attention given to mental health during the pandemic owes much to increased public awareness and sensitivity about the subject in the 21st century. This was partly the result of Time to Change, a 15-year campaign by Mind and Rethink Mental Illness, another charity, to change attitudes. The treatment of those with mental illness had improved enormously since the 18th century, when people could pay to watch the disturbed behaviour of the patients in ‘bedlam’– the Bethlem Royal Hospital, located until 1936 in the grand, colonnaded building which is now the Imperial War Museum in London. In Victorian times the attitude to mental illness was more humane, but treatment was based in large asylums with strict regimes which remained the norm well into the 20th century.
In the 1970s, however, the government was persuaded to adopt a policy of ‘care in the community’. This involved closing many of the big asylums and arranging for people to live independently, with psychiatric supervision if necessary, or to be cared for in smaller units and hostels. But care in the community had its failures. In one notorious case in 1992 a newly married man, Jonathan Zito, died after being stabbed in the face on a train platform in London by Christopher Clunis, a young man with a history of mental illness who had been deemed suitable for independent living despite repeated episodes of violent behaviour.35 This and other incidents led to a backlash in the tabloid press, which contended that community-based mental health services were failing to protect the public from what it called ‘schizos’ or ‘psychos’.36
The regular Community Attitudes to Mental Illness (CAMI) surveys, funded by the Department of Health and Social Care (DHSC), revealed fear and discriminatory attitudes.37 When the survey began in 1994, only 42% of a representative sample of the population believed that ‘mental hospitals are an outdated means of treating people with mental illness’. The proportion agreeing that ‘it is frightening to think of people with mental problems living in residential neighbourhoods’ rose from 15% in 1994 to 26% in 1997. In that year 33% also believed that ‘anyone with a history of mental problems should be excluded from public office’.
Mind decided to try to help bring public attitudes into line with public policy. Sue Baker, hired in 1996 to set up the charity’s media department, recalls one memorable double-page tabloid spread featuring pictures of machetes dripping with gore, accompanied by accusations that the government had blood on its hands because of its care in the community policies. She also remembers Mind’s head of policy returning from a visit to the regions and relating how someone had thrown a brick through a young woman’s window when her neighbours discovered she had recently been discharged from a psychiatric hospital: “We were hearing these sorts of things all the time, but for me that was the final straw.”
She organised a project called ‘Not just sticks and stones’, based on interviews with nearly 2,000 people with mental health difficulties who told story after story about being refused jobs, education or housing, losing friends or relationships or being verbally or physically abused.38 The media launch of the results was a great success, securing “wall-to-wall coverage on all the TV stations for 24 hours”, according to Baker, and from then on there was a discernible shift in the tone of press coverage. Subsequent CAMI surveys revealed a softening of public attitudes, albeit marginal, and Baker and her colleagues became convinced that a high-profile, multifaceted campaign to reduce the stigma of mental illness could have a real impact.
After two years in New Zealand working for the Mental Health Foundation there, Baker was rehired in 2007 to lead Time to Change, the joint campaign between Mind and Rethink, financed for four years with a grant of £20 million from Comic Relief and the Big Lottery Fund. The project ran programmes with employers and schools and helped people with experience of mental illness to tell their stories and set up campaign groups; from 2011 the DHSC also contributed funding. The evaluation of Time to Change from 2008 to 2014, based partly on an analysis by the Institute of Psychiatry, Psychology and Neuroscience (IoPPN) at King’s College, London, had encouraging results.39 This analysis drew on a survey in which 1,000 people who had used mental health services in the last 12 months were interviewed about their experiences. It said:
Comparing 2014 with 2008, there were significantly fewer experiences of discrimination with respect to friends, family, social life, dating, mental health staff, finding a job, keeping a job, police, education, religious activities, privacy, starting a family, or being shunned. The evaluation also notes a direct correlation between these findings and the Time to Change campaign. When the data from all time points are aggregated, a significant relationship between awareness of Time to Change and each of the outcomes is apparent.
In 2017, Time to Change and the IoPPN also released research showing that reporting of mental health by the print media was more balanced and responsible than before.40 This study was based on an analysis of articles on mental illness in 27 local and national newspapers on two randomly selected days of each month during 2016. For the first time since the study had begun in 2008, there were more articles promoting mental health or portraying mental illness in a sympathetic way (50%) than stories that portrayed people with mental illness as a danger or problem to others or as hopeless victims (35%). The remainder were mixed or neutral.
Professor Sir Graham Thornicroft, who leads the team at the IoPPN, credits Time to Change with making a definitive impact on attitudes to mental illness:
“There is no doubt that stigma and discrimination are slowly but steadily decreasing in England. This is against a backdrop where, before Time to Change, they were actually increasing. The team at King’s College has published over 100 scientific papers about stigma since Time to Change began, looking in detail at many aspects of the impact, and we’ve seen how it has improved knowledge, attitudes and behaviours. I do not think that all the stigma reduction in England is due to Time to Change, but I do think it has been the leader in this field and made the major contribution to these forms of social progress.”
The biggest lesson from ten years of Time to Change, says Baker, who went on to become the campaign’s global director, was that it demonstrated the effectiveness of leadership by people with direct personal experience:
“It’s those of us with mental health problems leading change in our communities, workplaces, schools, at a national level – using our mental health issues as an asset, not a deficit. It was because so many people stayed silent for so long that you didn’t realise you sat beside or were managed by or managed someone who had a mental health problem. All of that was hidden because people were so afraid of the consequences of being up-front about it.”
Steve Loft was one such individual. In 2011 he was signed off from his job at Transport for London (TfL) for eight months while being treated for stress and depression. But going back to work was a trial. “It was like there was a big exclusion zone around me – nobody knew what to say to me,” he recalls. “Although I had a good line manager, he did not have a clue about how to deal with someone with a mental health problem.” Loft discovered that TfL had in fact signed the Time to Change pledge two years earlier, and he persuaded the company to set up an intranet site and a peer-support group that by 2019 had nearly 300 members. Time to Change supplied resources and speakers, and Loft became a ‘workplace champion’:
“This is really powerful as it gives people confidence to share their own experiences. I’ve seen a sea-change in attitudes to mental health in the last six years. I go out now and train other champions, and if I had a pound for every time someone said attitudes are changing, I’d be a rich man. I think there is going to come a tipping point. I’m old enough to remember all the things that used to happen with race, but then at some stage people just weren’t prepared any longer to listen to other people talking and acting in a discriminatory way. I still think mental health has got a way to go, but it’s certainly shifted a hell of a lot in those few years, and that’s got a lot to do with those charitable organisations that have worked really hard to change things. Now, when people come back to work at TfL after being off for stress, I’ve noticed that others go and talk to them – they’re
