There's a lot of stigma surrounding mental health, so one of the challenges is getting people to seek help in the first place, but two researchers at Northeastern University have found a way to break down that barrier.
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WhatsApp Reddit Researchers at Northeastern University have found a simple and effective way to combat the stigma around mental health using a technique called “nudges” (phone surveys). Getty Images
The United States is in the midst of what many are calling a mental health crisis, a situation that has been exacerbated by the COVID-19 pandemic and is especially acute among young people.
Though more people are talking about mental health, one of the biggest challenges in addressing this global crisis is getting people to overcome the stigma around seeking help in the first place. Two researchers at Northeastern University set out to find a way to break down that barrier.
“The first thing we know about mental health is that people don't seek help,” said Nishit Prakash, a professor of public policy and economics at Northeastern University.
A study in Nepal, a country with few resources and little outreach to address mental health issues, found that a low-cost telephone intervention that normalized mental health issues and featured local celebrities as role models was remarkably effective in increasing people's willingness to seek help.
“Raising awareness through phone reminders or calls can be a valuable first step in resource-limited communities,” said Nirajana Mishra, assistant professor of marketing at Northeastern University and co-author of the study. “These low-cost interventions can be very effective for people experiencing early symptoms of depression or anxiety. But those with more severe symptoms will require more intensive treatment.”
Prakash and Mishra worked with the Nepal Mental Health Counseling Center, a Nepalese non-governmental organization, to compile some of the first comprehensive data sets on mental health in Nepal and also began to address an underlying issue: stigma.
According to the researchers, mental health stigma stems from internal and external factors. They categorize stigma into anticipated stigma, which is the fear that others will criticize you for seeking help, and personal stigma, which is the criticism someone places on themselves. In a survey conducted by the researchers, they found that both types of stigma were present among the residents of Nepal.
Armed with that information, they implemented two low-cost, easy-to-apply strategies that they hoped would begin to break down the personal and expected stigmas people may have around seeking mental health support.
In both cases, they contacted about 2,500 households by telephone in four districts of Nepal, starting with basic questions about demographic, social and economic information, and then asking about anxiety, depression and stigma, before implementing one of two strategies.
In the first strategy, callers presented data showing how prevalent mental health issues are. The aim was to normalize the need to receive mental health treatment by emphasizing that people are not experiencing these issues alone and that asking for help is a sign of strength. For the second strategy, Prakash and Mishra recruited a well-known Nepali comedian (his identity was kept confidential in the published study but was known to study participants) who had been open about his mental health struggles.
“We talked about how he suffered from mental health issues and was determined to seek treatment despite the stigma associated with it,” Mishra said.
After implementing one of these strategies, the caller asked whether the person would be willing to seek mental health treatment. The researchers found that both strategies were equally effective in reducing stigma and increasing willingness to seek help.
“What was interesting was that people with high personal stigma were more willing to seek treatment than those with low personal stigma,” Prakash says. “Similarly, people with high anticipated stigma were more willing to seek help than those with low anticipated stigma.”
The researchers also wanted to explore how the gender of the caller and study participants affected willingness to seek treatment. Men and women responded similarly to the outreach strategies. Notably, however, it was men with stronger traditional masculine values who responded best 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.
“Participants were more willing to seek help when the call was from a woman, and this was true regardless of gender,” Mishra said.
Mishra attributes this to strong masculinity norms in Nepal – the idea that men shouldn't shed tears – and suggests that this may make it “even more awkward for men to talk to a male caller than a female”.
Prakash and Mishra say the fact that both outreach strategies were effective with both men and women speaks to the power of simple, low-cost mental health outreach, especially in countries where resources are limited and people don't typically have these conversations.
“This may be a small trigger that can provoke a response from even the most stigmatized people,” Prakash says. “They can relate to this. The situation in Nepal is quite different from the US, where mental health is widely discussed and there are influencers on social media who are highlighting the topic. Mental health is barely talked about here, so even a phone message can make a strong impression and elicit a response.”
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