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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 EIGHT: ATTITUDES TOWARDS MENTAL HEALTH PROBLEMS
8.1 This chapter focuses on public attitudes towards mental ill-health, and considers apparent shifts in attitudes between 2002 and 2004. It also explores perceptions of the prevalence of mental ill-health in Scotland.
attitudes towards mental ill-health
8.2 Respondents were presented with a number of attitudinal statements relating to mental ill-health, and asked to indicate whether they agreed or disagreed with each. The resulting data provides some important insights into public perceptions and offers a preliminary indication of the Executive's progress towards its goal of promoting positive changes in attitudes towards mental ill-health and related issues.
8.3 As noted in the 2002 study, the public's attitudes are not straightforward. On the one hand there was a common recognition that 'anyone can suffer from mental health problems' and that 'people with mental health problems should have the same rights as anyone else'. Additionally, around half of respondents were of the view that 'the majority of people with mental health problems recover'.
8.4 On the other hand, significant proportions of respondents tended to agree with statements that either directly stigmatise, or acquiesce in stigmatising, mental ill-health. For example, 45% agreed with the statement 'if I were suffering from mental health problems I wouldn't want anyone knowing about it' which either reflects their own view that mental ill-health is shameful or acknowledges a broader societal stigmatisation of mental ill-health, making it something that is best kept to oneself. Around a quarter felt that 'the public should be better protected from people with mental health problems', a statement which at least implicitly assumes that that public should be protected and questions whether this protection should be better. Similarly, 15% agreed with the view that 'people with mental health problems are often dangerous'.
8.5 As table 8.2 shows, the results are broadly in line with findings from the 2003 DoH survey and the Mental Health Ireland study, referred to above. In these studies, majorities agreed that 'Virtually anyone can become mentally ill', that 'People with mental health problems should have the same rights to a job as anyone else' and that 'People with mental illness are far less of a danger to the public that most people suppose.' Additionally, significant minorities disagreed that 'Less emphasis should be placed on protecting the public from people with mental illness' (Taylor Nelson Sofres 2003; Millward Brown IMS 2003).
8.6 In Scotland there appear to have been significant shifts in attitudes towards mental health problems over the last couple of years. In general, the proportions agreeing with positive statements have either stayed high or increased slightly. Negative statements (apart from the 'blaming' statement, which was already very low at 7%) show significant decline since 2002.
8.7 As table 8.1 shows, there has been a decline in the proportions agreeing that 'if I were suffering from mental health problems I wouldn't want people knowing about it' and 'I would find it hard to talk to someone with mental health problems' (both down five points) and 'the public should be better protected from people with mental health problems' (down eleven points). More strikingly, the proportion agreeing that 'people with mental health problems are often dangerous' has fallen by 17 points. These positive shifts stand in contrast to trend data presented in the 2003 DoH study which suggest that levels of fear and intolerance of people with mental health problems have tended to
increase in recent years (Taylor Nelson Sofres 2003).
8.8 While it is difficult to comment with certainty about the causes of apparent changes in attitudes, it may be that the National Programme and in particular the work of the 'see me' campaign, have gone some way towards removing some of the stigma surrounding mental ill-health.
8.9 Despite the fact that attitudes to mental ill health varied by key socio-demographic variables, the apparent shifts in attitudes were not consistently more pronounced among a particular sub-group or sub groups of respondents. Rather, the shifts were evident to varying degrees across all groups.
Table 8.1: Percentage agreeing with attitude statements by year
Q I'd like you to tell me how much you agree or disagree with each of these statements…
| % Agreeing |
2002 | 2004 |
Base: All respondents | (1,381) | (1,401) |
If I were suffering from mental health problems, I wouldn't want people knowing about it | 50 | 45 |
The public should be better protected from people with mental health problems | 35 | 24 |
Anyone can suffer from mental health problems | 98 | 97 |
I would find it hard to talk to someone with mental health problems | 20 | 15 |
People are generally caring and sympathetic towards people with mental health problems | 36 | 39 |
People with mental health problems are often dangerous | 32 | 15 |
The majority of people with mental heath problems recover | 50 | 46 |
People with mental health problems should have the same rights as anyone else | 88 | 88 |
People with mental health problems are largely to blame for their own condition | 7 | 6 |
Source: MORI
Table 8.2: Attitudes toward mental health in UK and Republic of Ireland.
