National Survey of Mental Health Literacy and Stigma

i

National Survey of Mental Health Literacy and Stigma

Nicola J Reavley Anthony F Jorm

University of Melbourne

December 2011

ii Paper-based version

©Commonwealth of Australia 2011

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Internet version

©Commonwealth of Australia 2011

This work is copyright. You may download, display, print and reproduce this material in unaltered form only (retaining this notice) for your personal, non-commercial use or use within your organisation. Apart from any use as permitted under the Copyright Act 1968, all other rights are reserved. Requests and inquiries concerning reproduction and rights should be addressed to Commonwealth Copyright Administration, Attorney-General's Department, Robert Garran Offices, National Circuit, Barton ACT 2600 or posted at http://www.ag.gov.au/cca

Suggested reference

Reavley, N.J., Jorm, A.F. (2011) National Survey of Mental Health Literacy and Stigma. Department of Health and Ageing, Canberra.

Funding source

The survey was funded by the Commonwealth Department of Health and Ageing Acknowledgements

The authors would like to thank Alicia Holborn, Fiona Blee, Marie Yap and Stefan Cvetkovski for their

assistance in the preparation of this monograph. The work was undertaken while the authors were

at Orygen Youth Health Research Centre.

1

Contents

Executive summary ... 5

Background ... 5

Methods ... 5

Results ... 6

Recognition of disorders and help-seeking beliefs and intentions ... 6

First aid intentions and beliefs ... 6

Beliefs about outcomes, causes and prevention ... 6

Stigmatising attitudes ... 7

Exposure to mental disorders ... 7

Exposure to mental health-related organisations and media items about mental health ... 7

Change over time ... 8

Conclusions ... 8

1. Introduction ... 9

1.1. Previous surveys of mental health literacy in the Australian population ... 9

1.1.1. The 1995 National Survey of Mental Health Literacy ... 9

1.1.2. The 2003-2004 Australia-Japan Partnership Mental Health Literacy Survey ... 10

1.1.3. The 2006 National Survey of Youth Mental Health Literacy ... 11

1.1.4. The Fourth National Mental Health Plan ... 12

1.2. Aims of the 2011 survey ... 13

2. General community survey ... 14

2.1. Mental health literacy in adults ... 14

2.1.1. Recognition of disorders ... 14

2.1.2. Beliefs about treatments ... 14

2.1.3. Beliefs about causes and risk factors ... 14

2.1.4. Beliefs about first aid ... 14

2.1.5. Stigmatising attitudes ... 14

2.1.6. Improving mental health literacy in the Australian public ... 15

2.2. Methods ... 16

2.2.1. Survey interview ... 16

2.2.2. Content analysis of responses to open-ended questions ... 18

2.2.3. Comparison with earlier surveys ... 18

2

2.2.4. Statistical analysis ... 19

2.3. Results of the 2011 survey ... 20

2.3.1. Sociodemographic characteristics of population... 20

2.3.2. Recognition of disorders ... 22

2.3.3. Best method of help ... 25

2.3.4. Beliefs about specific interventions ... 27

2.3.5. First-aid intentions and beliefs ... 30

2.3.6. Beliefs about likely outcomes for those with mental disorders ... 33

2.3.7. Beliefs about the causes of mental illness ... 37

2.3.8. Stigmatising attitudes ... 38

2.3.9. Exposure to mental disorders ... 42

2.3.10. Health of respondents ... 44

2.3.11. Psychological distress ... 44

2.3.12. Treatment for mental health problems ... 45

2.3.13. Exposure to organisations related to mental health ... 48

2.4. Comparison with previous surveys ... 49

2.4.1. Recognition of disorders ... 49

2.4.2. Best method of help ... 51

2.4.3. Beliefs about specific interventions ... 53

2.4.4. Beliefs about likely outcomes for those with mental disorders ... 61

2.4.5. Beliefs about the causes of mental illness ... 63

2.4.6. Stigmatising attitudes ... 65

3. Youth survey ... 70

3.5. Mental health literacy in young people ... 70

3.5.1. Recognition of disorders ... 70

3.5.2. Beliefs about treatments ... 70

3.5.3. Beliefs about first aid ... 70

3.5.4. Beliefs about prevention ... 70

3.5.5. Stigmatising attitudes ... 71

3.5.6. Improving mental health literacy in young people ... 71

3.6. Methods ... 72

3.6.1. Survey interview ... 72

3.6.2. Content analysis of responses to open-ended questions ... 74

3.6.3. Comparison with the 2006 survey ... 74

3

3.6.4. Statistical analysis ... 75

3.7. Results of the 2011 survey ... 76

3.7.1. Socio-demographic characteristics of population ... 76

3.7.2. Recognition of disorders ... 78

3.7.3. Help-seeking intentions ... 81

3.7.4. Beliefs about specific interventions ... 87

3.7.5. First aid intentions and beliefs ... 90

3.7.6. Beliefs about prevention of mental disorders ... 95

3.7.7. Stigmatising attitudes and social distance ... 96

3.7.8. Exposure to mental disorders ... 99

3.7.9. Psychological distress ... 101

3.7.10. Exposure to media items and organisations related to mental health ... 101

3.8. Comparison with 2006 survey ... 103

3.8.1. Recognition of disorders ... 103

3.8.2. Help-seeking intentions ... 103

3.8.3. Beliefs about specific interventions ... 108

3.8.4. First aid intentions and beliefs ... 113

3.8.5. Beliefs about prevention ... 114

3.8.6. Stigmatising attitudes ... 115

3.8.7. Exposure to mental disorders ... 118

3.8.8. Psychological distress ... 119

3.8.9. Impact of campaigns and media exposure ... 119

4. Discussion ... 121

4.1. Recognition of disorders ... 121

4.2. Help seeking intentions and beliefs about treatment ... 122

4.2.1. General community survey ... 122

4.2.2. Youth survey ... 122

4.2.3. Change over time ... 123

4.3. Beliefs and intentions about first aid ... 124

4.4. Beliefs about outcomes ... 124

4.5. Beliefs about causes and risk factors ... 124

4.6. Beliefs about prevention ... 124

4.7. Stigmatising attitudes ... 125

4.7.1. Change over time ... 126

4

5. Conclusions ... 126

References ... 128

Appendix A ... 135

Appendix B ... 137

Appendix C ... 151

Appendix D ... 154

Appendix E ... 168

Appendix F ... 172

5

Executive summary

Background

• One in five Australians suffers from a mental or substance use disorder in any 12-month period. This prevalence rate rises to one in four young Australians between the ages of 16 and 24. However, the majority fail to seek professional help.

• A number of factors affect help seeking, including mental health literacy, which has been defined as knowledge and beliefs about mental disorders which aid their recognition, management or prevention.

• Previous surveys of mental health literacy in Australia in 1995, 2003-4 and 2006 covered depression and schizophrenia. These surveys found poor recognition of disorders and negative beliefs about some standard psychiatric treatments including medications. In contrast, there were positive views about self-help strategies, help from family and friends and psychological treatments such as counselling.

• The past few years have seen increased efforts to improve the mental health literacy of the Australian public, as outlined by the items in the Fourth National Mental Health Plan covering: a comprehensive national stigma reduction strategy; work with schools, workplaces and communities to deliver programs to improve mental health literacy and enhance resilience; and further development of national mental health data collections.

