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CHAPTER SEVEN: ATTITUDES TOWARDS MENTAL HEALTH PROBLEMS

7.1 This chapter considers public attitudes towards mental ill-health with a particular emphasis on changes in attitudes over the three waves of the survey. It also considers the perceived prevalence of mental ill-health in Scotland.

Attitudes towards mental ill-health

7.2 As noted in Chapter 1, one of the key aims of the National Programme for Improving Mental Health and Wellbeing is to promote positive changes in attitudes towards people with mental health problems. To help measure progress towards this aim, respondents in all three waves of the research have been presented with a number of attitudinal statements relating to mental health and asked to indicate whether they agreed or disagreed with each statement.

7.3 For the most part, attitudes appear to have remained fairly consistent since the time of the last survey. Thus almost all (97%) respondents continue to agree that 'anyone can suffer from a mental health problem', 85% think people with mental health problems should have the same rights as anyone else, 46% agree that 'the majority of people with mental health problems recover' and 40% agree that 'people are generally caring any sympathetic to people with mental health problems'. The percentages of respondents agreeing with some of the more negative statements also show little change since 2004: 17% say 'I would find it hard to talk to someone with a mental health problem', and 4% say 'people with mental health problems are largely to blame for their own condition' (table 7.1 below).

7.4 Notwithstanding these continuities, there also appear to have been some significant shifts in attitudes since 2004. First, the proportion of people agreeing with the statement 'If I were suffering from mental health problems, I wouldn't want people knowing about it', has continued to decline, from 50% in 2002, to 45% in 2004 and 41% in 2006. This is encouraging and suggests that the Scottish Executive's work on tackling the stigma and discrimination associated with mental health problems, especially through the 'see me' anti-stigma campaign, may be having a real impact on the way people think about mental health problems.

7.5 At the same time, however, the proportion agreeing that the public should be better protected from people with mental health problems (32%) has returned to the level recorded in 2002 (35%), despite a significant decrease in 2004 (24%). This may reflect events which took place at the time the survey was being conducted. Around the time of the data collection there was considerable media interest around the issues of secure care, violence and systems failures. Although it is beyond the scope of the present study to conduct a in-depth analysis of the media representation of mental health issues, we have reviewed a selection of the print media cuttings from across Scotland during the period of data collection, nationally and locally, broadsheet and tabloid. Across this non-systematic review of the cuttings, there were many somewhat negative media representations of mental health, secure care and the risk of mental health patients to the community. Headlines included "Dangerous offenders in bid to use loophole to win freedom from high-security units", "High-risk killers on the loose in Scotland and "The blunders that let mental patient roam free to kill". No review of cuttings was carried out in 2002 or 2004, so it is not possible to say whether there was an absence of such negative representations during these earlier waves of the survey.

7.6 However, it is important to bear in mind that the increase in the proportion saying that the public should be better protected from people with mental health problems has not been reflected in a more general negative shift in attitudes towards people with mental health problems. Most notably, there has been no corresponding increase in the proportion of people agreeing with the statement that 'people with mental health problems are often dangerous'.

Table 7.1: Attitudes to mental ill-health, by survey

Source: Ipsos MORI

7.7 In the Health Protection Agency Northern Ireland ( HPANI) survey cited earlier, respondents were similarly presented with the attitudes statements listed above. As table 7.2 below shows, there is broad consistency in the results for the two surveys but more people in Northern Ireland agree that if they were experiencing a mental health problem they wouldn't want people knowing about it, that the public should be better protected from people with a mental health problem and that people with mental health problems are often dangerous. Indeed, the Northern Irish results are more consistent with findings from 2002 Scottish survey. In part this may reflect the fact that there has not yet been a mental health anti-stigma and discrimination campaign in Northern Ireland akin to 'see me…'

Table 7.2: Attitudes towards mental ill-health in Scotland and Northern Ireland

Source: Ipsos MORI and HPANI

7.8 While women were more likely than men to disagree that they would find it hard to talk to someone with a mental health problem (73% versus 64%), men were more likely to feel that people are generally caring and sympathetic towards people with mental health problems (43% versus 36%). Young women (aged 16-24 years) were more likely than their male counterparts to disagree that if they were suffering from a mental health problem they wouldn't want people knowing about it (45% versus 31%).

7.9 As table 7.3 (below) illustrates, respondents who were aged 75 and over or had lower or no educational qualifications were among those most likely to agree that the public should be better protected from people with mental health problems and that people with mental health problems are often dangerous.

