PUBLIC KNOWLEDGE OF AND ATTITUDES TO MENTAL HEALTH AND MENTAL ILLNESS UPDATE OF 1997 BENCHMARK SURVEY R E S E A R C H R E P O R T F O R

Transcription

1 PUBLIC KNOWLEDGE OF AND ATTITUDES TO MENTAL HEALTH AND MENTAL ILLNESS UPDATE OF 1997 BENCHMARK SURVEY R E S E A R C H R E P O R T F O R MINISTRY OF HEALTH February 2005 Authors Alice Fearn BCom/BSc Allan Wyllie MSocSci, PhD Ref: R doc

2 CONTENTS 1. SUMMARY DISCUSSION AND CONCLUSIONS INTRODUCTION RESEARCH METHOD...20 Sample Selection...20 Method of Data Collection...20 Response Rate...21 Quality Control...21 Data Analysis...21 Differences Between The 1997 And 2004 Research Methods...22 Comparison Of 2004 And 1997 Sample Composition...22 Reporting FINDINGS TOTAL SAMPLE Experience with Mental Illness Defining Good Health Defining Mental Illness Prevalence of Mental Illness Causes and Recovery Capability and Social Acceptance of People with Mental Illness Attitudes to People with Mental Illness Impacts General Knowledge of Mental Illness and Mental Health Services Social Acceptance Segments FINDINGS MAORI Experience with Mental Illness Defining Good Health Defining Mental Illness Prevalence of Mental Illness Causes and Recovery Capability and Social Acceptance of People with Mental Illness Attitudes to People with Mental Illness Impacts General Knowledge of Mental Illness and Health Services FINDINGS PACIFIC PEOPLES Experience with Mental Illness Defining Good Health Defining Mental Illness Prevalence of Mental Illness Causes and Recovery Competency and Social Acceptance of People with Mental Illness Attitudes to People with Mental Illness Impacts General Knowledge of Mental Illness and Health Services APPENDIX: QUESTIONNAIRE

3 1. SUMMARY INTRODUCTION This survey is an update of a benchmark survey undertaken in 1997 before the Like Minds campaign began. It also includes new questions, based on qualitative research that preceded the survey. RESEARCH METHODS A sample was randomly selected from throughout New Zealand of 1008 persons aged 15 to 44 years. There was over-sampling of Maori, to provide a total of 252 Maori interviews. There was also over-sampling of Pacific peoples, to provide a total of 190 interviews. The data have been weighted by ethnicity, gender and age, to accurately reflect the New Zealand population aged 15 to 44 years as at the 2001 census. The interviews were undertaking using a CATI (computer assisted telephone interviewing) system, which allows a high level of quality control. The interviews were of 20 minutes average duration and were undertaken between August 25 and October 24, The weighted response rate was 81 percent. There were some differences between the methods used for the 1997 and 2004 surveys, but the largest impacts on the comparability of the data from the two surveys is likely to result from the low response rate achieved by BRC in the 1997 survey (19 percent weighted) and the fact that they did not weight for age despite their sample having an over-representation of older people. EXPERIENCE WITH MENTAL ILLNESS General Only one in five respondents report that they currently provide, or have ever provided, support or services to people who have a mental illness, either on a paid or voluntary basis. This is not significantly different from Approximately three-quarters report knowing someone who has, or has had a mental illness, although this level is a small but significant decrease on When asked to name the mental illness, some report illnesses that are not 3

4 actually mental illnesses. When these are removed, 59 percent of respondents know someone who has, or has had a mental illness 1. Six percent self-identify as someone who has or has had a mental illness 2. Maori A quarter of Maori provide, or have provided, services to a person with a mental illness, which has remained constant since Maori are more likely to be volunteer or community workers than New Zealanders in general. When those incorrectly including non-mental illnesses are excluded, the 2004 Maori figure for knowing someone with experience of mental illness is 59 percent, the same as for the 2004 total sample. Four percent of Maori self-identify as having, or having had, a mental illness. Pacific Peoples Similar patterns of experience with mental illness exist within the Pacific community as there are overall. There has been a significant increase in the proportion of Pacific peoples who report knowing someone who has, or has had, a mental illness (up from 66% to 76%). When those who incorrectly include people with non-mental illnesses are excluded, the 2004 figure reduces to 37 percent. This big decrease supports other findings in this study, that Pacific peoples have a higher misunderstanding than the total sample as to what are mental illnesses. Only one percent of Pacific respondents self identify as having, or having had, a mental illness. This level may be a reflection of the social undesirability of acknowledging this, particularly in a telephone interview. DEFINING GOOD HEALTH: MENTAL HEALTH CONTINUES TO HAVE LOW MENTION AS A CONTRIBUTOR TO GOOD HEALTH General Consistent with the 1997 survey, mental health and well being is not recognised as a primary contributor to good health. In fact, both top of mind and total mentions (unprompted) of it are down from 1997 (total mentions down from 14% to 10%) 3. 1 There was no comparable figure for 1997 as respondents were not asked what type of mental illness this was. 2 This should not be interpreted as the rate at which people experience mental illness. This is discussed further in the Main Findings section 3 All differences reported are significant at the 0.05 level 4

