Mental health awareness has increased dramatically (Hahn et al., 2023; Henderson, Potts and Robinson, 2020), particularly over the past two decades; however, mental health outcomes, especially among adolescents, do not appear to have improved and may have worsened (Haslam, 2016; Foulkes and Andrews, 2023). Data from the UK specifically shows rising rates among children and young people: prevalence has risen sharply, with around 1 in 5 now experiencing a probable mental health disorder, up significantly from roughly 1 in 10 in the early 2000s and 2010s (Number of children with mental disorders continues to rise, states NHS Digital, 2019).
The authors of this paper (Lucy Foulkes et al, 2026) outlined the goals of mental health awareness campaigns that aim to reduce stigma, increase mental health literacy (the ability to recognise symptoms), and encourage help-seeking behaviour. However, they highlight a key concern whereby most initiatives assume that simply increasing awareness will, of itself, directly improve mental health, but this assumption has limited empirical support. At the same time, rising rates of self-reported anxiety and depression, diagnoses and service use raise the possibility that awareness itself may be shaping how people interpret and report distress.
The paper aims to critically evaluate this assumption and explore potential unintended psychological consequences of awareness efforts.
Mental health awareness has grown substantially in recent decades, yet the assumption that greater awareness automatically translates to improved mental health outcomes is questionable.
Method
A narrative scoping review method was used, meaning the authors examined and synthesised findings from a wide range of existing studies rather than collecting new data. The authors drew on research from psychology and psychiatry to evaluate how mental health awareness campaigns influenced outcomes such as symptom reporting, stigma, and help-seeking.
Key concepts explored included “mental health literacy” (knowledge and understanding of mental health), “internalising symptoms” (conditions like anxiety and depression that affect inward feelings), and “iatrogenic effects” (unintended negative consequences of an intervention). This approach allowed the authors to critically assess both the benefits and potential harms of awareness efforts across different populations. They focused particularly on young people, as they are the primary targets of many awareness campaigns and show the largest increases in reported mental health difficulties.
The approach they used was ‘hypothesis-generating’, meaning the authors set out to identify patterns of existing data, proposed mechanisms that could explain those patterns, and highlighted gaps where further empirical research is needed.
Results
The paper highlighted that while mental health awareness campaigns are well-intentioned, the evidence suggests a complex and sometimes unintended set of psychological effects, particularly around how people interpret and report their own mental states.
The paper identified several key patterns:
1. Mental health awareness has increased
Young people were more able to recognise symptoms of mental illness, which was attributed to greater public discourse around mental health within schools, social media and broader media campaigns.
2. Reported mental health problems had also increased
There were significant rises in self-reported internalising symptoms such as anxiety and depression. There was a related increase in diagnoses and service demand, especially within adolescent populations.
The paper also highlighted evidence for increased self-labelling, where the boundaries of what was considered a mental health disorder evolved over time. This might contribute to higher reported prevalence rates, not necessarily because underlying disorder rates are rising, but because more experiences are being classified as ‘symptoms’. Related to this is the idea of “false positives,” where individuals adopt a diagnostic label that does not reflect a clinically significant condition.
3. Mismatch between awareness and outcomes
Despite improved recognition, there was little evidence of reduced prevalence through better, timely treatment. Some school-based interventions improved knowledge, but did not consistently improve mental health outcomes. Several high-quality trials found negative effects (i.e., worse outcomes), not merely null effects.
The authors expressed caution around the complex issue that increased help-seeking did not always translate into improved outcomes, and indeed may place additional demand on services without clear evidence of proportional clinical need. There was also concern that increased focus on symptoms may, in some cases, reinforce distress through a nocebo effect, where expecting to have a problem makes it more likely to be experienced or reported.
4. Changes in the interpretation of distress
The paper found that people might be more likely to label normal emotional experiences as pathological, and thereafter monitor and report symptoms more frequently, and use ‘clinical language’ in everyday contexts.
