Scottish Government

CHAPTER FOUR THE BACKGROUND AND STRATEGIC DEVELOPMENT OF ''see me''

Introduction

4.1 One of the aims of the evaluation was to examine how the 'see me' campaign was established, funded, the infrastructure developed and activities developed. Drawing on documentary and interview data, this chapter presents an account of the background behind the development of the campaign and the evolving campaign objectives, including the underpinning conceptualisations of stigma and discrimination and model for achieving change. The chapter then goes on to describe the funding, management, accountability and strategic decision-making structures that have been put in place.

Background context

4.2 As discussed in Chapter 1, Scotland's anti-stigma campaign emerged from the confluence of three streams:

• Legislative and policy developments within Scotland, particularly post-devolution
• The synergy between the four (and subsequently five) organisations who became the delivery agents
• Programmes and initiatives outwith Scotland, which provided an impetus and a model.

4.3 Influences within Scotland were the Millan Committee's recommendations for a mental health public education campaign and a parallel emphasis by the Scottish Executive on health improvement and reducing health inequalities. These came together in the commitment by the Scottish Executive, set out in Our National Health (Scottish Executive 2001c), to tackle stigma, develop a framework to address suicide and develop a campaign to promote positive mental health with initial funding of £4m available over three-years. The fact that the initial source of funding was via the 'Tobacco Tax' meant that funding was routed through the Scottish Executive Public Health Division, and, as such, was located within a health improvement framework.

4.4 Outwith the Scottish Executive, but contributing to the debate, was the work of the Scottish Public Mental Health Alliance. This informal grouping of two national mental health charitable organisations, a university public health research unit and a public policy 'think tank', published and consulted on its discussion document With Health in Mind throughout 2001 and 2002 (Scottish Public Mental Health Alliance, 2002). The aim of the alliance was to foster a public mental health agenda, encompassing the promotion of population mental health and prevention of mental health problems.

4.5 From the perspective of Scottish Executive stakeholders, the commitments made in Our National Health had two implications. First, it created what one Scottish Executive respondent described as "a vacuum" in the sense that a commitment had been made and monies identified, but there was no vehicle or vehicles to deliver on the commitment. Second, it was felt to have created a tension between a focus on anti-stigma activity and a public mental health agenda.

4.6 Running in parallel were the activities of the four agencies that came to form the initial management group for what was to become 'see me': SAMH, Penumbra, NSF and the Royal College of Psychiatrists (the Highland Users Group joined the alliance in early 2002). In late 2000 the four organisations met with the purpose of identifying common issues. As was suggested by the members of the management group interviewed, although sharing common interests the organisations had different 'takes' on these issues. Stigma, however, was one area on which they felt they could agree. They were also aware that the Millan committee had identified stigma as an issue that needed to be addressed. Each of the four organisations committed funding to preliminary work in this area, including organising a briefing within the Scottish Parliament to raise awareness among MSPs and to make the case for funding for an anti-stigma initiative. The group also commissioned designers to produce a leaflet and invitation under the name [ people too]. From the point of view of the management group, a key player in supporting them to progress their activities was Malcolm Chisholm, then Minister for Health and Community Care, who suggested the group work up and submit a business plan to the Scottish Executive.

4.7 An initial proposal was submitted by the alliance of agencies in October 2001 with a bid for in the region of £2m over two years. This included not just proposals for an anti-stigma campaign, but also included a mental health promotion/mental health literacy element and a focus on young people, employers and those who work in public services.

4.8 Effectively, then, the alliance provided an early opportunity to meet the commitments made in Our National Health. By the time a commissioning letter was issued to the alliance by the Scottish Executive in December 2001, the National Programme as a vehicle to integrate anti-stigma, suicide reduction and mental health improvement work, had been established. From the perspective of the nascent National Programme, the role of the alliance was configured as one of supporting the anti stigma strand; the 'mental health promotion' or literacy elements being seen as the role of other delivery vehicles.

4.9 This genesis has perhaps created the conditions for a strong sense, by those involved in the campaign, of its comparative independence from the National Programme.

