Literacy Education for Improving Engagement in Treatment and Community Inclusion for People with Serious Mental Illness


Limited literacy is an important and under-examined factor in the lives of people with SMI and is also associated with health disparities in multiple ways.

The relationships among literacy and health have been well documented, with research showing that people with lower literacy skills have worse health outcomes for a variety of chronic conditions, including cancer, diabetes, and asthma (Berkman et al., 2004).

Adults who report having a mental health problem have significantly lower literacy levels than adults who did not, even after controlling for education (Sentell & Shumway, 2003).

In public mental health treatment settings, from 54% (Currier, Sitzman, & Trenton, 2001) to 76% (Christensen & Grace, 1999) of participants score at or below the eighth grade level.

Emerging evidence suggests literacy is also related to psychiatric symptoms and diagnoses, mental health service utilization, quality of life, and community participation for people who live with mental illness.

Tufts Clinical and Transitional Science Institute

Funded by Tufts Clinical and Transitional Science Institute

Massachusetts Department of Mental Health

A collaboration with Massachusetts Department of Mental Health’s Massachusetts Mental Health Center

Boston University logo

And Boston University School of Medicine


The broad goal of this proposal is to conduct the first stage of the development of an intervention study to adapt Adult Basic Education (ABE) for use in a public, urban, mental health outpatient setting.

AIM 1: To adapt and modify ABE for use in an integrated primary care and wellness center embedded in a busy, public, urban outpatient mental health center. The adapted ABE (ABE-MH) will be service-user informed, recovery-focused, and co-led by a ABE instructor and a peer provider.

AIM 2: To conduct a pilot study of ABE-MH to assess the feasibility and acceptability of the model

AIM 3: To inform the development of a full trial of ABE-MH in busy, public, urban clinical settings.

Ultimately, the adaptation of ABE and the development of evidence-based methods to improve the reading skills of people with mental illness may have broad public health impact as seen in improvements in engagement in health and wellness activities, chronic disease management, adherence to mental health treatments and overall improvements in mental and physical health. In addition, given the stigma associated with limited literacy as well as the instrumental tasks of wellness and daily life that require reading skills, improvements in reading will facilitate access and promote community inclusion.

To identify class-specific facilitators and barriers to suicide prevention for each subgroup utilizing CBPR. Guiding questions: What are subgroup perceptions of the severity of suicide problems? What are the barriers and facilitators for the development of prevention programs?

Project Team

Alisa Lincoln - Institute for Health Equity and Social Justice Research, Northeastern University

Alisa K. Lincoln
Principal Investigator
Northeastern University

Suzanne Garverich

Suzanne Garverich
Program Manager
Northeastern University

Alexandra Alden

Alexandra Alden
Stipend Graduate Assistant
Northeastern University