October 2007 marked the launch of another programme in England to tackle stigma and discrimination. ‘Time to Change’ models national initiatives from New Zealand and Scotland drawing on an expanding stigma evidence base Reference Link and Phelan1 as well as lessons from past projects, including the Royal College of Psychiatrists' ‘Defeat Depression’ and ‘Changing Minds’ campaigns.
How might this programme succeed where others have stalled? The programme is resource rich with £18 million from the Big Lottery Fund and Comic Relief to channel into 35 linked programmes. It has 4 years to prove change among targeted audiences within a 30 million adult reach. It is a four-party coalition with a desire to learn from organisations across health and disability fields. It is adopting an evidence-based approach Reference Thornicroft2 – national social marketing, service user leadership and engagement, local direct action, multiple targets using ‘stick and carrot’ approaches – but this does not guarantee success.
Key challenges are identifiable. Preparatory consultation during February 2008 using a pragmatic, non-systematic survey method through the membership networks of 18 organisations generated responses from 3038 service users and 661 family or friend carers.
This consultation emphasised first, that stigma and discrimination are widespread and their impact far-reaching.
(a) Seventy-one per cent reported to have stopped doing things – accessing employment, making friends, joining groups, engaging with health professionals.
(b) Seventy-three per cent reported anticipated discrimination including one in two who fear disclosing their health problems because of the negative reactions they might receive.
(c) Carers reported fewer personal effects but 85% felt that the person they supported was affected.
(d) Time to Change will need to target its efforts to have a meaningful impact in any one area.
Second, that combating stigma and discrimination is not straightforward. Service users and carers warned that the entangled nature of mental illness and their own and other people's reactions make generic solutions difficult to find. Pinpointing exact goals for the 35 Time to Change programmes in terms of what needs to change will be central to proving any success.
Third, that Time to Change must set realistic goals. Variation in experiences particularly relating to physical health disabilities, sexuality, severe mental illness diagnosis and ethnicity of carers were found. Stakeholders will not equally benefit from Time to Change and the programme must be open and honest about its limitations from the outset. There is a danger that if it ‘fails’ to have an impact on lived experience of stigma and discrimination, people will give up hope that any change is possible.
Health professionals have a key role to play. General practitioners and psychiatrists were listed as stigma-generating agents, while National Health Service mental health trusts were prioritised by one in ten as the key target location for the social marketing campaign. However, the role goes far beyond being a target for interventions. Alongside Time to Change, momentum behind recovery-driven services is gathering pace. Reference Sheppard, Boardman and Slade3 Joining initiatives across psychiatry that have an impact on stigma and discrimination will assist this programme. For more information, please visit .
Declaration of interest
V.P. is employed by Rethink, one of the Time to Change partners.
Edited by Kiriakos Xenitidis and Colin Campbell