Q I'd like you to tell me how much you agree or disagree with each of these statements…
| % Agreeing |
UK | Republic of Ireland |
Base: All respondents | (2,000) | (1,000) |
Virtually anyone can become mentally ill | 89 | 92 |
Mental illness is an illness like any other | 74 | 76 |
We need to adopt a far more tolerant attitude towards people with mental illness in our society | 83 | 96 |
People with mental illness don't deserve our sympathy | 15 | 7 |
People with mental illness should not be given any responsibility | 16 | 11 |
People with mental illness are far less of a danger than most people suppose | 59 | 68 |
People with mental health problems should have the same rights as to a job as anyone else | 78 | 67 |
One of the main causes of mental illness is a lack of self discipline and willpower | 64 | n/a |
Less emphasis should be placed on protecting the public from people with mental illness | 31 | n/a |
Source: MORI
8.10 As table 8.3 illustrates, attitudes varied significantly by age. Respondents aged 75+ were among those most likely to agree with the statements 'the public should be better protected from people with mental health problems', 'I would find it hard to talk to someone with mental health problems', 'people with mental health problems are often dangerous' and 'people with mental health problems are largely to blame for their own condition'. On the other hand, older people were the most likely to agree that 'people are generally caring and sympathetic towards people with mental health problems'.
8.11 The tendency for older people to hold more negative attitudes than younger age groups towards mental ill health and people experiencing mental health problems is consistent with findings from the DoH study (Taylor Nelson Sofres 2003).
Table 8.3: Percentage agreeing with attitude statements by gender, age and personal experience of mental health problems
Q I'd like you to tell me how much you agree or disagree with each of these statements…
| % agreeing |
All | Men | Women | 16-24 | 45-54 | 75+ | Personally experienced mental health problem | Not personally experienced mental health problem |
Base: All respondents | (1,401) | (594) | (807) | (131) | (237) | (155) | (426) | (332) |
| % | % | % | % | % | % | % | % |
If I were suffering from mental health problems, I wouldn't want people knowing about it | 45 | 45 | 44 | 47 | 47 | 43 | 49 | 46 |
The public should be better protected from people with mental health problems | 24 | 45 | 48 | 25 | 23 | 43 | 20 | 36 |
Anyone can suffer from mental health problems | 97 | 96 | 97 | 96 | 98 | 92 | 97 | 95 |
I would find it hard to talk to someone with mental health problems | 15 | 17 | 13 | 14 | 14 | 25 | 15 | 21 |
People are generally caring and sympathetic towards people with mental health problems | 39 | 43 | 36 | 46 | 33 | 58 | 33 | 52 |
People with mental health problems are often dangerous | 15 | 15 | 16 | 10 | 14 | 27 | 13 | 22 |
The majority of people with mental heath problems recover | 46 | 43 | 50 | 43 | 48 | 39 | 57 | 42 |
People with mental health problems should have the same rights as anyone else | 88 | 87 | 89 | 85 | 88 | 85 | 90 | 85 |
People with mental health problems are largely to blame for their own condition | 6 | 5 | 6 | 9 | 4 | 12 | 5 | 9 |
Source: MORI
8.12 Women were more likely than men to
disagree that they would find it hard to talk to someone with a mental health problem (79% of women compared with 69% of men) and to
disagree that people are generally caring and sympathetic to people with mental health problems (48% of women compared with 40% of men)
8.13 Attitudes also varied depending on respondents' personal experience of mental ill-health. Specifically, those who said they had experienced a problem themselves were among those
least likely to agree that they would find it hard to talk to someone with a mental health problem, that people are generally caring and sympathetic to people with mental health problems and that people with mental health problems are often dangerous.
CHAID ANALYSIS OF ATTITUDES TO MENTAL HEALTH PROBLEMS
8.14 CHAID analysis was used to explore further the relationships between attitudes towards mental health problems and various socio-demographic and behavioural variables. The aim was to assess the
strength of these relationships or, in other words, to identify which variables were most closely linked with positive or negatives attitudes towards mental ill-health, as defined through the statements set out above.
8.15 Before carrying out the analysis it was necessary to reduce each respondent's answers to the nine different attitude statements into a single dependant variable. An attitudinal scale was created by allocating values to each of the response categories for each statement. For each positive statement about mental health (i.e. 'anyone can suffer from mental health problems', 'people are generally caring and sympathetic to people with mental health problems', 'the majority of people with mental health problems recover' and 'people with mental health problems should have the same rights as everyone else'), a value of 5 was allocated for strong disagreement, four for a tendency to disagree and so on, down to 1 for strong agreement. For the negative statements ('if I was suffering from a mental health problem I wouldn't want anyone knowing about it', 'the public should be better protected from people with mental health problems', people with mental health problems are often dangerous' and 'people with mental health problems are largely to blame for their own condition') a value of 1 was allocated for strong disagreement, 4 for a tendency to disagree and so on up to 5 for strong agreement. These were then summed to give a total value which varied from a minimum of 9 (least likely to stigmatise mental ill-health) to a maximum of 45 (most likely to stigmatise mental ill-health). However, in the event, the actual values varied between 9 and 35 with the majority ranging from 18 to 24.
