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WELL WHAT DO YOU THINK (2004): THE SECOND NATIONAL SCOTTISH SURVEY OF PUBLIC ATTITUDES TO MENTAL HEALTH, MENTAL WELL-BEING AND MENTAL HEALTH PROBLEMS
CHAPTER SIX: EXPERIENCE OF MENTAL HEALTH PROBLEMS
6.1 This chapter focuses on respondents' personal experiences of mental ill-health, both through having experienced a mental health problem themselves and through the experiences of people close to them. The chapter considers the social consequences of mental ill-health from the perspective of those with personal experience. It also looks at issues relating to recovery from mental ill-health: specifically at factors that help to promote recovery and at key signs of recovery.
Experience of mental health problems in someone close to respondent
6.2 Around three in five respondents (62%) said that someone close to them had experienced a mental health problem. In a 2003 survey of public attitudes to mental health in the UK, conducted on behalf of the Department of Health (DoH)
9, the comparable figure was 49% (Taylor Nelson Sofres 2003). Meanwhile, in a study of attitudes to mental health in Ireland, carried out for Mental Health Ireland
10, the figure was 73% (Millward Brown IMS 2003). Comparisons between the three surveys should be made with caution due to differences in the wording of the questions used. In the present study respondents were asked: 'from what you know, has anyone close to you ever experienced a mental health problem?' In the DoH and Mental Health Ireland Studies the question was: 'which of the following people closest to you has or has had some kind of mental illness'.
6.3 Women were more likely than men to say that someone close to them had experienced a mental health problem, and younger age groups were more likely than older respondents to do so, particularly those aged 75 years and over. Respondents with high GHQ12 scores were more likely to say they knew someone who had experienced mental ill-health than those with low GHQ12 scores (75% compared to 60%).
6.4 The results also varied depending on respondents' assessment of their ability to deal with their finances. Fifty-nine per cent of those who found it easy to manage on their income said that they knew someone who had experienced a mental health problem, compared with 65% of those who had difficulty managing. Analysis by social class indicated that those in managerial and professional occupations were more likely to say they knew someone who had experienced mental ill-health (75% and 65% respectively) than were those in routine occupations (54%), a finding that is consistent with results from the 2003 DoH and Mental Health Ireland studies. It may be that people of higher social grades are more likely to know people with mental health problems because they are more likely to have managerial responsibilities at work and therefore to know about the health of other staff.
6.5 The proportion saying that someone close to them had experienced a mental health problem increased when respondents were prompted with a list of specific conditions. Seven in ten respondents said that someone close to them had been diagnosed as having one of these problems. As in 2002, the conditions that most respondents said someone close to them had experienced were depression (48%), panic attacks (26%) and Alzheimer's Disease (20%) as table 6.1 illustrates. Other conditions mentioned by more than 10% of respondents included nervous breakdowns, anxiety disorders, post-natal depression and severe stress.
Table 6.1: Whether anyone close had experienced a mental health problem by sub-groups
Q From what you know, has anyone close to you ever been told by a doctor or other health professional that they had one or other of these kinds of specific mental health problem?
