Is "mental health awareness" counterproductive?

Challenging the way we think about mental health

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6 min read

Usually, when I come across a new research article that sparks my interest, I quickly scan the summary (abstract), and then stick it in an ever-growing document labeled TO READ, where it languishes, sad and forgotten, until I’m working on a new project and think Wait! Didn’t I read an article about online cat videos somewhere?¹² And then rediscover it again.

So it was unusual for me that, when I came across this article, I dropped everything and read it, title to references, in one sitting. The article, called Are mental health awareness efforts contributing to the rise in reported mental health problems? A call to test the prevalence inflation hypothesis, was published last week, and I can’t stop thinking about it. I even told my husband about it, in great detail, on our Valentine’s date night because nothing says I love you like a scientific analysis of the global mental health crisis.³ 

So, happy (belated) Valentine’s day, sapiens. Let’s discuss this one.

What’s the article about?

In a sentence: the authors are proposing the idea that mental health awareness efforts—like, in schools or via public health campaigns—are actually contributing to increases in mental health problems.

Now, before we get into the details, the most important thing to know about this paper is that it presents a hypothesis, not an empirical study. You may remember from your days in dusty, middle school science classrooms,⁴ wearing plastic safety glasses and observing tadpoles, that a hypothesis is a proposed explanation for a phenomenon. In other words, it has not yet been proven, or even tested. The authors are simply proposing an idea, and suggesting we need to study it more.

Now, let’s get into the details

So, we know that in the last decade or two, there has been an increase in “mental health awareness efforts”—everything from public health campaigns (e.g., “It’s Okay Not to be Okay”), to celebrities posting about mental health struggles, to school-based prevention programs.

The authors suggest that these efforts might lead to two different outcomes, one good and one not-so-good:

1. The Good: Awareness efforts likely lead to improved recognition. In other words, people who have a mental health condition are more likely to recognize their symptoms, understand that help is available, and seek treatment. This is the goal of these programs and is incredibly important. 

2. The Not-So-Good: The authors propose that awareness efforts could also lead to overinterpretation. In other words, some people may begin perceiving their mild distress or negative emotions as a mental health problem that needs to be labeled and treated. Paradoxically, this could then actually create or intensify mental health problems. If true, this is not good.

More on the Not-So-Good

The authors mention a few interesting components of this possible overinterpretation process:

• Public health campaigns might inadvertently encourage overinterpretation by teaching people to notice and label their negative emotions with psychiatric terminology (e.g., “depression” or “anxiety”)

• Campaigns often portray disclosing mental health struggles as brave or admirable. This is important for reducing stigma, but might inadvertently glamorize or romanticize mental health problems, further contributing to overinterpretation.

• Labeling normative experiences as a mental health problem could create a “self-fulfilling prophecy,” whereby a person actually changes their behavior or beliefs to fit a diagnosis, and then actually does experience that mental health problem as a result. 

• For example, a person begins to interpret mild nervous feelings as an anxiety disorder. They start to believe they need to avoid things, like social events or public transportation, due to “having anxiety.” But this avoidance actually exacerbates their anxiety, so they do end up having an anxiety disorder in the future. 

• Teens, versus adults, could be especially susceptible to these effects, both because they are frequent targets of awareness campaigns, and because they are increasingly being told that mental health problems are typical of people their age.

The authors also point to a few pieces of evidence for why this overinterpretation hypothesis could be true:

• Labelling theory: Labelling people in a certain way (e.g., labelling someone who commits a crime as “deviant,” or, in this case, with a mental illness) can become a self-fulfilling prophecy, both because other people start treating that person differently, and because the person changes their beliefs and behaviors to fit the label.

• Looping effects: When given a diagnosis (by a professional or, possibly, by oneself), people may change their behavior and self-concept to fit that diagnosis.

• Power of suggestion: Falsely telling people they have certain symptoms can lead to more reporting of those symptoms. In one experimental study, when participants were told they had high blood pressure (even when they did not), they reported more symptoms associated with high blood pressure (like headaches and feeling flushed).

So, what does this mean?

Here are a few things that this article does not mean:

• It does not mean that we should stop mental health awareness efforts.

• It does not mean that mental illness is “all in our heads” or somehow not “real.”

• It does not mean that awareness efforts are the sole reason for increases in mental health problems.

That said, there are a few implications of this article that really matter for how we approach the mental health crisis, especially among teens. 

There are probably a number of reasons why mental health issues have increased in recent years, and it’s near impossible to prove that any one reason is the capital-c Cause. Social media certainly could be one reason. Issues of overinterpretation, and the subsequent “self-fulfilling prophecy” that might play out, could be a reason, too. The interplay of social media and overinterpretation (like, through mental health awareness efforts on TikTok) probably also plays a role.⁵ We need more and better research to understand this.

We also know that mental health awareness efforts have important benefits for reducing shame and stigma, and for helping people seek out the help they need. We can’t take that away. But often, we’re operating under the assumption that any awareness effort is good, no matter the way it’s delivered or message it’s sending. We need to start figuring out how to optimize educational programs and mental health campaigns, so that we can get those benefits without inadvertently making things worse.   

In the end, this idea is still just a hypothesis, but I think it’s a hypothesis worth considering.

Further reading

• Foulkes, L. & Andrews, J.L. (2023). Are mental health awareness efforts contributing to the rise in reported mental health problems? A call to test the prevalence inflation hypothesis. New Ideas in Psychology.

• Can TikTok diagnose your anxiety? Techno Sapiens.

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1. I must—repeat, must—know how this paper came to exist. It is titled Emotion regulation, procrastination, and watching cat videos online: Who watches Internet cats, why, and to what effect? and was published in 2015 in a real, relatively high-quality academic journal. It was published by a single author and involved a study of over 6,000 people, so this was no joke. Highlights include: “A third of respondents (36.2%) described themselves as cat people while few (3.0%) reported being only a dog person” and “Results…demonstrate conceptual nuances related to the emotional benefits of watching Internet cats.” FWIW, I am not a cat person, Internet or otherwise.

2. Let me just emphasize again, I am really not a cat person. I am so allergic that when I was in graduate school, I had a good friend with a cat, and when I spent too much time in the same room with her, I would start sneezing, even when the cat was not there. [Or, now that I’m thinking about it, maybe the cat secretly was there, hiding behind a plant somewhere? Feels like something a cat would do.]

3. You know what else says I love you? This toy vacuum and mop set, which my mom got for my son as a Valentine’s gift. I have never seen him love a toy as much as he loves these things. He has spent the past week refusing other activities in favor of vacuuming, and has woken up from multiple naps shouting CLEANING. I don’t know whether to be excited about this or concerned?

4. While writing this sentence about middle school science classrooms, I had a sudden flashback to a 6th-grade assignment that involved constructing different types of cells using household objects. I was assigned paramecium. I vividly remember that it involved a flip flop (for the body) and some old carpet fringe (for the cilia, duh). Of course, I remember nothing else about paramecium.

5. Social media could play a significant role in overinterpretation, due to the immense quantity and reach of mental health-related content and inadvertent romanticizing of mental illness.