8.16 The attitudinal scale variables were put into the CHAID analysis with the following variables:
Control over factors affecting mental health
GHQ12
Experience of mental ill-health
Key sources of information on mental health problems
Portrayal of mental ill-health in the media
Knowledge of National Programme campaigns and initiatives
8.17 Additionally, the following demographic variables were used:
Age
Gender
Income
Managing on income
Education qualifications
Employment status
8.18 The analysis revealed that four variables were particularly strongly correlated with positive or negative attitudes to mental health problems. The first was knowledge of mental health campaigns and policy initiatives, and specifically of either the 'Choose Life' initiative or the 'see me' campaign. Respondents who said they had heard of one or both of these were more likely to hold positive attitudes towards mental ill-health than those who had not. While this correlation is intuitive, it is important to reiterate that reported recognition of 'Choose Life' may be inaccurate as it is possible that respondents confused the title with those of other initiatives unrelated to mental health. This in turn would mean that the reported correlation between attitudes and knowledge of 'Choose Life' may be spurious. However, there is no specific evidence to suggest that this is the case.
8.19 Secondly, and as already noted, those who said they have
personal experience of mental health problems had more positive attitudes than those with no such experience. It is, however, worth emphasising that there was no relationship between attitudes and possible psychiatric morbidity, as measured by the GHQ12 battery.
8.20 Respondents' self-assessed main
sources of information and influence on mental health problems were also a key discriminator of positive and negative attitudes. In particular, those who said that their information came mainly from personal experience, person contact or health professionals generally held more positive attitudes than other respondents. Meanwhile, those who mentioned word of mouth as an important source of information were particularly likely to hold negative attitudes
11.
8.21 Finally, and reinforcing other findings, the CHAID analysis found that women tended to hold more positive attitudes than men. However the variable
sex did not have as strong an effect as the other variables discussed above. Moreover, variation by gender proved to be significant only among respondents who had personal experience of mental health problems and not among those with no such experience.
8.22 In terms of the key variables discussed, the respondent group with the lowest average values on the attitudinal scale i.e. those likely to hold the most positive attitudes to mental ill-health, can be described as follows:
Say they have experienced mental health problems, and
Have heard of or seen the 'see me' campaign, and
Are most influenced in their understanding of the issue by personal contact or experience
8.23 It is important to note that this does not mean that all of those exhibiting 'positive attitudes' fall within this group, or that these characteristics are consistently correlated with positive attitudes.
8.24 Eighty-one respondents fell into this group and they have an average attitudinal value of 18.2
8.25 Meanwhile, the group with the highest average values on the attitudinal scale i.e. those most likely to hold negative attitudes towards mental ill-health can be described as follows:
Say they have not experienced mental health problems, and
Have not heard of 'Choose Life' (specifically - there was no correlation for 'see me'), and
Impressions of mental health problems are most likely to be influenced by 'word of mouth'
8.26 Again, it is important to note that this was not the only group with 'negative attitudes'.
8.27 Sixty five respondents fell into this group and their average attitudinal value was 21.5.
As noted in chapter 7, CHAID analysis is used to identify only the strength of relationships between variables and not the direction of causality in those relationships. Furthermore, it can only identify relationships between variables that are included in the analysis and not other latent variables. Still, the results of the CHAID analysis may indicate the potential of campaigns and initiatives like 'see me' and Choose Life to have a positive influence on public attitudes towards mental health problems and related issues.
Segmentation Analysis
8.28 Segmentation analysis was conducted on the data to further explore attitudes towards mental health problems. Segmentation analysis is a statistical data reduction tool that provides a means of simplifying survey questions into a smaller number of manageable themes or 'factors'. The process involves running a
factor analysis to look at common themes, followed by a
cluster analysis to segment the sample into like minded typologies based on these themes. The demographic composition of each typology can then be analysed.
8.29 In theory, segmentation analysis could have been run on all of the questions in this survey, however, to keep the task manageable it was decided to limit it to a core sub set of questions. These were as follows:
GHQ 12; possible psychiatric morbidity (12 items)
Attitudes towards mental ill health (9 statements)
Personal experience of mental ill health (14 conditions)
8.30 The analysis produced a 4 factor solution comprising the following elements:
Factor 1: Few, or no, signs of mental health problems
12;
Factor 2: Perceptions that the public should be better protected from people with mental health problems and people with mental health problems are often dangerous;
Factor 3: Personal experience of mental health problems; and
Factor 4: Perceptions that the majority of people with mental health problems recover and people are generally caring and sympathetic towards people with mental health problems.
