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%).
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 2013). By contrast, there has been a substantial increase in the proportion selecting 'other forms of treatment/therapy' (from 19% in 2008 to 27% in 2013) and 'finding out more about mental health' (from 8% in 2008 to 19% in 2013).
13. In 2013 the five factors chosen most often as hindering people's recovery by respondents with experience of a mental health condition were: 'not acknowledging I had a problem' (18%); 'not understanding what was going on' (16%); 'not feeling able to tell people about my mental health problem' (15%); 'continuing to experience symptoms' (13%); and 'negative attitudes of people around me' (11%). There has been very little change over time in relation to the factors that people regard as hindering their own recovery.
14. People with experience of a mental health problem were asked, 'What does recovery mean to you?', and given a list of response options. In 2013, the five most commonly chosen answer options were: 'having a satisfying and fulfilling life' (55%); 'getting back to normal' (46%); 'taking charge of my life again' (44%); 'feeling able to cope in general' (37%); and 'getting more sleep' (20%).
15. People with experience of a mental health problem were also asked to what extent professionals (nurses, doctors, support workers, etc.), and family and/or friends, gave them positive or negative messages about their recovery. Two-thirds (65%) received either a completely or mainly positive message from professionals. This is similar to the level recorded in 2006 (66%), but lower than in 2008 (73%). In relation to messages from family and/or friends, the proportion receiving a positive message declined, from 76% in 2006 and 79% in 2008 to 66% in 2013.
16. In 2013, a higher proportion of people said their family and/or friends gave them a completely positive message about their recovery (36%) than said the same about professionals (28%).
Knowledge, understanding and awareness of mental health problems
17. There is a great deal of consensus around the statement that 'anyone can suffer from mental health problems'. Between 2002 and 2013 this figure has fluctuated between 93% and 98%, with a figure of 98% being recorded both in 2002 and in 2013. People also agree to a very large extent that those with mental health problems are not to blame for their condition. The figures have been fairly stable since 2002; in 2013, 89% disagreed that 'people with mental health problems are largely to blame for their own condition'.
18. One-third (33%) agreed with the statement that 'the majority of people with mental health problems recover'. This has fallen from 50% who agreed with this statement in 2002. In 2013, the proportion agreeing with this statement was substantially higher for those with personal experience of a mental health problem (44% of this group compared with 30% who had no personal experience).
Stigmatisation of people with mental health problems
19. Almost half (47%) said that if they were suffering from mental health problems, they 'wouldn't want people knowing about it'. This figure has ranged between 41% and 50% since 2002 but there has been no consistent pattern to the variation over time.
20. Around one in six (17%) said that they would find it difficult to talk to someone with a mental health problem, a figure which has been fairly stable since 2002. Those who were more likely to say they would find this difficult included men, those aged 65 or above, the self-employed, those with no educational qualifications, and those who did not know anyone who has experienced a mental health problem.
Individual and public rights of people with mental health problems
21. Nineteen percent agreed with the statement that 'people with mental health problems are often dangerous'. This figure was much higher in 2002 (32%) and since then has fluctuated between 15%-19%. Over a quarter (27%) of those who did not know anyone who had experienced a mental health problem held this view, compared with 15% who knew someone.
22. Over a quarter (28%) agreed that 'the public should be better protected from people with mental health problems'. This figure has fluctuated between 24%-35% over the period 2002-2013 with the highest figure recorded in 2002. Again, knowing someone who had experienced a mental health problem reduced the likelihood of agreeing the public should be better protected (24% of those who knew someone who had experienced a mental health problem, compared with 36% who did not).
23. More than 4 in 5 people (82%) agreed that 'people with mental health problems should have the same rights as anyone else'. The figure in 2013 is lower than when it was first recorded in 2002 (88%) and slightly lower than the 2008 figure (86%). However, it would require further evidence to establish whether this is a longer term downward trend and what reasons might underlie such a decline.
Sources of help for people with schizophrenia and depression
24. Two scenarios, one describing someone with schizophrenia and one describing someone with depression, were given to respondents. Respondents were then asked a range of associated questions: what would be the best sources of help for each of the individuals described, how likely would each individual be to harm themselves or other people, and how willing the respondent would be to interact with these individuals in different situations.
25. The most commonly mentioned source of help deemed to be appropriate for someone with symptoms of schizophrenia was a specialist mental health professional (86%), followed by a family doctor (70%) and a family member (62%). The same three categories were also chosen most frequently for someone with symptoms of depression, but the ranking was different with the family doctor chosen most often (77%) followed by the specialist mental health professional (67%) and a family member (65%). Around twice as many people mentioned help from a friend or neighbour for the person with depression as for schizophrenia (21% compared with 11%).
26. Views on the best sources of help varied by age group. The youngest group (18-24) were more likely to mention family members and 'someone with the same problem' and less likely to mention a family doctor in both scenarios.
Likelihood of harming self/others for someone with schizophrenia or depression
27. Almost three-quarters of people (73%) thought that the person with symptoms of schizophrenia was likely to harm themself. This compared with 37% who thought the person with symptoms of depression was likely to harm themself.
28. In relation to harming others, more than two-fifths (43%) thought that the person with schizophrenia was likely to do something harmful or violent to others, compared with 10% who thought the person with depression would. Those who knew someone with schizophrenia were more likely than those who did not to think someone with schizophrenia would harm someone else (55% compared with 42%).
Willingness to interact with someone with schizophrenia or depression
29. Respondents were asked about their willingness to interact with those who have schizophrenia or depression in six situations including: making friends; having as a work colleague; having as a neighbour; and marrying into the family. More than one in five (22%) were not willing to interact with the person with schizophrenia in any of the ways mentioned compared with one in seven (15%) who said the same of the person with depression. Eight percent said they were willing to interact with the person with schizophrenia in all six ways, and 20% with the person with depression in all six ways.
30. Between three-fifths and two-thirds of people were willing to make friends with someone with schizophrenia (66%), have them as a work colleague (64%), or socialise with them (59%). However less than half (49%) were willing to have someone with schizophrenia as a neighbour and only one-third (34%) to have them marry into the family.
31. In relation to the description of someone with depression, around three-quarters (73%-76%) were willing to make friends with this person, have them as a work colleague, socialise with them, or have them as a neighbour. However less than half (45%) were willing to have someone with depression marry into the family.
32. Women were more willing than men to engage both with someone with schizophrenia and someone with depression, and those who knew someone who had experienced a mental health problem were more willing to interact with them than those who had not. Those aged 65 or above were less willing to interact with both someone with schizophrenia and someone with depression than those aged under 65.
33. Overall, the evidence from this current analysis is that attitudes towards mental health and those with mental health problems have been fairly stable in Scotland over the last decade. No clear trends towards either an overall reduction or an increase in stigmatising attitudes have been detected, although there have been a few notable changes in relation to individual questions.
Email: Fiona MacDonald