Mental Health Care Works: Insights From a Public Service Campaign

Abstract

The United States is experiencing a mental health crisis, with COVID-19 increasing the prevalence of mental health concerns and demand for services, but also leaving millions without care, including many who do not know that treatment is needed or available. The American Psychiatric Association Foundation’s Mental Health Care Works campaign was informed by results from an assessment of mental health awareness and perceptions of adults in the United States. These results highlighted the need for more public education about the efficacy of mental health care and ongoing need to normalize treatment and make care more accessible and relatable. The campaign features examples of success stories of treatment and helps spread the message that mental health care is effective. The campaign materials are a resource for health professionals to provide education to patients and society, informing them that mental health care works and that there is no health without mental health.

The United States was in the midst of a mental health crisis even before the COVID-19 pandemic, leaving many in need without the ability to access care (1). This was particularly true for children and adolescents, who saw rising rates of depression, anxiety, and suicide over the past decade (1). Even prepandemic, wait times to see a psychiatrist could be as long as 3 months (2). The COVID-19 pandemic both increased the need for mental health services and brought attention to the mental health crisis (1). There was an increase in the prevalence of mental health concerns, with contributing factors such as social isolation, economic difficulties, and the overall uncertainty of the pandemic (1). Despite the transition to and expansion of telehealth services, the increased demand was unable to be met, wait times continued to be long, and access still limited (1). Youths were particularly affected (1): Reports indicated that 42% of high school students experienced persistent feelings of sadness or hopelessness during those years (3) and that 18% of high school students made a suicide plan during the prior year (3). As of 2022, over 2.7 million youths are experiencing severe major depressive disorder, and six in 10 youths with major depressive disorder are not receiving treatment (4).

For adults, a twofold increase in suicidal ideation occurred compared with rates in 2018, as well as increases in substance use, with one in 10 adults reporting that they started or increased their substance use because of COVID-19 (5). The prevalence of anxiety symptoms in adults was about three times that in 2019 (25.5% compared with 8.1%), and four times higher for depressive symptoms (24.3% vs. 6.5%) (5). These mental health conditions disproportionately affected young adults, Hispanic and Black individuals, essential workers, unpaid caregivers, and those receiving treatment for preexisting psychiatric conditions (5). The pandemic also disproportionately affected communities of color (6), and although there is a general shortage of clinicians, there is an “even greater shortage of culturally or linguistically representative care available” (7). Almost one-third of the U.S. population identifies as Black or Hispanic, but only about 10% of practicing psychiatrists identify this way (7). Even 3 years after the onset of the pandemic, these mental health and substance use concerns remain elevated (8), and 90% of U.S. adults believe that the country is in a mental health crisis (8).

Although, in recent years, the importance of mental health is being recognized and more people are finding it acceptable to seek care, additional work still needs to be done to normalize mental health–related concerns and support individuals who experience mental health–related concerns in taking action to obtain care. The American Psychiatric Association Foundation (APAF), the philanthropic arm of the American Psychiatric Association, is positioned to lead the social change to help society and individuals view mental illness the same way as any general medical illness.

The APAF’s “Mental Health Care Works” Campaign

In its 3-year strategic plan, spanning 2024–2026, the APAF introduced a multiyear public service awareness campaign with the message that there is no health without mental health. The goal of the campaign is to promote the message that mental health care, indeed, works; normalize mental health treatment; and encourage individuals with mental health–related concerns to take the first step toward getting help. The campaign is supported by all of the APAF’s community-based and educational programs, including the Center for Workplace Mental Health, APAF Fellowships, and schools and justice initiatives.

The Mental Health Care Works campaign launched in July 2023 and was designed as a multiyear, multimedia, and multidimensional campaign that leverages media, including social media, and partners with like-minded organizations to spread the message that mental health care can work for the millions of people who are still struggling. The campaign features personas with stories inspired by real people who see and feel the benefits of mental health care. It is supported by an online destination (MentalHealthCareWorks.org), which features resources and inspiration to make people more comfortable with taking the first step to seek help. The campaign was designed to have three phases: 1) raise awareness: shift attitudes to help people understand that mental health care works; 2) drive behavior: encourage people to make the call; 3) drive attitudes: normalize the conversation around mental health (FINN Partners & APAF, unpublished data, 2023).

