In this Papers Podcast, research associate Dr. Claire Goodfellow discusses her CAMH paper ‘Associations between dimensions of mental health literacy and adolescent help-seeking intentions’ (https://doi.org/10.1111/camh.12608).
Claire is the first author of the paper.
There is an overview of the paper, methodology, key findings, and implications for practice.
Discussion points include;
- A definition of ‘Mental Health Literacy’, as it relates to young people.
- Increased ability to identify specific mental health problems was associated with decreased formal, and informal, help-seeking intentions.
- Is the fact that knowledge of treatment efficacy was positively associated with help-seeking, despite the ability to identify a mental health problem being negatively associated with help-seeking, unique or more pronounced in adolescents than adults?
- What are the implications of the findings for CAMH professionals, Educationalists, and other stakeholders?
- How can information relating to effective treatment for mental health problems be better disseminated to young people?
In this series, we speak to authors of papers published in one of ACAMH’s three journals. These are The Journal of Child Psychology and Psychiatry (JCPP); The Child and Adolescent Mental Health (CAMH) journal; and JCPP Advances.
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Dr. Goodfellow is currently a Research Associate at the University of Glasgow’s MRC / CSO Social and Public Health Sciences Unit (SPHSU).
She has a PhD in Public Health and Health Policy from the University of Strathclyde, during this programme, she completed a long-term secondment at the McSilver Institute for Policy and Poverty Research at New York University, as well as multiple secondments to the Finnish Association for Mental Health in Helsinki. Prior to this, she studied for an MSc in Cognitive Neuroscience at UCL, and also worked in Clinical Psychology settings within the NHS. Her research is grounded in public health approaches to promoting adolescent mental health, including research into mental health literacy in young people, as well as reduction of stigma towards poor mental health.
Currently, she is working on the SOCITS project which aims to develop a new, context-specific method of measuring youth mental health.
Featured Paper ‘Associations between dimensions of mental health literacy and adolescent help-seeking intentions’, Claire Goodfellow, Anna Macintyre, Lee Knifton, Edward Sosu
[00:00:01.410] Jo Carlowe: Hello, welcome to the Papers Podcast series for the Association for Child and Adolescent Mental Health, or ACAMH for short. I’m Jo Carlowe, a Freelance Journalist with a specialism in psychology. In this series we speak to authors of papers published in one of ACAMH’s three journals. These are the Journal of Child Psychology and Psychiatry, commonly known as JCPP, the Child and Adolescent Mental Health, known as CAMH, and JCPP Advances.
Today, I’m interviewing Dr. Claire Goodfellow, Research Associate at the Social and Public Health Sciences Unit at the University of Glasgow, and the first author of the paper “Associations Between Dimensions of Mental Health Literacy and Adolescent Help-seeking Intentions.” Recently published in CAMH. Claire’s paper will be the focus of today’s podcast. If you’re a fan of our Papers Podcast series, please subscribe on your preferred streaming platform, let us know how we did, with a rating or review, and do share with friends and colleagues.
Claire, welcome, thank you for joining me. Can you start with an introduction about who you are and what you do?
[00:01:10.760] Dr. Claire Goodfellow: Course, and thanks for having me today. So, as you mentioned, I’m currently a Research Associate at the University of Glasgow. The work that I’m doing today was partly done when I was at the University of Strathclyde, which is also in Glasgow, but by and large, my work mostly looks into, sort of, public health approaches to supporting youth mental health.
At the moment, I’m working on projects to develop new measures in mental health that are a little bit more contextualised. And previously, I’ve looked at things like loneliness and mental health in young people, as well, but my real interest is looking into mental health literacy and stigma in young people and how that might impact on things such as help-seeking, and, sort of, their overall mental health and wellbeing, as well.
[00:01:43.150] Jo Carlowe: We’re going to look at your paper, “Associations Between Dimensions of Mental Health Literacy and Adolescent Help-seeking Intentions,” which was recently published in CAMH. But before we go into the detail, I’m thinking it would be useful if you can give us a definition of ‘mental health literacy’ as it relates to young people.
[00:02:00.870] Dr. Claire Goodfellow: So, very broadly, mental health literacy is just about how much young people know about mental health, both good and bad. But more specifically, I think, the original definition of mental health literacy was put forward back in the late 1990s by Anthony Jorm and colleagues in Australia, and they defined it as “knowledge and beliefs about mental disorders, which aid their recognition, management and prevention.” It has gone through a couple of iterations since. More recently, it was updated by some colleagues in Canada, and it’s a little bit more holistic, so it looks at things like stigma reduction and maintaining good mental health.