| All | Male | Female | Aged 75+ | Aged 25-34 | Difficult to manage on income | Easy to manage on income |
Base: All respondents | (1,401) | (594) | (807) | (155) | (201) | (195) | (659) |
| % | % | % | % | % | % | % |
Alzheimer's Disease/dementia | 20 | 20 | 21 | 13 | 22 | 16 | 21 |
Anxiety disorder | 13 | 10 | 16 | 3 | 16 | 15 | 12 |
Depression | 48 | 43 | 51 | 14 | 60 | 60 | 46 |
Eating disorder (anorexia, bulimia) | 10 | 7 | 12 | 2 | 13 | 12 | 11 |
Manic depression (bipolar affective disorder) | 9 | 8 | 10 | 2 | 12 | 11 | 8 |
Nervous breakdown | 18 | 18 | 18 | 7 | 22 | 17 | 14 |
Obsessive compulsive behaviour/disorder | 6 | 6 | 6 | 2 | 11 | 7 | 7 |
Panic attacks | 26 | 23 | 29 | 6 | 29 | 33 | 24 |
Personality disorder | 3 | 5 | 2 | 2 | 4 | 6 | 2 |
Phobias (e.g. agoraphobia) | 7 | 8 | 7 | 2 | 9 | 10 | 8 |
Post-natal depression | 16 | 12 | 21 | 2 | 21 | 21 | 18 |
Schizophrenia | 7 | 6 | 8 | 3 | 8 | 8 | 8 |
Self harm | 8 | 8 | 8 | 1 | 10 | 13 | 7 |
Severe stress | 19 | 19 | 20 | 3 | 24 | 25 | 19 |
Any of these | 70 | 66 | 74 | 35 | 79 | 78 | 70 |
None of these | 29 | 32 | 25 | 62 | 19 | 21 | 28 |
Don't know/refused. | 1 | 2 | 1 | 3 | 2 | * | 2 |
Source: MORI
6.6 These figures are in line with findings from the Mental Health Ireland study. In that study, people who said that someone close to them 'has or has had some kind of mental illness' were asked about the nature of that difficulty. In response, 50% mentioned depression, around one in ten mentioned schizophrenia (10%), manic depression (10%) and anxiety/phobias/panic attacks (8%), 2% mentioned an eating disorder and 10% mentioned some other condition (Millward Brown IMS 2003).
Respondents' own experience of mental health problems
6.7 A quarter of respondents said they had personally experienced a mental health problem at some time in their life (26%). This is in line with the 2002 survey (27%) but is a higher proportion than that recorded in the Mental Health Ireland Study (9% Millward Brown IMS 2003). Respondents in the 2003 DoH survey were asked whether they had consulted a GP in the last 12 months about any personal mental, nervous or emotional problems (Taylor Nelson Sofres 2003), so findings are not directly comparable. However 13% said that they had contacted their GP about such a problems during that period, so it is likely that reported lifetime incidence would have been considerably higher than 13%.
6.8 As in 2002, the mental health problems that respondents had most commonly experienced were depression (17%), panic attacks (7%) and severe stress (6%). While this is consistent with results from other studies, the proportions of people experiencing these conditions in Scotland are higher than elsewhere. To illustrate, in the Mental Health Ireland study, six per cent said they had experienced depression, a third of the figure for Scotland. Likewise, one per cent said they had experienced an anxiety disorder or panic attacks, which is 7 times lower than the Scottish figure.
6.9 Table 6.2 presents self-reported experience of mental health problems for various sub-groups of respondents. While some of the differences between subgroups are statistically significant and others are not, all contribute to an understanding of ways in which mental ill-health is experienced by the study population.
6.10 Looking specifically at significant differences, women, and particularly those aged 35-54 years, were most likely to say that they had experienced any mental health problem. Those who said that they found it difficult to manage on their income were more likely to have experienced a problem than those who said they had no trouble managing. There was also a relationship between respondents' working status and their experience of mental ill-health: those who were in part-time work were more likely to say they had experienced a problem than those working full-time. There were no significant differences in the extent to which respondents in urban and rural areas had experienced mental ill-health.
6.11 As might be expected, respondents with high GHQ12 scores, or who felt that they had little or no control over factors that affected their mental health, were much more likely to say they had experienced mental ill-health than were those who felt that they had complete control. Additionally, mental health problems appeared to be more prevalent among those who rated their general health as poor.
6.12 Looking at the incidence of particular conditions among different sub-groups of the population, experience of depression was most common among women aged 35-54 and people who felt that they had little or no control over factors affecting their mental health, or who rated their general health poorly. Meanwhile, experience of panic attacks was significantly higher among those who said they felt they had little control over factors affecting their mental health (see table 6.2). These findings are consistent with results from the 2002 survey.
