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With mental health, part of the challenge is getting people to seek help in the first place because of stigmas attached to it. Two Northeastern researchers found a way to break through that barrier.
The U.S. is in the middle of what many are calling a mental health crisis, one that, exacerbated by the COVID-19 pandemic, is particularly acute among young people.
More people are talking about mental health, but one of the biggest challenges when it comes to addressing this global crisis is getting people to overcome the stigma of seeking help in the first place. Two Northeastern researchers set out to find a way to break through that barrier.
“The first thing we know about mental health is people just don’t reach out,” says Nishith Prakash, a professor of public policy and economics at Northeastern University.
The results of their research, conducted in Nepal, a country with few resources to tackle issues around mental health and with even fewer outreach efforts underway, found that low-cost interventions over the phone that normalized mental health issues and featured a local celebrity as a role model were remarkably effective in increasing peoples’ willingness to seek help.
“Using phone notifications or calls to raise awareness could be a valuable first step in communities with limited resources,” says Nirajana Mishra, an assistant professor of marketing at Northeastern University and co-author of the research. “These low-cost interventions can be quite effective for individuals experiencing early symptoms of depression or anxiety. However, those with more severe symptoms will require more intensive treatment.”
Working with the Centre for Mental Health and Counseling-Nepal, a nongovernmental organization in Nepal, Prakash and Mishra collected some of the first comprehensive data sets around mental health in Nepal while also starting to address the root problem: stigma.
The stigma around mental health, the researchers say, stems from internal and external factors. They break it down into anticipated stigma, the fear people have of being judged by others for seeking help, and personal stigma, the judgements someone puts on themselves. Both forms of stigma were applied to the population in Nepal, according to a survey the researchers conducted.
With that information, they implemented two strategies, both low-cost and easily applicable, that they hoped would start to pierce through the personal and anticipated stigma people had attached to seeking mental health support.
In both cases, they had callers contact about 2,500 households in four Nepali districts over the phone, starting with basic questions about the person’s demographic, social and economic information before asking questions about anxiety, depression and stigma. Then, they deployed one of two strategies.
With the first, the caller presented data that showed how prevalent mental health issues are. The goal was to normalize the need to seek mental health treatment by highlighting that people are not experiencing these issues alone and that it is a sign of strength to seek help. For the second strategy, Prakash and Mishra recruited a well-known Nepalese comedian (his identity was kept secret in the published research but was made known to people in the study) who was public about his mental health struggles.
“We shared how he struggled with mental health issues and despite the associated stigma decided to seek treatment,” Mishra says.
After deploying one of these strategies, the callers then asked how willing the person would be to seek mental health treatment. What the researchers found was that both strategies were equally effective in reducing stigma and increasing people’s willingness to seek help.
“What’s interesting is that individuals with high personal stigma showed a greater willingness to seek treatment compared to those with low personal stigma,” Prakash says. “Similarly, those with high anticipated stigma demonstrated a greater willingness to seek help than those with low anticipated stigma.”
The researchers also set out to see how the gender of the caller and study participant might affect a person’s willingness to seek treatment. Both men and women responded equally well to these kinds of outreach strategies. But, notably, it was men with stronger traditional masculine values that responded more to the outreach, Prakash says.
When it came to the gender of the caller, the researchers assumed that men would respond better to male callers and women would respond better to female callers. But they found something surprising.
“When female callers were the ones who were calling, participants showed more willingness to seek help, and this was across gender,” Mishra says.
Mishra attributes this to strong masculine norms in Nepal –– the ideas that “men should not shed tears,” suggesting that this may make “talking to a male caller even more awkward for men compared to a female caller.”
Prakash and Mishra say the fact that both outreach strategies were effective across both genders speaks to the power of simple, low-cost mental health outreach, especially in countries where resources are tight and people do not usually have these conversations.
“It tells me that it’s maybe a simple nudge which can, even for people with high stigma, make them respond,” Prakash says. “They can relate to this. In Nepal, the situation is quite different from the U.S., where mental health is widely discussed and there are influencers on social media addressing the topic. Here, mental health is rarely talked about, so even a message over the phone can make a strong impression and elicit a response.”