Mental health perceptions, knowledge, and skills is a broad construct category that encompasses many conceptually-overlapping factors that have often been studied in mental health help-seeking studies. Mental health perceptions, knowledge, and skills are most often measured via respondent-report measures, such as those administered on a survey or via an interview conversation. There is a growing array of self-report measures that can be used to inquire about individuals’ perceptions, knowledge, and skills. Most measures are subjective, but some are objective (e.g., objective measures of mental health literacy that assess the degree to which respondents can correctly answer questions about mental health and treatment).

This webpage is designed to introduce readers to some of the many measures of mental health perceptions, knowledge, and skills that exist, which professionals may leverage to answer questions about how these factors may shape people’s perceptions and behaviors related to seeking mental healthcare.

As noted on the evaluated need measures webpage, there is some item content overlap between measures of evaluated need and measures of mental health perceptions. When these measures (e.g., symptom-focused measures) are used for the purpose of understanding the subjective illness perceptions of respondents, these measures are considered assessments of constructs such as illness perceptions or perceived need. In contrast, when these measures are scored and interpreted by mental health professionals for the purpose of determining whether a respondent is sufficiently distressed/impaired to warrant treatment, these measures are considered assessments of evaluated need.

Given the multitude of existing and forthcoming measures, the below lists will be expanded and revised over time to maximize its value to those looking for measures with published evidence of reliability and validity. This webpage will discuss several types of measures within this construct category, in the following order: measures of illness perceptions, measures of mental health literacy, measures of perceived need, measures of perceived severity, and measures of behavioral skills.

Regarding illness perception measures:

  • Illness Perception Questionnaire – Mental Health (IPQ-MH; Witteman et al., 2011) (full-text download including an Appendix with copy of the items) – measures perceptions of mental illness identity, structure (chronic, cyclical), consequences, personal control, treatment control, coherence, and emotional representation.
  • Self-Identified Mental Health Concern – people can also be asked to report whether they personally believe that they have a mental health illness/disorder/condition/concern. This may be based on a combination of their subjective perception, what they have discerned from their information gathering (e.g., taking a screening measure, conversations with informal sources of support), and/or what they have been told by a medical professional (e.g., received a provisional or formal DSM-5 diagnosis). For example, Hammer & Spiker (2018) used this single-item binary (answered with a “yes” or “no”) measure: “Are you currently experiencing a mental health concern (e.g., difficulties related to depression, anxiety, family or relationship issues, academic or career problems, adjustment issues, alcohol, drug, or addiction problems, eating disorder or body image, grief or loss, abuse or trauma)?” Likewise, Moses (2009) used the binary item of “Do you think of yourself as having a mental health problem?”
  • There is also a popular single-item measures of self-rated mental health (SRMH; “In general, would you say that your mental health is excellent, very good, good, fair, poor or very poor?’” that was first used by McMichael & Hetzel (1974) and was systematically reviewed by Ahmad et al., (2014) and recently discussed by Stubbs & Achat (2023). A single-item measure like this is useful for identifying people who self-identify as having suboptimal (operationalized as a SRMH response of “fair”, “poor”, or “very poor”) mental health and therefore have a reason to seek help, but such a measure cannot identify people who would be evaluated as having clinical need despite not self-identifying as a person who has suboptimal mental health.

Regarding mental health literacy measures:

  • Dr. Hammer has not yet discovered a mental health literacy measure that he loves, but he is aware of what other scholars have recommended for measuring mental health literacy-related constructs.
  • Mental Health Literacy Scale (MHLS) (O’Conner & Casey, 2015) – 35-item measure of mental health literacy thought to be best measured with a single factor and mean score, with items measuring seven domains including ability to recognize disorders, knowledge of where to seek information, knowledge of risk factors and causes, knowledge of self-treatment, knowledge of professional help available, and attitudes that promote recognition or appropriate help-seeking behavior.
    • However, as discussed by Spiker & Hammer (2019), Dr. Hammer strongly suggests that the concept of “mental health literacy” be treated as a theory with multiple constructs included rather than a multidimensional construct. This recommendation, in part, comes from the fact that the dimension of “attitudes that promote recognition or appropriate help-seeking behavior” has overlap with the established construct of help-seeking attitude, which makes studying the relationship between “mental health literacy” and “help-seeking attitude” a problematic enterprise. Rather, Dr. Hammer recommends that “knowledge”, which is the historical heart of the concept of “mental health literacy”, be carefully assessed in a manner that allows study of how knowledge relates to other constructs. Dr. Hammer likes to see a focus on knowledge, rather than subjective beliefs, for measures pertaining to mental health literacy.
    • In addition, Dr. Hammer would like to see increased focus on objective measures (using items that can be scored as correctly or incorrectly answered) to complement the heavy historical focus on subjective measures of self-perceived mental health literacy (e.g., “I am knowledgeable about mental health matters.”). Objective measures of mental health literacy constructs such as knowledge are particularly useful when seeking to examine what moderators the relationship between help-seeking intention and prospective help-seeking behavior, whereas subjective measures of mental health literacy are typically only useful for understanding what shapes logistical beliefs and therefore personal agency related to seeking mental health care.
  • For additional measures to consider, consult systematic reviews of mental health literacy measures such as Kucera and colleagues (2023), Wei and colleagues (2015), Johnson and colleagues (2023), Tavousi and colleagues (2022), Chaves and colleagues (2021), and O’Conner and colleagues (2014).
  • As noted by Hammer and colleagues (2024), the concept of mental health “literacy” should be carefully used, because it has the potential to be applied in a manner that unfairly pathologizes people, given that the question of what is true knowledge about mental health/help seeking is subject to how one thinks about objectivity and evidence.