But really, and I’ll talk about this a little later, the definitions of mental health literacy are multidimensional, but we don’t really know about how those different dimensions of mental health literacy, such as things about knowing how to seek help and so on, how they might impact things like help-seeking. So, hopefully that’s where my paper stepped in and shed, hopefully, just a little bit of light, so…
[00:02:47.879] Jo Carlowe: Brilliant, and can you give us an overview of the paper, of the study? What did you look at and why?
[00:02:53.440] Dr. Claire Goodfellow: Primarily, we just wanted to know what mental health literacy looks like in a contemporary cohort of adolescents, almost, like, to get a baseline of what mental health literacy looks like in young people in the UK. And so we were also, obviously, interested in how mental health literacy is associated with help-seeking intentions, or young people’s willingness to seek help. And that was both from, sort of, formal and more informal sources, so formal is things like GPs, Psychologists, and Teachers, whereas, obviously, informal is more parents, friends and family. And we were also interested in gender differences, so if there might be differences in girls’ and boys’ levels of mental health literacy, or willingness to seek help.
And we also included some other covariates in the study, so things like socioeconomic position, ethnicity, and age, as well, just ‘cause we were a little bit interested if there was any differences there in how mental health literacy impacted on things like help-seeking and mental health. And, in general, there’s been a lot less work that’s looked at adolescents’ mental health literacy. Sort of, traditionally, it’s mostly been done on adult populations and so we do know a little bit less about mental health literacy in young people, and in particular about how those discrete dimensions of mental health literacy might impact on young people.
[00:03:52.579] Jo Carlowe: What can you tell us about the methodology that you used for the study?
[00:03:56.840] Dr. Claire Goodfellow: Yeah, so this was a cross-sectional study. So we developed a questionnaire for young people with the idea of collecting responses from young people aged between 12 and 18. And so that contained measures of, obviously, mental health literacy, help-seeking, and also we looked into stigma, as well, but that wasn’t included in the study, and obviously the, sort of, demographic information, as well.
Prior to using that questionnaire with young people in schools, we did do a little bit of piloting, which was actually quite interesting. So, in part, the piloting was, obviously, just to make sure the questionnaire was well-understood, that it was developmentally appropriate, and to make sure that it didn’t take too long for young people to complete.
But, really, what I was interested in was making sure that we had, I guess, construct validity around what mental health problems, what that phrase meant. So, I think going into the research, I was aware that I, as an academic and as someone who had previously worked clinically, and even just as an adult, I might have a different idea of what mental health problems meant compared to a teenager.
So I worked with two youth groups in different parts of the UK. So one in a very deprived area of North Glasgow, and one in a more affluent area in London, and just asked them, “Look, what does the phrase ‘mental health problems,’ what does that mean to you?”, and really interesting responses, actually. I think one participant had talked about dysregulation of the prefrontal cortex at, sort of, 14 years of age. So some really insightful answers, and some others that, kind of, looked into, you know, environmental causes and biological causes of poor mental health. So really informed responses, which we then used to create a working definition of mental health problems that we used throughout the research. So that wasn’t really mentioned in the paper per se, but I think that was a really enjoyable part of doing the research, was doing that slightly qualitative piloting with young people.
But once we had done that, and we had our questionnaire, kind of, ready to go, I went into ten different secondary schools from different areas of Scotland. Most of these were, kind of, urban or semi-urban. So we didn’t actually get into any rural schools, but once we’d collected our data, we managed to collect responses from just shy of 750 young people, so I think 734 was the total we were able to include. And once we’d collected all our cross-sectional data, we then did some confirmatory factor analysis and some structural equation modelling, so – just to understand the relationships between the key constructs of interest that we were examining and the research, so…
[00:05:59.090] Jo Carlowe: Can you share some of the key findings from your paper?
[00:06:02.360] Dr. Claire Goodfellow: So, I think, probably the first and the biggest thing to note is that when we were collecting data around young people’s mental health literacy, we were really keen to pick up on different dimensions of mental health literacy. So that’s where our confirmatory factor analysis stepped in. So, for those who don’t do that kind of analysis, that’s essentially looking within the data to, kind of, see what responses are grouping together and what kind of dimensions they represent.
