Join The Campaign to Change Direction

to Change the Culture of Mental Health

The Campaign Goal

The goal of the Campaign to Change Direction is to change the culture of mental health so that all of those in need receive the care and support they deserve. The Campaign encourages everyone to pay attention to their emotional wellbeing – and it reminds us that our emotional wellbeing is just as important as our physical wellbeing.  We provide a tool, the Five Signs of Emotional Suffering and the Healthy Habits of Emotional Wellbeing, so that we all have a common language to identify when someone is suffering and how we can stay emotionally healthy.


In order to change our culture, we have to start with a common language and learn the Five Signs of Emotional Suffering.

Actress Stephanie Szostak joins Give an Hour to launch a mental health project, The 180 Playbook, to help turn negative thoughts into positive, hopeful ones. Join us!

What are the Five Signs of Emotional Suffering and the Healthy Habits of Emotional Wellbeing?

Learn the Five Signs that may mean someone is in emotional pain and might need help:

Personality Change

Their personality changes.  You may notice sudden or gradual changes in the way that someone typically behaves. He or she may behave in ways that don’t seem to fit the person’s values, or the person may just seem different.


They seem uncharacteristically angry, anxious, agitated, or moody. You may notice the person has more frequent problems controlling his or her temper and seems irritable or unable to calm down. People in more extreme situations of this kind may be unable to sleep or may explode in anger at a minor problem.


They withdraw or isolate themselves from other people. Someone who used to be socially engaged may pull away from family and friends and stop taking part in activities he or she use to enjoy. In more severe cases the person may start failing to make it to work or school. Not to be confused with the behavior of someone who is more introverted, this sign is marked by a change in someone’s typical sociability, as when someone pulls away from the social support he or she typically has.

Poor Self-Care

They stop taking care of themselves and may engage in risky behavior. You may notice a change in the person’s level of personal care or an act of poor judgment on his or her part. For instance, someone may let his or her personal hygiene deteriorate, or the person may start abusing alcohol or illicit substances or engaging in other self-destructive behavior that may alienate loved ones.


They seem overcome with hopelessness and overwhelmed by their circumstances. Have you noticed someone who used to optimistic and now can’t find anything to be hopeful about? That person may be suffering from extreme or prolonged grief or feelings of worthlessness or guilt. People in this situation may say that the world would be better off without them, suggesting suicidal thinking.

Learn the Healthy Habits of Emotional Wellbeing

Take Care

Take care of you.  Eat, sleep and be active. We don’t often think about how important these basic activities are to our mental health – but they are critical!

Check In

Get checkups.  We get check-ups for our physical health and for our teeth. We even take our cars in for check-ups. It’s time to take responsibility and get check-ups for our emotional well-being. Talk with your doctor, a counselor, a faith-based leader… and your family and friends to make sure you are doing well emotionally.


Engage and connect wisely.  Pay attention to your relationships. We can’t be healthy if our relationships are not.


Be active, meditate, garden, dance, love, cook, sing…

Know the Five Signs

Learn the Five Signs of emotional suffering.  And if you see them in someone you love, reach out, connect and offer to be of help.

Change Direction Initiatives

320 Changes Direction

Music Changes Direction

Books Change Direction

Film Changes Direction

Corporations Change Direction

What can I do to


Share the awareness video

Share the PSA with your friends, family, & networks!


Make a pledge to know the Five Signs & learn the Healthy Habits.


Donate to help us Change Direction!

Join us on social media

Share our posts with your community!

Five Signs Selfie

Show you know the Five Signs! #changedirection

Download Tools

Check out our tools and help change the conversation about mental health.

If You Recognize That Someone In Your Life Is Suffering,
Now What?

You connect, you reach out, you inspire hope, and you offer help. Show compassion and caring and a willingness to find a solution when the person may not have the will or drive to help him- or herself. There are many resources in our communities. It may take more than one offer, and you may need to reach out to others who share your concern about the person who is suffering.  If everyone is more open and honest about mental health, we can prevent pain and suffering, and those in need will get the help they deserve.

Need help?

Reach out to the resources in your communities. Get the help you deserve.

