Journal of Psychiatric and Mental Health Nursing, 2014, 21, 635–641

The impact of an educational mental health intervention on adolescents’ perceptions of mental illness E . S A K E L L A R I 1 MSc RHV, A . S O U R A N D E R 2 A. KALOKERINOU-ANAGNOSTOPOULOU3 H . L E I N O - K I L P I 1,4 Ph D RN

Ph D

MD,

Ph D

RN

&

1

PhD Candidate, Department of Nursing Science and 2Professor, Department of Child Psychiatry, University of Turku, Turku, Finland, 3Associate Professor, Faculty of Nursing, University of Athens, Athens, Greece, and 4 Professor and Chair, Nurse Director, Hospital District of Southwest Finland, Turku, Finland

Keywords: adolescents, Greece, health

Accessible summary

education, interviews, mental illness, secondary schools



Correspondence: E. Sakellari



Nikopoleos 39 11253 Athens Greece E-mail: [email protected] Accepted for publication: 20 February 2014 doi: 10.1111/jpm.12151



Positive perceptions towards mental illness are essential for a mentally healthy society. This study explores adolescents’ perceptions of mental illness and examines the extent to which these perceptions changed after a mental health educational intervention. The results of this study demonstrate that there is a positive effect on adolescents’ perceptions towards mental illness.

Abstract Nowadays, in many countries, mental health care is primarily community based. Community perceptions of mental illness are an essential issue for the quality of life of people with mental health problems and the promotion of mental health in general. The aim of this study was to explore adolescents’ perceptions of mental illness and to examine the extent to which those perceptions changed after an educational mental health intervention. The data were collected twice, before and after the educational mental health intervention. Fifty-nine pupils from two Greek secondary schools were individually interviewed, and data were analyzed by inductive content analysis. The findings show that adolescents can provide a rich description of mental illness in a multidimensional way. After the intervention, they provide different descriptions, identify various forms of mental illness and express opinions on what mentally ill people need and how they should be treated. It is concluded that mental health educational interventions in schools can be effective in changing adolescents’ perceptions towards mental illness.

Introduction Mental health is an essential component of health. Approximately 14% of the global burden of disease has been attributed to neuropsychiatric disorders (Prince et al. 2007). It is estimated that nearly 50 million citizens experience mental disorders, with depression being the most prevalent health problem in many European Unionmember states (European Pact for Mental Health and Well-Being 2008). Most people who suffer from severe mental illness live within the community (Stark et al. © 2014 John Wiley & Sons Ltd

2004). In high-income countries, between 5% to 20% of children and adolescents need mental health services (WHO 2005). Furthermore, one in eight teenagers under 18 years old has a mental disorder (WHO 2004). Negative evaluations of the mentally ill date back to ancient times; public sentiment favoured socially rejecting mentally ill people and continually keeping a social distance from them (Martin et al. 2000). Currently, the public’s reactions to mental illness include a plethora of prejudicial beliefs and emotions and behaviours that lead to discrimination against the mentally ill (Corrigan 2004). 635

