COVID-19 Webinar 5: Best practice public information campaigns
Lancet Psychiatry, Mental Health Innovation Network, MHPSS.net and United for Global Mental Health have launched a series of weekly webinars designed to provide policy makers and the wider health community with the latest evidence on the impact of COVID-19 on mental health and how to address it.
Chair: Niall Boyce, Editor, Lancet Psychiatry
Panellists:
Alison Brunier, WHO, Switzerland
Pattie Gonsalves, Sangath, India
Taha Sabri, Taskeen, Pakistan
Suzanne Farrell & Ian Walker, Public Health England, UK
Niall Boyce, Lancet Psychiatry
Start with Alison. What has WHO been doing to help countries design and deliver public health information campaigns?
Alison Brunier, WHO
Responding to COVID-19 we had to take a fairly hard look at how we communicate to be more effective - making much broader use of research on attitudes and behaviours including using a company that looks at more than 50 countries to see what messages are working and what is needed. WHO has also broadened the partnership base e.g. with the large technology companies who we are working with much more proactively to reach more people and prevent misinformation and rumours from circulating widely. WHO has also made a huge effort to translate materials (beyond the usual UN languages) and disseminate in as many languages as possible - particularly those spoken very widely around the world.
[For more information see: WHO resources on mental health and COVID-19 and the new WHO guide on managing stress].
Niall Boyce
Different groups have languages and ways to process information e.g. children. What can be done to communicate effectively with children?
Alison Brunier
WHO works very closely with UNICEF and with other groups and organisations who communicate more with young people. One project that was a success was the children’s book collaboration of WHO, UNICEF and over 50 humanitarian partners. The book, for 6-11 year olds, explains COVID-19 to young children (both how to protect themselves and how to manage difficult emotions). There are now versions finalised or in production in over 100 languages, including audio versions and storytelling etc. This was only possible through collaboration.
Niall Boyce
It sounds like a combination of innovation and partnerships is important.
Now over to Pattie: talk about the situation in India. How is the Indian government educating people about CVOID-19, and also mental health?
Pattie Gonsalves, Sangath
The Indian government is using radio, TV and mobile phone networks and a new website launched by the government on COVID-19. The government has also set up an online resource centre and a - soon to be mandated - app to download. All the information curated or supported is actually produced by CSOs - so the burden for that has fallen on the CSO or NGO sector. The positive side is an explosion of online and TV initiatives - information, counselling etc. The negative of a ‘digital first’ approach including stigma and misinformation and ostracism against healthcare workers. So while the digital first approach is valuable it is equity insensitive so need to address that.
Niall Boyce
What can you do for those people who are offline?
Pattie Gonsalves
There is not much we can do but as Sangath we are strengthening face to face initiatives as these are still important (while being aware of safety). For example Sangath is developing a partnership with the Self-Employed Women's Association (SEWA) of India to train women's support groups to deliver psychosocial support. Therefore we need to keep a face to face approach where possible.
Niall Boyce
So a word of caution - we have to be very careful and not focused exclusively on digital interventions. Lower technology solutions are also important.
Then Taha. Recently, I know Taskeen has been putting together its own public health information campaign in Pakistan. Can you describe a bit more about it, how it works and who you are working with?
Taha Sabri, Taskeen
We found in Pakistan there was almost no mental health messaging in the COVID-19 response so we decided to create animations. We also formed a coalition with others to deliver services to those suffering from COVID-19 related mental health issues. The biggest learning is that the entire messaging can exclude those who live in very cramped conditions and who do not have access to water. Therefore we need to look at how we develop messaging that is relevant for those groups. Otherwise guidelines could worsen the mental health of underprivileged communities. There is a danger we only develop messages from the perspective of HICs. We have realised we need to develop completely different strategies and messaging with anthropological research on the impact of COVID-19 on lower resourced communities.
Niall Boyce
So this is interesting - we started this webinar series focusing on the experts and how we get the message out there on what we should do. But now we need information back from communities as to the situation at the grassroots and what information is pragmatically useful and helpful.
Over to Suzanne and Ian: Can you explain what public health information campaigns PHE has been doing on mental health during the time of COVID-19? What has worked best?
Suzanne Farrell, Public Health England
Public Health England is leading delivery of campaigns on mental health in England - the Every Mind Matters campaign that is operating for adults and the Rise Above campaign for young people. In the context of COVID-19 we are working with our colleagues on how to integrate mental health into the COVID-19 health information campaigns. We are working on messaging and guidance. The challenge now is reaching off-line communities; and the shifting messages in line with changing attitudes and concerns of people and to fit with the latest COVID-19 health information.
Niall Boyce
What so far seems to work and what is the evidence?
Ian Walker, Public Health England
We are getting data back from populations to understand how their mental health is faring through the pandemic - gathering this from community surveys, population surveys, public opinion surveys etc. Current priorities include developing messaging for subpopulations and more vulnerable groups. We need to tailor messages to key groups and which ones we need to target and what message would be more helpful. Hoping data will help us understand where we are at.
