Time to Change: Evidence for anti-stigma campaigns

Research led by Dr Claire Henderson, Professor Diana Rose & Professor Sir Graham Thornicroft 

Our research has informed and evaluated England’s national anti-stigma campaign Time to Change, which is clearly showing a reduction in stigma and discrimination towards people with mental illness.

People with mental health problems experience discrimination and prejudice from employers, public servants, families, friends and strangers alike. Our research has shown that people with mental health problems are treated unfairly in almost all areas of their lives because of people’s misconceptions, ignorance and fear – and that stigmatising attitudes and discriminatory behaviour is common in all countries around the world.

But in England, people are now reporting less discrimination than previously. Public attitudes towards mental health have improved since the start of Time to Change, a national programme launched in 2007 to tackle stigma and prejudice surrounding mental ill health.

A team led by Professor Sir Graham Thornicroft and Dr Claire Henderson have been involved in evaluating the programme and have shown that it is beginning to make a difference.

In the first annual Viewpoint survey in 2008, 91 per cent of people with mental health problems said they had experienced discrimination on at least one occasion in the last 12 months. By 2013, the survey showed significant reductions in those with mental health conditions reporting discrimination within several life areas, including their social life and securing a job.

The survey uses the Discrimination and Stigma Scale (DISC). The purpose-built questionnaire was developed and validated by our researchers. It was later adapted for New Zealand’s anti-stigma campaign, Like Minds Like Mine.

Our researchers have produced and tested a number of other research tools to evaluate Time to Change, including the Mental Health Knowledge Schedule (MAKS) and the Reported and Intended Behaviour Scale (RIBS). Both are now included in the Attitudes to Mental Illness Survey, commissioned by the Department of Health to track changes over time.

Thousands of people with experience of mental health problems have been involved with activities organised by Time to Change. Our research has informed these activities, by building on the evidence demonstrating both the need for Time to Change and the best way to change discriminatory attitudes and behaviour.

‘For example, our work showed that one of the most effective ways to reduce stigma is through direct personal contact with someone who has a mental illness,’ says Professor Sir Thornicroft. ‘Direct contact with individuals means people can learn the truth – that people with mental illness are just like everyone else.’

Thus one of the main planks of Time to Change is activities bringing together people with and without experiences of mental illness. In February 2011, the Government committed to support and work actively with Time to Change in its mental health strategy with the aim that fewer people will experience discrimination and stigma. The Government uses the Viewpoint and the Attitudes to Mental Illness surveys to monitor progress towards that goal.

Our researchers have also shared their evaluation methods with organisations working on anti-stigma campaigns around the world: the Opening Minds campaign in Canada, Time to Change Cymru in Wales, Samen Sterk tegen Stigma in The Netherlands, En Af Os in Denmark and Hjärnkoll in Sweden.

References

• Pinfold V et al. Reducing psychiatric stigma and discrimination: evaluating an educational intervention with the police force in England. Soc Psychiatry Psychiatr Epidemiol, 2003; 38: 337-44
• Pinfold V et al. Reducing psychiatric stigma and discrimination: evaluation of educational interventions in UK secondary schools. British Journal of Psychiatry, 2003 Apr; 182: 342-6
• Evans-Lacko S, Little K, Meltzer H, Rose D, Rhydderch D, Henderson C, and Thornicroft G Development and Psychometric Properties of the Mental Health Knowledge Schedule (MAKS), Canadian Journal of Psychiatry, 2010; 55: 440-8
• Evans-Lacko S, Rose D, Little K, Rhydderch D, Henderson C, Thornicroft, G. Development and Psychometric Properties of a Stigma Related Behaviour Measure. Epidemiology and Psychiatric Sciences, 2011; 20(3): 263-71
• Thornicroft G et al. Stigma: ignorance, prejudice or discrimination. British Journal of Psychiatry, 2007; 190: 192-3
• Brohan E et al. Development and psychometric evaluation of the Discrimination and Stigma Scale (DISC). Psychiatry Res, 2013; 208(1): 33-40. Doi: 10.1016/ j.psychres.2013.03.007
• Thornicroft G et al. INDIGO Study Group. Global pattern of experienced and anticipated discrimination against people with schizophrenia: a cross-sectional survey. The Lancet, 2009; 373: 408-15