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CHAPTER NINE: SOURCES OF INFORMATION ON MENTAL HEALTH PROBLEMS AND AWARENESS OF CAMPAIGNS, INITIATIVES AND PROMOTIONAL ACTIVITY

9.1 This chapter begins by considering how respondents have formed their impressions of mental health problems. It then explores their general recall of adverts and promotions about mental health and mental health problems, as well as their awareness of specific campaigns, initiatives and promotional activity.

Forming impressions and opinions about mental health problems

9.2 Asked which sources of information had been most important in forming their impressions about mental health problems, respondents most commonly mentioned personal contact or experience (59%) and television news and current affairs (45%). That said, newspapers, work, word of mouth and health professionals were also mentioned by relatively large numbers of people. These results are very much consistent with the comparable findings for 2004, although there has been a significant decrease in the proportion mentioning word of mouth (table 9.1).

9.3 Looking at respondents' single most important source of information on mental health problems, personal contact or experience and television news remain the top two responses, mentioned by 41% and 16%. The latter highlights the significant influence of televisual media representations on the formation of attitudes and beliefs. Work becomes the third most important source, (10%) ahead of national newspapers (4%). No other single source was mentioned by more than one in ten respondents (table 9.1).

Table 9.1: Forming impressions and opinions about mental health problems

Source: Ipsos MORI

9.4 Notwithstanding this general picture, there was some notable sub-group variation in the data. Men, especially those aged 35 to 54 years, were among those most likely to mention television news and national newspapers as one of their main sources, whereas books, leaflets, magazines, and television soaps were predominantly mentioned by women. Additionally, people aged 25 to 44 years, were among those most likely to mention personal contact or experience (table 9.2). This is consistent with the finding, reported in chapter 6, that younger people were more likely than older groups to have proxy experience of mental ill-health.

9.5 There was further variation by economic indicators with the highest earners being significantly more likely than lower income groups to mention media sources, work, health professionals, books, leaflets and magazines.

Table 9.2: Forming impressions and opinions about mental health problems, by sub-groups

Source: Ipsos MORI

General recall of adverts or promotions about mental health/mental health problems

9.6 Among the aims of the National Programme for Improving Mental Health and Wellbeing are improving awareness of mental health and promoting positive shifts in attitudes towards mental health problems. A number of major campaigns, initiatives and promotional activities have been launched to help achieve these aims, including the ongoing 'see me …' anti-stigma and discrimination campaign, which has included advertisements in various media. The present survey included a set of questions to gauge awareness of this type of activity.

9.7 Four in every five (79%) respondents said they had seen, read or heard an advert or promotion about mental health or mental health problems - a higher proportion than in 2004 (72%). This is perhaps unsurprising as the last two years have seen a significant increase in the number of mental health campaigns, initiatives and promotional activity taking place in Scotland (see below).

9.8 Over half of respondents said they had seen an advert or promotion in the cinema, while around a third mentioned leaflets in a doctor's or other type of surgery, and 20% mentioned newspaper adverts. Twelve percent mentioned each of magazine adverts, billboards/bus adverts and radio adverts, and just 4% mentioned adverts or promotions on the internet. While these figures are broadly in line with those for 2004, the proportions mentioning television/cinema adverts and newspaper adverts have both increased significantly, by 9 and 5 percentage points respectively.

9.9 As table 9.3 (below) shows, people aged 25 to 59 years were generally more likely to recall any type of advert or promotion than the younger or older age groups, and those in less deprived areas were more likely to do so than those in the most deprived areas. Recall was also higher among people with some experience of mental ill-health - whether personally or in someone close to them - than among those with no such experience. Reflecting this, respondents with a high mental ill-health score were more likely than those with a low score to say they had seen, read or heard an advert or promotion in a doctor's or other type of surgery or on television/at the cinema.

9.10 There were few regional differences but people living in the North East were significantly more likely than those in all other areas to recall seeing an advert or promotion on television or at the cinema. Reasons for this difference are unclear but it may be a legacy of work undertaken by Grampian Health Board in 2002 to boost the national 'see me…' campaign in their own area.

Table 9.3 Recall of adverts or promotions about mental health

Source: Ipsos MORI

Awareness of key campaigns, initiatives and promotional activity

9.11 In the 2004 survey, respondents were presented with a list of five specific mental health campaigns, initiatives and promotional activity, then asked which of these they had heard of. The five were:

• 'Choose Life' - the national strategy and action plan to prevent suicide
• 'see me…' the national anti-stigma and discrimination campaign
• the 'Breathing Space' telephone advice line for people experiencing low mood or depression
• Mental Health First Aid training
• the Scottish Recovery Network

9.12 For the 2006 survey, the list was extended to include:

• ASIST (Applied Suicide Intervention Skills Training)
• 'ArtFull' - the initiative to promote the arts in improving mental health and Wellbeing
• 'HeadsUpScotland', the national project for children and young people's mental health
• 'Doing Well by People with Depression', the programme which aims to improve access to appropriate services for people with depression
• 'Well' magazine, the bi-annual magazine on improving mental health and wellbeing in Scotland

9.13 These various campaigns and initiatives associated with the National Programme differ greatly in message, media used, style of delivery, target group and level of funding. This is likely to have a significant bearing on public awareness of each. For example, we would anticipate that people would be more aware of 'see me…' than other initiatives because it is specifically a media campaign.

