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Discussion

Overall, the Attitudes to Mental Illness 2023 presents a complicated picture of change over time. Following a period of improvement, headline knowledge, attitudes, and behaviour measures fell from 2019/2021 to 2023. In the vignettes and workplace attitudes, however, we saw a decrease in stigma and a decrease in the desire for social distance when comparing 2023 with 2007 or 2015.

Although the underlying patterns of change reflect the complex reality of mental health today, they are likely the product of 2 main shifts since measurement of stigma started in England in 2008. The first is that as the COVID-19 era developed into a cost-of-living crisis and widespread economic anxiety, social attitudes towards mental health may have hardened.[9]

Second, the pathbreaking Time to Change national anti-stigma campaign in England, run by Mind and Rethink Mental Illness, wrapped up in 2021. We may now be in a situation where awareness is high but activity specifically targeting stigma is lower than during the period when Time to Change operates.

A comprehensive analysis by The Lancet Commission on Ending Mental Health Stigma and Discrimination of 216 systematic reviews summarised the evidence: what works in tackling stigma is people with lived experience, including of more complex mental health problems, sharing their stories face-to-face.[10] This 'social contact' intervention is the reverse of the shunning many people with mental health problems experience.

Without Time to Change, social contact activities have been harder to organise and deliver at the level needed to continue improving the stigma towards mental health. It should be noted that England is the only nation in the UK not to have a national anti-stigma campaign, with campaigns in Wales and Scotland both receiving government funding.[11]

In Wales, Time to Change Wales is now in its 4th funding cycle focussing specifically on the stigma experienced by racialised communities and those experiencing poverty. The Welsh government mental health strategy, currently awaiting publication at time of writing, contains multiple references to stigma, including in the overall vision for mental health in Wales. This includes commitments to people living free from stigma and discrimination, the need to continue to tackle stigma and views associated with poor mental health and to build on the action already in place to tackling stigma both within the public and within services.

Positive changes have been maintained

While the picture of stigma today is not a simple one, particularly when compared to the changes between 2008/9 and 2019 and the period of the Time to Change campaign, it does seem that important achievements have been maintained. Specifically, decreases in prejudice and exclusion (as measured by the CAMI prejudice and exclusion subscale), a closing of the gap of stigma around schizophrenia and depression (as measured by the Stephen/Andy vignettes), and treatment in the workplace all seem to have held or continued improvements when comparing 2023 with previous data points. In other words, even in the face of the COVID-19 pandemic and economic upheaval, there seems to be a lower level of prejudice and desire for exclusion among adults in England when faced with a concrete example of someone with a mental health problem. This is reason for optimism.

Economic and political impacts on stigma

On the other hand, some aspects of the stigma of mental illness seem to have increased since 2019/21. Items on the CAMI subscale of attitudes relating to tolerance and support for community care, along with knowledge items relating to access to treatment, seem not to have been immune to the effects of the COVID-19 pandemic and the cost of living crisis. These changes suggest that attitudes towards mental illness do not exist in a political or social vacuum, and are closely related to overall perceptions of the efficacy and availability of services. Although it remains to be seen, it is possible that stigma might reduce once the economic situation improves and access to treatment improves, although it is unclear if this improvement in stigma is likely without a national programme of social contact (such as Time to Change).

Notes

[9] Time to Change Wales have commissioned a tracking survey looking at the trend around stigma in Wales, allowing us to see what the impact of these wider societal levers has been and whether this is consistent with what we have seen in England.

[10] See The Lancet Commission on Ending Stigma and Discrimination in Mental Health (2022)

[11] While Time to Change Wales and See Me in Scotland receive government funding, Inspire in Northern Ireland does not.

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