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'see me', the national Scottish campaign against the stigma and discrimination associated with mental ill-health, was launched in October 2002. Funded as part of the Scottish Executive National Programme for Improving Mental Health and Wellbeing, but managed by an alliance of five mental health organisations. The campaign's activities have included national-level publicity campaigns targeted at the general population, targeted publicity campaigns aimed at specific groups or environments, work with the media, and support for local activities.
An independent evaluation of the inception and the first four years of 'see me' was commissioned by the then Scottish Executive in 2006. The aims of the evaluation were to co-ordinate a detailed account of the development and activities of 'see me', determine the extent to which the campaign had met its own strategic objectives and make recommendations for future work in Scotland to address the stigma and discrimination experienced by people with mental health problems.
Main Findings
- As one of a range of initiatives funded as part of the National Programme for Improving Mental Health and Wellbeing, the 'see me' campaign has been central to giving a high-level profile and identity to activities aimed at increasing mental health awareness and drawing attention to the stigma and discrimination experienced by people with mental health problems.
- In terms of media reporting, the 'see me' campaign is perceived to have had an important role in creating an environment in which it becomes increasingly unacceptable to use derogatory terms or negative story lines in relation to mental health or people with mental health problems.
- The campaign has encouraged a breadth of local activity. Developing an approach of 'knocking on open doors' has been productive in the early stages, but different processes of engagement may need to be considered in those areas still behind 'closed doors'.
- Factors within the 'see me' campaign that have supported the realisation of its objectives include: a clear sense of purpose and direction, strategically and operationally; its professionalism, skills and expertise; and its relative independence from the Scottish Executive.
- A key factor within 'see me' 's environment that may have limited realisation of its objectives is the level of campaign funding at local and national level.
- Issues for the future include the need to address the discrimination embedded in the processes and practices of organisations and agencies. A three-tiered model is proposed, which places 'see me' at its heart while also encouraging others to take responsibility for overcoming the inequalities and systematic exclusions people with mental health problems continue to experience.
Background
The 'see me' campaign was launched in October 2002 with the purpose of tackling the stigma and discrimination experienced by people with mental health problems.
The campaign's inception and on-going development occurred in the context of wider political, policy and legislative changes within Scotland. This included the introduction of the new Mental Health (Care and Treatment) (Scotland) Act 2003 and the setting up of the National Programme for Improving Mental Health and Wellbeing (the 'National Programme'). The campaign was initially developed independently by an alliance of five mental health organisations, and subsequently came to form one part of the National Programme.
The 'see me' campaign's core objective was to tackle stigma and discrimination by raising public awareness of how both affect individuals with mental health problems, and by improving public understanding of mental health. In addition, the campaign aimed to challenge individual incidents of stigma and discrimination; involve people in anti-stigma activities across Scotland at national and local levels and across sectors and communities of interest; ensure that the voices and experiences of people with mental health problems and their carers are heard; and to promote a culture of learning and evaluation through all its work, so that effectiveness can be demonstrated and lessons shared.
The then Scottish Executive commissioned an independent evaluation of the first four years of the campaign (2002-2006).
Research aims
The main aims of the evaluation were to:
- Co-ordinate a detailed account of the development and activities of 'see me'
- Determine the extent to which the campaign had met its own strategic objectives
- Make recommendations for the future development of anti-stigma work in Scotland.
Evaluation approach
The evaluation drew on a range of methods including:
- Documentary analysis
- Face-to-face and telephone interviews
- Electronic surveys
- Workshops and focus groups
- Media content analysis.
The participants represented a broad range of actual and potential stakeholders including:
- The 'see me' management group, operational team, communications agency and media volunteers
- Service users and carers
- Scottish Executive stakeholders and other National Programme delivery vehicles
- Media professionals
- Agencies working with different equalities groups
- statutory agencies
- voluntary organisations,
- private companies
Main findings and conclusions
Background and strategic development
The campaign management group comprised representatives from the alliance of five organisations who initiated the campaign. Operationally, the campaign started with a team of three people and this had increased to eight by the time of the evaluation. Creative development and public relations activities were undertaken by a communications agency.
Although wholly funded by the then Scottish Executive, the early development and continued management of the campaign by the alliance of organisations gave 'see me' a strong internal cohesion and sense of its relative autonomy. This comparative independence was valued both by those directly involved in the campaign and those outwith for giving it a credibility and freedom of action that a government-run campaign may not have had. It did, however, raise governance issues in terms of ownership and control of the campaign 'messages'.
The campaign took a general population approach, informed by the model of a journey from raising awareness to changing attitudes and then to changes in behaviours. This model was underpinned by the view that it takes a generation to effect change. To begin this change process, the campaign used social marketing techniques coupled with a community development approach.
Drawing on these approaches, 'see me' developed high-level national campaigns targeted at the general public, workplace and young people, as well as a number of other mechanisms for raising awareness of stigma. These included developing a pool of volunteers trained to talk to the media about their own experiences, Stigma Stop Watch, which enabled people to draw the campaign's attention to negative (and positive) representations of mental health issues in the media, and the development of media guidelines and fact sheets. In addition, the campaign sought to link and work with local areas to support local level activities. Branding these local and national level activities under the 'see me' banner was felt to be important for maximising impact.
