Innovation summary

Research conducted by Time to Change in 2008 (Stigma Shout) found that nearly 90% of people with experience of mental health problems say they face stigma and discrimination. Since 2007, Time to Change has worked to improve public attitudes towards mental health problems and reduce mental health stigma and discrimination.

The second phase of Time to Change (October 2011-March 2015) is made up of nine broad strands of activity aiming to engage people in all sectors and communities, including:

  • Social Marketing
  • Community Engagement
  • Organisational Engagement
  • Social Leadership
  • Engagement of Children and Young People
  • Digital Outreach
  • Media Engagement
  • MindOut (focused on lesbian-gay-bisexual-transgender communities)
  • Pilot for young African and Caribbean men working with statutory services

Impact summary

  • Approximately 592,000 people engaged in Time to Change social contact activities during phase 1
  • 2.4% improvement in attitudes toward mental health nation-wide
  • Cost of changing one person’s behavior through Time to Change was $6.39 USD

"Time to Change has been instrumental in changing attitudes to mental health across the country."

 

Deputy Prime Minister Nick Clegg

 

Innovation details

The first phase of Time to Change was rolled out nationally in October 2007 and continued through September 2011. Following very promising results, the program was extended for a second phase from October 2011 to March 2015. The current phase aims to achieve four main outcomes:

  • 5% improvement in public attitudes towards people with mental health problems
  • 5% reduction in mental health discrimination
  • Improvement in the confidence and ability of people with mental health problems to take action to tackle discrimination
  • Improvement in the social capital of people with mental health problems by increasing their access to social resources

The second phase of Time to Change is made up of nine strands of activity, which aim to engage people in all sectors and communities:

Social Marketing

  • Two national campaign bursts per year using a range of channels, including television, radio, digital and PR
  • Targeted social marketing activity includes work with African and Caribbean communities, and a local activity (social marketing and events) in the Southwest

Community Engagement

  • Large events bringing people with and without experience of mental health problems together to break down stigma and discrimination (social contact)
  • External groups and organisations are supported to run their own social contact events
  • Grants program will fund up to 70 social contact projects across England

Organisational Engagement

  • At least 100 organisations supported to make a Time to Change pledge to tackle mental health stigma and discrimination as employers and service providers
  • Organizations are invited to undertake a health check, which involves a review of HR policies and practices
  • Organizations are invited to attend additional workshops and networking events

Social Leadership

  • Training, peer support and mentoring provided to Time to Change champions and others with lived experience of mental health problems
  • Regional and equalities-focused networking events are provided
  • Training is offered for people with lived experience to lead grant-funded projects

Children and Young People

  • Program of work aimed at 14 to 18 year-olds, including social marketing, leadership training, training for parents and youth professionals, and work within schools
  • Two pilot sites: West Midlands (ending in September 2013) and Southeast (starting in October 2013)
  • From September 2013, the project will be rolled out nationally, working with five schools in a different region each term

MindOut

  • Social contact delivered at LGBT-focused events

Young African and Caribbean men working with statutory services

  • A pilot project that aims to reduce stigma and discrimination experienced in statutory services (starting September 2013)

Media Engagement

  • Input is provided into mental health-related storylines and documentaries
  • Media organisations are supported to sign the media pledge
  • Seminars focusing on specific areas of the media are offered

Digital

  • Review, develop and update the Time to Change website and social media sites, including sourcing and promoting blogs

Key drivers

Social contact

There is a growing evidence base from Time to Change and other anti-stigma campaigns that knowing someone with mental health problems (social contact) is one of the most powerful factors in improving attitudes towards people with mental health problems.2 Events are generally not promoted, in order to attract the target audience of people who would not normally attend an event focused around mental health. Instead, the strategy is to ‘ambush’ people who were going about their daily lives, and then begin conversations about mental health. Social contact can also be virtual, where the audience sees an advert or film featuring someone talking about their experience of mental health problems and the impact of stigma and discrimination.

Governance and management

It is important to have clear governance and operational decision-making structures. Time to Change has a strategic governance group, the Senior Management Group (SMG), which is made up of senior representatives from the partner organisations and people with lived experience of mental health problems (including from black and minority ethnic communities). The Operational Management Team (OMT) is made up of project leads and representatives from the central management team, and makes recommendations to SMG. The structures ensure the various projects operate as a coherent program of work, and that the program priorities are reviewed and Time to Change is able to respond to evaluation findings and external influences.

Involvement of people with lived experience

The primary Time to Change audiences are people without experience of mental health problems. However, the success of Time to Change relies on the involvement of people with lived experience of mental health problems in all aspects of the program. This includes representation on SMG and project advisory groups, developing and running grant-funded projects, attending regional and equalities-focused networking events, and becoming event and media volunteers. Time to Change has eight regional coordinators and six equalities coordinators, all with lived experience of mental health problems, who work with networks across England. People with lived experience work with organisational stakeholders to run workshops and undertake organisational health checks, as well as telling their stories at events, including media workshops. The recent campaign bursts in January and August 2013 have featured real people who had experienced mental health problems and those who had supported them helped. This increases credibility among the campaign audience with more people believing what the advertising said in this burst compared with the two previous bursts.