• The aim of the current project was to carry out a national survey in order to assess whether there have been changes in recognition, treatment beliefs, stigmatising attitudes and other aspects of mental health literacy.

• Previous surveys have focused on depression and schizophrenia. The inclusion of vignettes for social phobia and post-traumatic stress disorder (PTSD) in the general community survey, and PTSD and depression with suicidal thoughts in the youth survey allowed for the

introduction of baseline assessments of mental health literacy and stigma for these disorders.

Methods

• The survey had two components: a general community survey covering those aged 15+ and a youth survey involving those age 15 to 25 years.

• The general community survey involved computer-assisted telephone interviews with a national sample of 6019 respondents and the youth survey involved similar interviews with 3025 young people. The surveys were carried out between January and May 2011.

• The interviews were based on a vignette of a person with a mental disorder. On a random basis, respondents in the general community survey were read one of six vignettes:

depression, depression with suicidal thoughts, early schizophrenia, chronic schizophrenia, social phobia and PTSD. For the youth survey, the vignettes were: depression, depression with suicidal thoughts, depression with substance abuse, psychosis/schizophrenia, social phobia and PTSD.

• After being presented with the vignette, respondents were asked a series of questions to

assess their recognition of the disorder in the vignette, help-seeking intentions, beliefs about

interventions, beliefs and intentions about first aid, beliefs about causes and risk factors,

beliefs about outcomes, beliefs about prevention, stigmatizing attitudes, exposure to mental

disorders, psychological distress, awareness of mental health-related organisations, media

exposure and sociodemographic characteristics.

6

Results

Recognition of disorders and help-seeking beliefs and intentions

• For both surveys, around 75% of those given the depression vignette were able to correctly label the disorder. Approximately one third of those given the schizophrenia and PTSD vignettes were able to do so. In the general community survey, only 9% of those given the social phobia vignette gave the correct label while, in the youth survey, only 3% did so.

General community survey

• In the general community survey, GPs were generally considered the best source of help for depression and schizophrenia, while counselling was generally considered the most helpful for anxiety disorders.

• Antidepressants for depression (along with antipsychotics for schizophrenia) were generally considered the most helpful medications, while lifestyle interventions such as physical activity, reading about the problem, getting out more and learning relaxation also received very high ratings of helpfulness.

Youth survey

• In the youth survey, the great majority of respondents reported that they would seek help, with symptoms of depression with suicidal thoughts and PTSD most likely to lead to help seeking.

• Intentions to seek help from informal sources were most common.

• Being too embarrassed or shy was the most highly endorsed barrier to young people’s help seeking.

• For all vignettes, close friends received the highest ratings of helpfulness in terms of people who might help, closely followed by GPs and counsellors.

• For depression, depression with substance abuse and social phobia, vitamins were rated as the most helpful, while antidepressants were rated as the most helpful for the other vignettes.

• For all vignettes, the most highly-rated lifestyle interventions were physical activity, support groups, relaxation training, and cutting down on alcohol, cigarettes and marijuana.

First aid intentions and beliefs

• For the general community survey, for all vignettes, listening and talking with the person was the most commonly nominated response. For all vignettes other than social phobia, encouraging the person to see a doctor was the next commonly nominated response. For the social phobia vignette, encouraging socialising and spending time with the person were more common than encouraging the person to see a doctor.

• For the youth survey, the most helpful first-aid intentions were considered to be listening to the person’s problems in an understanding way, rallying friends to cheer the person up, suggesting that the person seek professional help and encouraging physical activity.

Beliefs about outcomes, causes and prevention

• In the general community survey, in cases where the person received appropriate

professional help, the majority of respondents considered that full recovery with problems reoccurring would be the most likely outcome for all vignettes, other than the chronic schizophrenia vignette, for which partial recovery with problems reoccurring was considered to be the most likely outcome.

• In the general community survey, across each vignette, beliefs in social factors, such as day-

to-day problems, death of someone close, traumatic event, and problems from childhood as

likely causes were common. In addition, having a chemical imbalance was commonly rated

as a likely cause.

7

• For the youth survey, keeping in regular contact with friends and family and making regular time for relaxing activities were considered the best strategies to prevent mental disorders.

Stigmatising attitudes

• In the general community survey, perceptions of discrimination, social distance,

dangerousness and unpredictability were generally highest for chronic schizophrenia, while beliefs in the problem as a sign of personal weakness or ‘not a real medical illness’ were generally higher for social phobia than for other disorders.

• In the general community survey, for both personal and perceived stigma, across all vignettes, the statements with which respondents were most likely to agree or strongly agree involved a perception of others people’s belief in unpredictability, the belief that most other people would not tell anyone and the belief that most other people would not employ someone with the problem.

• In the youth survey, for both personal and perceived stigma, across all vignettes, a perception of other people’s belief in unpredictability was the statement with which

respondents were most likely to agree. They were least likely to agree that they would avoid someone with the problem.

• In the youth survey, perceptions of dangerousness and unpredictability and a desire for social distance were generally higher for psychosis/schizophrenia than for other disorders.

Exposure to mental disorders

• In the general community survey, having a close family member or friend who had

experienced a similar problem was most likely for the depression vignettes and least likely for the chronic schizophrenia vignette. Around 75% of respondents reported providing help to the friend or family member with the mental health problem.

• In the youth survey, having a close family member or friend who had experienced a similar problem was most likely for the depression vignettes and least likely for the PTSD vignette.

• In both surveys, family or friends who had experienced a problem like the social phobia vignette received the least professional help.

• In the general community survey, around one third of people had experienced a problem similar to that described in the depression vignettes.

• In the youth survey, approximately 25% of respondents had experienced a problem similar to that described in the depression vignettes.

• In both surveys, respondents were most likely to have received help for schizophrenia or psychosis and least likely to have done so for social phobia.

Exposure to mental health-related organisations and media items about mental health

• When asked if they had heard of any organisations related to mental health, 66.6% of respondents in the general community survey said that they had, with beyondblue being the most commonly nominated. When asked specifically, 77.7% of respondents said they had heard of beyondblue.

• In the youth survey, 34.2% of respondents nominated beyondblue when asked about mental health-related organisations, and 70.8% said they had heard of it when asked specifically.

• In the youth survey, 50.3% of respondents said they had seen, heard or read news stories

about mental health in the last 12 months. The most common types of stories were those

involving education/raising awareness, help seeking and mental health related crime or

violence. Television was the most common source of such stories, with 46.6% of

respondents nominating this.

8 Change over time

• The 2011 survey revealed improvements in mental health literacy in the Australian public since the first survey was carried out in 1995. This was particularly notable for improved recognition of depression in a vignette, increase in beliefs about the helpfulness of GPs, psychiatrists and counsellors, and beliefs in the helpfulness of medications, particularly antidepressants and antipsychotics.

• Public beliefs about outcomes and causes of mental disorders have become more realistic and closer to those of researchers and health professionals.

• Between the 2003-4 and 2011 general community surveys, limited changes in stigmatising attitudes were seen, with the most notable being increases in beliefs about dangerousness and unpredictability and decreases in the desire for social distance for all vignettes other than chronic schizophrenia.

Conclusions

• While beliefs about effective medications and interventions for mental disorders have moved closer to those of health professionals since earlier surveys, there is still potential for mental health literacy gains in the areas of recognition and treatment beliefs for mental disorders.

