Research shows that having a mental illness is a predictor of low literacy (Sentell & Shumway, 2003) and that the incidence rates of low levels of literacy in clients with mental illness are often not accurately assessed or understood, yet this impacts on health care (Grace & Christensen, 1999). It also impacts on all aspects of life including independent living skills and self-esteem of the person.
In 2003, the Journal of Nervous and Mental Disease published an article; Low Literacy and Mental Illness in a Nationally Representative Sample by Tetine L. Sentell, MA and Martha A. Shumway PhD stating that low literacy is a recognized barrier to efficient and effective health care (Ad Hoc Committee on Health Literacy, 1999). They stated that in mental health care, low literacy may have additional detrimental effects, diminishing comprehension of written and verbal diagnostic and assessment measures (Grace and Christensen, 1998), and complicating cognitive impairments associated with mental illness (Miles and Davis, 1995). Furthermore, chronic mental illness may lead to deterioration in literacy by limiting opportunities for reading and writing (Tfouni and Seidinger, 1997).
Sentell and Shumway refer to the 1999 study in which Christensen and Grace found that reading comprehension was not even correlated with educational level. Sentell and Shumway found that their respondents with mental health problems engaged in fewer literacy-related tasks than other respondents. They were less likely to read newspapers, to have read books in the last six months or to write letters and significantly more likely to watch television. Again the research concludes that mental illness is associated with both low literacy skills and limited literacy practice. This has important implications for clinical care. Low literacy is likely to limit the accuracy and validity of standardized diagnostic and outcome measures and the impact of written informational and educational materials (Miles and Davis, 1995; Christensen and Grace 1999).
Low literacy may interfere with clinician and patient communication because topics discussed in mental health treatment are both subtle and complex – descriptions of emotions and feelings, opinions about medication side-effects and treatment options (Frieman and Zuvekas, 2000). Clinical procedures must be designed to accommodate literacy limitations because individual patients may be unaware of their literacy limitations or too embarrassed to mention them to providers (Ad Hoc Committee on Health Literacy, 1999; Miles and Davis, 1995). This study also underscored previous findings that education level is not synonymous with literacy level in mental health care.