Directing Change: Evaluation of the Use of Public Service Announcements (PSAs) to Reduce Mental Illness Stigma and Prevent Suicide Among Youth and Young Adults

Background: Two studies were conducted to evaluate the Directing Change Program and Student Film Contest (Directing Change) from June through September, 2016. The purpose of the two studies was to evaluate the program on a set of knowledge, behavior and attitudinal outcomes, learn about the strengths of the program, and to identify areas for improvement.

Program background: Directing Change is designed to promote mental health and prevent suicide by educating young people about mental health and the warning signs for suicide. Directing Changeis implemented on high school and college campuses in California, with advisors assisting students age 14 to 25 to produce 60-second public service announcements (PSAs). The PSAs are submitted into the film contest to compete for recognition and awards. The goal of the program is not only to create awareness through campus and community-wide sharing of the PSAs, but also to change attitudes and behavior in order to reduce stigma and discrimination.

Evaluation Methods and Results: The first study was a cross-sectional case-control online survey. A convenience sample was obtained from all participants in the program database with recruitment via email invitation and follow up using Facebook and Twitter. Young adult controls were recruited from an online convenience panel and those aged 14-17 through parents in the panel. The sample originally consisted of 396 controls; however, after statistical matching, the final sample contained 268 controls and 131 cases. More than half of cases (52%) compared to 36% of controls reported providing support to someone experiencing a mental health challenge by standing up for them in a social situation in the past 12 months (p ≤ 0.001). Over half (60%) of cases agreed or strongly agreed that people who kill or attempt to kill themselves usually show some warning signs, whereas 40% of controls agreed or strongly agreed (p ≤ 0.05). The second study consisted of a series of group sessions with advisors of youth participating in the program. The sessions were designed to capture more in-depth qualitative aspects of the program. Advisors recognized the ability of the PSAs to reduce stigma and to support skill development in starting conversations about difficult subjects. They felt the PSAs created a safe space for grappling with students’ personal narratives.

Conclusions: Significant differences between cases and controls indicate the effectiveness of Directing Change.The quantitative study shows evidence of knowledge, attitudinal, and behavioral outcomes. It is remarkable that significant findings persisted even months after the program had ended—three to six months after film submissions. Findings from the advisor sessions underscored the effective elements of the program also identified in the survey; specifically, the effects of increasing interpersonal communication and engagement around the issues among the students participating in the program, on their campus and in their community.

Implications for research and/or practice: Creative approaches to educate youth and young adults, such as developing original PSAs, can assist in reducing stigma and providing opportunities for engaging in difficult conversations on sensitive health topics. A combined quantitative and qualitative evaluation methodology can provide a more comprehensive view of the effectiveness of a campaign or program.