Americans with a mental health condition
billion was spent on mental health care in the United States in one year
of those who are homeless have a mental illness
of people who die by suicide have a mental disorder.

We are at a crossroads when it comes to how our society addresses mental health. We know that one in five of our citizens has a diagnosable mental health condition, and that more Americans are expected to die this year by suicide than in car accidents. While many of us are comfortable acknowledging publicly our physical suffering, for which we almost always seek help, many more of us privately experience mental suffering, for which we almost never reach out.


The Change Direction initiative is a collection of concerned citizens, nonprofit leaders, and leaders from the private sector who have come together to change the culture about mental health, mental illness, and wellness. This initiative was inspired by the discussion at the White House National Conference on Mental Health in 2013, which came on the heels of the Newtown, Conn. tragedy.

By bringing together this unprecedented and diverse group of leaders we plan to spark a movement that:

  • frees us to see our mental health as having equal value to our physical health
  • creates a common language that allows us to recognize the signs of emotional suffering in ourselves and others
  • encourages us to care for our mental well-being and the mental well-being of others

The Pledges

The simplest pledge is one that anyone can do. Learn the Five Signs of Emotional Suffering so you can recognize them in yourself or help a loved one who may be in emotional pain. In short, the Five Signs are personality change, agitation, withdrawal, the decline in personal care, and hopelessness. Someone may exhibit one or more signs.

Moreover, a long and growing list of nonprofit organizations and private sector companies are making additional pledges to deliver educational tools and programs that will help change the national conversation about mental health.

  • military personnel, veterans, and family members
  • corporate employees
  • federal, state, and local government employees
  • first responders
  • students, teachers, school officials, and coaches
  • members of the faith-based community
  • health care professionals

The History

  • In 2013, Give an Hour President, Barbara Van Dahlen, Ph.D., put together a team after a conversation with staff from the Vice President’s office about the state of mental health in America following the tragic shootings at the Sandy Hook Elementary School in Newtown, Conn.
  • A number of individuals have served on the initial team formed in the spring of 2013. Current members of what is now referred to as the “steering committee” are:
    • Barbara Van Dahlen, Ph., Founder and President, Give an Hour
    • Paul Burke (retired), Executive Director, American Psychiatric Foundation
    • Andrea Inserra, Senior Vice President, Booz Allen Hamilton
    • David Park, Senior Strategist, Collaborative for Student Success
    • Randy Phelps, Ph.D., Clinical Psychologist
    • Jon Sherin, M.D., Ph.D., Director, Los Angeles County, Department of Mental Health
  • After studying the situation and meeting for several months, the steering committee recognized that significant knowledge and numerous resources exist to address the mental health issues and concerns that affect our citizens and burden our communities, nevertheless many in need are not receiving care.
  • Despite the resources available, there is a need to improve the coordination and collaboration among stakeholders across sectors. In addition, the cultural obstacles that prevent those in need from seeking the care they deserve are significant.
  • The conclusion: to improve our nation’s overall mental health we must change our culture so that mental health is seen as an important element of the human condition — something that we all have — something that we all should pay attention to.
  • This conclusion fit well with Dr. Van Dahlen’s experiences working with the military/veteran community for nearly a decade. Our nation’s service members, veterans, and their families — like civilians — are often unable to acknowledge their mental health struggles and are often unwilling to seek care because of embarrassment, shame, or guilt.
  • The steering committee began to explore what a national campaign to change the direction of mental health might look like. It was at this time that Dr. Van Dahlen met John Edelman, who agreed to lend the significant support of the Edelman firm to this effort.

The Campaign’s Progress

The campaign launched with 50 partners and now has 700 partners. Because of these amazing partnerships, over 44 million people have been exposed to the Five Signs of Emotional Suffering via our partners!

700 Partners

10.4M Partner Reach

6.6M Partner Reach

1.7M+ Total Site Visits

Mental Health Concerns/Mental Disorders

According to the National Institute of Mental Health (NIMH), mental disorders are common in the United States and internationally.