Table 6.2: Experienced a mental health problem themselves by sub-groups
Q Have you ever been told by a doctor or other health professional that you personally have had one or other of these kinds of specific mental health problems?
| Any | Depression | Panic attacks | Severe stress | None of these |
Base: All respondents |
Row percentages | % | % | % | % | % |
All (1,401) | 26 | 17 | 7 | 6 | 73 |
Male (594) | 20 | 13 | 5 | 5 | 80 |
Female (807) | 32 | 20 | 10 | 7 | 67 |
Male aged 16-34 (148) | 17 | 10 | 3 | 5 | 82 |
Female aged 16-34 (184) | 29 | 19 | 9 | 6 | 71 |
Male aged 35-54 (205) | 21 | 15 | 7 | 6 | 79 |
Female aged 35-54 (289) | 44 | 27 | 13 | 12 | 55 |
Male aged 55+ (241) | 21 | 12 | 4 | 6 | 79 |
Female aged 55+ (334) | 22 | 14 | 8 | 3 | 78 |
Working full time (1,200) | 25 | 15 | 7 | 6 | 75 |
Working part time (156) | 37 | 29 | 9 | 6 | 63 |
Easy to manage on income (659) | 21 | 12 | 6 | 5 | 79 |
Difficult to mange on income (195) | 49 | 32 | 16 | 9 | 51 |
Most urban (509) | 27 | 17 | 8 | 6 | 72 |
Most rural (106) | 29 | 6 | 9 | 3 | 71 |
Complete control (211) | 14 | 8 | 4 | 1 | 86 |
Good deal of control (690) | 23 | 14 | 6 | 6 | 77 |
Some control (337) | 33 | 21 | 9 | 8 | 67 |
Little Control (96) | 56 | 37 | 26 | 17 | 44 |
No control (43) | 37 | 31 | 9 | 6 | 63 |
General health good (1,134) | 23 | 14 | 6 | 4 | 77 |
General health poor (164) | 47 | 35 | 11 | 16 | 53 |
Low GHQ12 score (1,104) | 22 | 13 | 5 | 4 | 78 |
High GHQ12 score (196) | 57 | 43 | 19 | 18 | 43 |
Borders and South (197) | 22 | 13 | 6 | 7 | 78 |
Central Belt and West (410) | 28 | 17 | 9 | 6 | 71 |
Highlands and Islands (214) | 26 | 16 | 8 | 4 | 74 |
Lothian and Fife (313) | 28 | 20 | 8 | 9 | 72 |
North East (267) | 24 | 15 | 5 | 5 | 76 |
Source: MORI
CHAID ANALYSIS
6.13 While basic sub-group analysis provided a means of identifying relationships between respondents' experiences of mental ill-health and some key socio-demographic and attitudinal variables, it could not tell us anything about the relative
strength of those relationships. To obtain this information it was necessary to carry out a more sophisticated, multivariate analysis technique known as CHAID (Chi-squared Automatic Interaction Detector) analysis.
6.14 We found that the CHAID analysis simply reinforced the messages from the cross-tabulations which identified individual sub-groups in the sample. Specifically, it showed that women, younger people and people with high GHQ12 scores, were among the groups most likely to have experienced a mental health problem.
The SOCIAL IMPACT OF MENTAL ILL-HEALTH
6.15 Respondents who said they had experienced a mental health problem were asked about the social impact of their condition and specifically about any difficulties they had experienced in terms of other people's attitudes. Around two-thirds said that they had not experienced any difficulties in terms of other peoples' attitudes to them. However, 15% per cent said that they had been prevented or discouraged from participating in social events such as going out with friends, 6% said that they had been verbally abused within the family and 6% said they had been unable to take part in community life. As table 6.3 shows, these findings are in line with the 2002 results.