The authors showed that awareness efforts tended to increase people’s attention to, and monitoring of, their emotions and experiences, which can be positive. However, this may lead to what the authors described as increased “symptom perception” where normal variations in mood or stress are more likely to be interpreted as signs of a mental health problem. As a result, more people may identify themselves as having mental health difficulties, even when their experiences fall within the range of typical human distress.
Overall, several campaigns demonstrated meaningful improvements in stigma and public attitudes, including Time to Change and Beyond Blue, though these effects were not universal or sustained across all populations and settings. The authors therefore suggested that mental health awareness efforts may produce both benefits (such as greater openness and help-seeking) and potential harms (such as over-pathologising normal distress and inflating prevalence estimates).
Awareness campaigns show measurable benefits, but can also trigger self-diagnosis, nocebo effects, and over-pathologising of normal distress.
Conclusions
- The increase in mental health awareness efforts has been shown to produce beneficial as well as unintended psychological consequences.
- The increase in public discourse has appeared to help reduce stigma, encourage help-seeking behaviour, and improve early identification of mental health conditions.
- The heightened awareness, however, has also contributed to self-diagnosis, medicalisation of normal emotional experiences, and increased anxiety about psychological wellbeing.
- The exposure to constant mental health messaging, particularly on social media, has been shown to sometimes reinforce a focus on symptomatology and vulnerability narratives.
- While awareness initiatives are valuable for public health, they must be balanced with accurate education and responsible communication to avoid fostering unnecessary distress or distorted perceptions of mental illness.
The evidence calls for a more targeted, evidence-based approach to awareness; one that reaches those who need it, without harming those who don’t.
Strengths and limitations
The paper has several notable strengths and limitations, which are largely due to its nature as a review article and its focus on both positive and unintended outcomes.
A key strength of the study is its balanced approach. Instead of presenting mental health awareness as wholly beneficial, the paper evaluates both advantages, such as reduced stigma and increased mental health literacy, and the potential drawbacks, including over-medicalisation and self-diagnosis. This is important because it provides a more realistic and nuanced understanding of the impact of awareness campaigns. By acknowledging unintended consequences, the paper reduces bias and contributes to more informed policy and practice, allowing interventions to be refined rather than blindly promoted.
Another strength is its high ecological validity. The review article considers real-world influences, particularly the role of social media, in shaping mental health awareness. This is significant because much of modern exposure to mental health information occurs online, especially among young people. Including these factors makes the findings more applicable to contemporary society and increases the usefulness of the research for developing effective public health strategies.
Additionally, as a review article, the paper draws on a wide range of existing research. This is beneficial because it allows for broader conclusions to be made and identifies consistent patterns across multiple studies, increasing the overall reliability of the arguments presented. Nevertheless, many included studies are low quality, underpowered, or based on demand characteristics, which limits reliability of findings.
However, the paper also has limitations. One weakness is that, as a review, it lacks primary empirical data. This means it relies on the quality and scope of existing studies, which may vary in methodology and reliability. As a result, conclusions may be less definitive than those drawn from controlled experimental research.
Another weakness is the potential for interpretation bias. Since the authors select and evaluate which studies to include, there is a risk that certain perspectives are emphasised over others. This could influence how strongly the negative consequences, such as self-diagnosis, are presented.
Furthermore, while the paper highlights unintended effects, it may overgeneralise these findings. Not all individuals respond to mental health awareness in the same way, so applying these conclusions broadly may overlook individual differences in vulnerability and interpretation.
The review’s broad scope is a strength, but reliance on variable-quality studies limits how far its conclusions can be taken.