  • An estimated 5 million or 18.2 percent of Americans ages 18 and older—about one in five adults— experience a diagnosable mental disorder in a given year. (SAMHSA 2014)
  • Mental disorders are the leading cause of disability in the United States and Canada. Many people have more than one mental disorder at a given time. Nearly half (45 percent) of those with any mental disorder meet criteria for two or more disorders, with severity strongly related to comorbidity. (NIMH 2005)
  • In 2006, $57.5 billion was spent on mental health care in the United States, equivalent to the amount spent on cancer care. (NIMH 2011)
  • Much of the economic burden of mental illness is not the cost of care but the loss of income due to unemployment, expenses for social supports, and a range of indirect costs related to a chronic disability that begins early in life. (NIMH 2011)
  • One-half of all lifetime cases of mental illness begin by age 14, three-quarters by age 24. (NIMH 2005)
  • Twenty-four percent of state prisoners and 21 percent of those in local jails have a recent history of a mental health disorder. Seventy percent of youth in juvenile justice systems have at least one mental disorder, with at least 20 percent experiencing significant functional impairment from a serious mental illness. (NAMI 2011)
  • Over 50 percent of students age 14 and older with a mental disorder drop out of high school—the highest dropout rate of any disability group. (NAMI 2011)


  • According to the Substance Abuse and Mental Health Services Administration, 20–25 percent of the homeless population in the United States has some form of severe mental illness. (SAMHSA 2009)
  • In comparison, only 6 percent of Americans are severely mentally ill. (NIMH 2009)
  • In a 2008 survey performed by the U.S. Conference of Mayors, leaders of 25 cities were asked for the three largest causes of homelessness in their communities. Mental illness was the third largest cause of homelessness for single adults (mentioned by 48 percent of cities). And mental illness was mentioned by 12 percent of city leaders as one of the top three causes of homelessness. (U.S. Conference of Mayors 2008)


  • In 2011, more people died by suicide in the United States (39,518) than in motor vehicle crashes (32,367). (CDC 2011; NHTSA 2011 Annual Report File)
  • More than 90 percent of people who kill themselves have a diagnosable mental disorder, most commonly a depressive disorder or a substance abuse disorder. (NIMH 2010)
  • The VA estimates that 22 veterans die by suicide each day. (VA 2013)
  • The highest suicide rates in the United States are found among white men over age 85. (CDC 2013)
  • Four times as many men as women die by suicide; however, women attempt suicide two to three times as often as men. (CDC 2012)
  • For youth between the ages of 10 and 24, suicide is the third leading cause of death. (NAMI 2011)

Global Impact

Mental health has a tremendous impact on overall health, economic stability, and security around the world.

  • Recent reports estimate the global cost of mental illness at nearly $2.5 trillion (two-thirds in indirect costs) in 2010, with a projected increase to over $6 trillion by 2030. (NIMH, 2011)
  • Mental illness alone will account for more than half of the projected total economic burden from non-communicable diseases over the next two decades and 35 percent of the global lost output. (NIMH, 2011)
  • Mental illness in the United States, Canada, and Western Europe ranks first among illnesses that result in disability. In 2010, depression ranked second for global disease burden. By 2030, depression is projected to be the leading cause of years lived with disability worldwide. (NIMH, 2012; World Health Organization, 2012)

Original Steering Committee

Barbara Van Dahlen, Ph.D., Founder and President, Give an Hour

Paul Burke, (retired) Executive Director, American Psychiatric Foundation

Andrea Inserra, Senior Vice President, Booz Allen Hamilton

David Park, Senior Strategist, Collaborative for Student Success

Randy Phelps, Ph.D., Clinical Psychologist

Jon Sherin, M.D., Ph.D., Director, Los Angeles County, Department of Mental Health


  • Google
  • Joining Forces
  • National Endowment for the Arts
  • Office of the Army Surgeon General
  • Office of the Chairman of the Joint Chiefs of Staff
  • U.S. Department of Health and Human Services

Give an Hour is the backbone organization for the Campaign to Change Direction and is solely responsible for the initiative and its content.

If you need technical support or would like more information on the campaign, email For media inquiries, please email

Please note, this email is not for emergency help. For immediate assistance, visit the helplines provided.

This is a collective impact initiative of Give an Hour. For information about financials and governance, click here.