5 A wider definition of mental health and well being can also include: being happy in oneself; lack of stress in life; and rest, sleep and relaxation. The proportion that mention mental health/well being or any one of these related factors is 35 percent, compared with 41 percent in Maori In mentioning mental health/well being as contributing to good health, the rates for Maori are similar to the total sample. However, as in 1997, Maori are less likely to mention things that might contribute to a wider definition of mental health. Pacific Peoples 4 Pacific peoples had average mention levels for mental health/well being, but below average levels for mention of the wider grouping of mental health related issues. DEFINING MENTAL ILLNESS: CONFUSION WITH INTELLECTUAL DISABILITY/ BIG MOVE AWAY FROM MENTAL ILLNESS BEING DEFINED BY SCHIZOPHRENIA General Thirty-nine percent incorrectly consider "intellectual disabilities, such as IHC and Down's Syndrome" as mental illnesses. When asked what they immediately think of when they hear the term "mental illness", 41 percent responded with an illness that was in fact a mental illness, which was a big increase on 32 percent in Six percent mentioned the 'TV ads/like Minds campaign' as being what they immediately think of when they hear the term "mental illness". Five percent mentioned 'personal experience: self/family member/friend'. There has been a big move away from mental illness being defined by schizophrenia. In 1997, when asked what types of mental illness they had heard of, the illness most commonly mentioned first was schizophrenia, well ahead of anything else. In 2004, recall of different mental illnesses is more evenly spread, with big increases for depression and bi-polar. Maori Maori are the same as the total sample in terms of incorrect association of intellectual disability with mental illness. 4 The Pacific sample in 1997 was not sufficiently large to allow the current Pacific sample to be compared with it. 5

6 Maori show significant increases in awareness of depression and bipolar disorder compared to 1997, although a lower starting point (in 1997) has meant these levels are still lower than the total sample. After prompting, recall of the main mental illnesses is similar for Maori and for the total sample.. This contrasts with the 1997 findings where schizophrenia was the only illness recognised by Maori to a similar degree as by the wider public. Pacific Peoples There is a higher incorrect association of intellectual disability with mental illness (49%), than in the total sample. The inclination to associate mental illness with a specific illness is less evidenced for Pacific respondents than for the total sample. Pacific peoples are more likely than others to associate mental illness with: sickness in the head ; person who is not normal and feel sad/sorry for them. Pacific respondents also have lower awareness of specific mental illnesses, at all levels of recall (top of mind, unprompted and prompted), probably reflecting that these are western clinical concepts. PREVALENCE: DIFFERENCES PERCEIVED IN PREVALENCE OF DIFFERENT MENTAL ILLNESSES 5 General Consistent with 1997 results, anxiety disorders and depression are deemed to be much more common than bi-polar disorder and schizophrenia. Despite this, the proportion believing that more than half the population will have depression sometime in their life is down significantly (from 67% to 43%). There is a spread of opinion as to the prevalence for all four illnesses, with the largest grouping being between 11 and 50 percent for all four. Maori Consistent with the 1997 findings, Maori tend to perceive a higher prevalence of mental illness than the wider community does, except for depression. Pacific Peoples Pacific respondents are more likely to perceive a higher occurrence rate for bipolar than do the total sample. 5 In this and several other sections, respondents were asked questions in relation to one randomly selected mental illness that they had been aware of when prompted. There are some difficulties in making direct comparisons with the 1997 data for these questions, so the comparisons need to be interpreted with some caution, especially if the differences are not large (see Research Methods section for further discussion). 6

7 CAUSES: DIFFERENT CAUSES ATTRIBUTED TO DIFFERENT ILLNESSES General Most respondents feel they know some causes of depression, but fewer know any for schizophrenia and particularly for bi-polar. Consistent with the qualitative findings, there appears to be a greater focus on stress as a cause of mental illness in 2004 compared with Too much stress is a factor more often associated with the onset of anxiety disorders and depression, although the two most commonly mentioned causes of depression are results of major shock and money problems. The main perceived causes of anxiety disorder and depression remain similar to The most frequently mentioned causes associated with bi-polar disorder in 2004 are comparable with those for They are they inherit it/are born with it and chemical imbalance in the brain. However there was less association with social causes than in In 2004, as in 1997, the most commonly mentioned cause of schizophrenia was inheriting it. Maori Maori do not show any notable differences from the total sample in terms of causes attributed to illnesses. Pacific Peoples Pacific peoples are more likely than the total sample to mention stress as a cause of bi-polar disorder. They are less likely to attribute depression to a major shock. RECOVERY: MOST PEOPLE WITH MENTAL ILLNESS SEEN TO BE WELL MOST OF THE TIME General Most people believe that people who experience mental illness can generally stay well most of the time and are occasionally unwell. Few believe that they generally recover completely. For all four mental illnesses asked about, the two most frequently specified ways for assisting those with an illness to become well are family/whanau support and medication. Medication took a higher profile for schizophrenia. There has been a significant increase in mention of family/whanau support for bipolar (51 percent, up from 41 percent), possibly reflecting the inclusion of someone with bipolar in the most recent Like Minds campaign. 7