And so, we found two distinct dimensions of mental health literacy in the data that we collected. The first one we labelled “knowledge of treatment efficacy,” and the second one we labelled “ability to identify a mental health problem.” So “knowledge of treatment efficacy,” that just relates to the extent to which the young people that we surveyed agreed that things like medications and talking therapies and so on were effective treatments for mental health problems. “Ability to identify a mental health problem” is self-explanatory. So that was the extent to which young people thought that things like schizophrenia, bipolar disorder and depression were mental health problems, whereas things like stress and grief perhaps might not be.
And so we found that the greater extent that young people knew about effective treatments or knowledge of treatment efficacy, that was actually associated with an increased willingness to seek both formal and informal help. Whereas, on the contrary, and what was quite surprising, was that the more young people were able to identify those different mental health problems, the less likely they actually were to seek help.
And I also mentioned we were interested in gender differences, but we actually didn’t find any. So, I wanted to see if gender might moderate or change the strength of the association between these dimensions of mental health literacy and help-seeking. And actually, we didn’t find any significant difference between girls and boys, in terms of that association, which was a surprise, I think, based on the previous literature, I’d expected some sort of effect.
[00:07:38.270] Jo Carlowe: Any views as to why?
[00:07:40.849] Dr. Claire Goodfellow: Yeah, I think ‘cause – it did throw me, I’ll admit, ‘cause, you know, when you look at the literature on mental health literacy and help-seeking, it tends to be that girls are much more likely to seek help. They’re more interdependent, and so there’s less resistance to seeking help, and girls tend to be more knowledgeable about mental health. So I was expecting boys might have higher stigma, lower mental health literacy, and less likely to seek help.
I’m not really sure. I’ve seen maybe one other paper that’s found no gender differences, and they said it might be because they’re looking at a wider age range of adolescents. So, 12 to 18, which is the sample that I was using, and so it might be more down to age, rather than gender specifically, but I can’t really extrapolate from my own specific data. And I’d really love to do a bit more, kind of, qualitative work around gender differences and how that impacts on things like mental health literacy and stigma and help-seeking, but that’s going to be for future projects.
[00:08:25.060] Jo Carlowe: That will be very interesting. Let’s go back to something you mentioned, which I found interesting and rather surprising, and this is that the increased ability to identify specific mental health problems was associated with decreased formal and informal help-seeking intentions. What do you make of that finding?
[00:08:43.010] Dr. Claire Goodfellow: That was, kind of, a moment in the analysis where I thought, “I might need to doublecheck this, that I’ve not reverse coded something.” Because I think the underlying assumption is that all knowledge is good knowledge in mental health literacy, and the more we can increase that, the better that will be. So I think it was a surprise and it’s not something that I had necessarily seen in, sort of, the pre-existing literature.
So, I do wonder if part of the reason that we saw that effect might be, in part due, to the measure of mental health literacy that we used. And so, the items that were included for ability to recognise a mental health problem were things like schizophrenia and bipolar disorder and depression. So we do know that in young populations, schizophrenia and bipolar disorder, they’re particularly stigmatised, and there’s part of stigma that’s notions of perceived dangerousness and so on. So it might be that young people have quite high stigma towards these, or these are just unfortunately conditions that are in receipt of a little bit more stigma, and so that might, sort of, disinhibit willingness to seek help.
And, again, I can, sort of – from my nice cross-sectional quantitative data, I can say what’s happening, but I can’t really say why. And it would, again, be something that I’d love to explore in a little bit more depth, as – and, again, probably qualitatively is why is that happening, but it was an interesting finding and certainly it was one that did surprise me.
[00:09:53.350] Jo Carlowe: Your findings also show, as you mentioned, so, the ability to identify a mental health problem was negatively associated with help-seeking, while knowledge of treatment efficacy was positively associated. Is that unique to or more pronounced in adolescents than adults, and if so, why might that be the case?
[00:10:12.829] Dr. Claire Goodfellow: I’d really love to be able to give a really insightful answer to this question, but I don’t know that this specific research, looking at different dimensions of mental health literacy, has been done in an adult population. So I think that’s one of the novelties of the paper. So I don’t actually know if it’s something that might be more pronounced in young people. Obviously, we know that adolescents have different social pressures and different experiences to adults that could well make this more pronounced. But yeah, it is difficult to say, and I think it’s potentially another avenue for future research, so thank you for the idea.
