'Not in my backyard' : Public attitudes towards mental illness and people with mental illness living in sweden

Abstract: BACKGROUND Several studies reveal that inadequate knowledge exist regarding mental illness among the general population as well as stigmatizing attitudes towards persons suffering from a mental illness. The public s attitudes towards mental illness and people with mental illness can be summarised with the inference that the majority consider people with mental illness are in need of help and entitled to receive support; thus support the idea of social integration of individuals with mental illness. However, negative and stigmatizing attitudes towards persons with serious mental illness still present one main obstacle to overcome in order to facilitate social integration. AIM The overall aims of this thesis were 1) to explore, analyze and describe the public s opinions and attitudes towards mental illness in general and towards persons with a serious mental illness in particular, 2) to analyze the respondents attitudes in relation to their socio-economic background. An additional aim was to evaluate the reliability of an existing questionnaire; Community Attitudes Towards Mental Illness (CAMI), and subsequently adapt and develop the questionnaire in accordance with Swedish conditions. MATERIALS AND METHODS In sub-study I, nine psychiatric nurses were interviewed. Two men and seven women participated in the study. The method of interviewing and analysis was inspired by the constant comparative method of grounded theory . In sub-study II, nine psychiatric nurses were interviewed. Two men and seven women participated in the study and a qualitative content analysis was used for the analysis. In sub-study III, the English version of CAMI was translated into Swedish, renamed CAMI-S , and distributed to all nursing students who were in their second year of studies at three universities situated within large to mid-size cities in Sweden (n = 421). In sub-study IV, the CAMI-S questionnaire was supplemented with 9 items concerning the respondents intention to interact with a person with a mental illness and then renamed New CAMI-S . 5.000 questionnaires were sent out. The population consisted of a sample of Swedish residents aged 18-85 years. The sampling frame was based on the Register of Total Population (RTP) and consisted of all registered residents in Sweden aged 18-85 years. The number of individuals within the sampling frame included 7.055 235 people. An independent random sample, consisting of 5.000 people was extracted from the sampling frame; 2.391 (47.9%) of the 5.000 distributed questionnaires, were returned and analyzed. SUMMARY OF FINDINGS FROM EACH SUB-STUDY In sub-study I, the process of behaving as a nurse or not was identified as a core category. Four subcategories were identified: receiving involuntary information , to take action or not , behaving as a mediator in the neighbourhood and the freedom of choice . The findings show that psychiatric nurses with professional knowledge about mental illness have moral concerns about their role as nurses during their leisure time. In sub-study II, the nurses perceived that personal contact between the neighbour and the mentally ill person was one essential way to reduce fear of the mentally ill person. They viewed themselves as a link between the mentally ill person and other neighbours. Without the personal contact between the mentally ill person and the neighbours, there may be a risk that integration will fail, no matter how excellent the supported dwelling is framed. In sub-study III, a corrected inter-item-total correlation including all the 40 original statements, revealed a weak loading on 20 items and therefore was excluded. A factor analysis of the 20 items showed moderate to high loading, revealing the collected data could be adequately represented by extraction of three factors identified and labelled as; Open-minded and Pro-Integration, Fear and Avoidance and Community Mental Health Ideology. In sub-study IV, a majority of the respondents displayed moderately positive attitudes. Respondents within the age group 31-50 years, appear to have increased sympathetic attitudes towards persons with mental illness. Additionally; it is worth noting, that in contrary to previous research, results showed that persons with a lower level of education, tend to be more sympathetic towards persons with mental illness than persons with a high level of education. CONCLUSIONS A summary interpretation of the main findings contained within this thesis, reinforces the assumption that negative attitudes towards people with mental illness living in Sweden exists. This suggests that persons with mental illness frequently encounter stigmatizing attitudes in their surroundings as well as from mental health professionals. The present thesis also demonstrates that additional knowledge is not the only way to eliminate prejudices against mental illness and mentally ill people. Mental health professionals with knowledge also display stigmatizing attitudes, which implies that they, as well as other citizens, must examine their own moral attitudes, improve their ability to interact with persons with mental illness and become more tolerant in order to prevent alienation.