Abstract
Understanding trends and effective mechanisms that are likely to reduce public stigma and discrimination towards people with mental illness is important. We aimed to assess changes in public stigma in England after the introduction of the Time to Change anti-stigma campaign. We used data from the 2003 and 2007-13 national Attitudes to Mental Illness surveys to investigate 10-year trends in public attitudes across England before and during the Time to Change anti-stigma campaign. We present annual mean scores for attitude items related to prejudice and exclusion, and tolerance and support for community care. We also present an extrapolated linear trend line for the years 2009-13 and estimate population attitude scores without the campaign. We present unadjusted and adjusted linear regression models. In addition, we used multivariable linear regression models fitted to data aggregated by region to investigate whether a dose-effect response exists between campaign awareness and regional outcomes related to knowledge, attitudes, and intended behaviour. About 1700 respondents were surveyed each year. Significant increases in positive attitudes related to prejudice and exclusion occurred after the Time to Change campaign. In the multivariable analysis, we noted a significant increase in positive attitudes in relation to prejudice and exclusion after the launch of Time to Change (reverse-coded Z score 0·02, 95% CI 0·01 to 0·05; p=0·01), but not for tolerance and support for community care (Z score 0·01, -0·01 to 0·03; p=0·27). We also found evidence for a dose-effect relation between campaign awareness and regional improvement in knowledge (p=0·004) and attitudes (tolerance and support p<0·0001; prejudice and exclusion p=0·001), but not intended behaviour (p=0·20). The positive effects of Time to Change seem to be significant and moderate. Although attitudes are probably more at risk of deterioration during times of economic hardship, anti-stigma programmes might still play an active part in long-term reduction of stigma and discrimination, especially in relation to prejudice and exclusion of people with mental health problems. UK Department of Health, Comic Relief, Big Lottery.
Highlights
We noted a significant increase in positive attitudes in relation to prejudice and exclusion after the launch of Time to Change, but not for tolerance and support for community care (Z score 0·01, –0·01 to 0·03; p=0·27)
Public stigma and discrimination in relation to mental illness—ie, the mental-health-related knowledge, attitudes, or behaviour of the general public—can have important consequences for people personally affected by mental health problems
Higher levels of public stigma are associated with greater selfstigma,[1] disadvantages in relation to employment,[2] higher prevalence of suicide,[3] lower perceived health status,[4] and lower rates of help-seeking for mental health problems[5] among people with mental health problems, all of which shape and maintain health inequalities.[6]
Summary
Public stigma and discrimination in relation to mental illness—ie, the mental-health-related knowledge, attitudes, or behaviour of the general public—can have important consequences for people personally affected by mental health problems. 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)[11] and experiences of discrimination among service users were reduced.[12,13] findings suggested that the campaign represented a potentially cost-effective and low-cost intervention, especially when taking into account effects on the wider economy such as service use and employment.[14] Overall, the campaign was associated with modest but significant changes in public stigma.[11,15] the assessment of phase 1 was limited because only 1 year of baseline data were included and, a context for trends in public attitude could not be established before the launch of the campaign
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