Before the design and launch of the campaign, the APAF worked with the public relations firm FINN Partners to conduct a Mental Health Awareness and Perception Tracking Survey. This survey was fielded in English and Spanish in April 2023 to assess current perceptions about mental health treatment and access in an effort to better inform the engagement strategy that would be used in the campaign to reach audiences. The survey would establish the benchmark for adult consumers in the United States for recognition of mental health issues (illness and their impact on self); awareness and understanding of access to mental health professionals and treatment, including affordable treatment options; and openness to seek help for mental health issues (FINN Partners & APAF, unpublished data, 2023).

Internet-based sampling across the United States was conducted, which was estimated to be representative of 90% of the U.S. population. The online survey took approximately 15 minutes to complete, and there were 2,032 survey respondents, ages 18–64. Anyone who had been previously diagnosed as having a major psychiatric disorder was excluded through direct query in the survey (“Have you ever been diagnosed with a mental health condition by a licensed medical professional?”), because they have already been linked to care (FINN Partners & APAF, unpublished data, 2023). Gender was evenly distributed; 57% were between ages 25 and 44; 80% were White; and 10% were of Hispanic-Latino origin. Most respondents (57%) earned between $35,000 and $125,000 in household income. Most (55%) had at least a college degree, and more than half of the respondents were full-time employees, whereas 12% were unemployed (FINN Partners & APAF, unpublished data, 2023). Although limited in sample size, the survey provides insights into perceptions of mental health care in a population that has not been diagnosed as having a psychiatric disorder.

Lessons Learned From the Mental Health Awareness and Perceptions Survey

A key finding from the Mental Health Awareness and Perceptions Survey was that, although most respondents are aware of mental health services in their area (76%), and half of respondents reported having experienced a mental health–related issue, a third of those respondents did not seek treatment (FINN Partners & APAF, unpublished data, 2023). Others are uncertain if what they have experienced or are currently experiencing is a mental health–related condition (FINN Partners & APAF, unpublished data, 2023). Those who experienced a mental health condition but did not seek treatment skewed older (age 43 and over) (FINN Partners & APAF, unpublished data, 2023). Older generations are the least aware of how to take steps toward addressing their mental health concerns, and they experience higher levels of discomfort in seeking help (FINN Partners & APAF, unpublished data, 2023). Awareness and comfort in seeking help were found to be correlated. Seven in 10 respondents reported being comfortable seeking mental health care (FINN Partners & APAF, unpublished data, 2023). Those who were not as comfortable included men, those who are older, those who were less educated (with schooling until age 18), and those who work part-time or are self-employed (FINN Partners & APAF, unpublished data, 2023). The top barriers for those who have not sought treatment were access to mental health care information, financial resources, and access to providers, followed by stigma (FINN Partners & APAF, unpublished data, 2023). Even those who reported being comfortable seeking treatment felt that it is not a straightforward process and reported that affordability is a large barrier. Of those who have sought treatment, only half found it easy to do so (FINN Partners & APAF, unpublished data, 2023).

Additionally, respondents were more likely to seek treatment for their general medical health concerns (64%) than for their mental health concerns (58%), even if treatment was recommended by a professional (FINN Partners & APAF, unpublished data, 2023). Compared with older respondents, younger individuals (ages 18–42) were more educated about mental illness treatment and sought treatment more regularly (FINN Partners & APAF, unpublished data, 2023). They were more likely to attend treatment once a month or more, and those ages 18–26 were also the only respondents to prioritize mental over general medical health, with 67% reporting that they would seek treatment for their mental health concerns, compared with 59% for general medical health concerns (FINN Partners & APAF, unpublished data, 2023).

Being comfortable talking about mental health is increasing overall in the United States; however, skepticism about the effectiveness of psychiatric treatment remains. Although over three quarters of respondents were comfortable talking about mental health–related issues, less than half believe mental health care is effective (FINN Partners & APAF, unpublished data, 2023). Generation Z (people ages 18–26) were the most open to talking about mental health care and getting treatment, compared with people from older generations (FINN Partners & APAF, unpublished data, 2023). Those of lower income and who were older, less educated, and unemployed were more likely to not agree that mental health treatment is effective (FINN Partners & APAF, unpublished data, 2023). In terms of stigma, 74% of the respondents who utilize mental health treatment believe that there is still stigma associated with mental health in the United States. The respondents felt that it was a cultural problem, and most felt that governing bodies, schools, and family doctors should be leading the way to reduce the stigma but that psychiatrists should be providing more education (FINN Partners & APAF, unpublished data, 2023). Specifically, they felt that psychiatrists should share information on the treatment plans and/or options available; case studies of effective treatments; warning signs of mental health conditions; information on mental health resources; education around different mental health professionals and what they treat; and data and/or statistics on the increasing prevalence of mental health conditions (FINN Partners & APAF, unpublished data, 2023).

