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CHAPTER SIX: EXPERIENCE OF MENTAL HEALTH PROBLEMS

6.1 This chapter focuses on respondents' personal experience of mental ill-health, both through having experienced a mental health problem themselves and through the experiences of people close to them (experience by proxy). The chapter considers the social consequences of mental ill-health from the perspective of those with direct personal experience. It also looks at issues relating to recovery from mental ill-health, including factors which are thought to promote and hinder recovery, what recovery means to people experiencing mental health problems and the messages about recovery they have received from professionals and those close to them.

Experience of mental health problems in someone close

6.2 Around three in five respondents (61%) said that someone close to them had experienced a mental health problem, consistent with the findings from the 2004 survey (62%). This figure is lower than the 68% obtained from a 2005 survey of public attitudes to mental health in Ireland (Mental Health Ireland, 2005) but this may partly reflect differences in the question wording used in the two surveys.

6.3 Results varied as a function of age, with those aged 75 years and over being less likely than all other age groups to say someone close to them had experienced a mental health problem. On the one hand, this is surprising as it might be expected that older people would have greater experience of mental ill-health because of the length of time they have lived - and because people in their peer group are at greater risk of dementia. On the other hand, it may be that older people are less aware than younger groups of what constitutes a mental health problem today or more likely to stigmatise mental ill-health which in turn may lead them to disassociate themselves from people suffering from such problems, or to redefine mental ill-health in terms they find less stigmatising. Findings reported in chapter 7 (below), lend credence to this interpretation.

6.4 Recent research on income-related inequality in mental health has highlighted a correlation between lower income and higher prevalence of mental health problems (see, for example, Mangalore et al, 2007). The present survey reinforces these findings: people who found it difficult to manage on their income were more likely than those who found it easy to manage to say someone close to them has suffered from a mental health problem (71% compared with 58%). Proxy experience of a problem was also higher among those with high mental ill-health scores than among those with low scores (77% compared with 60%).

6.5 Respondents were presented with a list of specific mental health problems and asked if anyone close to them had ever experienced any of these. As in previous waves of the survey, the conditions that the respondents most commonly said someone close to them had experienced were depression (45%), panic attacks (23%) and Alzheimer's disease/Dementia (19%), followed by nervous breakdown (16%), anxiety disorder (15%), post-natal depression (15%) and severe stress (15%). Three of these conditions - panic attacks, anxiety disorder and severe stress - come under the clinical heading of neurotic and stress related disorders, as do phobias and excessive compulsive disorder (mentioned by 8% and 7% respectively). If all of these conditions are collapsed into one response category, a total of 37% of respondents have proxy experience of a neurotic or stress-related disorder.

6.6 Table 6.1 shows the results by key sub-groups. There were few differences by gender but age was a significant variable - people aged 25-34 were consistently more likely than those aged 75 or over to claim proxy experience of specific conditions. Again, these differences may reflect growing societal awareness and understanding of mental-ill health over time, as well as changes in the range of conditions classified as mental health problems.

6.7 For each of the specific problems listed, proxy experience was also more prevalent among respondents who found it difficult to manage on their income than among those who found it easy to manage.

Table 6.1: Experience of mental health problems in someone close.

Source: Ipsos MORI

Personal experience of mental health problems

6.8 Just over a quarter of respondents (28%) said they had personally experienced a mental health problem. Again, this is in line with the figures recorded in 2002 (27%) and 2004 (26%) but higher than that recorded in the 2005 Mental Health Ireland survey (10%) and the 2006 Health Protection Agency Northern Ireland ( HPANI) survey (15%). Again, this difference may be due to question wording or the methodology used. For example, the Mental Health Ireland survey was conducted over the telephone which may have resulted in different rates of participation or high item refusal.

6.9 The specific mental health problems most commonly experienced by respondents were depression (16%), followed by panic attacks (8%), severe stress (4%) and anxiety disorder (4%). However, if we collapse all of the neurotic and stress-related disorders into one category, as in the case of proxy experience of mental ill-health, we find that a total of 12% of respondents have had personal experience of such a disorder

6.10 As illustrated in table 6.2, women were more likely than men to say they had experienced any of the mental health problems listed (32% compared with 24%) and women aged 35-54 were the most likely to do so (36%). Women were also more likely than men to say they had experienced depression (19% compared with 14%). The findings reported here are similar to the prevalence of mental health problems in the UK reported by the Mental Health Foundation (2003). Women were more likely to report significant symptoms of depression and anxiety (18%) compared with men (12%) (Mental Health Foundation 2003).

