Mental Health: Spaces to breathe in universities.

The problem:

Levels of depression, anxiety and other mental health problems are increasing dramatically within the student population, with some studies citing percentages as high as 73% (Inam, Saqib, & Alam, 2003; Bayram & Bilgel, 2008). We have noticed that there is no ‘quiet’ space on the University of Warwick campus for individuals to go.

After an initial email reply from the counselling services, we confirmed that there is no open space that can be used to recharge and recuperate, which doesn’t have religious connotations. Therefore, our aim was to contact members of the university who would have an influence into getting a space for those students who need a safe and calm place to: breathe, relax and recharge, without any pressures.

What we did:

After discovering the huge problem of mental health among students, we started brainstorming ideas about what would help us if we were having a bad mental health day. This led us to discover relaxation pods and rooms in workplaces and schools. After further research and brainstorming, we thought this idea would be transferable to the university. Therefore, we drafted an email to the Vice Chancellor, Head of Counselling Services and the Welfare and Campaigns Officer of the University of Warwick. This email includes all the details about why the mental health services need to be expanded at the university, and why a Recharge Room could be the answer.

Our email:

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We hope you are well.
We are three final Psychology students looking to promote change. We have previously emailed asking if Warwick University offers a 'Safe Space' or 'Recharge Room' for students to go when they are needing to seek quiet in a comfortable environment. You kindly responded recommending the chaplaincy area and/or the multi-faith prayer rooms at WW and Gibbet Hill. However, there is no recharge room or quiet space that does not have connotations with religion. As part of our case, we have found a large number of other universities, just in the UK, that have taken the initiative to provide a wellbeing space for students. Here are just three website links to Bristol, Manchester and UCL universities that provide this kind of space for their students:

• University of Manchester -http://www.sport.manchester.ac.uk/facilities/wellroom/ - “We have two large activity studios, a lounge area and treatment room which houses our Physio and Masseur Clinic on the ground floor and we have a chill-out bean bag room and large group room on the 1st floor.
• University of Bristol - https://www.bristol.ac.uk/library/accessibility-support/wellbeing/ - Relaxation space in the Arts and Social Sciences Library “We’ve created a dedicated calm space on the first floor where you can take a break away from your study in order to recharge and refresh. Within the pleasant woodland and meadow-decorated space, you’ll find rocking chairs, blankets, comfortable floor pillows, a family of stress-busting cuddly animals and an assortment of materials designed to enhance your sense of wellbeing.
• UCL - https://www.ucl.ac.uk/students/support-and-wellbeing/specialist-information-and-support/religion-and-faith- “Quiet contemplation room”

Other educational and professional organisations have also started to provide these ‘recharge’ spaces for their students and staff, such as Google, Soundcloud, Nike, primary and secondary schools.

We all know that university can be a stressful time and evidence shows that university students report high levels of stress, with the prevalence of anxiety and depression in students of the 4th year, 3rd year, 2nd year and 1st year was 49%, 47%, 73% and 66% respectively. Relaxation techniques such as elevator breathing and guided relaxation have shown to have significant effects of reducing levels of test anxiety (Larson et al, 2010). There are also long term benefits such as increased self-esteem, improved grade point average overtime were supported by research (Sharif & Armitage, 2004) due to these relaxation techniques.

We recommend that these recharge spaces be areas of quiet, relaxation and minimal distractions. Therefore, not much is needed to fill these rooms - perhaps a few bean bags, relaxation technique posters and helpline guidance.Please let us know if we can progress this idea further in any way. We would love to be a part of this as much as possible. We have noticed in the Arts Centre there is a space for ‘creative learning’, consisting of children’s toys and furniture. We suggest that an area like this, with bean bags etc. would be great for the students of the University of Warwick. We would be more than happy to conduct a poll to see if there would be significant interest in a space like this. If you would like to have a look at further evidence we have gathered, the links are provided at the bottom of this email.

Thank you and we look forward to hearing back from you. Best wishes

Carnegie Mellon Uni - https://www.cmu.edu/wellness/be-mindful/mindfulness/index.html
University of Stirling - https://www.stir.ac.uk/about/faculties-and-services/information-services-and-library/current-students-and-staff/library-information/wellbeing-space/
University of Plymouth - https://www.plymouth.ac.uk/student-life/services/learning-gateway/counselling/space
Schools - https://www.safespaces.co.uk/safespace-in-schools/
University of Worcester - https://www.worc.ac.uk/content_images/labyrinth.pdf
Pop-up Wellbeing Spaces - https://www.tes.com/news/welcome-wellbeing-zone

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Techniques:

Our email consisted of concepts from two theoretical frameworks: the Elaboration Likelihood Model and the YALE approach to persuasion.

1. Elaboration Likelihood Model (ELM)

Firstly we investigated the ELM. This is a framework that was developed by Petty and Cacioppo (1986) with the aim of explaining why the same variable affecting persuasion sometimes enhances the effect, but in other circumstances minimises it. This model is a dual process model of persuasion. One process is automatic, quick and uses heuristics (peripheral route) and the other process is controlled, deliberate and rational (central route).

