Dr. Anthony Jorm and a Quest for Global Literacy with Mental Health

Paraphrasing from Dr. Tony Jorm, I’ll make a prediction. You know someone who is suffering from a mental illness. Each year close to 20% of adults will experience a mental health issue that might include anxiety, a drug problem, clinical depression, an eating disorder, schizophrenia, dementia — and quite possibly more than one. Despite the widespread incidence of mental health needs, it has taken people like Dr. Jorm and his partner in life and scholarship, Betty Kitchener, to create and implement Mental Health First Aid (MHFA) training.  This training enables members of the public to learn how to identify and provide some first-contact responsiveness to a person in need. Paralleling the concept and design of the available Red Cross first-aid courses (which train people to identify and respond appropriately to bodily injuries and emergencies), MHFA training orients people to the basics of mental health. What are the identifiable symptoms? Where should a person suffering those symptoms be directed? What does one do to help someone with mental health needs? Because you probably know someone with a mental health need and, with appropriate training, you can help.

Dr. Tony Jorm has had a career that started with theoretical and educational investigations of children’s reading, extended into studying older adults and issues with dementia, and developed into global population issues and how to support a more informed, better prepared public regarding mental health. It is a truly impressive set of contributions culminating with MHFA that has been completed by 3% of the entire public in Australia (his home nation and the origin of this program) and has extended into about a dozen countries around the globe!

Dr. Jorm introduces himself in this first excerpt from our conversation:

It would be difficult to have predicted the professional  and personal activities of Dr. Jorm from his early life. He is a professor from a family that embraced a blue-collar life and with parents not inclined toward heady, academic interests. He is an avid bicyclist who rides every day despite never having owned a bike nor even learning to ride prior to adulthood. He is a person with a somewhat quiet and reserved demeanor, and yet he has put himself far out into the global research spotlight as he endeavored to undertake massive national projects in Australia and his efforts to internationally extend these health initiatives. In a lot of ways, Dr. Jorm broke away from the structures of his early life and forged a very unexpected trajectory for himself.

He describes his parents and early life in this excerpt:

From his childhood, Tony seemed to adopt a love of written words through the eyes of his grandmother and her magnified images of the pages. Those precious books were the candy that his mind craved but his access to them was limited. It wasn’t until the start of school that he learned to read and in doing so gained access to new intellectual opportunities afforded by library of his primary school. You’d think that Tony would have loved school as a child but that really wasn’t the case. One could say that his school taught him some important skills (e.g., reading). But, candidly, he recalls that his high school rather stunk as an institution to promote education and the development of ideas.

He describes going to school in the following excerpt:

“Everybody hated going to school…” It is not exactly the typical origin of most future professors. For Tony and his peers school was awful with an emphasis on suppressing creative thought. The didactics were heavy on sarcasm and punishment. From that context, the teenaged Tony thought to apply to University of Queensland and, upon acceptance would go on to become an honors student there. In discussing all of this, one might speculate that Tony’s older brother was a rather critical influence. As described in the excerpt above, his brother provided a textbook on Theories of Personality that would prove fascinating and engage Tony’s early interests in Psychology. In addition,  one would note that for his brother to get this text, and subsequently to have a career in education, Tony’s brother also had to choose to attend university and may have modeled and echoed back some of that experience to Tony.  So Tony and his brother were first-generation college students with very modest encouragement from his parents to get involved in higher education, and certainly no love of school coming from the model he experienced in his primary education. However, Tony may have been fortunate to directly follow some of the experiences and interests of his brother, and subsequently Tony pressed on to go to Uni and to pursue his own educational path.

Going to university was very well-suited to Tony’s growing intellectual interests. He described in the excerpt above the educational system that was in place at the University of Queensland. Students were expected to be somewhat self-deterministic and, as such, there was no pressure to go to class. There was every encouragement to ask questions and question everything, and there were new opportunities to study, learn, and mature. Tony studied. He was inspired by his teachers, inspired by the ideas. He went on to complete an honors thesis and made a decision to enter grad school in Clinical Psychology. Australia had few such clinical programs at this time, so Tony moved up to Sydney, Australia where he completed his MA in Experimental Clinical Psychology (in 1975) followed soon after with his PhD in Psychology from the University of New South Wales. He worked for a year with the prison system and then started at Deakin University as a Lecturer in 1977.

