Today is Time to Talk Day. The aim is to get as many people as possible across England talking about mental health. Those running the campaign argue that the more we talk about mental health, the less stigma and discrimination surround this issue. More people feel able to open up about their own mental health problems and feel supported by those around them.
The day is run by an organisation called Time to Change. This is an anti-stigma campaign run by the mental health charities Mind and Rethink Mental Illness. It is funded by the Department of Health, Comic Relief and the Big Lottery Fund. The Government is spending millions of pounds on this campaign. So what is the evidence around tackling stigma in mental health?
Other countries have also attempted anti-stigma campaigns with indications of success. Before the Time to Change programme was introduced in England a similar initiative in Scotland ‘see me’ was run in 2002. Relative to Scotland during 2000 and 2003 attitudes towards those with mental health problems in England worsened (Mehta et al 2009). An analysis of the Like Minds Like Mine campaign in New Zealand found that 48% of participants thought that the “Like Minds Like Mine” programme had assisted in reducing discrimination “moderately” or “a lot” (Thornicroft et al, 2014).
So how successful has Time to Change been? Since the start of the campaign in 2007 there has been an 8.3% improvement in public attitudes towards mental health. While a significant improvement, that statistic alone does not provide a causal link. Neverthless, evaluation of the campaign has indicated such a link. Assessment of phase one of the campaign found that intended behaviour among the general public improved (ie, there was an increased willingness to live with, work with, live nearby, or continue a relationship with someone with a mental health problem) (Evans Lacko et al 2013) and experiences of discrimination among service users were reduced (Corker et al 2013). An Institute of Psychiatry evaluation, analysing regional differences in attitudes, found a clear and consistent link between awareness of the campaign and changes in attitude (Evans Lacko et al 2014).
The recent reduction in stigma has led to a spotlight on access to, and quality of, service provision. Historic issues such as underfunding and long waiting times are now making the headlines and the front pages on an almost daily basis. Research has found a significant increase in positive media coverage of mental health. There was a significant increase in the proportion of anti-stigmatising articles between 2008 and 2011 (Thornicroft et al 2013). The Equality4MentalHealth campaign in November 2015 garnered the support of hundreds of society’s opinion formers, from the Archbishop of Canterbury to Dawn French. The BBC has just announced a two week season of programmes on mental health across news, drama, documentaries and features. Programmes like Eastenders and the One Show will all feature mental-health related content. Alastair Campbell has said that it is ‘higher up the political agenda than it has ever been (Guardian, 26 Jan 2016).
As attitudes have begun to change, so mental health has risen up the political agenda. It was a priority for the last coalition government, with the introduction of the first ever waiting time standards, and for this government, with the Prime Minister recently making a major speech announcing £1bn extra funding.
There is clearly a long way to go to tackle the problems created by decades of underinvestment in mental health. There are numerous failings in the system. To take children’s services alone:
- 75% of children and young people with mental health problems are thought not to access treatment
- One in five providers of children’s mental health services responding to a Royal College of Psychiatrists survey had no out of hours service
- 350 under 18s were admitted to adult wards in 2013/14
CentreForum is running a Childrens Mental Health Commission which will explore the current state of services in more detail. There is wide variation and a long road ahead to reach equality with physical health.
Nevertheless, it seems that a small investment in challenging attitudes and awareness can have a major impact on the political agenda which in turn impacts on service provision. Further evaluation and research into this area is needed, but the evidence so far shows it’s definitely time to talk.