Progress against objectives
Objective 1: To tackle stigma and discrimination by raising public awareness of how both affect individuals with mental health problems, and by improving public understanding of mental health
National surveys and surveys commissioned by 'see me' over the period 2002-2006 revealed positive shifts in mental health awareness and in expressed attitudes towards people with mental health problems, as well as growing recognition of the 'see me' brand name. Awareness was particularly high among people with direct experience of mental health problems.
The number of other parallel initiatives over this period makes it difficult to estimate the specific contribution of 'see me'. Nonetheless, the perception among those interviewed as part of the evaluation was that the campaign had contributed to increased mental health awareness at individual and organisational levels. The campaign was also felt to have 'galvanized' the mental health community in Scotland.
Interviewees also raised a number of issues that may have implications for on-going work to tackle the stigma and discrimination experienced by people with mental health problems. These were:
- Whether the quality of the campaign may have had the unintended consequence of deferring responsibility for anti-stigma work to 'see me', rather than embedding it within agencies and organisations;
- To what extent the campaign had been able to reach beyond the environments of the already willing or sensitised;
- Although the campaign sought to be inclusive, whether a 'general population' approach can be sensitive to the diversity of the population, including people who may be subject to multiple sources of discrimination;
- whether a public relations campaign alone could lead to a deeper understanding of the issues.
Objective 2. To challenge individual incidents of stigma and discrimination
In terms of media reporting, the campaign, including the work of the media volunteers, was felt to have had an important role in creating an environment in which it was becoming increasingly unacceptable to use derogatory terms or negative story lines.
Objective 3. To involve people in anti-stigma activities across Scotland at national and local levels and across sectors and communities of interest
The campaign encouraged a breadth of local activity by adopting an 'open door' approach, developing contacts where there was already a degree of commitment or interest. While this may have meant that the campaign's reach did not extend to some of the more intractable environments, evidence suggests that 'see me's' involvement helped to initiate a number of anti-stigma activities and progress existing activities.
Objective 4. To ensure that the voices and experiences of people with mental health problems and their carers are heard
Whether as media volunteers and/or as participants in campaign design and implementation, 'see me' had sought to involve users and carers. The pattern at local levels was more variable.
Objective 5 . To promote a culture of learning and evaluation through all its work, so that effectiveness can be demonstrated and lessons shared.
'see me' had a strong within-campaign culture of research and evaluation. This included pre-campaign strand research and post-campaign strand evaluations of reach and recall. However, there was less evidence of this culture having extended to local areas.
Conclusions
Factors within the campaign that supported the realisation of its objectives include a clear sense of purpose and direction both strategically and operationally and its professionalism, skills, expertise. The level of campaign funding, to maintain both a national campaign and support developments at local level, may have limited the scope of what 'see me' could achieve.
To sustain and build on the gains that 'see me', together with its partners at local and national level, has achieved, a strategic approach that places 'see me' at its heart, but also encourages others to take responsibility for tackling the stigma and discrimination experienced by people with mental health problems is required.
Recommendations
Four specific recommendations are made. These are:
Promoting fairness and equality for people who experience mental health problems means addressing the stigma and discrimination both at the level of individual attitudes and behaviours, and at the wider structural level
This suggests the need to include a broader understanding of the processes both of stigma and of discrimination, including sources of 'institutional discrimination' that play out in the processes and practices of organisations and agencies.
The active engagement of other agencies, organisations and policy areas to integrate an understanding of the stigma and discrimination experienced by people with mental health problems within their own 'domains' and take responsibility for appropriate remedial action
The next phase would see 'see me' remain as a valued part of a wider programme of work, playing an enabling role, supporting others in striving towards common objectives.
A multi-dimensional approach is needed with supporting action at policy and legislative levels, but also through the development of interventions and approaches, tools and resources.
Action needs to be multi-layered to comprise developments within and across policies at national level; developments at local level and within organisations and institutions; and developments at the level of individual awareness raising and training.
The focus for this future work, informed by the evidence base should include:
- Targeting those environments where the greatest 'injury' may be sustained
- Targeting action on those groups whose exposure to stigma and discrimination may have an impact on their mental health and well being
- Targeting those groups where the evidence base suggests opportunity for positive change.
While there is clearly a need to maintain a high level national campaign, the complexity of the issue suggests that the next stage requires broadening out responsibility to ensure that the stigma and discrimination experienced is more sharply integrated into actions to tackle inequalities.
To inform this strategic approach, drawing on a health improvement paradigm, a three-tiered model is proposed encompassing primary level awareness raising; secondary level prevention and tertiary level direct action. As a first step, it is suggested that a forum for dialogue is established between different stakeholders.
1In September 2007, the Scottish Executive was re-designated the Scottish Government. In the interests of accuracy, the term Scottish Executive has been retained when this refers to actions prior to September 2007.
This document, along with "Evaluation of 'see me' - the National Campaign Against the Stigma and Discrimination Associated with Mental Ill-Health" (the full research report of the project) and further information about social and policy research commissioned and published on behalf of the Scottish Government, can be viewed on the Social Research website at: www.scotland.gov.uk/socialresearch. If you have any further queries about social research, or would like further copies of this Research Findings summary document, please contact us at socialresearch@scotland.gsi.gov.uk or telephone 0131 244 7560.
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