There are worrying signs that public attitudes to mental health in England may be going backwords. Indeed, a recent study from our research team reported significant changes in mental illness stigma and discrimination, indicating that public attitudes towards mental health are in decline for the first time in over a decade. After the positive changes that accompanied England’s Time to Change programme, which worked hard to reduce stigma and discrimination, it might seem reasonable to expect progress to continue, or at lease to plateau. However, the troubling finding of a decline in attitudes that started before the end of ‘Time to Change’ in 2021 suggests the story may be more complicated than that.
I’m Amy, a population mental health researcher at King’s College London, and I was part of the team that ‘broke the story’, so to speak, on this worrying trend in mental health stigma. Let me explain how.
The ‘Time to Change’ Campaign
‘Time to Change’ was a national campaign in England delivered by the mental health charities Mind and Rethink Mental Illness between 2007 and 2021. What was the aim of time to change? Social marketing campaigns were largely aimed at adults aged 25-45 from middle-income groups, with some targeted campaigning for men and other specific groups. The campaign focused on helping people to feel more confident talking about mental health, while encouraging people to maintain contact (as opposed to social distancing) with people with mental health problems. In 2009, some measures of stigma (e.g. desire for social distance, attitudes) were added to the already existing national Attitudes to Mental Illness survey so that the impact of ‘Time to Change’ could be assessed.
Between 2009 and 2019, results from the Attitudes to Mental Illness survey showed that there were significant improvements in mental health stigma nationally. Specifically, attitudes towards people with mental health problems improved, the desire for social distance from people with mental health problems decreased, and stigma-related knowledge increased steadily. Despite these improvement in stigma-related outcomes, ‘Time to Change’ was not funded beyond March 2021.
A Step Back?
The Attitudes to Mental Illness survey continued to collect data allowing us to see what happened after Time to Change ended. By 2023, the results were disheartening: public attitudes to people with mental health problems had dropped to levels not seen since 2014, driven largely by declining attitudes towards community-based care. While decreases in prejudicial attitudes were maintained, there seemed to be declining faith in the suitability and efficacy of care in the community for people with mental health problems. This may be related to an actual and/or perceived reduction in accessibility of such care. Reduced access to primary care during the covid-19 pandemic may have had a knock-on effect on access to the specialist mental health teams which provide community mental health care. In addition, some such teams were disbanded during the pandemic as their staff were redeployed.
Even more stark changes were seen in desire for social distance from people with mental health disorders, where levels had returned to those seen in 2009. This was largely driven by changing views in people’s willingness to live near or with someone with mental health problems. A cause for optimism, on the other hand, was that people were more likely to say they would be willing to make friends with someone with depression or schizophrenia, as well as have them as a colleague, accept them into their family and have them provide childcare.
These seemingly conflicting results may arise from the different way the questions are asked. Some scales ask about attitudes towards mental health in the abstract (e.g’. Do we need to adopt a far more tolerant attitude toward people with mental illness in our society?’) and some provide descriptions about individuals with symptoms of mental illness and ask questions about them specifically (e.g. ‘Would you be willing to live next door to Stephen?’). Asking about people with mental illness in general is different from describing a named person with depression or schizophrenia and then asking about willingness to interact with them, as the description provides a sense of familiarity. The positive change when given this sense of familiarity is in keeping with the messaging of Time to Change’s social marketing campaign, which highlighted ways people can support someone they know who has a mental health problem.
Worryingly, public knowledge of aspects of mental health also fell back to 2009 levels, driven by an increasing pessimism about the ability of people with mental health problems to access treatment and recover, and lack of knowledge about how to support someone with mental health problems.
What’s Behind the Shift?
Although there are some reasons for optimism, mental health stigma is on the rise after years of improvement, which is something that needs to be addressed. The Attitudes to Mental Illness survey data is collected to track changes over time, rather than explain them. However, I think there are several possible drivers of the increases in stigma we have seen since 2019. The COVID-19 pandemic and the cost-of-living crisis in the UK could be significant contributors here, both associated with greater difficulties in access to mental health care. It is plausible that the end of England’s campaign against mental health stigma in 2021 likely played a role as well.
We predict that the aspects of stigma which worsened since 2019 might just improve if and when economic conditions and access to treatment for mental health conditions improve. It remains to be seen whether the improvements we saw over the ‘Time to Change’ campaign can be regained in the absence of a national anti-stigma programme. The impact of current initiatives such as World Schizophrenia Day is unknown but potentially important in increasing understanding of this condition, as it less common than illnesses such as depression and hence less well understood. Media coverage of topics and events related to mental illness will continue to be influential; without positive messages, for example about the ability to live a fulfilling life despite some symptoms of illnesses such as schizophrenia, coverage of episodes of violence will continue to warp public perception of this illness. A new wave of Attitudes to Mental Illness survey data will be available in 2025, allowing us to shed more light on this…watch this space.