Action MindedCampaign Report

Action Minded created an average 8.4 percentage point reduction in stigma, making it one of the most successful mental health campaigns ever conducted.

7 million people in the United States now hold less stigmatizing views of mental health, equating to a cost of 11 cents per person to reverse stigma.

Action Minded’s use of evidence-based strategies, including;● tailoring messages for individuals along a spectrum of interest in mental health;● recruiting individuals already sharing about their mental health;● tapping into American’s love for pets by allowing submissions and then pairing animals

with mental health messages;● incorporating disease surveillance by monitoring mentions of mental health and analyzing

themes, categories, and trending topics of conversation;● supporting Kaiser Permanente’s existing network of community organizations;

have created a campaign that is significantly more effective at reducing stigma, and more cost-effective, than campaigns with more funding and the support of traditional PR.

Using an organic, truly community-led approach, Action Minded is today recognized by 49.4% of the public. What was an evidence-based but untested approach could now be best practice.

EXECUTIVE SUMMARY

BACKGROUND & METHODS

Mental health conditions (MHC) are highly stigmatized. Stigma perpetuates stereotypes and discrimination, and increases health disparities. The Public Good Projects and Kaiser Permanente designed a first-of-its-kind digital Community Health intervention, to reduce mental health stigma. Titled Action Minded, its strategy is taken directly from evidence-based public health interventions to reduce mental health stigma.1 These interventions employ three main strategies:

Education-Based Strategies

Education-based strategies include mental health literacy and awareness

campaigns. They focus on raising awareness, correcting misinformation,

and contradicting stereotypes.

Advocate-Based Strategies

Advocacy strategies are a means of directing the public’s interest in mental

health. Calls to action often include policy change. Simplified,

advocate-strategies give engaged individuals something to do.

Contact-Based Strategies

A lack of contact with individuals who live with MHC leads to increased distrust, fear, and desire for social distance. Contact-based programs

introduce individuals to individuals with MHC, emphasizing their common

humanity.

Citation: (1) National Academies of Sciences, Engineering, and Medicine. (2016). Ending discrimination against people with mental and substance use disorders: The evidence for stigma change. National Academies Press.

BACKGROUND

Campaign messaging is based on health information vetted by MHALO and NAMI.

Message themes change month by month, ranging from introductory information to more complex concepts. Themes apply to content across each of the sub-campaigns.

Monthly Themes

Sept/Oct 2018

Nov 2018

Dec 2018

Jan 2019

Feb 2019

Listening Language Myth v Fact Stress Mental Health Definitions

March 2019

April 2019

May 2019

June 2019

July 2019

Living w/Mental Health

Be an Ally Mental Health Stigma

Physical and Mental Health

Where Stigma Happens

CAMPAIGN MESSAGING

In order to determine campaign impact, two cross-sectional surveys were conducted within the 8 intervention regions that received the campaign, corresponding to Kaiser Permanente’s regions. Respondents were recruited through a third-party research survey vendor, Qualtrics. The first survey established the campaign baseline in July, 2018, with follow-up occuring in June, 2019.

Eligibility Criteria Individuals between the ages of 18-65, and currently living within one of the intervention regions. Respondents were recruited to mirror the racial and ethnic composition of each region, with approximately the same number of respondents per region in order to ensure no one region was overrepresented.

Data AnalysisResults from the survey were analyzed using IBM SPSS Statistics software and data were compared using a 2-sided Pearson Chi-squared test. At follow-up, data were weighted to match the baseline gender distribution of 48.4% male and 50.7% female.

EVALUATION METHODOLOGY

In line with evaluations of other large-scale stigma campaigns 1 2, the survey instrument utilized existing validated instruments of knowledge, attitudes, and reported and intended behavior, such as:

● The Reported and Intended Behavior Scale (RIBS) assessing social distance, or a respondent’s willingness to interact with a person experiencing a mental health problem in various relationship contexts such as socializing with, or living next door;

● The Mental Health Knowledge Schedule (MAKS) assessing stigma-related mental health knowledge;

● The Community Attitudes towards Mental Illness (CAMI) scale assessing attitudes related to susceptibility, commonality, dangerousness, and responsibility;

● Survey questions were also created by PGP to assess specific aspects of mental health stigma that were not included in other validated scales.

