British Journal of Psychiatry. Supplement

BACKGROUND: Evidence on the economic impact of social marketing anti-stigma campaigns in relation to people with mental illness is limited. AIMS: To describe the economic impact of the Time to Change (TTC) anti-stigma social marketing campaign, including the potential effects on the wider economy. METHOD: Data collected for the evaluation of TTC were combined with the social marketing campaign expenditure data to investigate differences in knowledge, attitudes and behaviour in relation to campaign awareness...

BACKGROUND: Education Not Discrimination (END) is the component of the Time to Change programme intended to reduce mental health stigma among professionals and professional trainees. AIMS: To investigate the impact of the END anti-stigma programme on medical students immediately and after 6 months with regard to knowledge, attitudes, behaviour and empathy. METHOD: A total of 1452 medical students participated in the study (intervention group n = 1066, control group n = 386)...

BACKGROUND: England's Time To Change (TTC) social marketing campaign emphasised social contact between people with and without mental health problems to reduce stigma and discrimination. AIMS: We aimed to assess the effectiveness of the mass media component and also that of the mass social contact events. METHOD: Online interviews were performed before and after each burst of mass media social marketing to evaluate changes in knowledge, attitudes and behaviour and associations between campaign awareness and outcomes...

BACKGROUND: In 2006 the Shaw Trust charity found high levels of ignorance and poor preparedness to deal with mental health problems among 480 senior employers in the UK. The UK government, non-governmental organisations and Time to Change (TTC) have since provided relevant assistance to employers. AIMS: To examine whether there have been improvements in mental health-related knowledge, attitudes and workplace practices among British senior employers between 2006 and 2010...

BACKGROUND: Better newspaper coverage of mental health-related issues is a target for the Time to Change (TTC) anti-stigma programme in England, whose population impact may be influenced by how far concurrent media coverage perpetuates stigma and discrimination. AIMS: To compare English newspaper coverage of mental health-related topics each year of the TTC social marketing campaign (2009-2011) with baseline coverage in 2008. METHOD: Content analysis was performed on articles in 27 local and national newspapers on two randomly chosen days each month...

BACKGROUND: Research suggests that levels of discrimination against people using mental health services are high; however, reports of these people's experiences are rare. AIMS: To determine whether the Time to Change (TTC) programme target of 5% reduction in discrimination has been achieved. METHOD: Separate samples of people using mental health services were interviewed annually from 2008 to 2011 using the Discrimination and Stigma Scale to record instances of discrimination...

BACKGROUND: Public stigma against people with mental health problems is damaging to individuals with mental illness and is associated with substantial societal burden. AIMS: To investigate whether public knowledge, attitudes and behaviour in relation to people with mental health problems have improved among the English population since the inception of the Time To Change programme in 2009. METHOD: We analysed longitudinal trends in public knowledge, attitudes and behaviour between 2009 and 2012 among a nationally representative sample of English adults...

This evaluation of the Time to Change anti-stigma campaign in England represents a milestone in international stigma research. While showing some positive outcomes, the overall picture is mixed and falls short of the wholesale shift in attitudes that is needed. A new approach is proposed for the coming decades.

Time to Change (TTC) is the largest-ever programme in England designed to reduce stigma and discrimination against people with mental health disorders. The TTC evaluation partner is the Institute of Psychiatry at King's College London. We give an overview of the TTC programme 2007-2011 and describe how it was evaluated, by introducing the seven interrelated papers in this supplement, which, taken together, describe a complex series of social interventions using a research design of hitherto unparalleled detail and comprehensiveness...

Time to Change is the largest national programme to counter stigma ever undertaken. It demonstrates that stigmatisation and its consequences are gradually becoming recognised as the most important obstacle to the development of mental health programmes. It also demonstrates that they can be prevented or reduced. The programme's evaluation answered many questions but others remain - concerning the indicators of success and ways of assessing them and relevance of the programme's achievements. The programme and its evaluation are important steps in the development of anti-stigma programmes worldwide...

The Time to Change campaign in England has attempted to change attitudes to mental illness at population level. The concept of cultural context is introduced to look at how mental illness functions in society and whether any change in the current context is feasible.

This commentary views the Time to Change programme from a triple perspective: that of a concerned family member, an academic investigator and an American. The programme's results are both encouraging and sobering. Progress has been made in employers' views, but mental health professionals remain a source of discrimination. Future initiatives must have realistic objectives, be multifaceted and avoid overzealous promises.

The Time to Change campaign and its evaluation in this supplement are looked at from a service user's perspective. A number of achievements are applauded, but pertinent questions about the campaign analysis are raised and a qualitative evaluation is called for.

The study of age at onset of mental health disorders is technically and conceptually difficult. It is important to consider these age distributions in order to understand causes and mechanisms of illness and to intervene at an appropriate juncture for primary and secondary prevention. This article reviews some of the approaches to studying age at onset, sets out the evidence to support the assertion that adult mental disorders begin in adolescence, and finds that perhaps half of all adult mental health disorders have begun by the teenage years...

This discussion paper outlines our personal views for debate on some of the complexities inherent in the crucial task of improving mental health services for young people in the UK.

BACKGROUND: Transfer of care from one healthcare provider to another is often understood as a suboptimal version of the process of transition. AIMS: To separate and evaluate concepts of transfer and transition between child and adolescent mental health services (CAMHS) and adult mental health services (AMHS). METHOD: In a retrospective case-note survey of young people reaching the upper age boundary at six English CAMHS, optimal transition was evaluated using four criteria: continuity of care, parallel care, a transition planning meeting and information transfer...

Despite the evidence showing that young people aged 12-25 years have the highest incidence and prevalence of mental illness across the lifespan, and bear a disproportionate share of the burden of disease associated with mental disorder, their access to mental health services is the poorest of all age groups. A major factor contributing to this poor access is the current design of our mental healthcare system, which is manifestly inadequate for the unique developmental and cultural needs of our young people...

Although the corrosive effect of mental ill health on human health and happiness has long been recognised, it is only relatively recently that mental illness has been acknowledged as one of the major threats to economic productivity worldwide. This is because the major mental disorders most commonly have their onset during adolescence and early adulthood, and therefore have a disproportionate impact on the most productive decades of life. With the costs associated with mental ill health estimated to double over the next two decades, a greater emphasis on prevention and early intervention has become even more imperative...

Borderline personality disorder (BPD) is a leading candidate for developing empirically based prevention and early intervention programmes because it is common in clinical practice, it is among the most functionally disabling of all mental disorders, it is often associated with help-seeking, and it has been shown to respond to intervention, even in those with established disorder. Moreover, it can be reliably diagnosed in its early stages and it demarcates a group with high levels of current and future morbidity and mortality...

BACKGROUND: The limited reach and effectiveness of psychological treatments for adolescent depression have fuelled interest in alternative approaches designed to promote resilience. Schools offer a convenient location for the widespread delivery of depression prevention programmes, although little research has evaluated the feasibility of delivering interventions in this setting. AIMS: To investigate the feasibility of delivering and evaluating a universal school-based depression prevention programme for children aged 12-16 years...