External stakeholders

Time to Change relies on external stakeholders to extend the reach of the campaign, including organising social contact events across the country. The number of social contacts are highest from community engagement events run by third party stakeholders and registered on the website.  It is important to ensure there are clear and consistent key messages that stakeholders can understand and promote.

Audience insights

Audience insight research is conducted before each new campaign burst, in order to understand more about the attitudes of the target audience. This research helps to shape the tone and content of the campaign.

Evaluation

There is a robust evaluation of Time to Change. This ensures that evidence is being collected that shows the continued need for anti-stigma work, as well as the impact of the Time to Change program.

Challenges

Concept of social contact

In order for social contact to be effective, there are certain pre-conditions, for example the two parties need to engage on an equal basis and it needs to be explicitly about mental health. It can be difficult to explain what is meant by ‘social contact’, in particular to external stakeholders. Many applications for funding, for example, have not fully understood the concept and, as a result, guidance has been created for future applicants (see link below), including examples of activities that promote social contact. In addition, the first phase of Time to Change involved organising activities around physical activity, and it was difficult to ensure that effective social contact was taking place. For example, a football match involving people with and without mental health problems is only ‘social contact’ if there are opportunities to talk about issues around mental health.

Reaching all audiences

Evaluation findings show that mental health stigma and discrimination vary across groups and communities. Although it is important to ensure the national campaign bursts and social contact activity reaches as many people as possible, it is also important to recognize that a ‘one size fits all’ approach does not always work. As a result, Time to Change has developed targeted work with specific audiences. In phase 2, the target audience is African and Caribbean communities, and events and campaign bursts are being developed with these communities. In addition, the program includes an LGBT social contact project, and six equalities coordinators working with their networks across England.

External environment

The program needs to respond to a more challenging external environment in which public attitudes to ‘out-groups’ may be hardening. While the results overall show that where the Time to Change campaign is reaching target audiences it is improving knowledge, attitudes and claimed behavior, in a more challenging economic climate the campaign will need to work hard to maintain this progress and build upon it further.  Qualitative research run in 2012 revealed an audience who are facing a great deal of pressure in their lives due to the economic climate which is causing people to focus on ‘them and their own’ to create an environment of safety, protection and survival. As a result, it is more important than ever to build empathy and make sure people with mental health problems are seen as ‘one of us’, and not as ‘other’. 

Institutional change

The transformation in the NHS and structures delivering health and public health services has had an impact on Time to Change’s ability to engage local and regional partners.  Many of the statutory organisations who contributed to Time to Change in its first phase (2008-2011), for example by delivering local and regional campaigns, have been less able to make the same contribution in recent years or have been replaced by new bodies.  Time to Change is now seeking to re-engage with stakeholders within these new structures to build support for the next campaign burst due to take place in January 2014.

Continuation

Time to Change is a national initiative; however, Time to Change recognizes that mental health stigma and discrimination vary across groups and communities. As a result, Time to Change has undertaken targeted work with children and young people, and black and minority ethnic communities. Additional efforts have been made to expand social marketing in the South West and to support anti-stigma and discrimination initiatives internationally.

Children and Young People

At the beginning of phase two, the first pilot children and young people (CYP) project was launched in the West Midlands. The second pilot will be launched in October 2013 in the South East (with a focus on Kent), and the programme will be rolled out nationally (with additional funding from the Big Lottery Fund) from September 2013. The CYP programme incorporates many of the elements of the adult programme, including social marketing activity, leadership training, social contact events and organisational pledges. Advisory groups, children and young people’s panels and parents’ panels have been recruited in the regional pilot areas to advise on the development and implementation of the program.

Black and minority ethnic communities

During Phase 1, a social marketing campaign was developed and run with South Asian communities in Harrow in North West London. The target audience in the second phase of the programme is African and Caribbean communities. Community engagement events are being developed in partnership with African and Caribbean communities, and additional funds from the Big Lottery Fund are being used to run targeted social marketing campaign bursts that will engage this audience. An African and Caribbean strategy working party is being set up to monitor the programme’s work with this audience and provide advice and support.

In addition, a black and minority ethnic public attitudes survey booster has been commissioned to increase the number of respondents from black and minority ethnic communities, and research has been commissioned to find out about experiences of mental health discrimination amongst people from black and minority ethnic communities.

Local social marketing activity

Social marketing activity is being developed at a local level in the South West, including running social contact and stakeholder events and local advertising.

International reach

Time to Change is a member of the international anti-stigma alliance. The aim of the alliance is to share learning about running a national programme to address mental health stigma and discrimination. Anti-stigma programs have been set up in Ireland, Denmark, the Netherlands, Canada and the USA, based on learning from the Time to Change programme.