E. Sakellari et al.

Studies have shown that the general public sees people with mental illness as being dangerous and that other people should fear them (Corrigan et al. 2001) and keep a social distance from them (Link & Phelan 1999). This fear is based on the perceived association between mental illness and violence (Monahan & Arnold 1996). The general public associates mental illness with hallucinations, delusions, psychomotor abnormalities and incoherent speech (Sartorius 1998). Researchers have identified stigma and discrimination as important obstacles to people with mental illness being integrated within society (Bjorkman et al. 2008). Thus, community perceptions of mental illness should be studied and efforts should be made to foster a positive awareness of mental illness, especially among adolescents who will soon assume adult responsibilities within the community. Education enables the public to make more informed decisions about mental illness (Corrigan & Penn 1999). Furthermore, modifying public perceptions about mental illness could promote policy changes favourable to psychiatry (Austin & Husted 1998). Because the promotion of mental health is a more extensive concept than preventing mental health problems (Puolakka et al. 2011), it is crucial to promote an understanding of the nature of mental health and mental illness as a means of changing policies and practices in education, employment, law and healthcare, which are critical to mental health (Herrman 2001). Adolescence is an age when views are formed on a range of topics that impact future adult behaviour (Pinfold et al. 2005) and define later attitudes (Fitzgerald et al. 1995), and should include the promotion of respect, tolerance, empathy and an appreciation of diversity (Sabir Ali & Iftikhar 2006). It is a time of rapid development in cognitive skills with intense acquisition of new information that establishes the basis for a productive adult life (Golub 2000). Schools play a very important role in promoting mental health (Johansson & Ehnfors 2006). Puolakka et al. (2011), support that mental health promotion in schools has risen as a very important developing area in public health service. Considering all this, adolescents are an ideal target group for addressing a study concerning mental illness, which will increase their awareness about mental illness and provide them information, and furthermore potentially promote mental health in the community. A review of the literature demonstrates that educational interventions for adolescents about mental illness are not a popular subject. The limited number of published studies primarily focuses on knowledge of and attitudes towards mental illness. The results are encouraging with regard to increasing adolescents’ knowledge about mental health and illness and reducing their negative attitudes towards people with mental health problems (Sakellari et al. 2011). 636

However, the previous studies do not provide information regarding how adolescents understand mental illness and therefore, our study begins to address this gap. The aim of our study was to explore perceptions of mental illness among adolescents and to examine the extent to which these perceptions changed after a mental health educational intervention. The ultimate goals of our study are to provide information for community mental health nurses internationally, to increase awareness about mental illness among adolescents and to stimulate further mental health educational interventions among this target group. The research questions are: 1. What is the perception of mental illness among adolescents? 2. Does the perception of mental illness change after a mental health educational intervention?

Methods Setting The study took place in two randomly selected secondary schools in different districts of Athens, Greece, with both schools following the national curriculum (Ministry of Education 2013). Because all schools in Greece follow the same curriculum and have the same structure, which is determined by the Ministry of Education, there were no exclusion criteria. The random selection of the two schools was made by a lottery draw.

Participants Fifty-nine pupils aged 13–16 years participated in this study. There were two groups of participants from two schools. One school was the intervention group (n = 28), while the second school was the comparison group (n = 31), to avoid possible contamination. Determination of the intervention and comparison group was also done by random selection. The 31 participants in the comparison group did not receive any mental health education intervention. Two participants dropped out of each group.

Data collection The data were collected twice from both groups; once before and once after the intervention. We chose individual structured interviews to know all possible ways in which the respondent views or experiences phenomena (Parahoo 2006). The baseline interviews were conducted over 1 week, during the same time period for both the comparison and intervention groups. The second interviews commenced 1 day after completion of the intervention and © 2014 John Wiley & Sons Ltd

Adolescents’ perceptions of mental illness

were conducted over the same time period for both the intervention and comparison groups. Individual interviews with the same open-ended questions before and after the intervention were conducted by the primary researcher (ES) in a classroom. The researcher asked the participants to present themselves to the classroom where the interviews took place. The researcher introduced herself at the first interview. Firstly, she asked the participants to answer some background information questions and then moved to the main research questions. The interview was digitally recorded throughout its whole duration. The same process was followed for both participant groups before and after the intervention. Anonymity was ensured because no names were used in any part of the data collection. Because the same person conducted all the interviews, achieving an adequate level of trustworthiness was established. In the interviews, the following questions were asked: What is mental illness? Could you describe a mentally ill person? In addition, we asked for the following background information: their age, the educational level of their parents, whether or not they had ever met a mentally ill person, whether they would ever visit a mental hospital or a guest house where people with mental health problems live and finally if they had ever discussed mental health or mental illness with their parents or siblings.