8 For all four illnesses, there has been a decrease in mention of counselling/group therapy as treatment options, with 'support groups' also showing a decrease in mention as a treatment option for depression. Maori Maori are similar to the total sample in their perception that most people with experience of mental illness will stay well most of the time. Compared with 1997, Maori are now less likely to see medication as a way of supporting someone with schizophrenia; Maori mention of this is now also lower than for the total sample. Pacific Peoples In 2004, as for 1997, the majority of Pacific respondents think someone with a mental illness will stay well 'most of the time'. However opinion about this is more widely distributed across the answer options than for the total sample. Like the general sample, Pacific peoples are most likely to mention family/whanau/fono support for assisting those with a mental illness to become well. They tend to be lower in their mention of friends support, with the differences being significant for anxiety disorder and bi-polar. They are also less likely to mention medication for depression and schizophrenia. CAPABILITY: MOST REALISE THAT IMPACT OF MENTAL ILLNESS VARIES General For each of the four mental illnesses, over 80 percent of respondents say the impact on a person varies from small to large for different people with the illness. Agreement that a person with a mental illness is just as capable as others ranges from 51 to 87 percent, depending on the illness and situation. As in 1997, there is evidence to suggest that people with depression are perceived to be less capable than people with other illnesses. The exceptions are people with schizophrenia,' receiving the lowest rating for being responsible parents, and people with bi-polar receiving the lowest rating for holding down a job. There are a number of significant improvements in perceived capability of people with each of the four mental illnesses, as follows (there are seven capability items) Anxiety disorder (4 out of 7) Bi-polar (6 out of 7) Depression (7 out of 7) Schizophrenia (6 out of 7) 8

9 Maori Maori attitudes regarding capability are generally very similar to those of the total sample. For each of the mental illnesses, the number of significant improvements in capability ratings is as follows. (While fewer than for the total sample, there are another five improvements (not included here) of a magnitude that would have been significant if the Maori sample had been the same size as the total sample.) Anxiety disorder (0 out of 7) Bi-polar (3 out of 7) Depression (4 out of 7) Schizophrenia (4 out of 7) Maori do not show any pattern of giving lower capability ratings for people with depression. Pacific Peoples Pacific peoples rate the capability of people with mental illnesses in a similar manner to the wider community. They show few differences between the capability ratings for people with different types of mental illnesses. SOCIAL ACCEPTANCE: VARIES DEPENDING ON LEVEL OF INTIMACY In 2004, similar to the tendency in 1997, respondents are willing to have increasing contact with people with a mental illness at decreasing levels of intimacy. Most 2004 acceptance levels do not differ significantly between the four types of mental illness, but the exceptions are: For mingling with a person at a social event, the rating for someone with depression is lower than for someone with schizophrenia, which has the highest rating. For living with you in your house of flat, there is less willingness to have someone with schizophrenia than either depression or bi-polar. For caring for your children, there is less willingness to have someone with schizophrenia than for any of the other three illnesses The biggest number of improved ratings since 1997 are for schizophrenia: Anxiety disorder (2 out of 10) Bi-polar (5 out of 10) Depression (4 out of 10) Schizophrenia (8 out of 10). 9

10 Maori Maori levels of willingness to accept are generally similar to the total sample. For each of the mental illnesses the number of significant improvements are as follows: Anxiety disorder (1 out of 10) Bi-polar (3 out of 10) Depression (5 out of 10) Schizophrenia (7 out of 10) Pacific Peoples There are a number of situations where Pacific peoples report being less willing than the general population to have contact with someone with a mental illness. ATTITUDES TO PEOPLE WITH MENTAL ILLNESS: EFFECTS OF LIKE MINDS CAMPAIGN EVIDENT General Only two of the statements show significant improvement between 1997 and 2004, while the rest show no change. On the face of it, these results might seem surprising, given the significant improvements shown in attitudes as measured in the Like Minds Tracking Surveys which monitor the impact of the advertising. However on closer examination it can be seen that the two statements that do show significant improvements are the ones you would expect the Like Minds campaign to have had the greatest impact on 6, these being: I think it is best to avoid someone who has a mental illness (93% disagree or strongly disagree in 2004 cf. 88% in 1997); People with a mental illness should not be given any responsibility (91% disagree or strongly disagree in 2004 cf. 85% in 1997). An unexpected finding is that for most statements the strong feelings of agreement or disagreement have reduced in favour of the less extreme view. This is also inconsistent with trends in the Like Minds Advertising Tracking Surveys and there is no apparent explanation for it. Interestingly, people with mental illnesses are less frequently seen as a danger than those with no mental illnesses. Twenty nine percent of respondents feel that those with no mental illness are 'sometimes' or 'often' a danger, which is a significantly higher perceived danger level than for those with anxiety disorders (22%), bi-polar (18%) and depression (18%). Only schizophrenia is not significantly lower (23%). 6 Most 1997 items that were similar to the Like Minds Tracking Survey questions were not included in the 2004 survey, given that they were already being monitored in the Tracking Surveys. 10

