Like many charities, Alcohol Change UK thus led the way during a national emergency in analysing the situation in its area of expertise, coordinating help and support for citizens and arguing for policy change by the government. In doing so it was building on nearly a decade of campaigns by both Alcohol Concern (which combined with Alcohol Research UK in 2017 to form Alcohol Change UK) and CRUK. Dryathlon, which involved giving up alcohol for January, was launched by CRUK in 2013; it was primarily a fundraising campaign, but it also reduced supporters’ consumption of alcohol, which is a known cause of some cancers. In its first three years 170,000 ‘Dryathletes’ raised more than £17 million.26 Dry January, by contrast, was devised by Alcohol Concern as a public health campaign intended to counteract Christmas and new year binge drinking and the growing consumption of alcohol by the British. One study of global drug use suggested that Britons got drunk more often than the inhabitants of any other country in the world.27
The idea for Dry January came from one woman, Emily Robinson, who decided to run a half-marathon in February 2011.28 She found the training hard and decided to see if giving up drinking would help. She noticed not only that she slept better, lost weight and had more energy, but also that everyone wanted to talk to her about what it was like to give up drinking for a while. One year later, Robinson joined the staff at Alcohol Concern and the idea for Dry January 2013 was born.
In that year, 4,350 people signed up. The following year more than 17,000 reported that they had stopped drinking for the month.29 A study by the University of Sussex six months later found that of 900 abstainers surveyed, 72% had kept harmful drinking down afterwards and 4% were still not drinking.30 Alcohol Concern struck up a partnership with Public Health England, and the government contributed £500,000 to Dry January in 2015, funding the campaign’s first radio advertisements.31 That year, 50,000 people gave up alcohol for the month, and in 2017 a YouGov survey found that four million had taken part.32 Although Dry January did not start out as a fundraising event, several other charities joined the campaign as fundraising partners, encouraging supporters to take part and raise sponsorship. The success of Dry January and Dryathlon prompted Macmillan Cancer Support to create its own alcohol-abstinence fundraising event, Go Sober for October, in 2014.
Care of the mentally ill
Charities also led the way during the coronavirus pandemic in identifying its damaging effects on mental health, providing help and support and arguing for improved services. Two months after the first lockdown in March 2020, the Centre for Mental Health – a charity focused on research and policy – published a study estimating that 500,000 more people in the UK would suffer from depression and other mental health problems as a result of isolation, fear, grief, boredom and job insecurity in the expected recession.33 It called for a continued financial safety net, government advice to businesses and institutions and targeted support for former COVID-19 hospital patients and health workers. Mind – the new name for the charity formed when three pioneering organisations merged in 1946 to become the National Association for Mental Health – published a survey showing that 65% of people with experience of mental health problems said their mental health was getting worse, and created a section of its website with comprehensive practical advice on improving mental well-being.34
The attention given to mental health during the pandemic owes much to increased public awareness and sensitivity about the subject in the 21st century. This was partly the result of Time to Change, a 15-year campaign by Mind and Rethink Mental Illness, another charity, to change attitudes. The treatment of those with mental illness had improved enormously since the 18th century, when people could pay to watch the disturbed behaviour of the patients in ‘bedlam’– the Bethlem Royal Hospital, located until 1936 in the grand, colonnaded building which is now the Imperial War Museum in London. In Victorian times the attitude to mental illness was more humane, but treatment was based in large asylums with strict regimes which remained the norm well into the 20th century.
In the 1970s, however, the government was persuaded to adopt a policy of ‘care in the community’. This involved closing many of the big asylums and arranging for people to live independently, with psychiatric supervision if necessary, or to be cared for in smaller units and hostels. But care in the community had its failures. In one notorious case in 1992 a newly married man, Jonathan Zito, died after being stabbed in the face on a train platform in London by Christopher Clunis, a young man with a history of mental illness who had been deemed suitable for independent living despite repeated episodes of violent behaviour.35 This and other incidents led to a backlash in the tabloid press, which contended that community-based mental health services were failing to protect the public from what it called ‘schizos’ or ‘psychos’.36
The regular Community Attitudes to Mental Illness (CAMI) surveys, funded by the Department of Health and Social Care (DHSC), revealed fear and discriminatory attitudes.37 When the survey began in 1994, only 42% of a representative sample of the population believed that ‘mental hospitals are an outdated means of treating people with mental illness’. The proportion agreeing that ‘it is frightening to think of people with mental problems living in residential neighbourhoods’ rose from 15% in 1994 to 26% in 1997. In that year 33% also believed that ‘anyone with a history of mental problems should be excluded from public office’.
Mind decided to try to help bring public attitudes into line with public policy. Sue Baker, hired in 1996 to set up the charity’s media department, recalls one memorable double-page tabloid spread featuring pictures of machetes dripping with gore, accompanied by accusations that the government had blood on its hands because of its care in the community policies. She also remembers Mind’s head of policy returning from a visit to the regions and relating how someone had thrown a brick through a young woman’s window when her neighbours discovered she had recently been discharged from a psychiatric hospital: “We were hearing these sorts of things all the time, but for me that was the final straw.”
She organised a project called ‘Not just sticks and stones’, based on interviews with nearly 2,000 people with mental health difficulties who told story after story about being refused jobs, education or housing, losing friends or relationships or being verbally or physically abused.38 The media launch of the results was a great success, securing “wall-to-wall coverage on all the TV stations for 24 hours”, according to Baker, and from then on there was a discernible shift in the tone of press coverage. Subsequent CAMI surveys revealed a softening of public attitudes, albeit marginal, and Baker and her colleagues became convinced that a high-profile, multifaceted campaign to reduce the stigma of mental illness could have a real impact.
After two years in New Zealand working for the Mental Health Foundation there, Baker was rehired in 2007 to lead Time to Change, the joint campaign between Mind and Rethink, financed for four years with a grant of £20 million from Comic Relief and the Big Lottery Fund. The project ran programmes with employers and schools and helped people with experience of mental illness to tell their stories and set up campaign groups; from 2011 the DHSC also contributed funding. The evaluation of Time to Change from 2008 to 2014, based partly on an analysis by the Institute of Psychiatry, Psychology and Neuroscience (IoPPN) at King’s College, London, had encouraging results.39 This analysis drew on a survey in which 1,000 people who had used mental health services in the last 12 months were interviewed about their experiences. It said:
Comparing 2014 with 2008, there were significantly fewer experiences of discrimination with respect to friends, family, social life, dating, mental health staff, finding a job, keeping a job, police, education, religious activities, privacy, starting a family, or being shunned. The evaluation also notes a direct correlation between these findings and the Time to Change campaign. When the data from all time points are aggregated, a significant relationship between awareness of Time to Change and each of the outcomes is apparent.
In 2017, Time to Change and the IoPPN also released research showing that reporting of mental health by the print media was more balanced and responsible than before.40