Mental Health: It's okay to not be okay

Mental Health: It’s okay to not be okay

The Problem

Mental health problems are increasingly common with lifetime prevalence being between 12% (Nigeria) and 47.4% (United States) across the world (Kessler et al., 2007).  In the UK, approximately 1 in 3 people will develop a mental health problem at some point in their life (McManus, Bebbington, Jenkins & Brugha, 2016) with 1 in 4 each year (McManus, Meltzer, Brugha, Bebbington & Jenkins, 2009) and 1 in 5 have suicidal thoughts.  This sets a huge precedent for need for psychological help and just not enough resources within the NHS or in fact in many countries to accommodate this need for help.  That means many people are suffering in their own way on their own every day and trying to find their own ways to get through and keep going.  Or in some cases there are people who live with mental health diseases without a cure.  There is no quick ‘fix’ but sometimes the only thing you can do is to let someone know that they are not alone.  That they will be okay and if they’re not then that’s okay too.

Why is it important?

The increasing mental health problems have already been established but this problem is important because of the effect that mental health problems can have on someone’s life.  Living with a mental health problem is incredibly difficult for anyone, even with treatment, even more so without.  There is not enough support for everyone, so they need help in the real world where they can’t always get any professional help.  The issue is widely spread and under-supported and this has led to many people with mental health problems suffering more indirect consequences of their illnesses.  

For example, research has shown that adolescent mental health conditions forecast an increased risk of unemployment which endures over a lifetime and is increased in times of economic uncertainty (Mousteri, Daly, Delaney, Tynelius & Rasmussen, 2019) although investment in youth mental health services and substance abuse prevention can reduce unemployment.  Therefore, this shows mental health problems affecting more than just a person’s mental state but also their employment and hence financial stability and there has previously been research showing a link between low socioeconomic status and increased mental health problems.  This is a vicious circle that makes a person’s mental health worse when it was already causing the problems to begin with.  This is just one reason why it is important to help manage mental health difficulties because they can cause even more problems for a person.  Where it is not always possible to get professional help, people turn to other means, anything that could help them.

However, there is much more than just a person’s economic wellbeing that is at stake, as suicidal tendencies are a common symptom of many psychological illnesses.  Between 2003 and 2013, 18,220 people with mental illness took their own lives in the UK (Appleby, Shaw & Amos, 1997).  Suicide is a real risk for many people with mental health issues, 1 in 15 people have at some point in their life made an attempt at suicide (McManus, Bebbington, Jenkins & Brugha, 2016).  It could simply be said that by helping people with mental health difficulties that you are in fact saving their life, since there is a chance that at some point in their life, they may try to take their own life.  Even if they don’t many people suffering from mental illness have been known to experience unexpectedly high rates of physical illness and shortened life expectancy compared to the general population (Edmunds, 2018).  Those suffering from severe mental illness are some of the most vulnerable populations in society, and therefore have fragmented and inadequate access to health and social services meaning many physical health conditions go untreated and hence their life expectancy is shorter because of this.  

This are just some of the reasons why mental health issues are important and need to be dealt with.  In a perfect world then everyone would be able to get the help that they need, professionally or otherwise and everyone could get to a point where they can feel better about themselves and their lives so that their mental illness does not impact upon them in a detrimental way.  But the world is not perfect and many people with serious mental illnesses remain untreated for various reasons (Kessler et al., 2001), but not everyone with a mental illness ends up taking their own life, so they have to find ways to take care of themselves.  This is because they perhaps have support of others (Kawachi & Berkman, 2001) which may help with mental well-being or because of their own strength and coping techniques.  Either way it is important for them to feel like they are not alone and maybe seeing something out there that recognises a problem and acknowledges that it’s okay could help someone.

Target Audience

Although it seems like this project is aimed solely at people suffering from mental health difficulties and that is the main target audience the more honest audience is everyone.  Even those who don’t suffer with mental illness, most will know someone who does and so this project may help change their views into how they view their friends, that maybe they don’t always need to be happy and they don’t always need to feel like their loved one needs fixing.  It can change a person’s view on how mental illness can be dealt with, that’s not to say spend all your time letting it consume you, but you don’t have to spend all your time trying to be better either.

This project is more suited to people possibly with mental health difficulties because social media was used as a means of reaching out to people, it is one of the easiest and most effective ways of spreading any particular message in a modern age.  Plus, there is still a lot of stigma surrounding mental health, and a more public as opposed to an anonymous method may cause unnecessary stress in anyone who the message is intended for.  On bad days, people may struggle to leave the house much less interact with strangers, but social media is still a way they can feel connected to society and hopefully this message can tailor to that and maybe feel less alone. It is also possible to gage feedback quite simply by the interaction the post receives, for example, on Facebook that is likes, comments and shares.

