Impact of a Media Campaign for Disaster Mental Health Counseling in Post-September 11 New York

The attacks on the World Trade Center on September 11, 2001, resulted in loss of life, disruption of daily routine, and increases in the prevalence of mental disorders ( 1 ). After the attacks, the New York State Office of Mental Health (NYOMH) and the New York City Department of Health and Mental Hygiene (DOHMH) alerted the public to the availability of counseling and referral services through LifeNet, a preexisting toll-free, 24-hour mental health hotline that offered multilingual services. These media announcements began within 24 hours of the attacks ( 2 ). This initial response was followed by the establishment of Project Liberty, a federally funded program that provided free, anonymous crisis counseling and public education services to people affected by the attacks.

Project Liberty was designed to deliver effective, community-based crisis counseling services in the five boroughs of New York City and in ten surrounding counties. Funded by two grants totaling slightly over $155 million by the Federal Emergency Management Agency (FEMA), Project Liberty was administered by NYOMH. In conjunction with local mental health departments, NYOMH mobilized a network of providers to deliver crisis counseling services to the affected populations on an ongoing basis and to initiate a campaign to raise awareness of the availability of free counseling, public education, and referral services.

Because mental illnesses are stigmatized in American society and because people generally do not anticipate needing mental health care in the event of a disaster, people are frequently uninformed about available mental health services. Given the stigma associated with mental illness, and by extension mental health services, people may refuse to seek help. Thus NYOMH viewed conducting a media outreach campaign as a critical element for informing disaster victims of the availability of crisis counseling services provided through Project Liberty and encouraging their use. Also, NYOMH considered "branding" such services as appropriate and potentially helpful for all people affected by the disaster, regardless of their pre-September 11 mental health status. The advertising focused on informing people about the availability of services and how LifeNet could help direct them to services that were convenient and culturally and linguistically appropriate given their disaster-related clinical and personal circumstances. With the goal of reaching the greatest number of people, NYOMH devised a multimedia public outreach strategy to prompt people to learn more about how Project Liberty could meet their disaster-related mental health needs.

NYOMH and DOHMH coordinated city-level and state-level media campaigns. The city campaign focused on reaching people through the dissemination of messages in the subway system, on buses, and in print, and the state campaign supplemented the city campaign by focusing on radio and television advertising, including celebrity endorsements ( 3, 4 ). For the latter strategy, NYOMH partnered with the Sloan Group, a New York City media firm, to develop and produce the radio and television advertisements. The Sloan Group was responsible for getting the advertisements on the air. Initially, NYOMH relied on public service announcements (the traditional vehicle used in past FEMA-funded crisis counseling programs), but statistics on airplay showed that television and radio stations were airing the ads only outside of peak viewing or listening hours (such as at 3 a.m.). Thus NYOMH decided to begin purchasing prime-time advertising slots from the major New York City broadcast media.

Underlying this strategy was the understanding that an effective media campaign requires broad dissemination of a large number of well-placed, influential media messages ( 5 ). However, this was an expensive proposition in the lucrative New York City media market. Therefore, to assess the impact of this strategy, NYOMH partnered with the New York Academy of Medicine to include questions about Project Liberty in their ongoing epidemiological surveys of the mental health impact of September 11 on New Yorkers. NYOMH's media spending decisions were subsequently guided by three data sources: Sloan Group data on airtime and the number of estimated viewers for the television spots and listeners for the radio spots, New York Academy of Medicine data on how many people reported they had heard about Project Liberty and through what media method they had gained that knowledge, and LifeNet data on changes in call volume over time. This last data source is the focus of the analyses reported in this article.

The DOHMH and NYOMH media campaigns were activated in three somewhat overlapping phases: three months after the attacks on the World Trade Center, the summer of 2002, and around the one-year anniversary of the attacks. NYOMH launched television and radio campaigns promoting awareness of Project Liberty through LifeNet telephone referral services. LifeNet is a community service of the Mental Health Association of New York City, Inc., and offers telephone help and referral to social service and psychology professionals in the greater New York metropolitan area 24 hours a day, seven days a week. After the World Trade Center disaster, LifeNet became the first line of contact for Project Liberty, which was specified in most of the advertising spots. LifeNet primarily assisted in setting up initial referrals, although additional referrals were occasionally given to repeat callers.

The first phase of the city media campaign (mid-November 2001 through April 2002) involved outdoor, print, and radio advertising and distribution of materials ( 3 ). In November 2001, DOHMH launched in English and Spanish the "New York Needs Us Strong" campaign on subways, telephone kiosks, and bus shelters. At the six-month anniversary, 1.4 million "New York Needs Us Strong" booklets in English, Spanish, and Chinese were distributed in major newspapers and delivered to many community organizations. These booklets provided important content regarding reactions to disaster and strategies for coping. In addition, a four-month radio campaign in English, Spanish, and Chinese was conducted on seven leading New York City radio stations having a combined audience of over five million listeners ( 6 ). Radio advertising was augmented by coping information provided for three months on the New York Times Web site, which was estimated to reach more than two million viewers. Throughout this phase, postcards, coffee cups, and wall posters featuring the Project Liberty logo, the LifeNet hotline number, and the campaign slogan were distributed in restaurants, bars, bookstores, and other social venues.

The second phase of the media campaign took place between May and August of 2002. A joint sponsorship with the New York Yankees and New York Mets baseball teams was designed to reach men, including rescue workers and those in the uniformed services. This campaign included messages promoting LifeNet, radio and television announcements, print program advertisements, outdoor signs in ballparks, and specialty promotional items. The program was estimated to have made more than 12 million impressions (the number of viewers seeing the promotions). In addition, television spots targeting different audiences were developed and aired. These included ads that focused on parents with young children and the signs and symptoms of traumatic stress in young children, older adults, and teenagers and young adults. During this phase, newspaper and outdoor media advertisements for Project Liberty services increased. Billboards with the slogan "New York Is Getting Stronger Every Day" were mounted throughout the city, providing 36.3 million impressions in a 90-day period ( 6 ).

The third phase used outdoor and material media, online Web advertising, and publication distribution targeting those who may have experienced delayed reactions to the disaster ( 6 ). Beginning in August 2002, NYOMH launched the "Honor the Past, Embrace the Future" campaign, which prepared for the upcoming anniversary of September 11. The outdoor campaign consisted of advertisements in subways, telephone kiosks, and bus shelters. The print campaign included distributing the Coping After September 11 brochure to target groups and posting Project Liberty advertisements in various newspapers.

In this report, we examine calls to LifeNet as an indication of the impact of Project Liberty's multimedia outreach efforts in notifying the public about ways to access counseling services. Associating the spending on media outreach with one key response to the outreach is a step in assessing the effectiveness of spending. Specifically, this article focuses on the nature, timing, and association between media activities (and media spending) and changes in the volume of calls to LifeNet.