Youth Perspectives of Mental Health and Being Mentally Healthy: "Everybody's Mind Is Different"

Background and Purpose:Adolescence is a critical life stage.  During this stage, young people have the potential to experience positive growth and development and psychological problems, and may explore risk-taking behaviors. Though adolescence presents mental, emotional, and behavioral challenges for youth, many successfully navigate this stage of development. There is, however, a continued need to focus on mental health promotion among this group based on research that exemplifies an increase in negative social and psychological development trajectories for today’s generation of adolescents.

Despite this need and over 60 years of scholarly work to define mental health in a manner that distinguishes it from mental illness, little is know about adolescents’ own conceptualizations of mental health. This study proposes that positive reconceptualization of mental health definitions, as well as development of accurate measures thereof, requires consideration of the constructs which adolescents themselves identify as comprising mental health. The qualitative data it presents contributes to the literature on adolescent perceptions of mental health.

Methods: Researchers used semi-structured interviews to conduct two focus groups of 11^th and 12^thgraders from a high school in Baltimore City. Focus group participants (n=15) were mainly female (12; 80%) and the majority identified as Black/African American (8; 53%).  Interview questions focused on the meaning of mental health, characteristics of being mentally healthy, and whether those characteristics varied by context (e.g., race); students were then provided mental health measures commonly used with youth, responded to the questions, and then asked to reflect on the measure’s ability to capture mental health. Focus group data were transcribed and analyzed thematically. Researchers individually coded each focus group transcript, and then met to triangulate and synthesize research themes.  Theme-checking was done between the data and existing models of mental health.

Results:Analysis of the data showed six key themes: 1) Mental health is an abstract or neutral concept; 2) Mental health is on a continuum; 3) Mentally healthy is less abstract and includes positive terms; 4) “Normal” encompasses a balance of emotions; 5) Environmental context matters (e.g., family); and 6) Comprehensive assessment is needed.  Participants discussed the consequences of mental health diagnosis and the importance of grit, coping, and resilience in mental health.  Differences between mental illness and mental health were emphasized, and participants suggested the concept of mentally stable; however, participants did not reach agreement for standard definitions of these concepts.  Scales of mental health were criticized based on their lack of open-ended questions as well as the lack of response sets specific to adolescents.

Conclusions and Implications: Understanding adolescent’s perspectives of mental health and being mentally healthy informs our ability to better design or adapt effective measures and interventions targeted at improving outcomes for adolescents.  These data suggest that current measures of mental health for adolescents should reflect the key areas that adolescents, themselves, associate with mental health.  Additionally, this research speaks to the way mental health and mental wellness are defined in adolescent culture, which deepens our understanding about how we communicate about mental health with adolescents.