[00:10:42.380] Jo Carlowe: Given your paper reveals then that knowledge of treatment efficacy was associated with increased help-seeking intentions, I’m wondering what the implications are for this for CAMH professionals, for educationalists, and any other stakeholders.
[00:10:55.930] Dr. Claire Goodfellow: Yeah, so I think that’s something that’s actually really interesting, and I think the results could translate into some sort of meaningful changes in terms of interventions. But I think for me, the first thing that struck me was it might actually feed into these broader narratives about moving away from maybe a deficit or a problem-focused framing of mental health, and more towards, kind of, a holistic discussion of mental health as being on a spectrum, and looking at mental health, both good and bad.
And I do think that it’s important to talk with young people about mental health as being on that, kind of, spectrum, and, you know, normalising some experiences of mental health and then recognising when things might trip into, sort of, the region where they might need to seek help. So, yeah, I think it speaks to me that we might need to shift an emphasis onto positive mental health, as well as, sort of, how to obtain and maintain some good mental health and wellbeing. And it might be that, you know, more research needs to be done in terms of the content of mental health interventions that we’re delivering in schools, and just really how we speak about mental health.
So I think when people talk about mental health, they do tend to think of poor mental health and mental health problems. And so I think we might need to switch it so that when we talk about mental health, we think about it in the same way that we think of someone who’s physically healthy. So if we say “mental health,” we think of someone who’s got a good awareness of their emotions and their behaviours and so on. So, yeah, I think it would be really great to get some feedback from Teachers and third party and other, kind of, stakeholders about what they think.
I speak from a very research perspective, so it’d be great to get some input from educationalists and other stakeholders, as well.
[00:12:18.600] Jo Carlowe: Yeah, I mean, do you imagine that would also not solve but help this issue of being able to identify a mental health problem being negatively associated with help-seeking? ‘Cause I’m imagining…
[00:12:28.670] Dr. Claire Goodfellow: Yeah.
[00:12:29.670] Jo Carlowe: …some of those words like ‘schizophrenia’ seem very scary to young people, and…
[00:12:34.400] Dr. Claire Goodfellow: Yeah, I think that would be an important part of, kind of, normalising mental health, you know, both good and bad. And I think, you know, I’ve spent some time working in Helsinki for the Finnish Association for Mental Health, where they talk about how they have, sort of, mental health education in their national curriculum, really all the way from nursery right through to the end of high school. And I remember, sort of, going on these visits, as a Stigma Researcher and a Mental Health Literacy Researcher, thinking that this is really how – like, a really effective way to end mental health stigma or really reduce it. Or to increase people’s mental health literacy, because it’s normalising that people have good and bad mental health, and giving young people coping skills for when they feel like their mental health is a bit too much. And then, sort of, also signposting, you know, how to seek help if things get to the point where they can’t manage it on their own. And I think it does take some of the fear of the unknown and these perceptions of dangerousness around some poor mental health problems. So yeah, I think that kind of conversation around normalising mental health are really important, particularly amongst young people.
[00:13:28.790] Jo Carlowe: I mean, you’ve already touched on this, but do you have any other thoughts about how information, relating to effective treatments for mental health problems, could be better disseminated to young people?
[00:13:39.290] Dr. Claire Goodfellow: Actually, when I finished this research that was written up in the paper, I was quite keen to speak to young people themselves about this. And so, as part of a subsequent fellowship, I did some small, kind of, focus groups with young people. So I had nice and lively group of youth advisers, and I did ask them, you know, “What’s a good way to engage young people in these conversations around mental health and mental health literacy?” So they were a lot less keen for traditional methods like leaflets or lectures or assemblies and so on. And I think there was a real keenness for peer-led or young people to, sort of, come in and talk about their experiences, not just of extreme or poor mental health, but also how they manage their mental health at times of stress, and how they manage to maintain wellbeing.
And I think one of the things that came out, which made me feel quite old, actually, was they’re really keen to engage with social media. And so, I think a lot of young people turn to social media for information, and so I think it’s important that that information is evidence-based and well-validated. But I did have one Youth Adviser, sort of, offer to edit some TikTok videos for me that share some of the results of this paper, and so that was quite well-received, and that was a nice way to do a bit of youth engagement.
So, I think in terms of disseminating to young people, it’s really important to meet them, kind of, where they are, and talk to them about what the best ways to engage them are. Some of them were really interesting, I think they talked about, you know, one school had had a Poet come in and talk about mental health. And so, I think there’s lots of really creative and really engaging ways to speak to young people about mental health, and working alongside young people to develop interventions would be a really strong way to start in terms of having those, kind of, more normalised conversations.
