Is mental health 'awareness' backfiring?

It's mental health awareness week, again. But the latest data shows that mental health stigma is increasing, not decreasing. What's going on there? And has mental health awareness gone 'too far'?

Image via Madison Inouye

I’ve never been one to say “I told you so”. Any prediction made about how events will unfold at the social level, which involves multiple individual humans reacting to their own circumstances, will always involve a significant element of luck/fluke¹. Insisting “I told you so” when something you predicted actually comes to pass completely ignores that.

It’s like winning the lottery and then saying “I knew those would be the numbers, that’s why I picked them”. No, you just got monumentally lucky.

…however, despite all that, I’ll admit to a degree of ‘I told you so’ during this Mental Health Awareness Week.

You might be thinking, “Didn’t we just have Mental Health Awareness Week?” No, we didn’t. That was World Mental Health day, which was back in October. Or Children’s Mental Health Week, in February. Or Time to Talk day, also in February. Or Stress Awareness Month, which was last month.

The fact that we can now legitimately end up confused about which mental health occasion is which suggest mental health awareness may have lost its value somewhat.

But then, this is me saying that. I spend almost every day immersed in the mental health discourse, so of course I’d find it a bit ‘omnipresent’.

It’s not just me though. There’s actual evidence for waning effectiveness of awareness campaigns. As recently flagged up by Dr Lucy Foulkes on Instagram, we’re seeing a tangible ‘backlash’ against mental health awareness. For instance, Dr Foulkes cites, a detailed study published in 2024 which reported a noticeable drop in positive attitudes to those with mental health problems since 2019, after a sustained decade-long trend of improvements.

What’s happened? Presumably mental health awareness campaigns were a big part of the significant improvement in attitudes, so why would they suddenly lose their efficacy?

Leaving aside the sorts who actively want to spread stigma and judgment (and there’s no shortage of them lately), there’s no easy answer to this. But here are some likely factors to consider.

Awareness is not enough by itself

Photo by Lisa from Pexels

The reason I ended up needing to quash a childish “I told you so” impulse upon learning that mental health stigma is increasing again, is that I warned about this outcome, a year before it showed up in the data.

Specifically, I wrote a Guardian article in 2018 titled “Mental health: awareness is great, but action is essential”. My overall point was that increased awareness of mental health problems is to be celebrated, but it’s a first step, not a destination. Without accompanying action to actually do something about the ever-increasing rates of mental health problems, awareness will eventually lose its impact.

Seven years later, here we are. Basically, if you spend years spreading awareness of mental health issues, but nothing beyond that, you may well end up with a population where many people say “OK, so depression etc. are real things… and?”

After all, I and many others are ‘aware’ of, say, skirting boards. But this doesn’t affect my thinking and behaviour in any way that I’m aware of.

Maybe awareness campaigns have made mental health too commonplace? Or perhaps they’ve helped ‘sanitise’ the mental health crisis? It’s hard to say, but worth considering.

Therapy speak, over-medicalisation, and the muddying of the waters

Photo by Brett Sayles

It’s a common complaint that ‘therapeutic’ terminology is used far too much these days. I’ve made similar observations myself, most recently about the invoking of dopamine where it’s not warranted, and the mainstream tendency to label anything and everything ‘addictive’. My contention is that overuse of these terms dilutes their meaning and leads to greater confusion and misunderstanding.

And so it is with the ever-increasing use of therapeutic terms, usually reserved for mental health treatment, being dropped into everyday conversation.

Years of awareness campaigns and the subsequent acceptance they’ve led to will have contributed to this ‘leakage’ of vocabulary from the clinical to the mainstream. And it doesn’t help.

For instance, ‘trauma’ is a term which clinical psychologists wish people were more discerning about. Trauma is usually used to describe the emotional response to a significantly negative event, like an attack, car crash, loss of a home, etc. It typically shouldn’t be applied to the awkwardness of embarrassment, or mild criticism from someone who doesn’t like your output.

This isn’t to say those things can’t be traumatic, because they could. Trauma describes the emotional response, not the experience itself, and if someone has poor enough mental health that one more negative encounter is the proverbial straw that broke the proverbial camel’s back, then they could experience low-key trauma.

Unfortunately, such individuals would likely be lumped in with those who describe their experiences as traumatic just to add a bit of spice to their language, to hype up their own experiences and piece of mind, or who simply just don’t know better. Such people can be, admittedly, rather exhausting.

This issue seems to be getting amplified by social media. It’s a common observation that countless people will post hashtags and memes about ‘time to talk’ or ‘be kind’ etc., whenever a mental health awareness campaign comes around, but never actually follow through with the offers of help and support, often straight back to posting their typical ‘less positive’ output the next day.

If your regular experience of mental health awareness is irksome types using it to self-aggrandise, that likely would sour you on the concept.

Mental health influencers are another concern. It’s great that individuals who deal with mental issues on the regular have a much bigger voice these days (they didn’t in the recent past, and that often led to problems), and that those who endure them don’t have to do so alone.

But there’s the increasing problem of mental health influencers spreading misinformation. Presumably by accident? They’re likely just sharing their own experiences, and subsequent insights. But mental health is a very subjective thing, and what applies to one person need not apply to others. Or anyone else. Hence, people who follow such influencers end up believing inaccurate notions, and acting on them, with often unhelpful outcomes.