Table 6.3: Social impact of mental health
Q Have you experienced any of the following as a result of other people's attitudes towards your mental health problem(s)?
| Percent Experienced |
Base: All who have personally experienced a mental health problem | 2002
(440 ) | 2004
(377 ) |
| % | % |
Unable to/discouraged from participating in social events | 12 | 15 |
Unable to/discouraged from taking part in community life | 4 | 6 |
Verbally abused within the family | 7 | 6 |
Experienced discrimination at work | 7 | 6 |
Been overlooked/refused for promotion | 4 | 5 |
Verbally abused in public | 8 | 5 |
Unable to/discouraged from going on holiday | 3 | 4 |
Been refused a job | 6 | 4 |
Physically abused within the family | 4 | 4 |
Unable to/discouraged from participating in school based activities | 1 | 2 |
Physically abused in public | 3 | 2 |
Graffiti or rubbish targeted that the home | 1 | 1 |
Other | 2 | 2 |
None of these | 68 | 64 |
Source: MORI
6.16 One in ten of those who said they had experienced a mental health problem had taken a conscious decision not to disclose their problem when making formal applications. For example, 7% said that they had chosen not to disclose their problem when applying for a job and 4% say they had chosen not to do so when applying for travel insurance, medical insurance or a driving licence, as table 6.4 illustrates.
6.17 Although sub-group sizes are small at this level of analysis, it does appear that younger people were more likely to say that they had chosen not to disclose their mental health problem when making applications than were older people (23% of 25-34 year olds, compared with 9% of 35-44 year olds and 5% of 65- 74 year olds).
Table 6.4: Disclosure of mental health problem
Q Have you decided not to disclose this problem/any of these problems when applying for any of these..?
| Percent decided not to disclose |
Base: All who have personally experienced a mental health problem | 2002
(373) | 2004
(377) |
| % | % |
Job | 10 | 7 |
Travel insurance | 3 | 4 |
Medical insurance | 1 | 4 |
Driving licence | 3 | 4 |
Bank loan | 2 | 3 |
Credit card | 3 | 3 |
Education and training opportunities | 3 | 3 |
None of these | 85 | 90 |
Source: MORI
RECOVERY FROM MENTAL ILL-HEALTH
6.18 A key aim of the National Programme is to support the process of recovery for people who experience mental ill health. Recovery aims to ensure that those who experience long-term mental health problems are enabled and supported to regain control and choice in their lives as full members of society. The Scottish Recovery Network (SRN) is being established as a platform to take this work forward. In order to investigate the general public's understanding of the concept of recovery, the 2004 survey included 3 new questions on this subject. In future runs of the survey it is planned to ask questions relating to recovery of all respondents, in order to help better understand the public's understanding and expectation of recovery and to track the impact of the SRN's work across all communities. However, as the initiative is still at an early stage, the new questions in the 2004 survey were asked exclusively of those respondents who said that they had personally experienced mental health problems and were in a position to consider factors affecting their own recovery
6.19 Respondents were asked to consider the factors they felt had been most important in supporting their recovery. Three-quarters mentioned support from family or friends while 38% mentioned medication. The next most common responses were counselling and having something worthwhile to do during the day, mentioned by 29% and 21% respectively. There were few sub-group differences for this item though women were significantly more likely to mention support from family and friends (80%) than were men (65%).
6.20 When asked if they felt that there were any factors that might have been helpful in their recovery,
had they been available, respondents tended to emphasise support from others. A quarter felt that counselling would have been helpful, if available, and 17% mentioned support from people with a similar experience. Twelve per cent mentioned alternative forms of treatment or therapy. More information on supporting recovery is illustrated in figure 6.1.
Figure 6.1: Factors important in supporting recovery
6.21 Asked to (spontaneously) identify key signs of recovery from mental ill-health, respondents emphasised changes in how they felt within themselves and returning to previous activities rather than strongly associating recovery with coming off medication or other forms of treatment. Thus, as table 6.5 shows, respondents mentioned feeling better generally, being able to cope and taking charge of one's life again.
Table 6.5: Key signs of recovery
Q For someone like yourself who has experienced a mental health problem, what do you think, are the key signs that might indicate that you are recovering?
Base: All who have personally experienced a mental health problem | (377) |
| % |
Feeling better generally | 42 |
Feeling able to cope in general | 39 |
Taking charge of your life again | 37 |
Feeling more positive about the future | 25 |
Getting involved in activities you enjoyed | 13 |
Getting back to work | 11 |
Fewer symptoms | 8 |
No longer requiring medication | 4 |
Taking up training or education opportunities | 2 |
No longer requiring treatment | 1 |
Source: MORI
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