Evaluation of the Time to Change Programme

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Evaluation of the Time to Change Programme
Claire Henderson Graham Thornicroft, Clare
Flach, Sara Evans-Lacko, Ann Law, Elly
Lewis-Holmes, Kirsty Little, Jillian London, Paul
McCrone, Danielle Rhydderch, Diana Rose
Institute of Psychiatry, Kings College London
Marshall Clemens and Philippe Vandenbroeck,
ShiftN TTC Central Management Team, LEAP, Mental
Health Media, Mind, Rethink
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Programme Foundations

• 1 Years of evidence that discrimination is at
  epidemic levels in the UK

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• 2 Evidence that public attitudes had declined

Dept of Health, Public Attitudes to Mental
Illness Surveys. 2000 Representative Adults in GB
( agreeing with key statements)
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Evidence that population-wide attitudinal change
is possible

• International
• Like Minds Like Mine (New Zealand)
• See Me (Scotland)

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Like Minds Years 1 to 1043 to 55 (1997 to
2002, after two advertising campaigns)55 to 62
(2003 to 2007, after third campaign)
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• Consortium of three voluntary sector partners
  Mind, Rethink, Institute of Psychiatry
• 16million Big (well-being) 2m Comic Relief.
  Government funds 1/3m for research tools and two
  secondees to TTC and DH-funded Shift in
  anti-stigma programme in England.
• Four year programme - 2007-2011 with a ten-year
  vision
• 35 projects - 6 national, 28 local, 1 evaluation

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Outcome Targets

• 5 positive shift in public attitudes towards
  mental health problems
• 5 reduction in discrimination by 2012
• 100,000 people with mental health problems with
  increased ability to address discrimination
• ¼ m people engaged in physical activity

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New Hybrid

• Social marketing to change the societal context
• Legal Rights (test cases, resources for
  employees)
• Empowerment - training and support to tackle
  discrimination, 32 local and 8 national user-led
  campaigns, improvements to empowerment and social
  inclusion indicators
• Individual wellbeing programmes and whole
  population wellbeing messages
• Training future professionals

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Delivery Model

• Community Action National Noise
• National Noise
• campaign website
• mass participation physical activity
• legal test cases
• Community
• 28 local physical activity projects (improved
  well-being, self-esteem, empowerment, social
  inclusion)
• 32 local user-led anti-discrimination campaigns

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Anti-stigma social marketing campaign - a
national social marketing campaign using
advertising, PR, and other marketing techniques
to change public attitudes. Reaching 30million
adults. Open Up 40 user-led projects and a
training programmes to empower and support a new
army of discrimination champions tacking
discrimination in local communities. Get Moving!
- annual mass participation event focusing on
physical activity for mental well-being.
Involving people with and without mental health
problems.
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Time to Challenge - taking high-profile test
cases on disability legislation to establish
legal rights, producing on-line legal resources
for people experiencing discrimination in the
workplace, and a resource to help employers
understand their legal duties. Website highly
inter-active tool supporting the whole programme,
activating public support, as well as sharing
models of good practice. END (Education Not
Discrimination) - anti-stigma training for key
professional audiences (trainee doctors,
teachers, head teachers social inclusion
officers).
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Stigma Causal Mechanisms- Basic Model
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Population level evaluation
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Target group level evaluation
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Service user level evaluation
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The Lancet
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DISC Discrimination and Stigma Scale

• Experience of discrimination
• Domains key areas of everyday life and social
  participation, including work, marriage,
  parenting, housing, leisure, and religious
  activities.
• Example questions
• Have you been treated unfairly by the people in
  your neighbourhood?
• Have you been treated unfairly in dating or
  intimate relationships?
• Have you been treated unfairly in your housing?
  (including becoming homeless)
• N/A Not at all A little Moderately A lot

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Negative Experienced Discrimination 1

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Anticipated Discrimination

• Similar ideas self-stigma, self-discrimination
• Avoidance of important actions eg
• applying for a job
• seeking a close relationship
• because of previous failure or
• in anticipation of failure

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DISC (2)

• Anticipated discrimination sub-scale
• 4 items address how far participants limit their
  own involvement in important aspects of everyday
  life, including work and intimate relationships.
• ExampleHave you stopped yourself from having a
  close personal relationship?
• N/A Not at all A little Moderately A lot

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Anticipated Discrimination
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Stigma Causal Mechanisms- Basic Model
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Understanding our Audience

• Thats sad, but its not me - stigma is often
  subconscious
• Discrimination? Whats that got to do with mental
  health?
• I wouldnt want anyone to know
• The fear factor
• Lack of understanding and information
• Theres not much connection between my life and
  mental health problems
• Walking on eggshells

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Stigmatisation overview
Generating societal change by targeting
subconscious stigmatisers is more likely to
impact conscious and active stigmatisers/discrimin
ators vs. head-on challenge
Subconscious Stigmatisers
Conscious Stigmatisers
Active Discriminators

• Socially unacceptable for mainstream society
• Finding channels and messages to address these
  individuals highly challenging

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Year One Target Audience
Core audience C1C2D, 27-46 (24m people)
No experience of Mental Health Problems
More experience
Very Close
Limited experience of Mental Health Problems, not
completely oblivious
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Mental heAlth Knowledge Schedule (MAKS) (1)
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Mental heAlth Knowledge Schedule (MAKS) (2)

• For questions 7-12, say whether you think each
  condition is a type of mental illness
• (Agree strongly----disagree strongly)
• 7. Depression
• 8. Stress
• 9. Schizophrenia
• 10. Bipolar disorder (manic-depression)
• 11. Drug addiction
• 12. Grief

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Community Attitudes to Mental Illness
(CAMI)

• Items targeted for goal of 5 reduction by 2012
• Virtually anyone can become mentally ill
• People with mental health problems are far less
  of a danger than most people suppose
• People with mental health problems should not be
  given any responsibility

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Reported and Intended Behaviour Scale
(RIBS) (1)

• Instructions The following questions ask about
  your experiences and views in relation to people
  who have mental health problems (for example,
  meaning people seen by healthcare staff)
• Are you currently living with, or have you ever
  lived with, someone with a mental health problem?
  (Yes/No/Dont Know)
• 2. Are you currently working, or have you ever
  worked, with someone with a mental health
  problem?
• 3. Do you currently, or have you ever, had a
  neighbour with a mental health problem?
• 4. Do you currently have, or have you ever had, a
  close friend with a mental health problem?

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Reported and Intended Behaviour Scale
(RIBS) (2)

• 5. In the future, I would be willing to live with
  someone with a mental health problem
• (Agree strongly----disagree strongly)
• 6. In the future, I would be willing to work with
  someone with a mental health problem
• 7. In the future, I would be willing to live
  nearby to someone with a mental health problem
• 8. In the future, I would be willing to continue
  a relationship with a friend who developed a
  mental health problem

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Empowerment Making Decisions (Rogers et al
1997)

• Examples
• People have more power if they join together as a
  group. (4 points, Strongly agree-strongly
  disagree)
• Getting angry about something never helps.
• I am usually confident about the decisions I make.

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Warwick-Edinburgh Wellbeing Scale

• Examples
• Ive been feeling optimistic about the future (5
  points, None of the time---All of the time)
• Ive been feeling useful
• Ive been feeling interested in other people

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Data from the Cambridge Pilot Time to Change
Campaign
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Campaign Overview

• Site specific launch in Cambridge
• 29th Sept 24th Oct
• Advertising venues included
• bus stops
• cafes, pubs
• local radio and paper
• street art
• 1 day football tournament

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Research Timeline - In
person Interviews
Pre-Campaign N92
Post-Campaign N120
During Campaign N198
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Sample Characteristics

• Quotas set pre/post
• 50 advertised press readers
• 50 advertised radio station listeners
• sex, age (25-44), SES (B, C1, C2)
• Social contact know, or have known, someone with
  a mental health problem
• Pre (40.2) Post (51.7)

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Campaign Awareness
Campaign period
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MAKS RIBS Psychometric
Data

• Validity
• Results of our work with expert panels (including
  service users) indicate content validity in MAKS
  and RIBS
• Reliability
• MAKS
• Test-Retest Overall (0.71), Items (0.59-0.91)
• RIBS
• Test-Retest Overall (0.74), Items (0.53-1.0)
• Internal Consistency (0.66-0.82)

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Did the 1-month Time to Change Campaign have any
effect on stigma related Knowledge, Attitudes, or
Intended Behaviour?
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Knowledge About Mental Health
(MAKS)
Significant at the p 0.05 level after
adjusting for social contact
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Attitudes About Mental Health (CAMI)



NOT significant at the p 0.05 level after
adjusting for social contact
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Changes in Intended Behaviour (RIBS) who
agree strongly/slightly
Q. In the future, I could


NOT significant at the p 0.05 level after
adjusting for social contact
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Conclusions and Future Research Directions

• Low to moderate levels of campaign awareness
• Potentially significant improvements in important
  knowledge and behaviour related constructs
• Important to explore the persistence of these
  trends during the national campaign and to
  further explore the relationship between
  knowledge, attitudes and behaviour
• Address potential social desirability and
  modality of MAKS and RIBS