In particular:

• Unlike other elements of the National Programme, it was conceived prior to and independently of the National Programme, only subsequently being absorbed into the wider well-being agenda. From the perspective of those involved in the campaign, the fact that the campaign and the National Programme developed independently and in parallel meant that there was a degree of "competition" between the two elements. Notwithstanding its subsequent absorption under the National Programme umbrella, those directly involved in the campaign felt that it did not sit within the Programme in the same way as the other elements, and, from the point of view of the 'see me' management group could not be so easily "reined in".
• It became active before the wider repertoire of activities under the National Programme umbrella became operational (Choose Life, for example was not launched until December 2002). From the point of view of the campaign, the fact that it was already established and delivering outputs meant the National Programme was able to point to the campaign as an early success, but possibly at the cost of the campaign's sense of independence.
• The original alliance, with the addition of HUG, has steered the campaign since its original conception, giving the management group a strong sense of ownership of the campaign (including the name 'see me', which is legally registered as a brand with SAMH).

4.10 The third stream influencing the mode and style of delivery was awareness of examples of other national-level anti-stigma campaigns among the key players within the alliance, as well as among Scottish Executive stakeholders. For example, in interviews those involved in the 'see me' campaign made reference to the success of the 'Like Minds Like Us' campaign in New Zealand. The proposal submitted by the alliance to the Scottish Executive in 2001 also draws attention to the evaluation of the Australian anti-stigma campaign, which was felt to have demonstrated the need for co-ordination at national and local levels proposing that "This supports our own view that to be successful, a high profile national campaign needs to be backed up by properly co-ordinated local action". The 'Mind out for Mental Health' campaign in England also provided a model of a campaigning and marketing approach, including the use of media volunteers. Early consideration had, in fact, been given within the Scottish Executive to 'piggy backing' on what was happening in England, but it was felt that this did not look "achievable".

Campaign aims and objectives

4.11 Over the period of 2001-2006, 'see me''s core aim has been articulated as being "to eliminate stigma and discrimination". Over this period the campaign's objectives have undergone some modification. This is illustrated in Figure 4.1 which draws on documentary material to compare the campaign's aims and objectives over the period 2001 to 2006-2008. This provides a summary of both the continuities and changes over time in the focus and direction of the campaign.

4.12 As the figure illustrates, in the 2001 Project Proposal, the key aim was "to end the stigma and discrimination associated with mental health problems by running a sustained, high profile Scotland-wide campaign". In the Operational Plans from 2004 onwards, however, eliminating stigma becomes the key overarching aim, supported by the objective of tackling stigma and discrimination "by raising public awareness of how both affect individuals with mental health problems and by improving public understanding of mental ill-health". Other changes include the removal of the objective of promoting mental health literacy which also features in the 2001 Project Proposal but no longer appears as a specific objective from 2004. Running the world's most successful anti-stigma campaign features in 2004 and 2005, but has gone by 2006. Challenging individual incidents of stigma appears in 2004, as does specific reference to involving people (rather than 'acting as a catalyst') in anti-stigma activity. By 2006 the reference to involving people at national and local levels has shifted toward an emphasis on "building long term sustainable action". In December 2005, the management group decided that the objective relating to improving awareness of sources of support should be an operational rather than a strategic objective, as a result of work carried out by 'see me' and an external consultant to refine the objectives.

Figure 4.1 Campaign objectives 2001 - 2006

4.13 What the changes reflect is the evolving nature of the campaign and the influence over the period of the three streams feeding into the decision-making processes, namely: the knowledge and experience of the management group; Scottish Executive imperatives; and the knowledge accruing from focus group contact with the field and 'see me''s research and evaluation of campaign strands. The commissioning letter issued in December 2001 by the Scottish Executive to the campaign, for example, discourages activity in relation to work in schools and in relation to mental health in the workplace. The former because of its perceived 'impracticality', the latter because of anticipated work by HEBS (subsequently NHS Health Scotland). In 2006, the documentary material alludes to changes in the 'external environment', and new priorities identified by the management group as influential on the change in strategic objectives for the period 2006-2008. The management group's own recognition of the 'save the world' tenor of the objective of running the world's most successful anti-stigma campaign led to its removal in favour of what were agreed to be more ' SMART' (specific, measurable, achievable, relevant and time-bound) objectives.

4.14 Focusing on the five core objectives which feature in one form or another from 2004 an analysis of documentary and interview material helps to illustrate how they came to inform the overall approach as well as individual elements of the campaign.

