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CHAPTER ONE INTRODUCTION

Background

1.1 According to the World Health Organisation ( WHO) "The single most important barrier to overcome in the community is the stigma and associated discrimination towards persons suffering from mental and behavioural disorders" ( WHO, 2001, p. 98). International research as well as studies undertaken in the UK reveal the extent of these negative attitudes and the very real impacts these have on the lives of people with mental health problems, on their families and those close to them (Glendinning et al, 2002; Braunholtz, et al, 2004; Braunholtz, et al, 2007; Manning and White, 1995; Payne, 2000; Read and Baker, 1996; Thornicroft, 2006).

1.2 To address the negative attitudes and behaviours which systematically disadvantage people with mental health problems and those close to them the 'see me' campaign was launched in October 2002 with the explicit purpose of ending "the stigma and discrimination associated with mental health problems by running a sustained, high profile Scotland-wide campaign" ( [people too] project proposal, 2001). Funded by the Scottish Executive ², but managed by an alliance of five mental health organisations, the campaign has encompassed: national level publicity campaigns targeted at the general population; targeted publicity campaigns aimed at specific groups or environments through its young people and workplace strands; work with the media; and support for local activity through the provision of materials, advice and guidance. This report presents the findings from an independent evaluation of the first four years of the campaign.

Understanding stigma and discrimination

1.3 Stigma has been described as:

" Any attribute, trait or disorder that marks an individual as being unacceptably different from the 'normal' people with whom he or she routinely interacts, and that elicits some form of community sanction" (Goffman, 1963; Scrambler, 1998 in Thornicroft, 2006).

It refers to the negative value attached by others to some personal characteristic, attribute or trait that someone may have, or is believed to have.

1.4 The concept of discrimination tends to be used to refer to behaviours, to the processes of exclusion, restriction or unfavourable treatment based on this personal attribute or trait (Link and Phelan, 2001; Sayce, 1998; Sayce, 2003). The 1995 and 2005 Disability Discrimination Acts, for example, describe direct discrimination as occurring when a disabled person is treated less favourably than someone else who is in similar circumstances or has similar abilities, and this difference in treatment is due to the disability. Stigma and discrimination are linked to the extent that stigmatising attitudes - holding the belief that someone is of negative or lesser value - can result in discrimination.

1.5 Discriminatory behaviour however, does not just occur between individuals. It can also occur at the societal or organisational level. Corrigan et al (2004) for example, describe the effects of what they call "Structural or institutional" discrimination. This includes policies that intentionally restrict the opportunities of people with mental health problems, as well as those policies that are not intended to discriminate, but which unintentionally have the effect of placing people with a mental health problem at a comparative disadvantage. This has parallels with the idea of "institutionalised racism" used in the McPherson Report on the police investigation of the death of Stephen Lawrence, where it is described as "The collective failure of an organisation to provide an appropriate and professional service to people because of their colour, culture or ethnic origin" (McPherson, 1999).

1.6 For people with mental health problems, the expected or actual negative attitudes or behaviours of others can also result in them avoiding people or situations, an experience which has been described as self-stigma (Thornicroft, 2006).

The policy context

1.7 The inception and on-going development of the 'see me' campaign is embedded within an interlocking web of political, policy and legislative influences generated both from within Scotland and externally.

1.8 Clearly, a significant feature of the policy landscape was the establishment in 1999 of the devolved administration, giving Scotland legislative powers and responsibilities across a range of social and environmental matters. Fiscal policy, social security and equal opportunities legislation are areas of policy which remain reserved to the UK government.

1.9 Within this political environment two key influences on the evolution of initiatives aimed at tackling the stigma and discrimination experienced by people with mental health problems and those close to them have been the process and implementation of new legislation relating to mental health care and treatment and the developing mental health improvement agenda.

