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Research Questions

  1. How do campaigns align or complement each other?
  2. Where are there overlaps and gaps in their scope and content?
  3. What are the unique contributions of each campaign?
  4. What is the collective reach of the campaigns via different channels?
  5. Do the campaigns follow best practices in their design and dissemination?
  6. Is it likely that campaigns as designed and implemented will achieve their goals?

More than 2.7 million service members have deployed to support operations in Iraq and Afghanistan since 2001, and many who return report symptoms of mental health disorders, such as depression, posttraumatic stress disorder, and problematic substance use. One deterrent to seeking appropriate treatment is the negative perceptions surrounding mental health disorders and their treatment. Mental health public awareness campaigns have been used as one strategy to combat stigma and promote treatment-seeking. This report describes an evaluation of the scope, content, and dissemination of four public awareness campaigns that aim to overcome negative perceptions and promote awareness of mental health disorders and their treatment, with a focus on military and veteran populations. The evaluated campaigns are the Real Warriors Campaign, Make the Connection, National Recovery Month, and awareness materials related to the Veterans Crisis Line. The purpose of this report is twofold. First, it provides a detailed description of how the evaluation was designed, drawing on a literature review, consultation with campaign staff, and feedback on evaluation design from experts. Second, it contains findings from the cross-agency evaluation of the campaigns' collective efforts. This cross-agency evaluation was conducted to determine progress toward the Obama administration's Cross-Agency Priority Goal of improving mental health outcomes for service members, veterans, and their families — this being the case, the report focuses on campaigns' collective reach and impact. Results and recommendations address four sets of findings related to efficiency and mental health messaging, content of campaign materials, dissemination and reach, and direct connections to care.

Key Findings

Efficiency and mental health messaging

  • The four campaigns have distinct yet overlapping audiences and share targeted outcomes (to improve knowledge of mental health symptoms and promote positive perceptions of individuals with mental health conditions and mental health treatment).
  • The campaigns offer a variety of messages to their common audiences (i.e., for those who are at-risk of mental health disorders, considering treatment, in need of immediate support, or in recovery).
  • The majority of campaign content (82 percent across all four campaigns) aligns with shared goals, and the individuals pictured in the materials reflect the target audiences of each of the campaigns.

Content of campaign materials

  • Most campaign content aligned with best practices, clearly communicated the messages, and used credible, positive messengers. However, content could be improved in several areas, including providing information about how anonymity and/or confidentiality is protected.

Dissemination and reach

  • Campaigns disseminated their materials and messages using multiple approaches including websites, public service announcements, social media, television, radio, and in-person engagement.
  • While the reach of most campaigns increased between 2012 and 2015, campaigns did not collect data about whether those reached were part of a specific target audience.
  • In 2015, campaign websites played host to more than 4 million sessions, and as many as 5.6 million people may have been reached via social media. The campaigns aired more than 400,000 combined radio and television public service announcements; other outreach resulted in campaign attendance at more than 250 events, distribution of more than 10 million materials, and partnering with more than 700 organizations and agencies.

Direct connections to care

  • All campaigns offered general resources on mental health symptoms, disorders, and treatment, but only 27 percent of campaign materials provided direct connections to care (defined as resources that provided a connection to a crisis line or chat or directly to a specific medical center to make an appointment).

Recommendations

  • The report makes several recommendations, broken out by areas of interest: messaging, content of campaign materials, dissemination and reach, and inclusion of direct connections to care. For each recommendation, there is also a suggestion about who should take the lead — a federal partner group or the campaigns themselves.
  • Among other things, campaigns should focus on the following: Cross-reference other campaigns more when presenting resources in campaign materials; review content and links to ensure they are all current; specify guaranteed levels of anonymity in any self-assessments or connections with care; develop strategies to use Twitter more effectively; and ensure that a direct connection to mental health care (i.e. phone line, live chat line, direct connection to a local medical center) is included on relevant campaign materials.
  • There are several recommendations for the federal partner group, including the following: Convene a set of national and regional partners to help define a strategic national direction for public mental health education that government agencies can use to guide their efforts; clearly define the unique contributions and intentional overlap in messages and target populations across the campaigns; develop a targeted set of performance measures that cuts across campaigns; monitor coordination of current and new campaign efforts to promote strategic messaging and dissemination across agencies; and determine whether a centralized call line that allows users (not in immediate crisis, but in need of care) to make an appointment for mental health care is a resource that should be offered by campaigns.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Approach to Evaluating Campaigns

  • Chapter Three

    Campaigns Selected for Cross-Agency Evaluation

  • Chapter Four

    Campaign Scope

  • Chapter Five

    Campaign Content

  • Chapter Six

    Campaign Dissemination

  • Chapter Seven

    Key Findings and Recommendations for Improving DoD, VA, and HHS Approaches to Mental Health Public Awareness Campaigns

  • Appendix A

    Literature Review Methods and Recommendations for Evaluating Mental Health Public Awareness Campaigns

  • Appendix B

    Methods to Elicit Expert Feedback on Evaluation Design and Recommendations

  • Appendix C

    Content Analysis Methods and Findings

  • Appendix D

    Methods Used to Analyze Campaign Process Evaluation Data and Findings

  • Appendix E

    Twitter Data Analysis Methods and Findings

  • Appendix F

    Development of a Best-Practices Checklist for Mental Health Public Awareness Campaigns

This research was conducted within the Forces and Resources Policy Center of the RAND National Defense Research Institute, a federally funded research and development center sponsored by the Office of the Secretary of Defense, the Joint Staff, the Unified Combatant Commands, the Navy, the Marine Corps, the defense agencies, and the defense Intelligence Community.

This report is part of the RAND Corporation research report series. RAND reports present research findings and objective analysis that address the challenges facing the public and private sectors. All RAND reports undergo rigorous peer review to ensure high standards for research quality and objectivity.

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