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

4.15 This is the core objective that remains throughout the period. What was understood by stigma and discrimination and where the emphasis was placed in the early years is discussed below. Organisational plans also underline the dual focus of raising public awareness of the impact of stigma and discrimination on people with mental health problems as well as improving public understanding of mental ill-health.

4.16 In undertaking this work the focus was on the general population and an approach that sought to avoid an accusatory, preaching or hectoring tone. This approach was felt to more readily appeal to the public than a more hard hitting campaign which evidence from England suggested could alienate the public.

4.17 The desire to avoid a tone which seemed to blame people for stigma and discrimination surfaces also in the workforce campaign. Although evidence from users and carers suggested the NHS was an area where people were experiencing stigma, the Scottish Executive and 'see me' agreed, early in the development of this campaign strand, not to specifically target this sector, or in fact 'employers' in the round, but to take a broader based approach focusing on the workplace environment. This is discussed in more detail in Chapter 6.

To challenge individual incidents of stigma and discrimination

4.18 This objective relates to challenging negative representations of mental health problems in advertising and the media. Working with the media was seen as being a key strand from the campaign's early inception. The [people too] proposal anticipates " develop[ing] a programme of action aimed at encouraging fairer, more accurate reporting of mental health issues". In addition, the proposal envisages drawing on the "enormous" power of "personal testimonies from individuals whose lives have been affected by stigma and discrimination". It was also anticipated that the campaign would collect examples of good and bad practice in media reporting, and encourage "campaign supporters to comment negatively or positively directly to print and broadcast media on their coverage". This objective sets in context the subsequent development of media guidelines, the development of the Media Volunteers programme and Stigma Stop Watch (see Chapter 5).

4.19 Unlike the 2004-2006 and 2005-2006 organisational plans, the 2006-2008 organisational plan explicitly sets out that tackling individual incidents of stigma and discrimination is not the responsibility of 'see me' alone. Rather, the role of 'see me' involves "promoting a culture" in which "we all challenge individual incidents".

To involve people in anti-stigma activities across Scotland at national and local levels and across sectors and communities of interest

4.20 For those involved in the campaign, this objective drew on evidence from Australia, New Zealand, USA and England, on the need not just for a "badge" of national work supported by campaigning at local levels but also for bottom up approaches. Prior to the formal launch of the first strand in October 2002 the campaign director embarked on six months of focus groups and meetings with individuals and groups across Scotland. The aim was both to enable people to inform the campaign, and also to try to ensure that people were made aware of and felt part of the campaign, "rather than going off and doing their own thing". The extent to which people have felt involved is discussed in Chapter 8. The related implications of seeking to bring together activities aiming to address the stigma and discrimination experienced by people with mental health problems under the 'see me' brand is discussed in Chapter 6.

To ensure that the voices and experiences of people with mental health problems and their carers are heard

4.21 The objective of providing a platform for people with lived experience and for those close to them was seen as not only "the right thing to do and it works", but also because of the evidence of the impact on attitudes of people talking about their experiences whether through the media or as trainers. The campaign drew on the model developed in England as part of 'Mind out for Mental Health', to develop its medial volunteer programme. Chapters 9 and 10 discuss the extent to which users and carers felt involved in other ways.

To promote a culture of learning and evaluation through all its work, so that effectiveness can be demonstrated and lessons shared

4.22 It was suggested by those involved in the campaign that this objective, which first appears in the Organisational Plan for 2004-2006, was added to make explicit what they felt they were already doing. It related to the process of evaluation and research that was undertaken both prior to campaigns to inform the creative designs and post launch to assess reach, recall and attitudes, and to inform future directions for the campaign. The case for the young people and workplace campaigns was made, drawing on this process of research and evaluation (see Chapter 6). The objective was also to encourage shared learning. This was an area where those directly involved in the campaign felt that they had been less successful to date. This is discussed further in Chapter 10.

'see me''s model of change

4.23 Interviews and documentary material indicate that the assumption held by those directly involved in the campaign was that it takes a generation to change attitudes. The basis for this assumption seems to draw from the example of areas such as racism and sexism, as well as perceived changes in attitudes to previously 'taboo' physical health problems such as cancer. This informed the early proposals to focus on young people, with a view to influencing attitudes before they become entrenched. On the basis of this assumed trajectory, at five-years old the campaign was described by a management group member as being only "one quarter" through the process.