8.31 Cluster analysis was run to segment the population into like-minded groups based on their factor scores. A range of cluster solutions were identified, the strongest of which comprised 6 clusters. These can be defined as follows:
Cluster 1 - base 235 (18%)
Respondents in this cluster were the least likely to agree that the public should be better protected from people with mental health problems. In fact, they did not have a problem with living next to or speaking to someone with mental health problems and they believed that people with mental health problems should have the same rights as anyone else. Of all the clusters (along with cluster 3) they were the least likely to have experienced mental health problems. The profile of this cluster is particularly interesting as it goes against the general finding that people who are least likely to have experienced a mental health problem tend to be more negative in their attitudes towards mental ill health than those with experience of a problem.
Demographic profile
Cluster 2 - base 128 (10%)
Respondents in this cluster were among those most likely to display signs of possible mental health problems
13 and to say they had experienced mental health problems. However, the attitudes of this group were not particularly distinct when compared with those of the population as a whole.
Demographic profile
Cluster 3 - base 290 (22%)
This cluster is characterised by its strong belief that people tend to recover from mental health problems and that people are generally caring and sympathetic towards those who experience mental ill health. Respondents in this group were as unlikely to have experienced mental health problems as those in cluster 1.
Demographic profile
Not particularly distinct in socio-demographic terms;
Higher number than expected of people under 24 and above 60 years old; and
More likely to have medium or lower level qualifications.
Cluster 4 - base 229 (18%)
This group was characterised by its strong beliefs that people generally do not recover from mental ill health and that people are not caring or sympathetic to people with mental health problems. While they were less likely than average to have experienced mental ill health, they had fairly strong views about those who do. Specifically, they believed that people with mental health problems were often dangerous and that the public should be better protected from them. Additionally, they felt that people with mental health problems should not have the same rights as others and that mental health problems were self-inflicted.
Demographic profile
Cluster 5 - base 247 (19%)
Of all the clusters this group was the most likely to experience mental health problems, however, they were no more likely to be unhappy or depressed than the other cluster groups (apart from cluster 2). Their attitudes towards people with mental health problems were neither as strong nor as positive as might be expected, although they were slightly more likely to disagree with the statement that 'people suffering from mental health problems are often dangerous'.
Demographic profile
Cluster 6 - base 171 (13%)
This cluster was characterised by its very strong views about mental health problems. More than any other cluster it was likely to stigmatise those who experience mental ill health. Respondents in this group believed that people with mental health problems were a danger to the public, that the public should be protected from people with mental health problems and that people with mental health problems were largely to blame for their condition. However, they also believed that people were generally caring towards people with mental health problems and that the majority of people with mental health problems recover, although these views were not as strongly held.
Demographic profile
8.32 The segmentation analysis reinforces the correlations discussed above but sheds additional light on ways in which the population divides in terms of its attitudes towards mental ill health. Two of the clusters, cluster 1 and cluster 5, displayed more positive attitudes than the population as a whole, but for what appear to be quite different reasons. Consistent with other findings, the more positive attitudes of cluster 5 appear to reflect the fact that this group is more likely than the other clusters to have experienced mental ill health at some point in their lives. For cluster 1, in contrast, attitudes appear to be a product of education - this group is the least likely of all clusters to have experienced mental ill heath but has higher than average qualifications.
8.33 Clusters 4 and 6 appear to hold the most negative attitudes of all the groups - that said, whereas the latter group agrees that people are generally caring and sympathetic towards people with mental health problems and that the majority of people with mental health problems recover, the former group disagrees with these statements. Looking at the determinants of attitudes among the two groups, it appears that education may again be an important explanatory variable, especially for cluster 4. While this group is very similar to cluster 1 in terms of its socio-demographic profile, it differs in one important respect, namely lower qualifications. Cluster 6 - the most negative group - similarly has lower educational qualifications than cluster 1. However, and consistent with other findings, it is the older age profile of this group which make it particularly distinct and which may therefore be the most important determinant of its attitudes.
8.34 Cluster 3 may be said to include a combination of the types of individuals who make up clusters 4 and 6. Like cluster 6, this group agree that people are generally caring and sympathetic towards people with mental health problems and that the majority of people with mental health problems recover. Additionally it has a higher than average number of older people. Like cluster 4, however, cluster 3 contains individuals with lower qualifications than those in cluster 1.