• This is particularly the case for schizophrenia and anxiety disorders which are less well recognised and for which there are strong beliefs in the helpfulness of self-help methods relative to professional mental health treatments.

• As a significant minority of respondents did not nominate responses that may be considered helpful, there is also the potential for improving community knowledge of appropriate first- aid responses.

• Further monitoring of population mental health is necessary to explore whether

improvements in mental health literacy translate into improvements in population mental health.

• The increase in views of dangerousness and unpredictability in the general community

survey is of some concern and points to the need for public education to address these

aspects of stigma towards those with mental disorders.

9

1. Introduction

The 2007 Australian National Survey of Mental Health and Wellbeing estimated that mental or substance use disorders affect as many as one in five people in any 12-month period [1]. For those aged between 16 and 24 years, this prevalence rate rises to one in four. However, only around one third of those meeting the criteria for a mental disorder seek professional help, with those in the youngest age group the least likely to do so [2].

There are a number of factors affecting help seeking and these interact to determine when and how people seek help for mental health problems [3]. They include structural factors, such as having sufficient treatment resources available, and individual factors, including mental health literacy, which has been defined as “knowledge and beliefs about mental disorders which aid their recognition, management or prevention” [4].

1.1. Previous surveys of mental health literacy in the Australian population

Three previous national surveys of mental health literacy have been conducted in Australia. These are the 1995 National Survey of Mental Health Literacy, the 2003-2004 Australia Japan Partnership Mental Health Literacy Survey and the 2006 National Survey of Youth Mental Health Literacy.

1.1.1.

The 1995 survey was a household survey of a national sample of 2,164 adults aged 18 years and over. The survey was commissioned by the Social Psychiatry Research Unit at the Australian National University and carried out by the Australian Bureau of Statistics as part of its Population Survey Monitor. The survey interview was based on a vignette, with participants randomly assigned to receive either a depression or schizophrenia vignette. The interview covered the following areas:

• Recognition of the disorder in the vignette

• Beliefs about people who could help

• Beliefs about treatments

• Knowledge of likely prognosis

• Knowledge of causes and risk factors

• Beliefs associated with stigma and discrimination

• Experience of mental disorders in self or others Major findings from the 1995 survey were:

• Recognition of disorders in the vignettes was poor, with 39% correctly labelling the depression vignette and 27% the schizophrenia vignette [4].

• While GPs and counsellors were generally rated as likely to be helpful, psychiatrists and psychologists were less so [4].

• Some standard psychiatric treatments (antidepressants, antipsychotics, ECT, admission to a psychiatric ward) were more often rated as likely to be harmful than helpful [4].

• Some non-standard treatments were rated highly (increased physical or social activity, relaxation and stress management, reading about people with similar problems) [4].

• Vitamins and special diets were more often rated as likely to be helpful than antidepressants and antipsychotics [4].

• Social environmental factors were rated as likely causes of both depression and

schizophrenia, while genetic factors were seen as a likely cause by only half the population [5].

• Half the population saw weakness of character as a likely cause of both depression and

schizophrenia [5].

10 In order to enable comparisons of public beliefs with those of health professionals, a postal survey of 872 GPs, 1128 psychiatrists and 454 clinical psychologists using the same vignettes was undertaken [6]. Respondents were asked to rate the likely helpfulness of various types of professional and non- professional help and of pharmacological and non-pharmacological interventions. Results showed that two-thirds or more of each profession agreed that the person with schizophrenia would be helped by GPs, psychiatrists, clinical psychologists, antipsychotic agents and admission to a psychiatric ward. Similarly, two-thirds agreed that the person with depression would be helped by GPs, psychiatrists, clinical psychologists, antidepressants, counselling and cognitive-behavioural therapy. In general, health practitioners were more likely to endorse the interventions associated with their own profession. When professional beliefs were compared with public beliefs, the following were found:

• Professionals gave much higher ratings than the public to the helpfulness of antidepressants for depression, and of antipsychotics and admission to a psychiatric ward for schizophrenia.

• The public gave much higher ratings than the professionals to the helpfulness of vitamins and special diets for both depression and schizophrenia, and to reading self-help books for schizophrenia.

• Compared to the public, professionals rated long-term outcomes more negatively and discrimination more likely.

1.1.2.

The Australia-Japan Partnership involves an agreement between the Australian and Japanese governments for a joint project on health. It was agreed that the second partnership project would be on mental health and suicide. As part of the project, researchers at the Centre for Mental Health Research at the Australian National University were asked to partner with a Japanese team of researchers to do a common survey of the public in both countries. It was agreed that the survey would incorporate the questions used in the 1995 Australian survey, plus additional questions of interest to both research teams. Because of the interest of the Japanese in suicide and chronic mental illness, the survey was expanded to involve one of four vignettes: depression, early

schizophrenia, depression with suicidal thoughts and chronic schizophrenia. The first two vignettes were the same as in the 1995 survey. The survey covered all the items of the 1995 survey, with the following areas added:

• Beliefs about sources of mental health information

• Mental health first aid intentions

• Personal and perceived stigma

• Social distance

• Recall of media items on mental health

• Awareness of beyondblue: the national depression initiative

The Australian survey was conducted by the company AC Nielsen in late 2003 and early 2004. This was a household survey with 3998 adults aged 18 years or over. The methodology tried to replicate that of the 1995 survey as far as possible.

Comparison of the 2003-4 Australian survey with the earlier 1995 survey found that:

• Recognition of depression and schizophrenia had improved [7].

• There were more positive ratings to a range of interventions, including help from mental health professionals, medications, psychotherapy and admission to a psychiatric ward [7].

• There was no change in belief about social causes, but belief in genetic causes increased [8].

• Belief that people with depression would be discriminated against increased in states where

beyondblue was most active, but did not change in other states [9].

11

• States with greater exposure to beyondblue had better recognition of depression, greater change in beliefs about the benefits of help-seeking, greater change in beliefs about counselling and medication, and a greater percentage of people identified themselves or their family or friends as having been depressed [9, 10].

Questions added to the 2003-4 survey showed that:

• Awareness of beyondblue was high [10].

• Stigmatizing attitudes were common, but people perceived stigma to be greater in other people than they reported it in themselves [11].

• Common mental health first aid responses were to encourage professional help-seeking and to listen to and support the person. However, significant minorities did not give these responses. Much less common responses were to assess the problem or risk of harm, to give or seek information, to encourage self-help, or to support the family [12].

When the data from the Australian public were compared to those from the Japanese public, the following were found:

• The Japanese public was more reluctant to use psychiatric labels and more reluctant to discuss mental disorders outside the family [13].

• Australians were more positive about the benefits of seeking professional help, particularly from GPs [13].

• Australians were more positive about lifestyle interventions, such as diet, physical activity, getting out more, relaxation, and cutting out alcohol [13].

• Australians were more optimistic about recovery [13].

• Stigmatizing attitudes were common in both countries, but more so in Japan [14].

• Both countries showed a predominant belief in social causes, but belief that mental disorders are due to weakness of character was stronger in Japan [15].

1.1.3.

This survey was carried out to complement the previous surveys that focussed on adults. The survey was commissioned by Orygen Youth Health Research Centre and was carried out by the Social Research Centre. It involved computer-assisted telephone interviews (CATI) with a national sample of 3746 young people aged 12-25 years and 2,005 of their co-resident parents.