Intervention

The intervention in this case was a poster, created and tailored to the idea that “it’s okay to not be okay”.  This was the main message of the poster but there are other affirmations written around it that aimed to make a person feel like they are strong, and they can make it through all the difficulties life has to offer, they are not alone and sometimes you don’t need to fix everything and you don’t need to always be happy. There are also a few tips on there of ways to help, simple things that have been proven to make a difference when someone’s struggling with their mental health.  The idea is to change behaviour so that the people this affects don’t put so much pressure on themselves to be perfect in an imperfect world and they can learn to accept themselves as they are, including their faults.  It can also help those around them to see this too, you love people for who they are, not because they always have to be happy, you have to accept the good and the bad together.  It could change how someone views mental illness and hence change their behaviour and attitudes towards it.  It could be seen as a more indirect way of reducing stigma and raising awareness.

Psychology and Persuasion Techniques used to Change Behaviour

The project consisted of several psychological persuasion techniques that were subtler in their workings and in their outcomes.  It was not the kind of project that was meant to effect big and obvious change in a person’s behaviour, with the more vulnerable audience that was being targeted, the idea is not to make people feel manipulated, but more to help them change their own way of thinking in a much more subtle and simple way.

The first psychological persuasion technique was the Elaboration-Likelihood Model (ELM).  It seems as though this may be a complicated persuasion idea and that the poster that was used is very simple and relied on ideas surrounding mental health and not on persuasion techniques, but this isn’t entirely correct.  ELM is the dual-processing model of persuasion, which means there are two routes for persuasion developed by Petty & Cacioppo (1986).  The peripheral (or automatic) route is used when the issue is not personally relevant, a person is distracted or fatigued or the message is incomplete or difficult to comprehend, basically meaning that it isn’t directly thought about.  The second route is the central (or controlled) route, which is used when the issue is personally relevant, a person is knowledgeable in that area or they feel personal responsibility, more simply this means that it is something that is thought about (Petty, Cacioppo & Schumann, 1983).  The ELM is often used in that it is a model designed with the idea of explaining how certain messages may persuade people more than others, however it is since used and exploited so that a desired outcome can be obtained (Griffith, Nolder & Petty, 2018).

The way people perceive the poster can be seen from either angle of the ELM, depending on their personal circumstances and intentions.  Someone with mental health difficulties may use a more central route to acknowledge what has been written and be more persuaded to listen to what has been said. The issue is personally relevant and there may be high motivation to pay attention to what is being said.  Therefore, they will listen to the quality of the argument, or in this case the effectiveness of what they read.  If they feel what they have read is in any way helpful, then the rightful outcome has been achieved.  This has been shown in research that central routes are used in health campaigns because it leads to more enduring attitude and behavioural changes, they are generally more persistent over time and resistant to attempted attacks at the beliefs (Petty, Barden & Wheeler, 2009).

However, the poster could also be said to use the peripheral route of persuasion in a subtler way, the messages that are being conveyed in the poster are short and simple and so do not require a lot of attention, instead a person may pay attention to the pretty background and be flattered by some of the messages.  In the case of peripheral routes, the flooding (a persuasion technique where to person is given a large quantity of arguments and because of this are more likely to pay attention to at least some (Mathews & Shaw, 1973)) of short arguments is more of the important factor.  This route may also be used due to the fact that the poster is being published on social media and because of this, readers may not be showing their full attention, although research shows social media can use either central or peripheral routes (Zha, Yang, Yan, Liu & Huang, 2018; Chen, Yang, Zhang & Yang, 2018).  There is also that people who do not have personal investment may still look at the poster and see the messages, but it is taken on through the peripheral route and so the poster is simply spreading awareness or perhaps affecting the general population more.  Everyone has bad days and the messages can work for those bad days too, they like the more positive messages and hence also take on the messages about mental health and perhaps feel less stigma towards it.

The second psychological persuasion technique was flattery, a simpler but sometimes effect technique to at the very least grasp the person’s attention, as mentioned previously.  It has been shown across research that flattery has a positive effect on people, it makes people feel good and hence if you feel good you’re more likely to buy what it is they’re selling, though in this case it may just be an idea, hence flattery works (Basso, dos Santos & Albornoz Gonçalves, 2014; Chan & Sengupta, 2008; Castaldo, 2010).  It has even been shown that insincere flattery works, so even if a person may not necessarily believe that what they’re reading is correct when it comes to them, it will still have an effect and they may still take it on board without realising it (Chan & Sengupta, 2010).  The idea of using flattery to persuade behaviour change may seem like a insincere method, especially on such a sensitive subject, but the flattery used was more to help people going through difficult times, hearing good things makes you feel better and that’s the idea of the poster, if it makes them also pay attention to the rest then that’s a bonus.

The final psychological persuasion technique is mere exposure.  The framework for this persuasion technique is quite simply the idea that merely by exposing people to something you can change the way they perceive it (Tucker & Ware, 1971; Zajonc, 1968).  This technique does not work alone but within the context of a world that is slowly becoming more accepting of mental illness. By exposing the general public to another piece of media on mental health issues, it is furthering the cause to reduce stigma and the way in which it is viewed and hence changing behaviour towards it.  On a much smaller scale the poster itself has repeated positive affirmations with the idea that by repeatedly exposure someone to the ideas suggested that maybe they could become more accepting.  Also perhaps by showing them something that they may not have considered about themselves and changing the way they view themselves and their behaviour should help them.