7.10 It is interesting to note that people with the highest educational qualifications were much more likely than the next most qualified group to say that if they had a mental health problem, they wouldn't want people knowing about it. It may be that the former group might feel their higher professional status would be threatened if a mental health problem were revealed. Or, the difference may simply be a reflection of the relative affluence of more and less educated groups. Those with higher education qualifications are likely to live in less deprived parts of the country where mental ill-health tends to be less prevalent than in more deprived areas, and possibly less talked-about as a consequence.

7.11 Other findings cast doubt on this latter hypothesis, however. Analysis by area deprivation reveals that people living in the most deprived areas were more likely than those in the least deprived areas to agree that they would find it hard to talk to someone with a mental health problem (24% versus 14%), that the public should be better protected from people with mental health problems (40% versus 31%), and that people with mental health problems are largely to blame for their own condition (8% versus 3%). Those in the least deprived areas were significantly more likely than those in other areas to disagree that people with mental health problems are often dangerous (68% versus 56% of those in the most deprived areas). Clearly then, the higher incidence of mental ill-health in more deprived areas does not result in higher tolerance of mental ill-health in those areas. It may be that those in less deprived areas have lower understanding of mental ill-health problems (or more experience of neighbourhood disruption caused by such problems) which makes them fearful of those who suffer in this way.

Table 7.3: Attitudes towards mental ill-health, by age and education

Source: Ipsos MORI

7.12 There was further variation in people's attitudes according to whether they had any experience of mental ill-health. As table 7.4 below shows, those with no proxy or personal experience of mental ill-health were more likely to agree that the public should be better protected from people with mental health problems, that they would find it hard to talk to someone with a mental health problem and that people are generally caring and sympathetic towards people with mental health problems. Conversely, respondents with experience of mental ill-health were more likely than those with no experience to disagree that people with mental health problems are dangerous and to agree that the majority of people with mental health problems recover. There was no variation by respondents' mental ill-health scores but people with poor mental wellbeing were more likely than those with good mental wellbeing to say they would find it hard to talk to someone with mental health problems (33% versus 12%). This is consistent with the finding, discussed in chapter 4, that people with good mental wellbeing tended to have higher levels of social engagement than those with poor mental wellbeing.

Table 7.4: Attitudes to mental ill-health, by experience of mental health problems

Source: Ipsos MORI

7.13 The sub-group differences reported above are broadly consistent with findings from the 2004 survey.

7.14 Hierarchical regression analysis was undertaken to assess the relative strength of different sets of socio-demographic and behavioural variables in terms of their relationship with attitudes towards mental health problems.

7.15 Before carrying out the regression analysis it was necessary to reduce respondents' answers on the nine different attitude statements to a single dependant variable. A numeric 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 1 was allocated for strong disagreement, 2 for a tendency to disagree and so on, up to 5 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 5 was allocated for strong disagreement, 4 for a tendency to disagree and so on down to 1 for strong agreement. These were then summed to give a total value for each respondent. A higher value indicates more positive attitudes towards mental ill-health, and a lower value, more negative attitudes.

7.16 The attitudinal values were put into the regression analysis with the following variables:

• Control over factors affecting mental health
• GHQ12 ¹⁹
• Experience of mental ill-health
• Key sources of information on mental health problems
• Knowledge of National Programme campaigns, initiatives and promotional activity

7.17 Additionally, the following demographic variables were used:

• Age
• Sex
• Ease of managing on income ²⁰
• Education qualifications
• Employment status

7.18 The analysis revealed that the regression model explained 10% of the variance in attitudes. Further, no one variable dominated over the others in terms of the strength of its association with attitudes towards mental ill-health.

7.19 However, of the 10 factors included in the analysis, 4 stood out as being more strongly correlated with attitudes than others. The first and strongest of these was mention of personal contact or experience as an important source of information on mental ill-health, that is, respondents who mentioned this were less likely to hold negative attitudes towards mental ill-health.

7.20 Consistent with findings reported above, the second strongest factor was age, with older people tending to hold more negative attitudes towards mental ill-health than younger groups.

7.21 The third factor was the GHQ12 item 'have you recently lost much sleep over worry?' Those who said they had recently lost sleep rather more than usual or much more than usual also held more negative attitudes.

7.22 The fourth factor also concerned respondents' main sources of information on mental ill-health, and specifically whether they mentioned health professionals. This was correlated with more positive attitudes towards mental ill-health.

7.23 In sum, the regression analysis identified two main correlates of attitudes towards mental health problems: experience of mental ill-health and sources of information on mental health. Clearly, these two correlates are very much related as the specific sources of information that emerge as significant are personal contact or experience and health professionals.