the general curriculum. The teaching methods used were lecture and discussion. Lecture is a primary method for health education and the adolescents are familiar to this method because it is a method widely used in schools for teaching. As the health education methodology literature supports (e.g. Gilbert et al. 2011); slides were shown emphasising the key points. The lecture gave the opportunity to provide factual information in a logical sequence. Because of the long time of the lecture, the educator summarized and reviewed the key points and also checked to be certain that the participants were following and understanding as well as allowing questions at any time. At the end of the education, there was time for the participants to ask additional questions, seeking clarification and challenging and reflecting on the subjects presented. Efforts were taken to make the content comprehensible by adapting the language to fit the age and cognitive level of the pupils and professional terms were not used. However, the diagnostic labels were used because the aim was for the participants to learn the correct names and definitions of the different illnesses. However, the diagnostic criteria or the clinical descriptions in terms of the International Classification of Diseases, ICD-10 (classification of mental and behavioural disorders) or Diagnostic and Statistical Manual of Mental Disorders, DSM IV were not presented.

Data analysis Mental health educational intervention The mental health educational intervention was designed by the researchers for this study using definitions, concepts and evidence from the existing literature. The mental health educational intervention included the following; (1) an introduction; (2) defining and describing mental health and the experience of mental health, as well as mental health prevention; (3) identifying different types of mental illness (bipolar mood disorder, depression, schizophrenia), their causes (biological, psychological, social factors), how patients experience mental illness (symptoms, etc.) and forms of treatment (medication, psychotherapy, counselling, rehabilitation interventions); (4) discussing myths and truths about mental health and mental illness; (5) focusing on some things to remember (help-seeking, facing difficulties, mental health promotion, etc.); (6) mental health care services in Athens (about 60 min in total); and, (7) discussion (about 30 min). The intervention was implemented for the intervention group after the baseline interviews were completed. It was conducted in a classroom by the primary researcher (ES) who is a health professional qualified in health education. It lasted for two teaching hours (including the discussion) during a standard school day and was included as part of © 2014 John Wiley & Sons Ltd

The interviews were transcribed verbatim in Greek. The unit of analysis was the whole interview as the literature suggests (Graneheim & Lundmand 2004). The analysis strategy used was inductive content analysis, which is associated with the techniques described for social scientists by Strauss (1987). The researchers read the interviews several times to become familiar with the data. First, the data were open coded based on the content of the interviews. This phase included unrestricted coding of the data, which was tentative at this point. Then categories were formed using words taken directly from the participants’ responses. We did this through labelling to group together similar responses. Finally, we developed emerging categories by combining similar content areas to reduce the number of categories by including some of them within similar, yet broader, categories. The final categories illustrated the participants’ perceptions of mental illness with the aim of covering what they included in their responses.

Ethics Approval to conduct the study was obtained from the Greek Ministry of Education. Because the participants 637

E. Sakellari et al.

were pupils under 18 years of age, participants as well as their parents or guardians signed a written informed consent form. We provided information to the participants and their parents/guardians concerning the nature of the study, how the study would proceed and the objectives of the study. Participation was voluntary and no identifying information has been used to ensure the anonymity and confidentiality of the participant and the right of the participant to withdraw from the study at any time.

Results All of the participants were born and raised in Athens. The mean age was 14.3 years [standard deviation (SD) = 1.0 years] for the comparison group and 13.7 years (SD = 0.5 years) for the intervention group. The two groups of adolescents were similar in terms of sex. The educational level of the mothers did not differ statistically between the two groups (Pearson Chi-square test, asymp. sig. 0,464, 2-sided) and neither did that of the fathers (Pearson chisquare test, asymp. sig. 0,341, 2-sided). Also, the same proportion of adolescents had ever had contact with a mentally ill person (41.4% in the comparison group and 34.6% in the intervention group). Furthermore, we asked the participants for other background factors, which are presented in Table 1.

