Mental Health Literacy Scale (MHLS)

The Mental Health Literacy Scale (MHLS) is a 35-item, scale-based measure of knowledge and beliefs about mental disorders which aid their recognition, management or prevention (Jorm et al., 1997; O’Connor & Casey, 2015). The MHLS assesses six attributes of mental health literacy.

• Ability to recognise specific disorders
• Knowledge of how to seek mental health information
• Knowledge of risk factors and causes
• Knowledge of self-treatments
• Knowledge of professional help available
• Attitudes that promote recognition and appropriate help-seeking

Example MHLS Items

The MHLS is used to assess knowledge of a range of areas in mental health and attitudes toward mental health and help-seeking (O’Connor & Casey, 2015). It can be used to identify individuals who have low levels of mental health literacy and may benefit from further education. It can also be used to detect changes in mental health literacy within an individual and thereby assess the impact of educational efforts to improve their mental health literacy.

Studies show that mental health professionals and individuals with more direct or indirect experience with mental illness have higher levels of mental health literacy (Caldwell & Jorm, 2000; Furnham et al., 2011; Lauber et al., 2005; O’Connor & Casey, 2015). Some research suggests that higher levels of mental health literacy among mental health professionals may improve quality of care.

Studies also suggest that higher levels of mental health literacy are associated with greater intentions to seek help for mental health issues (O’Connor & Casey, 2015; Smith and Shochet, 2011). There is some evidence that improving mental health literacy could lead to more self-care and help-seeking behaviours, however findings have not been consistent (Bjornsen et al., 2017; Chung & Tse, 2022; Suwanwong et al., 2024).

Improving mental health literacy among professionals and clients may be beneficial for reducing stigma associated with mental illness, promoting help-seeking behaviours, and improving quality of care, ultimately leading to better mental health outcomes. The MHLS provides a methodologically robust and time-efficient means to assess and track improvements in these and other aspects of mental health literacy.

Scores on the Mental Health Literacy Scale (MHLS) range from 35 to 160, with higher scores indicating higher levels of mental health literacy (O’Connor & Casey, 2015).

High mental health literacy is associated with help seeking behaviour, self care and lower levels of stigma.

Low scores suggest that the respondent may benefit from further information or training aimed at improving their knowledge and attitudes regarding mental health and help-seeking.

The MHLS measures six attributes of mental health literacy.

Recognition of Disorders (Items 1 to 8)
Ability to correctly identify features of a disorder, a specific disorder or category of disorders.

Knowledge of Risk Factors and Causes (Items 9 and 10)
Knowledge of environmental, social, familial or biological factors that increase the risk of developing a mental illness.

Self-Treatment Knowledge (Items 11 and 12)
Knowledge of typical treatments recommended by mental health professionals and activities that an individual can conduct.

Knowledge of Professional Help Available (Items 13 to 15)
Knowledge of mental health professionals and the services they provide.

Knowledge of How to Seek Mental Health Information (Items 16 to 19)
Knowledge of how to seek mental health information: Knowledge of where to access information and capacity to do so.

Attitudes that Promote Recognition and Appropriate Help-Seeking (Items 20 to 35)
Attitudes that impact on recognition of disorders and willingness to engage in help-seeking behaviour.

A MHLS score is presented and the scoring approach uses qualitative descriptors to categorise this score. The ranges for these descriptors were determined using percentiles derived from a community sample of 372 university students obtained from a study by O’Connor and Casey (2015).

• Low (score of 35 to 110) (less than or equal to the 10th percentile)
• Below Average (score of 111 to 118 (percentile between 10 and 24)
• Average (score of 119 to 136) (percentile between 25 and 75)
• Above Average (score of 137 to 143) (percentile between 76 and 89)
• High (score of 144 to 160) (greater than or equal to the 90th percentile)

A graph comparing the respondent’s score to the community sample and a sample of mental health professionals is presented, with shaded areas around the means demarcating the two middle quartiles between the 25th and 75th percentile (O’Connor & Casey, 2015). The 50th percentile represents the typical level of mental health literacy in each sample. This graph contextualises the respondent’s score relative to the typical level of mental health literacy in the community and among mental health professionals.

Although the MHLS does not include subscales, a graph showing the respondent’s score as a percentage of the highest possible score for each attribute of mental health literacy is presented. Converting each attribute’s score to a percentage of its maximum provides a standardised way to compare scores across different attributes. This highlights which areas of mental health literacy the respondent is stronger or weaker in, relative to the best possible performance for each attribute.

If administered more than once, a meaningful change in mental health literacy is defined as a change of 6 or more points in the total score based on a Minimally Important Difference (MID) calculation (i.e., a 6 or more point increase indicates significant improvement; a 6 or more point decrease indicates significant reduction; and less than a 6 point change indicates no significant change).

The Mental Health Literacy Scale (MHLS) was developed by O’Conner and Casey (2015), who demonstrated that it had good internal consistency (Cronbach’s alpha = .873) and good test-retest reliability over a two-week interval (r = .797, p < .001). It was found to measure a single underlying construct and successfully differentiate between groups expected to have different levels of mental health literacy.

• Mental health professionals (n = 43, Mean = 145.49, SD = 7.19) scored significantly higher than a community sample (n = 372, Mean = 127.38, SD = 12.63) (large effect size, d = 1.76).
• Individuals with personal experience of mental illness (Mean = 130.97, SD = 13.21) scored higher than those without (Mean = 125.19, SD = 11.76) (small effect size, d = .46).
• Those who had seen a mental health practitioner (Mean = 133.53, SD = 12.02) scored higher than those who had not (Mean = 123.88, SD = 11.61) (large effect size, d = .82).
• Individuals with a family member or friend with mental illness (Mean = 129.53, SD = 12.12) scored higher than those without (Mean = 122.69, SD = 12.49) (medium effect size, d = .56).

The MHLS was significantly positively correlated with help-seeking intentions as measured by the General Help-seeking Questionnaire (GHSQ) (r = .234, p < .001), indicating good convergent validity, and there was no significant relationship between the MHLS and psychological distress as measured by the Kessler Psychological Distress Scale (K10) (r = -.087, p = .092), indicating good discriminant validity.

If you are interested in using the MHLS for research purposes, please contact the developer at [email protected] The MHLS is not to be used for commercial purposes.

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