Is #mentalhealth anti-stigma work a drive for acceptance or a driver for change?

The below is the original draft of an article by Mark Brown which appeared in a different form at BBC Ouch under the title ‘Viewpoint: Talking about mental health is just the first step’

More people in the UK than ever before are talking about mental health and mental illness.  On February 5th this year, people will be encouraged to spend five minutes talking about mental health as part of the second annual Time to Talk day, an initiative of the national anti-mental health stigma campaign Time to Change.

Launched in 2007, Time to Change is a partnership between Mind and Rethink Mental Illness, two of Great Britain’s largest mental health charities.  Its website states that it is a “groundbreaking anti stigma campaign across England to challenge attitudes and change behaviour around mental health problems”.  Time to Change is based on the idea that more people speaking about mental health difficulties will remove judgemental attitudes toward those people who experience them.

Stigma is the interaction between people or characteristics that society feels unacceptable and the people this labels.  Experiencing a mental health difficulty can be isolating and frightening.  We can find ourselves unwilling or unable to talk to others about the things we experience because we are fearful of the consequences.  People experiencing mental health difficulties like schizophrenia, bipolar disorder, eating disorders and depression have often experienced prejudice, discrimination and have often been  excluded from areas of life and community in which they might otherwise expect to take a full part. Part of stigma is the internalised feeling of shame for being what you are, and receiving positive responses rather than negative ones can help to dispel this feeling.  From an individual perspective, it can be liberating and validating to be able to ‘come out’ and speak about difficult experiences or sensations.

To date, Time to Change has received £38million in funds to change our minds about people with mental health difficulties: £18m in its initial phase, £16m from the Department of Health and £4m from Comic Relief in 2011; with more funds promised to carry the programme beyond the end of its current funding March 2015.  According to Mind, the most recent National Attitudes to Mental Illness survey, carried out in 2013, found that “since the beginning of the current programme of Time to Change (2011) an estimated two million people – or 4.8% of the population – have improved attitudes towards people with a mental illness.”

Whether the rise in positive attitudes translates into an improvement in the lives of those with mental illnesses is something critics of the programme question.  Time to Change was launched at the beginning of worldwide financial crisis and has run alongside  austerity reforms to social security protections such as the removal of Incapacity Benefit, the introduction of the Work Capability Assessment and cuts to social care and NHS funding which some source allege disproportionately affected the lives of many people with mental health difficulties.  Critics of Time to Change claim its approach is too shallow and does not examine ways in which prejudice and discrimination can be structural as well as personal.  Some liken Time to Change to similar campaigns in the broader Disability world which have focused on slogans such as ‘See the person, not the disability’ which focus on being ‘nicer’ to individuals rather than changing structures, laws and circumstances that disadvantage Disabled people collectively.

Some argue that Time to Change actually makes it more difficult for people who do have stigmatised experiences such as voice hearing; or who have periods of illness or symptoms that disrupt their lives; by pushing these less palatable experiences to the margins in an effort to sanitise the image of mental health difficulty for public consumption.  A subsection of campaigners and activists feel that the focus on the telling of personal stories of mental health difficulty to fight stigma has individualised understandings of mental illness, moving the debate further away from what concrete, collective social changes need to be made to support people with their mental health.  These people would claim that shame is not their problem but systematic prejudice and discrimination.

Over the lifetime of Time to Change discussion about mental health has risen in prominence in the public sphere, as have media portrayals and news coverage. The Liberal Democrats, as partners in the current Coalition government have given prominence to mental health within their campaign for this year’s general election and have promised new funds and standards for NHS mental health care.

As with all mass campaigns; a message clear enough to penetrate the background chatter of everyday life is in danger of losing some of its nuance and context.

The focus of Time to Change is not solely on encouraging people to have their first conversation about mental health, but this has been its most prominent call to action. The conversations that Time to Change encourages, from five minute chats to grand media saturated political performances are an attempt to build the platform for a wider change.  There is a danger that the people talking about personal experiences and others accepting them is seen as the goal.  For each year that it and programmes like it continue, the number of people who have already had their first conversation about mental health will grow.

Today, on Time to Talk day, some already comfortable speaking about mental health and mental illness will asking: if we’ve started people thinking and talking about mental health and how they behave towards people with mental health difficulties, how will we move people on to thinking about the way that society as a whole treats those same people?

Mark Brown is development director of Social Spider CIC. He is @markoneinfour on twitter

 

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3 Responses to Is #mentalhealth anti-stigma work a drive for acceptance or a driver for change?

  1. Mike says:

    Great article Mark. I agree that removing stigma and increasing understanding is good, but it doesn’t change anything if companies and government don’t make changes to support people more with mental health issues.

    When I had mental health issues the NHS were absolutely useless. I had to pay for my own counselling which got me in to debt. The whole ATOS situation surrounding ESA made my illness deteriorate (Rethink, the mental health charity, has echoed this as a common occurrence in others). In short no change has been made, and in fact the government has made it far worse for people.

    In funding Time To Change, the government is merely doing a PR exercise and trying to make themselves look compassionate. Their overall effect has been to make the situation far worse. TTC appear to have honourable intentions, and they have made a big difference. But like I say the government doesn’t really want to make changes for the better.

    A certain section of the mainstream media has created huge stigma for those on benefits, including those on sickness benefit. This has public opinion decline. So it’s a situation where people are more understanding (i.e. “Poor you, you have mental health issues”), but the other opinion running in parallel with this is “but my taxes aren’t going to help support you”.

    In short the current government don’t care, and even more they are doing high amounts of damage to society as a whole.

  2. Rosanna Hunt says:

    It is a very positive step to have started people thinking and talking about mental health through these campaigns. It is empowering for those who “come out” and share their stories (including myself – http://changeday.nhs.uk/story26/). We wouldn’t be able to do this without all the campaign energy that is behind us, enabling us to share through social media.

    If we are going to move people on to thinking about the way that society as a whole treats those same people – I think we need to start by focussing on how the individual behaves towards people with mental health difficulties. Whether or not these campaigns have succeeded in reducing the stigma, I’m not sure that it automatically follows on that people now know how to behave towards people with mental health difficulties.

    Fundamentally, people with mental health difficulties are treated by those around them as though they are to blame for their behaviour. Perhaps if we can strive to understand what triggers the “unacceptable” behaviour, we can start to have more open conversations about what everyone involved can do, to remove them.

    So, perhaps the next step on from sharing our stories and experiences, is to share our triggers, our coping strategies and how believe that those around us can help us better. Whatever we do, we must keep the energy positive and progressive. This isn’t about finding fault in anyone or any system, this is about everyone helping each other to make the world a better place to live.

  3. John Vanek says:

    There are some excellent comments here. The Time to Change campaign hasn’t (as Mike points) affected government policy. Talking Therapies have been and still are, touted as an available service and legal right for anyone on a care plan. But when I worked directly with clients with long-term MH conditions these were NEVER available in the south London borough where I worked.

    Also, Time to Change is predicated on a medical model – talking about your diagnises or symptoms. To me this still laves the discussion indirectly in the overall hands of the clinicians. There are many more approaches to mental health empowerment. As Mike points out, once you’ve found ‘time to’ talk about conditions, diagnoses and stigma, where is there to go to follow on? Mental health management also requires assessments based on individuals’ goal, hopes aspirations. The asassessor should be equipped to guide rlthe client to further outlets in mainstream where these aspirations can be developed. The continuation of a purely diagnostic model can only result in further spins of the revolving door.

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