WELL? WHAT DO YOU THINK?
CHAPTER SEVEN. MENTAL HEALTH PROBLEMS: PEOPLE'S VIEWS, ATTITUDES AND OPINIONS
7.1 A major section of the interview covered issues relating to people's attitudes to mental health problems. The section began with an attitude battery to assess the way in which people responded to statements about non-specific mental health problems. The statements, which were randomly rotated, are reproduced in Table 7.1. Notably, there was almost universal recognition that anyone can suffer from mental health problems and extensive support for equal rights for people who have mental health problems. However, half of the people in the sample agreed (at least to some extent) that they would not want people to know if they had a mental health problem, while a third of respondents thought that people with mental health problems were often dangerous.
Attitudes to mental health problems and calculating scores on a stigma scale
Table 7.1: I'm now going to read out some things people have said about mental health problems. Taking your answer from this card, I'd like you to tell me how much you agree or disagree with each of these statements.
Base: all = 1381
| Agree strongly
% | Agree slightly
% | Neither
/nor
% | Disagree slightly
% | Disagree strongly
% |
If I was suffering from mental health problems, I wouldn't want people knowing about it | 18 | 32 | 17 | 21 | 13 |
The public should be better protected from people with mental health problems | 10 | 25 | 23 | 22 | 20 |
Anyone can suffer from mental health problems | 83 | 15 | 1 | * | * |
I would find it hard to talk to someone with mental health problems | 4 | 16 | 11 | 26 | 43 |
People are generally caring and sympathetic to people with mental health problems | 8 | 28 | 12 | 30 | 22 |
People with mental health problems are often dangerous | 5 | 27 | 20 | 27 | 21 |
The majority of people with mental health problems recover | 14 | 36 | 31 | 15 | 4 |
People with mental health problems should have the same rights as anyone else | 69 | 19 | 7 | 4 | 1 |
People with mental health problems are largely to blame for their own condition | 1 | 6 | 7 | 22 | 65 |
7.2 The series of statements was used in an aggregate analysis to develop a classification of overall views on mental health problems. A scoring system was used to reflect the positive/negative balance of each attitude statement - those in italics in Table 7.1 were scored with five points for strong disagreement, through to only one point for strong agreement (e.g. " Anyone can suffer from mental health problems"). The five remaining statements were scored in the opposite way (e.g. " People with mental health problems are often dangerous"). The overall scores therefore varied from a theoretical minimum of 9 points (relatively tolerant) to a maximum of 45 points (least tolerant). In practice, the lowest score was 10 and the highest was 34 - a clear majority of people scored between 19 and 26 points on the scale.
7.3 The banded score distribution is shown in Table 7.2 along with some of the key breakdowns from the data analysis. Those respondents with no experience of people with mental health problems had a significantly higher mean score than those who had such experience. Age had some association with the tolerance of views expressed: older respondents were more likely to have a high score, while the figure for 16-24 year olds in Table 7.2 was typical of all people aged under 65. CHAID analysis also showed the importance of both age and experience of mental health problems. It is worth noting that the mean score did not show a great deal of variation across the overall sample (for example, by working status, social class or the urban/non-urban split).
Table 7.2: Summary scores on the stigma scale
Base: all = 1381
| All
% | Experience of someone else having mental health problems
% | Have had own mental health problems
% | No experience of people with mental health problems
% | 16-24
% | 75+
% |
Most tolerant: up to 18 points | 29 | 33 | 31 | 20 | 32 | 20 |
19-21 points | 27 | 26 | 33 | 23 | 24 | 23 |
22-26 points | 34 | 32 | 27 | 42 | 33 | 42 |
Least tolerant: 27+ points | 10 | 9 | 8 | 15 | 11 | 15 |
Mean average points | 21 | 20.6 | 20.5 | 22.2 | 20.9 | 22.3 |
Cluster analysis
7.4 The scale discussed above provides a useful way of summarising the views expressed by people in the sample. However, with a total of nine very different statements, there are various ways in which two people can give different answers but emerge with the same score on the scale. In order to investigate people's attitudes in a little more detail, the nine statements were fed into a computer programme that produces up to 10 cluster solutions. This programme grouped people by the responses to the attitude statements that they appeared to hold in common. An efficiency score was calculated: this needed to be as large as possible to ensure that the clusters were distinct from one another. However, the size of the efficiency score needed to be balanced against robust sample sizes for each cluster. In this instance, a six cluster solution produced optimum results (the largest drop in efficiency score was between six and five clusters). Further details of the cluster breakdown is given in Annex F to this document.