The evaluation tools used by Time to Change have also been adopted by other campaigns. For example, Like Minds in New Zealand is using the Discrimination and Stigma Scale (DISC), which was developed by the Institute of Psychiatry and used in the annual Viewpoint survey commissioned by Time to Change.

The Time to Change film ‘Schizo: the movie’, as another example, has been adapted for an American audience as part of the Bring Change 2 Mind campaign.

Partners

Funders

Evaluation methods

The evaluation of the first phase of Time to Change (October 2007 to September 2011) was conducted by the Institute of Psychiatry, King’s College London. The findings were published in the British Journal of Psychiatry in April 20131-5  and included:

Surveys

  • Annual survey with the public using tools to measure knowledge, attitudes and behaviour, including a booster survey with people from black and minority ethnic communities
  • Annual Viewpoint survey with people who have accessed secondary mental health services to measure their experience of discrimination in a number of life areas
  • A survey has been developed to find out about mental health discrimination experienced by people from black and minority ethnic communities

Targeted evaluations

  • Pre- and post-campaign burst evaluation
  • Pre- and post-evaluation of the Children and Young People pilot sites
  • Evaluation of how the Time to Change audiences have engaged with community-based activities and the organisational pledge and workshops
  • Evaluation of involvement with Time to Change by people with lived experience of mental health problems, including questions relating to confidence and access to social capital

Additional research

  • Research into how mental health issues are reported in print media and portrayed on the television.

Cost of implementation

The phase 2 budget of Time to Change is $37,324,567 USD.

The economic evaluation2 of phase 1 showed:

  • The average cost of reaching one person to build awareness in the target population (English adults age 25-45) is $0.19 USD
  • Economic benefits outweigh costs even if the campaign only results in 1% of people with depression accessing services and gaining employment
  • The cost to improve intended behavior in one person is $6.39 USD at most (if we assume the campaign is responsible for 50% of the change)

Impact details

The findings from the first phase of Time to Change, which ran between October 2007 and September 2011, are summarized below. The second phase has not yet been evaluated, though some process indicators are also reported.

Public attitudes

  • 2.4% improvement in attitudes at a national level (2008-2011)3
  • People aware of the Time to Change campaign scored higher on attitude (4.8% higher), intended behavior (3.6%) and knowledge (4%) than people who were not aware of Time to Change (2008-2011)3

Discrimination

  • Discrimination was reduced in 17 out of 21 life areas (2008-2011)4
  • 3% improvement in the number of people who reported no discrimination in their lives (2008-2011)4
  • 11.5% reduction in the average amount of discrimination experienced (2008-2011)4

Bringing people with and without mental health problems together

  • In total, 591,787 people engaged in social contact activities by Time to Change over phase 1 (2008-2011)
  • 162,196 people with experience of mental health problems were engaged over phase 1 of the Time to Change programme (2008-2011)
  • 35-53% of social contact event attendees without mental health problems left with a more positive impression of people with mental health problems (2009-2011)4

Improved knowledge, confidence and assertiveness to challenge discrimination

  • Viewpoint survey participants who were aware of Time to Change reported feeling more confident in challenging stigma and discrimination than a year ago (2010-2011)4
  • 85% of people with mental health problems who attended a Time to Change social contact event reported that they felt more confident to tackle mental health discrimination as a result (2010)4

Employment

  • The Viewpoint survey showed discrimination when getting and keeping a job decreased significantly (2008-2010)
  • Survey of employers showed improved knowledge of common mental health problems and more policies in place to support people with mental health problems in the workplace (2006-2010)4

Media reporting

  • Study comparing newspaper reporting of mental health found an increase in the proportion of anti-stigmatising articles, but no significant reduction in the amount of stigmatizing articles (2008-2011)5
  • The project has supported 16 storylines in soaps operas and dramas (2007-2013)
  • 235 media professionals have attended workshops (2007-2013)
  • Nearly 7,000 have viewed the online resource for journalists (2007-2013)

References

  1. Evans-Lacko S et al. (2013) Public knowledge, attitudes and behaviour regarding people with mental illness in England 2009-2012. British Journal of Psychiatry, 202: s51-s57.
  2. Evans-Lacko S et al. (2013) Economic evaluation of the anti-stigma social marketing campaign in England 2009-2011. British Journal of Psychiatry, 202:s95-s101.
  3. Evans-Lacko S et al. (2013) Influence of Time to Change’s social marketing interventions on stigma in England 2009-2011. British Journal of Psychiatry, 202:s77-s88.
  4. Corker E et al. (2013) Experiences of discrimination among people using mental health services in England 2008-2011.  British Journal of Psychiatry, 202:s58-s63.
  5. Thornicroft et al.(2013) Newspaper coverage of mental illness in England 2008-2011. British Journal of Psychiatry, 202:s64-s69.

Research

Tools

Multimedia

Reports
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