1.10 In 1998 the Millan Committee was established to review the Mental Health (Scotland) Act 1984. Both the process and outcomes of the Review were directly and indirectly influential on the development and direction of the anti-stigma campaign. As a process the committee aimed to be inclusive, engaging in an extensive consultation exercise before publishing its recommendations (Scottish Executive 2001a). The committee and the subsequent Mental Health Legislation Reference Group, set up to advise the Executive as it developed its policy response (Scottish Executive, 2001b) also included a number of the key actors who subsequently formed the alliance of organisations that spearheaded the development of 'see me' .

1.11 The Millan Committee's report set out 10 principles which were subsequently embodied in the Mental Health (Care and Treatment) (Scotland) Act 2003. These included principles of non-discrimination, equality, respect for diversity, reciprocity, informal care where possible, and participation (Scottish Executive, 2001a). Importantly, in the current context, the Millan Committee recommended that " There should be a campaign of public education designed to improve public understanding of mental disorder, and attitudes towards people with mental disorders, and to reduce the stigma of mental disorder"(Scottish Executive, 2001a, p. 19 para. 114).

1.12 The bulk of the provisions under the Mental Health (Care and Treatment) (Scotland) Act 2003 came into effect in October 2005. In addition to covering criteria and processes for assessment and compulsion on the grounds of mental disorder, Sections 25-27 of the Act place an obligation on local authorities and their partners to make provision for people with a mental disorder of care and support services, services designed to promote well-being and social development, training and assistance in obtaining or undertaking employment and assistance with travel.

1.13 Running in parallel to the legislative changes was the development of a health improvement agenda that included a focus on improving population mental health. Following on from the pre-devolutionary white paper, Towards a Healthier Scotland (Scottish Office, 1999, cm 4269) the Scottish Executive published Our National Health: A Plan for Action, a Plan for Change (Scottish Executive 2001c). This included a commitment to improving health and reducing health inequalities, including investing Scotland's share of resources from the 'Tobacco Tax' (an additional tax imposed on cigarettes in the 2000 budget) into a Health Improvement Fund. Specifically in relation to mental health it was proposed to invest £4m over three years in a campaign "to promote positive mental health and well-being" (p.71). This was reiterated in the Scottish Executive response to the Millan Committee recommendations, which included a commitment to develop proposals for initiatives both to promote positive mental health and reduce stigma (Scottish Executive, 2001b, para. 61).

1.14 This provided the policy and fiscal background to the setting up, in October 2001, of the Scottish National Programme for Improving Mental Health and Well-being (the National Programme) with a remit to take forward the mental health improvement agenda (defined in terms of both promotion and prevention). In its first two years the focus was on anti-stigma and suicide prevention initiatives, including funding the development of the 'see me' campaign, establishing the Choose Life suicide prevention strategy and the Breathing Space telephone advice line. Its three-year action plan, published in 2003 (Scottish Executive, 2003), set out the National Programme's four aims and six priority areas over the period covered by the evaluation of 'see me' (see Annex 1).

1.15 Each of the key aims of the National Programme is being taken forward by an identified main delivery vehicle:

• Promoting positive mental health and well-being:NHS Health Scotland, including rollout of Scotland's Mental Health First Aid;
• Eliminating stigma and discrimination:see me… campaign
• Preventing suicide: Choose Life National Implementation Support Team and local networks
• Promoting and supporting recovery: Scottish Recovery Network.

1.16 These are complemented by a range of other agencies and initiatives funded by the National Programme, including: the Breathing Space telephone advice line for people (young men in particular) experiencing low mood or depression; HeadsUpScotland (the National project for Children and Young People's Mental Health); and Artfull, a collaboration with the Scottish Arts Council to promote the use and value of arts and culture as a means of raising awareness about mental health issues and of supporting recovery from mental health problems.

1.17 All of the main delivery vehicles are subject to independent evaluation to assess their effectiveness and to inform future action. In addition, every two years the Executive commissions an independent National Scottish Survey of Attitudes to Mental Health and Mental Illness, "Well, What Do You Think?" (hereafter referred to as the 'Well, What do you think?' survey), to help assess the effectiveness of the National Programme's actions.