[00:15:04.000] Jo Carlowe: Great, sounds really important. Claire, is there anything else in the paper that you would like to highlight?
[00:15:08.399] Dr. Claire Goodfellow: Yeah, I think we’ve maybe covered some of the – sort of, the surprising points around, kind of, the lack of gender difference and, you know, some forms of mental health literacy, potentially having this negative association on help-seeking. But I think things that struck me, when I was doing the research, was around how we speak about help-seeking, I think that might need to be a little bit updated. So, the measure of help-seeking that I use, you know, asks about things like, “Would you phone Childline or use a helpline?” and things like that, and there was no real mention of the internet or social media, anything. So I think, you know, we might need to develop new measures of help-seeking, as well as mental health literacy, just to make sure that we’re keeping pace with the changes that are happening in young people’s lives and just making sure that the research that we’re doing is relevant.
[00:15:47.410] Jo Carlowe: Are you planning any follow-up research or is there anything else in the pipeline that you’d like to share with us?
[00:15:52.360] Dr. Claire Goodfellow: I mentioned earlier that when I was doing the research that was written up in the paper, this was mostly done in, kind of, urban settings, and so I was really keen to speak to young people in rural areas. So, I’ve done a little bit of work recently with young people in rural and remote parts of Scotland, talking to them about their experiences of mental health literacy, and particularly stigma, which we know might be a little bit more visible in rural communities. And actually, some of the responses that we had around rural mental health were quite mixed. I was quite surprised that some young people were saying things like, you know, “The smaller communities means that there’s more adults who I trust, and so who I feel that I can go to with my poor mental health, or I can go to and talk about my mental health if I’m struggling.” Whereas others, and kind of more what I had expected, had said that, actually, particularly from older adults, they felt like there was this lack of understanding or poor mental health per se and, kind of, increased stigma that made it more difficult to seek help. And so I think there may be a lot more work that needs to be done with rural adolescents to see how their experiences with mental health literacy and stigma might impact on help-seeking. So that’s something that I’d certainly like to do a little bit more of in the future.
In terms of other work, I’m also really interested in how, kind of, peer and social relationships impact on mental health. I would love to explore, kind of, the relational aspect of both mental health literacy and stigma, ‘cause we know that peer relationships are highly influential during adolescence, and so it might be that there’s a certain degree of similarity and beliefs in peer groups, and so how do you challenge that? So if you can get some really good, strong mental health literacy into a few, kind of, influential peers, will that then, kind of, spread to the other peers? So I think there’s some really interesting, kind of, social network aspect to the work that could be done in the future. So, if I’m lucky and have the time and the funding, that might be another avenue that I’d like to go down.
[00:17:32.340] Jo Carlowe: Wow, yes, such a rich area for exploration, isn’t it?
[00:17:35.660] Dr. Claire Goodfellow: Yeah, definitely.
[00:17:37.240] Jo Carlowe: Finally, Claire, what is your take home message for our listeners?
[00:17:40.580] Dr. Claire Goodfellow: I think the big one is that we can’t just assume that all information is necessarily good and useful information. So I think there’s a real need to evaluate mental health literacy interventions in schools to make sure that they are effective, and to make sure that, actually, they’re not increasing harm. You know, we want to make sure that these things are increasing wellbeing and opportunities to access support. So I think we need to do a little bit more work into dimensions of mental health literacy and make sure that these interventions are really routed in the current research.
More broadly, I think we just need to keep exploring mental health literacy in adolescents and how different dimensions might have these different impacts. ‘Cause I do think there’s a huge potential for mental health literacy to be this really powerful upstream public health approach to promoting mental health and wellbeing. So if we can educate Teachers and young people and make them mental health literate, it could have really strong impacts on wellbeing going forward.
]00:18:29.220] Jo Carlowe: Thank you ever so much.
[00:18:30.220] Dr. Claire Goodfellow: Yeah.
[00:18:31.220] Jo Carlowe: For more details on Dr. Claire Goodfellow, please visit the ACAMH website, www.acamh.org, and Twitter @acamh. ACAMH is spelt A-C-A-M-H, and don’t forget to follow us on your preferred streaming platform. Let us know if you enjoy the podcast, with a rating or review, and do share with friends and colleagues.