6.11 The highest and lowest income groups were more likely to have experienced a mental health problem than middle income groups. At the same time, however, the lowest income group was considerably more likely than the highest income group to have experience of depression. Reflecting these difference, people who found it difficult to manage on their income were twice as likely as those who found it easy to manage to have had a mental health problem and to have experience of depression specifically.

6.12 People with high mental ill-health scores were more likely than those with low scores to have personal experience of mental ill-health, while those with poor mental wellbeing were more likely to report such experience than those with good mental wellbeing. And, people who felt they had little or no control over factors affecting their mental wellbeing were more likely to have experienced a problem than those who felt they had at lest a good deal of control. There was also significant variation by respondents' general health status. Those who said their general health was "bad" were more likely than those who felt they had "good" general health to say they had experienced one or more of the mental health problems listed in the table below (59% compared with 23%). The latter finding is consistent with other research conducted in recent years. For example, the 2000 Adult Psychiatric Morbidity Study (Singleton et al, 2000) found that having a neurotic disorder substantially increased the likelihood of reporting one or more physical complaints. Of course, it is difficult to know whether certain mental health problems make people more susceptible to physical illness or whether having a physical illness makes people more susceptible to mental health problems. However, there is increasing evidence that being depressed or stressed can make people more susceptible to illnesses such as heart disease and cancers (see, for example, Stansfeld and Marmot, 2001).

6.13 Looking at geographical variation, people in the most rural areas were more likely than those in more urban areas to have experienced a problem, although there was no equivalent variation by NHS board area.

Table 6.2: Personal experience of a mental health problem

Source: Ipsos MORI

Telling others about mental health problems

6.14 A new question was introduced in 2006. Respondents who said they had personally experienced a mental health problem were asked if they had told anyone (other than their doctor or other health professionals) about their problem. Overall, 86% said they had done so, with the majority (80%) saying they had told family and friends. One in five said they had told their boss or manager at work (20%) or other colleagues at work (20%), while smaller proportions had told other people they don't know well (6%) or a tutor or member of staff at college or university (5%). Fifteen per cent said they had told no-one about their mental health problem (figure 6.1 below).

6.15 Although not directly comparable, the Mind Out for Mental Health¹⁶ survey in the UK found that 74% of job applicants with mental health problems did not disclose their condition in application forms and 52% concealed their mental health problems for fear of losing their job. A similar pattern of findings was evident in Ireland also. A survey conducted in 2005 by Workway¹⁷ found that two thirds of those surveyed felt unable to disclose their mental health problems at interview and 4 in 10 had not disclosed their mental health problems to anyone in the workplace.

Figure 6.1: Disclosure of mental health problems

6.16 Sub-group findings cannot be reported for this question because of the small base sizes. Further, as this question was only asked in the 2006 survey it has not been possible to combine the data sets from all three waves to allow for more robust analysis, as has been done elsewhere in this chapter.

The social impact of mental ill-health

6.17 In the 2004 survey, 64% of those who had personally experienced mental ill-health had not experienced any difficulties in terms of other people's attitudes towards their problem. This figure has risen over ten percentage points to 75% in the current survey. Among the minority who have experienced difficulties in terms of other people's attitudes, the most common experiences remain being discouraged from participating in social events (11%), discrimination at work (5%) and being refused a job (5%) as table 6.3 shows. While the proportions mentioning each of these are fairly consistent with 2004, there has been a decrease in the percentage saying they have experienced verbal abuse in public.

Table 6.3: Social impact of mental ill-health. Data from 2002, 2004 and 2006

Source: Ipsos MORI
^† Wording of codes changed from 2004 questionnaire

6.18 The data for the three surveys were combined to allow for robust sub-group analyses. As table 6.4 shows, a number of interesting findings emerged. In particular, men were more likely than women to say that they had been refused a job because of other people's attitudes towards their mental health problem, while women were more likely to say they had not experienced any such forms of stigma. This may be because people are less comfortable about interacting with a man who has a mental health problem than with a women who has the same problem- a hypothesis that is considered further in chapter 8.