4.24 A key feature of the campaign was its focus on higher-level awareness raising, rather than interventions targeted at specific groups such as medical students or police officers. (Thornicroft, 2006). This population level approach was informed by an elevator model of change, or what was described by one campaign respondent as a "virtuous circle": moving people along on a "journey" which commenced with raising awareness, through to changing attitudes leading to behavioural change. The model itself draws on the approach developed by the communications agency with whom 'see me' works (Figure 4.2). The implications of this model are returned to in Chapter 8.

Figure 4.2 Awareness and behaviour

'see me''s model of stigma and discrimination

4.25 As suggested in Chapter 1, this model of change influenced the initial emphasis 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 behaviour change has been through the campaign's work in challenging negative media portrayals of people with mental health problems.

4.26 However, although there is a clear awareness of the difference between attitudes and behaviours, between what people think and say and what they actually do, in the early stages at least there does not seem to have been an explicitly worked out definition of 'stigma' or 'discrimination'. Implicitly, a distinction did seem to have been drawn between attitudes towards those perceived to be different and behaviours on the basis of those perceptions. However, the extent of consideration that was given to whether and how different approaches might be developed to address the different dynamics at play in relation to 'stigma' or 'discrimination'. Thinking has, however, moved on as the campaign has evolved and developed. This is reflected in the suggestion made by 'see me' campaign respondents that, in addition to placing increasing emphasis on addressing self-stigma, the "wider issue of discrimination will be key in the future". The implications of this, including the roles of both 'see me' and other agencies and organisations are considered in Chapter 13 below.

Social Marketing

4.27 To achieve its strategic objectives, the main model that the campaign has drawn on is social marketing. As discussed in Chapter 1, social marketing uses commercial marketing techniques to achieve social goals. The approach used for the campaign was described as a combination of the campaign director's experience in community development, particularly the emphasis on mobilising support and buy-in, and the social marketing model for developing advertising campaigns used by the campaign's communications agency. The social marketing process has been influential in informing the direction and focus of the campaign. For one 'see me' respondent, "the process drives everything". The implementation of this model is discussed in Chapter 6.

Development of the 'see me' management group

4.28 Although representing different organisations, the comparatively small mental health community in Scotland meant that there were already pre-existing working relationships between key individuals. The representative of the Royal College of Psychiatrists had contributed to a joint seminar with NSF prior to the four organisations coming together in 2000. The NSF and HUG representatives had both been members of the Millan Committee. The SAMH representative had been on the Scottish Executive Mental Health Legislation Reference Group.

4.29 Despite the pre-existing relationships, there was, as one campaign respondent who was involved in the early stages commented, a degree of 'wariness' between the voluntary sector, professional organisations and the Scottish Executive. For the four organisations, addressing stigma was a shared interest, around which they could "rally", and to which they could all contribute different skills, expertise and capacities.

4.30 The model of a small core of voluntary and professional organisations funded to provide an anti-stigma campaign on behalf of the Scottish Executive had three implications: structural, operational and 'political'.

4.31 Structurally, it meant that the campaign was not identified as a Scottish Executive campaign. Although this raised issues of accountability and 'ownership', the absence of a Scottish Executive logo was felt to be beneficial (by those associated with the campaign, the Scottish Executive stakeholders and those outwith these groups), it was felt to give the campaign a perceived independence from the "nanny state".

4.32 Further, from the perspective of the Scottish Executive, what the five organisations brought were links to a range of different stakeholders which, it was felt, would not have been available to a communications company acting alone.

4.33 On the other hand, it was suggested by several respondents outwith the campaign that the perceived narrow range of organisations represented, compared to the consortium model employed by the Scottish Recovery Network ( SRN) (set up after 'see me'), not only excluded other mental health related organisations, but also precluded the involvement of other "equalities" bodies, or agencies with a remit beyond mental health to support the process of "transformational change".

4.34 Operationally, however, the small number of representatives on the group, and the consistency over time, has enabled the group to cohere. It has opened the space for debate and discussion between members around core issues, including different models of illness as well as of ways of addressing stigma and discrimination.

4.35 'Politically', this structure has had at least two implications. From the perspective of the Scottish Executive, the fact that the membership group comprises organisations that garner respect ( e.g. the Royal College) gives public credibility to the campaign.

