Mental Health Literacy and Treatment Compliance among Clients with Mental Illness in India

Dear Editor, Mental health literacy means having knowledge and understanding about mental health. It plays a key role in understanding mental health issues and an important factor in addressing the challenges of mental illness. It helps decrease the stigma linked to mental health issues, fostering a more supportive and understanding community environment.[1] Mental health literacy is crucial for improving treatment adherence, as it enhances individuals’ understanding of their condition and the importance of following prescribed interventions. Higher literacy reduces stigma, fosters trust in healthcare providers, and encourages consistent engagement with treatment plans.[2] This results in improved health and a better quality of life for individuals with mental health conditions. Mental health literacy in India remains low among the general public and individuals with mental illness, limiting awareness of mental disorders, symptoms, and treatment options. Among those with mental illness, poor understanding of their condition leads to low treatment adherence and suboptimal outcomes. The lack of accessible mental health education, especially in rural areas, exacerbates these issues.[3] Further, cultural beliefs often associate mental health issues with supernatural forces or moral weaknesses, contributing to stigma and delayed help-seeking.[4] Investigating treatment adherence and mental health literacy in India is essential due to the substantial treatment gap and the stigma surrounding mental illness, which discourages help-seeking behavior. While there are studies that explored mental health literacy among the community population in India,[5,6] and there is limited research on mental health literacy specifically among people with mental illnesses. This gap underscores the need for targeted investigation and intervention in this area, as understanding mental health literacy in this population is crucial for improving treatment outcomes and compliance. To address this gap, the present study evaluated mental health literacy and treatment compliance among people with mental illnesses visiting the outpatient department of a tertiary care hospital in North India. This cross-sectional study was carried out with 350 patients seeking outpatient treatment for mental illness at a tertiary care hospital in North India between March 2022 and April 2022. Participation was voluntary, and all participants were provided with a detailed participant information sheet before completing the questionnaires. Ethical approval for the study was obtained (BREC/21/106 dated October 29, 2021), and permission from relevant authorities was obtained. Participants knowing to read and write Hindi or English were considered for inclusion. They were given the participant information sheet, informed consent forms, and research questionnaires. Participants filled out these forms independently, with the principal investigator available to clarify any doubts or assist if needed. Only individuals without a current history of mental illness or ongoing treatment for such conditions were included. Exclusion criteria included a known history of cognitive impairment, refusal to provide consent, unwillingness to participate, or inability to follow instructions. Data on the participants’ sociodemographic details were gathered, and mental health literacy was assessed using the knowledge of mental illness scale.[7] The scale includes five items assessing knowledge of diagnosis, symptoms, causes, medications, and treatment. Each item is scored on a three-point scale, with higher scores reflecting greater understanding of the illness. The Treatment Compliance Assessment Scale (TCAS) was used to assess treatment adherence, which is a 7-item scale that evaluates compliance under two factors, namely “Medication adherence” and “Attitude toward current treatment.”[8] Participants were encouraged to complete the scales independently, with the principal investigator providing clarification when needed. The sample predominantly comprises 350 individuals aged 18–50 years (72.84%) with nearly equal gender distribution (49.7% of males and 50.3% of females). Most participants are married (87.1%), live with family (99.4%), and are unemployed (63.7%). High school or graduate education is most common (32.6%), and 19.4% report a family psychiatric history. Mood-affective disorders are the most common diagnosis (51.7%), followed by psychotic disorders (45.4%) and other disorders (2.9%). The survey responses reveal significant differences in participants’ awareness of their illness. Only 20.3% of respondents were aware of their diagnosis, while 76.6% understood what their condition causes. Awareness of symptoms was notably high, with 94.9% affirming knowledge. However, understanding of treatments (4.9%) and medications (4.0%) was alarmingly low, highlighting the need for targeted educational efforts in these areas. The total score of the TCAS had a mean of 12.07 with a standard deviation (SD) of 1.693, within the possible range of 7–21. The medication compliance domain of the TCAS had a mean score of 5.82 (SD ± 0.512) within a range of 3–9, while the attitude toward current treatment domain had a mean score of 6.23 (SD ± 0.505) within a range of 3–12. These results indicate moderate levels of compliance in both medication adherence and attitudes toward treatment. Based on the findings of the 2015–2016 National Mental Health Survey, nearly 80% of individuals with mental health conditions do not seek treatment due to limited knowledge about mental illnesses and a lack of access to care. This treatment gap highlights the urgent need for initiatives aimed at improving mental health literacy across the country.[9] Community-focused awareness initiatives and the inclusion of mental health services in primary healthcare are effective strategies to tackle this issue. To cite, a study found that nurse-led psychoeducational intervention have shown potential in increasing awareness and reducing stigma among patients with mental illness.[10] Enhancing awareness through targeted public and hospital initiatives can greatly improve mental health literacy and encourage better treatment compliance among individuals those affected by mental health conditions. Author Contribution Jaison Joseph was responsible for the conception of the study, as well as the analysis and interpretation of data. Sarika Devi contributed to data collection under the supervision of Bhupendra Singh. Rajeswari Devi was involved in drafting the manuscript, while intellectual revisions were carried out by Jaison Joseph and Bhupendra Singh. Declaration for AI use The author acknowledges the use of generative AI for English language editing and grammar correction of this manuscript. The author affirms full responsibility for the accuracy and integrity of the entire content, including the portions revised with the assistance of AI tools. Declaration of use of copyright tools The authors utilized publicly available tools and provided appropriate references. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.