7.5 Once the six clusters had been identified, the characteristics they shared were examined. There is a dilemma in reporting this aspect of the findings. On the one hand, to provide a profile of the characteristics of people in the various clusters, or to append a word or phrase to summarise the attitudes they appear to hold in common may be in itself stigmatising. On the other hand, detailed information about people who share certain attitudes is valuable in assisting the targeting of activities to raise public awareness and address issues of discrimination and stigma. The clusters were numbered: Cluster 1 (whose attitudes were most sympathetic towards and understanding of mental health problems and the people who suffer from them) through to Cluster 6 (who held the least sympathetic and least tolerant attitudes). Tables 7.3 and 7.4 sketch out the attitudes that people in each cluster appear to hold in common, along with the demographic characteristics they share.
7.6 As noted earlier, when discussing the stigma scale, there is considerable evidence of tolerant views among the people in the sample, with nearly half of all respondents sharing attitudes common to Clusters 1 or 2. However, a smaller set of people were much more negative in their views and one in five were at the far end of the spectrum, in Cluster 6. It seems probable that people who share the attitudes held by Clusters 5 and 6, who are likely to be older and to avoid exposure to mental health issues, will be difficult to reach through awareness raising initiatives. If opinions are to be influenced, there may be more scope to reinforce positive messages, not only with people who hold the attitudes common to Clusters 1 and 2, but with the clusters in the middle of the spectrum, notably people who are broadly non-judgemental, but are also scared of the effects of mental health problems.
Table 7.3: Summary of attitudes in cluster solutions and profile of the groups
Part 1 - most positive
Base: all = 1381
Cluster 1
(26% of the total) | Do not see people who have mental health problems as a threat Feel that they can talk to people who have mental health problems Think that people with mental health problems can recover
Demographics - AB, social class, 35-54 year olds and those in work More likely to have stress in their lives Have lowest scores on stigma scale Feel that people with mental health problems receive negative media portrayal Often get information on mental health from personal experience and contact Want the government to help people understand about mental health
|
Cluster 2
(20%) | Would not mind people knowing if they were suffering from a mental health problem Think that people who have mental health problems do not recover Think people with mental health problems should have the same rights as others Do not think people with mental health problems are to blame for their problems
Demographics - female and no children in household Low scores on the stigma scale Higher level of experience of mental health problems Want government to help people understand about mental health Get information about mental health from personal experience and contact
|
Cluster 3
(23%) | Would not want people to know if they were suffering from a mental health problem Find it hard to talk to people with mental health problems Think the public should be better protected from those with mental health problems More likely to think that people with mental health conditions are dangerous BUT think anyone can suffer from a mental health problem Think people with mental health problems should have the same rights as anyone else Do not think people with mental health problems are to blame for their problems
Demographics - in work Get information on mental health issues from TV news Describe good mental health as being in control More likely to think that people with specific symptoms of mental health problems should live in specialist community-based units
|
Table 7.4: Summary of attitudes in cluster solutions and profile of the groups
Part 2 - more negative
Base: all = 1381
Cluster 4
(12%) | Do not agree very strongly that anyone can suffer from a mental health problem Find it hard to talk to people who have such problems More likely to think that people with mental health problems are largely to blame for their problems Less likely to think that people with mental health problems should have the same rights as anyone else Think that the general public are generally caring towards people with mental health problems
Demographics - 16-34s and men Report lower level of stress in their lives Low level of experience of mental health problems
|
Cluster 5
(10%) | Agree that people are to blame for their mental health problems If they were suffering from a mental health problem they would not tell anyone They find it hard to talk to people with mental health problems They think people with mental health problem are dangerous
Demographics - over 75s and DE social class More likely to report stress in their lives Second highest scores on the stigma scale Relatively low advertising/promotion recall Least likely to want government to improve services for people with mental health problems
|
Cluster 6
(9%) | Do not agree very strongly that people with mental health problems should have the same rights as anyone else More likely to think that people with mental health problems are dangerous Tend to think that people need to be protected from those with mental health problems Disagree that people with mental health problems recover
Demographics - over 75s Have highest scores on the stigma scale Often use national newspapers as source of information on mental health issues Have the lowest agreement on equal rights for people with mental health problems Least keen on contact with someone with a mental health problem
|
Case study vignettes
7.7 The questionnaire included a substantial section dealing with a series of vignettes. These vignettes described some symptoms associated with three mental health problems (depression, schizophrenia and stress). Each vignette was varied by gender, so that there were six in total. One vignette was used per interview and the process was randomised so that more or less equal numbers of each scenario were covered during the data collection period. Having digested the description of the problems experienced by the person in the vignette (but without being given a diagnosis), respondents were asked questions about what they thought the cause of the person's condition might be, and how willing they would be to engage with the person. They were also asked to say how they thought the person might be helped, and to estimate how likely it was that the person was experiencing depression, schizophrenia and stress.