The survey interview was based around vignettes chosen to match the range of mental disorders that might occur during this period of life. There were four vignettes: depression, depression with substance abuse, psychosis (schizophrenia) and social phobia. The social phobia vignette was included because of the high prevalence of anxiety disorders and the lack of coverage of such disorders in previous surveys. The survey interview covered:

• Recognition of the disorder in the vignette

• Help-seeking intentions

• Mental health first aid intentions

• Beliefs about people who could help

• Beliefs about treatments

• Beliefs about prevention

• Personal and perceived stigma

• Social distance

• Exposure to campaigns (including beyondblue) and media items

• Experience of mental disorders in self or others

12 Key findings of the 2006 Youth Survey were:

• For adolescents, family members were seen as the main source of intended help for a mental health problem, while less so for young adults. However, only a minority of young people saw GPs as a source of intended help [16].

• There was broad agreement from young people and their parents about what sort of interventions would be helpful. However, these were general and informal sources of help rather than specialist mental health services [17].

• There was widespread awareness among young people that use of substances is harmful for mental health [18].

• When young people were asked what they would do if a peer had a mental health problem, the value of encouraging professional help-seeking was not universally recognized [19].

• Nearly half of young people were aware of beyondblue and awareness was associated with better mental health literacy [20].

• Stigma was lower in young people who had experience of mental health problems in self or others, who had been exposed to mental health campaigns, and whose parents had less stigmatizing attitudes [21].

• The most common news stories about mental illness recalled by young people were those involving crime or violence, mental health system failures, or disclosures of mental illness by prominent individuals. Recall of disclosure was associated with less stigma in terms of seeing the people with a mental health problem as weak [22].

In order to enable comparisons of public beliefs with those of health professionals, a postal survey of GPs, psychiatrists, mental health nurses and psychologists using the same vignettes was undertaken [23]. Respondents were asked to rate the likely helpfulness of various types of professional and non- professional help and of pharmacological and non-pharmacological interventions. Results showed that clinicians showed consensus about the helpfulness of a number of professions, reducing substance use, cognitive behaviour therapy (CBT), counselling, physical activity, relaxation training, and (for social phobia) meditation. Antidepressants were generally recommended only for

depression in a 21-year old. When the beliefs of young people and their parents were compared to those of clinicians, the key findings were:

• For depression and social phobia, young people and their parents showed much lower endorsement than clinicians of antidepressants and CBT, while clinicians had much lower endorsement than the public of informal supports such as family, friends and support groups.

• For psychosis, young people and their parents showed much lower endorsement than clinicians of the helpfulness of seeing a psychiatrist, using mental health services and taking antipsychotic medication, while clinicians had much lower endorsement than the public of informal social supports, generic counselling and general stress reduction methods.

• When mental health first aid strategies were examined, young people and their parents were less likely than clinicians to believe that it would be helpful to a person with mental health problems to ask about suicidal feelings.

1.1.4.

Evidence of the relatively low levels of mental health literacy in members of the public has led to

campaigns to improve this in a number of countries. Such campaigns have tended to focus on

mental illness broadly, or specifically on depression [24-27]. In Australia, the past few years have

seen increased efforts to improve the mental health literacy of the Australian public, as outlined by

the Fourth National Mental Health Plan, in particular the following action items in the Plan:

13

• Improve community and service understanding and attitudes through a sustained and comprehensive national stigma reduction strategy.

• Work with schools, workplaces and communities to deliver programs to improve mental health literacy and enhance resilience.

1.2. Aims of the 2011 survey

The aim of the current project was to carry out a national survey in order to assess whether there have been changes in recognition, treatment beliefs, stigmatising attitudes and other aspects of mental health literacy. The survey had two components: a general community survey involving those aged 15+ years and a youth survey involving those age 15 to 25 years.

For the general population, comparison with previous surveys allowed assessment of 16-year longitudinal change for depression and early schizophrenia vignettes, and 8-year change for the depression with suicidal thoughts and chronic schizophrenia vignettes. The inclusion of vignettes for social phobia and post-traumatic stress disorder (PTSD) vignettes allowed for the introduction of baseline assessment of mental health literacy and stigma for these anxiety disorders.

For the youth survey, comparison with the previous survey allowed assessment of five-year

longitudinal change for depression, psychosis, social phobia and depression with substance misuse

vignettes. The inclusion of vignettes for depression with suicidal thoughts and PTSD allowed for the

introduction of baseline assessment of mental health literacy and stigma for these disorders.

14

2. General community survey

2.1. Mental health literacy in adults

Since the initial 1995 Australian survey of mental health literacy, there has been growing interest in this area, with surveys carried out in a number of countries. Taken together, these studies have examined a number of components of mental health literacy which could affect whether an

individual suffering from a mental disorder receives appropriate treatment. These include the ability to recognise specific disorders, knowledge of causes and risk factors, of self- treatments, and of professional help available; and attitudes that promote recognition and appropriate help-seeking.

2.1.1.

It is generally agreed that recognition of a problem is the necessary first step to seeking help from an appropriate professional, with failure to recognise signs and symptoms likely to delay help-seeking.

This is of importance as there is evidence that early recognition and treatment may improve long- term outcomes for those with mental disorders [28, 29]. Moreover, the use of correct psychiatric labels may facilitate communication with health professionals and it has been shown that GPs are more likely to diagnose mental disorders if patients ask them about these directly [30].

2.1.2.

Beliefs about treatments, including professional help, medications and other interventions also impact on help-seeking. If a person believes that consulting a health professional or taking a medication is unhelpful, they are less likely to receive appropriate medical help or may not comply with treatment. Negative attitudes towards medications such as antipsychotics and antidepressants are common in several countries [4, 31, 32]. In contrast, psychological therapies are viewed more positively, as are complementary therapies (such as vitamins and herbs) and self-help strategies such as exercise and relaxation [4, 33].

2.1.3.

Professionals working in the area of mental disorders generally consider that these disorders arise as a result of a complex interplay of biological, psychological and social factors. However, public beliefs about causes of mental illness are generally less sophisticated. Previous surveys of mental health literacy have shown that many people believe that social factors are more likely to be the causes of mental disorders than genetic factors, particularly in the case of depression [5, 32, 34-37]. Another relatively common belief is that personal weakness is a cause of mental disorders [5, 35, 38]. While this belief is less common than those about social factors, it is of concern as it reflects stigmatising attitudes towards mental disorders.

2.1.4.

As the prevalence of mental disorders is relatively high, it is likely that most members of the public will, at some time, have had contact with someone with a mental disorder. Help given by members of a person’s social network, which may be defined as ‘first-aid behaviours’ can have an important role to play in providing support and encouraging appropriate help seeking. There is evidence someone with a mental disorder is more likely to seek help if another person recommends it [39].

2.1.5.

Stigmatising attitudes are a key issue in mental illness and are often nominated as the issue of most

concern to consumers [40, 41]. As with other components of mental health literacy, stigmatising

attitudes may inhibit help seeking and may also increase the psychological distress of those with

disorders and may adversely affect their successful reintegration into society [42-44]. Evidence

suggests that stigmatising attitudes vary according to type of mental illness and that there is a need

to explore attitudes to different illnesses separately [21, 45].