1.18 Although post-dating the development of 'see me', a number of national and international initiatives give added weight and political legitimacy to initiatives aimed at tackling the stigma and discrimination experienced by people with mental health problems and those close to them.

1.19 At the international level, the final report of the UN Ad Hoc Committee on a Comprehensive and Integral International Convention on the Protection and Promotion of the Rights and Dignity of Persons with Disabilities aimed to "promote, protect and ensure the full and equal enjoyment of all human rights and fundamental freedoms by all persons with disabilities, and to promote respect for their inherent dignity". Article 4 specifically includes a request that states "To take all appropriate measures to eliminate discrimination on the basis of disability by any person, organisation or private enterprise" (Article 4 (e); UN 2006). For the purposes of the Convention people with disabilities include those who have long-term mental impairment.

1.20 The imperative to address stigma and reduce discrimination is reflected in the Declaration and Action Plan following the WHO European Ministerial Conference on Mental Health, held in Helsinki in 2005. This identifies the need to tackle the stigma and discrimination faced by people with mental health problems as one of the 12 action areas to be addressed in the mental health policies in the countries of the WHO European Region ( WHO Europe, 2005). The Implementation Plan for 2005-2010 has four objectives, including 'reducing stigma, promoting mental well-being and preventing mental health problems'. The plan's five priority areas include the need to collectively tackle stigma, discrimination and inequality and to empower and support people with mental health problems and their families to actively engage in the process. To support this work, NHS Health Scotland has been identified as a collaborating centre with responsibility to take the lead on stigma, discrimination and social inclusion.

1.21 The European Commission Green Paper on Mental Health (European Commission, 2005) also emphasised as one of the areas for action the need to promote the social inclusion of mentally ill or disabled people and protect their fundamental rights.

1.22 The UK-wide Human Rights Act 1998 and Disability Discrimination Acts 1995 and 2005 provide the legislative framework for addressing discrimination. The Disability Discrimination legislation seeks to protect disabled people from unlawful discrimination in employment, education, access to goods and services and in buying or renting property. In addition, the Disability Discrimination Act 2005, which became operational in December 2006, places a duty on public authorities to promote equality of opportunity between disabled people and others in the exercise of their functions.

'see me', Scotland's anti-stigma campaign

1.23 Therefore, the evolution and on-going development of 'see me', the Scottish mental health campaign to tackle the stigma and discrimination experienced by people with mental health problems, has to be understood as one of a repertoire of initiatives within a landscape which, in legislative and policy terms, was underscoring both the legal and moral imperatives to addressing stigma and discrimination. At the same time it was also creating a 'discourse', or way of thinking and talking about mental health and well-being, that sought to 'normalise' mental health problems and promote a positive conceptualisation of mental health.

Aims and objectives

1.24 Working from the assumption that it takes a generation to change attitudes, the 'see me' campaign has focused on raising 'public awareness' in two overlapping senses: in the sense of drawing attention to the impact of stigma and discrimination on people who experience 'mental ill-health' and in the sense of improving public understanding of mental ill-health. ³

1.25 As will be discussed in Chapter 4, 'see me''s aims and objectives have been modified over the period since its inception. The core aim, however, has been articulated as being "to eliminate stigma and discrimination". For the purposes of the evaluation, the five core objectives against which the effectiveness of the campaign was to be assessed were:

• 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
• To challenge individual incidents of stigma and discrimination
• To involve people in anti-stigma activities across Scotland at national and local levels and across sectors and communities of interest
• To ensure that the voices and experiences of people with mental health problems and their carers are heard
• To promote a culture of learning and evaluation through all its work, so that effectiveness can be demonstrated and lessons shared.

1.26 A key feature of the campaign has been its population level approach and a sequential model of change moving from awareness, to attitudes to behavioural change: a process that it was believed would take a generation to fully embed this change across society.