11 However, there is still a relatively strong perception associating people with experience of mental illness with violent crimes. Maori There are three significant improvements over 1997, compared with two in the general population. Maori generally have similar attitudes to the general population. Even more so than in the general population, Maori are more likely to perceive those without mental illness as being violent, compared to those with mental illnesses. Maori are more likely than the total sample to associate higher proportions of violent crimes with people with experience of mental illness. Pacific Peoples On all but one of the measures, Pacific respondents attitudes towards people with experience of mental illness are less positive than those of the general population. Pacific peoples are much more likely than others to believe that both people with mental illness and those without are sometimes or always a danger. Also, unlike Maori or the total sample, they see people with mental illness as being just as dangerous as those without. However, Pacific peoples do not differ from the wider community in their association of people with mental illness with violent crimes. IMPACTS: FOUR IN TEN REPORT MAKING POSITIVE CHANGES General Thirty-nine percent reported making at least one positive change to the way they feel or act towards people with mental illness. The most common changes are being more accepting/less judgmental (23%) and knowing more about the person s illness (14%). Maori Maori responses are generally similar to the total sample. Pacific Peoples Thirty-one percent of Pacific respondents report having made a change to their feelings or behaviour towards people with mental illness. While this is less than the 39 percent in the total sample, it is not significantly less. 11

12 GENERAL KNOWLEDGE OF MENTAL ILLNESS AND HEALTH SERVICES: IMPROVED PERCEPTIONS OF MENTAL HEALTH SERVICES General The proportion of people agreeing that there are not enough mental health services in New Zealand has decreased significantly since 1997, although there is still a majority who agree that there are not enough. There has also been an increased perception that the 'mental health authorities appear to make good decisions about people with mental illness'. However opinion is still quite divided on this issue, with almost as many disagreeing as agreeing. Forty-two percent agree that they are not sure where people can go to seek help or support for mental illness, while 87 percent agree that their GP would be able to help if they wanted advice on mental health services. Just over one half feel they are either somewhat or very informed about mental illness and issues relating to mental illness, which is an increase from The Like Minds ads, close experience with someone with mental illness and the news media are the main sources of information on mental illness. The news media, other media articles and friends all show decreases as mentioned sources. Most information sources are seen as being at least 'somewhat' accurate. There is high interest in a range of information types identified in the qualitative research.. More than nine out of ten respondents are either very or somewhat interested in how to support a friend or work mate, what to do if you have a mental illness, and things that might trigger an episode. Maori Maori hold similar attitudes to mental health services to the general population, and show similar improvements in attitudes. There is also increased agreement among Maori that their GP would be able to help if they wanted advice on mental health services (88%, up from 81%). Forty-five percent of Maori report being unsure where they can go for help or support for mental illness, a similar level to Just over half of Maori respondents, as with the total sample, feel very/somewhat informed about mental illness. The main sources of information about mental illness mentioned by Maori are similar to the total sample, with similar changes between surveys. Since 1997, there has been an increase in the accuracy that Maori ascribe to the main sources of information; thus the perceived levels are now similar to those for the general population. As with the total sample, Maori respondents show high interest in receiving all the other types of information listed. 12

13 SOCIAL ACCEPTANCE SEGMENTS The data from the total sample were divided into three segments based on their level of acceptance of people with mental illness. Significant differences between the groups include. The low acceptance group has no distinct demographic profile. In 1997 there had been more males in this group 7. Lower acceptance is linked to not knowing anyone with a mental illness and to feeling less well informed. While people with lower acceptance are less interested than the other groups in some types of information, they still show a strong interest in further information. In terms of age, the high acceptance group are more likely than the others to be aged 25 to 34 years. Maori are more likely to be in the medium acceptance group. The high acceptance group are more likely than the others to be female. There is a spread of household income levels across all three groups. In accord with their lower levels of acceptance, the low acceptance group are also less positive in their attitudes towards people with mental illness. 7 Comparisons with 1997 need to be made with some caution due to the different sizes of the three segments in the two surveys. 13