6.19 As a whole, the younger age groups were more likely than older age groups to have experienced the difficulties listed. There are a number of possible explanations for this difference. It may be that older people are simply less likely to have revealed their problem to others for fear of stigmatisation. Alternatively, it may be that younger people move in a wider range of social environments than older groups - whether this be in terms of education/ employment or other social situations - and in the process are exposed to a wider range of people and thus perspectives on mental ill-health.

6.20 There was further variation by income, with lower income groups more likely than those on a higher income to have experienced some form of stigma. Similarly, people who had trouble managing on their income were more likely to have experienced difficulties than those who found it easy to manage. In part, these differences may reflect the contrasting social milieus in which better and less well off respondents move. As is reported in later chapters, more economically advantaged segments of society tend to hold more liberal attitudes toward mental ill-health than more disadvantaged groups.

Table 6.4: Social impact of mental ill-health

Source: Ipsos MORI

6.21 Respondents to the 2006 survey who said they had experienced a mental health problem were asked if they had ever chosen to avoid a social event because of the way they thought people would react to their mental health problem. One in five (22%) said they had done so. This is significantly higher than the proportion who had actually been discouraged from participating in a social event, which suggests that self-stigmatisation is a major issue that requires to be addressed. It is the anticipation of failure or rejection which limits, in part, an individual's behaviour. The implications of self-stigmatisation are considerable and can impede recovery. Indeed, a recent study of patients diagnosed with schizophrenia found that self-stigmatization undermined self-efficacy and empowerment which was associated with poorer quality of life and depression (Vauth et al., 2007). These findings suggest that more work is required to change an individual's thoughts and attitudes to facilitate recovery from mental health problems.

Recovery from mental health problems ¹⁸

6.22 Promoting and supporting recovery is one of the four key aims of the Scottish Executive's National Programme for Improving Mental Health and Wellbeing. The Scottish Recovery Network ( SRN) was launched in late 2004 as part of this Programme. The main aims of the SRN are to raise awareness that people can and do recover from long term and serious mental health problems, identify what recovery might mean for people and build understanding of what helps people recover and stay well. In the 2004 survey, a series of questions were introduced to investigate the public's views on recovery and to provide a baseline measure to later track the impact of the SRN's work across communities. The questions focused on factors important in supporting recovery and key signs of recovery. For the 2006 survey, the questions were refined slightly. They were also supplemented with additional items on the factors that hindered recovery and messages of recovery received from other people. Accordingly, any comparison between the two sets of results should be treated with due caution. As in 2004, these questions were only asked of those who said they had experienced a mental health problem.

6.23 The factors that respondents felt had been most important in supporting their recovery were support from family or friends (56%), medication (35%), developing their own coping strategies (30%), having belief in themselves (27%), and other forms of treatment or therapy such as psychology, counselling, alternative treatments and support groups (20%) (table 6.5). The rank ordering of these factors is broadly consistent with the comparable 2004 findings, although the introduction of new items to the 2006 questionnaire means that the absolute levels of response differ across the two surveys. The emphasis on support from family and friends, self belief and personal coping strategies is also in line with findings from a recent narrative research study undertaken by SRN (Brown and Kandirikirira, http://www.scottishrecovery.net/content/default.asp?page=s5_4).

6.24 There was a small amount of sub-group variation in the findings. Women were more likely than men to mention medication as a factor promoting their recovery (41% versus 25%) and young women were more likely than all other groups to mention support from family and friends (78% versus for example 48% of women aged 35 to 54 years). Respondents with the highest educational qualification were among those most likely to mention 'developing my own coping strategies' (43% compared with 12% of those with no qualifications).

Table 6.5: Factors important in supporting recovery

Source: Ipsos MORI
^†Wording of code changed from 2004

6.25 Factor analysis was conducted to identify related recovery strategies. The analysis provided a two-factor solution, with one factor ('factor 1') grouping strategies that mainly related to the extent to which people rely on support from others, and the other ('factor 2') relating mainly to more action-orientated strategies that could be employed without the help of others (table 6.6 below).