Peripheral route: Persuasion occurs via the peripheral route when the persuasive conditions promote low elaboration. Either the message is thought about very little (the idea that we are cognitive misers; we like to use little effort to think (Stanovich, 2008), or the one being persuaded lacks ability and motivation (factors determined by things such as how much the message is personally relevant to them, whether they have knowledge in the domain, or feel responsible) to understand what is being said. People going down the peripheral route rely on more judgemental heuristics and superficial features, for example, agreeing with a request because the speaker is attractive (Halo Effect (Nisbett & Wilson, 1977), or believing they are qualified/authoritative because they are wearing a suit blazer, despite having no specific expertise in the field.

Central route: On the other hand, the central route persuasion occurs when the message has been thought about and elaborated on. The person receiving the message has the ability to pay attention to the logic and rationale of what is being said, going beyond what is apparent from the surface. The ability to do this increase with clear presentation, attention, time and having the cognitive resources available, i.e. being awake and alert. Petty and Cacioppo (1986) argued that persuasion via the central route leads to more predictive future behaviour and information processing, it is more stable over time, and more resistant to future persuasion formed under peripheral route conditions (Petty, Barden & Wheeler, 2009).

Therefore, for our project, we chose to focus on the central route. This was for a number of reasons. 1. The request we were making needed an active response and action, whereas the peripheral persuasion route tends to be passive. 2. The people we contacted in order to find out the feasibility of having a recharge room and the associated benefits, have a deeper understanding and expertise in the field: the University’s Head of Counselling, Vice-Chancellor and the Student’s Union’s Welfare and Campaign’s Officer. 3. The topic of a recharge room was salient, relevant and important to those listening, thus increasing the motivation for them to listen to the message they were being given. 4. According to the ELM, the message itself needs to be coherent, logically sound and compelling (Petty, Cacioppo & Heesacker, 1981; Areni & Lutz, 1988). Therefore, the email described what we were asking, why it was important and contained the persuasive evidence that has been found to support recharge rooms at different universities, schools and workplaces across the UK and worldwide.

2. The YALE Approach

Secondly, we used the YALE approach. This is a persuasion technique developed by Carl Hovland at Yale University (Hovland et al, 1953) which aims to study conditions in which people are more likely to change their response according to persuasive messages. There are three components in Yale approach to form a persuasive message: the message source (who), the content of the message (what), and the receiver (whom).  

On the ‘who’ level: the credibility of the sources can affect how persuasive a message is, for example, experts opinions are more persuasive than non-experts, and increase the trustworthiness of the source. A study showed that compliance and agreement with the topic are greater if the source is from an expert (Maddux & Rogers, 1980). Next, on the message ‘what’ level: higher quality messages are more persuasive, for instance, the vividness of message can affect the quality of message and messages that focus on a single individual are more persuasive than fact-based messages. Combined with graphic images this technique can induce fear into people, which increases the persuasiveness of the message. An example of this would be a cigarette warning label with graphic images. Another study showed that fear appeals with instructions for what to do in response were the most effective treatment (Leventhal et al, 1967). Lastly, on the ‘whom’ level: age of the audience is also a contributing factor. Young people are more susceptible to persuasion than old people. Additionally, the mood of the receiver can also play a role, for example, feeling very negative or very positive increases susceptibility to persuasion.

For our project, we focused on the quality of sources. We supported our suggestions by referencing scientific papers with empirical research that investigated the advantages of having a safe space and how relaxation techniques help reduce anxiety. This would increase the strength of the argument and highlight the importance of this issue. We hypothesised that those we contacted were more likely to take the central route to consider our suggestion and with reference to expertise and research, this would increase the persuasiveness of our message.        

Conclusion:

Overall, our project was a way of increasing the awareness of ongoing mental health problems to those in higher positions within our University. Our thorough research has shown us that recharge rooms/safe spaces are beneficial for all involved and can help students when they’re going through a troubling period. We thought that the best way to persuade the university to seriously look at the potential of getting a space was to contact them with all the statistics and information about the benefits, meaning that there was less research for them to do. We used the Elaboration Likelihood Model and the YALE approach to do this. However, unfortunately, we did not receive a definitive reply, with a plan of action, within the 4 weeks. Depending on the direction of a future response, we will try to use persuasion techniques that are appropriate for the direction: either a decline of a recharge room or acceptance. If they decline, we will ask why, then work on turning the ‘no’ into a ‘yes’. If we know the reason why not, we can research ways around this. If they accept, our job is done.

References:

Areni, C.S., & Lutz, R.J. (1988). The role of argument quality in the Elaboration Likelihood Model. Advances in Consumer Research, 15, 197-203.

Bayram, N., & Bilgel, N. (2008). The prevalence and socio-demographic correlations of depression, anxiety and stress among a group of university students. Social Psychiatry and Psychiatric Epidemiology, 43, 667-672.

Dehghan-nayeri, N., & Adib-Hajbaghery, M. (2011). Effects of progressive relaxation on anxiety and quality of life in female students: a non-randomized controlled trial. Complementary Therapies in Medicine, 19, 194-200.

Eppley, K. R., Abrams, A. I., & Shear, J. (1989). Differential effects of relaxation techniques on trait anxiety: a meta‐analysis. Journal of Clinical Psychology, 45, 957-974.