Pattie Gonsalves
Similarly for our work online we have been asking for feedback and creating spaces for young people to talk with a mental health professional. Topics are consistent with other countries: acute reactions of worry and anxiety; concern about employment and the impact on their aspirations and careers. The vast majority of the Indian population are young people and they are impacted by disruption to national exams etc. We have been signposting to online resources. Having a range of options for online resources has been great. People are also focusing on particular vulnerable groups such as those facing violence. We are constantly asking what is on their minds, knowing it might change and we need to be flexible and responsive.
Taha Sabri
Agree with Ian and Pattie. For us what works is: de-medicalisation, indigenisation and collaboration. The language we use for the masses needs to be simple and not scare people with medical terminologies. We need to communicate resilience, hope etc. On indigenisation we need to communicate according to the local context so interweave standard content with local cultural coping mechanisms. And collaboration means working with lots of different partners. We are working now with the federal and local government, business and media. We have reached 10 million people because of collaboration.
Niall Boyce
Could altruism be a very effective factor to use in communication? Does appealing to people’s better instincts of caring towards others help with public mental health messaging?
Alison Brunier
Yes altruism is an important message e.g. WHO is consistently using a message of solidarity and emphasising kindness to one another. We also do media monitoring to evaluate what messages work. We are trying new approaches - we have become less risk averse and more open to new approaches e.g. new apps, working with new partners from musicians to TV presenters, WHO ambassadors etc.
Niall Boyce
Are there potential adverse consequences to mental health campaigns?
Ian Walker
We have tried to incorporate messages for the public on the importance of limiting exposure to all social and general media to reduce anxiety. We have encouraged people not to become overloaded constantly but take breaks.
Suzanne Farrell
We are conscious particularly of populations at risk. We have learnt from CSOs - e.g. OCD community on how to manage these messages.
Alison Brunier
We have put out the message a lot emphasising people should not be too hard on themselves and encouraging them to be aware of their limitations and congratulate themselves on the small things they achieve.
Pattie Gonsalves
One of our insights is how to tailor messages and the need to be quite specific e.g. children, parents, health workers etc. We need to get the information right and be really specific and useful e.g. videos for mums at home taking care of children who are not in school, or videos for young people with existing MH problems or illness. We appreciate the need to develop messaging quickly but in the next few weeks and months we have an opportunity to take more time to get it right.
Niall Boyce
So in summary we need nuance and to tell people to give themselves a break from both the media and maybe their own overly high expectations of themselves. This is related to a question we have received from a professor in Bangalore highlighting a key challenge - empowering for emotional health. What are the panels’ experiences in this area?
Taha Sabri
What we focus on is resilience and adopting and practicing healthy coping skills. We have worked on targeting segmentation - e.g. people caring for taking care of others (by different categories), first responders, media personnel etc. We have been developing content specific to each. We are already doing 10 animations and have 10-15 more to come. We agree the messaging needs to be very specific. People like stories and humour. Stories really gain attention - we want to lift people’s spirits up.
Niall Boyce
Most health messaging has usually been focused on things one must “always” or “never” do. But in the context of COVID-19, eventually lockdowns will ease and the messages encouraging people to stay at home will need to change. There may be an issue with people having the confidence to resume normal life. Does the panel have insight into this and how best to shift messaging? How do we build confidence and empowerment?
Suzanne Farrell
We test what works with the public and we find using incremental and small steps works best. We will need to build up people's confidence and mental health messaging link to broader health messaging around COVID-19.
Alison Brunier
As more people come out of confinement we know messages for managers and employers will be needed to see how people can help come back to work and what physical distancing messages are needed to accommodate changes in the way people work together. There will need to be some provision of mental health and psychosocial support in the workplace.
Niall Boyce
Coming back to de-medicalisation, a degree of anxiety in this situation is normal but we need people to move on and get back to work eventually etc. Will a de-medicalised approach be useful in the longer term as well?
Taha Sabri
Initially we planned for a COVID-19 mental health strategy for 1-2 months, now we are planning for 2 ½ years: developing countries expect the vaccine will come much later for them than for high income countries so we are looking at the impacts of the crisis in that context. The messaging needs to be very careful and not speak in absolutes, it needs to be very flexible and ready to change according to challenges of new knowledge. We need to be comfortable with saying we don’t know. This is a better way to build credibility - taking a long term approach. The biggest issue right now is fake news and very few credible organisations. If organisations such as WHO lose credibility then no messaging will work. WE need to be careful, nuanced and be fine to admit what we do not know.
Niall Boyce
So we need to build trust - to be honest about the limitations of our knowledge.
I will end with a round-up question for each panellist. In one line, what comes next? What are your biggest priorities now for public health information campaigns?
Pattie Gonsalves
Broaden the mental health conversion [in India] to include everyone and have messaging tailored and suited to peoples’ needs.
Alison Brunier
People’s mental health and wellbeing will be one of the key factors that brings us through this pandemic and we need to pay attention to that.
Ian Walker
The digitally excluded is a key challenge - in the UK that is 10% of the population. Our current challenge is how to reach that 10%.
Suzanne Farrell
Our current challenge [in the UK] is communications with sub-groups and the difficulties of transitioning messaging as we all go through the next stage of pandemic response.
Taha Sabri
Focus on the 80% of the population [of Pakistan] not online and tailor the messages to reach them.
Niall Boyce
Thank you. The recording and notes of the session will be posted on the UnitedGMH.org website very shortly.