7.24 It is worth noting at this point that the analysis also found awareness of specific mental health campaigns and initiatives to be correlated with attitudes but the relationship was weaker than for the four factors described above. The relationship between attitudes and awareness of campaigns and initiatives is examined more fully in the next chapter.

7.25 In addition to the regression analysis, segmentation analysis was undertaken on the attitudinal data to explore further the links between attitudes and other variables. However, the resulting data added little value to the findings reported above. A full discussion of the segmentation analysis is provided in Annex I.

Perceived prevalence of mental health problems

7.26 To help assess the Executive's progress towards its target of improving mental health literacy, respondents in the survey were asked how many people in Scotland out of 100 will have a mental health problem at some point in their lives. According to the Mental Health Foundation, the actual lifetime incidence of mental health problems is around 25% (Mental Health Foundation 2003).

7.27 The results are very similar to those obtained in 2004, with respondents tending to over-estimate the prevalence of mental ill-health. Indeed, seven in ten thought over 30% of people would experience a mental health problem at some point in their lives, and 20% thought the figure was over 70%. The mean estimate given was 47% (table 7.5).

7.28 Again, these findings stand in contrast to results from other similar surveys, in which respondents generally tend to underestimate the prevalence of mental ill-health. For example, in a survey conducted in 2006 by the Health Promotions Agency for Northern Ireland, 63% of respondents underestimated the extent of mental ill-health in their country, with 18% underestimating the figure considerably to be either 1 in 100 or 1 in 1000 (Health Promotion Agency, 2006). As was noted in the report on the 2004 Scottish survey, it may be that the higher estimates for Scotland are a function of the various campaigns, initiatives and promotional activity described chapter 1, of which there have been no equivalents in Northern Ireland. However, this may also be a methodological issue and a result of the different way in which the questions was asked in the two surveys.

7.29 As table 7.6 (below) shows, those who had experienced a problem personally, or knew someone close to them who had, gave significantly higher estimates than those with no such experience. Likewise, estimates were higher among those with a high mental ill-health score than among those with a lower score (mean estimates of 52% versus 43%).

7.30 Additionally, women tended to give significantly higher estimates than men. Similarly, people aged 16 to 64 years tended to give higher estimates than people aged 65 and over - although in part this reflects the fact that there was a high proportion of 'don't know' responses among the latter group.

Table 7.5: Perceived prevalence of mental ill-health, by subgroups

Source: Ipsos MORI

7.31 Regression analysis was undertaken to explore further the relationship between respondents' estimates regarding the prevalence of mental health problems and their responses to other key questions in the survey. Specifically, the analysis sought to explore the relative influence of the following 5 key factors on respondents' estimates:

• Willingness to engage with people displaying symptoms of mental ill-health (this measure was derived from a battery of questions which are discussed in detail in the next chapter)
• Someone close to you has experience of mental ill-health
• Someone close to you has experience of any of 15 specific mental health problems (problems as listed in chapter 6)
• Personal experience of mental ill-health
• Personal experience of any of 15 specific mental health problems (problems as listed in chapter 6).

7.32 The analysis revealed that 7 factors were correlated most strongly with estimates regarding the prevalence of mental ill-health and that for all 7, the correlations were positive - that is they were associated with higher estimates. As the chart below shows the strongest factors were being willing to interact with someone displaying symptoms of mental ill-health, and, consistent with findings reported above, having experience of mental ill-health - both personally and with respect to someone close. The other factors were knowing someone who has experienced depression, panic attacks and manic depression, and having personal experience of depression. The figures in the chart indicate the relative strength of each factor. So, for example, experience of mental ill-health in someone close is correlated twice as strongly with estimates of the prevalence of mental ill-health as experience of panic attacks in someone close.

Figure 7.1: Regression analysis of perceived prevalence of mental ill-health

7.33 It is not clear why willingness to interact with a person with mental ill-health should be related to higher prevalence estimates. It may be that people who assume mental ill-health is relatively common are less likely to regard those who suffer from problems as somehow different, abnormal or strange and thus to be avoided. Alternatively, the relationship may be explained by the fact that those willing to interact with a person with symptoms of mental ill-health are more likely to have had a mental health problem themselves or to know someone with a problem - it is clear from the remaining factors that having such experience tends to lead one to assume that mental health problems are more common than they actually are. This may be because those with experience of a problem are more likely to be aware that anyone can suffer from a problem and that sufferers may choose not to disclose their problem for fear of stigma - with the effect that official figures may understate the prevalence of mental ill-health.

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