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This post explores how public narratives and mental models influence mental health stigma, access to care, and long-term public health outcomes. It explains why improving mental health requires more than expanding services alone and highlights the importance of addressing social conditions, system design, and public understanding. The post also offers practical considerations for evaluators, funders, and coalition leaders working to improve mental health systems and outcomes.

This blog is written in honor of May being Mental Health Awareness Month. There are many resources available promoting mental health resources. Here are a few you can check out: National Alliance on Mental Illness, Mental Health America, and SAMHSA.

More than 20% of U.S. adults report not receiving the mental health treatment they need (2024 National Survey on Drug Use and Health).

Stigma is one of the most significant barriers to mental health treatment and wellness. It influences whether people feel safe acknowledging symptoms, talking openly about emotional distress, seeking care, remaining connected to treatment, or asking others for support. It also influences whether communities invest in long-term mental health infrastructure and whether systems are designed in ways that feel accessible, trustworthy, and humane for people living with mental health conditions.

Part of the challenge is that public understanding of mental health is shaped by the narratives and assumptions reinforced through media, institutions, policy discussions, and everyday conversation.

Mental models are the assumptions and beliefs people hold about how something works, and over time they often become dominant public narratives. These narratives shape social norms, public attitudes, policy priorities, and systems of care. As a result, the way society understands mental health influences what gets funded, measured, prioritized, and viewed as politically and socially acceptable.

When mental health conditions are repeatedly framed through narratives of instability, deficiency, unpredictability, or danger, those narratives contribute to the stigma associated with mental illness. And stigma has real consequences, it contributes to people going without treatment and support.

This creates a harmful cycle. The more stigma grows, the more likely people are to remain silent, delay seeking help, disengage from services, or internalize shame about their condition. Without the treatment and support they need, conditions can worsen, while society may further stigmatize visible symptoms and behaviors. That stigma, in turn, becomes another barrier to engaging in care and support services.

Meanwhile, there is not enough attention paid to addressing the underlying factors that contribute to declines in mental health — such as trauma, chronic stress, isolation, poverty, discrimination, housing instability, violence, and lack of access to care. These factors often remain insufficiently addressed.

Changing mental models can help interrupt this cycle.

People are more likely to seek help early when they believe they can do so without punishment, exclusion, judgment, or fear of being permanently labeled. When mental health is understood as a health condition deserving compassion, support, treatment, and sustained public investment, people may feel safer disclosing symptoms and seeking help sooner. Families may feel more comfortable talking openly about their experiences. Communities may become more willing to invest in accessible services and support. Systems may become more responsive to the realities people face when trying to sustain care.

Changing mental models shifts the focus away from blaming individuals and toward improving the conditions that influence mental health in the first place. This means focusing on structural changes that strengthen the social, economic, relational, and community conditions that help people maintain mental wellness over time, which require investments and policy changes aimed at supporting strategies to improve and transform mental health care.

If we want to improve mental health outcomes, we must continue changing the narratives that shape how society understands mental health and the people living with mental health conditions.

What can those who implement and evaluate mental health initiatives do to promote mental models that support better public health?

Public narratives matter. One important step is to support public messaging and campaigns that help change the narrative around mental health. Too often, public messaging focuses primarily on encouraging individuals to change their behavior without addressing the systems and conditions surrounding them. More effective approaches recognize that mental health is shaped not only by biology, but also by social, economic, environmental, and relational conditions, as well as access to care and support.

When violent incidents involving someone experiencing unmet mental health needs receive public attention, public conversations can quickly reinforce fear-based assumptions about mental illness. These moments create an opportunity for reporting and public messaging to acknowledge the importance of access to mental health services and support without reinforcing harmful stereotypes. The reality is that very few people living with mental illness are violent.

Systems themselves also communicate values about how mental illness is perceived. Long waitlists, fragmented care, inaccessible services, and short-term funding structures can unintentionally communicate that mental health support is optional, temporary, or available only once someone reaches crisis. Systems designed around continuity, dignity, accessibility, and sustained care communicate something different: that mental health is an essential part of public health worthy of long-term investment and support.

When considering strategies to improve mental health, it’s important to focus on the underlying conditions that contribute to declines in mental health rather than placing responsibility solely on individuals. Strategies should address the structural factors that exacerbate trauma, social isolation, discrimination, financial stress, housing instability, community violence, lack of access to health care, and fragmented systems of support. Improving mental health requires healthier conditions in which people can live, work, connect, heal, and thrive.

So, what can you do? Those implementing and evaluating mental health initiatives can start by broadening how success is measured. Shift the evaluation away from a narrow focus on whether individuals changed their behavior, experienced reduced symptoms, or remained in treatment. While those outcomes matter, they don’t fully capture whether systems themselves are becoming more accessible, coordinated, trustworthy, and responsive.

Instead, ask questions that help better understand how narratives and system conditions shape mental health outcomes and behaviors:

• Are people able to access services earlier?
• Are systems becoming easier to navigate?
• Are services affordable and continuous over time?
• Do people feel safer seeking help?
• Are communities becoming more open and supportive when discussing mental health?
• Are systems addressing the root causes that contribute to emotional distress and instability?

Improving mental health requires changing the mental models that shape stigma, influence systems, and determine whether people feel comfortable asking for help in the first place. Shifting these mental models can help build systems and communities where people feel safer seeking support and where mental health is treated as an essential part of public health.

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