6.26 Looking at factor 1 (support strategies) in more detail, two sub-factors were observed. The first comprised external support, including 'support from people with a similar experience', 'support from colleagues/work', 'having others believe in me' and 'support from family/friends'. The second was 'developing my own coping strategies' - a more internal coping strategy. Respondents who scored highly on factor 1 tended to mention the various forms of external support a lot, while those with a low score tended not to mention external forms of support and/or to mention 'developing my own coping strategies' instead. So what is particularly noteworthy here is that, within this factor, people usually reported engaging in external or internal strategies not both. It is also of interest that 'developing my own coping strategies' loaded on factor 1 and not factor 2.

6.27 Within factor 2 (action orientated strategies) there was a clear distinction between behaviour-driven strategies that tackle mental ill-health directly, and more indirect strategies. The behaviour driven strategies included 'other forms of treatment/therapy', 'medication' and 'finding out more about mental health'. The indirect strategies included 'self belief', 'having something worthwhile to do during the day' and 'having a chance to contribute and be valued'. Respondent who scored highly on factor 2 tended to mention the behaviour driven strategies and not the indirect strategies.

6.28 To explore the extent of any relationship between respondents' recovery strategies and their mental health, their scores on the factors were correlated against their GHQ12 and WEMWBS scores. WEMWBS showed a relatively strong negative correlation with factor 2, that is, there was a tendency for those with good mental wellbeing to employ the more indirect recovery strategies, rather than the more behavioural driven strategies. Looking more closely at how this factor is constructed, the specific strategy that is by far the most strongly correlated with WEMWBS is, 'having belief in myself'. Thus it may be said that, above all else, good mental wellbeing among those recovering from a problem, is associated with self belief or mastery. This finding is consistent with research within the psychological domain which highlights the central importance of self-belief and self-efficacy in the aetiology and maintenance of mental and physical health (e.g, Mitchell, 1998; Higgins et al., 1992; Stepney & Davis, 2004).

Table 6.6: Factor analysis 2 factor solution

6.29 In terms of the factors which had most hindered their recovery, around one in five respondents (19%) said 'not acknowledging I had a problem', 'continuing to experience problems' (17%) and 'not understanding what was going on' (17%). The prominence of the latter factor is consistent with the finding from the SRN narrative research which revealed that learning more about mental health and wellbeing can be a key step towards recovery for many people.

6.30 A third (34%) said that none of the factors presented had hindered their recovery. Given that this figure is relatively high, it may be that there are factors, over and above those listed in the question, which contribute to recovery. However, no further information was collected in this run of the survey (table 6.7).

Table 6.7: Factors hindering recovery

Source: Ipsos MORI

6.31 When asked 'what does recovery mean to you?', around half said 'getting back to normal', while 38% said 'taking charge of my life again'. The next most common responses were 'feeling able to cope in general' and 'having a satisfying and fulfilling life', mentioned by 32% and 20% respectively. The proportion mentioning 'fewer symptoms' is relatively low at 9%. Consistent with the conception of recovery detailed in the SRN narrative research, these results suggest that what is important to people is not an absence or remission of symptoms but being able to go about their day to day life, despite symptoms (Table 6.8).

Table 6.8: Meanings of recovery

Source: Ipsos MORI

6.32 Respondents were asked to what extent they had received a positive or negative message about their recovery from professionals and people close to them. Most respondents had received positive messages from both groups; two thirds (66%) received a positive message from professionals while three quarters (76%) did so from people around them (figures 6.2 and 6.3 below).

6.33 There was a correlation between the valence of recovery messages respondents had received and their mental health. Specifically, those who had received positive messages were more likely to have a low mental ill-health score and good mental wellbeing than those who had received negative messages. This reinforces findings from the SRN narrative research which found that if a message of hope is delivered at the time of diagnosis and treatment, this hope is carried by the patient and can be a catalyst for getting better (Brown & Kandirikirira, 2006).

Figure 6.2: Message of recovery from professionals

Figure 6.3: Message of recovery from people close

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