California Mental Health Prevention Effort Is Showing Positive Early Results

An effort to improve mental health prevention and early intervention in California is showing positive early results for programs targeted at reducing stigma and discrimination, educating the public about suicide prevention and improving the mental health of students, according to a new RAND Corporation report.

The study evaluates social media marketing campaigns, training efforts and other statewide prevention and early intervention activities undertaken as a result of Proposition 63, which imposed a tax on high income California residents to expand mental health service.

“Although still in the early stages, we found evidence that the statewide prevention efforts were launched successfully and are beginning to make a difference toward reducing stigma and empowering people to prevent mental health problems,” said Nicole Eberhart, co-leader of the project and a behavioral scientist at RAND, a nonprofit research organization.

California voters approved Proposition 63 (the Mental Health Services Act) in 2004. Under the initiative, significant new funding was dedicated to providing intensive mental health treatment at the community level for individuals with serious mental health challenges.

The law, enacted in January 2005, also set aside 20 percent of the revenue raised annually for counties to provide prevention and early intervention services, with the goal of connecting individuals with services before symptoms set in, or early in the course of a mental health challenge.

In addition to local programs, California counties are working together through the California Mental Health Services Authority (CalMHSA) to deliver statewide prevention and early intervention services. Goals of the program are to reduce stigma and discrimination surrounding mental illness, prevent suicides, and improve the mental health of students in K-12 schools and colleges across the state. These statewide interventions are being evaluated by RAND, a nonprofit research organization.

"CalMHSA is proud to show California that our state's leadership in innovative mental health prevention strategies are delivering positive results for communities," said Wayne Clark, CalMHSA executive director. "By empowering Californians to stop suicide, changing attitudes about mental health, and equipping educational systems to meet the mental health needs of students, we are creating a state where each mind matters."

RAND researchers have evaluated a variety of activities:

• Education efforts were aimed at reducing stigma among middle school students. The evaluation found that students who attended the “Walk in Our Shoes” presentations expressed less stigmatizing attitudes, were more willing to interact with fellow students with a mental health problem and had more positive emotional responses to a hypothetical student with a mental health problem.

• A social media campaign titled “Know the Signs” was designed to empower Californian residents to prevent suicide. Those who viewed the campaign were more confident in intervening with those at risk of suicide, more comfortable discussing suicide, more aware of the warning signs, and felt they had greater skills and knowledge on intervening with or referring someone at risk to help.

• Trainings about mental health issues were delivered to a diverse group of school staff, teachers and students statewide. Those who participated in the trainings reported greater confidence to intervene with students in distress, greater confidence to refer students to mental health resources, and a greater likelihood to intervene or refer students in distress.

Researchers say the goal of prevention and early intervention is to strengthen resilience in the community by teaching people how to help each other and how to assist vulnerable individuals, including those with newly experienced mental health problems, to access treatment at an early stage to prevent long-term suffering and lifetime consequences for themselves and their families in areas like education, work and relationships.

“Often the most meaningful effects of prevention and early intervention programs cannot be detected immediately, so it will be important to continue to track public attitudes and knowledge regarding mental health, as well as impacts in reducing the negative consequences of mental health problems, over a longer period of time,” said M. Audrey Burnam, a RAND senior behavioral scientist and co-leader of the project.

The study was sponsored by the California Mental Health Services Authority and conducted independently by RAND. The report, “Evaluation of California's Statewide Mental Health Prevention and Early Intervention Programs: Summary of Key Year 2 Findings,” can be found at www.rand.org. Other RAND reports about the California mental health prevention and early intervention program are available online.

Other authors of the report are Sandra H. Berry, Rebecca L. Collins, Patricia A. Ebener, Rajeev Ramchand, Bradley D. Stein of RAND and Michelle W. Woodbridge of SRI International.

RAND Health is the nation’s largest independent health policy research program, with a broad research portfolio that focuses on health care costs, quality and public health preparedness, among other topics.