Gloria Chirwa

Mental health literacy (MHL) in Malawi is low. Mental illness is often attributed to substance abuse or spirit possession, resulting in stigma, maltreatmen

Background: Mental health literacy (MHL) is the ability to recognise mental disorders; have knowledge of professional help available, effective self-help and prevention strategies; and have the skills to support others. MHL is linked to better help-seeking behaviours and better management of mental illness. Mental illness prevalence is increasing in Malawi. Assessing MHL in communities crucially helps identify knowledge gaps, informing the development of evidence-based interventions. Aims: This study assessed the MHL levels of young adults (16–30 years old) in rural and urban communities in Malawi. Method: A cross-sectional national survey was administered to 682 people across 13 districts in Malawi, using a self-reporting Mental Health Literacy questionnaire (MHLq) that assessed knowledge of mental health problems, erroneous beliefs/stereotypes, first aid skills, help-seeking behaviour and self-help strategies. Results: Most respondents were either unemployed (36%) or enrolled in school (43%). A total of 73% completed primary or secondary education, and 48% knew someone with a mental illness, but only 14% of this group could specify the illness. The mean MHL score was 111.8 (s.d. 13.9). Individuals with primary and secondary school qualifications had significantly lower scores in factor 2 (erroneous beliefs/stereotypes) and factor 3 (first aid skills and assistance-seeking behaviour) of the MHLq than those with higher education. Conclusions: This research highlights persisting mental health misconceptions, limited knowledge about specific mental illnesses and low help-seeking behaviour among young adult Malawians. Higher education is linked to a better understanding of mental health. Prioritising community education on causes, signs, treatments and prognosis of mental illness is crucial for increased MHL.

In Malawi, it is difficult to promote positive mental health due to poverty, cultural beliefs, and stigma associated with mental illness. Mental health literacy (MHL) is not integrated into the education system despite evidence suggesting educational settings as ideal to deliver MHL programmes. Stakeholder input is crucial during development of interventions. This paper reports on our work with diverse stakeholders to culturally adapt a MHL course (MHLc) for implementation in Malawi universities. The MHLc structure and content development involved focus group discussions (FGDs) with 44 Malawian youth from universities and youth organisations, a national MHL survey and a systematic review exploring adolescent substance use in Africa. The MHLc was delivered to 35 first‐year university students. Students’ MHL was assessed using two questionnaires before and 3 months after MHLc delivery during an evaluation session which also included FGDs with 20 participants to explore course satisfaction. MHL questionnaire responses were analysed using paired t‐tests and FGD transcripts were thematically analysed. Overall student attendance rate during the MHLc delivery was 92%. However, only 57% attended the evaluation session. Students’ MHL increased after course completion (pre and post scores were 116.7 and 117.9 respectively) however this change was not significant. Student feedback about the MHLc was positive. They highlighted acquiring considerable mental health knowledge and skills that they would utilise in their lives daily. A key challenge raised was disruption of course delivery due to electricity outages. The MHLc content was acceptable among university students with high attendance rates and positive feedback regarding impact on participants’ mental health knowledge and attitudes. This paper highlights the value of stakeholders’ input when designing mental health interventions. In future, we need to mitigate disruption of the MHLc delivery and consider incentives to reduce participant dropout at follow up points.