15 2.1.6.

While surveys of mental health literacy have been carried out in a number of countries [13, 32, 33, 46-50], there have been relatively few attempts to assess change in mental health literacy over time.

Comparison of the results of the 1995 and 2003-4 surveys described above offered the opportunity to assess changes in relation to depression and early schizophrenia and showed better recognition of these disorders, as well as more positive ratings for a range of interventions including help from mental health professionals, medications, psychotherapy and psychiatric ward admission [7].

Changes in beliefs about causes and risk factors for mental disorders have also been shown [8].

There is also some evidence that campaigns, such as those carried out by beyondblue have led to improvements in mental health literacy in the Australian public, particularly in relation to depression [7, 10]. Studies conducted in South Australia examined changes in mental health literacy in regard to depression between 1998, 2004 and 2008 [50, 51]. Results showed that there was a significant increase in the proportion of people recognising depression in the vignette, acknowledging personal experience of depression, and perceiving professional assistance to be more helpful and less

harmful. However, relatively little is known about mental health literacy in relation to anxiety

disorders [52, 53].

16

2.2. Methods

The 2011 general community survey involved CATI with a national sample of 6019 members of the general community aged 15+. The survey was carried out by the survey company Social Research Centre. The sample was contacted by random-digit dialling of both landlines and mobile phones.

This approach was taken in order to minimise the potential bias of collecting data solely from households with a landline telephone connection. A landline-only approach may under-sample young people, particularly young men [54]. In order to achieve a mobile/landline distribution representative of the Australian population, targets of at least 1500 mobile and 4000 landline interviews were set. Interviews were conducted between January and April 2011.

2.2.1.

The interview was based on a vignette of a person with a mental disorder. On a random basis, respondents were read one of six vignettes: depression, depression with suicidal thoughts, early schizophrenia, chronic schizophrenia, social phobia and PTSD. Respondents were also randomly assigned to receive either male (“John”) or female (“Jenny”) versions of the vignette. All vignettes were written to satisfy the diagnostic criteria for either major depression or schizophrenia according to DSM-IV and ICD-10.The vignettes are given in Appendix A.

2.2.1.1

After being presented with the vignette, respondents were asked what, if anything they thought was wrong with the person described in the vignette, how the person could best be helped and a series of questions about the likely helpfulness of a wide range of interventions (rated as likely to be helpful, harmful or neither for the person described in the vignette). The interventions were: a typical GP or family doctor; a typical chemist (pharmacist); a counselor; a social worker; a telephone counseling service, such as Lifeline; a psychiatrist; a psychologist; help from close family; help from close friends; a naturopath or a herbalist; the clergy, a minister or priest; John/Jenny tried to deal with his/her problems on his/her own; vitamins and mineral, tonics or herbal medicines; pain relievers, such as aspirin, codeine or Panadol; antidepressants; antibiotics; sleeping pills; anti- psychotics; tranquillizers such as Valium; becoming physically more active, such as playing more sport, or doing a lot more walking or gardening; reading about people with similar problems and how they have dealt with them; getting out and about more; attending courses or relaxation, stress management, meditation or yoga; cutting out alcohol altogether; psychotherapy; hypnosis; being admitted to a psychiatric ward of a hospital; undergoing electro-convulsive therapy (ECT); having an occasional alcoholic drink to relax; going on a special diet or avoiding certain foods.

2.2.1.2

To assess respondents’ spontaneously reported first aid intentions, they were asked: “Imagine John/Jenny is someone you have known for a long time and care about. You want to help him/her.

What would you do?” The interviewer recorded the response verbatim. Responses were coded into the following categories: listen/talk with the person; accompany the person to professional help;

contact professional help on the person’s behalf; encourage the person to seek help; encourage the person to see a GP/doctor; encourage the person to see a counsellor; encourage the person to see a psychiatrist; encourage the person to see a psychologist; encourage the person to contact a

health/welfare organisations; encourage the person to contact a helpline; encourage the person to go to hospital; encourage the person to go to a mental health clinic; encourage professional help;

ask if they want help; assess the problem/risk of harm; do an intervention; cheer them up/boost their confidence; encourage socialising; give advice; seek information for the person; help make new friends; help with chores/work; provide general support e.g. practical, emotional; spend

time/socialise with the person; encourage them to become physically active; and tell their parents or

family.

17 2.2.1.3

The interview also included questions asking about the likely result for the person in the vignette with and without "the sort of professional help you think is most appropriate" The response options were: Full recovery with no further problems; Full recovery, but problems would probably re-occur;

Partial recovery; Partial recovery, but problems would probably re-occur; No improvement; Get worse. A further question asked “For each of the following, how do you think (he/she) would be in the long term, compared to other people in the community: be violent; drink too much alcohol; take illegal drugs; have poor friendships; attempt suicide; be understanding of other people's feelings;

have a good marriage; be a caring parent; be a productive worker; be creative or artistic? The options were: more likely, just as likely, less likely, depends, don’t know or refused.

2.2.1.4

Respondents were asked about the likelihood of various possible causes of the disorders described in the vignettes. These included viruses; allergic reactions; day-to-day problems such as family arguments, difficulties at work or financial difficulties; recent death of a close friend or relative;

recent traumatic event; problems from childhood; inherited or genetic causes; chemical imbalance in the brain; being a nervous person; and have weakness of character. The options were: very likely, likely, not likely, depends, don’t know or refused.

2.2.1.5

Respondents were also asked if anyone in their family or close friends had similar problems to the person described in the vignette, what, if anything they did to help the person and whether the person received professional help for the problem. They were also asked if they had problems similar to the person described in the vignette, whether they received professional help for the problem and whether they had ever had a job that involved providing treatment to a person with mental health problems.

2.2.1.6

Respondents were asked to rate their health as excellent, good, fair or poor. They were also asked if, in the last month, they had suffered from any of the following:

ore throats, headaches, dizziness, palpitations, breathlessness, backache, flu, anxiety, depression, tiredness, irritability or nervousness. Psychological distress was assessed by the Kessler 6-item (K6) symptom questionnaire [55].

2.2.1.7

2.2.1.7.1 Personal and perceived stigma

Stigmatising attitudes were assessed with two sets of statements, one assessing the respondent’s personal attitudes towards the person described in the vignette (personal stigma) and the other assessing the respondent’s beliefs about other people’s attitudes towards the person in the vignette (perceived stigma) [56]. The personal stigma items were: (1) People with a problem like

(John/Jenny)'s could snap out of it if they wanted; (2) A problem like (John/Jenny)'s is a sign of personal weakness; (3) (John/Jenny)'s problem is not a real medical illness; (4) People with a problem like (John/Jenny)'s are dangerous; (5) It is best to avoid people with a problem like

(John/Jenny)’s so that you don't develop this problem; (6) People with a problem like (John/Jenny)'s are unpredictable; (7) If I had a problem like (John/Jenny)'s I would not tell anyone; (8) I would not employ someone if I knew they had a problem like (John/Jenny)'s; (9) I would not vote for a politician if I knew they had suffered a problem like (John/Jenny)'s.

The perceived stigma items covered the same statements but started with “Most other people believe that...” Ratings of each were made on a 5-point Likert scale ranging from ‘strongly agree’ to

‘strongly disagree’. For these analyses the ‘agree’ and ‘strongly agree’ categories were combined.