There are some developmental aspects to Dr. Jorm’s career from his brief foray with investigating methods for prison, but it was at Deakin University (just outside of Melbourne, Australia in Geelong, pronounced zheh-LONG) that he found his start as an independent scholar. Once at Deakin he took on a graduate student, David Share (now Dr. Share) and they collaborated on  a number of studies to investigate reading development in children.

Dr. Jorm described the theoretical approach in the following excerpt:

This is a fairly brief excerpt, but it encompasses a lot. Dr. Jorm loved books, loved reading from an early age and his early research during the late-1970’s/early 1980’s at Deakin University reflected this early interest. He engaged to work with the local school system and assessed children looking at the devices and cognitive strategies that they developed during years 5-8 of their primary schooling. From those assessments he and Dr. Share theorized a model of acquisition for early development that would be restructured as the reading skills came to mastery. As he described in the excerpt above, using a acquisition-based model and projecting forward into new reading acquisition (as opposed to theorizing backwards from children who had already obtained reading mastery) created a different perspective from many ideas popular in studies of reading at that time.  Moreover, it involved Dr. Jorm in some of the methodological techniques that would be employed much more broadly in his future epidemiological studies. Even with a high teaching load and in a new position, he was researching with hundreds of participants and visualizing the research issues as paradigms best completed in conjunction with external, public institutions (i.e., the schools). Those reading studies were conducted using involved longitudinal designs which followed children over months and years of their reading acquisition.

While Dr. Jorm was productive at Deakin University, in 1984 he sought a new position and committed himself to studying new issues with a position at the Australian National University (ANU) in Canberra, Australia. The reasons for making this move were both personal and professional — importantly the new position would free up time and resources for scholarship. As per the advertised needs of that position, Dr. Jorm set to assessing  totally new issues with an emphasis on mental health in older adults. It was a considerable research jump for Dr. Jorm:  his first studies years before investigated memory (undergrad), in grad school he began in clinical training (grad), first professional position targeted prison reform (1-yr position), his first programmatic research was on children’s reading (Deakin), and now he would study aging and Alzheimer’s disease at ANU.  Interesting issues were ahead and Dr. Jorm recalls the start of that position:

It was in that new position at ANU that Dr. Jorm started to fully embrace a global and epidemiological model of mental health. Dr. Jorm began working with the national public systems in Australia, such as the compulsory voting registry, to contact large, representative samples of people for this new research. With his new ANU colleagues, Dr. Jorm developed an assessment tool directed at age-related changes and dementia. As opposed to previous assessments that involved self-assessments and/or brief clinical observations, this new assessment tool drew on the observations of family or friends for that individual. People who had lived with that aging person, and who would have seen the putative day-to-day changes in their mental states over the recent years.  That tool, the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) became the centerpiece of a number of assessments  and engaged Dr. Jorm in national efforts to understand and provide support for Alzheimer’s disease and facilitated his engagement with the World Health Organization.

In addition, Dr. Jorm described an influential book he read during those years from Thomas McKeown.  In that book, Dr. McKeown collated population data and assessed some of the global changes that may have precipitated a decline in the rates of disease  — declines that were unrelated to advances in medicine and rather highlighted some of the other variables that may have been affecting rates of illness. That book and its fascinating thesis, along with his newfound position, seems to have engaged Dr. Jorm in an emerging global struggle to improve the world’s health.

The scholarly contributions made by Dr. Jorm to reading and to our understanding of aging and the development are excellent, but, of course, there was an additional major area of undertaking to come in his career.

Dr. Jorm recollects some details of how MHFA started in this excerpt:

From from an invigorating discussion at a conference, to a conversation walking the dog between partners, to a volunteer community session by Betty Kitchener, to an ever-expanding training system in dozens of countries and adapted to multiple languages, cultures, and needs! The initial insight from Dr. Jorm about the need for this program is worth reiterating. By the 1990’s there had been some great advances and primary care providers were informed and prepared to assist those with mental health needs. That was achieved with tremendous investment in the years prior so that the medical providers. But having that critical, but small group of medical professionals well-prepared has limitations: the public at large doesn’t necessarily choose to see health providers even when they have need — especially if there is misinformation or mistrust about the issues by the public. There was an imbalance between the medical approaches that were working and the public awareness and embrace of those approaches. In contrast, with bodily-health issues there had been successful campaigns helping the public to become  more aware and prepared to deal with skin cancer, with heart disease, with choking hazards, etc. This approach — that brought health information directly to the public — could be applied to mental health. The MHFA was created to do just that. And it has.

