American Journal of Health Education

ISSN: 1932-5037 (Print) 2168-3751 (Online) Journal homepage: https://www.tandfonline.com/loi/ujhe20

Mental Health v. Mental Illness: A Health

Education Perspective

Mark J. Kittleson

To cite this article: Mark J. Kittleson (2019) Mental Health v. Mental Illness: A Health
Education Perspective, American Journal of Health Education, 50:4, 210-212, DOI:
10.1080/19325037.2019.1616011

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Published online: 03 Jun 2019.

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AMERICAN JOURNAL OF HEALTH EDUCATION
2019, VOL. 50, NO. 4, 210–212
https://doi.org/10.1080/19325037.2019.1616011
COMMENTARY
Mental Health v. Mental Illness: A Health Education Perspective
Mark J. Kittleson
New York Medical College
ABSTRACT
Mental health is different than mental illness. Yet, public and professional’s views of mental health
often confuses the two terms. This commentary explores what mental health is, what components
consist of a mentally healthy person, and how one can improve and enhance mental health
among youth.
I congratulate Dr. Eddy and the Editorial Board of the
American Journal of Health Education in the creation of
this special issue on Mental Health. Never before has
the topic of mental health been more timely and perti-
nent in our society. However, I am concerned that our
profession may be confusing mental health with mental
illness. Even the call for the Special Issue in the
American Journal of Health Education, “Mental Health
as a Chronic Disease Issue” implies mental illness.
Issues such as suicide, addictive behavior, depression,
ADHD and mood disorders are illnesses, and are just
a subset of mental health.
Nearly 30 years ago, I authored an article in which
I did a comparison on personal health textbook’s dis-
cussion on mental health.1 Most of the content in the
“mental health” chapter was on mental illness.
Although the content has changed in personal health
textbooks, there is still a tendency to confuse mental
illness with mental health. Ask either the public or
professionals what mental health is and they both are
likely to cite issues that are mental illness – many of the
items that are listed in this call for papers. Professions
like Social Work are taking the lead (with financial
support) to deal with the mental health of various
populations – in reality, they are dealing with mental
illness. Mental Illness, and strategies to combat it, are
very important. However, as health educators, we
should not fall into the trap of confusing mental illness
as mental health.
So what is mental health? Let me give an example
using a different dimension of health – physical health.
When health educators are asked about their thoughts
on physical health, there is a tendency to talk about issues
such as exercise, diet, and weight control. These are items
that tend to “promote” physical health – a positive
CONTACT Mark J. Kittleson mkittleson@nymc.edu New York Medical College, Department of Public Health, 19 Skyline Drive, Valhalla, NY 10595
© 2019 SHAPE America
ARTICLE HISTORY
Received 5 December 2018
Accepted 21 December 2018
approach to this dimension of health. While there may be
discussion on the results of failure to deal with these
activities (heart disease, stroke, high blood pressure) it is
typically not the health educator’s first thoughts in discuss-
ing physical health. Health Education (and health promo-
tion) is a prevention-focus discipline that looks at ways to
promote physical health, rather than just deal with diseases.
Yet, when the topic of mental health is broached,
there is a tendency to focus on the illness aspect.
Whereas those issues associated with mental illness
are important, let’s not be confused that this is mental
health. We should focus on the positive aspect of men-
tal health – much like in the example above regarding
physical health. Our educational effort should be to
help promote mental health, not provide information
on illness areas only.
Let me be clear. Mental illness is important; it is
critical; it is a major concern in our country. Issues
such as depression, suicide, addictions, and the variety
of mental illnesses are important to discuss, educate,
and treat. Funding is absolutely critical to assist indivi-
duals suffering from such issues. However, like the
physical health above, mental health should focus on
those issues that promotes mental health.
Again, using physical health as an example, what
does it take to be physically healthy? Exercise, eating
right, maintaining good weight would be some of the
main answers. Now let’s ask, what does it take to be
mentally healthy? Do we as a profession have clarity to
respond to this? I believe we do have clear criteria to
what constitutes a mentally healthy person (besides
being absent of a mental illness).
In the 1987 article mentioned earlier, it stated that
there were several dimensions to positive mental health:
a) a positive self-image, b) effective decision-making