18

Self-reported willingness to have contact with the person described in the vignette was measured using the 5-item scale developed by Link et al. [35]. The items were rated according to the person’s willingness to (1) move next door to (John/Jenny); (2) spend an evening socializing with

(John/Jenny); (3) make friends with (John/Jenny); (4) working closely with (John/Jenny) on a job; (5) have (John/Jenny) marry into their family. Each item was rated on a 4-point scale ranging from

‘definitely willing’ to ‘definitely unwilling’. For these analyses the ‘definitely unwilling’ and ‘probably unwilling’ categories were combined.

2.2.1.7.3 Perceived discrimination

Perceived discrimination was examined by asking if respondents thought the person in the vignette was likely to be discriminated against by others in the community. Possible responses were ‘yes’,

‘no’ and ‘I don’t know’.

2.2.1.8

Respondents were asked if they had ever received treatment for any mental health problem, if this was in the last 12 months and what the treatment was. Verbatim responses were recorded.

Responses were coded into the following categories: medication; psychologist; psychiatrist;

counsellor; GP/doctor; hospital/psychiatric ward; social worker; psychotherapy; professional treatment (unspecified); CBT; ECT; hypnosis; natural therapy; exercise; dietary change; sought information; relaxation therapy; religious/spiritual support; and friends/family support.

Respondents were also asked if they did anything else for the mental health problem. Verbatim responses were recorded and responses coded into the following categories: hospitalised;

medication; professional help; exercise; yoga/meditation; relaxation techniques; dietary change;

natural therapy; more sleep; changed lifestyle; reduced drug/alcohol use; religion/spirituality;

Socialising; talk with family and friends; create music/art; hobbies/activities; self-reflection; CBT;

positive thinking; kept busy; started working; changed job/reduced hours; volunteer/community work; self-education on disorder/treatment strategies; set aside time for rest; worked through it alone; turned to pet; moved house; and travel/holiday.

2.2.1.9

Exposure to mental health-related organisations was assessed by asking respondents if they had heard of any of these and if yes, what the names were. They were also asked if they had heard of beyondblue. Because such recognition questions may elicit false positive responses, a question was also asked about a fictitious organization: The Mellow Yellow Institute. Responses to this question were used to gauge false-positive rates.

2.2.2.

Responses were coded based on the categories identified from previous surveys.

Additional categories were formed in recognition of the different population studied and vignettes used.

Responses were coded with a ‘yes’ or ‘no’ in each category, so that multiple categories were possible.

2.2.3.

Results from the 2011 survey were compared with those from previous years. As the 1995 survey only included depression and chronic schizophrenia vignettes, comparison over there time points was possible for responses relating to these vignettes. The 2003-4 survey also included depression with suicidal thoughts and chronic schizophrenia vignettes. Thus, for data relating to these vignettes, comparison over two time points was possible.

The 1995 and 2003-4 surveys only included adults aged 18+ and to make the samples comparable,

those aged 15-17 from the 2011 survey were dropped from the analyses reported here. For

19 comparisons between the 2003-4 and 2011 surveys, this left a total of 5860 respondents: 992 people who received the depression vignette, 979 who received the depression with suicidal thoughts vignette, 972 who received the early schizophrenia vignette and 972 who received the chronic schizophrenia vignette. For comparisons that included the 1995 survey results, those aged 75+ from the 2011 survey were dropped from the analyses reported here. This left a total of 5417

respondents: 893 people who received the depression vignette, 903 who received the depression with suicidal thoughts vignette, 892 who received the early schizophrenia vignette and 915 who received the chronic schizophrenia vignette.

The 1995 and 2003-4 surveys involved household interviews. Because of the much greater expense of household surveys, the 2011 survey adopted computer assisted telephone interviewing (CATI) as an alternative. When comparing the findings from 2011 with the earlier years, some caution was required in interpreting any differences in case the change in method might have affected the results.

2.2.4.

The data were analysed using percent frequencies and 95% confidence intervals. A pre-weight was applied to adjust for the dual frame design and the respondent chance of selection. The achieved sample was close to the Australian national population in terms of geographic distribution, however, there was an under-representation of males and of younger adults, and an over-representation of university educated persons and persons with an English-speaking background. A population weight was used to adjust for these biases. All analyses were performed using Intercooled Stata 10

(StataCorp LP, Texas, USA).

Because of the large sample sizes, even very small differences between surveys can be statistically significant. We therefore focussed on the effect sizes of the differences between surveys. The interpretation is focussed on those effect sizes which equal or exceed Cohen’s definition of a ‘small’

(h> 0.2) effect size [57]. All analyses were performed using Intercooled Stata 10 (StataCorp LP,

Texas, USA).

20

2.3. Results of the 2011 survey

The response rate for the survey was 44.0%, defined as completed interviews (6019) out of sample members who could be contacted and were confirmed as in scope (13 636). Overall, 4324 (65.7%) interviews were conducted on landlines and 1696 (34.3%) on mobiles. The numbers assigned to each vignette were: depression, n=1016; depression with suicidal thoughts, n=1008; early schizophrenia, n=1002; chronic schizophrenia, n=993; social phobia, n=992; and PTSD, n=1008.

2.3.1.

Table 2-1, Table 2-2 and Table 2-3 show the sociodemographic characteristics of the survey population.

Table 2-1 Age, gender, marital status and educational status of respondents

Sociodemographic characteristic n % (95% CI)

Gender

Male 2670 49.7 (48.3-51.2)

Female 3349 50.3 (48.8-51.7)

Age category

15-17 150 3.1 (2.7-3.7)

18-19 219 4.8 (4.2-5.5)

20-24 446 9.2 (8.4-10.2)

25-29 365 8.1 (7.2-9.1)

30-34 403 8.9 (8.0-9.9)

35-39 468 8.0 (7.2-8.8)

40-44 551 9.4 (8.6-10.3)

45-49 501 8.9 (8.2-9.8)

50-54 566 9.7 (8.9-10.6)

55-59 535 6.4 (5.8-7.1)

60-64 563 6.9 (6.3-7.5)

65-69 445 5.6 (5.0-6.2)

70-74 355 4.7 (4.2-5.3)

75+ 443 6.0 (5.5-6.7)

Refused 9 0.1 (0.1-0.2)

Marital status

Never married 1540 31.2 (29.8-32.6)

Married, De facto 3440 53.1 (51.7-54.6)

Separated, divorced or widowed 1023 15.3 (14.4-16.3)

Refused 16 0.3 (0.2-0.7)

Highest level of education completed

Still attending school 47 0.9 (0.7-1.3)

Year 9 or lower 473 8.4 (7.7-9.2)

Completed Year 10 1022 19.4 (18.3-20.6)

Completed Year 12 1173 25.7 (24.4-27.1)

Trade certificate/apprenticeship 448 9.9 (9.0-10.8)

Other certificate 369 7.5 (6.7-8.3)

Associate or undergraduate diploma 502 11.0 (10.1-12.0)

Bachelor's degree or higher 1920 15.9 (15.1-16.7)

Other 36 0.6 (0.4-0.8)

Don't Know 21 0.4 (0.2-0.7)

Refused 8 0.3 (0.1-0.7)

