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Brian van den Hurk, James Mok, Simon Sievert, Murray Watt, Nick Pengelly, Esther Watkins, Kate Heatley, Matt Scott, Candace Bagnall
Barbara Phillips, Derek Thompson, Hon Dr Jonathan Coleman
Since its inception in 2006 the National Depression Initiative’s advertising campaign has had a marked impact on the attitudes of New Zealanders towards the illness. Whilst this has translated to a steady increase in access to services such as GPs and the depression helpline, with one in seven New Zealanders experiencing depression at some point in their lives, there is still a lot of work to be done.
In 2010, the Ministry of Health (MOH) and DraftFCB sought to find a new way to get significantly more people to recognise the illness and take action about recovery. The answer was to use media to take the treatment to the people by creating an end-to-end pathway for people to find a way through depression that combined DRTV driving web traffic, traditional information site for high-level information, a relationship marketing-style programme for greater engagement using web, txt and email, technical and operational integration to the depression helpline for personal support, and referral pathways to GPs for escalation.
The results have been astonishing. In the first four months of the campaign going live, more than 150,000 Kiwis responded to the call and visited the site to assess their level of risk. 8,300 of them took the next step, signing up for The Journal to begin to learn the skills to guide their own recovery. Some found their journey too challenging to tackle alone and reached out, with 551 messages, to the personalised services for help. In addition, many GPs have reported patients discussing the programme during consultations.
To give some sense of the magnitude of this response, it should be remembered that approximately 2,000 people would normally visit their doctor for depression in the same period.
The strategy has tapped a latent market for options built on self-empowerment and respect. By integrating all activity into a singular process the ongoing popularity of the TV campaign has been converted into real action.
Depression is a leading preventable cause of death and disease, but despite this there is a reluctance to seek professional help. Clearly awareness is not a strong enough driver to get people to take action, so the promotion of self-help as a treatment option has been the key to success.
By creating an entirely new class of mental health service and applying best-of-breed relationship marketing techniques to the process, not only did DraftFCB and MOH create an end-to-end pathway for people to find a way through depression, but the whole process was completely measureable. Instead of waiting for years to get results through the public health system, online analytics allowed agency and client to follow the progress in real time. This is believed to be the first time in the world an advertising campaign had been combined with online self-help therapy and a helpline counselling team to create a single, integrated social marketing programme.
Everything about this project turned the current paradigm of mental health on its head, challenging established practices and addressing risk management issues.
What is surprising is that the project came to fruition during a major recession and a change to a social-marketing averse National government. But with New Zealand having one of the highest suicide rates in the world and the cost to society in any given year being in excess of $200 million, government support was a given.
Increased engagement is important but the true measure of success is an improvement in the condition of the engaged individuals. To measure the efficacy of the approach, DraftFCB and MOH used the medical industry standard test - the PHQ9 - to assess people’s condition. The early results have proved promising with 69.42% of people completing The Journal improving their score (by more than 25%). The Ministry of Health is continuing to conduct a full trial on The Journal.
Depression impedes people’s capacity to learn so the campaign needed to accommodate the clinical effect depression has on its sufferers. This includes a severe lack of motivation, difficulty concentrating, impaired decision-making and reasoning processes, social isolation (both self imposed and stigmatic) and extreme mood changes, including suicidal thoughts.
The focus to-date had been to get people with mild or moderate depression to visit their doctor for treatment – usually taking medication or visiting a psychiatrist. An emerging alternative was online therapy (or eTherapy), which adapts traditional treatments for delivery over the internet. The problem with these programmes is that they tend to suffer from poor user experience. DraftFCB and MOH went beyond the medical approach and used techniques of relationship marketing. This meant centring the eTherapy programme on the needs of the user, and using interactivity and digital channels to engage with them.
By reaching out to deliver help to people in their own place and time they could be kept engaged in the process. By integrating the eTherapy programme into their everyday lives, they could be helped to make the changes in small, practical steps. To protect their safety, the existing helpline service supports users of the eTherapy programme and refers them on to healthcare services as required.
The programme has been marketed to GPs as a complement to their existing treatments.
The creative strategy was to maintain the relationship built since 2006 with spokesperson John Kirwin (JK) throughout the process.
The Journal addressed six key aspects of improving diet, getting regular exercise, improving sleep quality, reducing stress, practicing positive thinking, and learning how to overcome problems. This was done through six lessons to break the programme down into smaller steps, a rich, interactive experience to hold user’s attention, over 50 minutes of video footage featuring mental health experts explaining the theory behind each lesson, practical (offline) tasks to cement behaviour, a planning tool to set their own pace, and built-in access to the live support team.
The programme also added the ability to measure the efficacy of the ‘treatment’ as it was administered. Because people would visit The Journal regularly, web analytics software was able to be used to track their progress by assessing their condition at the beginning, midpoint and end of the programme.
The very nature of eTherapy (online and offline exercises to complete) with The Journal meant that reminders needed to be built in non-intrusively to keep participants coming back.
This was achieved via text and email messages that were activated depending on the stage the participant was at, and the period of inactivity in relation to the website visitation.
Getting people into (and through) The Journal requires precise media integration. Each channel was designed to achieve a specific task along the user experience – creating a simple, seamless journey to recovery.
Television has always been the lynchpin channel in the campaign for building mass awareness quickly and cost-effectively. The ads used DRTV tactics with a strong drive to web. Up-weighted daytime spots caught people at home alone, when they were most likely to take action. Search and banner activity continued visibility between TV flights, while PR activity ahead of the launch increased JK’s visibility and profiled The Journal.
The existing website continued to deliver information in the traditional way, but it also acquired and directed visitors to The Journal.
The Journal maintained engagement with participants through personalised txt reminders on the day of their tasks and emails prompted their next lesson visit.
Multiple channels were used to seamlessly connect users to the personalised support service and integrated The Journal with their CRM system to improve contact management through txt, email, phone, built-in chat with instant messenger.
To educate and ‘recruit’ GPs, a short DM campaign was run, letting them know about the programme and how to use it with their patients.
The media campaign did an outstanding job, exceeding the target of a 300% increase in visits to www.depression.org.nz. 8,231 people signed up for The Journal in the launch period – four times the number that visited their GP in the same period.
It was expected some users’ condition would worsen as a result of acknowledging the issues they needed to address. These users are identified and receive a range of messages from JK to escalate them to the Helpline or their doctor.
Comparing scores from the start and end of the programme showed an average change of 9.3 points (out of 24), greatly exceeding the target of 5 points set for traditional treatments.
To put this in human terms, these scores indicate the average user went from moderately severe depression (the upper end of the target audience) to almost none.
It may appear somewhat callous to measure ROI on a programme such as this in monetary terms. However the reality of depression is not only its phenomenal social cost, but the economic cost to society for every suicide is $448,250.
Lifeline, who provide the one-on-one support to those engaged in the programme, can report that they were able to positively intervene in at least four cases during the launch period where emergency services were called. Therefore the direct saving to society to-date in the most conservative of terms is $1,793,000 – making it more than ‘break even’, which for a social marketing campaign is hugely gratifying. And this doesn’t even begin to take account of the non-economic benefits to society at large.