April 3, 2013

Sue Baker, Director of Time to ChangeFor the first time ever in England, there is clear evidence that generations of entrenched stigma and prejudice relating to mental health are beginning to be overturned in some areas.

When we began running Time to Change in 2007, we looked at what had been achieved by anti-stigma campaigns in other countries including Scotland’s See Me campaign and New Zealand’s Like Minds, Like Mine programme. But while building from what had worked elsewhere, we were also attempting something entirely new and uniquely ambitious. We knew that it was real behaviour change, not just attitude change, that would make the most tangible difference to people’s lives – and no other campaign had measured the actual levels of discrimination reported by people using secondary mental health services, alongside surveys looking at public attitudes.

We didn’t know whether it would be possible to bring about a significant drop in actual discrimination at such an early stage, or which approaches would be most effective. That’s why evaluation has always been such a vital part of Time to Change – so that we can find out what was working and adapt our approach, based on this learning, as we go along. And that’s why this study - the first of its kind in the world - is so encouraging, as it shows that improving people’s lives by changing public behaviour on this most taboo of health topics is possible.

3% more people now experience no discrimination at all. For those that still do faces stigma and discrimination, the average levels reported have decreased by 11.5%. And there is a clear trend towards improved attitudes. There is now a higher proportion of anti-stigmatising articles in the press, more people with mental health problems being quoted as sources, and among the more stigmatising articles fewer now portray people with mental health problems as potentially harmful to others.

However, as we always predicted, improvements are both slow and fragile. In this early era of change, we are hostage to factors in the external environment which we can’t control or influence. The unfavourable economic climate is almost certainly making it difficult to sustain the same rate of progress that we saw in the first few years of the campaign.

An area of concern is that attitudes among health professionals, including mental health professionals, are not improving in line with the general trend. Apart from a small pilot with medical students, there has not been a concerted focus on health professionals as a target audience more widely, but we are going to bring key professional groups together to explore the complex issues behind this.

We have always believed that ours is the work of a generation – issues like racism and homophobia still exist despite the huge social change that decades of campaigning has brought about; and likewise mental health stigma is not going to be eradicated in just four years – or even ten. That’s why this needs a long term focus – and voices speaking out against stigma and discrimination need to be heard more than ever in times like these. Even if the impact we can have is hindered by the economic climate, the data cannot tell us how much worse things may have been without all of our efforts to tackle stigma. The momentum we have built with more people speaking openly about their experiences and stigma and discrimination higher on the public agenda than ever, will stand us in good stead to sustain improvements over the coming years and even decades.

One of the most encouraging pieces of the evaluation for me is evidence of the positive impact of knowing someone who is open about having a mental health problem. With more of us now able to speak openly about our experiences, we are moving closer to that tipping point where the vast majority of the public realise that mental health affects someone in their life – where having a mental health problem is no longer remarkable, but just a part of everyday experience.

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