21 Table 2-2 Aboriginal Torres State Islander status, country of birth and language spoken at home

Sociodemographic characteristic n % (95% CI)

Aboriginal Torres Strait Islander (ATSI) Status

Yes 113 2.3 (1.9-2.8)

No 5897 97.5 (97.0-98.0)

Refused 9 0.2 (0.1-0.5)

Country of birth

Australia 4396 68.7 (67.2-70.1)

UK 485 6.4 (5.8-7.1)

New Zealand 170 2.6 (2.2-3.1)

Italy 35 0.9 (0.7-1.3)

Greece 10 0.2 (0.1-0.4)

China 69 1.5 (1.1-2.0)

Vietnam 18 0.5 (0.3-0.8)

Other 821 18.7 (17.4-20.0)

Don’t know 6 0.2 (0.1-0.5)

Refused 9 0.3 (0.1-0.7)

Speak a language other than English at home

English only 5147 81.4 (80.1-82.7)

Italian 90 1.6 (1.3-2.0)

Greek 46 0.8 (0.6-1.1)

Cantonese 39 0.9 (0.7-1.4)

Mandarin 70 1.4 (1.1-1.9)

Arabic 36 1.1 (0.8-1.6)

Vietnamese 28 0.7 (0.4-1.1)

German 46 1.0 (0.7-1.4)

Spanish 34 0.6 (0.4-0.9)

Tagalog 32 0.7 (0.5-1.1)

Other language 443 9.4 (8.5-10.4)

Don’t know 4 0.1 (0-0.3)

Refused 4 0.2 (0.1-0.6)

Table 2-3 State of residence of respondents

State of residence n % (95% CI)

NSW 1978 32.4 (31.1-33.8)

VIC 1531 25.5 (24.3-26.8)

QLD 1138 20.2 (19-21.4)

SA 468 7.5 (6.8-8.3)

WA 601 9.9 (9.0-10.7)

TAS 150 2.3 (2.0-2.8)

NT 53 0.8 (0.6-1.1)

ACT 100 1.4 (1.1-1.7)

Location

Capital city 3961 25.5 (24.3-26.8)

Rest of state 2058 20.2 (19.0-21.4)

22 2.3.2.

Table 2-4 shows the percentage of respondents mentioning the categories to describe the problems shown in the vignettes. ‘Depression’ was the term used most often to describe both the depression vignette and the depression with suicidal thoughts vignette. ‘Depression’ and ‘schizophrenia’ were the terms most often used for the early schizophrenia vignette while ‘mental illness’ and

‘schizophrenia’ were the terms most commonly used for the chronic schizophrenia vignette.

‘Anxiety/anxious’, ‘depression’, ‘shy’ and ‘low self-confidence/self esteem’ were the terms most often used to describe the social phobia vignette. ‘PTSD’, ‘depression’, ‘stress’, ‘trauma’,

‘anxiety/anxious’ and ‘fear’ were the terms most often used to describe the PTSD vignette.

23 Table 2-4 Percentage (and 95% CI) of respondents mentioning each category to describe the problem shown in the vignette

Category mentioned Depression Depression with suicidal thoughts

Early schizophrenia Chronic schizophrenia

Social phobia PTSD

Depression 73.7 (70.4-76.7) 86.0 (83.1-88.4) 38.1 (34.8-41.5) 5.6 (4.1-7.5) 20.1 (17.4-23.1) 19.8 (17.2-22.7)

Nervous breakdown 0.2 (0.1-0.8) 0 0 0.1 (0-0.6) 0.5 (0.2-1.2) 1.1 (0.6-2.0)

Schizophrenia 0 0.5 (0.2-1.3) 37.3 (34.0-40.7) 31.9 (28.7-35.2) 1.1 (0.5-2.1) 0.9 (0.4-1.9)

Mental illness 2.8 (1.8-4.4) 4.0 (2.8-5.7) 19.2 (16.7-22) 35.4 (32-38.9) 3.7 (2.6-5.1) 3.4 (2.2-5.0) Psychological/mental/

emotional problems

1.6 (1.0-2.8) 2.6 (1.6-4.1) 8.4 (6.7-10.4) 10.6 (8.6-13.1) 4.1 (3.0-5.6) 5.5 (4.0-7.5) Anxiety/anxious 11.1 (7.3-16.4) 11.8 (7.0-19.2) 9.6 (6.1-14.8) 1.9 (0.8-4.7) 32.7 (29.0-36.7) 14.8 (12.1-18.1)

Worried/nervous 1.4 (0.4-4.5) 0.7 (0.1-4.7) 0 0 3.7 (2.4-5.6) 1.4 (0.7-3.0)

Anxiety disorder 0 0.4 (0.1-3.0) 0 0 2.4 (1.5-3.8) 0.1 (0-0.5)

Social phobia 0 2.1 (0.6-11.2) 2.4 (0.8-6.9) 0 (0-0.3) 9.2 (6.9-12.1) 0.8 (0.3-2.1)

Agoraphobia 0 0 1.7 (0.6-4.7) 0.1 (0-0.6) 4.9 (3.4-6.8) 0.8 (0.3-2.5)

Panic disorder 0.7 (0.1-4.6) 0 0 0 2.1 (1.2-3.5) 0.1 (0-0.4)

Lonely 0.3 (0-2.4) 2.1 (0.8-5.5) 4.1 (1.8-8.8) 13.6 (9.8-18.5) 2.1 (1.3-3.5) 0

Shy 0 0 0 0 20.0 (17.0-23.4) 0

Insecure 0 0 0 1.5 (0.4-5.1) 2.5 (1.5-4.1) 0.7 (0.2-2.1)

Introverted/antisocial 0 0 0.5 (0.1-3.4) 0.4 (0.1-2.7) 4.3 (2.9-6.1) 0.2 (0.1-0.9)

Social problems 0 0.6 (0.1-4.4) 2.0 (0.7-5.4) 1.2 (0.4-3.5) 2.1 (1.2-3.7) 0.3 (0-1.8)

Withdrawn 0 0 3.1 (1.5-6.4) 0.7 (0.1-4.5) 1.6 (0.9-2.7) 0.1 (0-0.9)

Low self- confidence/self- esteem

3.9 (1.7-8.5) 12.9 (8.1-20.0) 3.1 (1.5-6.2) 2.4 (0.9-6.0) 18.3 (15.4-21.6) 0

PTSD 0.3 (0-2.1) 0 0.9 (0.2-3.7) 0.8 (0.2-2.8) 0.2 (0.1-0.9) 37.5 (33.5-41.6)

Fear/scared 0 0 1.8 (0.5-5.6) 1.1 (0.3-3.4) 3.9 (2.4-6.1) 12.2 (9.4-15.6)

Trauma 0 0 0 0.7 (0.2-2.7) 0.1 (0-0.4) 13.3 (10.5-16.6)

Shock 0 0 0 0 0 5.0 (3.5-7.1)

Fatigue/burnout 12.2 (8.1-18.0) 7.7 (4.2-13.8) 0 0 0 2.2 (1.2-4.0)

Stress 7.1 (5.4-9.3) 2.8 (1.8-4.5) 1.3 (0.7-2.4) 0.1 (0-0.5) 0.9 (0.5-1.8) 15.0 (12.7-17.6)