7.8 The full text used for each vignette is shown below - the vignette was presented to the respondent in the form of a showcard. The formal clinical diagnosis (shown in brackets after each paragraph) was not included with the showcard text.
1. Robert has been feeling really down for the last few weeks. He wakes up in the morning with a flat heavy feeling that stays with him all day long. He doesn't enjoy things the way he normally would. In fact, nothing gives him pleasure. Even when good things happen, they don't seem to make Robert happy. He has to force himself to get through the day, and even the smallest things seem hard to do. He finds it hard to concentrate on anything and has no energy at all. Even though Robert feels tired at night, he still can't sleep, and wakes up too early in the morning. Robert feels worthless and feels like giving up. Robert's family has noticed that he hasn't been himself for about the last month. He doesn't feel like talking and isn't taking part in things like he used to. ( Depression (male)) |
2. Shona has been feeling really down for the last few weeks. She wakes up in the morning with a flat heavy feeling that stays with her all day long. She doesn't enjoy things the way she normally would. In fact, nothing gives her pleasure. Even when good things happen, they don't seem to make Shona happy. She has to force herself to get through the day, and even the smallest things seem hard to do. She finds it hard to concentrate on anything and has no energy at all. Even though Shona feels tired at night, she still can't sleep, and wakes up too early in the morning. Shona feels worthless and feels like giving up. Shona's family has noticed that she hasn't been herself for about the last month. She doesn't feel like talking and isn't taking part in things like she used to. ( Depression (female)) |
3. Robert is a man who was doing pretty well until about a year ago. But then things started to change. He thought that people around him were criticising him and talking behind his back. Robert was convinced that people were spying on him and that they could hear what he was thinking. Robert couldn't work any more, and he stopped joining in with family activities. He retreated from everything, until he eventually spent most of his day in his room. Robert heard voices even though no one else was around. These voices told him what to do and what to think. He has been living this way for six months. ( Schizophrenia (male)) |
4. Shona is a woman who was doing pretty well until about a year ago. But then things started to change. She thought that people around her were criticising her and talking behind her back. Shona was convinced that people were spying on her and that they could hear what she was thinking. Shona couldn't work any more, and she stopped joining in with family activities. She retreated from everything, until she eventually spent most of her day in her room. Shona heard voices even though no one else was around. These voices told her what to do and what to think. She has been living this way for six months. ( Schizophrenia (female)) |
5. Robert is a man who was doing pretty well until about a year ago. While nothing much was going wrong in Robert's life, he had a few problems that were really beginning to get to him. He started to feel worried, and a little sad, and had trouble sleeping at night. Things bothered him more than they bothered other people, and he started to get nervous and annoyed when things went wrong. Otherwise Robert is doing OK. He enjoys being with other people, and though he sometimes argues with his family, he has generally been getting on pretty well with them. ( Stress (male)) |
6. Shona is a woman who was doing pretty well until about a year ago. While nothing much was going wrong in Shona's life, she had a few problems that were really beginning to get to her. She started to feel worried, and a little sad, and had trouble sleeping at night. Things bothered her more than they bothered other people, and she started to get nervous and annoyed when things went wrong. Otherwise Shona is doing OK. She enjoys being with other people, and though she sometimes argues with her family, she has generally been getting on pretty well with them. ( Stress(female)) |
Causes of the mental health problem
7.9 The series of questions about the vignette began by asking the respondent how likely they thought it that the situation had been caused by each of a number of factors. Table 8.5 shows a summary of the responses (very/somewhat likely) to each suggested cause of Robert/Shona's condition, broken down by the vignettes considered by people in the sample. The modest sample sizes within each vignette category mean that there was little possibility to provide a valid disaggregation of responses by demographic group. Stressful or disturbing events were the most commonly suggested causes of the condition described in each vignette. Some vignettes were associated with particular factors: depression was linked with physical illness, for example, particularly in Robert's case. Schizophrenia was seen by almost 80% of people in the sample as being connected with chemical imbalance in the brain. A link between schizophrenia and genetic problems was also suggested by approximately 60% of people who considered these vignettes. Correspondence Analysis confirmed these broad findings and also noted a negative association between the symptoms of schizophrenia and the situation being Robert/Shona's own fault.
