Our live journal club chat will take place on Monday 22nd April at 8.00-9.00 pm UTC (UK time). To follow and participate, search for our hashtag #PHTwitJC on Twitter, and remember to use the hashtag if you want to contribute. If you’ve never joined a Twitter chat before, please see the ‘About ‘ tab above for some tips. Absolutely anyone is welcome to join in; and we welcome ‘stupid’ questions (there is of course, no such thing).
The paper we will be discussing is:
Corker E, Hamilton S, Henderson C, Weeks C, Pinfold V, Rose D, Williams P, Flach C, Gill V, Lewis-Holmes E, Thornicroft G. (2013). Experiences of discrimination among people using mental health services in England 2008-2011. British Journal of Psychiatry [Suppl] 2013 Apr;55:s58-63. doi: 10.1192/bjp.bp.112.112.912 http://bjp.rcpsych.org/content/202/s55/s58.full
Levels of discrimination against mental heath service users are high and there was evidence that public attitudes relating to mental health deteriorated up to the mid-2000s. A population level intervention, Time to Change, was developed to tackle stigma and discrimination. It was funded for four years, 2007-11, at a cost of around £21 million. It included social contact and social marketing elements (which were delivered from 2009-11), and was delivered by the major mental health charities. It had clear goals and outcomes (set out by Thornicroft and Corker 2013 in their editorial):
- -significantly increased public awareness of mental health (an estimated 30 million English adults would be reached), a 5% positive shift in public attitudes towards mental health problems and a 5% reduction in discrimination by 2012;
- -100 000 people with mental health problems to have increased knowledge, confidence and assertiveness to challenge discrimination by 2012;
- -provision, through physical activity, of greater opportunities for 274 500 people with a range of mental health problems to come together, both to break down discrimination and to improve well-being, by 2012.
The paper under discussion is one of several that have come out of the official evaluation project led by the Institute of Psychiatry (Kings College London). They were published in a special supplement of the British Journal of Psychiatry in April 2013. The two editorials in the (fully open access) issue provide a good overview of the issues; of the Time to Change programme, and the overall evaluation results. Some positive outcomes were achieved, although they fell short of the targets.
Other papers in the issue report on changes in attitudes of the general public, newspapers, and medical students, to people with mental health problems; on the impact of specific aspects of the programme (social marketing; social contact events); and provide an economic evaluation of the the campaign.
The experiences study
This survey study was designed to capture any changes in discrimination experienced by mental health service users between the period before TTC was implemented, up to 2011.
A telephone questionnaire was administered to people identified as mental health service users across different mental health trusts in England, in 2008, ’09, ’10 and ’11. The questions covered different areas of life, for example, family and friends, work and benefits. The questionnaire used was the ‘Discrimination and Stigma Scale ‘ (DISC), which was developed by an international team (some details here).
The authors report a small but significant overall increase in the proportion of the participants who had no experiences of discrimination in 2011 versus 2008. In all years, the great majority of respondents reported at least one experience of discrimination. Discrimination in four of the 21 domains covered in the questionnaire increased slightly over the period (safety, benefits, marriage and transport).
Questions for discussion
1. Does the study address a clearly focused question/issue? Is the study design appropriate to address this?
2. Were the methods of selecting and recruiting to the study adequately described; were they appropriate?
3. Was the sample adequate & representative of the population (mental health service users in England)?
4. Is the survey tool (DISC) likely to measure appropriately; is it a valid tool?
5. Results: are these presented adequately so that the reader can assess their validity & reliability? Are they adequately explained (any confounders)?
6. What implications are there for policy and practice?