Mental illness stigma in England: What happened after the Time to Change Programme to reduce stigma and discrimination?

BackgroundWe investigated the extent to which positive changes in stigma outcomes reported over the course of Time to Change were sustained by 2023, two years after the programmes end in 2021. MethodsWe used regression analyses to evaluate trends in outcomes. Measures were of stigma-related knowledge (Mental Health Knowledge Schedule (MAKS)), attitudes (Community Attitudes to the Mentally Ill scale (CAMI)), and desire for social distance (Reported and Intended Behaviour Scale (RIBS)). We also examined willingness to interact with people based on vignettes of depression and schizophrenia, and attitudes towards workplace discrimination against people with these conditions, using data from the British Social Attitudes Survey (BSAS) 2015 for comparison. FindingsReported in standard deviation units (95% confidence intervals (CI)), attitudes towards mental illness improved between 2008 and 2023 (SD=0.24, 95% CI=0.16 to 0.31), but following an increase of 9.9% between 2008-19, scores decreased by 3.3% (p=0.015). After improvements to 2019, 2023 MAKS and RIBS scores no longer differed from 2009 scores, indicating decreases since 2019 in stigma-related knowledge (MAKS scores declined 7.8% since 2019, p<0.001) and willingness to interact (RIBS scores declined by 10.2% since 2019, p<0.001). Conversely, comparison with BSAS 2015 data indicated that in 2023 respondents were more willing to interact with people with depression ({beta}=-2.69, p<0.001) and schizophrenia ({beta}=-2.70, p<0.001); and more likely to agree that people with either condition are just as likely to be promoted, and to disagree that their medical history should influence this. This change was most pronounced for schizophrenia (OR=2.52, 95% CI=2.02 to 3.14). ConclusionsThe lasting positive changes reflect support for non-discrimination and willingness to interact with someone after a sense of familiarity is evoked. Besides the end of Time to Change, interpretations for declines in other outcomes include the impacts of the covid-19 pandemic; economic stress; and reduced access to healthcare.