In order to examine changes and campaign progress, surveys contained the same questions over time.

SURVEY MEASURES

Citations: (1) Evans-Lacko, S., Henderson, C., & Thornicroft, G. (2013). Public knowledge, attitudes and behaviour regarding people with mental illness in England 2009-2012. The British Journal of Psychiatry, 202(s55), s51-s57. (2) Burnam, M. A., Berry, S. H., Cerully, J. L., & Eberhart, N. K. (2014). Evaluation of the California Mental Health Services Authority's Prevention and Early Intervention Initiatives: Progress and Preliminary Findings. Rand health quarterly, 4(3).

RESULTS

A total of 4,080 respondents completed a survey: 2,039 respondents at baseline and 2,041 respondents at follow-up, with respondents recruited approximately evenly across all KP regions (approximately 250 respondents per region).

Demographic information was similar between time periods.

Respondents were recruited to match the demographic characteristics of each region.

SURVEY DEMOGRAPHICS Baseline Follow-up

Age Group 18-25 25.3% 26.5%

26-35 25.2% 33.1%

36-45 17.6% 17.0%

46+ 31.9% 23.4%

Gender Male 48.4% 48.4%

Female 50.7% 50.7%

Race & Ethnicity (respondents chose all that apply)

White 63.8% 53.6%

Black 13.3% 22.2%

Asian 14.5% 11.8%

American Indian 2.6% 6.0%

Hawaiian/ Pacific Islander 3.5% 3.8%

OtherRace 5.1% 9.1%

Hispanic 19.6% 26.8%

Education Less than high school 2.7% 3.8%

High school graduate or GED 21.0% 24.0%

Some college, no degree 29.1% 29.9%

Associate's degree 11.9% 12.6%

Bachelor's degree 25.6% 20.9%

Ph.D., graduate or professional degree

9.4% 8.4%

RESULTS - CAMPAIGN AWARENESS

At follow-up, 49.4% of respondents reported awareness, with statistically significant differences between respondents who reported campaign awareness compared to those who did not.

Results stratified by campaign awareness are presented in addition to the overall sample throughout the results section.

Results showed statistically significant decreases in desires for social distance. Social distance is measured by a willingness to interact with a person who is living with a mental health condition in varying environments. The largest difference was seen in willingness to live with someone with a mental health condition, with a 11.9 percentage point increase at follow-up.

Respondents with campaign awareness reported significantly higher agreement across all social distance measures, indicating people exposed to the campaign are more willing to interact with those who have mental health conditions.

OVERALL SAMPLE CAMPAIGN AWARENESS

RESULTS - SOCIAL DISTANCE

OVERALL SAMPLEIn general, attitudes toward mental health conditions showed significant improvements in beliefs around susceptibility to a mental health condition, ability to handle responsibility, recovery, and perceptions of dangerousness. The largest improvement was seen in perceptions of effectiveness of treatment, with an 8 percentage point increase.

RESULTS - ATTITUDES TOWARD CONDITIONS

Respondents with campaign awareness reported significantly higher agreement in perceptions of treatment, susceptibility to a mental health condition, positive recovery beliefs, and perceptions of dangerousness. The largest difference was seen in the latter measure, with a 13.7% percentage point difference in agreement about the dangerousness of people with a mental health condition.

CAMPAIGN AWARENESS

In the past six months, have you provided support to someone with a mental health

condition in the following ways:

Results showed an increase in confidence providing advice to a friend with a mental health condition (56.8% at baseline, 68.1% at follow-up).

This was reflected in respondent actions as well - with a statistically significant increase in having provided support to someone with a mental health condition in person, via phone, on social email, and via email.

