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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 SEVEN: SOURCES OF INFORMATION ON MENTAL HEALTH PROBLEMS AND AWARENESS OF CAMPAIGNS AND INITIATIVES

7.1 This chapter examines how people form opinions and impressions about mental health problems. It also discusses perceptions of the media's portrayal of people with mental health problems, before moving on to gauge levels of public awareness of campaigns and policy initiatives which deal with mental health issues in Scotland. Having an understanding of both the key media for mental health information and current awareness of campaigns and policy initiatives is important, not only in promoting positive mental health, but in gauging how successful the campaigns and policy initiatives have been for future projects.

Forming impressions and opinions about mental health problems

7.2 Personal contact or personal experience was the most commonly-mentioned source of information or influence affecting peoples' impressions of mental health (57%) followed by information from television news and current affairs programmes (44%). A third (32%) said they received their information via word of mouth, and one in four (27%) cited health professionals as an important source. As table 7.1 shows, these results are slightly different to those obtained in 2002 but this can probably be attributed to the greater emphasis on asking people how they formed their impressions and opinions (rather than asking about 'sources of information' which was the emphasis in 2002). The impact has been to raise the profile of personal contact or personal experience at the expense of national newspapers.

7.3 People who mentioned more than one source of information were asked which one had been most influential to them in forming their impressions of mental health problems. Again, the main sources of acquiring information were personal contact or personal experience (39%), television news and current affairs programmes (15%), health professionals (8%), work (8%) and word of mouth (7%).

Table 7.1: Forming impressions and opinions about mental health problems

Q1. Taking your answers from this card, which, if any, of the following have been important in forming your impression?
Q2. Which one of these sources would you say was the most influential for you?

	Q1		Q2
	2002	2004	2002	2004
Base: All respondents	(1,381)	(1,401)	(1,381)	(1,401)
	%	%	%	%
Personal contact or personal experience	38	57	21	39
Television news and current affairs	51	44	18	15
Word of mouth	29	32	5	7
Health professionals	33	27	17	8
National newspapers	34	26	8	4
Work	20	24	7	8
Books/leaflets/magazines	28	24	5	3
Television soaps	14	15	2	2
School/college	17	13	3	4
Local newspapers	16	13	2	1
Other TV	6	12	1	2
Radio	10	10	1	1
Internet	1	5	*	*
None of these	6	3	6	4
Other	1	1	1	*
Don't know	1	1	2	2

Source: MORI

7.4 As table 7.2. shows, the sources of information or influence listed were mentioned to varying degrees by different groups of respondents. People aged 25-29 years were among those most likely to mention personal contact or experience. Additionally, men aged 35-54 years were more likely than others to say television news and current affairs programmes was an important source of information. Men aged 15-24 years were more likely than any others to mention school or college. This is in contrast to 2002 when young women were the most likely to mention these sources.

7.5 There was also some variation by economic variables. In particular, people who had an annual household income of 26,000 or more, and who lived in less deprived areas, were more likely to regard health professionals as important sources of information on mental health problems than were those living in lower income households or in more deprived areas.

Table 7.2: Top 4 influential sources of information about mental health by sub-groups

Q Which one of these sources would you say was the most influential for you?

	Personal contact or personal experience	Television news and current affairs programmes	Work	Health professionals
Base: All respondents	%	%	%	%
All (1,401)	39	15	8	8
Male (594)	38	16	6	7
Female (807)	40	14	10	8
Male 16-34 (148)	39	11	2	8
Male 35-54 (205)	39	19	7	6
Male 55+ (241)	35	16	8	6
Female 16-34 (184)	38	12	11	7
Female 35-54 (289)	45	11	10	10
Female 55+ (334)	34	19	8	7
Annual household income of 5,000 or less (114)	42	15	2	8
Annual household income of 26,000 or over (258)	43	12	12	7
IMD - least deprived area (band 5) (305)	45	11	9	9
IMD - most deprived area (band 1) (312)	38	15	7	6

Source: MORI

Media portrayal of people with mental health problems

7.6 Respondents were more likely to think that the media portrays people with mental health problems in a negative light than in a positive light. Over two in five said the media portrayed people with mental health problems negatively compared to 15% who said they were portrayed positively. Around a third thought the media portrayed people with mental health problems both positively and negatively. As can be seen from table 7.3, perceptions in this area have remained stable between 2002 and 2004.

