The Care System The mental health services available. to New York City residents include. the New York City Community Mental

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1 Findings from a survey of the public image of mental health services and personnel in New York City are presented. There is a generalized acceptance of the need for various community mental health services, particularly for those that provide immediate help. Although there is optimism about the treatment of mental illness, attitudes of rejection are not completely dispelled. Mental health professionals are not too well known to the public, and there is little public knowledge about specific services and available facilities. THE PUBLIC IMAGE OF MENTAL HEALTH PROFESSIONALS AND ACCEPTANCE OF COMMUNITY MENTAL HEALTH SERVICES Elena Padilla, Ph.D., F.A.P.HA.; Jack Elinson, Ph.D., F.A.P.H.A.; and Marvin E. Perkins, M.D., M.P.H., F.A.P.H.A. THE NEW YORK CITY Community TMental Health Board, as the agency responsible for the city's community mental health program, invited the Columbia University School of Public Health and Administrative Medicine to jointly conduct a sociological survey of the public image of mental health services among residents of the city. This was an effort to gauge how the public views the currently available system of mental health care and the expansion and innovation needed for its improvement. The relevance of the survey was heightened by the Federal Mental Health Program of grants to the states and its emphasis on local community planning and community care of the mentally ill and the retarded. This paper focuses on findings from this survey pertaining to the public images of mental health facilities and the professionals and on the public alertness to need for community mental health services in the context of attitudes toward mental illness and the mentally ill. The Care System The mental health services available to New York City residents include numerous public and private facilities, a large majority of which participate in the New York City Community Mental Health Board program. New York City is served by more than 150 offices of licensed psychiatric clinics, by 16 general hospitals with psychiatric units, ten night and day care programs, five private mental hospitals, 13 aftercare and rehabilitation services, nine state mental hospitals, and five state schools for the retarded. There is a large population of consumers of mental health services. In 1963, more than 300,000 New York City residents were either on the rolls of private and public mental health 1524 VOL. 56. NO. 9. A.J.P.H.

2 PUBLIC IMAGE OF MENTAL HEALTH SERVICES facilities or under private care of mental health professionals. The Survey The survey which was conducted in 1963 was based on household interviews. A multistage probability area sample was designed to yield 3,000 adults 20 years old and over, representative of the five million civilian, noninstitutionalized adults living in the city. The findings presented here are based on an over-all total of 2,118 interviews. Due to the scope of the study, three overlapping questionnaires, each one addressed to one-third of the sample, were administered. The survey was financed by the Health Research Council,* which is also an agency of the city government. Findings Awareness and Experience of New Yorkers with Mental Illness Mental illness and mental health professional care appear to be familiar experiences to many New York City adults. Over half claim to have personally known someone who has had help for a mental or emotional problem. Almost as many admit to having had personal problems themselves for which they could have used help. One out of 11 reports having gone for professional help for a mental or emotional condition. Half of the persons reported as known to have had professional help for these conditions are family members or relatives. Over a third of adults claim to know someone who was hospitalized for a mental or emotional problem. In fact, the majority of persons reported as known to have had professional help were hospitalized for their mental or emotional conditions. Two per cent of all adults admit to having been hospitalized themselves. One in six adults claims to know someone who goes to a psychotherapist * Contract U regularly; and 1/2 per cent of all adults admit that they themselves are now under mental health care. People report being asked advice about personal problems of mental illness and troubles by their friends, by their immediate family and relatives, and by co-workers. Two out of five adults report that they are often or sometimes asked advice in this area. Yet, when they have long-standing personal problems which do not get any better, more New York City adults spontaneously respond that they would try to help themselves rather than go somewhere for help. When they mention what professionals they would see for these problems, physicians, clergymen, and psychiatrists are mentioned most frequently. Counselors of various kinds are also mentioned, but less often than are friends or spouses. Going to facilities rather than to persons for professional help is seldom mentioned; and also seldom mentioned are referral sources or other intermediaries. Opinions About Mental Illness and the Public Image of the Mentally Ill Mental illness is viewed as a serious problem. A majority share the view that "mental illness is now the most serious health problem in the country"; and nearly nine out of ten agree that "most people feel very helpless about mental illness"; or as many as hold an opinion about helplessness regarding cancer. Notwithstanding this view, the view is also quite prevalent that "mental illness is like any other illness," and optimism prevails as to its treatability. These views coexist with such conflicting notions as that "unlike physical illness, mental illness tends to repel other people," although a large majority, however, deny being repelled themselves by mental illness. Rejection of the mentally ill is not completely dispelled; and there are qualified reservations toward how closely one SEPTEMBER,

