To mark World Mental Health day 2016, the NHS, working in partnership with YMCA, has launched a new campaign #IAMWHOLE . This is designed to challenge stigma about mental health and specifically targets young people. It is the first time that the NHS has produced a music video and the campaign is fronted by young UK musical artist Jordan Stephens of established UK hip-hop act, Rizzle Kicks. He has talked openly about using music as a way of coping with mental health issues and the campaign uses social media explicitly to connect with younger audiences through the hashtag #IAMWHOLE. This references the original song which has been written especially for this purpose by Stephens:
Spirit Media who produced the campaign found that Jordan Stephens was a perfect ‘fit’ in terms of reaching young people aged 11-24 years. But is this approach to social stigma as innovative as NHS ‘experts’ claim or is this simply another campaign that reworks old ideas about stigma through new digital means? There is considerable evidence that young people do have mental health concerns. Indeed, research compiled by YMCA for this campaign identified that of those young people who say they experience stigma around their mental health concerns more than a third (37% ) say it happens at least once a week and 54% say it originates from their own friends.
The video that accompanies the song features some young people staring down the camera as they recite the most common pejorative terms for people affected by mental illness, “mad”, “nutter”, “freak” “schizo” and so on. Later, Jordan appears on camera to explain that these stigmatising words stop young people from seeking help and yet:
most people who experience mental health problems recover fully and if not they are able to manage them and live well especially if they get help early on. Together we can support one another and fight stigma. Together we’re whole.
This message is supported by a cast of different celebrities, including musician Ed Sheeran and comedian James Corden. They each hold their hand up to camera, in turn, to display the emblematic circle that signifies the campaign brand. Each celebrity repeats the phrase “I am whole”. The clip concludes with the declaration that we should “Challenge harmful language” and urges that people should seek help.
Using celebrities in health related advertising is now standard. The assumption is that audiences can connect emotionally with the issue when it is presented through the lens of a familiar figure. Whilst there is no reason to doubt the sincerity of Stephens in his efforts to promote a more inclusive culture, this campaign raises interesting questions about the inter-relation between celebrity, anti-stigma campaigns and their purpose. A few years ago, the English Time to Change campaign was designed as the largest programme ever to target knowledge, attitudes and behaviour towards people using mental health services within the general population. The campaign received significant funding (£21 million), and yet the evaluation of its success was mixed. Public attitude surveys showed no significant improvement in knowledge or reported behaviour and employers showed increased awareness of common mental health problems but also believed that prospective employees should disclose their history before employment.
A common criticism is that people who are living with long term or chronic distress are largely ignored in these sorts of campaigns. Also, many wider structural issues tend to be consistently underplayed or entirely absent. In this regard, Canadian writer Carolyn Shimmin points out that the Mental Health Commission for Canada needs to take a more nuanced approach to such campaigns and cites a study which found that factors associated with stigma appear to vary by gender, and therefore gender differences must be embedded in national initiatives which are aimed at reducing stigma:
gender differences in negative mental health attitudes and willingness to use mental health services are already present early in adolescence. In a study examining the willingness of teens to use mental health services it was found that more girls than boys turned to a friend for help for an emotional concern, whereas more boys than girls turned to a family member first. So, here again, messaging to youth must take into account that girls’ and boys’ attitudes about mental health are different in important ways.
But more nuanced targeting of messages can only go so far. The very notion of a public anti-stigma campaign is premised on the idea that the situation can be resolved by a little more understanding and empathy shown towards people who are living with mental distress yet there are clearly elements of this problem which are health inequalities issues and what is termed stigma can also be viewed through the lens of discrimination and human rights. There is little of this debate to be seen in any of the commentary that has so far focused on the campaign. Instead there are reflections on the innovative nature of this approach by the NHS.
Dr Rebecca Jarvis, Clinical Lead for Mental Health for NHS Brighton and Hove Clinical Commissioning Group, said:
We created #IAMWHOLE to tackle mental health stigma in a way that speaks directly to young people, so that they feel as comfortable seeking help for a mental health issue as they would for a physical health condition such as asthma. One in ten children and young people experience mental health difficulties every year across the UK, but we know that only 25% of those in need of effective mental health support are currently accessing it.
There is a well – developed survivor/advocacy movement which may argue that accessing treatment for mental health, or what they may term emotional distress continues to promote a simplistic medical model of therapy and recovery and the cultural positioning of mental health is not the same as that of physical health conditions. The figures on young people and mental health are stark. This makes it all the more ironic that the campaign is launched at a time when the swingeing cuts to mental health provision are being felt. Official figures indicate that NHS spending on children’s mental health services has fallen by more than 6% in real terms since 2010. This equates to nearly £50m and resulted in Labour accusing the government of breaking its promise to make mental health a priority.
The complex nature of mental health and public stigma are problems which are not easily resolved by media campaigns but even if this were to be possible, does the NHS have sufficient resources to actually deliver the support? If services are currently overstretched at a time when just 25% of those believed to be in need of mental health support are accessing it, then it is debatable whether services would be able to meet additional requests for help which surely raises serious ethical issues.