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WELL? WHAT DO YOU THINK?
EXECUTIVE SUMMARY
INTRODUCTION
1. The Scottish Executive is committed to policies and initiatives designed to raise awareness of mental health issues and to promote positive mental health and well being. As part of the early work of the National Programme for Improving the Mental Health and Well Being of the Scottish population, a survey was commissioned to assess people's understanding of mental health and well being, sources of information about mental health issues, experience and perceptions of mental health problems, and attitudes towards mental health problems and people who suffer from them. The contract was awarded to NOP Research Group's Social and Political division. (See
Chapter 1)
2. This project was based around an in-home random sample of 1381 interviews conducted with a representative sample of adults across Scotland. Since the sample size would not give robust data relating to minority ethnic people in Scotland, a 'booster' of 51 interviews with non-white people was included. Data was weighted to correct for differential chance of respondent selection and demographic imbalance. (See
Chapter 2)
GENERAL HEALTH AND LIFESTYLE
3. Half of the people in the sample rated their general health as very good or excellent. The best health was enjoyed by those people who reported the least stress in their lives, people under the age of 55 and those living in affluent areas. (See
Chapter 3.8)
4. Highest mental health and vitality scores were recorded for those people who reported that their lives had been relatively free of stress during the last year and those who felt they had complete control over factors affecting their mental health. Respondents living in professional/managerial households, people who found it easy to manage on their income and people with no long-standing health problems also scored highly. (See
Chapter 3.11)
5. Long-standing limiting health conditions were most common among older people, those living on low incomes, people who found it hard to manage on their income, smokers and those who had experienced mental health problems. (See Chapter
3.12 and
3.13)
6. Stress, or the perception of it, declined with age. This may be due to educational and social changes that have led younger people to feel more comfortable in discussing stress. Reported stress levels were particularly high among people aged between 35 and 54 (especially women), respondents who had experienced mental health problems and people with low mental health/vitality scores. (See Chapter
3.14 and
3.15)
7. The heaviest users of GP services were older people, those who reported higher levels of stress and people who had experienced mental health problems. (See Chapter
3.16 and
3.17)
8. Smoking was most common in people who scored modestly on the mental health/vitality scales, and among people working in unskilled jobs or reliant on state benefits. (See Chapter
3.18 and
3.19)
9. Twelve percent of people in the sample reported having caring responsibilities for sick, disabled, elderly or frail people. The figure was higher among those who experienced a higher level of stress. (See Chapter
3.21)
10. Half of the people in the sample said that they knew many or most people in their neighbourhood. However, respondents who reported that they were stressed, those with low mental health/vitality scores and those who had little control over factors impacting on their own mental health were likely to know fewer people in the neighbourhood. (See Chapter
3.22 to 3.27)
PEOPLE'S VIEWS OF THEIR OWN MENTAL HEALTH AND WELL BEING
11. Asked to describe good mental health, the most common responses were: being happy (especially among people between the ages of 16 and 34), healthy (notably among those people with high mental health/vitality scores), being in control (particularly among men aged between 16 and 54 and those people on higher incomes), confident (notably among people between the ages of 16 and 24) and loved (especially women). (See
Chapter 4.1)
12. Factors likely to have the most positive effect on mental health and well being included support from family and partners, being healthy (notably people over the age of 75), leisure and social life (particularly the 16 to 34 age group) and having a good income (especially those aged between 25 and 54). (See
Chapter 4.2)
13. Factors likely to have a negative effect on respondents' mental health and well being included stress (particularly in the 25-54 age group), physical illness (notably older women) and lack of money (the 25-54 age group again). (See
Chapter 4.3)
14. The three main categories of factors that respondents felt would make the biggest difference to their own mental health and well being were financial (a view notably held by men), health (people aged 55 or older) and stress (people under the age of 55). (See
Chapter 4.4 to 4.6)
15. Only 14% of people in the sample said that they had complete control over factors that could affect their own mental health and well being, although 57% thought that they had a good deal of control. People who had experienced mental health problems, and people between the ages of 25 and 54 were least likely to feel they had control over these factors. (See
Chapter 4.7 to 4.9)
16. Respondents were asked to choose from a prepared list of suggestions how the government in Scotland might prioritise spending to improve the mental health of the Scottish population. The most popular options were: improving services for people with mental health problems (often mentioned by those in professional/managerial households), providing support to people at difficult times in their lives, helping people understand mental health (a view put forward particularly by those who had experienced mental health problems) and helping to end poverty (suggested most often by unskilled workers and those reliant on state benefits). (See
Chapter 4.10 and 4.11)
PEOPLE'S EXPERIENCE OF MENTAL HEALTH PROBLEMS
17. More than two-thirds of people in the sample said that someone close to them had been diagnosed with a mental health problem at some time in their life. Depression was the most common diagnosis, followed by panic attacks, severe stress and Alzheimer's Disease. Women, people aged 25-54, higher income groups and those people with high levels of stress were most likely to have this kind of contact. (See
Chapter 5.1 and 5.2)
18. Just over a quarter of respondents (27%) said that they themselves had been diagnosed with a mental health problem at some time in their lives - again, depression was the most common condition. People who reported having the most stress in their lives, those with little or no control over factors affecting mental health and people who found it difficult to manage on their income were most likely to say that they had experienced mental health problems. (See
Chapter 5.3 and 5.4)
19. A third of those people who reported that they had had a mental health problem diagnosed at some time in their lives said that they had experienced difficulties in terms of other people's attitudes. These difficulties included being unable to participate in social events and experiencing verbal abuse at home and elsewhere. (See
Chapter 5.5 and 5.6)
WHERE DO PEOPLE GET THEIR INFORMATION ON MENTAL HEALTH ISSUES?