3 should associate with those known to have been in a mental hospital. At one extreme, seven out of ten say that they would be willing to have an ex-mental hospital patient as co-worker or neighbor; but less than one in four say that they would be willing to share an apartment with an ex-mental hospital patient, or to agree if someone in their family wanted to marry such a person. Many, however, qualify their opinion as to the kind of social relationships they are willing to have with ex-mental hospital patients by noting that it would depend on the kind of mental illness the person had. Popular Image of Mental Health Professionals In the public view mental health services are multiprofessional. Yet, there is considerable ignorance and confusion as to the identity, qualifications, and roles played by the various mental health professions. For example, nearly half of the public cannot distinguish between psychiatrists and psychologists; and as many say they do not know, or deny, that anyone but a psychiatrist can treat a person for emotional or mental conditions. Three out of four say that a psychiatrist "does a better job in dealing with mental troubles" than a psychologist or a social worker. Two out of three say that a psychiatrist rather than a social worker or psychologist "does a better job in dealing with emotional troubles." With "family troubles," however, a majority feel that a social worker does a better job than a psychiatrist or a psychologist. In comparison with other medical specialists, the public acknowledges the expertise of psychiatrists about mental and emotional conditions and appreciates the difficulty of their job. Three out of four consider psychiatrists to be more knowledgeable about mental and emotional conditions than other medical specialists. Nine out of ten say that I S26 psychiatrists are as interested as other specialists in the welfare of their patients; and as many believe that psychiatrists are as successful in helping their patients. Somewhat less, four out of five, consider the mental health of psychiatrists to be at least as good as that of most medical specialists. More than half deem the job of the psychiatrist to be more difficult. The income of psychiatrists is believed to be higher than that of other specialists by two out of five, believed equal by another two out of five, and less by one out of ten. The public rarely counts mental health professionals among their relatives, friends, and other social acquaintances. As professionals, the public does not accord as high a general standing to them as to comparable occupations. In contrast to such health personnel as physicians, dentists, and nurses, mental health professionals are little known to the general public as social acquaintances. Two out of three count nonpsychiatric physicians among their friends or relatives, compared to one in five who knows psychiatrists socially. Of the mental health professions, more people know psychiatrists and psychologists than know psychiatric social workers or psychiatric nurses. To the public, mental health professionals are quite anonymous. Nearly nine out of ten New York City adults cannot produce the name of a psychiatrist; even more cannot name a psychologist or a psychotherapist. When considering the general standing of various occupations, the public rates psychiatrists lower than their medical colleagues, but higher than psychologists, nurses, or social workers. Physicians are rated as high as judges, but not as high as scientists who are rated highest. Psychiatrists are rated about the same as lawyers and dentists. Psychologists are rated higher than hospital nurses, who in turn are rated about the same as public school teachers and pharmacists. Social workers VOL. 56, NO. 9. A.J.P.H.

4 PUBLIC IMAGE OF MENTAL HEALTH SERVICES are rated lowest among all the professionals considered. Popular Images and Knowledge of Mental Health Facilities and Services One out of four views state mental hospitals as being like prisons, but conditions in mental hospitals are regarded as improving by a substantial majority. The public image of the quality of care now rendered in mental hospitals is lower, but not much different from the public image of the quality of care rendered in general hospitals. Paradoxically with this view, however, but perhaps consistent with attitudes toward the mentally ill, four out of five agree with the notion that "Even if patients do not get better there, state mental hospitals are needed because they do a job of protecting the community." The public is rather unaware of some of the leading mental health facilities and services that are available in the city. Knowledge and orientation as to where a person may go for mental health problems vary somewhat with the kind of problem; but there is also a generalized expectation of a wide variety of services being available through certain municipal hospitals and agencies, notably the Bellevue and Kings County Hospitals, both of which, in addition to operating a variety of mental health services, function as the largest receiving hospitals for state hospital patients in the city. Three out of four cannot correctly produce the name of any mental health clinic in New York City. Of those named, Bellevue and Kings County Hospitals are most frequently mentioned. Two out of five can not correctly name any general hospital that has beds for mental patients; again, Bellevue and Kings County are the hospitals most frequently named. A somewhat larger proportion of people, three out of five, cannot name any state hospital that takes patients from the city. Creedmoor, Rockland, and Pilgrim State Hospitals are most frequently mentioned, followed by the Bellevue and Kings County city hospitals. With regard to where to go for specific problems, the public appears to know most about places for the treatment of alcoholism. Seven out of ten are able to give a correct response. Most frequently mentioned are Alcoholics Anonymous, followed by Bellevue and Kings County. Least well known of all appear to be places where old people with mental or emotional problems may go for help. Two in five are able to name correctly places where such help may be obtained. Bellevue, Kings County, and the Welfare Department are mentioned more often than any other places. Three in five can name correctly places where help may be obtained for a family or marriage problem. Most frequently mentioned are the Family Court, the Domestic Relations Court, and Catholic Charities. Three out of five can mention appropriate places where one may go for help for children with mental or emotional problems; Bellevue, Kings County, and Jacobi Hospitals are most frequently mentioned. Over half know where to go for treatment of narcotic addiction. Bellevue and Kings County are mentioned most frequently as providing this service. Over half know where to go for psychotherapy or psychoanalysis, and again Bellevue and Kings County are mentioned most frequently. The name of Bellevue Hospital is almost universally known to New York City adults and four out of five who have heard about Bellevue also know that this hospital deals with mental or emotional problems. Approval of and Recognition of Need for Community Based Mental Health Services alert A large segment of the public is to the need for a wide variety of com- SEPTEMBER S27

5 munity mental health services and generally approves that such services be established in New York City. Fourteen concepts of elements of community-based services for modem mental health care were described to respondents who were asked whether there should be such a service in New York City, whether they knew anyone who could have used such a service, and which of these services was the most needed in the city. Respondents were also asked how the service deemed most needed should be mainly paid for. Except for foster home care, a majority of the public believe that New York City should have all the service elements described for community mental health programs. Greatest recognition of need and of acceptance is given to those services that appear to be threat-reducing or to give quick help with problems of mental illness needing immediate attention than to apparently threat-inducing mental health services which bring mental patients into close contact and participation with community members. Thus, nine out of ten believe that there should be a telephone information service available at any time of day or night for the caller to inquire about where help may be obtained for himself or someone else. More New Yorkers say that they know persons who could have used such a telephone information service than any other service described. One in three regard the telephone information service as the one most needed in the city. Other services highly approved by the public are: walk-in or trouble-shooting clinics, emergency psychiatric services, psychiatric services in a general hospital, and neighborhood aftercare and rehabilitation services. Less approved are foster care in families, open mental hospitals, night hospitals, work-study projects, day hospitals, and ex-patient clubs. Suicide prevention centers, halfway houses, and psychiatric care in the home have intermediate public approval. Fewer people approved of foster care than any other service and very few say that they know anyone who could have used such a service. Even fewer feel that foster care is the most needed service in New York City. Three in five of those who named any service as most needed believe that such a service should be mainly paid for by taxes. Summary New York City has a large complex of facilities and a relatively large population of consumers of mental health services. A majority of the public are familiar with persons who have received professional care for mental illness. In the public view, there is optimism about the treatability of mental illness; yet attitudes of rejection of the mentally ill are not completely dispelled. The public prefers not to have close social relationships with ex-mental hospital patients. A major function of mental hospitals is believed to be the protection of the community. Mental health care is viewed as multiprofessional although professional identities and roles are confused. In dealing with problems of mental and emotional conditions, psychiatrists are deemed more effective than psychologists or social workers, but in dealing with family problems, social workers are deemed more competent than psychologists or psychiatrists. In comparison to other health professionals, mental health professionals are not well known to the public and their general standing is rated lower than those of comparable occupations. There is little public knowledge about specific services and available facilities. There is a generalized acceptance and recognition of need for a variety of community mental health services. In the context of such acceptance, the 1528 VOL. 56. NO. 9, A.J.P.H.

6 PUBLIC IMAGE OF MENTAL HEALTH SERVICES greatest public preference is for those those which place mental patients in a services which appear to provide imme- foster home. These preferences appear diate help. There is less preference for to be consistent with the prevailing services which bring mental patients public images of the mentally ill and back into the community, and least for of the mental health professions. Dr. Padilla is chief research scientist (behavioral sciences), New York City Community Mental Health Board; Dr. Elinson is professor of administrative medicine, Columbia University School of Public Health and Administrative Medicine; and Dr. Perkins is commissioner of mental health services, City of New York (93 Worth St.), New York, N. Y This paper was presented before the Mental Health Section of the American Public Health Association at the Ninety-Third Annual Meeting in Chicago, Ill., October 21, New Publication The second edition of "Recommended Methods for the Microbiological Examination of Foods" is now available. This volume presents a well-rounded approach to the microbiology of the major classes of foodstuffs. The methods given are applicable in the well-equipped laboratory but do not require sophisticated procedures or equipment. The book will give the microbiologist a grasp of the entire field without getting into the marginal or exploratory methods which may not survive the intense scrutiny under way in specialized laboratories. Methods and references have been expanded and updated for each chapter to allow investigator and student alike an insight beyond the immediate pages. Ample correlation is made with the methodology given in the several companion publications of APHA, and the several professional and regulatory groups so active in this field have been recognized. The book was prepared by the Subcommittee on Laboratory Methods for the Microbiological Examination of Foods of the Committee on Evaluation and Standards, under the chairmanship of John M. Sharf, Ph.D. Available now from APHA Book Service, 1790 Broadway, New York, N. Y. Price, $6. SEPTEMBER

7 This article has been cited by: 1. G F Jacobson Emergency services in community mental health: problems and promise. American Journal of Public Health 64:2, [Citation] [PDF] [PDF Plus]