1.27 Therefore, the initial focus of the campaign has been on stigma - on challenging ignorance/lack of understanding and negative attitudes, rather than discrimination in terms of behaviours. This is reflected in the campaign's own review of its first four years, in which it describes how "In 2001, the 'see me' campaign set out to challenge the stigma of mental ill-health" ('see me', 2006). The one area where the focus has been more directly on effecting behavioural change has been through its work with the media in challenging negative portrayals of people with mental health problems.

The early development of the campaign

1.28 Although the National Programme funded and supported 'see me', it evolved out of an idea developed in 2000/2001 by four mental health-specific organisations: the Scottish Association for Mental Health ( SAMH), the Royal College of Psychiatrists, the National Schizophrenia Fellowship ( NSF) and the voluntary agency Penumbra. Having identified stigma as an area of common concern, the four organisations each contributed funding to begin to develop an anti-stigma campaign. With the working title and strap line of [ people too], destigmatising mental illness, the alliance of organisations was encouraged by Malcolm Chisholm, then Minister for Health and Community Care, to develop and submit a business plan. This overlapped with the need on the part of the Scottish Executive to identify a vehicle or vehicles to meet the mental health improvement commitments set out in Our National Health. This combination of factors (an alliance of organisations with a commitment to addressing stigma and discrimination prepared to act as a 'delivery agent', political support, and a Scottish Executive programme with a population mental health remit which included tackling stigma) provided the funding and the impetus for the subsequent evolution of [ people too] into what became 'see me'.

1.29 A project plan was submitted to the Scottish Executive by the four organisations in 2001 and an amended version approved in March 2002. By this time the original four organisations had been joined by Highland Users Group ( HUG). The first campaign director, Linda Dunion, came into post in January 2002.

1.30 The name 'see me' emerged from the process of testing different campaign names and design solutions undertaken prior to the launch of the first campaign in 2002. Coupled with photographic images of people wearing clothing or jewellery with words such as "anorexic" and "depressive" written on, this was elaborated into 'see me…. I'm a person not a label'.

Management and organisational structure

1.31 Management of the campaign has remained in the hands of the five founding members of the Alliance: SAMH, the Royal College of Psychiatrists, Penumbra, HUG and NSF. As discussed in Chapter 4, a Scottish Executive 'observer' also sits on the management group.

1.32 From an original operational core of Campaign Director, administrative assistant, Campaign Development Officer and Campaign Administrator, the organisation had expanded by the time of the start of the evaluation in autumn 2006 to comprise a Campaign Director, Deputy, Campaign Administrator, three Development Officers (one with specific responsibility for the media volunteer programme) and two administrative assistants.

1.33 A Communications Agency undertakes the creative design work and public relations activities and manages the campaign research and evaluation activities. The agency, which was initially called Citigate Smarts, and was subsequently renamed IAS Smarts, won the commission following a competitive tendering process (see Chapter 5).

1.34 The management and accountability structure within 'see me' and between 'see me' and the Scottish Executive is outlined in Figure 1.1

Figure 1.1 'see me' management structure

1.35 In its original proposal the management group proposed funding for locally based co-ordinators to take forward anti-stigma work locally. This, however, was not accepted by the Scottish Executive. As a result, unlike Choose Life, there is not a network of people with specific responsibility to take the anti-stigma agenda forward. Although in some areas 'see me' has been able to work collaboratively with local Choose Life co-ordinators, the campaign has had to rely to a much greater extent on local champions i.e. people willing to take on activities as an add on, rather than as an integral part of their role. The implications of this for the pattern of local take up are discussed further in Chapter 7.