OVERALL SAMPLE CAMPAIGN AWARENESS

RESULTS - ATTITUDES TOWARD CONDITIONS

A greater proportion of respondents with campaign awareness reported feeling confident providing advice to a friend with a mental health condition (71.3% of those aware vs. 64.9% of those not aware).

Those with campaign awareness reported more frequently providing support to someone with a mental health condition across all the measures asked, indicating campaign awareness is associated with an increase in support behaviors.

CONCLUSIONS

Action Minded created statistically significant reductions in stigma, as indicated by 58 different measures and stratified by campaign awareness. The large-scale anti-stigma campaigns Time to Change and Each Mind Matters employ 16 measures and 4 measures, respectively.1 2

This chart shows the common questions reported by PGP’s evaluation as well as the evaluations of Time to Change and Each Mind Matters. The percentage point changes over time are provided. In 7 of the 11 common questions highlighted below, Action Minded showed the largest reduction in stigma.

Overlapping Questions Action Minded Time to Change Each Mind Matters

In the future, I would be willing to live with someone with a mental health condition. ↑11.9 percentage points ↑9 percentage points

In the future, I would be willing to work with someone with a mental health condition. ↑6.2 percentage points ↑7 percentage points ↓2 percentage points (Phrased as unwilling)

In the future, I would be willing to live nearby to someone with a mental health condition. ↑8.6 percentage points ↑8 percentage points ↓5 percentage points(Phrased as unwilling)

In the future, I would be willing to continue a relationship with a friend who developed a mental health condition. ↑6.8 percentage points ↑7 percentage points

Most people with mental health conditions want to have paid employment. ↑6.1 percentage points ↑4 percentage points

If a friend had a mental health condition, I know what advice to give them to get professional help. ↑11.3 percentage points ↑5 percentage points

Psychotherapy (eg talking therapy or counseling) can be an effective treatment for people with mental health conditions. ↑8 percentage points ↑4 percentage point

People with severe mental health conditions can fully recover. ↑6.9 percentage points ↑4 percentage points ↑2 percentage points

Those with mental health conditions are far less of a danger than most people suppose. ↑5.4 percentage point ↑7 percentage point

Virtually anyone can be diagnosed with a mental health condition. ↑4.5 percentage point ↑4 percentage point

Most people with mental health conditions go to a healthcare professional to get help. ↑3.8 percentage point ↓5 percentage points

Citations: 1. Time to Change. (2012). Latest survey shows public are less likely to discriminate against people with mental health problems. Retrieved July 3, 2019 from https://www.time-to-change.org.uk/news/latest-survey-shows-public-are-less-likely-discriminate-against-people-mental-health-problems. (2). Collins, R. L., Wong, E. C., Roth, E., Cerully, J. L., & Marks, J. (2015). Changes in Mental Illness Stigma in California During the Statewide Stigma and Discrimination Reduction Initiative. Rand health quarterly, 5(2).

COMPARISON TO OTHER CAMPAIGNS

Action Minded created an average 8.4 percentage point improvement in attitudes toward mental health conditions in KP regions.1

This translates to 7,071,265 people who now hold less stigmatizing views.

When examined by campaign cost, this equates to11 cents per person to change stigmatizing beliefs.

Citation: (1) Improvement in attitudes calculated in line with methods used by: Time to Change. (2012). Latest survey shows public are less likely to discriminate against people with mental health problems. Retrieved July 3, 2019 from https://www.time-to-change.org.uk/news/latest-survey-shows-public-are-less-likely-discriminate-against-people-mental-health-problems

CAMPAIGN IMPACT & ROI

Current large-scale mental health campaigns require budgets of many millions of dollars, due to the cost of purchasing media (time on television, radio, billboards, etc.) and the tradition of hiring external marketing and advertising agencies. The UK’s Time to Change campaign, heavily promoted by traditional PR, exceeds $25 million (£20 million) over four years.

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