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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 TEN: CONCLUSIONS
10.1 The overarching aim of the 2
nd National Scottish Survey of Public Attitudes to Mental Health, Mental Well-being and Mental Health Problems was to examine the views of a representative sample of the adult Scottish population on a range of mental health related issues and to compare findings with other relevant survey data, particularly that from the 2002 survey. Within this broad framework, key areas of interest were people's perceptions of their own general health and lifestyle; perceptions of factors affecting mental health and well-being; experience of mental health problems; sources of information on mental health problems; awareness of promotional activity in Scotland; and attitudes towards mental ill-health and related issues. In each of these areas, the survey provides a range of important findings for the National Programmes key aims and objectives.
10.2 There were striking correlations between respondents' self-assessed health ratings and a range of socio-economic indicators including income, ease of managing on income and affluence of area. Those who had a low income, found it difficult to manage on their income or lived in a relatively deprived area were among those most likely to rate their health as poor. In terms of possible psychiatric morbidity, as measured by the GHQ12
15 battery, a similar set of correlations emerged - groups who perceived themselves to be, or objectively were, less well off tended to report signs that they had possible mental health problems, saying, for example, that they had felt more unhappy and depressed than usual, been losing confidence in themselves, felt constantly under strain or less capable of making decisions. Such evidence, linking social-economic circumstance with poor heath, reinforces the need for health policies and initiatives which are both targeted and linked into broader social inclusion agendas.
10.3 The link between people's financial situation and their attitudes towards mental health was again evident when respondents were asked to consider factors influencing their own mental health. Having enough money, or a good income, were identified as positive influences on mental health, while not having enough money or having a low income were among the most commonly mentioned negative factors. Apart from money, others factors seen to have a positive impact on mental health were supportive relationships with family, friends and partners, exercise, leisure activities and work. Perceived negative influences included illness, family problems and work. The prominence of work in both the positive and negative lists is worthy of note, and again emphasises the links between mental health and other policy areas. Work is a hugely significant aspect of people's lives, providing economic independence and promoting positive feelings such as a sense of purpose and achievement. Equally, however, factors such as unmanageable workloads, unrealistic deadlines, lack of support or motivation, and changing systems and structures contribute to levels of stress which can undermine psychological health. The Executive identified improving mental health and well being in the workplace as a key priority in the Challenge document (Scottish Executive, 2003c). The action plan for
Healthy Working Lives, launched by the Deputy Minister for Health and Community Care in August 2004 (Scottish Executive 2004) demonstrates a commitment to take forward action to promote public health and tackle inequalities among the working age population of Scotland.
10.4 Looking at people's experience of mental ill health, certain findings stand out. One is the strong link between people's self-assessed general health and their stated experience of mental health problems. Specifically, those who rated their health as poor were more likely to say that they had experienced a mental health problem than those who said their health was good. Likewise, those with high GHQ12 scores were more likely to say they had experienced a mental health problem than those with low GHQ12 scores. These findings reinforce the need for a holistic approach to tackling mental ill-health, which emphasises the role that a healthy lifestyle can play in promoting mental health and well-being. The Executive's 'healthy living' initiative, of which the National Programme is a part, emphasises the link between physical activity, greater well-being and less anxiety, depression and stress. Findings from the survey suggest that the public, and younger age groups in particular, may be receptive to such messages - around one in five of those aged 16-34 identified exercise as a factor promoting positive mental health and around half of this proportion mentioned 'being healthy'.
10.5 The data relating to people's experience of mental health problems also provided some important information with respect to the Executive's aim of promoting wider understanding and awareness of factors that help to promote recovery from mental health problems. While support from family and friends, and medication were clearly important to them, there was also a (perhaps unmet) demand for more social support in the form of counselling, therapy and help from others who had similar experiences. These findings suggest a need for more signposting of relevant sources of help and a greater emphasise on informal support networks.
10.6 While public attitudes towards mental ill-health remain ambivalent, in some respects, there appear to have been some positive shifts between 2002 and 2004. Most notably, 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.
10.7 An apparent 'softening' of attitudes towards mental health problems was further evident in respondents' reactions the scenarios, particularly those depicting symptoms of depression. For example, between 2002 and 2004, the proportions who said that the depressed Robert/Shona was likely to harm themselves or others, fell significantly. Meanwhile, the proportions who said that they would be willing to interact with Robert/Shona in a range of circumstances (from doing them a favour to having them marry into their family) increased significantly.
10.8 While it is difficult to be certain what has brought about these changes, and too early to be confident that they represent a long-term trend, it may be that work of the National Programme and, in particular, the 'see me' campaign has helped to reduce some of the stigma surrounding mental ill-health. The findings of the CHAID analysis lend credence to this interpretation, showing that knowledge of the 'see me' campaign and 'Choose Life' initiative was consistently among the strongest discriminators of positive and negative attitudes towards mental health problems - those who had heard of 'see me' or 'Choose Life' were significantly more likely to have positive views than those who had not.
10.9 Of course, it is important to exercise a degree of caution when making inferences about attitude change based on data from two time points. Only after a third or fourth survey is conducted will it be possible to judge whether differences observed since the 2002 survey represent a trend or simply short term fluctuation. Still, the findings provide ground for optimism and should assist the National Programme in its goal of developing effective policies and initiatives to improve mental health and well-being in Scotland and to support the recovery of people who experience mental health problems.
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