Table 7.3: Media portrayal of mental health

Q. Overall, how do you think the media, such as newspapers, television and radio, portray people with mental health problems?

	2002	2004
Base: All respondents	(1,381)	(1,401)
	%	%
Almost always positively	4	2
More positively than negatively	11	13
Both positively and negatively	35	36
More negatively than positively	35	36
Almost always negatively	9	7
Don't know	6	6

Source: MORI

7.7 As table 7.4 shows, there were no significant differences in the perceptions of men and women with regard to the media's portrayal of people with mental health problems. However, older respondents and people with lower educational or professional qualifications were significantly more likely than other groups to view the media's portrayal positively.

Table 7.4: Media portrayal of mental health by sub-group

Q. Overall, how do you think the media, such as newspapers, television and radio, portray people with mental health problems?

	Positively	Negatively
Base: All respondents	%	%
All (1,401)	15	43
Men (594)	15	46
Women (807)	16	40
16-24 (131)	18	42
25-44 (458)	11	50
45-59 (355)	16	43
60-64 (115)	17	43
65-74 (187)	20	29
75+ (155)	24	30
Group 1 - qualifications (120)	25	34
Group 2/3 - qualifications (241)	22	41
Group 4/5/6 - qualifications (244)	12	48
Group 7/8/9 - qualifications (410)	8	52

Source: MORI

Group 1 - School Leaving Certificate, new National Qualification Access Unit or equivalent

Group 2/3 - O grade, Standard grade, SVQ level 1, NQA 3 or Intermediate 1 or 2 or equivalent

Group 4/5/6 - Highers, GSVQ advanced, SCOTVEC national diploma, City and Guilds or equivalents

Group 7/8/9 - HNC, HND, first degree, professional qualification or higher

Awareness of advertising and promotion of mental health

7.8 One of the aims of the National Programme is to raise the general public's awareness of mental health issues. Several major policy initiatives and campaigns currently underway in Scotland as part of the work of the National Programme include awareness-raising in their remit; in particular the national anti-stigma campaign 'see me.' The survey aimed to track whether and how promotional material is reaching particular sections of the general public and to explore the messages people are taking from what they see, read and hear. However, this was not a dedicated campaign tracking study and so questions were unprompted: no stimulus materials such as leaflets or stills from advertisements were used to aid recall.

7.9 As table 7.5 illustrates, the majority of respondents (72%) had either seen, read or heard an advert or promotion about mental health/mental health problems in the last year, whereas one in four (28%) said they did not remember, or were unsure whether they remembered, any promotional material. In 2002, 43% of respondents said they remembered an advert or promotion in the last six months and 57% said they did not or were unsure. The question in the 2002 survey was less in-depth and related to a shorter period and a time when there was less promotional activity in Scotland, but it appears that there is greater awareness of campaigns and other promotions than there was two years ago. Fieldwork in 2002 was carried out before the launch of the high profile national public awareness campaign 'see me,' which has included a wide range of promotional activity. The National Programme's magazine 'Well?' has been published on a six monthly basis since September 2002, highlighting aspects of the National Programme's work and providing news and information. Other promotional work carried out since the 2002 survey includes a series of television advertisements produced by NHS Health Scotland as part of their national role in raising awareness and promoting mental health and well-being. The most recent Department of Health survey Attitudes to Mental Illness, which took place in March 2003, reported that respondents in Scotland were more likely to be aware of publicity about mental health issues in TV commercials than were people in other regions or countries in the UK (Taylor Nelson Sofres, 2003).

Table 7.5: Recollection of mental health promotion in last year

Q In the last year, have you seen, read or heard an advert or promotion about mental health/mental health problems in any of these places?