Perception of mental illness Pupils in both groups described mental illness in a multidimensional way before and after the mental health educational intervention, and they are illustrated in Table 2. Mental illness is being or not being in a state of . . . Participants described mental illness according to different states of being or not being in a state of something. It can Table 1 Willingness to visit a mental hospital and discussion of mental illness among family Intervention group n = 28 ‘Would you ever visit a mental hospital?’ f % Yes 11 39.3 No 4 14.3 Maybe 7 25 Yes, if it was a relative 6 21.4 or friend ‘Have you discussed mental illness in your family?’ f % Yes, with parents 18 64.3 Not with parents 10 35.7 Yes, with siblings 21 75 Not with siblings 7 25

638

Comparison group n = 31 f 9 8 7 7

% 29 25.8 22.6 22.6

f 19 12 25 6

% 61.3 38.7 80.6 19.4

be seen that both groups’ responses did not differ. After the intervention, the responses among the comparison group remained similar. On the other hand, after the intervention, the intervention group participants offered fewer responses that included elements of mental illness as ‘being in a state of . . .’, while their responses included three new elements: being distant (one participant), that any one of us could possibly be mentally ill (two participants) and that a mentally ill person is afraid of rejection (two participants). Furthermore, after the intervention, several participants from the intervention group said that mentally ill people are not dangerous and that they are not so different/special. Mental illness is doing (behaving) Participants perceived of mental illness as doing something or behaving in some way. After the intervention, although the responses among the comparison group are similar, there were few differences among the intervention group participants in the ways they described mental illness. Two of them stated that mental illness involves behaving differently, which participants had not included in their response prior to the intervention, and none of the participants described mental illness as doing crazy things or doing things that are crazy or not quite normal, right or usual. Mental illness is having or not having something . . . Participants before the intervention described mental illness as having or not having something with the dominant description having psychological or other problems. After the intervention, six of the participants from the intervention group described mental illness as having problems. Before the intervention, 14 of the participants described mental illness in this way. Additionally, after the intervention, two participants described mental illness as having a disorder of the soul (psyche), while before the intervention, only one participant described mental illness in this way. Furthermore, the participants included some elements that were not mentioned before the intervention: that mental illness is having an illness (one participant) and

Table 2 Mental illness is . . . Before the intervention

After the intervention

1 2 3 4 5 6 7 8

1 2 3 4 5 6 7 8 9 10 11

... ... ... ... ... ... ... ...

being . . . / . . . not being . . . doing (behaving) . . . having . . . / . . . not having . . . not knowing . . . seeing . . . not being able to . . . feeling . . . talking to oneself . . .

. . . being . . . / . . . not being. . . . doing (behaving) . . . . . . having . . . / . . . not having . . . . . . not knowing . . . . . . seeing . . . . . . not being able to . . . . . . feeling . . . . . . talking to oneself . . . . . . an illness . . . Expressed by attitudes . . . needing . . .

© 2014 John Wiley & Sons Ltd

Adolescents’ perceptions of mental illness

that it involves having extra stress (one participant), displaying extra sadness (six participants) and having a symptom (one participant). Finally, in terms of the responses about ‘not having something’, after the intervention several of the intervention group participants only mentioned ‘not having logic’ and ‘not having friends’ (two participants and one participant respectively). The responses of the comparison group did not change after the intervention. Mental illness is not knowing . . . Before the intervention, participants defined mental illness as a person not knowing what is going on around them and not knowing what he or she is talking about or doing. There are still the same responses among the comparison group after the intervention. However, after the intervention, only a few participants in the intervention group described mental illness as a person not knowing what is going around them and not knowing what she/he is doing. Mental illness is seeing . . . Before the intervention, participants referred to mental illness as seeing everything in black and imagining things that are not based on reality. After the intervention, participants in the intervention group did not include any of the above elements in their explanations of mental illness, while one of the participants of the comparison group did as before the intervention. Mental illness is not being able to do something . . . Before the intervention, participants stated that mental illness involves not being able to do certain things. After the intervention, participants within the intervention group described mental illness differently; they did not include all of the same elements that they had before the intervention. Moreover, there were two new responses after the intervention: one participant said that mental illness is not being able to control one’s feelings, and four said it is not being able to do all of one’s activities. On the other hand, the responses of the participants of the comparison group are similar before and after the intervention. Mental illness is feeling . . . Before the intervention, participants described mental illness in terms of feelings of a mentally ill person. However, after the intervention, intervention group participants described mental illness as feeling different, while none of the participants of the comparison group included any elements in terms of feelings. Mental illness is talking to oneself Before the intervention, participants stated that mental illness involves talking to oneself. The same was expressed © 2014 John Wiley & Sons Ltd