The lives of Betty Kitchener and Tony Jorm started to reorient in response to the growing popularity and importance of MHFA. They worked to support the training needs, to assess and understand how the training was being received, and to understand where it produced improvements in public knowledge and where improvements were needed. They moved from ANU to start the Population Mental Health Group within the Centre for Mental Health at the Melbourne School of Population & Global Health (at the University of Melbourne).

There is much more that followed and I look forward to sharing more stories and reflections from Dr. Jorm in the book! But for now…

Here are some of the wonderful publications from Dr. Jorm:

Jorm, A. F. (1983). Specific reading retardation and working memory: A review. British journal of Psychology, 74(3), 311-342.

Jorm, A. F. (1994). A short form of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): Development and cross-validation. Psychological Medicine, 24(1), 145-153.

Jorm, A. F. (2000). Mental health literacy: Public knowledge and beliefs about mental disorders. The British Journal of Psychiatry, 177(5), 396-401.

Jorm, A. F. (2000). Does old age reduce the risk of anxiety and depression? A review of epidemiological studies across the adult life span. Psychological Medicine, 30(1), 11-22.

Jorm, A. F. (2000). Is depression a risk factor for dementia or cognitive decline?. Gerontology, 46(4), 219-227.

Jorm, A. F. (2001). History of depression as a risk factor for dementia: an updated review. Australian & New Zealand Journal of Psychiatry, 35(6), 776-781.

Jorm, A. F. (2004). The Informant Questionnaire on cognitive decline in the elderly (IQCODE): A review. International Psychogeriatrics, 16(3), 275-293.

Jorm, A. F. (2012). Mental health literacy: Empowering the community to take action for better mental health. American Psychologist, 67(3), 231-243.

Jorm, A. F., Christensen, H., Henderson, A. S., Jacomb, P. A., Korten, A. E., & Rodgers, B. (1998). Using the BIS/BAS scales to measure behavioural inhibition and behavioural activation: Factor structure, validity and norms in a large community sample. Personality and Individual Differences, 26(1), 49-58.

Jorm, A. F., & Jacomb, P. A. (1989). The Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): Socio-demographic correlates, reliability, validity and some norms. Psychological Medicine, 19(4), 1015-1022.

Jorm, A. F., & Jolley, D. (1998). The incidence of dementia A meta-analysis. Neurology, 51(3), 728-733.

Jorm, A. F., Korten, A. E., & Henderson, A. S. (1987). The prevalence of dementia: A quantitative integration of the literature. Acta Psychiatrica Scandinavica, 76(5), 465-479.

Jorm, A. F., Korten, A. E., Jacomb, P. A., Christensen, H., Rodgers, B., & Pollitt, P. (1997). “Mental health literacy”: A survey of the public’s ability to recognise mental disorders and their beliefs about the effectiveness of treatment. Medical Journal of Australia, 166(4), 182-186.

Jorm, A. F., Korten, A. E., Jacomb, P. A., Christensen, H., & Henderson, S. (1999). Attitudes towards people with a mental disorder: a survey of the Australian public and health professionals. Australian and New Zealand Journal of Psychiatry, 33(1), 77-83.

Jorm, A. F., Korten, A. E., Rodgers, B., Jacomb, P. A., & Christensen, H. (2002). Sexual orientation and mental health: results from a community survey of young and middle–aged adults. The British Journal of Psychiatry, 180(5), 423-427.

Jorm, A. F., & Share, D. L. (1983). An invited article: Phonological recoding and reading acquisition. Applied Psycholinguistics, 4(2), 103-147.

Share, D. L., Jorm, A. F., Maclean, R., & Matthews, R. (1984). Sources of individual differences in reading acquisition. Journal of Educational Psychology, 76(6), 1309-1324.

(Pictured is Dr. Jorm at the park across the street from his office at the University of Melbourne)