20. Major sources of information about mental health issues included television news and current affairs, personal contact and experience (notably for those with experience of mental health problems), national newspapers (particularly for older men) and health professionals (especially for those who reported high levels of stress). (See
Chapter 6.1 to 6.3)
21. More than 40% of people in the sample reported that they had seen, read or heard of advertising or promotional activity for mental health and well being in the last six months. The most 'aware' groups were younger people and those who had experienced mental health problems. (See
Chapter 6.4)
22. Media portrayal of people with mental health problems was rarely seen as being entirely positive or entirely negative. However, the general view was that portrayal tended to be negative (a view held notably by 25-54 year olds). Only 10% of those who had experienced mental health problems thought that people with such conditions were positively portrayed. (See
Chapter 6.5 and 6.6)
MENTAL HEALTH PROBLEMS: PEOPLE'S VIEWS, ATTITUDES AND OPINIONS
23. People in the sample were asked to respond to a series of statements about mental health problems. Responses were used in an aggregate analysis to develop a classification of overall views on mental health problems in order to measure levels of tolerance. Low scores (i.e. reflecting generally tolerant attitudes) were recorded for most people. However, mean scores for people over the age of 75 were significantly higher than for other age groups and those with no experience of mental health problems scored significantly higher than those who did have such experience. (See
Chapter 7.1 to 7.3)
24. The statements about mental health problems were also used in cluster analysis, in which people were grouped according to the way they responded to the attitude statements. The attitudes that people in each group held in common and the characteristics that they shared were then explored. This work will help to understand how activities to raise public awareness and tackle stigma might be targeted most effectively. While the attitudes of almost half the people interviewed placed them in the two most tolerant groups, one in five expressed opinions that placed them at the other end of the spectrum.
25. The cluster analysis showed one group of people who were in the middle of the spectrum, exhibiting a mixture of sympathy and concern. People in this group indicated that they might find it difficult to talk to people with mental health problems, they tended to think that the public should be protected from people with mental health problems and they would not want people to know if they were suffering from a mental health problem themselves. On the other hand, they thought that anyone can suffer from a mental health problem and agreed with the idea of equal rights. It is possible that this group will be most receptive to initiatives to improve awareness of and information about mental health problems. People in this group were most likely to be in work, and the news on television was likely to be their main source of information about mental health issues. (See
Chapter 7.4 to 7.6)
26. Respondents were shown one of six vignettes which described symptoms associated with depression, schizophrenia or stress in a man (Robert) or woman (Shona). No diagnosis was included in the description. People were then asked a number of questions relating to the person described in the vignette. Respondents thought that many factors were likely to have caused Robert or Shona's condition. Stressful or disturbing events were cited by more than 80% of respondents to all case studies. Some vignettes were associated with particular factors: symptoms of depression were seen as being linked with physical illness (particularly in Robert's case) while schizophrenia was seen as being connected with chemical imbalance in the brain and, to a lesser extent, with genetic problems. (See
Chapter 7.7 to 7.18)
27. Respondents were asked who would be the best person to help Robert or Shona (options included family members and friends and service users as well as a range of service professionals). The most commonly suggested source of help for the person in each vignette was the family doctor (GP). However, for those respondents considering symptoms associated with schizophrenia (and the depressed Shona) the GP's input was seen to be less helpful. The specialist skills of a psychiatrist were more likely to be suggested to engage with Robert/Shona's symptoms of schizophrenia. A qualified counsellor was a popular option with those considering Robert/Shona's symptoms of depression. Family members received frequent mentions as potential sources of help for the person in the vignette, particularly the male version of each case study. (See
Chapter 7.19)
28. Very few respondents thought that Robert or Shona should live alone, whatever the symptoms described. For the person suffering depression or stress, living at home with family members was a popular option (although not for the depressed Shona). Approximately half of the respondents who considered a person experiencing symptoms of depression or schizophrenia thought that Robert/Shona could live at home with professional help. Some respondents opted for the idea of special housing with professional support for the person with schizophrenia, particularly those who considered the male version of the vignette. (See
Chapter 7.20 and 7.21)
29. A quarter of those respondents who considered the symptoms of stress, half of those who looked at symptoms of depression and two-thirds of those responding to symptoms of schizophrenia thought it likely that Robert/Shona would harm him/herself.
