Do mental health awareness events reduce mental health problems? We don’t know but we must find out

In our final blog marking University Mental Health Day, Lucy Foulkes looks at the concept of awareness days or weeks and asks whether we are doing enough to measure their outcomes.  

Yesterday was University Mental Health Day: a day designed to draw attention to student mental health and make it a university-wide priority. It’s a distinct day because of its student focus, but there are many such campaigns trying to put mental health on the map. In February it was Children’s Mental Health Week, followed by Eating Disorders Awareness Week. In May, it’s the more generalised Mental Health Awareness Week; in July, National Schizophrenia Day; and in October we go global, with World Mental Health Day. Every day, it seems, is mental health awareness day.

Mental health awareness efforts work on a key principle, applied to everything from exam stress to suicidality: if we can get people to identify mental health problems in themselves and others, then they can access effective help, which will reduce those problems. Awareness is good, in other words, because it should ultimately alleviate or eliminate people’s distress.

‘Unleashed into the wild’

The trouble is, no one really knows if awareness initiatives work in this way. There is some evidence that England’s 2009-2011 Time To Change campaign improved attitudes towards individuals with mental health problems, and led to an increase in intended help seeking, which is important. But from the data we have so far, these campaigns don’t seem to be resulting in more people actually getting help. At a population level, rates of mental health problems certainly aren’t decreasing; quite the opposite. Part of the issue is that, for many of these campaigns and initiatives, no one has even asked the question: the leaflets and social media posts that promote mental health awareness are simply unleashed into the wild, with little empirical evaluation of the impact they are having down on the ground.

We must not assume that everyone has, or is able to have, the same experience when they see a campaign

Lucy Foulkes

This doesn’t necessarily mean we should stop raising awareness. I’m sure it has been invaluable for many people. Indeed, those who speak publicly about their experience of mental health problems often recall a moment when they finally understood what was happening to them, or realised they were able to get help, and awareness can play a crucial role in these moments. But these stories reach the headlines because these are the people well enough to talk. We must not assume that everyone has, or is able to have, the same experience when they see a campaign. In fact, I think we need to flip this on its head, and start asking ourselves whether for some people, all this awareness-raising might be part of the problem.

As an academic psychologist, I am interested in the possibility that mental health awareness efforts might make some people feel worse. If you encourage someone to conceptualise their distress as a ‘mental health problem’, but that isn’t paired with enough funding for meaningful change or support, could this engender a sense of frustration or hopelessness that increases distress? Is it possible that awareness materials can lead to an increase in mental health problems in a self-fulfilling manner – for example, if people learn about anxiety and then start avoiding the things that makes them anxious, which can exacerbate anxiety? Is it possible that telling young people how common mental health problems are in their population might lead them to self-diagnose with disorders they don’t have, in a way that only adds to their difficulties? These are all just ideas right now. I might be wrong; it would be great if I was wrong. But as rates of mental health problems continue to swell, particularly in young people, isn’t it at least time we start asking the questions?

Unintended consequences

I’ll caveat this the way I always do. There are an awful lot of people who need mental health support right now, and who are being failed on a horrifying level by the people and systems who are supposed to help them. The way we are dealing with mental health at the moment is very clearly not working, and awareness efforts are part of a vital movement that are trying to change the status quo. But things can be good and bad at the same time, and helpful things can have unintended consequences. Maybe awareness efforts are both useful and problematic, depending on the context, depending on the individual. Right now, we really have no idea.

This is therefore an impassioned call for research, and for caution while we wait. We need to treat mental health awareness efforts as phenomena in need of, and worthy of, empirical investigation. When we expose people to awareness-raising materials – in the classroom, at university, online – what psychological variables are we expecting to change? And the people designing these materials are expecting something to change. That’s the whole point. Considering this, can we measure these outcomes in controlled experimental conditions before pumping these ideas into the public consciousness? Yes, we can and we should. And as the awareness days continue to blossom around us, we should start as soon as possible.