Author: Bryan P. White
Original Publication: 05/02/2020
Time to Change
Time to Change (NSMC, 2010a) is an anti-stigma campaign in the United Kingdom (UK) that is focused on reducing the stigma associated with mental illness in the workforce. The focus of this campaign was to change the perception, and ultimately influence behavior, of people who might be interacting with those that have mental illness in a work-place setting. The need for this campaign is due to the high level of individuals with mental illness experiencing some negative behavior directed towards them in the workplace as a result of their mental illness (9 out of 10 affected by mental health problems have reported some type of discrimination at work as a result of this). Additionally, large numbers of people have reported being dismissed from a job for mental health problems (1/3rd), 49% had been harassed or attacked, and 24% had been refused insurance, finance companies, or some other business type of transaction for their mental health.
Since many people will experience mental health issues at some point in time in their life (1 out of 4 people), expanding resources to reduce these types of negative behaviors is a critical health goal of the Department of Health & Social Care (UK). In order to work towards ending these types of discrimination, Mind and Rethink and the Institute of Psychiatry at King’s College, London have developed the Time to Change program, and England-wide social marketing program to end discrimination surrounding mental health problems. Specific goals for the program included an increase in public awareness of the issue to the 30 million adults living in England, achieve recordable positive attitude shifts towards people with mental health problems, increase the ability of people with mental health problems to challenge discrimination, engage people in participation of physical activity events, and improve the mental and physical wellbeing of people with mental health problems through community projects. Previous attempts to achieve these goals have been rather piecemeal, and Time to Change sought to be a comprehensive program.
This program began in 2007 where it entered a “Scoping Phase”, which was used to determine the scope, target audience, and implementation details of the project by conducting a series of surveys. The group determined that the target audience to be middle to lower socio-economic status in the mid-20’s to mid-40’s and have some proximity to people with mental health problems, such as friends, co-workers, or family members. In order to best understand how members of these target groups might be influenced to improve their behaviors towards people with mental health problems, interviews were conducted. Some of the key discoveries here were that the origins of discrimination might be derived from fear, a perception that mental health is an invisible issue (no connection to their personal life), lack of the perception of their own knowledge gap surrounding mental health, a feeling like they are “walking on eggshells” (again related to knowledge gap), and an overall misperception that mental illness is uncommon.
The next phase of the program was the development portion, which included the consulting of people affected by mental health problems. These individuals helped develop guidance for the program, review program progress, and act as external spokespeople for the program. Some of the outputs of the program included “Get Moving Week”, an outdoor activity designed to get people with mental health problems out in the same area as people without mental health problems and engage in some fun outdoor activities together. Another program output was “Time to Challenge”, which aimed to take instances of potential discrimination due to mental health through the courts and establish precedence for protecting the rights of those with mental health problems. One last program was the “Education Not Discrimination (END)” program, which aimed to provide training towards medical students, teachers, and school social officers. Increasing social contact was a key aim of this program, which was done through lectures, testimonies, and interactive group activities.
In terms of media campaigns, TV and radio advertisements were created, as well as print ads, and millions of “myth/fact” beer mats (coasters) were created. Facebook, YouTube, and Twitter were also used to initiate program activities, program recruitment, and engage the various audiences in informational campaigns as well as give participants a way to show their support for the program.
The key results from 2009 to 2010 from the program were a 4% decrease in discrimination experienced by people who have a mental health problem, 9% decrease in discrimination while searching for a job, and 6% reduction in the number of people who lost a job due to a mental health problem. The broader, public health reach was enumerated by a reach of 34 million people through advertising and PR, a 1.3% increase in positive public attitudes towards people with mental health problems, a strong reduction of people who viewed people with mental health problems as dangerous (19% of those who were engaged in the campaign), and a large percent of people (35%) engaged in the “Time to Get Moving” event left the event with a more positive impression of people with a mental health problem than before. Overall, the program could be considered a success, and the data and research gained from it will be used to develop and incorporated into future public health outreach programs using mass media.
Worklessness Collaborative Programme
The “Worklessness Collaborative Programme” (NSMC, 2010b) is a collaborative program aimed at reducing worklessness (“unemployment” in the US) in highly affected regions (wards) in the UK. The goal of the program was to engage the community through the creation of community teams made up of local residents and service providers who could inspire community members to achieve personal change, enable them to access appropriate work, and reduce the dependence on social benefits by gaining independence.
This program was conducted in the North East Lincolnshire (NEL) region of England, which has suffered from a decline in its traditional industries of fishing and manufacturing. This has resulted in a large rate of worklessness, 17.5%, which is higher than the national average of England at 13.2%. Funding for the program was awarded as part of a broader goal to increase full-time sustainable work in the area. This program was developed as a 14-month pilot program to test and understand what types of community initiatives might be effective at reducing worklessness in the area.
