Stigma and discrimination compound the difficulties people with mental health problems already face. There is a substantial literature on stigma and the evidence mostly concerns attitude surveys rather than evidence of effective interventions for reducing discriminatory behaviours.

Stigma is made of up three elements:

• problems of knowledge (ignorance),
• problems of attitudes (prejudice),
• and problems of behaviour (discrimination).

Our evaluation will therefore assess all three of these elements as follows:

Knowledge:

To assess and track changes in knowledge about stigma surrounding mental health, both among the general population and among specified groups, we will carry out repeated surveys throughout the lifetime of the programme.

Attitudes:

The annual National Public Attitudes to Mental Illness survey has been conducted by the Department of Health (DoH) since 1993. As part of the Time to Change evaluation this survey will be repeated on an annual basis between 2008 and 2011 to allow us to accurately assess changes in attitudes over time. It will be administered to targeted groups within the overall programme.

Behaviour:

In order to monitor changes in discriminatory behaviour, an annual Viewpoint survey will be conducted looking at the experiences of discrimination by people with mental health problems, as well as experiences of confidence and empowerment to reduce stigma, among a sample of 1,000 people in contact with mental health services across England. In addition to surveying service users, each year we will assess reported and intended behaviour towards people with mental illness via the RIBS. This survey is adapted from the social distance scale (Link et al. 1987; Penn et al. 1994).  Additionally, there is clear evidence that media coverage of mental health problems tends to be negatively biased and influences the attitudes and behaviour of the general public. In order to monitor any effect that Time to Change may have in this area, we shall undertake annual analyses of press coverage of mental health related items. By categorising their content we aim to establish whether there is a trend over the period of Time to Change towards more positive coverage.