Gotink, R. A., Chu, P., Busschbach, J. J., Benson, H., Fricchione, G. L., & Hunink, M. M. (2015). Standardised mindfulness-based interventions in healthcare: an overview of systematic reviews and meta-analyses of RCTs. PloS one, 10, e0124344.

Hovland, C. I., Janis, I. L., & Kelley, H. H. (1953). Communication and persuasion.

Inam, S. N. B., Saqib, A., & Alam, E. (2003). Prevalence of anxiety and depression among medical students of private university. Journal-Pakistan Medical Association, 53, 44-46.

Larson, H. A., El Ramahi, M. K., Conn, S. R., Estes, L. A., & Ghibellini, A. B. (2010). Reducing Test Anxiety among Third Grade Students through the Implementation of Relaxation Techniques. Journal of School Counselling, 8, 19.

Leventhal, H., Watts, J. C., & Pagano, F. (1967). Effects of fear and instructions on how to cope with danger. Journal of Personality and Social Psychology, 6, 313.

Maddux, J. E., & Rogers, R. W. (1980). Effects of source expertness, physical attractiveness, and supporting arguments on persuasion: A case of brains over beauty. Journal of Personality and Social Psychology, 39, 235.

Neuderth, S., Jabs, B., & Schmidtke, A. (2009). Strategies for reducing test anxiety and optimizing exam preparation in German university students: a prevention-oriented pilot project of the University of Würzburg. Journal of Neural Transmission, 116, 785-790.

Nisbett, R. E., & Wilson, T. D. (1977). The halo effect: Evidence for unconscious alteration of judgments. Journal of Personality and Social Psychology, 35, 250-256.

Petty, R. E., Barden, J., & Wheeler, S.C. (2009). The Elaboration Likelihood Model of persuasion: Developing health promotions for sustained behavioural change.

Petty, R. E., Cacioppo, J. T., & Heesacker, M. (1981), The Use of Rhetorical Questions in Persuasion: A Cognitive Response Analysis. Journal of Personality and Social Psychology, 40, 432-440.

Petty, R. E., & Cacioppo, J. T. (1986). The elaboration likelihood model of persuasion. Advances in Experimental Social Psychology, 19, 123-205.

Sharif, F., & Armitage, P. (2004). The effect of psychological and educational counselling in reducing anxiety in nursing students. Journal of Psychiatric and Mental Health Nursing, 11, 386-392.

Stanovich, K. E., & West, R.F. (2008). On the relative independence of thinking biases and cognitive ability. Journal of Personality and Social Psychology, 94, 672–695.

PartyPlugs: Protect your ears while going out

The Problem and its Relevance

More and more young people willingly expose themselves to loud noise, especially in recreational settings (Quintanilla-Dieck, Artunguaga & Eavey, 2009). Yet, any exposure of significant intensity and duration can be harmful, even if the noise is not experienced as too loud (Rabinowitz, 2000). It can cause ear pain, noise sensitivity, tinnitus and even hearing loss (Gilles et al., 2012). Over a longer period, exposure to loud music damages the inner and outer hair cells which can result in permanent hearing loss (Zhao, Manchaiah, French & Price, 2010). Even though many people do know that loud noise can be harmful, many people don’t consider it a problematic health issue (Quintanilla-Dieck et al., 2009).

Concerts, personal listening habits and nightclubs are commonly identified as the main sources of exposure to loud noise in recreational contexts (Rawool & Colligon-Wayne, 2008; Gilles et al., 2012). Attendance to nightclubs has repeatedly been reported as the cause for symptoms such as tinnitus, ear pain and hearing loss (Chung, Des Roche, Meunier & Eavey, 2005). Tinnitus is defined as the ‘perception of sound in absence of an actual external sound’ (Han et al., 2009, 11) and can take different forms. The sounds most often associated with tinnitus are high-pitched sounds like escaping steam (Han et al., 2009). Even though the quantitative relationship between recent loud music exposure and tinnitus is not well understood (Moore, Zobay, Mackinnon Whitmer & Akeroyd, 2017), the relatively long exposure to high sound levels when going out might be responsible for transient tinnitus (Gilles et al. 2012). For comparison: Hearing protection is compulsory for workers that are exposed to noise more than 85 dB(A) for 8 hours a day. Music in nightclubs, however, ranges from 95 to 110 dB(A) with a tendency to increase during the night (Gilles et al., 2012). A weekly exposure of over 1.25 hours to such sounds levels is considered to exceed occupational safety standards (Vogel, Brug, van der Ploeg & Raat, 2010). Given that people might go to clubs several nights per week and/or spend several hours in a club, the exposure is beyond safe levels. However, only a minority of people report using hearing protection or engaging in protective behaviours (Vogel et al., 2010; Chung et al., 2005; Rawool & Colligon-Wayne, 2008)

In one study among Dutch students, 89.5% of students reported having experienced tinnitus after loud music exposure (Gilles et al., 2012). In another study by Rawool & Colligon-Wayne (2008) 66% of respondents in a student population reported that they had experienced tinnitus in the past. However, most of the students (58%) were not concerned about it. This showcases a contradiction in people’s attitude towards loud music: Even though many have suffered from its consequences, it is not deemed an important issue. Rather tinnitus is understood as a natural consequence of clubbing and no action is taken (Gilles et al., 2012).

