Mental health is treated as a difficult subject, and that difficulty keeps people from asking for help. Advocacy is one of the things that shifts it. This post looks at what advocacy is, what the research says it changes, and, just as importantly, what the research does not support. We have tried to be honest about both, because a case for advocacy built on overstated evidence is not much of a case.
The scale of it
The World Health Organization estimates that nearly 1 in 7 people worldwide, around 1.1 billion, were living with a mental disorder in 2021. Anxiety and depressive disorders are the most common. You may have seen an older WHO figure of 1 in 8; that came from earlier data and has since been revised. The change reflects updated estimation methods as much as any real increase, so it is a better number rather than evidence of a worsening world.
Mental illness starts young. The largest analysis of onset data, pooling 192 studies and more than 700,000 people, found that about a third of mental disorders begin by age 14 and nearly half by age 18. The single most common age of onset is 14.5. You will often see this quoted as “half of all mental health conditions begin by 14.” That version overstates the threshold, though it gets the underlying point right: adolescence is when most of this starts, which is why early support matters so much.
Closer to home, the picture among Ontario students is sobering. In the Centre for Addiction and Mental Health’s 2023 student survey, covering 10,145 students in grades 7 to 12, just over half met the threshold for moderate to serious psychological distress on a screening scale, roughly double the proportion a decade earlier. About a third of students said they felt they needed professional support in the past year and did not seek it.
That last figure is the one this post is really about. It is worth being precise about what these numbers are: they come from an anonymous questionnaire and measure symptoms and distress, not diagnoses. Nationally, Statistics Canada uses structured diagnostic interviews instead, and found that 18.3% of Canadians aged 15 and over met criteria for a mood, anxiety, or substance use disorder in a year, with the sharpest ten-year increases among young women aged 15 to 24.
What stigma does
Stigma is the set of negative assumptions attached to mental illness: that it is a weakness, a character flaw, something to manage quietly. It shows up as being labelled, avoided, or not taken seriously, and it makes people keep quiet about what they are going through.
It does keep people from getting help, though it is worth being accurate about how much. The most thorough review, covering 144 studies and more than 90,000 people, found a small to moderate association between stigma and reduced help-seeking. Internalised stigma, the beliefs a person turns on themselves, mattered more than what strangers think. Young people, men, and people from ethnic minority communities were among the most affected.
Notably, stigma ranked fourth among the barriers people reported, behind more practical obstacles like not knowing where to go, cost, and waiting. We mention this because “stigma is the main reason people don’t get help” is a common line, and it is not what the evidence says. Reducing stigma matters, and it will not on its own fix a system people cannot get into.
What advocacy changes
Anti-stigma programs do work, in a specific and limited sense. A 2025 meta-analysis of 97 randomised trials involving nearly 44,000 young people found meaningful improvements in mental health knowledge, and smaller improvements in attitudes and in reported behaviour.
The harder question is whether it lasts. Gains tend to fade. A review looking only at follow-ups of a month or longer found that programs built around meeting someone with lived experience, the approach that performs best in the short term, were no better than other approaches at that distance. The practical lesson is that a single assembly or awareness day is unlikely to change much on its own. Sustained contact does more than one-off exposure.
There is also a gap worth naming between changing attitudes and changing behaviour. Most studies measure what people say on a questionnaire shortly afterwards. Far fewer measure whether anyone was actually treated differently. When we say advocacy improves attitudes, we mean it. When you see a claim that it reduces discrimination, that is usually running ahead of the evidence.
Media portrayals are the clearest case of measurable effect. In a US experiment, people who read a news story about a mass shooting committed by someone with a mental illness afterwards reported more negative attitudes and less willingness to work alongside or live near someone with a serious mental illness, compared with people who read nothing. A Cochrane review of 22 randomised trials found the reverse holds too: media interventions can reduce prejudice. Whether they change discriminatory behaviour remains insufficiently studied.
Public figures speaking openly can shift things as well, though the evidence is thinner than the confidence with which it is usually asserted. The strongest study followed South Korea’s entire population after three celebrities disclosed panic disorder, and found diagnoses rose sharply and stayed elevated for a decade, while a comparison condition showed no change. What that study measured was diagnoses, not stigma, and researchers who study this caution that the effect depends on who is speaking, what they say, and who is listening. It is not automatic.
One boundary matters here and we want to be explicit about it. Someone speaking about their ongoing struggles is not the same as media coverage of a death by suicide. A meta-analysis of 31 studies found suicide rates rose by around 13% after celebrity suicides were reported, and by about 30% for the specific method when it was named. Advocacy that encourages open conversation should never blur into coverage that describes means.
Where the evidence is weaker than we would like
Two things we do, and believe in, have less support than we would prefer to report.
Peer-led programs in schools are widely used, and the evidence base is genuinely thin. The most careful review found only 11 studies rigorous enough to assess. Results were mixed. Benefits were better documented for the students trained and given the role of peer leader than for the young people receiving support from them. A minority of studies found unintended effects, including one where recipients reported more learning stress and lower overall mental health scores, and one where peer leaders reported increased guilt.
That does not mean peer support is a bad idea. It means anyone running one, ourselves included, should measure their own outcomes rather than assume the model works.
Support groups show a similar pattern. Across 49 randomised trials involving more than 12,000 people, peer support produced small improvements in what researchers call personal recovery, meaning a person’s sense of hope, agency, and connection, along with modest reductions in anxiety. Evidence that support groups reduce clinical symptoms is considerably weaker, and reviewers repeatedly note that trial quality needs to improve. Small, real, and worth having is a fair summary. A treatment substitute it is not.
What you can do
You do not need to be a professional to make a difference.
- Learn enough to be useful. Understanding what conditions actually are makes it easier to respond well when someone tells you something hard.
- Share your experience if you want to, and only then. Disclosure helps others, and it costs the person disclosing. Nobody owes anyone their story.
- Support organisations doing the work. Volunteering and donating both keep services running.
- Make the spaces you are in easier to speak up in. Most of this happens in ordinary conversations, not campaigns.
- Challenge the casual stuff. The offhand joke, the throwaway “crazy”. Not aggressively, just not letting it pass.
The path ahead
Advocacy is not a cure, and this post has tried not to sell it as one. What it does is measurable and modest: it improves what people know, shifts attitudes somewhat, and makes it a little more likely that someone struggling will say so out loud.
Given that a third of Ontario students who felt they needed help last year did not ask for it, a little more likely is worth a great deal. The barriers that come after that first conversation, the waiting lists and the costs and the services that were never designed with you in mind, are a separate fight. Both need fighting.
If you are struggling right now, you do not have to wait for any of this to change. Call or text 9-8-8, free and open 24 hours a day across Canada.