Has a problem 2.3 (1.4-3.7) 1.5 (0.8-2.8) 2.2 (1.2-3.9) 2.7 (1.8-4.1) 3.1 (1.9-5.0) 1.9 (1.1-3.1)

Cancer 1.3 (0.7-2.3) 0.5 (0.2-1.4) 0.1 (0-0.8) 0 0 0

24 Category mentioned Depression Depression with

suicidal thoughts

Early schizophrenia Chronic schizophrenia

Social phobia PTSD

Nothing 0.5 (0.2-1.4) 0 0.4 (0.1-1.3) 0.7 (0.3-1.6) 0.7 (0.4-1.4) 0.3 (0.1-0.9)

Other 25.9 (22.8-29.2) 16.3 (13.8-19.2) 24.2 (21.3-27.3) 29.2 (26.1-32.5) 28.4 (24.8-32.4) 26.0 (22.4-30.1) Don’t know 3.1 (2.1-4.5) 1.8 (1.0-3.1) 2.2 (1.3-3.8) 1.9 (1.1-3.2) 4.3 (3.0-6.2) 2.6 (1.7-4.0)

Refused 0 0 0 0.1 (0-0.7) 0 0.1 (0-0.4)

25 2.3.3.

Table 2-5 shows the frequency of responses to the open-ended question about how the person in

the vignette could best be helped. For the depression, depression with suicidal thoughts and early

schizophrenia vignettes, GPs were considered the most helpful. For the chronic schizophrenia

vignette, GPs and psychiatrists were considered the most helpful. For social phobia, counselling and

talking things over with family and friends were considered the most helpful, whereas for PTSD,

counselling was considered the most helpful.

26 Table 2-5 Percentage (and 95% CI) of respondents mentioning each category in response to the open-ended question about how the person in the vignette could best be helped

Type of help mentioned

Depression Depression with suicidal thoughts

Early schizophrenia Chronic schizophrenia

Social phobia PTSD Talk over with friends

and family

9.4 (7.4-11.8) 12.4 (10.1-15.0) 9.8 (7.8-12.2) 5.6 (4.1-7.5) 12.4 (10.1-15.2) 11.6 (9.3-14.3) See a doctor/GP 43.9 (40.4-47.4) 33.7 (30.5-37) 24.7 (21.9-27.7) 13.1 (10.8-15.8) 11.7 (9.7-14.1) 16.4 (14-19.1) See a psychiatrist 3.6 (2.5-5.2) 5.2 (3.7-7.1) 14.8 (12.5-17.4) 14.1 (11.8-16.8) 6.5 (4.8-8.7) 9.9 (7.9-12.3) Take medication 1.8 (1.1-2.9) 2.2 (1.4-3.6) 3.6 (2.5-5.2) 5.8 (4.4-7.5) 0.7 (0.3-1.3) 0.5 (0.2-1.4) See a psychologist 4.0 (2.6-6.1) 5.3 (4.0-7.1) 9.4 (7.6-11.7) 6.6 (5.0-8.6) 6.3 (4.9-8.0) 11.2 (9.2-13.6) See a counsellor or

have counselling

15.3 (13.0-17.9) 17.9 (15.4-20.8) 13.0 (10.8-15.5) 9.2 (7.4-11.4) 18.0 (15.5-21.0) 32.7 (29.5-36.1) Person must first

recognise the problem

0.8 (0.4-1.8) 1.0 (0.5-2) 1.4 (0.8-2.5) 1.3 (0.7-2.4) 1.8 (1.1-3.0) 0.9 (0.5-1.8)

Other 18.4 (15.8-21.2) 20.6 (17.9-23.6) 20.9 (18.2-23.9) 38.5 (35.1-42.0) 37.6 (34.2-41.2) 14.3 (12.0-17.0) Don't know 2.9 (1.9-4.3) 1.7 (1.0-2.8) 2.3 (1.5-3.6) 5.7 (4.3-7.6) 4.9 (3.6-6.6) 2.4 (1.5-3.8)

Refused 0 0 0 0.2 (0-1.3) 0.1 (0-0.5) 0 (0-0.2)

27 2.3.4.

Figure 2-1 shows respondents’ ratings of the helpfulness of interventions, while Figure 2-2 shows rating of harmfulness (and see Appendix B, Table B 1 and Table B 2).

2.3.4.1

For the depression, depression with suicidal thoughts and early schizophrenia vignettes, GPs received the highest rating. For the other vignettes, counsellors received the highest rating. For all vignettes, dealing with the problem alone was considered the least helpful and the most harmful.

2.3.4.2

Antidepressants were considered the most helpful for all vignettes. Around 50% of survey

respondents rated antipsychotics as helpful for both schizophrenia vignettes. Vitamins and minerals were also relatively highly rated compared to other medications, with between 37.9 and 49.3% of respondents rating these as helpful.

Sleeping pills and tranquillisers were considered the most harmful medication across all vignettes, although pain relievers were considered more harmful than sleeping pills for PTSD.

2.3.4.3

For all vignettes, the most highly rated interventions were physical activity, reading about the problem, ‘getting out more’, learning relaxation and seeing a health educator.

Electroconvulsive therapy (ECT), being admitted to a psychiatric ward and having an occasional drink

were rated the most harmful across all vignettes. In addition, more people thought it would be more

helpful than harmful to have an occasional alcoholic drink to relax for the depression and anxiety

disorder vignettes.

28 Figure 2-1 Percentage of respondents rating each type of intervention as “helpful” for the person described in the vignette

0 10 20 30 40 50 60 70 80 90 100

Health educator Book Expert via email Website Special diet Occasional drink ECT Psychiatric ward Hypnosis Cognitive behaviour therapy Psychotherapy Cut out alcohol Learn relaxation Get out more Read about problem Physical activity Tranquilisers Antipsychotics Sleeping pills Antibiotics Antidepressants Pain relievers Vitamins/minerals Deal with alone Clergy Naturopath/herbalist Close friends Close family Psychologist Psychiatrist Phone counselling Social worker Counsellor Pharmacist GP

Percentage

Intervention

Social phobia PTSD

Depression Depression with suicidal thoughts

Early schizophrenia Chronic schizophrenia

29 Figure 2-2 Percentage of respondents rating each type of intervention as “harmful” for the person described in the vignette

0 10 20 30 40 50 60 70 80 90 100

Health educator Book Expert via email Website Special diet Occasional drink ECT Psychiatric ward Hypnosis Cognitive behaviour therapy Psychotherapy Cut out alcohol Learn relaxation Get out more Read about problem Physical activity Tranquilisers Antipsychotics Sleeping pills Antibiotics Antidepressants Pain relievers Vitamins/minerals Deal with alone Clergy Naturopath/herbalist Close friends Close family Psychologist Psychiatrist Phone counselling Social worker Counsellor Pharmacist GP

Percentage

Intervention

Social phobia PTSD

Depression Depression with suicidal thoughts

Early schizophrenia Chronic schizophrenia

30 2.3.5.

Table 2-6 shows the first aid intentions nominated by more than 1% of respondents in answer to the

questions about what they would do if the person described in the vignette was someone they knew

well or cared about. For all vignettes, listening and talking with the person was the most commonly

nominated response. For all vignettes other than social phobia, encouraging the person to see a

doctor was the next commonly nominated response. For the social phobia vignette, encouraging

socialising and spending time with the person were more common than encouraging the person to

see a doctor.