Future Work

If this project was to be seen as a pilot study for a larger piece of research, then the feedback would need to be more carefully monitored of the response to the poster online and perhaps even the demographics of people that show a response.  In a larger study it would also make more sense to take note of a participant’s emotional state and stigmatisation before and after been exposed to a larger piece of media than has been used here, a video instead of a poster.

However, the purpose of this particular project was not to be monitoring society and researching their opinions towards raising mental health awareness through social media or testing investment and persuasion attitudes.  The purpose of this project was to attempt to affect some sort of behaviour change. Although this could be turned into a larger study, change isn’t always about what is quantifiable because by helping even just one person or changing one person’s views then change has been affected and so it has succeeded.  No one can change the world, especially with a poster on social media or project of such small magnitude, but maybe it is possible to change the way one person views the world or even how they view themselves.  By extension it has then changed the world because it has changed their world and so anyone can change the world just one person at a time.

References

Appleby, L., Shaw, J. & Amos, T. (1997). National confidential inquiry into suicide and homicide by people with mental illness. The British Journal of Psychiatry, 170 (2), 101-102.

Basso, K., dos Santos, C.P. & Albornoz Gonçalves, M. (2014). The impact of flattery: The role of negative remarks. Journal of Retailing & Consumer Services, 21 (2), 185-191.

Castaldo, J. (2010). The delicate art of strategic sucking up. Canadian Business, 83 (19), 81.

Chan, E. & Sengupta, J. (2008). Flattery and Persuasion: A Dual Attitudes Perspective. Advances in Consumer Research, 35, 778-779.

Chan, E. & Sengupta, J. (2010). Insincere Flattery Actually Works: A Dual Attitudes Perspective. Journal of Marketing Research, 47 (1), 122-133.

Chen, Y., Yang, L., Zhang, M. & Yang, J. (2018). Central or peripheral? Cognition elaboration cues’ effect on users’ continuance intention of mobile health applications in the developing markets. International Journal Of Medical Informatics, 116, 33-45.

Griffith, E.E., Nolder, C.J. & Petty, R.E. (2018). The Elaboration Likelihood Model: A Meta-Theory for Synthesizing Auditor Judgement and Decision-Making Research. Auditing: A Journal of Practice & Theory, 37 (4), 169-186.

Kawachi, I. & Berkman, L.F. (2001). Social ties and mental health. Journal of Urban Health, 78 (3), 458-467.

Kessler, R.C., Angermeyer, M., Anthony, J.C., De Graaf, R.O.N., Demyttenaere, K., Gasquet, I., De Girolamo, G., Gluzman, S., Gureje, O.Y.E., Haro, J.M. & Kawakami, N. (2007).  Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organisation’s World Mental Health Survey Initiative. World Psychiatry, 6 (3), 168.

Kessler, R.C., Berglund, P.A., Bruce, M.L., Koch, J.R., Laska, E.M., Leaf, P.J., Manderscheid, R.W., Rosenheck, R.A., Walters, E.E. & Wang, P.S. (2001). The prevalence and correlates of untreated serious mental illness. Health Services Research, 36(6), 987.

McManus, S., Bebbington, P.E., Jenkins, R. & Brugha, T.S. (2016). Mental health and wellbeing in England: Adult psychiatric morbidity survey 2014. Leeds: NHS Digital.

McManus, S., Meltzer, H., Brugha, T.S., Bebbington, P.E. & Jenkins, R. (2009). Adult psychiatric morbidity in England, 2007: The NHS Information Centre for health and social care.

Mousteri, V., Daly, M., Delaney, L., Tynelius, P. & Rassmussen, F. (2019). Adolescent mental health and unemployment over the lifespan: Population evidence from Sweden. Social Science & Medicine, 222, 305-314.

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. (1986). The elaboration likelihood model of persuasion. Communication and Persuasion (1-24). Springer, New York, NY.

Petty, R.E., Cacioppo, J.T. & Schumann, D. (1983). Central and peripheral routes to advertising effectiveness: The moderating role of involvement. Journal of Consumer Research, 10 (2), 135-146.

Tucker, R.K. & Wave, P.D. (1971). Persuasion via Mere Exposure. Quarterly Journal of Speech, 57 (4), 437-443.

Zajonc, R.B. (1968). Attitudinal effects of mere exposure. Journal of personality and social psychology, 9(2), 1.

Zha, X., Yang, H., Yan, Y., Liu, K. & Huang, C. (2018). Exploring the effect of social media information quality, source credibility and reputation of informational fit-to-task: Moderating role of focused immersion. Computers in Human Behaviour, 79, 227-237.