For Release Wednesday

June 26, 2019

An unprecedented social marketing campaign in California intended to reduce stigma about mental health issues appears to have encouraged more people to seek care for their symptoms of mental distress, according to a new RAND Corporation study.

Surveying California residents over the two-year period when the campaign was at its height, researchers found that people who recalled seeing or hearing aspects of the campaign and who had mental health needs were more likely to receive treatment than those who did not recall the campaign.

Researchers estimate that if all California adults with probable mental illness had been exposed to the campaign, the number of those seeking treatment could have increased by nearly one-third. The study is published in the June edition of the American Journal of Public Health.

“It appears that California's innovative stigma-reduction campaign may have increased the likelihood that residents experiencing a mental illness recognized their symptoms and interpreted them as something that might require treatment,” said Rebecca Collins, the study's lead author and a senior behavioral scientist at RAND, a nonprofit research organization.

In 2013, California began the most comprehensive mental illness stigma and discrimination reduction campaign ever conducted in the U.S. The effort was funded through Proposition 63, an initiative that created a special tax on people with high incomes to support mental health programs across the state.

About 1 in 5 people in the U.S. have a mental health problem, but less than half of them receive treatment. California has been attempting to get help to more people at an earlier stage of illness.

The campaign was a complex, multi-level social marketing effort designed to shift the broader social and structural environment about mental illness. It used a variety of approaches to increase education about mental wellness and foster contact with individuals who have had mental health challenges. The intense portion of the campaign evaluated by RAND lasted two years, although the effort continues in reduced forms.

The RAND study is based on an analysis of about 2,000 California adults who were surveyed in 2014 and 2016 as a part of the California Well-Being Survey, which was intended to assess the impact of the state's mental health prevention and early intervention programs supported by the Proposition 63 funding. All of those surveyed had previously reported symptoms suggesting they probably had a mental health problem.

Participants were asked if they had been exposed to the slogans “Each Mind Matters” and “Sana Mente,” and other parts of the mental health social marketing campaign. They also were asked about their mental health status, whether they had recently received mental health treatment and their views about stigma related to mental illness.

A bit more than one-quarter of those surveyed reported being exposed to the stigma-reduction campaign, with Latinos and blacks being more likely to be exposed to the messages and interventions than whites.

Those exposed to the campaign were more likely to agree that people can recover from mental illness and lead normal lives, and there was some limited evidence they were more able to recognize the signs of mental illness and advocate for those affected by it.

The positive effects of the campaign on treatment appeared to be caused, not by a reduction in stigma (its primary goal), but because the anti-stigma activities increased awareness of mental health issues, researchers say.

“California's unprecedented stigma reduction campaign holds promise for positive change,” Collins said. “We found the first evidence that a social marketing effort may be useful for increasing the percentage of people with signs of mental illness who obtain treatment.”

She cautioned that the study could not rule out the possibility that those who sought treatment simply were more likely to notice and recall the campaign. Similar results also might not be observed in a less-supportive environment.

“Any influence of the stigma reduction campaign also may have benefited from the broader climate in California and its support of those with mental health challenges—support that was reflected in the passage of Prop. 63,” Collins said.

But the results do suggest that similar efforts hold promise as a way of closing the gap between the large number of people with mental health needs and the much smaller percentage of people who use mental health services, Collins said.

Support for the study was provided by the National Institute of Mental Health and the California Mental Health Services Authority. Other authors of the study are Eunice C. Wong, Joshua Breslau, M. Audrey Burnam, Matthew Cefalu and Elizabeth Roth.

The RAND Social and Economic Well-Being division seeks to actively improve the health, social and economic well-being of populations and communities throughout the world.