Funding

1.36 Funding is made available to 'see me' as a grant offered through the legislative power of Section 16b of the NHS (Scotland) Act 1978. Table 1.1 summarises the payments made by the Scottish Executive over the period 2001 - 2006. ⁴ Over this period 'see me' received regular funding amounting to just under £2.5m. Additional funding has also been made available for specific activities over this period. In the financial year 2005/2006 'see me' also received additional recurring funding to extend the media volunteer service to support the work of the other National Programme delivery agents, including Choose Life, Breathing Space and the Scottish Recovery Network. In 2005/2006 this amounted to £78,528.

Table 1.1 Annual funding received by 'see me' from the Scottish Executive 2001 - 2006

Table 1.2 Additional funding received by 'see me' from the Scottish Executive, for specific activities

1.37 In addition, local areas have provided additional funding for specific work in their areas over the life of the campaign. In March 2005, for example NHS Lanarkshire, North Lanarkshire Council and South Lanarkshire Council jointly contributed £20,000 for work to be undertaken locally.

Social Marketing

1.38 To realise its objectives, 'see me' has drawn on social marketing approaches. As a process this reflects the model used by the communications agency IAS Smarts. There are a number of different definitions of social marketing, but broadly it describes the use of commercial marketing techniques to influence behavioural change for a social good (Stead et al, 2007; National Social Marketing Centre, www.nsms.org.uk).

1.39 Social marketing comprises six elements:

• Consumer orientation
• Clear behavioural goals
• Use of a 'marketing' or 'intervention' mix
• Audience segmentation: clarity of audience focus
• Exchange: being clear what is expected of the 'consumer'
• Competition: understanding the factors that impact on the customer and that compete for their attention time.

(adapted from National Social Marketing Centre: www.nsms.org.uk)

1.40 According to the National Social Marketing Centre ( www.nsms.org.uk) successful social marketing interventions tend to:

• Invest in effective scoping and development phases
• Use customer understanding and 'insight' as the central driver
• Clearly address incentives and barriers to behaviour
• Establish clear and measurable behavioural goals
• Have clear and systematic overall planning
• Actively involve and prime key people and players
• Have multi-sector stakeholder and delivery coalitions in place
• Have integrated co-ordination
• Have a budget appropriate to the aims and methods selected
• Integrate monitoring and evaluation throughout.

1.41 As a case study of a social marketing approach 'see me' was assessed as part of a separate research project to inform the development of a social marketing strategy for health improvement in Scotland. This identified a number of strengths and weaknesses in the implementation of the social marketing model (Stead et al, 2007). For the purposes of assessing whether and how 'see me' has achieved its strategic objectives, what needs to be understood is how adopting social marketing as a process impacted on outcomes. This is discussed in more detail in Chapter 5.

Campaign strands 2002 - 2006

1.42 Over the period covered by the evaluation, the campaign as a whole has had a number of strands.

• General public campaign strand. The first strand, used to launch the campaign in October 2002, was targeted at the general public and comprised TV and cinema advertisements, outdoor posters, press releases and other materials downloadable from the 'see me' website. This first campaign featured images of people wearing jewellery or items of clothing imprinted with a diagnosis; a man, for example wearing a tie with the words 'depressive' woven into the pattern and a footballer wearing a shirt with the label 'schizophrenia' above the player's number. In October/November 2003 and January 2004 a further general public campaign was launched focusing on the statistic that as many as one in four people may experience mental health problems and that people can and do recover. It features an image of a man pushing a child on a swing with the tagline "If I'm open about my depression…will they shut me out?"