skills, c) expressive communication skills, and d)
awareness of one’s value’s system. These areas were
inadequately discussed in the personal health textbooks
in 1989 (coverage is much better in today’s general
health textbooks). The article also stated that coping
was an important part of mental health, and acknowl-
edged that textbooks did a sufficient job discussing this
topic within the stress management chapters. Since that
article was published, two additional components
would be added to dimensions of positive mental
health: a) assertiveness training, and b) risk-taking.
These concepts are expanded below.2
(1) A Positive Sense of Self-Esteem/Self-Worth.
As a profession, how do we instill this compo-
nent? Parents and teachers play a critical role.
There are four major components that assist
students to create a positive sense of self: 1)
A sense of connectiveness – ensuring that the
child has groups to be affiliated with (ie, family,
sports, church); 2) Power – possessing the abil-
ity to make choices that impact them; 3)
Uniqueness – the quality of feeling special; 4)
Modeling – having role models (ie, sports her-
oes, teachers, coaches). Each of these areas can
clearly be discussed in a classroom setting or
through parenting activities.
(2) Effective Decision-Making Skills. Part of
learning decision-making skills is acknowled-
ging the consequences of such decisions – both
short term and long term, along with negative
and positive consequences. Generally speaking,
mentally healthy people have a mechanism to
make decisions. People who are not mentally
well often have difficulties making decisions,
and are often paralyzed when forced to make
a decision, or they make a decision that leads to
severe negative consequences. Again, numer-
ous activities exist for teachers and parents to
help provide direction on how to improve
a child’s decision-making process.
(3) Values Awareness. Values awareness is the
process to understand one’s values, where
they come from, and how they were developed.
An important part of this component is to
allow youth to understand the vast difference
in values in our society – perhaps it will encou-
rage tolerance among differing views from this
pluralistic society. All one has to do is to read
the headlines in today’s newspapers to realize
that many people in our society are intolerant
MENTAL HEALTH V. MENTAL ILLNESS 211
of people unlike themselves. The classroom and
the family can be used to examine values and
ways to create an awareness of how these values
have been instilled.
(4) Effective Communication Skills. The ability to
teach students effective communication skills,
including the use of “I” statements, are critical
to one’s mental well-being. Anybody who has
been involved in a relationship with poor com-
munication skills can attest to the difficulties
this causes in one’s life. Again, teachers and
parents play a critical role in helping teach
children how to effectively communicate.
(5) Effective Coping Skills. Teaching students
how to deal with stresses are essential to one’s
mental health. Within this component, one
would include assertiveness training and peer-
resistance skills. Whereas the classroom can be
an excellent setting to expose students’ ways to
cope, it is also important that parents play
a critical role through their modeling on deal-
ing with stress.
(6) Assertiveness Training. Assertive training is
a type of behavior training to provide skills to
allow people to stand up for themselves.
Assertiveness is the middle ground between
being passive and aggressive behavior. Having
assertiveness training skills provides
a framework for students to stand up for issues
they believe in, reduce the consequences of
bullying and allows students to minimize
aggressive behavior.3
(7) Risk-Taking Skills. Research has shown that
it is important to let students know that it’s
okay to take risks.4 We’re not talking suicidal
or unprepared risks. Risks can be categorized
as physical risks (ie, climbing a mountain;
running a marathon; skydiving; camping),
intellectual risks (ie, taking a new job; going
to college; or listening to a different person’s
view point), and emotional risks such as ask-
ing brave questions, giving brave answers or
giving brave statements to those close to us
(this component closely relates to effective
communication skills). Risks keep people
sharp, challenged, and allows a sense of
accomplishments. All one has to do is to
ask an individual who has done some activ-
ities such as sky-diving why they did it. They
talk about the exhilaration, the excitement, or
the ability to face a challenge. Long-distance
212 M. J. KITTLESON
legend George Sheehan said that long-
distance running was a way for a person to
challenge themselves and to prove themselves
a hero to themselves. He stated
“… I want to be challenged. I want to find out whether
or not I am a coward. I want to see how much effort
I can put out … what I can endure … if I measure up.
Running allows that.” In Sheehan’s opinion, complet-
ing a marathon may be exhausting, but the mental
boost to one’s life is enormous.5
Obviously, each risk-taking area (Physical Risks;
Emotional Risks; Intellectual Risks) needs good pre-
paration. One would never go sky-diving without
proper training and equipment. In addition, appro-
priate preparation for those engaging in both emo-
tional and intellectual risks needs to be done.
So what does this have to do with this special issue
of the American Journal of Health Education? For each
of these articles, I ask the following questions: “What
can health education do about this?”
In many instances, there is nothing we can do (if
mental illness is the focus). A person suffering from
clinical depression needs medication and/or profes-
sional counseling. The best that a health educator
can do is to recognize potential signs of depression.
A person suffering from addiction also needs pro-
fessional care. Again, little that health educators can
do to treat…we are not trained in that area. As with
depression, hopefully, we can be aware of signs that
would allow us to encourage professional health.
I would hope that the articles, besides explaining the
problem, would allow significant coverage on how we
address these behavioral-based issues to prevent. For
example, bullying is an excellent example of
a behavioral-based issue. An article may talk about its
prevalence, destructive consequences, or costs to
society. I would hope that there would be as much
time to discuss ways to reduce or prevent the incident.
Hopefully, the “components” of mental health outlined
above could serve as a mechanism to address these
issues.
Disclosure statement
No potential conflict of interest was reported by the author.
ORCID
Mark J. Kittleson http://orcid.org/0000-0003-3534-3559
References
1. Kittleson MJ. Mental health vs. mental illness:
a philosophical discussion. Health Educ. 1989;20:40–42.
2. Donnelly J, Eburne NC, Kittleson MJ. Mental Health:
Dimensions of Self-Esteem and Emotional Well-Being.
Boston, MA: Allyn and Bacon Publishers; 2000.
3. Assertiveness training. Encyclopedia of mental
disorders. http://www.minddisorders.com/A-Br/
Assertiveness-training.html. Updated 2018. Assessed
December 20, 2018.
4. Benefits of positive risk-taking. Frontier support.
http://www.frontiersupport.co.uk/blog/the-benefits-of-
positive-risk-taking/. Published February 16, 2017.
Accessed December 20, 2018.
5. George A. Sheehan quotes. AZ Quotes. https://www.
azquotes.com/author/13442-George_A_Sheehan.
Accessed December 20, 2018