Table 7.5: Summary of all saying that the factor was very/somewhat likely to have been a cause of the situation.
Base: all = 1381
| Respondent shown vignette describing symptoms of… |
Depression (male) | Depression (female) | Schizo-phrenia (male) | Schizo-phrenia (female) | Stress (male) | Stress (female) |
% | % | % | % | % | % |
Robert's/Shona's own character or personality | 51 | 48 | 55 | 61 | 68 | 71 |
Chemical imbalance in the brain | 64 | 69 | 77 | 78 | 57 | 59 |
The way Robert/Shona was brought up | 45 | 39 | 46 | 40 | 48 | 48 |
Stressful or disturbing events in Robert's/Shona's life | 92 | 92 | 89 | 88 | 90 | 85 |
Genetic or inherited problem | 54 | 51 | 62 | 60 | 51 | 48 |
Abuse Robert/Shona suffered as a child | 61 | 54 | 59 | 59 | 53 | 47 |
Fate | 29 | 25 | 26 | 24 | 29 | 28 |
Physical illness | 81 | 73 | 59 | 68 | 62 | 69 |
Robert's/Shona's own fault | 22 | 14 | 15 | 19 | 20 | 20 |
7.10 Tables 7.6 to 7.18 show the full range of responses to each of the suggested causes summarised in table 7.5. Most of the people who considered the vignettes describing symptoms of stress thought it likely that Robert/Shona's own personality or character was a cause of the situation (Robert: 68%; Shona: 71%). Sixty percent of the people who considered the female version of the vignette describing symptoms of schizophrenia thought that Shona's personality or character was a cause of her condition. At the other end of the spectrum, almost a quarter of people who considered the male vignette thought it very unlikely that Robert's personality was a cause of his problems. Approximately half the people who looked at the vignettes relating to symptoms of depression thought that there was a link between the person's character and the condition.
Table 7.6: In your opinion, how likely is it that Robert's/Shona's situation might be caused by each of the following: Robert's/Shona's own character or personality
Base: all = 1381
| Respondent shown vignette describing symptoms of… |
Depression (male) | Depression (female) | Schizo-phrenia (male) | Schizo-phrenia (female) | Stress (male) | Stress (female) |
% | % | % | % | % | % |
Very likely | 16 | 11 | 23 | 19 | 20 | 17 |
Somewhat likely | 35 | 37 | 33 | 41 | 49 | 54 |
Somewhat unlikely | 24 | 23 | 15 | 22 | 19 | 14 |
Very unlikely | 21 | 25 | 24 | 14 | 10 | 12 |
Don't know | 4 | 4 | 5 | 5 | 2 | 3 |
7.11 Chemical imbalance in the brain was picked up as a likely cause of the situation by most of those who looked at each of the vignettes, especially those describing symptoms of schizophrenia.
Table 7.7: In your opinion, how likely is it that Robert's/Shona's situation might be caused by each of the following: Chemical imbalance in the brain
Base: all = 1381
| Respondent shown vignette describing symptoms of… |
Depression (male) | Depression (female) | Schizo-phrenia (male) | Schizo-phrenia (female) | Stress (male) | Stress (female) |
% | % | % | % | % | % |
Very likely | 14 | 24 | 34 | 24 | 16 | 11 |
Somewhat likely | 50 | 45 | 41 | 53 | 41 | 45 |
Somewhat unlikely | 9 | 8 | 8 | 5 | 16 | 16 |
Very unlikely | 10 | 10 | 4 | 6 | 10 | 15 |
Don't know | 17 | 13 | 14 | 10 | 17 | 13 |