The primary aims of the pilot program were to reduce child poverty, improve worklessness statistics, and increase economic wellbeing and profitability in the region. To achieve this, broad goals included raising awareness of tools already in place, helping people to access these tools and community support resources, and increasing the total number of people accessing help.
The target audience of the program was initially identified as economically inactive (“workless”) residents in the priority regions, specifically focusing on caregivers (e.g., parents, grandparents, or others) and lone parents.
This audience was further segmented into four subcategories: 1. Out of work but looking to re-engage: Requires some assistance 2. Out of work but potentially looking to re-engage: Some skills-based barriers 3. Out of work and lacking motivation: Requires additional support and skills-building 4. Out of work for a prolonged period: Significant resource need, potentially including healthcare resources
Following the identification of an initial target audience, an initial set of community workers began surveying the area to identify additional specifics about the reasons behind their experiencing worklessness. Key factors preventing members of the target audience from obtaining work included: 1. Search difficulty - Difficulty in the perceived amount of time required to obtain a job. 2. Social standing – People seemed relatively unengaged in a peer-setting in terms of job seeking behaviors. 3. Childcare time – Some people prefer to differ job seeking until their children reach a certain age 4. Economic benefits – People are reluctant to give up social benefits obtained during worklessness and did not see the benefit of having a jab 5. Child dependence – Childcare by a parent takes up a significant amount of time that could be driven towards job seeking, skills training, or other employment-related behaviors 6. Economic downturn – National and local media reflect a negative image of worklessness, which feeds back into a fatalistic attitude and can create low self-esteem among the target audience 7. Inflexibility in services – Social services providing work seeking help were seen as inflexible and not responsive to jobseekers needs. 8. Inappropriateness of services – A perception that existing services did not benefit jobseekers needs. 9. Customer service – Some community members perceive the services as being “lecturing” or “judgmental” 10. Peer influence – How community members saw themselves perceived by their peers might have influenced their behaviors towards job seeking 11. Low motivation - Low confidence or motivation might prevent community members from accessing job seeking resources 12. Lack of trust – Many community members reported a general distrust of the sources of information related to job seeking, regardless of region
To address these issues identified in the communities, teams were developed that consisted both of hired professional community workers as well as local unemployed individuals who were either young parents or older unemployed people. Community team members were rewarded based on their participation in acquiring new skills (e.g., training themselves or community members in research skills), developing confidence to influence their community, and participating in learning events. One of the motivating factors that were identified during the surveys and community activities was the children of young unemployed parents, summarized by the quote that parents would “do anything for their children”. Some of the community members were employed as “community champions” and served to further expand the communication and information resources related to job seeking in their communities, as well as expanding their own work-related skillsets.
Overall, the program saw the inclusion of 2,098 participants during the years of 2009 and 2010. Some of the key metrics they saw improvements on included the following: Increasing the availability of new jobs, demonstrating partnership working between agencies, increasing worker referrals to jobs programs, increasing confidence in available programs, increasing volunteering roles, and increasing publicity of the programs. Some of the challenges the program saw were difficulties in measuring confidence, difficulty in engaging with the Jobcentre Plus agency (likely due to unwillingness by the agency to engage at a local level), managing the complexity of programs and dealing with large variety of local and regional stakeholders.
Comparison of the Two Programs
The first study, Time to Change, is a more traditional public health intervention, whereas the second study, Worklessness Collaborate Program, is more of a community intervention that worked well within existing frameworks. It seems like in the case of Time to Change, the primary issue with mental health is public perception of individuals with mental health problems, and a general lack of willingness to engage with those people, which results in negative stereotypes and perceptions. In the case of the Worklessness Collaborative Program, public distrust of existing government agencies, as well as motivational issues, appear to be the primary problem. In both cases, the issue of public distrust is a major problem. It could be a cultural bias in the UK towards public distrust of the government and medical issues, in general, perhaps due to historical biases in their class structure system. At least one previous study has reported the notion of public distrust as a determining factor in public health in the UK (Swift et al., 2018).
National Social Networking Centre (NSMC). (2010a). Time to Change | The NSMC. Retrieved 05/01/2020, from https://www.thensmc.com/resources/showcase/time-change
National Social Networking Centre (NSMC). (2010b). Worklessness Collaborative Programme | The NSMC. Retrieved 05/01/2020, from https://www.thensmc.com/resources/showcase/worklessness-collaborative-programme
Swift, J. A., Strathearn, L., Morris, A., Chi, Y., Townsend, T., & Pearce, J. (2018). Public health strategies to reduce sugar intake in the UK: an exploration of public perceptions using digital spaces. Nutrition bulletin, 43(3), 238-247.