Attitudes to Mental Health in Scotland: Scottish Social Attitudes Survey 2013 Health and Social Care Attitudes to Mental Health in Scotland: Scottish Social Attitudes Survey 2013 Susan Reid, Stephen Hinchliffe & Jennifer Waterton ScotCen Social Research Scottish Government Social Research 2014 This report is available on the Scottish Government Publications Website (http://www.scotland.gov.uk/Publications/Recent). The views expressed in this report are those of the researcher and do not necessarily represent those of the Scottish Government or Scottish Ministers. © Crown copyright 2014 You may re-use this information (not including logos) free of charge in any format or medium, under the terms of the Open Government Licence. To view this licence, visit http://www.nationalarchives.gov.uk/doc/open-government-licence/ or write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or e-mail: ACKNOWLEDGEMENTS ScotCen Social Research is very grateful to the various organisations who have contributed to funding the Scottish Social Attitudes survey over the last decade – particularly Scottish Government Social Research, the Economic and Social Research Council, the Leverhulme Trust and the Nuffield Foundation. We would also like to thank everyone involved in the preparation of this report, particularly Fiona MacDonald, Nicola Radley and other colleagues at the Scottish Government, as well as members of the steering group: Simon Bradstreet (Scottish Recovery Network), Joanne McLean (Mental Health Foundation) and Judith Robertson (‘see me’ campaign). Thanks are also due to our colleagues in NatCen’s operations and computing departments (particularly Emma Fenn and Sue Corbett), to Joan Corbett our data manager, and to our team of interviewers and supervisors. Finally, thanks to all those respondents who gave up their free time to take part in the survey. Responsibility for the opinions expressed in this report, and for all interpretation of the data, lies solely with the authors. Susan Reid, Stephen Hinchliffe & Jennifer Waterton Table of Contents EXECUTIVE SUMMARY 1 1 INTRODUCTION 7 Background 7 Research questions 7 Policy context 8 What is a stigmatising attitude in relation to mental health problems and why do attitudes matter? 11 Previous research 11 Report structure 12 About the data 13 Limitations of the data 13 Analysis and reporting conventions 14 2 PERSONAL AND INDIRECT EXPERIENCE OF MENTAL HEALTH PROBLEMS 15 Knowing someone with a mental health problem 15 Personal experience of mental health problems 17 Telling others about mental health problems 19 Social impact of mental health problems 20 3 ATTITUDES TO MENTAL HEALTH RECOVERY 23 Factors supporting recovery 24 How attitudes to factors that support recovery varied between sub-groups 26 Factors hindering recovery 27 How attitudes to factors that hinder recovery varied between sub-groups 28 What recovery means? 29 Messages about recovery from professionals, and from family and/or friends 30 4 PUBLIC PERCEPTIONS OF MENTAL HEALTH PROBLEMS 32 Approach to analysis 33 Knowledge, understanding, and awareness 34 Stigmatisation of people with mental health problems 38 Individual and public rights 41 5 PUBLIC ATTITUDES TOWARDS PEOPLE DISPLAYING THE SYMPTOMS OF SCHIZOPHRENIA AND DEPRESSION 45 Approach to analysis 46 Sources of help 47 Named and unnamed conditions and suggested sources of help 48 Likelihood of harming self or others 49 Willingness to interact with someone with schizophrenia 51 Willingness to interact with someone with depression 52 How willingness to interact with someone with schizophrenia varied between sub-groups 53 How willingness to interact with someone with depression varied between sub-groups 54 Named and unnamed conditions and willingness to interact 55 Attitudes towards both schizophrenia and depression 55 6 CONCLUSIONS 57 REFERENCES 62 ANNEX A – DETAILED TABLES 65 ANNEX B –TECHNICAL DETAILS OF THE SURVEY 128 List of tables and figures Figure 2.1: Experience of mental health problems in someone you know (2008 & 2013) .................. 17 Figure 2.2: Personal experience of mental health problems (2008 & 2013) ...................................... 18 Figure 2.3: Telling others about mental health problems (2006, 2008 & 2013) .................................. 19 Figure 2.4: Social impact of mental health problems (2008 & 2013) ................................................. 21 Figure 2.5: Whether avoided a social event by income (2013) .......................................................... 22 Table 3.1: Factors supporting recovery (2004, 2006, 2008, 2013) .................................................... 25 Figure 3.1: Factors supporting recovery by gender (2013)................................................................ 27 Table 3.2: Factors hindering recovery (2006, 2008, 2013) ................................................................ 28 Figure 3.2: Negative attitudes of people around me by income (2013) .............................................. 29 Figure 3.3: Messages about recovery from professionals, and from family and/or friends (2013) ...... 30 Table 4.1: Level of agreement with statements demonstrating knowledge, understanding and awareness of mental health issues, 2002 to 2013 ............................................................................ 35 Figure 4.1: ‘The majority of people with mental health problems recover’ by personal experience of mental health problems (2013) ........................................................................................................ 37 Table 4.2: Strongly agree / tend to agree with statements demonstrating the stigma towards those with mental health problems, 2002 to 2013 ...................................................................................... 38 Figure 4.2: ‘If I were suffering from a mental health problem I wouldn’t want people knowing about it’ by whether could rely on a neighbour (2013) .................................................................................... 39 Figure 4.3: Who have told about mental health problem, by whether would want people to know about own mental health problems (2013) ................................................................................................. 40 Table 4.3: Level of agreement with statements about perceived danger from people with mental health problems and the balance between individual and public rights (2002 to 2013) ...................... 41 Figure 4.4: ‘People with mental health problems are often dangerous’ by attitudes to ethnic diversity and personal experience of mental health problems ......................................................................... 43 Figure 5.1: Three best sources of help for someone with schizophrenia or depression (2013) .......... 