after the intervention by a couple of the comparison group participants. In contrast, after the intervention, none of the intervention group participants described mental illness in this way. Mental illness is an illness . . . Before the intervention, only one of the participants included the diagnosis of schizophrenia in his description; this response was among the comparison group and it is also found after the intervention. After the intervention, several participants in the intervention group included in their description of mental illness such things as depression, schizophrenia or bipolar disorder. Furthermore, after the intervention, some participants in the intervention group stated that mental illness is an illness that is no different from any other illness, or they described it as a physical illness, an illness that anyone is vulnerable to and an illness that can be managed. Mental illness . . . as expressed by attitudes Only after the intervention and only the participants in the intervention group expressed positive attitudes towards the mentally ill people, which they had not done before the intervention. They said that we should be friendly to them and that we should not be afraid of them, not behave differently towards them and not leave them in the margins. Mental illness is needing . . . Only after the intervention and only participants in the intervention group described mental illness in terms of needing specialized help; in contrast, participants in the comparison group did not describe it in this way.

Discussion This study describes the perceptions of mental illness among adolescents and the results of a mental health educational intervention. The findings show that participants described mental illness in a multidimensional way. Nevertheless, the participants changed their descriptions somewhat after the intervention and added new elements to their descriptions of mental illness. The greatest change after the intervention involved new categories added by the participants in the intervention group. It has been found that in younger age (8–9 years) there is a lack of understanding of mental illness, lacking wellformed conceptions of mental illness while unable to provide examples of people with mental illness (Adler & Wahl 1998). On the contrary, the participants in our study who are adolescents were able to describe their perceptions of mental illness and provide a rich description of it. Previous research also supports that a young person’s under639

E. Sakellari et al.

standing of mental illness becomes more sophisticated as she/he progresses in age and school grade (Wahl 2002). One of the dominant answers among the participants from both groups when referring to mental illness was having psychological or other problems. It has been found that young people identified physical and mental disabilities, bullying and psychological problems as the main characteristics displayed by mentally ill people (Dogra et al. 2005). The participants described mental illness as being shy and sad and causing a person to cry. In the same way, it has been shown that the general public often described mentally ill people as being more sensitive and that only a minority of them (8%) believed that the mentally ill are more intelligent than other people (Wolff et al. 1996). Studies conducted in Northern Sweden showed that many perceived mentally ill people as being more capable of committing violent acts than others (Ineland et al. 2008). However, only three participants in our study described mentally ill people as being dangerous. After the intervention, the responses of the participants also included the need for specialized care. Similarly, other researchers have found that young people and their parents think that mental illness is a disability of the brain requiring hospitalization (Dogra et al. 2005). Furthermore, it has been found that the young people’s attitudes revolved mainly around sympathy and fear (Secker et al. 1999). Likewise, earlier it has been found that a minority of respondents (9%) objected to ex-psychiatric patients living in their neighbourhood (Ineland et al. 2008). In our study, after the intervention, the intervention group said that we should not be afraid of mentally ill persons, treat them differently or leave them in the margins. Overall, the results of our study indicate that small changes occurred because of the mental health educational intervention. Relatively minor changes can be seen among the variety of elements used by the participants to describe mental illness before and after the intervention. However, the greatest change after the intervention involved new categories added by the participants in the intervention group. They suggested that mental illness is an illness just like any other (or a physical illness). They suggested that it is an illness that can be faced or that is manageable and mentioned specific illnesses, such as depression or schizophrenia. They also included the need for therapy, treatment (medication) and medical consultation in their responses. Finally, they expressed their attitudes towards mentally ill persons by saying that we should not be afraid of them, not treat them differently or not leave them in the margins. Instead, we should be friendly to them. The possible limitations of our study were that the educational mental health intervention was short and not tested beforehand, which suggests that the intervention 640