However, there are certain behavioural changes that can lower the risk of tinnitus and hearing loss. Visitors of nightclubs are recommended to keep at least two meters distance from the music source and take breaks from exposure during the night (Vogel et al., 2010). Additionally, wearing hearing protection can reduce the impact loud music has on the ears. Toivonen and colleagues (2002) show that proper insertion of earplugs can attenuate noise by up to 31 dB. This would reduce sound to safe levels.

The target audience

With our project, we want to raise awareness for the dangers of loud music and promote the use of earplugs among students. However, the target audience of this project are nightclubs around the University of Warwick. We decided not to approach the students directly but to address nightclubs instead. Thereby, we wanted to influence them in a more indirect way (see Psychological Persuasion Techniques used in our project).

Our intervention: PartyPlugs

In order to get an insight into the experiences of students at Warwick, we set up a short questionnaire. We asked where they go out, how often they went on a night out and how they experienced the volume of the music in nightclubs. We were also interested if they had ever worn earplugs and if not why they didn’t wear them. Fifty people filled out the online questionnaire. The results show that the majority of the students goes out more than once a week (62%). They experience the music to be at adequate or slightly too loud levels. When asked if they experienced a beeping noise after going out, more than half of students indicated to have experienced this at least once. Out of these, 36% reported experiencing transient tinnitus sometimes. However, only a small majority of students (8%) occasionally wear earplugs when going out.

We used this information to compose an email that we send afterwards to eight nightclubs around the University of Warwick. In this email, we described the harms of loud music supported by scientific evidence. We also included the results from our own questionnaire to inform the nightclubs on how their guests experience the music volume. Furthermore, we asked if they had any policy in order to protect the clubbers against tinnitus and hearing loss. We proposed to help raise awareness by putting up posters we would provide them with. Another option we suggested was to make earplugs available in their club. 

We didn’t get any response to the emails we send to the nightclubs. As a consequence, we decided to contact them through Facebook. We sent a shortened version of the information we used in the email. This time we got one message back. The club answered that they take ear protection very seriously. They explained that they have a sign at the entrance informing the guests that free earplugs are available at the bar. The other nightclubs opened our message but did not reply. In addition to this, we wrote an email to the well-being officer of the Student Union to ask about their opinion on the problem. However, we have not received an answer to this day.

Psychological and persuasion techniques used

In our project, we used several persuasion techniques to raise awareness for the issues around exposure to loud music. We chose to address nightclubs instead of students for several reasons.

Taken from Ajzen, 1991

According to the theory of planned behaviour (Ajzen, 1991), intentions towards a certain behaviour can be accurately predicted by attitudes, subjective norms and perceived behavioural control. An attitude towards a behaviour refers to the degree to which someone has a (un)favourable evaluation or appraisal of the behaviour. In our case, it refers to how favourable or unfavourable students evaluate the use of hearing protection while going out. From our literature review, it seems that the general attitude of young people towards hearing protection is rather indifferent. To be able to change students’ behaviour so that they use hearing protection, their attitude has to shift to a favourable appraisal of it. One way of changing people’s attitudes towards a behaviour is by making the intended behaviour more familiar. As Cialdini argues, familiarity has a positive effect on liking, which in turns affects persuasion (Cialdini, 2009). Part of this familiarization could be established by seeing posters or earplugs at nightclubs. Monahan, Murphy and Zajonc (2000) showed that unconscious repeated exposure to a stimulus can affect liking. Even if the posters are not consciously seen by the partygoers, they could still increase familiarity and liking. Moreover, if students like the clubs they go to, which we assume to be the case, this positive affect could be diffused towards the messages about earplugs (Monahan et al., 2000).
Secondly, social norm refers to the perceived social pressure to perform or not perform the behaviour. Since the use of earplugs is not common among young people nowadays, social pressure to wear them is low. If we want students to use hearing protection while going out, we would need to create a higher social pressure. We reasoned that one way to achieve this is through the nightclubs themselves. If they advertise the use of earplugs and make them available at the bar, they convey the norm that it is normal in their club to wear earplugs.

Perceived behavioural control, finally, refers to the perceived ease or difficulty of performing the behaviour, reflecting both past experience and anticipated obstacles. Not considering attitudes or social norms, wearing earplugs itself can be considered easy. However, buying earplugs and bringing them on the night out might be considered hard by students. When the clubs provide earplugs, on the other hand, this would remove an important obstacle. Therefore we asked the nightclubs in our email to make earplugs available at the bar.

To make the nightclubs themselves aware of the issue we used both scientific evidence and the results of an exploratory survey, as described above.
By using scientific evidence in our email, we aimed at increasing the perceived authority. As students, we might not possess sufficient authority to persuade nightclubs. Therefore, by adding solid empirical evidence to our argument, we wanted to induce a sense of knowledge and authority. As Cialdini (2009) argues the perception of authority or expertise can make people more susceptible to persuasion. People tend to mindlessly believe or obey authority figures because they seem trustworthy and a reliable source of information. Hovland and Weiss (1951) also showed that people are more likely to believe a message conveyed by a trustworthy source. This is what we attempted in our email through the use of scientific evidence.

