Abstract
We support a public awareness campaign – it is a must. It is fundamentally wrong that a vulnerable group in our society should be continually subjected to the comments and actions of those who possess an outcast mentality … We are optimistic enough to believe that a well-informed New Zealand public will then realize that people with a mental illness are people whom we should nurture and value. 1
‘Like Minds, Like Mine’ is a New Zealand project that was developed to counter the stigma and discrimination associated with mental illness. Funding for the project began in 1996 following a ministerial inquiry, commonly known as the Mason Inquiry, into certain mental health services. One of the recommendations from this inquiry was that a campaign be funded to counter stigma and discrimination associated with mental illness. Following the inquiry, funding from the Ministry of Health was made available to set up, coordinate and implement a campaign.
The project challenge is to create an environment that values and includes people living with mental illness. Essential to this aim is reducing the barriers of stigma and discrimination associated with mental illness.
Discussion of a mass media component to the project began soon after funding became available. Advertising was seen as a powerful way of reaching large numbers of people. Early planning also recognized the need for local follow up. Grassroots activities would increase the chances of messages being reinforced with different target audiences in a range of settings.
KEY ELEMENTS OF THE PROJECT
We cannot assume … that even where we succeed in influencing attitudes – and even where this coincides with successes in changing law and policy – this will necessarily change behaviour. We will also need to make inclusion happen, at the grassroots – to put enlightened policies, where they exist, into meaningful practice, and to capitalize on the research finding that public education is most effective where it combines educational messages with grassroots approaches that bring users/survivors into contact with different communities. 2
Active involvement of people with experience of mental illness
Negative attitudes can be reduced by promoting direct contact between members of the public and people with experience of mental illness. This is most effective in structured settings where the person with experience of mental illness is perceived as having equal or greater status. This can be done face to face, or via educational presentations and mass media. 3
Mass media, communications and community action
Research has shown that campaigns that set realistic outcome criteria and are backed up with community-based education and training are more effective. 4 Although media can be most effective at raising awareness and changing the climate of public opinion, changing behaviour requires more direct action to address the real situations in which discriminatory behaviour occurs.
NATIONAL AND REGIONAL ACTIVITIES
Activities between 1997 and 2000
Key activities from 1997 to when the first television, radio and cinema advertisements were launched in 2000 included:
exploratory research into the thoughts, feeling and behaviours of the general public towards people with experience of mental illness; providers in place for research, public relations (PR) communications support and mass media advertising; contracts with 26 organizations in locations around New Zealand to develop and implement locally based education, training and grassroots activities aimed at attitude and behaviour change; establishment of a national advisory group to the project, made up of people with experience of mental illness; completion of a benchmark study on general public attitudes; and publishing of a national plan.
National plan
In 2000, the national plan (developed in consultation with people with experience of mental illness) identified six key objective areas to assist the national and local activities to work more effectively together around common objectives. The six objectives entailed a mixture of ways of changing attitudes and behaviours, and arranging audiences where changed attitudes and behaviours would have the most impact on the lives of people with experience of mental illness.
The priority audiences were mental health services; government organizations that have frequent contact with people with experience of mental illness; Maori; Pacific peoples (given the different cultural approaches that were required); the media; key opinion leaders; and the general public aged 15-44 years. The methods included involvement of people with experience of mental illness; education; community action; policy development; evaluation; research and attitude tracking; PR and communications support; and mass media.
Activities between 2000 and 2003
From 2000 to July 2003, people with experience of mental illness have become increasingly involved in leadership and other aspects of the projects work, including input into the overall strategic direction of the project through the National Advisory Group.
During this period, two phases of mass media television and radio advertising were launched. Innovative community action and education activities were also implemented, including:
programmes (including training) for people with experience of mental illness to work as educators (incorporating personal story telling has proven to be a particularly powerful medium); annual award ceremonies (many done in local mayoral council chambers) to people who showed respect throughout the year; education and training workshops (most run by or involving people who have experience of mental illness) to staff in government organizations including the Police, Housing New Zealand, Ministry of Social Development (including work and income support areas) and mental health services; a national discrimination survey recording people's experiences of discrimination in relation to their mental illness (785 written responses were received); and increased advocacy through the media by spokes-people giving a service user perspective (in both news and feature articles), education presentations in journalism courses and funding of journalism research fellowships through the Carter Center USA.
ADVERTISING
Project's communication challenges
Exploratory research for the project in 1997 found that the general public had a low level of understanding and interest in the topic of mental illness. 5 Therefore, the initial communication challenge was to create enough interest in the topic to get it on the public's agenda.
The research also found that the public's limited understanding of mental illness was gained from news and entertainment media. Media overwhelmingly promotes associations of mental illness with crime, violence and bizarre events. Media-fed stereotypes and the fact that mental illness is hidden and not talked about have contributed to mental illness being seen as uncommon, scary and ‘not my problem’.
When considering how to address these communication challenges, the project also needed to acknowledge that the European concept of mental illness is viewed differently by Maori and Pacific peoples. Other key considerations were that the commonality of mental illness was not understood and people were not aware of how they discriminated. Focus group interviews carried out on concepts developed by an advertising company also found out that the communication needed to be carefully planned because there would be apathy towards any perceived ‘government/preachy’ messages.
