Helen Osborne defines health literacy as, “…the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions.”

Health literacy is an important topic to consider when exploring the effective delivery of health services to diverse populations. Health literacy is especially important when considering empowered decision making for those dealing with mental illness.

The effects of low health literacy can be viewed from both an individual and systems perspective. Viewing low health literacy from the perspective of the individual requires the health practitioner to put themselves in the care recipients shoes.

Take for example an adult male who is experiencing psychosis and is brought to the emergency room by police due to erratic behavior. The patient is unable to explain his symptoms in a rational, logical way and the emergency room staff diagnose him as a drug user in need of detox and hold him for observation.

As Osborne wrote, “Providers need to present information about new diagnoses, treatment options, and self-care instructions. Patients need to describe their symptoms, ask questions, and express opinions about treatment and care.” In this example with the male patient experiencing psychosis, he is unable to communicate effectively, leaving him at risk for receiving inappropriate treatment.

This example can also be viewed from a systems perspective. Researchers Zarcadoolas, Pleasant, and Greer wrote,

…when complex messages convey complex issues, low-health-literate people are placed in a kind of triple jeopardy: they cannot understand the information, they cannot judge the trustworthiness of the information, and they are forced to rely upon information that is difficult to understand and may be unreliable.

In the case of serious mental illness, patients often encounter limitations in the health system as far as practitioners who know how to interpret what they are experiencing and know how to then take appropriate action. Serious mental illness, and psychosis in particular, is extremely complex and in the example mentioned, the parties with the low health literacy issue are the healthcare practitioners and the policies they rely upon that dictate their actions in complex health situations. The healthcare system is not the only system that can break down in this instance; the law enforcement system is another example where low health literacy can impact and individual experiencing an altered mental state and can too often lead to forceful action and violence due to miscommunication or misinterpretation.

In the case of the individual with mental illness entering a hospital emergency room, the best strategy for the individual and the system is to involve advocates. As Osborne wrote, “It can be extra hard to advocate for yourself when feeling vulnerable, scared, overwhelmed or ill… consider inviting a family member or friend to help…”

Involving advocates would greatly help combat issues of low health literacy in the case of the individual seeking mental health care. Individuals can also self-advocate by preparing a Psychiatric Advanced Directive (PAD). According to the Mental Health America website, a PAD is “…a written document that expresses your wishes in advance about what types of treatments, services and other assistance you want during a personal mental health crisis”. Utilizing a PAD and including advocates in your care are some strategies individuals could employ.

In the case of the low health literacy of the mental health and law enforcement systems, policies would need to be implemented to improve outcomes for mental health patients.

Two of the strategies that Osborne details for practitioners include:

1) Viewing the patient as the expert about their diagnosis and

2) Providing an environment that allows communication on the patients terms – whether that be providing writing materials, allowing phone calls, or engaging the use of smart phones and online sources of information.

Any professional providing health services needs to keep in mind that the way they talk about illness may not be the way their patient experiences it. Zarcadoolas et. al. wrote,

…deficits become most salient when experts of any type need to communicate with non-experts.

Taking this fact to heart, health practitioners in mental health systems should acknowledge the extreme stress a person experiencing psychosis is under by providing a safe environment, by allowing ample time for communication and assessment, and by gathering enough information, such as the existence of a PAD or the opinions of family members, in order to then inform the best course of action.

Creating meaning and understanding in situations where there is frustration or powerlessness will go a long way in bettering the health literacy of individuals and systems in the face of serious mental illness. Zarcadoolas et. al. wrote, “Literacy helps us get on in the world; it gives us access and privilege”.

It is incredible to realize that above-average health literacy can allow us to carry on with our day while, in contrast, the next person with low health literacy can end up having a horrible experience despite a similar set of circumstances. This is a disparity of outcomes that can begin to be bridged by raising awareness around mental health literacy issues of not only individuals, but health practitioners and systems as well.


Osborne, H. (2012). Health Literacy from A to Z. Jones & Bartlett Publishers.

Zarcadoolas, C., Pleasant, A., & Greer, D. S. (2006). Advancing health literacy: A framework for understanding and action (Vol. 45). John Wiley & Sons.

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