The Every Mind Matters campaign in England: changes in mental health literacy over 30 months and associations between campaign awareness and outcomes

BackgroundThe Every Mind Matters campaign and web resource launched in October 2019 by Public Health England aimed to equip adults to take action to improve their mental wellbeing by providing NHS-assured resources. The aim of this study is to investigate the effects on population level mental health literacy of Every Mind Matters over 30 months following campaign launch. MethodsTo observe changes in mental health literacy over time, we conducted regression analyses on a nationally representative, repeated cross-sectional dataset of nine survey waves from September 2019 to March 2022. We conducted an individual participant data meta-analysis with data from October 2019 to March 2021 to examine the association between campaign awareness and the outcomes, treating each survey wave as separate trials. FindingsThere were small improvements in knowledge of management of stress, depression, and anxiety, mental health vigilance, sleep literacy and psychological wellbeing self-efficacy from September 2019 to March 2020. By March 2022 there was a deterioration in all mental health literacy outcomes compared to September 2019, except for sleep literacy which was unchanged from baseline. Campaign awareness was positively associated with symptom management of depression and anxiety, help seeking self-efficacy, stigma related to mental disorders and mental health vigilance. InterpretationThere is little evidence that the campaign improved mental health literacy in the general population beyond March 2020. Those who were aware of the campaign may have benefitted from its resources. FundingPublic Health England, National institute for Health Research (NIHR) Policy Research Programme Research in context panelO_ST_ABSEvidence before this studyC_ST_ABSWe used PubMed and Google Scholar to search for studies published between 2000 and 2022. We included papers that showed the relationship for mental health literacy ("mental health literacy, "stigma", "help seeking", "self-efficacy"), common mental health problems ("depression", "anxiety", "stress", "sleep", "low mood", "common mental health problem"), mental health literacy interventions ("mental health literacy intervention"), and public health campaigns ("public health campaign*", "anti-stigma campaign", "mental health literacy campaign"). We also included studies discussing the mental health of the population because of COVID-19 ("population mental health", "COVID-19", "pandemic", "wellbeing"), as lockdown started in the UK around six months into the campaign. Research into public health campaigns shows small-to-moderate improvements in mental health literacy, however, the campaign efforts have often been limited to stigma reduction. A meta-analysis found that Mental Health First Aid training led to small-to-moderate improvements in mental health first aid knowledge including recognition of mental health problems, beliefs about treatment, and attitudes related to stigma. Another meta-analysis found that web-based interventions could lead to improvements in mental health literacy if it included an active ingredient such as including evidence-based content or tailoring intervention to specific populations. However, these mental health literacy interventions often focussed on controlled settings rather than at a general population level. One study in Australia using national survey data found that public health campaigns focusing on a wider concept of mental health literacy than stigma improved beliefs about treatment and help seeking. Added value of this studyThis study adds value by evaluating a public health campaign at a population level and its effects based on a more comprehensive understanding of mental health literacy than has previously been operationalised. To do so, we used measures of mental health literacy developed to assess lay knowledge of daily life signs of depression, anxiety, and stress. Our study therefore has implications for stakeholders of the effectiveness of public health interventions, and whether these interventions can improve mental health literacy in the general population in a relatively short time span. Implications of all the available evidenceThe current evidence base indicates that sustained public health campaigns lead to small-to-moderate improvements in stigma related knowledge, attitudes and desire for social distance from people with mental health problems in the general population. However, we do not know whether all aspects of mental health literacy beyond help-seeking and stigma can be improved at population level through a campaign and web resource.