Process of advertising development
The key components in developing the advertising were:
a strategy and concept brief based on research findings; development of possible concepts and story lines (presented in audiovisual formats, usually with photos with voice overs); feedback from a mass media advisory group that was made up of people who had experience of mental illness and people who understood mass media communications and communications with Maori and Pacific peoples; formal pre-testing of the concepts; final input from the mass media advisory group; television and radio advertising production; and a benchmark survey prior to launch and tracking surveys at the end of each phase (at approximately 10 month intervals).
Strategy and advertising concepts used
The basis of the initial strategy and concept brief for phase 1 was to give mental illness personal relevance. It needed to communicate commonality, overcome people's lack of interest and counter negative stereotypes. It needed to be positive and ethnically inclusive to avoid buy-out from any of the target population groups of general public, Maori and Pacific peoples.
The concept used was of a range of national and international famous and ordinary people who have experienced mental illness, who raised the question ‘Are you prepared to judge?’
A literature search identified that negative attitudes can be reduced by promoting direct contact between members of the public and people with experience of mental illness. This can be particularly effective when the person with experience of mental illness is perceived as having equal or higher status. People often think of a respected celebrity as a friend.
The phase 2 strategy built on this by going into more depth (four 1 min documentaries) on the lives of four of the well-known New Zealanders who had experience of mental illness. The advertisement also included one of their friends who was also well known, talking from the perspective of a supportive friend.
To ensure that the people who agreed to be part of the campaign were in control of their involvement, protocols were adopted to allow the person to withdraw from the campaign at any time, even after the advertising went to air. In the event that the general public wanted to talk to someone as a result of seeing the advertising, a ‘freephone’ number staffed by trained telephone counsellors was available.
Media placement
Television was the primary communication medium used because it can reach large numbers of people and can also make powerful emotional connections. Changing perceptions around a complex issue such as mental illness takes time, so we needed to be regularly raising the issue with the public. Within the available budget, a long-term media placement approach was needed. This included, for example, advertisement placement for 1 week on and 3 weeks off for periods of up to 8 months.
Other mass media used in support of the television included: cinema advertising, youth radio, Iwi radio (in Maori), Pacific radio (with ads in Samoan, Tongan, Nuiean, Cook Island), magazine articles (Mana and Tu Mai magazines) and a range of other marketing type techniques including posters, news-letters, flyers, facts sheets, feature articles, press releases and local spokespeople.
RESULTS
Soon after the launch in 2000, awareness of the phase 1 advertising was at 67%, and after the laucnch in 2002 of phase 2, awareness wat at 80% in the 15-45 years target age group surveyed. Significantly, 62% reported discussing the advertising one or more times with someone else. Even after a period of 8 months off air, awareness of the advertisements was at 53%. A general public awareness survey in May 2003 (after 8 months of being off air) found that, of the 759 people surveyed, the following messages were being taken out of the advertisements:
it's not shameful, it's an illness like any other (46%); it affects a wide range of people (46%); and you should give support and not discriminate: show tolerance, understanding, respect, be less judgemental, people need our help (42%).
During both phases of advertising, the freephone number received many calls from people who were motivated to ring after seeing the advertisements (1374 calls over one 3 1/2 month period 1 July 2002-13 October 2002). A ‘tape talk’ service was also available for people to listen to prerecorded information tapes with information about mental illness, depression, schizophrenia, bipolar disorder and anxiety disorders. During the same 3 1/2 month period, 3806 calls were taken by the ‘tape talk’ system.
A benchmark survey (prior to any advertising in 1999) and three attitude tracking surveys have also been carried out at different stages over the 3 years of advertising. The following are some of the results from the questions asked.
Results of attitude tracking surveys
From the surveys, the predominant pattern was of significant improvements in general public attitudes as a result of both phases of mass media advertising.
The percentage figures relating to the latest tracking survey done in 2002, and the benchmark tracking survey done in 1999 prior to any advertising, are given in Table 1. 6
Changes reported by people with experience of mental illness
The ads have proven to support me when it comes to feeling acceptable in society. The project itself has given me the confidence to speak up about mental illness in my life. 7
Research sought feedback on the Like Minds project from people with experience of mental illness through indepth interviews with 20 key informants, 266 self-completed questionnaires and focus groups with 42 Pacific peoples.
Advertising was seen to be having an impact. More than 80% of survey participants felt that the ads were helping to reduce stigma and discrimination associated with mental illness. The main effect was seen to be increased awareness and understanding.
Other parts of the project were also seen to be having an impact. Key informants mentioned a range of effects, including the greater participation of people with experience of mental illness in the project.
Impact of national media campaign
Considerable numbers of survey participants reported having noticed or experienced reduced stigma and discrimination associated with mental illness over the last 3 years in a range of organizations and groups. Further, more than half of the survey participants reported reduced levels of stigma and discrimination for family, mental health services, and the public, respectively. A little less than half reported a reduction for Work and Income New Zealand (WINZ), while around one-third mentioned a reduction within the Police, Housing New Zealand and the media.
FUTURE DIRECTIONS
A third phase of television and radio advertising has been planned with supporting communications and community-based follow up.
Building on the increasing interest created in mental illness by the advertising and community follow up, the project is aiming to identify specific discriminatory practices and advocate for changes.
A key strategy for making needed changes will be supporting people with experience of mental illness and their allies to advocate for changes. To prepare for this, the project is in partnership with the Human Rights Commission around developing a training resource for people with experience of mental illness to know and advocate for their rights under the Human Rights Act.
For further information on the project, please visit http://www.likeminds.govt.nz