is considered fundamental to improving a person’s health outcome, decreasing health inequities in populations, and enhancing the operation of health systems and the development of health policy. Thus it is now recognized as necessary to improve health outcomes at both the individual and population levels. For example, Kanj and Mitic proposed a tiered HL model comprising functional HL (generic skills applied by people within health care environments), conceptual HL (generic skills applied in social contexts), and HL as empowerment for people in social and political contexts. The Wagner Chronic Care Model, and other current approaches to chronic illnesses require the enhancement of HL as a core competency for people receiving health care to enhance the likelihood of provision and receipt of effective and collaborative health care. In this context, HL has evolved from a risk factor for poor health outcomes as a result of inadequate treatment adherence to an asset that can be enhanced through educational strategies. Recent research continues to demonstrate that poor HL is related to numerous negative health and social outcomes, including but not limited to: increased rates of chronic illness; decreased use of health services; increased health care costs; and early mortality. The WHO has identified that HL is perhaps the most important component of the social determinants of health, noting that it is ‘‘a stronger predictor of an individual’s health status than income, employment status, education and racial or ethnic group. ’’ p 7 Currently, HL is understood to include the following components: the competencies needed by people to help obtain and maintain health and identify illness; understanding how and where to access and how to evaluate health information and health care; understanding how to properly apply prescribed treatments; and, obtaining and applying skills related to social capital, such as understanding rights related to health and health care and understanding how to advocate for health improvements. Further, HL is understood necessarily to be developmentally appropriate; contextually applied; involving multiple related stakeholders; and, available through existing institutional and