R U OK? Day: Impact on Mental Health Questioned

Every September, Australians are encouraged to ask someone a simple question: "Are you OK?"

R U OK? Day is Australia's most recognisable mental health campaign, and a familiar part of workplace morning teas, school assemblies and social media feeds.

But does it actually improve mental health? Our new study suggests it does. We found a small but measurable improvement in mental wellbeing after R U OK? Day. The gain was largest among men aged 25-49.

But we found no increase in visits to a GP for a mental health treatment plan, or in prescriptions filled for mental health-related medicines.

Together, these findings show both the value and the limits of public awareness campaigns.

What we studied and how

R U OK? Day is held annually on the second Thursday of September. The campaign asks Australians to follow four steps:

• ask someone whether they're OK
• listen with an open mind
• encourage them to take action if needed
• check in with them over the next couple of weeks.

We used nine years of data drawn from across the Australian population, from 2011 to 2019, to test whether the campaign changed two main outcomes.

First, we used responses from the long-running Household, Income and Labour Dynamics in Australia survey, which happens to conduct annual interviews in the months around R U OK? Day. Participants answered nine questions about how they had felt during the previous four weeks. These included how often they had felt happy, nervous, full of life, or so down that nothing could cheer them up. We combined their answers into an overall measure of mental wellbeing.

Second, we used national health records from Medicare to count the daily number of mental health treatment plans GPs prepared and prescriptions filled for psychiatric medicines.

The statistical analysis compared the change in these outcomes in the four weeks before and after R U OK? Day in more recent years, when the campaign was highly visible, with the same change in earlier years, when its reach was much smaller. We also accounted for weather, seasonal patterns, economic conditions and other factors.

This comparison captures the campaign's short-term population-level effect. That includes the combined effect of direct conversations, workplace events, media coverage, and the wider attention given to mental health around R U OK? Day.

A small lift in how people feel

The encouraging finding is that R U OK? Day does appear to improve mental wellbeing.

Across the population, the campaign produced a measurable increase in self-assessed mental wellbeing, equivalent to moving the average person from the 50th to the 53rd percentile of wellbeing.

This is not a dramatic change - it means people felt slightly more full of life, calm, energetic or happy, and slightly less down in the dumps.

But this is an average across the whole population, including many people who had no direct contact with the campaign. The improvement among people who took part in an R U OK? conversation was probably much larger, although our data cannot isolate that effect.

The effect was strongest for men aged 25 to 49 - the increase in their mental wellbeing was twice as large. This is important because middle-aged men are among the least likely to seek help for mental health problems, and they are disproportionately represented in Australia's suicide statistics.

The most plausible mechanism is social connection. Being asked "are you OK?" by a colleague or friend, or getting together with others to talk openly about mental health, may reduce feelings of isolation. It may also signal that it is socially acceptable to acknowledge when you are struggling.

We see this reflected in our results. R U OK? Day increased people's sense that they had someone to turn to for support, with the strongest improvement again among men aged 25 to 49.

No increase in mental health care

R U OK? Day also encourages people who are struggling to seek professional support. On this outcome, however, we found no detectable effect.

National records showed no increase in visits to a GP for a mental health treatment plan.

Nor was there an increase in prescriptions filled for mental health-related medicines.

The result was the same when we extended the follow-up period from four weeks to two and three months.

This doesn't mean nobody sought help because of R U OK? Day. But any individual responses were not large enough to produce a measurable increase across the population. It is also possible that individuals sought help from other services, such as helplines, which we cannot measure.

Encouraging someone to seek help is only one part of the process. A person may still worry about stigma or be unsure where to go. Even when someone decides to seek professional help, the health-care system itself can create barriers, including long waits for appointments and high out-of-pocket costs.

Policy implications

R U OK? Day appears to be achieving something valuable.

Our findings suggest peer-support campaigns can produce real psychological benefits. Encouraging people to check in with one another, listen and offer support can make a meaningful difference, especially for population groups unlikely to seek out help.

Public campaigns also point people towards support. But whether people can act on that encouragement depends on the health system: care needs to be accessible, timely and affordable. Achieving this may require changes that reduce waiting times, lower out-of-pocket costs and make care easier to navigate.

R U OK? Day shows that asking a simple question can help people feel more supported. But when the answer is "no", the next step also needs to be within reach.

If this article has raised issues for you, or if you're concerned about someone you know, call Lifeline on 13 11 14.

Nicole Black receives funding from the Australian Research Council.

David Johnston receives funding from the Australian Research Council.

Johannes Kunz received funding from NHMRC.

Lachlan Deer does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.