Mental health literacy in developing countries

The article on mental health literacy by Jorm (2000) was interesting and stimulating and we were encouraged to see reference to the mental health literature in developing countries. However, it portrayed a rather incomplete and negative view of the situation. It has rightly been pointed out that the beliefs in supernatural causes of mental disorders are more widely held and traditional sources of help, such as spiritual healers, are preferred over medical advice for a range of mental health problems in these countries. It was not mentioned, however, that mental health literacy is perhaps part of general literacy. In some developing countries where more than half of the population may be illiterate the dimensions of mental health literacy are totally different from those in Western countries. One corollary of this is that mental health professionals will have to adopt innovative approaches to mental health literacy.

The community mental health programme in Pakistan is an example. With a literacy rate of about 40%, it was not conceivable to adopt the approaches discussed by Jorm (2000). The innovative approaches adopted instead ranged from creating awareness at all levels of health personnel, including primary health care physicians, schoolchildren and teachers in the community, and collaborating with other sectors like traditional faith healers. One interesting attempt in this direction was to create awareness among schoolchildren and their teachers. We believe that the schoolchildren in rural areas are the eyes and ears of the community. In a study evaluating the effect of the school mental health programme it was shown that knowledge, attitudes and superstitions about mental health problems significantly improved in a group of schoolchildren, their friends and neighbours after implementation of the programme, compared with a control group (Rehman et al, 1998). More recently, the work has been extended to the detection of disabilities by children (Gater et al, 1999). This article, which gained the Barker Memorial Award, clearly showed the impact of improved mental health literacy through the strong messenger force of children in the rural community. An interesting impact of improved mental health literacy was its effect on general health indicators such as maternal mortality, infant mortality and the immunisation of children, which were significantly improved following integration of the mental health awareness campaign within primary health care (Maqsood et al, 2001). Similarly, educating the traditional faith healers assisted tremendously in identification and referral of people with mental illnesses for proper psychiatric treatment (Saeed et al, 2000). These are just a few examples of indigenous projects undertaken in the community, which highlight innovative approaches to mental health literacy in a developing country.

Recently, the issue of the role of the World Health Organization in improving mental health literacy in developing countries has been debated (Mubbashar & Saeed, 2000) and directions for developing cost-effective and sustainable mental health programmes have been outlined.