8.35 In summary, the findings of the segmentation analysis clearly reinforce the significance of age and experience as important determinants of attitudes, but they also highlight the significant of education - those with higher qualifications appear to hold the most positive attitudes, regardless of their age and whether or not they have experienced a mental health problem.
8.36 Clearly, the challenge facing the National Programme is to bring the attitudes of the general public more into line with those of cluster 1. While educational campaigns offer one possible means of achieving this, one might question the extent to which the most negative group, the elderly, will be receptive to such campaigns. Still, the composition of cluster 4 suggests that negative attitudes also exist among significant proportions of younger age groups, and it is these groups which the SE might be advised target in future campaigns
perceived prevalence of mental ill-health
8.37 The 2004 survey included a new item to gauge the perceived prevalence of mental ill-health in Scotland. Respondents were asked how many people out of 100 in Scotland will have a mental health problem at some point in their lives. The actual lifetime incidence of mental health problems is estimated to be around 25%, although whether this is an understatement continues to be debated in the academic literature (see for example Stewart-Brown 2002).
8.38 In general, respondents tended to overestimate the proportion of people who would experience mental health problems. The mean percentage given was 48%, although a significant proportion - around a third - gave a response of 30% or under and nineteen percent of respondents thought that at least 70% of the population would experience a mental health problem at some time in their life. On average, women gave significantly higher estimates than men. Likewise, younger age groups tended to give higher estimates than older respondents, particularly, those aged 75 years and over. That said, the 75 years and over age group were much more likely than other groups to answer 'don't know' as table 8.4 illustrates. It is possible that people's estimates could be influenced by personal experience. For example, respondents living in areas with a high number of risk factors (such as unemployment, deprivation, high levels of crime) might be more likely to perceive the level of risk in general as being higher than is actually the case. Analysis by area lends credence to this interpretation. Respondents living in the most deprived areas of Scotland gave higher average estimates regarding the prevalence of mental ill-health than those in the most affluent areas (51% versus 45%).
Table 8.4: Percentage of people across Scotland who might have had a mental health problem in their lives
Q How common do you think it is for people to have mental health problem at some stage in their lives. Out of 100 people in Scotland, how many do you think will have a mental health problem at some stage in their lives?
| All | Male | Female | Aged 16-24 | Aged45-54 | Aged 75+ |
Base: All respondents | (1,401) | (594) | (807) | (131) | (237) | (155) |
| % | % | % | % | % | % |
1-10 | 7 | 11 | 4 | 3 | 7 | 13 |
11-20 | 9 | 13 | 5 | 11 | 9 | 12 |
21-30 | 15 | 17 | 13 | 14 | 14 | 17 |
31-40 | 10 | 10 | 10 | 10 | 11 | 6 |
41-50 | 16 | 12 | 19 | 19 | 17 | 19 |
51-60 | 11 | 9 | 13 | 12 | 10 | 7 |
61-70 | 8 | 7 | 10 | 8 | 8 | 2 |
71-80 | 12 | 10 | 13 | 10 | 16 | 2 |
81-90 | 3 | 2 | 5 | 4 | 3 | 2 |
91-100 | 4 | 3 | 4 | 7 | 3 | 0 |
Don't know | 5 | 6 | 5 | 3 | 2 | 20 |
Average | 48 | 43 | 53 | 51 | 49 | 36 |
Source: MORI
8.39 In the 2003 DoH study, discussed earlier, respondents were also asked for their views on the proportion of people who might experience a mental health problem at some point in their life. In that survey, respondents were given a list of options, comprising a series of ratios from 1 in 3 to 1 in 1,000. In contrast with the above findings, respondents in the DoH study generally
underestimated the extent of mental ill-health in the UK. A quarter thought that the proportion was 1 in 10 and 38% thought it was less than this. Twelve per cent correctly stated that the overall proportion was 1 in 4 and 9% thought it was higher than this (Taylor Nelson Sofres 2003). Of course, differences in the question used in the 2004 Scottish Executive Survey and the DoH survey preclude direct comparison of the two sets of results. There are methodological problems with providing people with lists in the way the DoH study did, as people often opt for some mid-point, as a 'safe option', in the absence of any greater knowledge.
14 Still, the higher estimates given in the SE study may in part reflect the impact of recent advertising campaigns in Scotland. It may be that the campaigns have increased the profile of mental health problems in the public mind and thereby led people to give more 'liberal' estimates regarding the prevalence of such problems than might otherwise have been the case.
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