14 2. DISCUSSION AND CONCLUSIONS CHANGE SINCE 1997 REFLECTS LIKE MINDS CAMPAIGN CONTENT It was always accepted before this project was begun that the ability to make comparisons with the 1997 survey would be limited by the low response rate in the benchmark survey. The comparison of the sample demographics, while showing a reasonable match, does have some differences that could have impacted on the overall figures being used for comparison. The problems resulting from different screening questions for the section asking about each of the four mental illnesses also adds to the difficulties making comparisons. However, having said that, a lot of the findings are very consistent between 1997 and 2004, which provides confidence that those that are different may well be reflecting real change. The changes are also generally in accord with expectations, based on what both the Like Minds Tracking Surveys and the preceding qualitative research have been showing. The research has shown that the change is very much linked to the content of the Like Minds advertising campaign and that has not generalised to other attitudes towards people with mental illness. The key areas where change has been identified are: People with mental illness being seen as more capable, in all sorts of roles Increased social acceptance of people with experience of mental illness, in a range of situations Increased acceptance that people with mental illness should not be denied responsibility MAORI SHOW A LOT OF SIMILARITIES WITH GENERAL POPULATION As identified in the qualitative research, there is a lot of commonality between Maori attitudes and those of the wider community. While they sometimes do not show quite as many significant improvements as the total sample in the survey, this may be a product of the smaller Maori sub-sample sizes. PACIFIC PEOPLES APPEAR TO HOLD MORE NEGATIVE ATTITUDES BUT THIS MAY REFLECT A DIFFERENT STAGE IN THE CHANGE PROCESS In terms of social acceptance and the general attitudes towards those with mental illness, Pacific peoples often gave lower ratings than the general population. This may in part reflect Pacific peoples being at a different stage in the change process, having been at a different point when the Like Minds campaign began. For many Pacific peoples the concepts and labels associated with mental illness are quite new and they may be more at the point of still trying to understand what mental illness is and less at the stage of looking at their attitudes towards those who have mental illness. This is reflected in their higher incorrect association of intellectual disability with mental illness (one in two make this association). The qualitative research would suggest that the less people know about mental illness, the more 14

15 likely it is that they have misconceptions and less understanding about the stigma and discrimination experienced by people with mental illness. The other point to note in relation to the Pacific attitudes is that the Like Minds has, until the most recent campaign, had a very low Pacific presence in the advertisements. We know from the qualitative research undertaken when pre-testing Like Minds advertising concepts, plus other qualitative research with Pacific peoples, that they will seldom take notice of ads that do not feature Pacific people. PAKEHA HAVE MORE FOCUS ON CHEMICAL IMBALANCE Another qualitative finding confirmed by this study was that chemical imbalance, as a cause of mental illness, is more likely to be mentioned by Pakeha. CONFUSION WITH INTELLECTUAL DISABILITY CONFIRMED The study has confirmed a further qualitative finding that there is a lot of confusion between mental illness and intellectual disability. As noted above, this was particularly the case with Pacific peoples, but it was also quite common among Maori and the general population, where the rate was still four in every ten. SEVERITY OF MENTAL ILLNESSES One of the concerns associated with the Like Minds campaign has been whether, in the efforts to have people with mental illness accepted, it has led to people conceptualising 'friendly' versus 'unfriendly' mental illnesses. This survey has found a lot of commonality in the perceptions associated with the different mental illnesses. In fact one of the key findings has been that most people do understand that, for all illnesses asked about, the impact on the person experiencing it varies from small to large for different people. However, the Tracking research has shown that acceptance of people with experience of schizophrenia has been at lower levels than for mental illness in general. These measures have also been less responsive to the campaigns, although this appears to have improved in the third campaign. The current study has shown that in many ways people with schizophrenia are seen as at least as capable and are as socially accepted as those with other illnesses. However the items on which schizophrenia rates significantly lower are particularly telling, these being: Being capable of being responsible parents Being willing to have them care for your children Being willing to have them live with you in your house or flat These are the most intimate situations asked about and the ones where any fears are most likely to be present. The qualitative research showed that the fear of unpredictable and possibly violent behaviour was particularly present for the public when thinking about schizophrenia. Given these findings, it was perhaps surprising to find schizophrenia receiving a similar response to the other mental illnesses in terms of the extent to which people 15

16 think those with the illness are a serious danger to other people. It would seem that this question has not tapped the component of danger that is of concern to people. It may well be that the public accept that people with schizophrenia are dangerous no more often, but it is the nature of the danger that may well be the issue. DANGER FINDINGS SHOW COMPLEXITY OF THE ISSUE The research may assist in putting the danger issue in some perspective. With the media so often highlighting mental illness in association with violent crime, it is useful to note that the public actually see those without mental illness as more likely to be 'a serious danger to other people'. However a separate question relating to the 'percentage of violent crimes in New Zealand committed by people with experience of mental illness' shows that there are still a lot of people who make an inappropriately high association between the two. This is probably not surprising given the media coverage. These seemingly conflicting findings do show that understanding the violence/fear issue is not straightforward. The qualitative research has identified that, when it comes to issues of mental illness, people are not necessarily consistent in their responses, as they are in a process of attitudinal change. (This inconsistency would also be found in relation to attitude change for other issues, but the level of inconsistency would depend on how hidden and taboo the issue was.) SOCIAL PRESSURES ARE SEEN AS THE NUMBER ONE CAUSE The qualitative research identified that one of the reasons people are now more accepting of people with mental illness is because they can increasingly see that social factors such as stress are causes of mental illness. Such causes are emotionally accessible, with less fear attached to them. This survey has confirmed an increase in social factors, particularly stress, as perceived causes of mental illness. However, it has also shown that the social causes are now more clearly associated with depression and anxiety disorders and less with bi-polar disorder. IMPORTANCE OF CONTACT WITH PEOPLE WITH EXPERIENCE OF MENTAL ILLNESS REINFORCED One of the key recommendations from the literature review when this project began was the importance of the public having contact with people with experience of mental illness. This has again been confirmed in this study, with acceptance of people with experience of mental illness showing an upward trend with increasing intimacy of contact with such people. COMMON PERCEPTIONS OF RECOVERY There is a widespread perception that most people who experience mental illness generally can stay well most of the time and are occasionally unwell. This is consistent with the qualitative findings. 16