48 Figure 5.2: Likelihood of someone showing the symptoms of schizophrenia or the symptoms of depression harming themselves or others (2013) ............................................................................. 49 Figure 5.3: Willingness to interact with someone showing symptoms of schizophrenia (2013) .......... 52 Figure 5.4: Willingness to interact with someone showing symptoms of depression (2013)............... 53 Figure 5.5: Willingness to have someone with schizophrenia as a work colleague by whether told only symptoms, or that they had schizophrenia (2013) ............................................................................ 55 Figure 5.6: Whether unwilling to interact with someone with schizophrenia and someone with depression....................................................................................................................................... 56 Table A.1: Whether know someone with a specific mental health problem? (2008 & 2013)............... 65 Table A.2: Personal experience of specific mental health problems (2004, 2006, 2008 & 2013) ....... 66 Table A.3: Whether has a mental health problem by age, gender, income, education and area deprivation 2013 .............................................................................................................................. 67 Table A.4: Social impact of having mental health problems (2002, 2004, 2006, 2008 & 2013) .......... 68 Table A.5: Social impact of having a mental health problem by age, gender, income, education and area deprivation 2013 ...................................................................................................................... 69 Table A.6: Main factors supporting recovery by age, gender, income, education and area deprivation 2013 ................................................................................................................................................ 70 Table A.7: Factors hindering recovery by age, gender, income, education and area deprivation 2013 ........................................................................................................................................................ 71 Table A.8: What recovery means (2006, 2008 & 2013) .................................................................... 72 Table A.9: What recovery means by age, gender, income, education and area deprivation 2013 ..... 73 Table A.10: Positive messages from professionals and family/friends by age, gender, income, education and area deprivation 2013 ............................................................................................... 74 Table A.11: Anyone can suffer from mental health problems by demographic, area, mental health experience and social attitudes ........................................................................................................ 75 Table A.13: People with mental health problems are largely to blame for their own condition by demographic, area, mental health experience and social attitudes ................................................... 81 Table A.14: People are generally caring and sympathetic to people with mental health by demographic, area, mental health experience and social attitudes ................................................... 84 Table A.15: If I was suffering from mental health problems, I wouldn't want people knowing about it by demographic, area, experience of mental health and social attitudes ............................................... 87 Table A.16: I would find it hard to talk to someone with mental health problems by demographic, area, mental health experience and social attitudes .................................................................................. 90 Table A.17: People with mental health problems are often dangerous by demographic, area, mental health experience and social attitudes ............................................................................................. 93 Table A.18: The public should be better protected from people with mental health problems by demographic, area, mental health experience and social attitudes ................................................... 96 Table A.19: People with mental health problems should have the same rights as anyone else by demographic, area, mental health experience and social attitudes ................................................... 99 Table A.20: Best sources of help for Andy (schizophrenia), combined sample - % mentioned ........ 102 Table A.21: Best sources of help for Stephen (depression), combined sample - % mentioned ........ 104 Table A.22: How likely Andy (schizophrenia) would harm someone else, combined sample ........... 106 Table A.23: How likely Andy (schizophrenia) would harm himself, combined sample ...................... 107 Table A.24: How likely Stephen (depression) would harm someone else, combined sample .......... 109 Table A.25: How likely Stephen (depression) would harm himself, combined sample ..................... 110 Table A.26: How willing to make friends with Andy (schizophrenia), combined sample ................... 111 Table A.27: How willing would you be to have Andy (schizophrenia) as work colleague, combined sample .......................................................................................................................................... 113 Table A.28: How willing would you be to spend evening socialising with Andy (schizophrenia), combined sample .......................................................................................................................... 115 Table A.29: How willing would you be to move next door to Andy (schizophrenia), combined sample ...................................................................................................................................................... 117 Table A.30: How willing would you be to have Andy (schizophrenia) marry into your family, combined sample .......................................................................................................................................... 119 Table A.31: How willing would you be to have Andy (schizophrenia) provide childcare, combined sample .......................................................................................................................................... 121 Table A.32: How willing to make friends with Stephen (depression), combined sample .................. 122 Table A.33: How willing would you be to have Stephen (depression) as work colleague, combined sample .......................................................................................................................................... 