4.36 For the members of the management group, working together has encouraged greater understanding of, and respect for, the different perspectives of each other's organisations. This had a 'knock on' effect in the joint work between the Royal College and SAMH, outwith the campaign that might not otherwise have happened. As discussed below ( Chapter 10), this is an unintended but positive outcome.

Funding

4.37 As noted in Chapter 1, over the period 2001-2006, 'see me' received regular payments from the Scottish Executive of around £2.5m. Additional ad hoc payments were made to support specific campaigns, or to re-run advertisements prior to a new launch campaign (tables 1.1. and 1.2). Funding was offered under the legislative power of Section 16b of the NHS (Scotland) Act 1978. The pattern of spending and agreement on the payment of the next tranche of funding is discussed between the Scottish Executive and the campaign on a six-monthly basis.

4.38 Funding an external, voluntary agency to undertake the campaign had a number of advantages. At a practical level, the charitable status of SAMH as budget holder meant that VAT did not have to be paid on advertising. At a 'political' level it also meant that the campaign could avoid being caught up with debates around the Scottish Executive advertising budget. Strategically, it also meant the campaign could develop an identity separate from the Scottish Executive.

4.39 The evaluation was not required to undertake an analysis of the cost effectiveness of the campaign. The documentary material, however, reveals repeated concerns by the campaign over the period about the level of funding available. Those running the campaign felt it was under-funded both in absolute terms, limiting the opportunity to undertake a "sustained campaign", but also in relative terms compared to other Scottish Executive campaigns. The interview material similarly reflects the frustration on the part of those most directly involved in developing and running the campaign, who felt the breadth and depth of what they were able to achieve was curtailed by the perceived limited funding. Examples of areas where it was felt more could be done included funding a sustained advertising campaign, workshops with trainee journalists and establishing a Speakers' Bureau of people able to give presentations and talks. What also emerges, both from the comments of those internal to the campaign and local areas, is that a trade off appears to have had to be made between work at local level and a national level campaign.

4.40 In its early business plan to the Scottish Executive, the management group included proposals for local anti-stigma co-ordinators in each local area. Funding was not made available to cover this. The available material does not indicate the reasons behind this decision. It has meant, however, that to undertake local work has involved either working collaboratively with local Choose Life co-ordinators, responding where there is local interest, or considerable input from 'see me' staff to generate local activity. The perceived variable take up across Scotland (see Chapter 7) may suggest that this has had an impact on opportunities to build capacity in areas where there may not be any evident product champions or local buy-in.

4.41 From the perspective of local areas, drawing on data from the NHS Board survey and three local area workshops (see Chapter 7); the lack of resources specifically ear-marked for activities addressing the stigma and discrimination experienced by people with mental health problems was felt to undermine what could be achieved locally.

Management, accountability and decision-making structures

4.42 Figure 1.1 in Chapter 1 describes the lines of accountability within 'see me', and between 'see me' and the Scottish Executive as primary funder. What this illustrates is the number of different layers of accountability:

• Between 'see me' as a 'delivery agent' and the Scottish Executive
• Within the 'see me' management group (and, not illustrated but present, between the management group and the organisations the members each represent)
• Between the management group and the operational arm of 'see me'
• And at operational level.

Decision-making processes

4.43 In the context of the campaign there are two decision-making processes and structures at play: those informing the strategic direction and focus of the campaign as a whole, including the broad strands of activity; and those informing the style, form and content of these strands of activity. The processes and structures for informing the creative decisions are discussed in more detail in Chapter 7 below. The two are in practice, however, inextricably linked creating grey areas between responsibility for the creative process and outputs and accountability for outcomes.

4.44 Strategically, as the accountability structures suggest, three streams fed into the decision-making process; the within-group knowledge and expertise of the management group; 'bottom up' intelligence from the market research process and through contacts with the field; and 'top down' from the Scottish Executive as funder. The three streams both informed each other, and together influenced the evolution of the campaign over time. For example, as was noted earlier, the Scottish Executive initially discouraged a focus on schools, the workplace and mental health literacy. Subsequently, focus groups undertaken in the first stages of the campaign suggested children and young people and the workplace as the foci for subsequent stages. Improving the mental health of children and young people was also a priority for the National Programme.

4.45 What becomes evident is the high degree of trust required on the part both of the management group, and the Scottish Executive, in the market research process as a basis for informing the strategic direction. As one member of the management group suggested this was trust that had to be gained as part of a steep learning curve on the part of the management group.

