Professor Sir Graham Thornicroft, who leads the team at the IoPPN, credits Time to Change with making a definitive impact on attitudes to mental illness:
“There is no doubt that stigma and discrimination are slowly but steadily decreasing in England. This is against a backdrop where, before Time to Change, they were actually increasing. The team at King’s College has published over 100 scientific papers about stigma since Time to Change began, looking in detail at many aspects of the impact, and we’ve seen how it has improved knowledge, attitudes and behaviours. I do not think that all the stigma reduction in England is due to Time to Change, but I do think it has been the leader in this field and made the major contribution to these forms of social progress.”
The biggest lesson from ten years of Time to Change, says Baker, who went on to become the campaign’s global director, was that it demonstrated the effectiveness of leadership by people with direct personal experience:
“It’s those of us with mental health problems leading change in our communities, workplaces, schools, at a national level – using our mental health issues as an asset, not a deficit. It was because so many people stayed silent for so long that you didn’t realise you sat beside or were managed by or managed someone who had a mental health problem. All of that was hidden because people were so afraid of the consequences of being up-front about it.”
Steve Loft was one such individual. In 2011 he was signed off from his job at Transport for London (TfL) for eight months while being treated for stress and depression. But going back to work was a trial. “It was like there was a big exclusion zone around me – nobody knew what to say to me,” he recalls. “Although I had a good line manager, he did not have a clue about how to deal with someone with a mental health problem.” Loft discovered that TfL had in fact signed the Time to Change pledge two years earlier, and he persuaded the company to set up an intranet site and a peer-support group that by 2019 had nearly 300 members. Time to Change supplied resources and speakers, and Loft became a ‘workplace champion’:
“This is really powerful as it gives people confidence to share their own experiences. I’ve seen a sea-change in attitudes to mental health in the last six years. I go out now and train other champions, and if I had a pound for every time someone said attitudes are changing, I’d be a rich man. I think there is going to come a tipping point. I’m old enough to remember all the things that used to happen with race, but then at some stage people just weren’t prepared any longer to listen to other people talking and acting in a discriminatory way. I still think mental health has got a way to go, but it’s certainly shifted a hell of a lot in those few years, and that’s got a lot to do with those charitable organisations that have worked really hard to change things. Now, when people come back to work at TfL after being off for stress, I’ve noticed that others go and talk to them – they’re not frightened any more. When I was off work, a lot of my problems stemmed from the fact that, as a middle-aged bloke, you just weren’t conditioned to talk about your mental health. But it’s very different now.”
Unfortunately, however, in October 2020 the DHSC declared that it could not continue to fund Time to Change, and the charities that had run it for 15 years reluctantly announced its closure, with a warning that the gains made as a result of the campaign were at risk of sliding backwards.41 Time to Change ended on 31 March 2021, very likely a direct casualty of the pressures on public spending created by the coronavirus pandemic.
Cervical screening
Other health campaigns by charities may be less high profile than those on smoking or mental health, but they appear regularly. They often form part of the controversies, debates and stories in the media that lead to improvements in official policy or changes in funding decisions. Early in 2018, for example, BBC News reported on a survey of more than 2,000 women which showed that one in four of them did not take up regular invitations to have a smear test, and that the figure was one in three for the 25–35 age group, in which cervical cancer is the most common form of cancer.42 The reason women most commonly cited for not booking a test was embarrassment about a stranger examining their bodies. The research had clear implications for social policy and clinical practice, however, and Steve Brine MP, then the junior health minister responsible for cancer, pledged to support a campaign to reassure women and improve the level of response to invitations to smear tests, which are offered every three years to women aged between 25 and 49 and every five years to those between 50 and 64.
Who carried out and publicised the survey in question? It was a small charity called Jo’s Cervical Cancer Trust, founded in 2000 by a London businessman, James Maxwell, after the death from cervical cancer at the age of 40 of his wife, Jo. She had wanted other women to have what she had missed: better screening and diagnosis, more medical information, the confidence to challenge doctors, and communication with others suffering from the disease.
In the following 20 years the Trust expanded and made a significant contribution to advances in the prevention and treatment of cervical cancer, including the introduction in 2008 of a programme of vaccination for girls in school against human papilloma virus, the cause of nearly all cases of the disease. In 2020 the Trust was employing about 25 people, running a comprehensive website, campaigning for better prevention and treatment, providing detailed medical information and offering emotional and practical support to women. Its annual income in 2019 of £1.6 million was a mixture of voluntary donations, grants from the DHSC and the Scottish Government, and gifts in kind such as advertising on Google.
Changing people’s behaviour is rarely easy, especially when it involves asking them to re-examine deep-seated attitudes or to stop doing something they find pleasurable or convenient. The examples in this chapter show that it can be done through a combination of information, persuasion and legislation, and that charities have played a key part in both large- and smaller-scale measures to produce change affecting people’s physical and mental health. The next chapter examines the involvement of charities in campaigns about something just as fundamental and often more controversial – human rights and equality.
Equality, slavery and human rights
When George Floyd, an unarmed Black1 man, died after a White police officer knelt on his neck for nearly nine minutes in the US city of Minneapolis in June 2020, there was an upsurge of protest around the world, especially in the UK. There were marches and demonstrations all around the country throughout June, even in provincial centres such as Bournemouth and Cheltenham; protestors dumped the statue of the 18th-century slave trader Edward Colston into Bristol harbour and daubed the words ‘was a racist’ on the statute of Sir Winston Churchill in Parliament Square in London.
The protests took place under the banner of the Black Lives Matter movement, which started when Trayvon Martin was shot dead by a vigilante in Florida in 2013. The movement gathered strength from a shocking series of police shootings of Black people in US cities in the following years, and a UK version of Black Lives Matter was set up in 2016 for a demonstration on the fifth anniversary of the fatal shooting by the Metropolitan Police of Mark Duggan in north London. But the protests of June 2020, some of which resulted in clashes with police and a number of arrests, created a dilemma for the estimated 200 registered charities in England that are Black led or work in the area of race relations.2
“Most of them are involved in service delivery and are not campaigning organisations,” says Elizabeth Balgobin, a charity governance consultant specialising in equality and diversity:
“A lot of them have council