This isn’t to say the medical/clinical establishments are blameless, of course. The creep of medicalisation, of turning everyday traits into medical problems to be treated/cured², is has been flagged up for almost as long as awareness campaigns have existed.

To what extent overmedicalisation is a legitimate problem is hard to establish, given the vagaries of mental health problems and how they’re defined. But that’s not the issue; if enough people believe overmedicalisation is a problem, they’ll be increasingly likely to dismiss or scorn those with legitimate issues.

The Pandemic

Photo by cottonbro studio

Whenever a big societal change happens after 2019, you can’t avoid asking if COVID-19 may have played a wee part in it.

And it’s hard to imagine it didn’t here. Data suggests that the pandemic led to a massive increase in mental health problems worldwide. And honestly, why wouldn’t it? It was an incredibly stressful, often genuinely traumatic years-long period for so many. It would be a miracle if mental health problems didn’t spike dramatically in the wake of that.

But the ripple effects of this are many and varied.

Did constant exposure to just how deeply overwhelmed the medical system is, or can be, give people a more hard-line view of who is or isn’t ‘unwell’?

Would round-the-clock coverage of a genuinely fatal respiratory illness make people less sympathetic to those revealing their own more subtle, less tangible mental ailments?

If far more people overall have experienced a decline in mental health and had to soldier on regardless, would they more readily expect others to do the same? If we’re ‘all in the same boat’, you’re not going to have much patience for those moaning about getting wet.

…to clarify, I’m by no means claiming that those with mental health issues are complaining needlessly. But, again, the experiences of the pandemic may have led to more people believing they are.

There are no doubt many other aspects of the pandemic experience that will be shaping attitudes towards mental health. Suffice to say, it was a significant external shock that we’re still unpacking.

The lack of concern from those with power

Photo by Lukas

This very morning as I write this, the current education secretary has announced that, to tackle the school mental health crisis, children will be taught to show some 'grit' (thanks to Natasha Devon for flagging this up).

While the actual proposal does seem more measured and nuanced, the headline statement alone reveals the usual default assumption; people who claim mental health issues, especially young people, just lack fortitude. They’re throwing in the towel rather than grow some backbone, blah blah blah.

It’s a view that will resonate with many a middle-aged tabloid reader, sure, but it’s also deeply harmful, for obvious reasons. Like, the idea that young people are struggling mentally purely for reasons relating to being too soft, or whatever, completely ignores the vast range of other stressors and problems young people have to put up with on a daily basis, especially post-pandemic. Problems that the older generations in power never had to deal with, but are largely responsible for causing, or propagating.

It’s basically yet more evasion of the fact that genuinely effective mental healthcare that would actually tackle to problem is expensive, time consuming, and would take a very long time to deliver nuanced results. Basically kryptonite to most modern governments.

But it also reveals a deeper, more persistent problem, with those with the power to make actual, effective changes; a lack of drive to do so, and a resultant tendency to put the responsibility for dealing with mental health issues on those experiencing them.

It’s common enough from any government, using slogans instead of actual investment. And you regularly hear of companies and organisations who ‘take mental health seriously, by offering employees workshops and classes on things like ‘resilience training’. There’s nothing wrong with this in isolation, as long as employers don’t end up treating it as a blank cheque to pile more work on employees. Judging from the ever-increasing rates of workplace burnout, I’m not optimistic about that.

There’s a more sinister version of this too; the whole ‘toxic positivity’ angle. The idea that, with just some happy mindsets and inspiring slogans, you too can ‘choose your mood’. After all, ‘the only disability in life if a bad attitude’.

And logically, if we can choose to be happy and capable, those who say they aren’t, are choosing not to be. And that’s on them.

Attitudes often flow from the top, and if those who run your country, pay your wages, and influence you online, are constantly saying those with mental health issues are responsible for their own problems, that’s going to sink in eventually. And increasingly negative attitudes towards them will be the most likely outcome.

And so on.

There are no doubt countless other factors that could be causing the decline in positive attitudes towards mental health matters. Please feel free to flag them up in the comments if you know one I’ve not included that’s probably very important.

I will stress, though, that a decline is not a full reversal. We’ve still come a great distance, and remain far ahead of where we were when even I started writing, some 20-ish years ago.

But if we concede that a lot of people are now aware of mental health problems, maybe it’s about time we started doing something more nuanced, more practical, and more useful with it? We’ve filled the awareness fuel tank, to the point that it seems to be sloshing over the sides. So let’s see if we can use it to actually go somewhere.

---

I discuss mental health matters in all my books, including the most recent one, which you could give young people, instead of ‘grit’.

Why Your Parents Are Hung-Up on Your Phone and What To Do About It

1. This is why I get very irked by films or books where the plot revolves around the antagonist/protagonist having a plan which involves dozens of different, unconnected people behaving exactly as they predict they will. It’s basically the equivalent of saying “I’ll roll a hundred dice, and they’ll all land on 4 or higher”. This is a feasible outcome, but , you can’t guarantee it. No matter how smart you are.

2. The explanation for this is usually that medical organisations and pharmaceutical companies are always looking for more ‘problems’ to ‘treat’ so they can profit from selling unnecessary medications. If you’re mostly experienced in the UK system, it can seem baffling, the idea that already-threadbare and underperforming mental health services would be conspiring to create more work. But when you consider the influence drug companies have in the for-profit US healthcare system (which strongly influences mental healthcare practices in general), it doesn’t seem so unlikely.