Another reason to use empirical evidence can be explained based on the Elaboration Likelihood Model (ELM) (Petty & Cacioppo, 1986). According to this model, there are two possible routes to persuasion: the central route and the peripheral route. The central route, firstly, results from a person’s careful and thoughtful consideration of the quality of the information presented in support of an argument. Persuasion through the peripheral route, on the other hand, results from a simple cue in the persuasion context that induced change without necessitating scrutiny of the true quality of the information presented. Persuasion via the central route is showed to be more enduring than persuasion via the peripheral route (Petty & Cacioppo, 1986).

According to the ELM, the processing is central and the persuasion lasting if people are motivated and willing to elaborate. In this context, elaboration means the extent to which one thinks about the issue-relevant arguments in a message (Petty & Cacioppo, 1986). To make the addressed nightclubs more motivated to read and consider our proposal, we added data from students who actually go to these nightclubs, taken from our survey. Since these students are the target audience of the clubs, this information could make the issue more relevant to them. Petty and Cacioppo (1986) argue that when personal relevance increases, people become more motivated to make the cognitive effort of processing the issue-relevant arguments presented. Personal relevance is, therefore, an important determinant of the route to persuasion.

For our project, we therefore mainly used a combination of the Theory of Planned Behaviour, the effect of familiarity on liking and the Elaboration Likelihood Model as persuasion strategies.

Final notes

As we explained earlier, we did not approach students directly but contacted nightclubs in the area around campus. In the future, a campaign by the Students Union or individual students should directly target students, informing them about the harms of loud music and the benefits of earplugs. This should address social norm and existing attitude to eventually change their behaviour.

The fact that neither the nightclubs nor the well-being officer of the Students Union answered our emails can be seen as proof for the lack of awareness for the problem we addressed. As evidence shows (see above), many people do not consider the harms of loud music a problematic health issue, which might partially account for the non-response. Well-designed campaigns might change this in the future and make clubbing an even more enjoyable experience. 

References

Ajzen, I. (1991). The theory of planned behaviour. Organizational Behavior and Human Decision Processes, 50(2), 179-211. https://doi.org/10.1016/0749-5978(91)90020-T 

Chung, J. H., Des Roches, C. M., Meunier, J., & Eavey, R. D. (2005). Evaluation of noise-induced hearing loss in young people using a web-based survey technique. Pediatrics, 115(4), 861–867. https://doi.org/10.1542/peds.2004-0173

Gilles, A., Ridder, D. de, van Hal, G., Wouters, K., Kleine Punte, A., & van de Heyning, P. (2012). Prevalence of Leisure Noise-Induced Tinnitus and the Attitude Toward Noise in University Students. Otology & Neurotology, 1. https://doi.org/10.1097/MAO.0b013e31825d640a

Han, B. I., Lee, H. W., Kim, T. Y., Lim, J. S., & Shin, K. S. (2009). Tinnitus: characteristics, causes, mechanisms, and treatments. Journal of Clinical Neurology (Seoul, Korea), 5(1), 11–19. https://doi.org/10.3988/jcn.2009.5.1.11

Hovland, C., & Weiss, W. (1951). The Influence of Source Credibility on Communication Effectiveness. The Public Opinion Quarterly, 15(4), 635-650. Retrieved from http://www.jstor.org.kuleuven.ezproxy.kuleuven.be/stable/2745952

Monahan, J. L., Murphy, S. T., & Zajonc, R. B. (2000). Subliminal Mere Exposure: Specific, General, and Diffuse Effects. Psychological Science, 11(6), 462–466. https://doi.org/10.1111/1467-9280.00289

Moore, D. R., Zobay, O., Mackinnon, R. C., Whitmer, W. M., & Akeroyd, M. A. (2017). Lifetime leisure music exposure associated with increased frequency of tinnitus. Hearing Research, 347, 18–27. https://doi.org/10.1016/j.heares.2016.10.030

Passchier-Vermeer, W., & Passchier, W. F. (2000). Noise Exposure and Public Health. Enviromental Health Perspectives, 108(1), 123–131. Retrieved from http.//ehpnetl.niehs.nih.gov/docs/2000/suppl-1/123-131passchier-vermeer/abstract.html

Petty, R. E. and Cacioppo, J. T. (1986).The Elaboration Likelihood Model of Persuasion. Advances in Experimental Social Psychology, 19, 123-205.

Quintanilla-Dieck, M. d. L., Artunduaga, M. A., & Eavey, R. D. (2009). Intentional exposure to loud music: the second MTV.com survey reveals an opportunity to educate. The Journal of Pediatrics, 155(4), 550–555. https://doi.org/10.1016/j.jpeds.2009.04.053

Rabinowitz, P. M. (2000). Noise-induced hearing loss. American Family Physician, 61(9), 2759–2760.

