Are university health education programs addressing mental health issues?

American Journal of Health Studies, Fall, 2004 by JoAnn Kleinfelder, Susan K. Telljohann, James H. Price

Abstract: The importance of offering mental health courses and their rate of inclusion within university health education programs was investigated. Findings from 163 health education chairpersons (60 %) revealed that requiring mental health courses was perceived as important at the undergraduate level (55%) and at the graduate level (50%). More than one-half believed that offering an elective mental health course was important to undergraduate programs (60%) and graduate programs (61%). Mental health courses were required (68%) or offered as an elective (58%) in undergraduate programs. However, mental health courses were less likely to be required (24%) or offered as an elective (43%) in graduate programs.

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The United States Surgeon General defines 'mental health' as "the successful performance of mental function, resulting in productive activities, fulfilling relationships with other people, and the ability to adapt to change and to cope with adversity. From early childhood until late life, mental health is the springboard of thinking and communication skills, learning, emotional growth, resilience and self-esteem" (United States Department of Health and Human Services, 1999, p. ix). A recent proposal describes a model whereby mental health is seen as an above normal state, a positive psychology, maturity, emotional or social intelligence, resilience and subjective well being (Valliant, 2003).

The prevalence rate for mental disorders for adults in the United States varies. Early studies report that approximately 20 percent of adults have a diagnosable mental disorder in any given year (Regier et al., 1993). However, more recent reports estimate that 5 to 7 percent of Americans, 18 years of age and older, have a mental disorder in any given year (United States Public Health Service Office of the Surgeon General, 2001; Kessler et al., 2001). In addition, it is reported that between one-tenth and one-third of American children have a diagnosable mental problem (United States Public Health Service, 2000). It is projected that by 2020, psychiatric and neurological disorders will account for 15 percent of the total global burden of disease with unipolar depression expected to rank 2nd for disease burden (Murray & Lopez, 1996).

The burden of mental illness continues to have an effect on health care costs. Coffey, et al. (2000) reported that in 1997, the latest year comparable data are available, the United States spent more than $1 trillion on health care. Approximately $71 billion of the total health care costs were spent on treatment of mental illnesses

Stigma, myths and misconceptions about mental illness still exist. The perception that those with mental illnesses, especially those with schizophrenia and other psychotic disorders, are dangerous has increased since the 1950s (Phelan, Link, Stueve & Pescosolido, 2000). The label of dangerousness leads to social distancing which is counterproductive to findings that reveal that those who have contact with a person who has a mental illness have a more positive attitude about mentallyill persons (Corrigan, Edwards, Green, Diwan & Penn, 2001; Martin, Pescosolido & Tuch, 2000; Link, Phelan, Bresnahan, Stueve & Pescosolido, 1999). Corrigan, et al. (2001) also found that, in addition to personal experience with a mentally iii person, school learning (i.e. education) is a factor in reducing prejudicial attitudes about this group.

Mental health education plays an important role in the personal health of all people and the professional decision making of health educators. Mental and physical processes interact with each other, sharing a cause-and-effect relationship. For example, it is well documented that negative mental health can affect physical health by reducing the efficacy of the immune system (Greenberg, 1999). Specifically, the numbers of lymphocytes that fight infection are reduced, resulting in increased vulnerability to infections and cancer (Dantzer & Kelley, 1989; Herbert & Cohen, 1993; Cohen & Rabin, 1998). The added dimension of mental health knowledge often reveals clues to health problems that might otherwise be overlooked. This ability may be in the form of recognizing that a seemingly physical ailment is rooted in psychological issues and vice versa. Because many health education professionals evaluate and refer persons to health care professionals, it is important that they are able to accurately distinguish the root of the ailment and refer the client accordingly.

Currently, there is a paucity of research that addresses the frequency with which units in courses or entire mental health courses are offered and the kinds of mental health topics that are covered in university health education programs. Maylath and Ubbes (1996) found that approximately 56 percent of 52 United States colleges and universities required their health education undergraduate majors and minors to take courses that emphasized mental health or mental illness. In addition, about 89 percent of the programs that offered mental health courses offered them in the health education department while about 12 percent relied on psychology or counseling departments to provide required courses. The authors concluded that "a substantial number of undergraduate professional preparation programs in health education do not require a course with an emphasis in mental health or mental illness" (p. 373).