Journal of Rural Community Psychology               Volume E8   Number 2   Fall 2005

 

 

Will Advertising Improve the Organizational Image

of Rural Mental Health Service Providers?

 

Michael Lee Bishop Ph.D.

Ogeechee Behavioral Health Services

 

ABSTRACT

 

In this paper, the position is taken that the organizational image of rural mental health service providers could benefit through the utilization of advertising.  Through an analysis of current research on advertising it was determined that rural mental health service providers could benefit by advertising psychological services that achieve these three results: 1) the reduction of stigma regarding mental illness, 2) the communication of facts to reduce misperceptions about costs, and 3) increasing community awareness about services provided.  It is concluded that if the advertisement utilized achieves these three results and does not violate any ethical guidelines set forth by the American Psychological Association and does not harm or mislead any prospective or current patients, then the goal of improving organizational image can be achieved.

 

 

INTRODUCTION

 

Advertising has been a long-standing subject of ethical debate in mental health (Frisch & Reberg, 1991; Shead & Dobson, 2004).  Psychologists have many self-imposed restrictions on advertising due to the ethical guidelines set forth by the American Psychological Association.  For instance, it would be unethical, according to the American Psychological Association, to go to areas of New Orleans affected by hurricane Katrina and advertise trauma counseling for hurricane victims (American Psychological Association, 2002).  On the other hand, it is ethical, according to the American Psychological Association, to use testimonials in advertising with the written consent of former patients (American Psychological Association, 2002).  Restrained by the many ethical pitfalls and caveats in advertising mental health services, most community mental health service providers do not advertise.

 

 

Review of the Literature on Advertising in Mental Health

 

There have been numerous changes to the standards that guide mental health workers may follow in regard to the ethical advertising of psychological services (Frisch & Reberg, 1991).  In order to develop a clear and accurate picture of why so many mental health service providers are reluctant to advertise, an examination of the history of the guidelines set forth by the American Psychological Association for advertising mental health services is warranted.

           

Until 1972, psychologists were held in ethical violation for using bold print when advertising in the Yellow Pages (Goebel & Beach, 1981).  Additionally, psychologists were expected to limit their advertisement to only their name, highest degree, address, telephone number, and a succinct description of only their area of specialty (American Psychological Association, 1967).  This restraint of ethical advertising changed in 1972 when the Federal Trade Commission complained to several professional associations, including the American Psychological Association, that their ethical codes prohibited truthful advertising on the part of the mental health provider (Frisch & Reberg, 1991).

           

The American Psychological Association has changed the code for ethical behavior in advertising numerous times since the Federal Trade Commission complained.  The last publication of the ethical code occurred in 2002 and included five changes related to advertising (Frisch & Reberg, 1991). The first guideline change enabled psychologists to use testimonials from former patients (Koocher, 1994).  Psychologists may use testimonials from former patients if they are not subject to ďundue influence.Ē  Testimonials from current patients are not allowed (American Psychological Association, 2002). 

 

The second guideline was also rescinded and thus enabled psychologists to list any unique abilities such as hypnosis or play therapy.  Prior to this, statements of ability of uniqueness were not allowed (Koocher, 1994).  The American Psychological Associationís stance prior to this change was that the field of psychology should be advertised as a field of professionals with universal competence (American Psychological Association, 1967).  This prior stance is in direct contrast to the American Psychological Associationís current position which allows the advertising of unique abilities such as hypnosis, bio-feedback or eye movement desensitization reprocessing. 

 

The third guideline rescinded enabled psychologists to use advertising that appealed to a patientís fear and anxiety (Koocher, 1994).  Miller (2000) argues that people deserve better than to be left open to exploitation and that appealing to a patientís fear and anxiety lessens the credibility of psychology as a profession.  Miller cites in his article an advertisement for an addiction hospital that depicts a drug abuserís family at his grave site.  He argues that these scare tactics manipulate patients into seeking treatment and hurts the profession of psychology.     

 

The fourth guideline rescinded enabled psychologists to make statements that compare one psychological service to another (Koocher, 1994).  Prior to the rescinding of this guideline, psychologists were not even allowed to use objective data to support their claims in advertising.  For instance, if a cognitive-behavioral psychologist developed a technique for smoking cessation that was 90% effective compared to a client-centered technique that was only 20% effective, the psychologist could not use this data to advertise services.

 

Finally, the fifth guideline rescinded enabled psychologists to directly solicit individual patients.  This guideline has since been reinstated and it is no longer ethical for psychologists to solicit individual patients (Frisch & Reberg, 1991; Koocher, 1994).  The rescinding and subsequent reinstatement of this guideline is a testament to the confusion of what is considered ethical in advertising by the American Psychological Association and by the mental health field at large.

           

Shead & Dobson (2004) suggest in their paper Psychology for sale: The ethics of advertising professional services that adhering to these strict advertising guidelines from the American Psychological Association impedes the ability of mental health professionals in accomplishing their goals.  On the other side, proponents of these strict guidelines assert that the public image of mental health service providers suffers when advertising practices are not followed (Shead & Dobson, 2004).  Regardless, it is undeniable that the mental health profession does not advertise to the same extent as similar professions.  Any current edition of the Yellow Pages will generally display page after page of attorneys and physicians with up-to-full page advertisements, yet it is rare to find more than a few small advertisements for mental health professionals.  This is due in part to the history of strict regulations on mental health advertising and the uncertainty of what is ethical and acceptable by many mental health service providers. 