needs to be further tested. Whereas recall bias could be another limitation because the participants may repeat the same responses during the second interviews, we could clearly see that the responses by the participants in the intervention group differed after the intervention. Moreover, the participants did not know the researcher who conducted the study; this may have influenced their answers. Another possible limitation is the use of a qualitative approach, which does not facilitate reporting the impact of the intervention. Nonetheless, the responses provided by the participants in the study provide a rich window into how adolescents perceive mental illness. Finally, the responses of the adolescent participants who used less sophisticated descriptions resulted in simple written categories. Mental health education is an area that needs to be developed among adolescents. These initiatives should take into account the perspectives of adolescents to address their needs for mental health education. The findings of our study open up new perspectives and opportunities for mental health education as they provide a description of mental illness as it was perceived by the participants before and after the intervention. Our study demonstrates that mental health education in schools can have a positive impact on increasing positive perceptions of mental illness among adolescents. Such interventions may improve the overall health of the community by producing individuals who are knowledgeable about mental illness and who will have a better understanding of mental illness because adolescents are the future adults who will have an impact on the quality of life of the whole community. Because mental illnesses affect people worldwide (WHO 2011), mental health educational interventions are relevant internationally. Our findings can be used in the context of different cultures, because similar results have been found in other studies (Wolff et al. 1996, Wahl 2002, Dogra et al. 2005, Ineland et al. 2008) and they can be further tested. Community mental health nurses play an essential role in promoting mental health in our communities and the current study will be useful for their everyday practice. The findings of our study should make community mental health nurses more aware of the need to give emphasis to mental health educational interventions and introduce initiatives that promote mental health. Mental health educational interventions among adolescents, which strengthen an understanding of mental illness and enhance the positive perceptions of mental illness, should be considered by community mental health nurses. However, further research is needed on longer mental health educational interventions so that community mental health nurses can have more available information when implementing such interventions in the future. © 2014 John Wiley & Sons Ltd

Adolescents’ perceptions of mental illness

References Adler A.K. & Wahl O.F. (1998) Children’s beliefs about people labelled mentally ill. American Journal of Orthopsychiatry 68, 321–326. Austin L.S. & Husted K. (1998) Cost-effectiveness of television, radio, and print media programs

Graneheim U.H. & Lundmand B. (2004) Qualita-

upper level of comprehensive school from the

tive content analysis in nursing research: con-

viewpoint of school personnel and mental

cepts, procedures and measures to achieve

health workers. Scandinavian Journal of Caring

trustworthiness. Nurse Education Today 24, 105–112. Herrman H. (2001) The need for mental health

Sciences 25, 37–44. Sabir Ali B. & Iftikhar R. (2006) Promotion of mental health in developing countries: a concep-

promotion. Australian and New Zealand

tual system. Primary Care Mental Health 4,

Journal of Psychiatry 35, 709–715.

29–36.

Ineland L., Jacobsson L., Salander Renberg E.,

Sakellari E., Leino-Kilpi H. & Kalokerinou-

et al. (2008) Attitudes towards mental disorders

Anagnostopoulou A. (2011) Educational inter-

Bjorkman T., Angelman T. & Jonsson M. (2008)

and psychiatric treatment-changes over time in

ventions in secondary education aiming to affect

Attitudes towards people with mental illness: a

a Swedish population. Nordic Journal of Psy-

pupils’ attitudes towards mental illness: a

cross-sectional study among nursing staff in

chiatry 62, 192–197.

review of the literature. Journal of Psychiatric

for public health education. Psychiatric Services 49, 808–811.

psychiatric and somatic care. Scandinavian Journal of Caring Sciences 22, 170–177. Corrigan P.W. (2004) Don’t call me nuts: an international perspective on the stigma of mental illness. Acta Psychiatrica Scandinavica 109,

Johansson A. & Ehnfors M. (2006) Mental healthpromoting dialogue of school nurses from the perspective of adolescent pupils. Vard I Norden 26, 10–13 + 19. Link B.G. & Phelan J.C. (1999) Public conceptions of mental illness: labels, causes, dangerousness,

403–404. Corrigan P.W. & Penn D.L. (1999) Lessons from social psychology on discrediting psychiatric stigma. American Psychologist 54, 765–776.