Rawool, V. W., & Colligon-Wayne, L. A. (2008). Auditory lifestyles and beliefs related to hearing loss among college students in the USA. Noise and Health, 10(38), 1. https://doi.org/10.4103/1463-1741.39002

Toivonen, M., Pääkkönen, R., Savolainen, S., & Lehtomaki, K. (2002). Noise Attenuation and Proper Insertion of Earplugs into Ear Canals. The Annals of Occupational Hygiene. Advance online publication. https://doi.org/10.1093/annhyg/mef065

Vogel, I., Brug, J., van der Ploeg, C. P. B., & Raat, H. (2010). Young people: taking few precautions against hearing loss in discotheques. The Journal of Adolescent Health : Official Publication of the Society for Adolescent Medicine, 46(5), 499–502. https://doi.org/10.1016/j.jadohealth.2009.10.013

Zhao, F., Manchaiah, V. K. C., French, D., & Price, S. M. (2010). Music exposure and hearing disorders: an overview. International Journal of Audiology, 49(1), 54–64. https://doi.org/10.3109/14992020903202520

MENTALLY ILL AT UNI

The Problem 

Mental health is an uncomfortable topic for many people. Unlike a physical illness or injury, you can’t readily see or even understand the cause for mental illnesses and this causes people to feel uncertain and afraid. As one comedian and mental health advocate, Kevin Breel, put it: 

"We live in a world where if you break your arm, everyone runs over to sign your cast, but if you tell people you're depressed, everyone runs the other way".

This sad state of affairs is caused by stigmas - negative characteristics or attributes associated with mental illnesses. Stigmas are a lot like stereotypes and are often widely applied to cover a whole range of very different mental health issues. This, sadly, has a lot of far reaching impacts on the people affected, from feeling socially excluded, to being unable to find work due to their mental health history.

Take a look at pop culture for instance. Films like Split, Psycho, Wonderland, Shutter Island, Silver Linings Playbook, The Visit, and especially TV shows like The Simpsons and The Big Bang Theory, all involve some form of mental illness or neuroatypical characters, and sadly these characters are often over the top caricatures of what people believe a person with mental illness behaves like. For example, it is commonly accepted that Sheldon from The Big Bang theory is autistic, yet his symptoms are played for jokes and mocked excessively. 

Take Split, a film about a man suffering from Dissociative Identity Disorder (more commonly thought of as ‘Split Personality Disorder’, hence the title). In patients actually dealing with this condition, the person often lives with two or more distinct personality states (alters). They may suffer from memory loss, often have to cope with other mental health problems like depression, and have little control over which alter is dominating at a time (American Psychiatric Association, 2013). In Split, the main antagonist suffers from DID and is later portrayed as a supervillain. The character has around 20 or so different personalities, with one particularly vilified personality referred to as ‘The Beast’. Now whilst a lot of how the disorder presents in patients was accurate in the film, the portrayal of someone with DID as violent, unstable and down right creepy at times has only increased the negative stigma surrounding the illness. Unfortunately, this negative effect isn’t limited only to the mental illness portrayed, but can be generalised to mental illness as a whole.

In the 90’s and 00’s, and still to this day, common insults or derogatory slang terms used by adults and children were terms like ‘spastic’ or ‘retarded’. These words originally came from the medical terms used to diagnose people on the autistic spectrum, however they fell into common use as insults designed to label someone as slow or strange, often used to imply that if you were ‘retarded’ then there was something wrong with you, you were sub-human. It’s a sad truth that the misuse of these terms can still be found in today’s society, and it is propagated by a lack of understanding about what the terms actually mean, a lack of education and willingness to talk about people who are neuroatypical. It is this lack of understanding and interest in being open about mental illness that we hope to address.

Why is this problem important?

The stigma arising from lack of education and exposure to real life mentally ill people has profound effects on those who are mentally ill. Citizens are less likely to hire someone who is mentally ill, less likely to rent them housing and more likely to press false charges for violent crimes (Bordieri & Drehmer, 1986; Page, 1977; Sosowsky, 1980). Experience of mental illness stigma is also associated with reduced help seeking (Rafal, Gatto & Debate, 2018), low self esteem, less willingness to disclose their mental illness, avoidance of social opportunities, lower trust in others, and persistence of symptoms (Wahl, 1999). This highlights the importance of countering stigma in daily life; it has real and damaging effects on those who struggle with mental illness. 

Who is our target audience?

Our target audience was those who may not be educated on mental illness, and hold stigmatised views. This is in the hopes that they would hold less stigmatised views and understand mental illness more, and therefore be more supportive of mentally ill people they more interact with, and possibly be more likely to seek help themselves if they experience mental health problems. Therefore, our project was designed so as many people from the general population would be exposed to our intervention as possible.

The Intervention

We considered an open platform project to encourage our target audience’s curiosity, so we ran the project with a stall outside of Warwick University’s library. This spot was strategic as many students would have to walk past us to access the library or move between lectures, exposing us to a large group of people throughout the day. Our idea was based on the social norm of reciprocity (Whatley, Webster, Smith, & Rhodes, 1999) with the prospect of an exchange: we planned to give out biscuits and chocolate, to encourage passerbys to stop and talk to us. This seemed like a fair bargain to us - all the audience had to do was start a polite conversation, and they would get a free snack. We specifically encouraged our audience to ask us any question they wished about mental illness - as stated on our banner: “we are mentally ill, ask us anything”. We placed posters around campus during the weeks before we ran our stall so people were aware that we would be there in advance and be aware of the prospect of free food. We also created a facebook event to which all added contacts were invited.