 

 

Analysis of How the Image of Rural Mental Health Service Providers

Can Be Improved Through Advertising

           

In this paper, the position is taken that the organizational image of rural mental health service providers could benefit through the utilization of advertising.  Rural mental health service providers could benefit by advertising psychological services that achieve these three results: 1) the reduction of stigma regarding mental illness, 2) the communication of facts to reduce misperceptions about costs, and 3) increasing community awareness about services provided.  If the advertisement utilized achieves these three results and does not violate any ethical guidelines set forth by the American Psychological Association and does not harm or mislead any prospective or current patients, then the goal of improving organizational image can be achieved.

           

The first goal of advertisement should be to reduce the stigma regarding mental illness.  In a study conducted by Wrigley et al. (2005), the role of perceived stigma was examined in relation to predicting help-seeking from a general practitioner for mental health problems in a rural town.  A self-report questionnaire was administered assessing current symptomatology, disability, attitudes toward mental illness, knowledge of prevalence and causes of mental illness, contact with mental illness, help-seeking behavior, and preferences and attitudes toward seeking professional psychological help.  It was found that perceived stigma and causal attributions influence attitudes to seeking out help for mental problems.  In fact, an individualís level of symptomatology was found to be less of a determinate for seeking help with mental problems than stigma.  The perceived helpfulness of the physician was the only variable that predicted willingness to discuss mental health issues (Wrigley et al., 2005).

           

Obviously reducing stigma is an important part of ensuring a patientís willingness to seek mental health services in a rural area.  Advertising can achieve this objective by normalizing the impact of mental illness.  For example, one component of an advertisement for services for rural mental health service providers can stress the high rates for depression in the United States.  

           

The second goal of advertisement should be to communicate facts in order to reduce misperceptions about costs at rural mental health service providers.  The need to communicate facts about costs was examined in a recent article by Audran (2005).  In her article, Audran reports the results of interviews with 20 uninsured, depressed women in Allegheny County, Pennsylvania.  Audran discovered that factors hindering access to mental health services include the stigma of mental illness and the lack of knowledge among uninsured people that treatment is available for them (Audran, 2005).  This discovery is also supported by my own personal observation that many low income and non-insured patients reluctantly enter treatment, thinking that they will be incurring a significant debt for themselves.  Many patients are surprised to find out that state-run mental health service providers in Georgia cannot deny services due to an inability to pay.  

           

The third goal of the advertisement will be to foster awareness about the services provided by rural mental health service providers.  The need for increasing awareness of services provided was discovered through my own personal interactions with patients in rural Georgia.  Many patients are surprised to find out that they can receive services such as psychiatric rehabilitation, adolescent inpatient drug treatment, community support counseling, parenting skills training, and supportive living assistance.  I believe that if the community became aware of these services through the utilization of advertising, the result would be improved organizational image and a larger patient population.

 

 

CONCLUSION

           

As the subject of advertising has been a long-standing topic of ethical debate in mental health, many mental health service providers do not advertise (Frisch & Reberg, 1991).  Supporters of the strict guidelines for mental health advertising set forth by the American Psychological Association assert that the public image of mental health service providers suffers when prescribed advertising practices are not followed (Shead & Dobson, 2004). Shead & Dobson (2004) suggest that adhering to these strict advertising guidelines promulgated by the American Psychological Association conflicts with the ability of mental health service providers to accomplish their goals.  The ethical debate over advertising mental health services has undoubtedly resulted in hesitancy on the part of mental health service providers to utilize advertising to the extent used by professionals in related fields such as physicians and attorneys.

           

If advertising was utilized, the organizational image of rural mental health service providers could be improved.  The position of this paper is that effective advertising to improve the organizational image of rural mental health service providers should include statements which result in the reduction of stigma regarding mental illness, the communication of facts to reduce misperceptions about cosst, and the increase of community awareness about services provided.  This position is supported by research into the factors behind the reluctance of potential patients to enter treatment.  Wrigley et al. (2005) studied the role of perceived stigma in a rural town and found that perceived stigma influences attitudes on seeking out help for mental problems.  Audran (2005) interviewed 20 uninsured, depressed women in Allegheny County, Pennsylvania and discovered that factors hindering access to mental health services include the stigma of mental illness and the lack of knowledge among uninsured people that treatment is available for them.  The need for and increase in community awareness about services provided is my own personal observation that resulted from over two years of providing referrals to services in rural Georgia.

 

 

REFERENCES

 

American Psychological Association (1967). Casebook on ethical standards of psychologists. Washington, DC: Author.

 

American Psychological Association (2002). Ethical principles of psychologists and code of conduct. Washington, DC: Author.

 

Audran, B. J. (2005). Access to mental health care for uninsured women (Doctoral dissertation, University of Pittsburgh, 2005). Dissertation Abstracts International, 65(7-B), 3378.

 

Frisch, G. R. & Reberg, D. (1991). Effects of advertising on psychology. Canadian Psychology, 32, 176-180.

 

Goebel, J. B. & Beach, D. A. (1981). Telephone directory advertising: Who is a psychologist? Professional Psychology, 12, 535-536.

 

Koocher, G.P. (1994). APA and the FTC: New adventures in consumer protection. American Psychologist, 49, 322-328.

 

Miller, W. R. (2000). Professional ethics and marketing of treatment. Addiction, 95, 1764-1765.

 

Shead, N. W. & Dobson, K. S. (2004). Psychology for sale: The ethics of advertising professional services. Canadian Psychology, 45, 125-136.

 

Wrigley, S., Jackson, H., Judd, F., & Komiti, A. (2005). Role of stigma and attitudes toward help-seeking from a general practitioner for mental health problems in a rural town. Australian and New Zealand Journal of Psychiatry, 39(6), 514-521.