17 NEED TO KNOW WHERE TO GET HELP The qualitative research identified that people generally knew almost nothing about what was available, or where to go for help. The questions included in this survey were repeated from 1997, but unfortunately the two related attitude statements do lead to possibly biased responses. One statement says: 'I'm not sure where people can go to seek help or support for their mental illness' and the other: 'My GP would be able to help if I wanted advice on mental health services'. The order in which these were asked was randomised in each survey, but if the GP question is asked first it is likely to influence the response to the other. We therefore think the 42 percent who agree that they are unsure where to seek help may be an understatement. It may also be that people do not want to admit to not knowing something when answering the survey, but are more honest in their responses to the in-depth qualitative interviewing. Most people admitted in the qualitative interviews that they would go to their GP if talking with family and friends didn't help, however there was not a sense that GPs were clearly seen to be useful sources of information; it was more a case of them seeming to be a logical place to turn to. So, while the survey results show 87 percent agreeing that their GP would be able to help, one has to question how confident people are in the quality of help they will receive. CLEAR POINTERS TO TYPE OF INFORMATION SOUGHT The qualitative research identified several types of information that people appear to want more of and these were included as items in the survey. There was high interest in all of them. In particular people want to know how to interact with people with mental illness, especially in settings where they have close contact with that person. ROLE FOR PROMOTION OF MENTAL HEALTH The qualitative research concluded that the perception that mental illness often happens 'out of the blue' indicates a need for more understanding around mental health (as opposed to illness). The research noted that people often talk about pressure and strife that precedes mental illness among family or friends, without fully realising that these things were indicators of deteriorating well-being or mental health. People wanted more understanding about what good mental health is and how one can keep it, and this was confirmed in the survey with 94 percent reporting an interest in how to stay mentally healthy. This item has the highest 'very interested' rating of the six different types of information asked about. There also appeared to be quite low mention of mental health when asked what contributes to a person's good health. TARGETING BY LEVEL OF ACCEPTANCE Looking at the segments of the sample with differing levels of acceptance provides some useful insights in terms of targeting. Initially in a campaign one usually looks to the early adopters to pick up new ideas first. The campaign is certainly well beyond this stage and is at least looking to impact on those who usually follow early 17

18 adopters. The low level of acceptance segment identified in the analyses are clearly the last group one would seek to try and impact. However it is interesting that they do express high levels of interest in the different types of information, so it may be that appropriate information might make a difference with this group as well. CONCLUSIONS This study has reinforced the Tracking Survey findings that the Like Minds campaign is having a positive impact on changing attitudes. This research is part of a concurrent series of studies and the results of all of them, plus other factors, need to be considered in determining the implications for future directions for the Like Minds project. 18

19 3. INTRODUCTION BACKGROUND In 1997, when the Like Minds Like Mine project to counter stigma and discrimination associated with mental illness was just beginning, a benchmark national survey was undertaken by BRC to establish public knowledge of and attitudes to mental health and mental illness. Since then Phoenix Research have been undertaking national surveys to track changes in awareness and attitudes in association with the national media advertising. This has identified a general pattern of improving attitudes following each of the three media campaigns. Given the project has been running for seven years, the Ministry decided to undertake a repeat of the 1997 study to ascertain what had changed in the wider range of measures that this study included that were not in the tracking surveys. This update survey was preceded by a major qualitative study undertaken by Phoenix Research, which examined current public attitudes and perceptions and, where possible, changes over the seven year period. Issues identified in that study were included in the national update survey. To allow the new questions to be added, some of the 1997 questions were not included in the 2004 survey. This study is part of a programme of research that will inform future directions for the Like Minds project. It also includes qualitative research with employers and qualitative and quantitative research with people working in mental health services. OBJECTIVES 1. To provide an update on data obtained in the BRC benchmark national survey in To quantify issues emerging from qualitative research undertaken earlier in To identify an employer/manager/supervisor sub-sample, to allow comparison of 'employer' attitudes and behaviours with the general population (this is reported separately along with findings from qualitative employer research) 19

20 4. RESEARCH METHOD SAMPLE SELECTION As with the 1997 survey, all respondents were aged 15 to 44 years, which was the target group for the campaign. A general population sample was generated using randomly selected phone numbers, stratified by region. To obtain equal proportions of males and females in each region, some interviews contacted specifically for males. This general population sample consisted of 663 people, of whom 82 were Maori (where at least one ethnic group they identified with was Maori) and 15 Pacific peoples. The proportion of Maori was 12 percent (compared with 14 percent for this age group in the 2001 Census). The proportion of Pacific peoples was 2 percent (compared with 6 percent in the Census). A separate Maori sample was also generated using phone numbers matched to Maori names randomly selected from the electoral rolls. It was also stratified by region, with similar numbers of male and female interviews being undertaken in each region. This generated 170 interviews, which combined with the Maori in the general population sample, gave a final Maori sample of 252 (increased to 25 percent of sample). A separate Pacific peoples sample was based on randomly selected Pacific peoples names from phone directories in Auckland and Wellington/ Hutt (these two regions account for 83 percent of the Pacific Peoples population in New Zealand). A total of 175 Pacific peoples interviews were undertaken using this method, which gave a final Pacific sample of 190 when combined with the 15 from the general population sample (increased to 19 percent of sample). The three surveys had a combined sample size of 1,008. METHOD OF DATA COLLECTION The surveys were undertaken using a CATI system (computer assisted telephone interviewing) by trained PHOENIX interviewers. The interviews were of 20 minutes average duration and were undertaken between August 25 and October 24, All the interviewing in the separate Maori sample was undertaken by Maori interviewers. All had some knowledge of Te Reo, although the questions were only asked in English. The additional Pacific peoples interviews were undertaken by Pacific peoples interviewers. In the general sample everyone was told that if they were a Maori or Pacific person they could be interviewed by a Maori or Pacific interviewer if they wished. 20

21 RESPONSE RATE Considerable efforts were made to maximise the response rate. This included making at least 15 calls to each number and sometimes more than this if necessary to make contact with a household or qualifying respondent. In keeping with Ministry of Health procedures, a weighted response rate is reported, which takes into account that some of the refusals would have been non-qualifying households. The weighted response rate in the general survey was 80 percent, in the Maori survey it was 87 percent and in the Pacific peoples survey it was 80 percent, averaging 81 percent overall. QUALITY CONTROL The advantage of the CATI system is that any call can be monitored at any time, as they are all undertaken from one centralised contact centre. Phoenix Research also operate a 'call catcher' which records all calls and allows them to be listened back to at a later date if required. The Phoenix contact centre is IQS accredited, which is the industry quality standard. DATA ANALYSIS The total sample data were weighted to reflect the proportions in the total population by age, sex and ethnicity. The weighting was based on Statistics New Zealand's 2001 Census data. The separate Maori analyses and reporting were based on the 252 Maori respondents and their data were weighted by age and sex. Likewise the separate Pacific analyses were based on the 190 Pacific respondents and their data were weighted by age and sex. Database Raw Data % Weighted Total Sample Data % Maori Pacific Peoples Other Total 1, , Numbers do not add to 100% due to rounding to the nearest whole number. 21

22 DIFFERENCES BETWEEN THE 1997 AND 2004 RESEARCH METHODS The biggest difference was the response rates, where we have calculated the weighted response rate to be 19 percent. This compares with 81 percent in the current survey. The low response rate in the 1997 BRC survey raises questions about how adequately the findings represented the target population at the time. The 1997 study added one to the randomly selected phone numbers to allow unlisted numbers to be included. This meant that a lot of businesses and 'no such number' lines got called. This method was not repeated in 2004, in part because of the cost it adds, but also because people with unlisted numbers often get upset if they are contacted for surveys, and some ethics committees consider they should not be contacted. The 1997 survey did not use a CATI system, so the responses were recorded on questionnaires and then data entered. This form of data collection and entry does allow for errors to occur with interviewers not following correct instructions or data entry errors, although there were high levels of checking of data in the 1997 survey. Some of the Maori interviews in 1997 were not undertaken by Maori interviewers. The 2004 study over-sampled Pacific peoples to get a larger data base for their analyses. However, the general population analyses are comparable between the two surveys as both were weighted to reflect the correct ethnic proportions in the population aged 14 to 55 at the census nearest the survey. The 1997 survey did not weight for age and therefore there are age biases in the sample. COMPARISON OF 2004 AND 1997 SAMPLE COMPOSITION The low response rate in 1997 raised concerns about how representative the respondents were. We have therefore provided a comparison of the sample composition for the two surveys, using weighted data. Both surveys were weighted by gender and ethnicity, but the 2004 survey was also weighted by age. The key differences between the two samples are: The 1997 survey had fewer people aged 15 to 24 years and more aged 35 to 44 years The 1997 survey had more people with children aged up to 12 years, which is likely to be a product of the response rate, as these are the types of people who are more likely to be home when interviewers ring. Likewise, the 1997 survey had fewer full time wage and salary earners The 2004 Maori sample has more people who are supervisors or managers, but at least some of this difference may reflect a real change over the seven year period. 22