	No	Yes - advert in newspaper	Yes - advert in magazine	Yes - leaflet in Dr/other Surgery	Yes - advert on billboard/bus	Yes advert on TV/at cinema	Yes advert on radio
Base: All respondents	%	%	%	%	%	%	%
All (1,401)	26	15	12	31	9	46	12
Men (594)	27	17	9	26	8	46	13
Women (807)	25	14	14	36	9	46	12
16-24 (131)	22	20	20	31	11	64	21
25-34 (201)	17	13	9	32	14	57	16
35-44 (257)	14	16	12	42	10	58	17
45-54 (237)	19	17	14	35	10	48	12
55-59 (118)	28	16	9	36	5	42	7
60-64 (115)	36	14	10	21	4	33	6
65-74 (187)	46	14	8	21	3	27	3
75+ (155)	61	7	6	11	1	18	4
Easy to manage on income (659)	26	17	13	31	8	43	12
Difficult to manage on income (195)	23	12	7	34	6	67	14
Most urban (509)	29	13	11	28	12	45	13
Most rural (106)	27	9	13	32	4	48	6
Borders and South (197)	22	19	13	35	5	46	12
Central Belt West (410)	26	14	11	29	9	44	15
Highlands and Islands (214)	33	18	15	30	7	45	12
Lothian and Fife (313)	24	11	8	34	12	51	11
North East (267)	27	19	13	30	7	44	10
General Health good	24	16	12	31	9	47	14
General health poor	40	13	8	28	5	39	7
Personal experience of mental health problems (426)	20	11	11	44	11	48	13
No personal experience of mental health problems (332)	44	10	6	17	4	34	6

Source: MORI

7.10 Respondents to the 2004 survey were most likely to say they had seen promotional material in advertisements on television or at the cinema. Leaflets at a doctor's or other surgery were also mentioned by a third of all respondents, and 15% of respondents said they had seen material in a newspaper. People who said they had no experience of mental health problems were less likely to have noticed promotional material than those who said they had experienced a mental health problem, or knew someone who had. Men and women aged 55+ were less likely to have seen promotional material than any other sex/age category, as were those who rated themselves as having poor, rather than good, general health.

7.11 Respondents who said they were aware of recent promotional activity were asked what they thought the material was trying to make them do or think (no prompts were given). The most common response was that the promotional material was trying to raise awareness of the campaign (25%), and that mental health problems are more common than people think and can happen to anyone (19%). One in six (18%) felt that the material was intended to help remove the stigma associated with mental health problems; one in ten felt it was aimed at encouraging people to be more sympathetic and understanding towards people with mental health problems.

Key Campaigns and Policy Initiatives

7.12 The National Programme has launched a number of linked national initiatives to address its aims. The 'see me' national anti-stigma campaign has now been in existence for two years. The infrastructure to support 'Choose Life,' the national strategy and action plan to prevent suicide is in place; progress towards the first set of milestones en route to achieving a 20% reduction in the rate of suicide in Scotland will be measured in 2006. The 'Breathing Space' telephone advice and referral service for people experiencing low mood or depression, launched in 2002 and promoted in its initial phase across Greater Glasgow, Argyll and Clyde, will be rolled out across Scotland by the end of 2004. A Scottish Recovery Network is being developed to create awareness and understanding of the concept of recovery from mental health problems and to contribute to the development of values, conditions, environments and relationships which support recovery (official launch in December 2004). A successful programme of Mental Health First Aid (MHFA) training, developed in Australia and adapted for a Scottish audience, has been piloted across all service sectors and among mental health service users and their carers, and the general public. To examine the impact of work to date, respondents were asked whether they were aware of each campaign or initiative. (No additional stimulus material was provided.)

Table 7.6: Awareness of key initiatives and campaigns by grouped Health Board Area

Q. There have been a number of campaigns and initiatives regarding mental health in Scotland. Have you heard of any of the following initiatives, or not?

