Evaluating Los Angeles County's Mental Health Community Engagement Campaign

As a step toward meeting the mental health needs of residents in Los Angeles County, the Los Angeles County Department of Mental Health (LAC DMH) launched the WhyWeRise campaign in May 2018. The campaign is intended to promote community engagement with mental health issues, targeted at youth ages 14–24. The campaign's ultimate goals are to increase access to mental health care and improve understanding of mental health challenges.

To accomplish this, the campaign seeks to activate youth to advocate for mental health and access to quality mental health care as civil rights. The campaign also promotes awareness of how to find mental health care along a continuum, from self-care to professional treatment services. The campaign's centerpiece was the WeRise event that took place May 19 through June 10, 2018, an immersive experience in downtown Los Angeles (see Figure 1). The event included an art gallery with exhibits about mental health subjects, a rally, performances, panels, and workshops and was promoted through social media. The campaign also has an ongoing social media component meant to increase discussion and awareness of mental health issues.

Figure 1. Photos of the WeRise event (courtesy of LAC DMH)

LAC DMH, in partnership with the California Mental Health Services Authority (CalMHSA), commissioned the RAND Corporation to evaluate the WeRise event and the WhyWeRise campaign's reach and impact during the period WeRise was active. To perform the evaluation, a RAND team surveyed WeRise attendees in person; analyzed Los Angeles–based Twitter conversations related to mental health, mental illness, and well-being; and conducted a web-based survey of a broader population of Los Angeles County youth in the 14–24 age range targeted by WeRise/WhyWeRise.

The WeRise/WhyWeRise Campaign Reached More Than One in Five Los Angeles County Youth

• The evaluation's countywide survey found that 22 percent of youth in the targeted 14–24 age group had some exposure to the campaign.
• By way of comparison, California's statewide Each Mind Matters campaign, which focused on reducing the stigma of mental illness and was sustained over a much longer period, reached 17 percent of adults in its first year and 38 percent in its second year. The latter percentage is in line with major mental health campaigns conducted internationally. This suggests that the reach of WeRise/WhyWeRise was substantial for a campaign that had been under way for only a few months prior to the survey.

Figure 2. People who attended the WeRise event for longer were significantly more likely to express support for and understanding of people with mental illness

People Exposed to the Campaign Appeared to Benefit from the Experience

WeRise Attendees

• WeRise attendees had positive perceptions of the event: 91 percent of teens and 95 percent of adults said that they would recommend the event to a friend.
• At the event, 90 percent or more of teens and adults said that it made them want to be more supportive of those experiencing mental illness and that they felt more empowered to take care of their own mental well-being.
• More exposure to the event — measured in terms of an hour or longer spent at WeRise — was associated with greater perceived understanding of mental health issues and support for people with mental health challenges, compared with the perceptions of attendees who spent less time there (see Figure 2).

Youth Countywide

• RAND's countywide survey of youth found that those who reported exposure to the campaign (at the event or online) were more likely to report feeling empowered and mobilized toward mental health activism (see Figure 3).
• Those exposed to the campaign also reported an increased awareness of the challenges that people with mental illness face, from stigma to treatment access. These youth were also more likely to know how to get help with mental health challenges (see Figure 3).

Figure 3. Young people exposed to the campaign were more likely to . . .

The Social Media Campaign Was Associated with Increased Discussion of Mental Health Among Twitter Users in Los Angeles County

• The WeRise/WhyWeRise social media campaign was associated with a moderate increase in Twitter discussion of mental health and well-being and a notable increase in discussion of the campaign.

Recommendations

The evaluation team identified additional steps that the campaign could undertake to build on its initial progress:

• Consider including approaches to reducing negative stereotypes and increasing mental illness–related knowledge as a complement to WhyWeRise. Reducing negative stereotypes and increasing knowledge of symptoms are central to increasing social inclusion for those experiencing mental health challenges and increasing the likelihood that these individuals will seek treatment.
• Engage men, younger audiences, and those who do not already have a connection to mental health. The WeRise in-person event mostly attracted female attendees. Males tend to make less use of mental health services and experience higher levels of stigma, so engaging this group might require more-targeted outreach. The event mostly reached older youth and those already engaged with mental health. Future outreach should more effectively target individuals who have lower awareness of mental health issues and attempt to bring in greater numbers of high school and college-age youth.
• Build stronger social media connections between "mainstream" and social justice–oriented online communities. The @WeRise_LA Twitter handle was part of a Twitter community that discussed common topics in mental health circles, such as the link between mental health and gun violence, and suicide. This community was well connected with a second community that tweeted about mental health in the context of issues related to civil rights and unequal access. However, this second community was not tweeting about the campaign. Given the alignment between the second community's interests in social justice and LAC DMH's goal of fostering a movement to address inequalities in access to mental health, RAND recommends that the campaign reach out to this community and persuade them to tweet about the campaign.
• Keep the campaign going. Public attitudes tend to change slowly, and RAND evaluated the campaign only a few weeks after launch. Given early evidence that may be pointing to the campaign's success, it is reasonable to expect more progress as time goes on. Los Angeles County has continued the WhyWeRise campaign since the WeRise event. Its continued social media efforts include posting video excerpts from WeRise interviews, panels, and performances to drive youth to the WhyWeRise website. In addition to the continued social media push, there are new components to the campaign: outdoor advertising (e.g., billboards, buses, and signs at bus shelters), a hip-hop radio station campaign includes live DJ events at colleges and schools, and a documentary film that is being produced featuring students talking about their feelings and experiences at the WeRise event. These continued efforts may sustain the changes RAND observed, or even lead to further changes.
• In addition to continuing campaign activity, it would be helpful to conduct continued evaluation. This is needed to distinguish between causal effects of the campaign and other potential explanations for RAND's findings, such as the possibility that people drawn to the campaign were already relatively active around addressing mental health inequalities.

Conclusion

Overall, the evaluation found that Los Angeles County's mental health community engagement campaign had impressive reach into the Los Angeles youth community it targeted. Early evidence suggests that campaign exposure is linked to positive outcomes. These include more-understanding attitudes toward people with mental illness, greater awareness of the challenges people with mental illness face, knowledge of how to get help for mental health challenges, and mobilization of the targeted youth population toward activism around mental health issues.

CalMHSA

The California Mental Health Services Authority (CalMHSA) is an organization of county governments working to improve mental health outcomes for individuals, families, and communities. Prevention and early intervention programs implemented by CalMHSA are funded by counties through the voter-approved Mental Health Services Act (Prop. 63). Prop. 63 provides the funding and framework needed to expand mental health services to previously underserved populations and all of California's diverse communities.