9.14 The results confirm this hypothesis. Of all the campaigns, initiatives and promotional activity, 'see me…' and 'Choose Life', had the highest profile among respondents, with 37% and 32% respectively saying they had heard of these. While the figure for 'see me…' is in line with the comparable result for 2004 (34%), recognition of 'Choose Life' has increased significantly, by 6 percentage points.

9.15 Around a quarter of respondents had heard of 'Breathing Space' and 'Well' Magazine. The figure for Breathing Space is also significantly up on 2004 - by 10 percentage points (14%).

9.16 Around one in five people said they had heard of 'HeadsUpScotland' and ASIST, while roughly half this proportion had heard of Mental Health First Aid, The Scottish Recovery Network, 'ArtFull' and 'Doing Well by People with Depression'. The figures for Mental Health First Aid and the Scottish Recovery Network have remained static since 2004.

9.17 Awareness of the various campaigns, initiatives and promotional activity varied among different sub-groups. Consistent with their higher reliance on leaflets and magazines in forming an impression of mental health problems, women were almost twice as likely as men to be aware of 'Well' magazine (31% versus 18% respectively). In part, this may be because they are more likely than men to visit doctors' surgeries and the other types of places where the magazine is available.

9.18 Awareness of 'Choose Life', 'see me…', 'Breathing Space', and 'HeadsUpScotland' decreased with age, but awareness of ASIST was at it highest among people aged 35 to 54 years (table 9.4 below).

Table 9.4: Awareness of mental health campaigns, initiatives and promotional activity, by age

Source: Ipsos MORI

9.19 As in 2004, awareness of the campaigns, initiatives and promotional activity also varied by NHS Board area. In particular:

• Awareness of 'see me…' was significantly higher in the North East than in the Borders and South (43% versus 30% respectively)
• Awareness of 'Breathing Space' was higher in Central Belt West and the North East than in the Borders (29% and 26% versus 15% respectively)
• Awareness of 'Artfull' was higher in the Borders and South than in all other areas (16% versus 7% in Central Belt West, the Highlands and Islands and Lothian and Fife, and 11% in the North East)

9.20 Again, the higher awareness of 'see me…' in the North East is likely to reflect the additional work undertaken by Grampian NHS in their area. The differential awareness of 'Breathing Space' and 'Artfull' is more puzzling. 'Breathing Space', although initially promoted in Greater Glasgow, Argyll and Clyde, was rolled out nationally by the end of 2004. 'Artfull', similarly is a national initiative and certainly the number of related organisations and projects in the Borders and South is no higher than in other NHS Board areas.

9.21 With the exception of 'Artfull', 'HeadsUpScotland' and 'Doing Well', the campaigns, initiatives and promotional activity generally had a higher profile among people who have had a mental health problem or witnessed a problem in someone close to them, than among those with no such experience, (table 9.5 below). More specifically, those with personal or proxy experience of mental ill-health were twice as likely to have heard of 'see me…', 'Breathing Space', the Scottish Recovery Network and ASIST. Similarly, 'Choose Life' was familiar to around a quarter of those with no experience of mental ill-health, compared to over a third of those with personal or proxy experience. On one level, these findings are intuitive - it might be expected that people for whom mental ill-health is an issue will be more likely to notice relevant campaigns and initiatives. However, the results also provide an indication that the campaigns and initiatives are reaching those to whom they are likely to be most helpful.

Table 9.5: Awareness of mental health campaigns, initiatives and promotional activity, by personal experience of mental ill-health

Source: Ipsos MORI

9.22 Correlation analysis was undertaken to explore further the relationship between awareness of the campaigns, initiatives and promotional activity, and experience of mental ill-health. To provide as full as possible an exploration of the data, five different measures of awareness were considered namely:

• Awareness of any campaign, initiative or promotional activity
• The total number of campaigns, initiatives and promotional activities of which respondents had heard
• Awareness of either of the suicide prevention initiatives, 'Choose Life' or ASIST
• Awareness of 'HeadsUpScotland', the national project for children's and young people's mental health
• Awareness of either of the training intervention initiatives, ASIST or Mental Health First Aid.

