The Time to Change campaign seems to have made an encouraging impact on attitudes towards mental illness in England. According to independent evaluation of the campaign’s first four years, people with mental health problems are experiencing less stigma and discrimination, are feeling more empowered and are enjoying more social contact.
One group in society appears to be proving resistant to this positive influence, however. Extraordinarily, the evidence suggests that attitudes among mental health professionals are not improving in line with the general trend.
The evidence is based on responses from a telephone survey of a panel of 1,000 users of mental health services, conducted annually between 2008 and 2011. They were asked to report discrimination experienced on 21 different measures, ranging from keeping a job to use of transport.
While notable improvement was recorded over the four surveys on measures including discrimination by friends and by family, there was no comparable change in discrimination by mental health professionals: 34.3% of respondents reported such treatment in 2008, falling only slightly – and not statistically significantly – to 30.4% in 2011.
Why should this be so? One possible answer is that the campaign, funded over its first four years by £16m from the Big Lottery Fund and £4m from Comic Relief, has been aimed primarily at shifting public attitudes rather than those of care professionals. Where professionals have come across its messages, they may feel they know all about them.
A second, more worrying, possibility is that care workers are becoming more hardened and cynical about people who use their services. Because secondary services, in particular, are concentrated increasingly on those with the greatest needs and most complex diagnoses, professionals are not seeing people recover in the same numbers or over the same timescales.
A further, linked factor might be that growing numbers of care workers are buckling under the strain of an overstretched system and experiencing burnout symptoms that are affecting their attitudes towards service users.
The danger of this trend, if sustained, is that people with mental health problems might be deterred from seeking professional help. As Dr Claire Henderson, clinical senior lecturer in psychiatry at the Institute of Psychiatry, King’s College London, and joint leader of the evaluation, said at its launch, it would be a terrible irony if people were encouraged by Time to Change to ask for help – only to find that those providing it held prejudicial views.
Sue Baker, Time to Change’s director, says the campaign is conscious of this threat and is planning a series of high-level discussions with royal colleges and other organisations representing health professionals, both mental and physical, as part of the programme’s current second phase, funded by Comic Relief and the Department of Health.
“There are signs that we are moving towards a tipping point for change [generally],” Baker says. “We need to find out why we are not seeing such a level of change among health staff. We want to bring people together to discuss that.”
One consolation for mental health professionals will be that the evaluation survey also found no statistically significant improvement in reported discrimination by police officers. But the proportion of respondents saying they had experienced police discrimination in 2011 was just 16.1% – barely half the number reporting the same by mental health staff.
David Brindle is the Guardian’s public services editor. He was a trustee of Mental Health Media, one of the charities that helped establish Time to Change.
David Brindle – guardian.co.uk