Regarding perceived need measures:

  • Perceived need is often measured with single-item measures.
  • For example, the annual Healthy Minds Study (see the latest HMS questionnaire codebook found on that website) has an ordinal-scale single-item measures for both prior (past 12 month) perceived need and current perceived need. Current perceived need is measured with the single item of “I currently need help for emotional or mental health problems such as feeling sad, blue, anxious or nervous.” using a 6-point ordinal scale of 1=Strongly agree, 2=Agree, 3=Somewhat agree, 4=Somewhat disagree, 5=Disagree, 6=Strongly disagree. The same 6-point scale is also used for the single-item measure of prior perceived need, with the item worded as follows: “In the past 12 months, I needed help for emotional or mental health problems such as feeling sad, blue, anxious or nervous.”
  • Likewise, Eisenburg and colleagues (2007) used the binary-response single-item perceived need measure developed for the Healthcare for Communities Study (Wells et al., 2006). The item is “In the past 12 months, did you think you needed help for emotional or mental health problems such as feeling sad, blue, anxious or nervous?” Researchers can code the perceived need variable as 1 for those who answered “yes” and 0 for those who answered “no” or “don’t know.” Please note that this is not a measure of current perceived need, but rather of prior (past 12 months) perceived need.
  • Katz and colleagues (1997) and Mojtabai & Mechanic (2002) used a multi-question algorithm to measure retrospective report of past 12 month perceived need using a binary scoring system of 0 (no need) or 1 (need). The algorithm is described by Katz and colleagues (1997) as follows: “People who saw any professional for a mental health problem were asked: “Was this something you wanted to do or did you go only because someone else put pressure on you?” Individuals who indicated that they wanted to go were considered to have perceived need for care. Those who did not go to a professional for a mental health problem were asked “Was there a time during the past 12 months when you thought you needed to see someone for a problem with your nerves or emotions or your use of alcohol or drugs?” Those who answered “yes” to this question were considered to perceived need for mental health care. Thus, we assessed perception of need for mental health care among both users and nonusers of mental health services.” (p.41). Please note that this is not a measure of current perceived need, but rather of prior (past 12 months) perceived need.
  • On the more complex end of perceived need measurement options, Meadows and colleagues (2000) created the Perceived Need for Care Questionnaire (PNCQ), which is typically administered via interview (but perhaps could be adapted to internet self-report survey administration using adaptive testing functionality), which measures five categories (medication, information, psychotherapy, social intervention, skills training) of perceived need that are each assigned to one of four levels of perceived need (no need, unmet need, partially met need and met need).

Regarding perceived severity measures:

  • Most help-seeking scholars appear to do one of three things: (1) create an ad hoc measure of perceived severity (e.g., Muscari & Fleming, 2019), (2) adapt a perceived severity for another health condition to the context of mental illness (e.g., Wang et al., 2024), or (3) use a measure of evaluated need (e.g., GAD-7) as a proxy for perceived severity (e.g., Kim & Zane, 2016; Langley et al., 2020).
  • O’Conner and colleagues (2014) used Saleeby’s (2000) Health Beliefs About Mental Illness (HBMI) instrument, which included a subscale entitled “Emotional/Nervous Severity Scale” consisting of 7 items (e.g., “Emotional or nervous problems would threaten my relationship with family or friends”) on a 5-point Likert scale from 1 (strongly disagree) to 5 (strongly agree). However, this instrument was psychometrically examined using data from only 81 participants and, as was normal for scale developers in the early 2000’s, used a scale validation process (e.g., use of principal components analysis, items for single subscale appearing on more than one factor) that would be considered inadequate by modern standards. Thus, Dr. Hammer cannot recommend use of this instrument unless further psychometric support is provided for this instrument. Because the perceived severity items have strong conceptual overlap with items used to measure illness perceptions (see above), it may be more advisable to use an illness perception measure such as the IPQ-MH.

Regarding behavioral skills measures:

  • Certain mental health literacy measures (see above) assess respondents’ self-perceived (i.e., subjective) level of behavioral skills related to the mental health help-seeking process. However, Dr. Hammer is not aware of any objective measures of these skills. Objective measures of people’s ability to (a) seek accurate information about mental health help seeking and (b) initiate a treatment relationship with a provider would be valuable tools for helping us gain a better understanding, in particular, of how the presence/absence of these skills can influence whether or not people who intend to seek help are successful in obtaining that care.