• Employment and workplace campaign strand. In June 2004, one of the key TV adverts from the general public campaign, the image of a 'goalie' with the word 'schizophrenic' printed on the back of his shirt, was re-run immediately prior to the launch of the 'Employment and workplace' strand in July 2004. This strand involved radio adverts supported by posters, postcards and downloadable screen savers with the image of people wearing uniforms and work labels with different diagnoses above the job description, for example, "the schizophrenic doorman".
• Young people campaign strand. In January 2005 'see me' launched its young people campaign strand. Using two 'cartoon' images: one of a boy who self-harmed and a girl who had an eating disorder (referred to as 'Cloud Boy' and 'Cloud Girl' to reflect the image of cloud hanging over their heads), the tagline read "see me…I'm a person just like you". The campaign included TV advertising, with a particular focus on Channel 4 and MTV with the aim of reaching the target audience, posters and postcards. A micro-website for young people was also developed, which re-produced the images and provided links for young people who were looking for help.
• Media volunteer programme. Through this programme, people with lived experience of mental health problems are trained to speak with the media. Initially set up to provide support to the campaign, additional funding was made available in May 2005 to extend the programme to support the work of other elements of the National Programme, including the Scottish Recovery Network, Choose Life, Breathing Space and HeadsUpScotland. The media volunteer programme is discussed in more detail in Chapters 5 and 8.
• Stigma Stop Watch. Stigma Stop Watch was launched in March 2003. This strand enables people to notify and be notified by 'see me' of negative (or positive) representations of people with mental health problems in the media or advertising. This enables people to complain individually or for 'see me' to take action where it feels a representation warrants a response. In 2003, for example, 'see me' responded to the Sun headline "Bonkers Bruno", which related to the boxer Frank Bruno's detention under mental health legislation.
• Media guidelines. In 2002 'see me' also launched its media guidelines 'Mind Your Language' to support the use of non stigmatising language when reporting mental health related issues. The campaign also developed, in collaboration with the National Union of Journalists in Scotland, "a practical guide" for journalists on the reporting of mental health and suicide.
• Throughout the campaign's life it has worked to support local activity, providing materials, expertise and advice. This has included working with local voluntary groups, private companies and public authorities. This is discussed in more detail in Chapter 7. To indicate buy-in to the anti stigma message, the campaign has also inaugurated the 'see me' anti-stigma Pledge. Institutions publicly signing the Pledge over the period covered by the evaluation included the higher education establishment Bell College and Motherwell Football Club.

1.43 In addition, the 'see me' website ( www.seemescotland.org) provides information on the campaign and the strands, as well as links to other agencies. Factsheets on different mental health problems are also downloadable via the website.

1.44 Figure 1.2 illustrates 'see me''s timeline over the period from the formal funding agreement to September 2006. This covers the period the evaluation was asked to consider. In the following period 'see me' published its own four year review ' see me so far' (October, 2006), and undertook and published a self-report survey of experiences of stigma and discrimination. The findings of the survey were published by 'see me' in June 2007.

Figure 1.2 'see me''s timeline 2001 - 2006

Other national approaches to addressing the stigma and discrimination experienced by people with mental health problems and those close to them

1.45 Internationally, a range of different initiatives have been directed towards addressing the stigma and discrimination experienced by people with mental health problems and those close to them. In North America, public opinion surveys have been conducted for over half a century (Star, 1952; Nunnally, 1961; Cumming and Cumming, 1965; Phelan et al, 2000; Regier et al, 1988; Wells et al, 2004; Corrigan and Penn, 1999; Corrigan et al, 2001), usually limiting themselves to describing popular opinion. An exception was an intervention programme in Saskatchewan in Canada, which found that most people were reluctant to have close contact with people with mental health problems and that attempts to reduce social distance were unsuccessful, indeed producing hostility to research staff (Cumming and Cumming, 1957; Phelan et al, 2000). Relatively early, therefore, it became common to think that public education campaigns rarely produced meaningful and sustained change.

1.46 More recent evidence has begun to challenge this received wisdom, and suggests that campaigns to raise the level of 'literacy' about mental health problems can have a positive effect, as they have had for HIV/ AIDS (Herek and Capitanio, 1993; Herek et al, 2002). In Australia, 'beyondblue' is a concerted programme to convey accurate information about depression. Its initial evaluation showed a series of benefits including: better community recognition of people with depression; reforms in life insurance and income protection; and the initiation of awareness and intervention programmes in schools (Ellis and Smith, 2002; Hickie, 2004). An important aspect of this programme is that some of the Australian states and territories have a high level of exposure to the 'beyondblue' intervention, and others a low level of exposure, to allow a comparison of the impact. Compared with the low-exposure states, the high-exposure states had greater change in beliefs about some treatments for depression, particularly counselling and medication, and a higher recognition of the benefits of help-seeking in general. Between 1995 and 2003 the recognition of depression improved greatly throughout all of Australia, but slightly more so in the high-exposure states (Jorm et al, 2005).

