Campaigning to improve sexual and mental health, and for the rights of those with long term conditions, requires a different approach to other charity campaigns. Stigma, prejudice and ignorance, as well as strong moral or cultural values, can obstruct change. There have been successes but much more needs to be done. Talking about sexual and mental health openly has certainly become easier and access to services improved. Yet last year there was a 5% increase in STI diagnoses in England, and one in four people in the UK are still affected by mental illness. This year the Mental Health (Discrimination) Act has removed the last significant forms of discrimination in the UK. However, an attempt to add Sex and Relationship Education to the national curriculum was voted down in the Commons.
With significant achievements in some areas and work to do in others, what do some of the leading sexual and mental health charities think are the lessons for campaigning in the future?
Sexual and mental health issues can be very sensitive, even taboo, for many people to discuss. Shame and judgement can prevent successful dialogue. This is why we have to “go in and be strong about the fact it’s not embarrassing or dirty” says Simon Blake, CEO of young people’s sexual health charity Brook. If we want a world where discussing sexual and mental health can be open, honest and non-judgemental then we must speak, write and campaign accordingly. Making the initial breach into open conversation can be the most difficult part however, which is why placing the issue among other non-related activities is a means of both normalising and raising the topic. Lisa Power, Policy Director of HIV and sexual health charity Terrence Higgins Trust, mentions the organisation’s ‘Play It Safe’ project offering free rapid HIV tests at the African Nations Cup UK as one way of raising awareness about HIV and encouraging regular testing without making it confrontational or “making a fuss” about it as something distinct to everyday life.
The problem is not only discussing sexual or mental health with someone who does not see it as part of everyday conversation, but getting those who have or have had sexual or mental health diagnoses to feel confident in standing up for change in the face of possible stigma. Personal disclosure remains powerful, and the examples set by celebrities like Stephen Fry can create confidence in people to feel ‘normal’ and be more vocal about what they need. Nevertheless campaigning organisations need to be aware of what their campaigning volunteers with lived experience require to be successful.
Volunteers with a lived experience of the topic you’re campaigning for add authenticity to the message, and when they are the constituents of politicians or local health commissioners being targeted, they bring the answer to the all important question ‘why should I care?’. Jules Hillier (Brook Deputy CEO) makes the point that “pragmatically, people who need to be voted for listen to future voters” when it comes to young people and their sexual health campaigns. When campaigners are passionate limited input may be required; Brook supports and advises its young volunteers when they decide which issue most concerns them. In this way campaigns wholly address the concerns of young people’s sexual health. However it can be limiting, as Jules finds there are difficulties in getting those young people who may be the most vulnerable (e.g. those with learning difficulties or who are out of the education system) to come forward and equally shape the campaigns to their individual needs.
Support is needed for those who may encounter obstacles to personal campaigning of this nature, something Victoria Bleazard, Associate Director of Policy, Research, Campaigns & Advice at Rethink Mental Illness, knows a lot about. Whilst speaking to an MP or journalist may be old hat for professional campaigners, someone living with mental illness may have needs which require additional support. This may include having prompts written down, rehearsing several times, or having a back-up plan of someone else stepping in if it is required. Campaigning organisations need to know what support volunteers will need and have the resource devoted to supporting volunteers properly if they want to be effective.
Whether approaching volunteers, the public, or decision-makers, campaigning organisations must set out clearly what they want to be done. “The more specific you can be,” says Simon Blake “the more impact you will have.” People are bombarded with so many notifications, adverts and pop-ups during the day that most are simply overlooked, and any ambiguity will only frustrate and alienate people away from a campaign’s message. When it comes to behaviour change, this means giving simple and easy-to-follow instructions: look both ways when crossing the street, always wear a seatbelt, always use a condom during sex. In this way the complications of engaging people’s values or prejudices about sexual or mental health is bypassed in order to simply push out an achievable behaviour change. With volunteers, initial passion to get involved will usually be high but it may quickly wane without direction or guidance. So the advice of Victoria Bleazard is to “be really clear about what you want people to be involved in” and then make sure it is as easy as possible for them to do it. And most politicians will most likely not have the same level of interest in the issue as the campaigners do, so they need to know exactly what it is you’re asking them to do, and of course this has to be something they have the power to do with reasons for why it is important.
Most campaigners are passionate people who care deeply about the topic they work for. The problem is most other people probably won’t care nearly as much. It is vital therefore to understand where your topic fits into other people’s potential list of priorities. As Jules Hillier points out, sexual health may be far down the list of health issues requiring attention in a country where most deaths have links to diet, exercise, smoking and alcohol. Better then, with politicians and commissioners, to point to the financial argument. How many years of work are lost in the economy due to anxiety and depression? How much does providing IVF treatment cost compared to a Chlamydia test?
Understanding priorities is also important when trying to advance your message. Your organisation may not be the best placed to get certain demographics on board. Extending coverage of the message of sexual and mental health may be helped by family charities, young or older people’s charities, BME charities, alcohol or drug charities, depending on what and who you are trying to influence. Campaigning charities must recognise that they cannot do it all alone, and building supportive networks of charities with different focuses and audiences will be vital for maximum impact.
Similarly, targeted messages are much better than general ones. With people from different backgrounds, in different stages of their lives, experiencing and prioritising different things, you need to know why your issue should concern them, what impact it might have on their life. Thus, much of the campaigning work of Terrence Higgins Trust around HIV focuses on the groups most at risk (men who have sex with men, and African people) while that of Rethink focuses mainly on people who have a relative or other close person affected by mental health illnesses. If people have a reason to care about what you are saying, they are far more likely to listen.
When it comes to the big challenges and stigmas in society, change can be very slow yet achievable. For example, it was 25 years ago that Section 28 was introduced banning the promotion of homosexuality as a ‘pretended family relationship’, and now a Conservative led government is trying to introduce gay marriage. For Lisa Power, this is just one example of all the “swings and roundabouts” of the campaigning world. Talking about HIV was once the only acceptable way for homosexuality to be discussed by politicians because people were dying from AIDS, but now gay rights charities can confidently court MPs of all parties whilst HIV becomes simply one of many long-term health conditions.
Campaigning is a long process of building relationships and generating discussion. Getting people to talk about sex and mental illness can be a very difficult task, but bringing it into discussion is the most important first step in empowering people to make informed decisions about their health. And when enough people feel confident enough to ask for what they need, politicians and decision makers begin to listen, and this can pay dividends as mental and sexual health charities continue to prove.