Stigma and discrimination can greatly exacerbate the difficulties faced by people with mental health problems. We know that; we’ve heard it repeatedly; many of us have experienced it. We know that stigma is not just a word but a toxic concoction of ignorance and fear, of prejudice and power play, that continues to have a real and substantial impact on the daily experiences of thousands of people, in relationships with friends and family, in attempts at finding and keeping employment, and even in accessing healthcare.
Stigma is bad; we can all agree. But what’s to be done about it? How do you reduce stigma? How do you even measure it? And if you do invest in a “treatment programme” aimed at reducing discrimination, how on earth can you demonstrate your investment was worthwhile?
On Wednesday Time to Change, the anti-stigma campaign, led by the mental health charities, Mind and Rethink Mental Illness, publishes a series of articles in the British Journal of Psychiatry evaluating the first phase of the programme, which ran in England between 2007 and 2011. The results present a highly nuanced and complex picture. This is hardly surprising given the multifaceted nature of the programme.
But if one cannot escape some sense of disappointment that “the wholesale shift in attitudes that we all want to see has yet to occur”, as Dr Michael Smith puts it in his editorial, it is undeniable that the scale of the programme and the rigour of this evaluation provide an immensely valuable resource both for the ongoing evolution of Time to Change and for other anti-stigma campaigns internationally.
Time to Change was aimed at both the general population and at specific target groups, such as employers and medical students, as well as people with mental health problems. The campaign made use of social marketing, advertising campaigns and one-day events designed to deliver social contact between people with experience of mental health problems and various target groups. Perhaps the most encouraging finding was the positive impact of such contact, especially on personal relationships. There was a significant reduction in discrimination from friends (14% reduction), family (9%) and in social life (11%), as reported by service users (albeit from a very low survey response rate of 6-11%). It may not be especially surprising, but it is certainly worth underlining, that knowing someone who is open about having a mental health problem has a clear and positive impact on attitude and behaviour. In other words, the more of us who are willing to hold up our hands, the better for everyone.
Other results were less persuasive. Surveys of public attitudes to mental illness showed no significant improvement in either knowledge or reported behaviour. Employers showed an increased awareness of common mental health problems, though, worryingly, a large majority believed that prospective employees should disclose these prior to employment. Medical students showed a significant improvement in attitude directly after intervention but this tailed off after six months.
The success of the campaign must also be viewed against the particular social and political backdrop. Indeed, it could be argued that in the current climate of government-stoked hostility towards so-called “skivers and scroungers“, any reduction in levels of stigma should be regarded as nothing short of a triumph.