1.47 In Germany, public attitudes surveys have been conducted since 1990 and show that over the following decade the German public became more ready to recommend help from psychiatrists or psychotherapists for schizophrenia or major depression. There was also an increase in the willingness to recommend treatment, especially drug treatment or psychotherapy for people with schizophrenia. Since there is no controlled comparison of interventions over that period for the whole country, it is possible that these favourable changes are more linked to improvements in treatment services than to any public information campaigns (Angermeyer and Matschinger, 2005b; Gaebel and Baumann, 2003). At the same time, contradictory evidence has emerged in Germany that attitudes to people with this condition have worsened in recent years, despite a greater appreciation of the biological causes of schizophrenia which was expected to engender greater public sympathy (Angermeyer and Matschinger, 2005a).

1.48 There have been several national initiatives in England. The Defeat Depression campaign targeted primary care practitioners as well as members of the general public with information about depression (Priest et al, 1996; Paykel et al, 1997; McKeon, 1998). The results showed modest but positive changes in attitudes to depression, particularly favouring counselling, but antidepressants were seen as addictive and less effective (Paykel et al, 1998). Among family doctors 40% reported that they had improved their recognition and treatment of depression, and this was especially so for younger doctors and those who had undertaken previous psychiatric training (Rix et al, 1999). At the same time, it needs to be appreciated that because there was no clear-cut comparison between regions which did or did not receive the interventions, it is possible that these changes were not related to the campaign.

1.49 In New Zealand the programme 'Like Minds Like Mine' was initiated in 1996 www.likeminds.govt.nz to "reduce the stigma of mental illness and the discrimination experienced by people with mental illness". Like Minds undertakes activities on a variety of levels; regionally there are 26 health promotion providers around the country undertaking a wide variety of promotional and training activities with their local communities, organisations and their local media. Nationally, the project consists of public relations, advertising, the development of national policy and evaluation. This is widely regarded as the most successful anti-discrimination programme in relation to mental health problems with detailed evaluation reports helping others to learn from its success stories. Having taken stock of activities in 2004 (Vaughan and Hansen, 2004; Akroyd and Wyllie, 2003; Mental Health Commission 2004), a multi-agency plan for 2005-2007 was launched, emphasising human rights, social inclusion, advocacy, public health and recovery.

1.50 Notwithstanding the different initiatives that have been implemented and evaluated, according to Thornicroft (2006), at present little is known about which methods of conveying information to mass audiences are likely to be more effective. Possible contenders include personal testimonies by people with mental health problems, incorporating mental illness-related story lines into popular drama, such as 'soap operas', using commercial brand awareness public relations methods, adapting 'social marketing' techniques (Kotler et al, 2002), or deliberately associating mental illness with positive attributes, such as art exhibitions of work by people with mental health problems (Thomashoff and Sartorius, 2004).

Structure of the report

1.51 The aims and objectives of the evaluation are described in Chapter 2. Chapter 3 describes the evaluation methods. Key findings from each of these different elements are described in Chapters 4 to 9. Drawing on qualitative and quantitative data, Chapter 10 provides an assessment of the effectiveness of the 'see me' campaign, as measured against its own five strategic objectives. Chapter 11 presents views on the future direction for work in Scotland addressing the stigma and discrimination experienced by people with mental health problems and those close to them. The conclusions drawn from the evaluation are presented in Chapter 12, followed in Chapter 13 by draft recommendations for the future.

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