Accountability between 'see me' and the Scottish Executive

4.46 From the accounts of those directly involved in the campaign and Scottish Executive stakeholders, the relationship between the management group and the funders could perhaps be characterised as a combination of both freedom and constraint: a combination that at times created a tension on both sides. On the one hand the campaign had, as noted above, a strong sense of its own identity and independence from the Scottish Executive, having been conceived independently of, and prior to, the inception of the National Programme and managed by a group with a strong sense of ownership over the 'brand'. At the same time, the campaign was almost wholly funded from public monies, and therefore financially accountable to the Scottish Executive. As one of the repertoire of initiatives under the National Programme, it was also represented on the broad based National Programme National Advisory Group ( NAG), and the National Programme Executive Group made up of representatives from all the delivery agents (see Chapter 7 below).

4.47 As also suggested above, the Scottish Executive and those involved in the campaign valued its relative autonomy: both in terms of how it was perceived and in terms of the freedom it gave from the constraints that might have been placed on it had it been done 'in-house'. There was also a recognition that it was a resource with expertise and able to draw on its own constituencies of interest. At the same time this relative freedom raised governance issues in terms of ownership and control over the message and the mode of its delivery. At times, for example, the Scottish Executive felt they were to an extent presented with a fait accompli about campaign launches rather than being consulted in advance.

4.48 The campaign documentary material also suggests tensions over 'ownership' of the campaign. A management meeting note in July 2002, for example, refers to the concerns on the part of the 'see me' management group that the Scottish Executive appeared "uncertain" about the nature of the relationship "and that ultimate responsibility and ownership of the campaign rests with management group not the National Programme Director and the Scottish Executive".

4.49 In terms of the focus of the campaign as a whole, and strands within it, 'see me' was not entirely autonomous. The proposals set out in the original [ people too] business plan to include a focus on schools, the workplace and mental health literacy, for example, were discouraged by the Scottish Executive. On the other hand, an initial decision (in 2002) by 'see me' not to become involved in local 'not in my back yard' ( NIMBY) campaigns over the location of secure mental health units was subsequently reconsidered. This followed a request by the then Head of the Mental Health Division in the Scottish Executive for the campaign director to assist with the communications dimension of the consultation being undertaken on the site for a forensic unit.

4.50 Over the period there was a shift from a comparatively arms-length relationship to a more managerial one on the part of the Scottish Executive, reflecting a growing concern with the governance and accountability for all parts of the National Programme. This resulted in a change of role of the Scottish Executive 'representative' on the 'see me' management group. Early in 2002 the 'see me' documentary data indicate that the Scottish Executive asked permission for a representative to be in attendance at what was still the [ people too] management meetings. From the management's group's perspective the role of the representative was to share relevant Scottish Executive information with them and to inform colleagues within the Scottish Executive about the campaign. By 2006, with the creation of a new post in the Scottish Executive to oversee performance management of all part of the National Programme, the role of 'observer' had shifted towards one of 'Performance Management' and quarterly performance management meetings were held with the Scottish Executive, outwith the two-monthly 'see me' management meetings.

Accountability within the 'see me' management group

4.51 The five organisations comprise a management group, not a governing body. Early on within the management group there had been discussions about whether 'see me' should be run as an independent organisation, but it was felt internally that there were few advantages to be derived from setting up a new organisation. There were, however, early discussions about the need for a constitution or memorandum of agreement between the five organisations. This was not pursued because members agreed that these issues could be resolved among themselves.

4.52 For purposes of accountability, however, there was a requirement by the Scottish Executive for one of the five organisations to be identifiable as responsible for managing the funding and to present auditable accounts. SAMH agreed to take on this responsibility, also acting as an official signatory for contractual purposes, and providing, on behalf of the management group payroll, financial and recruitment services. SAMH also provided line management supervision to the campaign director.

4.53 The management group, however, comprises not just an alliance of five organisations, each with its own constituencies of interests and members, but also five individuals who not only represent their organisations, but bring their individual management experience. In this context the two issues which emerged were: ensuring parity of contribution by individual members of the management group; and constructing and maintaining the relationship between the campaign, the representatives on the management group and the organisations which they represent.