	% Yes
	All	Borders/South	Central/West	Highlands/ Islands	Lothian/Fife	North East
Base: All respondents	(1,401)	(197)	(410)	(214)	(313)	(267)
	%	%	%	%	%	%
'Choose Life', the national strategy and action plan to prevent suicide	26	23	28	27	26	26
'see me'…The national anti-stigma campaign	34	31	36	33	33	36
The 'Breathing Space' telephone advice line for people experiencing low mood or depression	14	13	18	13	9	13
Mental Health First Aid	8	8	5	10	9	12
The Scottish Recovery Network	8	5	12	6	6	9

Source: MORI

7.13 Respondents were most likely to be aware of 'see me' (34%), followed by 'Choose Life' (26%). Fourteen percent said they had heard of 'Breathing Space' (14%) Eight percent of respondents said they were aware of MHFA and the same percentage of people said they had heard of the Scottish Recovery Network.

7.14 The context for the questions was clearly stated as mental health but, in interpreting the findings, it is important to consider that some respondents may have associated the titles of the campaigns and policy initiatives with other issues. In particular, the term 'Choose Life' may have been associated with pro-life, anti abortion campaigns which often receive coverage in the media. 'Choose Life' was also a prominent slogan in the film Trainspotting and has since been associated with campaigns against drug misuse. The phrase was also used on t-shirts by the pop group Wham! during the 1980s, a time in which the group was popular. Given these points, it may be that the level of awareness of 'Choose Life' recorded in the present study overstates the true extent of public familiarity with Scotland's national strategy and action plan to prevent suicide.

7.15 These issues aside, the variation in awareness of the 5 campaigns and initiatives may be explained, in part, by the relative prominence that each has been given and the length of time it had been in place when fieldwork for the survey took place. As noted above, the Scottish Recovery Network was at a developmental stage during 2004, with the official launch planned for December 2004. MHFA was still at the piloting stage at the time the survey took place, with 15 instructors trained to manage MHFA programmes across Scotland. For these reasons, the advisory group felt it was unlikely that members of the general public would have heard of either initiative: in effect, MHFA and the Scottish Recovery Network were included as 'control' prompts in the survey questionnaire.

7.16 As table 7.6 shows, people appeared to be more aware of the 'Breathing Space' service in the Central Belt West NHS Board area, compared with the Lothian and Fife Health Board areas. As noted above, 'Breathing Space' was launched in 2002, with initial publicity focussed on Greater Glasgow and Argyll and Clyde; national rollout of publicity began in Summer 2004 and is due to complete by the end of 2004. Levels of awareness, therefore, appear to reflect the National Programme's promotional strategy. The 'see me' campaign has been promoted across Scotland using cinema and television advertising, bus side and roadside billboard advertising, advertisements in the Glasgow underground and mass distribution of campaign materials. Proactive public relations work resulted in coverage on radio (national Scottish and local), newspapers (national Scottish and local), and UK magazines. The 'see me' website has been promoted in all these aspects of the campaign. In addition, NHS Grampian and Greater Glasgow Health Board funded work to boost the campaign in their own areas, a factor which may be at least partly responsible for higher levels of awareness of campaign material in the Central Belt West and North East NHS Board areas.

7.17 There appears to be a correlation between age and awareness of campaigns and policy initiatives. Both men and women aged over 55 were significantly less likely than men and women in other age groups to have heard of most of the campaigns and initiatives, as can be seen in table 7.7. People aged 55+ were less likely than other groups to say they remembered seeing any adverts or promotions on television or at the cinema, which may explain their low recognition of specific campaigns and initiatives.

Table 7.7: Awareness of key policy initiatives and campaigns by age within sex

Q. There have been a number of campaigns and initiatives regarding mental health in Scotland. Have you heard of any of the following initiatives, or not?

	% Yes
	All	Male			Female
		16-34	35-54	55+	16-34	35-54	55+
Base: All respondents	(1,401)	(148)	(205)	(241)	(184)	(289)	(334)
	%	%	%	%	%	%	%
'Choose Life', the national strategy and action plan to prevent suicide	26	28	35	18	33	32	13
'see me'…The national anti-stigma campaign	34	49	33	15	40	48	18
The 'Breathing Space' telephone advice line for people experiencing low mood or depression	14	22	10	11	17	13	11
Mental Health First Aid	8	7	10	9	9	7	9
The Scottish Recovery Network	8	8	11	9	10	7	5

Source: MORI

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