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

Background We 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 programme’s end in 2021. Methods We 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. Findings Reported 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 (β=-2.69, p<0.001) and schizophrenia (β=-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). Conclusions The 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. ### Competing Interest Statement C.H. has received consulting fees from Lundbeck and educational speaker fees from Janssen. A.R. declares no conflict of interest. No authors participated in the planning or execution of Time to Change. ### Funding Statement The funding for the research following Time to Change was provided by Mind. The Time to Change evaluation was funded by the UK Government Department of Health and Social Care, Comic Relief and Big Lottery Fund. C.H. was supported by these grants during phases 1 to 3 of TTC and E.J.R. during phases 2 to 3. The funding source had no involvement in the study design, data or report writing. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Kings College London Psychiatry Nursing and Midwifery Research Ethics Subcommittee exempted analysis of these survey data as secondary analysis of anonymised data. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors