In these four posts, I am examining the evidence about the limited impact of education on stigma change. Public service announcements (PSAs) are another way to present facts about mental illness in order to erase stigma. Why might the PSA impact be so limited? Consider distribution in American media outlets.
The Federal Communications Commission mandates that broadcast stations using the public airwaves must serve the “public interest, convenience, and necessity.” One way television networks do this is as vehicles for PSAs that provide potential avenues for addressing mental health and anti-stigma agenda. Unfortunately, these opportunities are limited by when, or how often, PSAs are aired.
Campaigns focused on mental health must compete with PSAs that consider other prominent issues: e.g., child welfare, breast cancer, and military veterans, each with important messages. PSAs are often broadcasted at off-hours (2 to 4 a.m.) when fewer people are watching TV.
Even if PSAs receive air time, they are often pulled quickly from the air, because PSA producers have contractual relationships with actors that stipulate the length of time in which the video may be broadcasted, often one year. Distributors have to pay residuals to actors in cases when the PSA is used beyond the year. Given that PSAs are produced and distributed using charitable donations and/or public funds, additional monies to keep them on the air are often unavailable.
Still, PSAs seemed to have had a major influence on smoking and HIV/AIDS. What’s the difference? The action messages of anti-stigma PSAs are much more difficult to pose concisely. PSAs action for smoking: Stop smoking. HIV/AIDS: Safe sex. I don’t mean to say that realizing smoking and HIV goals is easy, but communicating the focus can be done simply and efficiently.
What’s the goal for anti-stigma PSAs: Don’t be a bigot? First, this will have little effect, because biased people never recognize themselves in the group of bigots. Second, even if the PSA gets their attention, what does it mean to stop being a bigot? Stop discriminating against someone. “But I don’t discriminate now.”
Some anti-stigma programs promote affirming actions instead. SAMHSA’s Be There! Campaign does this nicely by promoting support among friends. When peers are troubled, be there for them.
PSAs may have a boomerang effect. One study examined the impact of a print add (Lienemann, Siegel, & Crano, 2013): “You are not to blame for the cause of your depression. Depression is treatable if you are willing to seek help.”
The bottom half of the advertisement then listed the indicators of depression: persistent sad mood, feelings of hopelessness, and decreased energy. The expected benefits might include viewers being more open to help-seeking. The results, however, were the reverse. People who saw the PSA were more likely to endorse the self-stigma of depression.
THE BASICS
Source: Pixabay Direct-to-consumer advertising (DTCA) uses marketing strategies to undermine stigma and promote product sales. DTCA for prescription medications exploded after the FDA lifted restrictions in 1985. American media has been pelted by DTCA for anti-depressants; DTCA revenue for Cymbalta, an anti-depressant medication manufactured by Eli Lilly, was ranked fifth among all medications in 2008.
One study examining the impact of a Cymbalta advertisement demonstrated the complexity of DTCA effects (Corrigan, Kosyluk, Fokuo, & Park, 2014). The advertisement showcased seven people (men and women from diverse ethnic backgrounds) struggling with depression, mentioned the benefits of Cymbalta as an antidepressant, summarized the possible physical and psychiatric side effects, and ended with people seemingly feeling better. Unintended effects were found on public stigma: Namely, people were less likely to endorse recovery or self-determination after seeing the Cymbalta advertisement. However, if people had lived experience, or reported previous episodes of depression, the Cymbalta ad seemed to cause less blame and higher endorsement of empowerment.
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How Anti-Inflammatory Drugs Could Ease Depression Growing concern about penetration and boomerang effects has led to skepticism about PSAs, which has begun to sway big-picture perspectives about anti-stigma programs. The Canadian Mental Health Commission, for example, launched its Opening Minds anti-stigma initiative in 2009 with a large social marketing campaign. The results of a population survey, however, showed the campaign had no measurable effect on the Canadian public (Stuart et al., 2014). As a result, the Commission jettisoned large-scale social marketing for more local and targeted strategies.