One of our posters up outside of the library

The poster

The event on facebook

We ran the project on a Tuesday and Wednesday during week 7. Our aim was to have three volunteers on the stand per session to give us room to take toilet breaks or breathing space where needed. It was an imperative for us, from the onset, to ensure that those who volunteer would be kept safe and reminded of their autonomy to answer questions however they wanted (if at all). We ran the stall for 5 hours a day on both Tuesday and Wednesday. On the stall were flyers providing links to resources available, flyers for the well being department, a disclaimer saying we had the right to not answer a question if we choose, and the snacks. Tapped across the tables was the banner, clearly visible to anyone who walked past, and from a distance. We also decided to tally those who approached our stall to ask a question, and to note down questions of interest, in the knowledge that some people would ask the great unknown, and that some may just have wanted small talk.

The stall, with the banner on the front

We contacted the university Wellbeing Service representatives for additional guidance, and we were given some helpful insight into ensuring ethical standards and to create the most welcoming space for both those who would volunteer for us, and those who would stop at the stall and ask us a question. The Wellbeing Service provided accountability for us, such as questioning: Who would be ‘talking’?  Would people be ‘identified’ as having mental health problems? If so, how would we do this? The service also emphasised how It is important that those talking/running the stand feel OK to talk about their story and are not overwhelmed. Similarly, how would we handle the situation if a student discloses something very painful/serious about themselves? To manage this, we ensured that all volunteers at the stall were fully aware of what the project involved, our aims, and their right to decline answering questions or withdrawing at any point. We ensured all participants had formally diagnosed mental health problems and/or are participating in a counselling or therapy service, and/or taking medication for mental health issues. We also gave links and resources available to the following: counselling service on campus, wellbeing service on campus, Samaritans, the University Health Centre, and the IAPT counselling service. We ensured all volunteers were aware that they could only share their own experiences if they wished, and were not able to give advice or suggest treatment. We additionally contacted the admin team in the Psychology department to help us with supplies. 

Persuasion Techniques 

There are several reasons why we carried out our project in the way we did: from the general principle, to the details. 

Firstly the general idea of going out into a public space to interact with others and answer their questions in return for a snack; the core of this was based on exposure. There is a significant body of research that demonstrates that one of the best ways to reduce stigma towards a group is exposure, and interaction with, members of this group (see Pettigrew & Tropp, 2006 for an overview). Several pieces of research demonstrate that this does also apply to the reduction of mental illness stigma (Sadow, Ryder & Webster, 2002; Rüsch, Angermeyer & Corrigan, 2005), including specifically with undergraduates (Kolodziej & Johnson, 1996), whom were our target group. This research is based off intergroup contact theory (Allport, 1954), which suggests that interactions between groups can lead to improved intergroup attitudes. In fact, it has been directly found that those of the general population who meet and interact with people with mental illnesses are more likely to lessen their levels of prejudice (Corrigan, 2005). 

In terms of specific details, Rüsch, Angermeyer and Corrigan (2005) outlined a number of factors that help create the right environment for interpersonal contact and stigma reduction, and we aimed to fit all of these factors. Firstly, equal status among targets. This is part of why we targeted the general student population, as students ourselves. This creates both this equal status, and highlights the similarity between us and them - hence why are posters and banner were titled “mentally ill at uni”, to highlight that we are all students. As shown in previous research, similarity breeds both liking and compliance (Burger et al., 2001), hopefully making it more likely that people would approach. Next, cooperative interaction. The conversations in our project were all 2 way; they ask a question, we answer, and in almost all cases conversation began. This is one of the reasons why we chose this method, rather than an educational seminar, which would involve a one-way depositing of information. Cooperation is also supported by the reciprocal relationship of “ask us anything, and get a free snack”. Finally, institutional support. For this, we added the Propaganda for Change logo to our posters, and the Wellbeing Service at the university provided us with several of their handouts to place on their stall, showing their approval of our intervention. They also suggest that it is important for some of the minority members that the majority interacts with to seem to mildly disconfirm the stereotypes surrounding the minority, likely in part because research suggests that ingroup members are viewed as diverse, and out-group embers are soon as less diverse (the outgroup homogeneity effect, Walch et al., 2012), and this aims to counter that. The main stereotypes around the mentally ill are that we are to be feared, irresponsible, and childlike (Rüsch, Angermeyer & Corrigan, 2005). We have designed our project to contradict all of these: by holding pleasant conversations and being approachable we show we are not to be feared, by showing we have organised this project effectively we show we are responsible, and by answering questions clearly and seriously (some of which were fairly complex questions about the nature of mental health) we show we are not childlike. Allport (1954), also proposed the Contact Hypothesis, that states that groups will reduce prejudice under 6 conditions, several of which we achieved within our intervention. Firstly, mutual interdependence was achieved as we relied on each other to get what we wanted: to get food had to ask us something, and for them to ask us something we had to give them food. Secondly, equal status. As stated previously, we highlighted the fact that we were all students. Thirdly, informal personal contact. The conversations were kept friendly and informal - we avoiding putting any pressure on our audience, and emphasised that this was not a study, and that we didn’t expect them to act any specific way. 