Conclusions and Future Directions

These survey results highlight opportunities to make mental health care more accessible, relatable, and accepted. There is a need to provide more education on what resources exist; to improve perceptions of effectiveness across generations, particularly for those who are most reluctant to seek help or are unsure whether they need it; and to show that mental health care is working for people who experience similar symptoms. Younger generations show more openness in seeking mental health care and are critical partners in changing the culture. The APAF has built on these principles in the campaign, and through its work, the APAF is also seeking to empower schools, employers, trainees, and other community partners to deliver the campaign message that mental health care works and to make mental health care more accepted and easier to navigate. For instance, the APAF’s Center for Workplace Mental Health has programming for employers that highlights the benefits of mental health care in the workplace.

The campaign features personas that are based on stories of real individuals in an effort to make mental health issues and treatment more relatable. Three personas were featured in the first 6 months: a young adult with anxiety that prevented her from engaging in hobbies, a woman with postpartum depression who realized that she had to address her mental health condition to support her child, and an older man with grief and depression after his wife passed away. These personas were selected to start with because they cover common conditions and life stages across a spectrum of ages. The campaign utilized billboards, bus advertisements, social media, and radio interviews across the nation, as well as videos on the MentalHealthCareWorks.org website sharing the stories of the personas. After 1 year, the campaign messaging was viewed over 323 million times. In the second year, the campaign is expanding to include personas covering alcohol use disorder, obsessive-compulsive disorder, and attention-deficit hyperactivity disorder through a partnership with Edelman, a global public relations firm. As the campaign progresses, the public will be resurveyed to look for changes in attitudes and perceptions about mental health treatment. Additional personas covering common mental health concerns are planned for the third year; however, severe mental illness (i.e., bipolar spectrum disorders and schizophrenia) is beyond the scope of this campaign.

In addition to educating the public, the APAF works to provide education to the future of the psychiatric workforce. The APAF Fellowships are the largest and longest continuously operating professional development programs for psychiatrist trainees in the world. More than 100 resident psychiatrists across the nation are selected each year to participate in the nine APAF Fellowship programs. The Fellowships provide lectures, mentorship, and experiential learning opportunities and are key in developing well-rounded leaders in psychiatry who will promote mental wellness in the patients and communities they serve. In 2024, the APAF also launched a Psychiatry Ambassadors and Student Scholarships (PASS) program to foster connections between the broader trainee community and the APA-APAF, as this program is open to psychiatry residents and medical students, with about 800 participants, expanding beyond the Fellowship program. The Fellowship and PASS programs support the Mental Health Care Works campaign, as it is essential to involve our future psychiatrists in this mission and prepare them to provide holistic care and education to their patients.

Psychiatrists and other health professionals play a key role in educating not only individual patients but also society at large about mental health. As the Mental Health Awareness and Perceptions Survey indicated, there is a desire for more knowledge, and the APAF works with clinicians to disseminate reliable information. Most people with mental health conditions will be evaluated in primary care settings (9), and the APAF promotes integration with the frontline medical fields to grow capacity to treat mental health conditions. The Mental Health Care Works campaign supports the collaborative care model and a holistic view of health to reinforce the message that mental health should be prioritized the same way as general medical health.

Public service announcements (PSAs) or public service campaigns related to mental illness have typically been described as either educational or contact based (i.e., based on direct contact with individuals with mental illness), with the goal of challenging prejudice and decreasing discriminatory behavior (10). Many PSAs combine education and contact by featuring a person telling their story while sharing facts about the illness (10), which is similar to the Mental Health Care Works persona videos. PSAs have shown limited impact in the literature, and it has been proposed that social marketing campaigns could increase impact with more focused targeting of groups and locations (10). Although the hope is that many individuals will come across the campaign materials organically, having clinicians share the relevant personas and resources on an individual level in their own clinics and communities leverages the impact of the message. The Mental Health Care Works campaign materials serve as a resource to start conversations and make changes to the way society views mental health treatment.