123 Table A.34: How willing would you be to spend evening socialising with Stephen (depression), combined sample .......................................................................................................................... 124 Table A.35: How willing would you be to move next door to Stephen (depression), combined sample ...................................................................................................................................................... 125 Table A.36: How willing would you be to have Stephen (depression) marry into your family, combined sample .......................................................................................................................................... 126 Table A.37: How willing would you be to have Stephen (depression) provide childcare, combined sample .......................................................................................................................................... 127 EXECUTIVE SUMMARY 1. This report presents findings on three questions relating to public attitudes to mental health: How have attitudes to people with mental health problems changed over time? What factors are related to people’s attitudes towards people with mental health problems? For those with direct experience of mental health problems, what have the social impacts been, what has helped or hindered their recovery, and have they received positive messages about their recovery? 2. The report uses data collected on the Scottish Social Attitudes (SSA) survey between June and October 2013. To address the question of change over time, SSA 2013 data are compared with data collected on four separate occasions (in 2002, 2004, 2006 and 2008) as part of the National Scottish Survey of Public Attitudes to Mental Health, Mental Wellbeing and Mental Health Problems. This survey series is referred to in what follows as the Well? survey(s). Methodological changes were implemented between the Well? survey series and SSA 2013. There were changes to the method of data collection for questions asked of those who had experienced mental health problems (face-to-face in the Well? series and self-complete in SSA 2013). There were also some alterations to question wording and question ordering. This means that findings on change over time should be treated with caution. Knowing someone with a mental health problem 3. Around two-thirds of people said they knew someone who had ‘ever experienced a mental health problem’ (65%), a similar proportion to that found in both the 2006 and 2008 Well? surveys. This figure rose to almost 8 in 10 (79%) when people were asked whether they knew someone with any of 15 specific listed conditions. 4. Fifty-one percent of people said they knew someone who had experienced depression and nearly a third (30%) that they knew someone with dementia. Over a quarter (27%) knew someone who had experienced panic attacks and slightly under a quarter (23%) knew someone who had experienced an anxiety disorder. The proportions knowing someone with depression, dementia, or anxiety disorder have all increased significantly (by between 6% and 10%) since 2008. Personal experience of mental health problems 5. A quarter of people (26%) said they had personally experienced a mental health problem at some point in their life time. This is consistent with the levels found in previous Well? surveys when the proportion ranged between 26% and 28% from 2002 to 2008. When people were asked whether a doctor or health professional had ever told them that they had a specific mental health problem, chosen from a list of 15 different types of mental health problems, this figure rose to almost one third (32%). 1 6. The most commonly cited mental health problem people had experienced was depression, with around 1 in 5 (21%) saying they had experienced depression at some point in their lives. The next most common conditions mentioned were panic attacks (9%) and anxiety disorders (8%). These were also the three most commonly mentioned problems in the 2008 Well? survey. The proportions who said they had experienced depression, anxiety disorder, or indeed any form of anxiety or stress disorder, had increased (by 4% in each case) since 2008. 7. Gender, age and income were all significantly related to the reported prevalence of mental health problems. In particular, women were more likely than men to say they had experienced a mental health problem (36% compared with 27%); people over 55 years were the age group least likely to say they had experienced a mental health problem (23%); and those in the lowest income group were more likely than those in the highest income group (41% compared with 25%) to have experienced a mental health problem. Telling others about mental health problems and their social impacts 8. Among those who identified themselves as having experienced a mental health problem, 85% had told someone about it, a similar proportion to 2006 (85%) and 2008 (88%). In 2013, as in previous years, people were most likely to have told family and friends (more than 4 out of 5) with much smaller numbers having told their manager or boss (around 1 in 5) or a colleague (around 1 in 6). 9. Over one third of people (37%) who identified as having experienced a mental health problem had experienced some negative social impact (for example they had been discouraged from attending an event, been refused a job, or been verbally or physically abused). This was an increase from 2008, when the equivalent figure was 23% and a return to the level recorded in 2004 (36%). 10. In 2013 13% of people said they had been discouraged from attending an event by someone else. However, when asked whether they themselves had decided to avoid a social event because of the way they thought people would treat them, a substantially larger proportion (22%) said they had done so. Recovery for those who had experienced mental health problems 11. In 2013 those who had experienced a problem were asked to identify the two or three most important factors that supported their recovery. The five factors chosen most often were: medication (42%); ‘support from family or friends’ (41%); ‘other forms of treatment/therapy (e.g. psychology, counselling, alternative treatments, support groups)’ (27%); ‘developing my own coping strategies’ (26%); and ‘finding out more about mental health (e.g. through support groups, leaflets, web information)’ (19%). 12. There have been quite substantial changes since 2008 in the factors chosen as supporting an individual’s recovery. In particular, there has been a sharp decline in the proportion choosing ‘family or friends’ (from 62% in 2008 to 41% in 2013) and choosing ‘having belief in myself’ (from 31% in 2008 to 15% in 2