A member of the group enjoys painting in their spare time, so jumped at the chance to design the banner, with their choice of colour and motif deliberate. They consciously applied the persuasion techniques of the MINDSPACE mnemonic (Dolan et al, 2012) for marketing purposes. Our banner calls the audience in an assertive black Sharpie to ‘ask us anything’, as an incentive. For the audience, they had the opportunity to detach the apprehension or hesitance they may have concerning bringing up mental illness into conversation. In our experience, many people are uncomfortable and ask for assurance to talk about or ask about mental health. We understand that and are grateful for asking for our consent to discuss this, but those tentative social niceties are not necessary in this space we have designed: the banner says ‘yes, it is okay to ask me anything’, an incentive for the audience to approach us where there is no risk involved in hesitation of saying the wrong thing and any resulting negative consequences. Appealing to salience was important during design: the colours used were bold poster paint, in warm colours to signify approachableness and kindness, such as orange, pink and beige (Grieve, 1991), which may also act as a priming agent for approach and kindness in our audience. The hope for painting an open envelope with love hearts emerging, was a priming effect: before speaking to us, those who see the banner can notice that this is an open space with our aim to express more love and compassion, towards ourselves and others, those who are mentally ill and those who are not. Those who see this banner would make a commitment to their identity: we enjoy thinking of ourselves as warm and loving beings, and this was meant to be reinforced through the painting on the banner, also connecting to ego - people want to act in ways that make them feel better about themselves. 

As noted previously, there is a reason we chose this method for our project, rather than an education seminar or leaflets. Education is associated with lessened stigmatising attitudes (e.g. Herek & Capitanio, 1995; Pinfold, Toulmin, Thornicroft, Huxley, Farmer & Graham, 2003; Tanaka, Ogawa, Inadomi, Kikuchi & Ohta, 2003; Esters, Cooker & Ittenbach, 1998), which is why we included the education aspect of answering questions about mental health, rather than just simply interacting with people. However, education programmes tend to only reach those who already agree with the message (Devine, 1995), so it was likely if we held an educational seminar or handed out leaflets, only those who hold less stigmatising views of the mentally ill, or were passionate in reducing stigma themselves, would engage with it, and we would not engage with our target audience.

A persuasive method we utilized was the The Pique Technique. These technique relies on the idea that if a request is specific or strange, people are more likely to comply as these requests more mindful cognitions about the appeal, leading to the person entertaining in their mind what would happen if they did comply. The effect is more impactful the less the person has accountered the request/question before. This is why our banner clearly stated “we are mentally ill, ask us anything”. It is rare for people to be so forward about their mental health, let alone be so open to questions regarding this. We hope that the novelty of this question led people to entertain in their heads what question they would ask us, making it more likely for them to approach us to ask us their question. In fact, many people approached us to ask us why we were doing this, which we then used to lead into educating them and facilitation the asking of more questions.

Finally, the core technique of this project was the norm of reciprocity. The basic idea of this is that if you do something for someone, they feel obligated to do something in return. Therefore, we decided that if we wanted people to behave in a way that we wanted (to ask us questions about mental health and allow us to educate them), we would need to provide them with something. We had some people come up to take some food, and then see the nature of our stall, so they felt obligated to ask us something in return. It is also possible that some people viewed us answering their questions and educating them as us doing something for them, leading to them wanting to do more in return, such as asking another question, allowing us to provide them with even more information. We often found that by answering a question, people would then disclose more personal details in their next question, similar to Cunningham, Strassberg and Haan’s (1986) finding that we self-disclose to those who have disclosed themselves to us. 

Future Directions

Whilst we feel we utilized these techniques effectively, if we were to repeat this project we would make some small changes. Firstly, as we were sat at our stall, it meant people had to approach us to take the free food, which people may be unwilling to do. It may have been more effective to approach people with a plate of free food and offer it to them, and after they take it to ask them to ask us a question - much like the Hare Krishna Movement, where the sales force would approach people and give them a flower. Furthermore, it may have been useful to provide more information of why we wanted people to ask us questions. As demonstrated in Langer, Blank and Chanowitz’s (1978) study, the more information you provide a person within a request, the more likely they are to comply. This additional information could perhaps take the form of “we’re mentally ill, ask us anything to help combat stigma!”. 

Notable outcomes

To close off, we would like to note some notable outcomes of our project. We had a several people inform us that they were unaware that the university provided a counselling service, and that they were likely to seek it out in the future. We also had several people who were mentally ill themselves tell us that they were glad to see people being so openly mentally ill, and that it takes “guts” to put ourselves out here like this. We hope that from this, other mentally ill people are more willing to be open about their mental health, and possibly be more likely to seek the treatment they need. We also had two people talk to us about how within the culture, mental illness is rarely spoken about, and that people are expected to keep it hidden and private. Hopefully by us showing that mental illness isn’t something to be ashamed of, they can bring that idea to others within their culture and work towards changing attitudes within their group. In total, 56 people approached us and asked us a question about mental health. These questions ranged from “what is mental illness?”, “what are you diagnosed with?”, to “how does religion and mental illness interact?”.

What stuck out the most was when a man approached us and told us that he had in the past said that he didn’t believe that mental illness was “real”, and proceed to ask us questions in order to better educate himself and avoiding making holding such stigmatising and negative views of mental health again, which was exactly what we aimed to do with this project.  

References

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