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HOW DOES THE COMMUNITY CARE? PUBLIC ATTITUDES TO COMMUNITY CARE IN SCOTLAND

CHAPTER TWO: COMMUNITY CARE AND SOCIAL INCLUSION

ACCEPTABLE NEIGHBOURS

There were significant differences ² in how comfortable people said they would feel living next door to each of the individuals described in the vignettes. Most people (73%) said they would feel either very or fairly comfortable living next to an older person who sometimes falls ('Sarah' or 'Paul'). Over half (61%) would feel comfortable living next to the person with learning disability ('Alice' or 'David'). But less than half (45%) would feel comfortable living next door to the person with a mental illness ('Stuart' or 'Pat'). The lowest comfort was registered for the older person with dementia (42%) ('John' or 'Susan'). These differences are significant except for the difference between the older person with dementia and the person with a mental illness. The 95% confidence interval for all these items except for S/P who often falls is +/- 2.4, while that for S/P is +/- 2.2.

Table 2.1 How comfortable would you feel if they lived next door?³

For no group does the reported level of comfort fall below 40%. On the other hand people did feel different levels of comfort according to the needs of the person described and some needs proved to be more acceptable in a neighbour than others.

In order to examine variations in responses to the different individuals, we examined differences in levels of comfort between the vignettes according to income, social class, rural or urban area, gender and personal experience of giving or receiving care, but found very little variation. Levels of comfort proved similar across income and class groups and between rural and urban areas. Nor did personal experience of care appear to affect the degree of comfort that people felt. On the whole female and male respondents did not react differently to whether the story was told about a man or a woman. The one exception to this was that female respondents were significantly less comfortable than males when the person with a mental illness was described as male (Chi-square=13.2,p<0.01).

Table 2.2 Vignette of person with mental health problems: reactions to male and female vignettes by sex of respondent

Social class (measured by the Goldthorpe ⁴ schema (Goldthorpe,1983)) and education (measured by highest level of educational qualification achieved) did make some differences to the comfort people said they felt, but not for all vignettes. Professionals/managers and people with degrees were more likely to report that they would feel comfortable living near a frail older person. 78% of professionals and managers ('the salariat') were 'comfortable' compared with 69% of working class respondents. This difference is significant (Chi-square=10.2, p<0.01). Just over four fifths of people with a degree said they would feel comfortable, compared with 67% of people with no qualifications, again a significant difference (Chi-square=16.5, p<0.01).

Older people were significantly less comfortable living next to a person with a learning disability or a frail, older person. Over two thirds of people aged 35 and under said they would feel comfortable living next door to David or Alice (people with a learning disability), compared with 50% of people aged 55 and over (Chi-square=30.9, p<0.01). Almost four fifths of people aged under 35 would be comfortable living next door to Sarah or Paul (frail older people), compared with 63% aged 55 and over (Chi-square=25.8, p<0.01). This shows how difficult it is to interpret the influences that may be at work and that these might not be the same for each vignette. Older people might be more conscious of a 'burden' of care than younger people, but we do not know if this is a valid explanation.

THE ACCEPTABILITY OF COMMUNITY CARE POLICIES

Respondents were asked where they thought it would be best for these individuals to live if all options were possible. They were offered a choice of options - in own house with some help, with another family member, in special housing with support in the community, in a residential or nursing home or in hospital. The question was:

"If all the options on this card were possible, where do you think it would be best for … to live?"

People overwhelmingly selected community-based options (in own house with some support, with another family member or in special housing with support in the community), suggesting a strong acceptance of community care policy to shift the balance of care into the community. Answers ranged from 88% in favour of the community for a person with learning disabilities to 58% for a person with dementia. The proportion of people selecting a community based option for the person with dementia is higher than the proportion of those who said they would feel comfortable living next door to such a person (42%).

People also clearly distinguished between options for people with different needs. Half the respondents thought that the frail older person would be best in their own home with support. Half selected 'special housing with support' as the best option for the person with learning disability and this was also the most favoured option for the person with a mental illness. Hospital was only selected as an option for the person with a mental illness (7%). For the older person with dementia 40% selected a care home. The most common 'other' response was 'wherever they want'.

Table 2.3 Where would it be best for the person to live?

Younger people were significantly more likely than older people to select care in their own home as the preferred option for people with learning disabilities. Whilst we cannot be certain, this may indicate that expectations of independent living may be changing for people with learning disabilities. Whereas 38% of people aged under 35 thought they would be best living in their own home with some help only 19% of people aged 55 and over thought so (Chi-square=43.8, p<0.01). Older people themselves were slightly less in favour of care in their own home for the frail older person (42%) than was the population as whole (50%).

Table 2.4 Choice of own home with support by age of respondent

In summary, community care is an accepted feature of Scottish society with broad support for its main objectives but while people in Scotland expect those who need support will live in the community, they are not equally comfortable with everyone and may see someone who they perceive as posing a risk as a less desirable neighbour.

CITIZENSHIP

Jury service was selected as the measure of whether people were perceived as able to exercise the rights and duties of a citizen. The question, which was asked about the person with learning disability and the person described as having a 'mental illness', was as follows.

"Some people might say that .. should not be considered for jury service. Others would say s/he has as much right to sit on a jury as anyone else and should get any help s/he needs to do so. What do you think? Should … be considered for jury service or not?"

Seventy three per cent of people in Scotland think that the person with a learning disability should not serve on a jury but 82% think that the person with a mental illness should not. The difference is significant (confidence intervals 2.2:1.9).

Table 2.5 Whether person should serve on a jury

Younger people and those with degrees were significantly more accepting of jury service for both examples. Fifty eight per cent of people aged under 35 thought David or Alice with a learning disability should not be on a jury compared to 86% of people in Scotland aged 55 and over (Chi-square=95.1, p<0.01). For Stuart/Pat with a mental illness, 77% of people aged under 35 thought they should not be on a jury compared to 87% of people in Scotland aged 55 and over (Chi-square=13.8, p<0.01).

Sixty six per cent of graduates thought that a person with a learning disability should not be on a jury compared with 77% of people in Scotland with no qualifications (Chi-square=11.1, p<0.01). For Pat who had a mental illness, 69% of graduates said no compared with 85% of people in Scotland without qualifications (Chi-square=12.2, p<0.01).

It is worth noting that it was the vignette about the person with a learning disability that emphasised capacity whereas the vignette about the person with a mental illness said that the illness was controlled.

On the face of it these results suggest that there seems to be a clear case for public education as to what a particular disability or illness means that people can and cannot do. In fact there is no automatic bar to a person with a learning disability being on a jury. In practice, however, anyone who needs someone to support them is discriminated against because it is not allowable to have someone else present in the jury room. It will be important to know whether in time the Adults with Incapacity (Scotland) Act (2000) will lead to greater awareness and clarity on issues of capacity.

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