Implications for practice
As a clinical psychologist working within Child and Adolescent Mental Health Services (CAMHS), particularly in the context of long waiting lists and high referral thresholds, this paper felt especially relevant. It highlighted to me how increased mental health awareness, while beneficial in reducing stigma and encouraging help-seeking, may also shape the nature and volume of referrals received within the NHS. This can result in services being approached by young people and families who are more attuned to psychological language and symptom frameworks, but whose difficulties may fall within the range of typical emotional or developmental variation. For me, this also raises important questions about the education and guidance provided to referrers such as GPs, schools, and allied professionals. It might be useful if clearer psychoeducation were provided to support more appropriate referrals and reduce the likelihood of either over-referral or experiences of rejection following assessment.
At present, within CAMHS specifically, there can be a gap in shared understanding of what constitutes a mental health difficulty versus what reflects typical child development (the expected emotional, cognitive, and behavioural progression associated with age). Without this shared framework, there is a risk that services inadvertently contribute to invalidation when referrals are closed due to not meeting clinical thresholds.
The paper also prompted me to reflect on practice itself. Clinicians are required to continuously recalibrate their understanding of “normal” development, particularly as societal awareness and language around mental health evolve. This highlights the importance of maintaining a balanced perspective that avoids both pathologising distress and minimising genuine need.
Furthermore, the assessment process (a structured clinical evaluation used to determine whether a young person meets criteria for a mental health condition and requires intervention) becomes central in managing these challenges. Comprehensive assessments are essential to differentiate between clinical presentations and normative distress. However, when individuals arrive with pre-formed expectations, symptom labels, or diagnostic assumptions, clinicians require sufficient time and capacity to collaboratively explore and “unpick” these narratives, and rewrite preconceived ideas rather than simply screen or assess for mental health service criteria.
Finally, the paper highlighted to me a key tension whereby when individuals present to services with expectations shaped by heightened awareness, services may not always be able to meet these expectations. This may lead to disappointment, misunderstanding, or perceived rejection.
Feelings of rejection could, in turn, impact subsequent help-seeking behaviour and recovery (Appleton et al., 2020). For example, if someone feels they might not be taken seriously, they may be less likely to seek support in future. This, in turn, could delay treatment and subsequently lead to a deterioration or worsening of symptoms. Furthermore, it may even reduce trust in services, and we know the therapeutic relationship is key, and individuals rely heavily on trust and rapport. Young people, who already find it hard to trust, could disengage from services altogether if they experience or perceive a sense of rejection.
Overall, while mental health awareness is beneficial in reducing stigma and increasing understanding, it is important to maintain a balance so that individuals receive appropriate support when needed, ensuring the right help is provided to the right people at the right time and for the right reasons.
For CAMHS clinicians, these findings underscore the need to balance openness to help-seeking with careful assessment of what truly constitutes clinical need.
Statements of interest
Lisa Lloyd is a clinical psychologist in CAMHS services. No conflicts of interest to declare.
Edited by
Dr Dafni Katsampa.
Links
Primary Paper
Foulkes, L., Winterburn, I., Sandra, D., Inzlicht, M., Andrews, J. L., & Guzman Holst, C. (2026). The psychological consequences of mental health awareness efforts. Nature Reviews Psychology, 5(3), 173–184.
Other references
Appleton, R. et al. (2020) ‘“I’m just a long history of people rejecting referrals” experiences of young people who fell through the gap between child and adult mental health services’, European Child & Adolescent Psychiatry, 30(3).
Foulkes, L. and 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, 69(1), p. 101010.
Hahn, J.S. et al. (2023) ‘The Every Mind Matters campaign: changes in mental health literacy and its associations with campaign awareness’, European Journal of Public Health, 33(6), p. 145.
Haslam, N. (2016) ‘Concept creep: Psychology’s expanding concepts of harm and pathology’, Psychological Inquiry, 27(1), pp. 1–17.
Henderson, C., Potts, L. and Robinson, E.J. (2020) ‘Mental Illness Stigma after a Decade of Time to Change England: Inequalities as Targets for Further Improvement’, European Journal of Public Health, 30(3), pp. 497–503.
‘Number of children with mental disorders continues to rise, states NHS Digital’ (2019) Nursing Children and Young People, 31(1), pp. 7–7.