4.54 The interviews suggest the "robust" and "healthy" debates which took place within the management group prior to arriving at resolutions or compromise solutions with which everyone could feel comfortable. On the one hand, this space for debate was felt to add value to the outcomes. On the other hand it did require all participants to feel equally able to contribute. Minutes from management group meetings in both September 2002 and February 2004 suggest that not all participants did feel able to participate equally. The learning this suggested was the need to ensure that all members of the management group were of equal (managerial) status within their own organisations, so that all felt equally confident to contribute. Additionally, it was suggested that this would help to ensure the strategic impact of the 'see me' campaign within their own organisations.

4.55 One of the values of the model, from the point of view of both the management group and the Scottish Executive was the different stakeholder groups to which the five organisations had access. The 'see me' documentary material draws attention to the need to develop processes for encouraging 'ownership' of the campaign within the five organisations, but also to manage the consistency and unity of the 'message' (about 'see me') across these organisations. In a sense this points up the difference between the members of the alliance as individuals and as 'representatives' of wider constituencies. At different stages throughout 2003-2006 different ways for raising the profile of the campaign within the five organisations were being proposed, for example, including two pages on 'see me' within annual reports.

4.56 At the same time, as a management group 'representing' 'see me' as a separate entity, there was also a perceived need to ensure the unity of the messages being given out by the individual alliance members and organisations. In July 2002, for example, it was agreed that neither the 'alliance' (as the management body) or 'see me' would have a public position on the mental health bill, and public comment would only be made where it presented an opportunity to put across the anti-stigma message. In 2003, concerns were being expressed about the unity of messages being given out about 'see me' and the need to "coach" and encourage people not to go "off message".

Between the management group and the operational arm of 'see me'

4.57 The main link between the management group and the operational arm of the campaign was via the campaign director. The main issue to emerge was in relation to the boundaries between responsibility for strategic, 'creative' and operational decision-making in determining the direction and 'look' of the different campaign strands.

4.58 As early as September 2002, for example, documentary material suggests that concerns were being raised within the management group about how creative decisions were being made, and the management group's involvement in those decisions. The interviews and documentary material suggest there was a balance to be struck between a respect for the 'process' of consultation to ensure that the creative solutions would have resonance with the different target populations, and issues of accountability for the outcomes. The solution arrived at was for the operational arm to be responsible for developing the creative approaches but for the management group to ensure that it saw, contributed to and signed off the outputs from this process.

Staff team accountability

4.59 Within the team, the campaign director, at the time of the evaluation, had overall operational responsibility. The deputy director managed the staff and prepared the work plan for management group ratification.

4.60 An additional element that is an integral part of, but located outwith, this structure, is the communications agency appointed to provide the public relations input including creative development and design, advertising and media-related activity and evaluation. In a way which perhaps mirrors the tension between the Scottish Executive and the campaign as a whole, the documentary material suggests, on the one hand, an acknowledgement of the expertise and value that the communications agency were felt to bring to the campaign, and, on the other, concerns on the part of both the management group and the Scottish Executive about the relative costs of media buying and PR spend and value for money. These concerns surface in 2003, throughout 2004 and again in 2006. Notwithstanding these concerns, the communications agency continued to be the sole provider of advertising, design and PR activities throughout the period covered by the evaluation. 'see me' raised concerns about costs with the communications agency at regular intervals, and the fees were negotiated on an annual basis.

Key Points

• The early developmental phase evolved independently and outwith the Scottish Executive but was subsequently included under the National Programme umbrella. This pre-history gave the campaign a strong sense of internal cohesion as well as of its relative autonomy from the Scottish Executive.
• The campaign's five objectives evolved over time influenced by the knowledge and expertise of the management group, Scottish Executive imperatives and knowledge accruing from the field.
• The campaign takes a general population approach informed by a model of a 'journey' moving people from raising awareness to changing attitudes to effecting behaviour change.
• The campaign is funded through the Scottish Executive. Documentary and interview material suggests that aspects of the campaign were limited by a perceived lack of capacity. In particular there may have been a trade off in the later years between high level national campaigning and supporting local activity.
• External accountability mechanisms reflect the campaign's relative autonomy from the Scottish Executive. A shift, however, was apparent over time from a fairly arm's length approach on the part of the Scottish Executive, to a greater emphasis on performance management, reflecting the Scottish Executive's desire to manage the performance of all aspects of the National Programme.