30. Between 12% and 15% of people who considered the stressed Robert/Shona and depressed Shona thought that he/she might harm someone else. Robert with symptoms of depression was thought to be somewhat likely to cause harm to others by 21% of people who considered this vignette. Respondents who considered the vignettes which described symptoms of stress were less likely to believe Robert or Shona was likely to harm other people. However, almost 40% of those who were presented with the vignette describing the symptoms of schizophrenia thought that Shona and (more particularly) Robert might be violent to other people. (See
Chapter 7.22 to 7.23)
31. There was overwhelming support for the idea that the depressed or stressed Robert/Shona should have the same rights as other people. However, 10% of respondents who considered the symptoms of schizophrenia in a man felt that Robert should not have such rights. (See
Chapter 7.24)
32. Respondents were generally quite willing to have contact with and even make a friend of Robert or Shona, although there was less enthusiasm for the idea of him/her marrying into the family. Thirty-eight percent of people who responded to the male version of the vignette describing symptoms of schizophrenia said they would be unwilling for Robert to marry into the family. (See
Chapter 7.25 to 7.31)
33. Almost all the people who considered vignettes describing symptoms associated with depression thought it likely that Robert/Shona was suffering from depression. More than 80% of people who had looked at symptoms of schizophrenia and stress also felt that Robert/Shona was depressed. There was less certainty about Robert/Shona experiencing schizophrenia, although more than 70% of people who had considered the relevant vignette felt that the symptoms were associated with schizophrenia. Ninety-five percent of people felt that the stressed Robert/Shona was, indeed, experiencing stress. However, 90% of those who had considered symptoms of schizophrenia and 95% of those who had been asked to think about symptoms of depression also felt that Robert/Shona was experiencing stress. (See
Chapter 7.32 to 7.35)
KEY MESSAGES FROM THE RESEARCH
34. Findings in all the areas addressed by the survey provide useful information for national and local policy and practice. There were strong links between both general health and rates of mental health/vitality and a range of socio-economic factors. There were also links between levels of stress reported by respondents and their assessment of their own health, energy and state of mind.
35. People demonstrated awareness of factors that might influence their own mental health and well being (positively or negatively). There were significant differences in the factors considered important by people in different age groups. However, it was not possible to tell whether priorities change as people become older, or whether factors such as the language, education and social conditioning of different generations influence their responses to questions of this type.
36. There are various encouraging findings from the parts of the survey which dealt with people's attitudes towards those who experience mental health problems. People in the sample were generally ready to socialise or work closely with a man or woman exhibiting the symptoms of depression, schizophrenia or stress. There was also widespread recognition that people with mental health problems are not to blame for their condition and should have equal rights with the rest of the population. However, there was some reluctance by some people to get too close (for example, to have a man with depression or schizophrenia marry into the family).
37. Analysis of people's responses to a battery of attitudinal statements indicated that younger people were (broadly) likely to be more tolerant than people over the age of 75. Approximately a quarter of all respondents displayed a mixture of attitudes, suggesting that they could be amenable to initiatives to increase awareness and tackle stigma. Almost half of all respondents recognised that the media tend to deal negatively with mental health problems - three times as many as thought the media had a positive slant in this respect.
38. The sample size for the survey is robust and representative of the Scottish population, so there are no obvious caveats to be borne in mind when considering its findings. Although there was a relatively high refusal rate (23%) there was no evidence of visible bias in terms of the noted profile (ethnicity, evidence of children in the home etc) of those people who refused to participate. However, it is not possible to tell whether there are attitudinal biases in the weighted sample of participants.
39. In the course of the survey, respondents who said that they had personal experience of mental health problems were asked if they had ever decided not to disclose the condition during a variety of formal application processes. We respect the position of those who agreed that they had made such a decision, and accept that reluctance to reveal personal experiences may have influenced people's responses to some of our wider survey questions. This reinforces the agenda for change and improvement in current attitudes to people who experience mental health problems.
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