and social distance. American Journal of Public Health 89, 1328–1933. Martin J.K., Pescosolido B.A. & Tuch S.A. (2000)

and Mental Health Nursing 18, 166–176. Sartorius N. (1998) Stigma: what can psychiatrists do about it? Lancet 352, 1058–1059. Secker J., Armstrong C. & Hill M. (1999) Young people’s understanding of mental illness. Health Education Research 14, 729–739. Stark C., Paterson B. & Devlin B. (2004) Newspaper coverage of a violent assault by a mentally ill person. Journal of Psychiatric and Mental

Corrigan P.W., Green A., Lundin R., et al. (2001)

Of fear and loathing: the role of ‘disturbing

Familiarity with and social distance from people

behaviour’, labels, and casual attributions in

Strauss A.L. (1987) Qualitative Analysis for Social

who have serious mental illness. Psychiatric

shaping public attitudes toward people with

Scientists. Cambridge University Press, Cam-

Services 52, 953–958.

mental illness. Journal of Health and Social

Dogra N., Vostanis P., Abuateya H., et al. (2005)

Behavior 41, 208–223.

Understanding of mental health and mental

Ministry of Education (2013). Greek education

illness by Gujarati young people and their

system. [online]. Available at: http://archive

parents. Diversity in Health and Social Care 2,

.minedu.gov.gr/en_ec_ page1531.htm (accessed

91–97.

28 August 2013).

Health Nursing 11, 635–643.

bridge, UK. Wahl O. (2002) Children’s views of mental illness: a review of the literature. Psychiatric Rehabilitation Skills 6, 134–158. WHO (2004) Prevention of mental disorders. Effective interventions and policy options. [online].

Available

at:

http://www.who.int/

European Pact for Mental Health and Well-Being

Monahan J. & Arnold J. (1996) Violence by

(2008) EU High-level Conference ‘Together

people with mental illness: a consensus state-

mental_health/evidence/en/prevention_of

for mental health and well-being. [online].

ment by advocates and researchers. Psychiatric

_mental_disorders_sr.pdf (accessed 28 August

Available

Rehabilitation Journal 19, 67–70.

at:

http://ec.europa.eu/health/ph

_determinants/life_style/mental/docs/ pact_en.pdf (accessed 28 August 2013). Fitzgerald M., Joseph A.P., Hayes M., et al. (1995) Leisure activities of adolescent schoolchildren. Journal of Adolescence 18, 349–358. Gilbert G.G., Sawyer R.G. & McNeil E.B. (2011) Health Education. Creating Strategies for School and Community Health. Jones and Bartlett Publishers, Sudbury, MA. Golub M.S. (2000) Adolescent health and the environment. Environmental Health Perspectives 108, 355–362.

© 2014 John Wiley & Sons Ltd

2013).

Parahoo K. (2006) Nursing Research. Principles,

WHO (2005) Atlas: Child and adolescent mental

Process and Issues. Palgrave Macmillan, New

health resources. [online]. Available at: http://

York.

www.who.int/mental_health/resources/Child

Pinfold V., Thornicroft G., Huxley P., et al. (2005) Active ingredients in anti-stigma programmes in

_ado_atlas.pdf (accessed 28 August 2013). WHO

(2011)

Mental

health

atlas

2011.

mental health. International Review of Psychia-

[online]. Available at: http://whqlibdoc.who.int/

try 17, 123–131.

publications/2011/9799241564359_eng.pdf

Prince M., Patel V., Saxena S., et al. (2007) No health without mental health. Lancet 370, 859– 877. Puolakka K., Kiikkala I., Haapasalo-Pesu K.M., et al. (2011) Mental health promotion in the

(accessed 28 August 2013). Wolff G., Pathare S., Craig T., et al. (1996) Community knowledge on mental illness and reaction to mentally ill people. The British Journal of Psychiatry 168, 191–198.

641

The impact of an educational mental health intervention on adolescents' perceptions of mental illness.

Nowadays, in many countries, mental health care is primarily community based. Community perceptions of mental illness are an essential issue for the q...
82KB Sizes 3 Downloads 3 Views