23 Gender Total General Maori Pacific Total General Maori (1,008) (566) (252) (190) (1733) (1260) (473) % % % % % % % Male Female Total Note: Components may not add to 100% due to rounding Age Total General Maori Pacific Total General Maori (1,008) (566) (252) (190) (1733) (1260) (473) % % % % % % % 15 to 19 years to 24 years to 34 years to 44 years Total Note: Components may not add to 100% due to rounding 23

24 Ethnicity Total General Maori Pacific Total General Maori (1,008) (566) (252) (190) (1733) (1260) (473) % % % % % % % New Zealand European Maori Samoan Cook Island Maori Tongan Niuean Other Pacific Chinese Indian New Zealander/Kiwi Other Asian Refused Other European Other Total ** ** ** ** ** ** ** Note: **Total may exceed 100% due to multiple responses Children in household Total General Maori Pacific Total General Maori (1,008) (566) (252) (190) (1733) (1260) (473) % % % % % % % A child under 5 years A child aged 5 to 12 years A child aged 13 to 18 years None of these Total Note: Components may not add to 100% due to rounding 24

25 Employment status Total General Maori Pacific Total General Maori (1,008) (566) (252) (190) (1733) (1260) (473) % % % % % % % Self-employed Full time salary or wage earner Part time salary or wage earner Full time home-maker Student Unemployed Other beneficiary Total Note: Components may not add to 100% due to rounding Household income Total General Maori Pacific Total General Maori (1,008) (566) (252) (190) (1733) (1260) (473) % % % % % % % Up to $10, Up to $20, Up to $45, Up to $60, Up to $80, Up to $100, More than $100, Don't know Refused Total Note: Components may not add to 100% due to rounding 25

26 Regional location Total General Maori Pacific Total General Maori (1,008) (566) (252) (190) (1733) (1260) (473) % % % % % % % Northland Auckland Counties/Manukau Waikato Bay of Plenty East Coast/Gisborne Hawkes Bay Taranaki Manawatu/Wanganui/ Wairarapa Wellington/Hutt Valley Nelson/Malborough/ Tasman West Coast Canterbury Otago Southland Don't know Total Note: Components may not add to 100% due to rounding 26

27 Employer or manager Total General Maori Pacific Total General Maori (683)* (403)* (172)* (108)* (1102)* (828)* (274)* % % % % % % % Employer Supervisor or manager Neither Don't know Total Note: Components may not add to 100% due to rounding * Sub sample of those working REPORTING The results of the 2004 survey have been reported on in three sections. Firstly total sample results are presented along side the total sample results from the 1997 survey. Significance testing, where appropriate, has been carried out to determine where shifts in attitude have occurred. The second section features 2004 Maori results. Significance testing has again been carried out, this time between the 2004 and 1997 Maori samples to determine where changes for Maori have occurred. Testing has also been done comparing 2004 Maori and 2004 total sample results to determine where Maori differ from the wider community 9. The third and final section contains 2004 Pacific peoples results. As the equivalent results were not reported on in 1997 because of the small numbers of Pacific peoples interviewed, no comparisons can be made. Significant differences between Pacific peoples and the total sample are indicated in the text and tables. NOTES REGARDING COMPARISON OF 2004 AND 1997 DATA The 1997 survey asked a set of questions relating only to one of four illnesses, anxiety disorders, bi-polar disorder/manic depression, depression and schizophrenia. Respondents were randomly assigned one of the illnesses, provided they had demonstrated previous awareness of it. If they were then able to describe characteristics of it to a satisfactorily level they were asked the set of questions. The 2004 Survey did not require respondents to describe the illness they had already indicated awareness of. 9 The total sample data is sometimes referred to as the 'wider community' in the reporting. 27

28 The 1997 results, as reported by BRC at the time, included in their base respondents who could not adequately describe the illness, even though they were not asked the questions. The percentages for each mental illness were: 9 percent for anxiety disorder, 13 percent for bi-polar, 3 percent for depression and 8 percent for schizophrenia. Therefore where a question within this set has structured responses, the 1997 results have been reproduced without this group of respondents, so that it is more directly comparable with the 2004 results. Where a question was open-ended this group of respondents has been combined with 'don't know' in the 1997 results. This is because there were high levels of don't knows on the 2004 survey for these open-ended questions, reflecting that there were a group who knew little about the illness they were answering for, many of whom would have been in the group who did not answer the question in By including those in the 1997 results who did not know anything about the illness the data become more directly comparable. These differences in question design mean that for the sections of the report based on the specific mental illnesses, the comparisons between 1997 and 2004 need to be made with some caution. However, there is a high degree of consistency between the two sets of data, as reported, so there are reasonable grounds for believing that larger significant changes are reflecting real change. Note: For the sections of the report that refer to questions asked with a specific illness in mind, mention of bi-polar disorder in the text and tables includes manic depression. SIGNIFICANCE TESTING The following terminology is used throughout this report: Terminology Significantly different Slightly different Higher or lower to the 95% confidence level unless otherwise specified Higher or lower though not significant to the 95% confidence level 28