9.23 The analysis revealed that all five of these measures of awareness were correlated with proxy²² experience of mental ill-health, but only the first measure - awareness of any campaign or initiative - was correlated with personal experience of mental ill-health. Further, all five measures were correlated with proxy experience of depression and panic attacks specifically.

9.24 Additionally, the second measure of awareness - the number of campaigns of which respondents had heard - was correlated with proxy experience of eating disorders, manic depression, self harm, postnatal depression and severe stress, while awareness of the suicide prevention initiatives was correlated with proxy experience of postnatal depression and self harm. Awareness of 'HeadsUpScotland' was correlated with proxy experience of self harm only.

9.25 The results of the correlation analysis are largely intuitive but are important as they are reinforced by research evidence. As already noted, we would expect those with experience of mental health problems to be both more exposed to, and more likely to take notice of, mental health campaigns and initiatives than those with no experience. For similar reasons, we might also expect the observed associations between awareness of specific campaigns and initiatives and experience of particular conditions. For example, in relation to the association between 'HeadsUpScotland' and proxy experience of self harm, this initiative is aimed at supporting young people and as self harm is relatively common in young people (e.g., approximately 1 in 10 adolescents self harm, Hawton & Rodham, 2006), this finding is unsurprising.

9.26 As already noted, some of the campaigns, initiatives and promotional activity are aimed at promoting positive shifts in attitudes to mental ill-health. Accordingly, correlation analysis was also undertaken to explore the links between awareness of the campaigns, initiatives and promotional activity and attitudes towards mental health (as measured in the previous chapter), including willingness to interact with someone with a mental health problem ^. Again, the analysis considered the 5 different measures of awareness, set out above.

9.27 Table 9.6 (below) summarises the results of the analysis. It highlights all correlations identified and whether these were positive or negative in direction.

9.28 All five measures of awareness were correlated positively with willingness to interact with someone with a mental health problem, working closely with them. In other words, on each of the measures, those with the highest levels of awareness of the campaigns and/or initiatives were more willing to interact with someone with a mental health problem under a range of circumstances - these include, making friends with them, moving next door to them and working closely with them.

9.29 Three of the measures of awareness - awareness of any campaign, initiative or promotional activity; total numbers of campaigns aware of; and awareness of suicide prevention initiatives - were also correlated with positive attitudes towards mental ill-health. Thus, those with higher awareness on these measures were more likely to inter alia agree that anyone can suffer from a mental health problem, that people with mental health problems should have the same rights as anyone else, and to disagree with the statement that the public should be better protected from people with mental health problems and that people with mental health problems are often dangerous. However, none of the 3 measures of awareness was correlated with response to the statement, 'If I were suffering from mental health problems I wouldn't want people knowing about it'. In other words, whether people agreed or disagreed with the statement had no relationship with their awareness of campaign or promotional activity. This suggests that the processes which are associated with changing attitudes towards those with mental health problems are different from those associated with changing your beliefs when the mental health problems concern yourself - perhaps this could be characterised as someone who is not prejudiced themselves but recognises that prejudice exists and consequently is reluctant to disclose. Further, all of the measures of awareness were negatively correlated with the view that people are generally caring and sympathetic towards people with mental health problems - in other words, the more campaigns and initiatives people had heard of the less likely they were to agree with this statement. The latter finding may be a reflection of the fact that the 'see me…' campaign in particular has tended to highlight the stigma surrounding mental health, albeit with a view to challenging this, which in turn may have contributed to a view of the general public as uncaring towards those with problems.

9.30 With regard to the remaining measures of awareness, familiarity with the intervention initiatives was correlated with the view that people with mental health problems should have the same rights as anyone else, but, as in the preceding analysis, negatively correlated with the view that people are generally caring and sympathetic towards people with mental health problems. Meanwhile, 'HeadsUpScotland' was correlated with just one of the attitudinal statements, namely, 'the public should be better protected from people with mental health problems' - those who had heard of 'HeadsUpScotland' were less likely to agree with this.

9.31 While correlation analysis cannot tell us anything about the causal direction of the relationship between two sets of findings, the results do provide cause for optimism. Awareness of campaigns and initiatives does appear to be correlated with more positive attitudes towards mental ill-health, including willingness to interact with people with mental health problems. That said, the absence of a correlation between awareness of campaigns and initiatives, and response to the statement, 'If I was suffering from a mental health problem I wouldn't want people knowing about it' suggests that stigma is fairly complex in nature, and that while campaigns and initiatives may be helping to change attitudes, there may still be some way to go before this is reflected in changing behaviour.

Table 9.6: Correlation analysis of awareness of campaigns, initiatives and promotional activity, and attitudes to mental ill-health

Source: Ipsos MORI

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