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British Journal of Psychiatry (1996), 168, 191-198

Community Knowledge of Mental Illness and Reaction 'to


Mentally 111 People
GEOFFREY WOLFF, SOUMITRA PATHARE,TOM CRA1G and JULIAN LEFF
Background. We test the hypothesis that negative attitudes to mentally ill people may be fuelled by
a lack of knowledge.
Method. A census of knowledge of mental illness was conducted in two areas prior to the opening
of long-stay supported houses for the mentally ill in each area. Three attitudinal factors ( Fear and
Exclusion, Social Control and Goodwill) which had been extracted by factor analysis of the
CommunityAttitudes toward the Mentally III (CAMI) inventory (see previous paper) were analysed in
respect of their associations with knowledge of mental illness. Results. Most respondents (80%)
knew of somebody who had a mental illness but a substantial proportion of respondents had little
knowledge about mental illness. Social Control showed an association with knowledge of mental
illness. Groups who showed more socially controlling attitudes (especially those over 50 years old,
those of lower social class, and those of non-Caucasian ethnic origin) had less knowledge about
mental illness. Regression analysis revealed that when knowledge was taken into account, age had
no effect on Social Control, and the effect of social class and ethnic origin was diminished.
Respondents with children, who showed more Fear and Exclusion, were not less knowledgeable
about mental illness. Conclusions. The results support the hypothesis that negative attitudes,
especially in older people, are fuelled by a lack of knowledge. Negative attitudes among people
with children are not related to a lack of knowledge.

The general public is coming into increasing contact


with the mentally ill with the shift towards communitybased care in the UK. The community's attitudes
towards the mentally ill will have a major influence on
the acceptance of the mentally ill and their social
.integration. These attitudes may be at least partly
determined by knowledge about mental illness. This
paper reports on community knowledge about mental
illness and reaction toward mentally ill people, prior to
the opening of group homes in the vicinity.
Method ,

Details of the survey, interviews and questionnaires are


given in the previous paper (WolfT et al, this issue).
Three factors had been extracted by factor analysis of
the Community Attitudes Toward Mental Illness
Inventory (CAMI). These were labelled Fear and
Exclusion, Social Control and Goodwill. Fear and
Exclusion included items such as "It is frightening to
think of people with mental problems living in
residential neighbourhood". Social Control included
items such as: "As soon as a person shows signs of
mental disturbance, he should be hospitalised".
Goodwill included items

such as: "We need to adopt a far more tolerant attitude


toward the mentally ill".
Statistical analysis
Analysis was carried out using SPSS (Norusis, 1988).
Tests of relationship of attitudes to knowledge and
behavioural intention variables were carried out using a
Student's <-test where the characteristic has two
categories (e.g. belief about the intelligence of the
mentally ill) and using a one way A-NOVA where there
were more than two categories (e.g. number of illnesses
named). Correlations were performed using Spearman's
r. Analysis of relationships between categorical
variables was carried out using ^2. The effect sizes (the
difference in means divided by the population standard
deviation) were calculated for associations with Fear
and Exclusion, Social Control and Goodwill (see
previous paper). Stepwise multiple regression was
carried out on factor analysis scores, sociodemo-graphic
and knowledge variables.
Results
Two hundred and fifteen people were interviewed.
Further details of the respondents are given in the
previous paper.
191

192

WOLFFETAL

Table 1
Relationship between knowledge of mental illness and mental handicap and the belief that the mentally ill may be
less intelligent v. Fear and Exclusion (factor 1), Social Control (factor 2) and Goodwill (factor 2)
Social Control

Feat and Exclusion

Mean

(s-d.)

Number of illnesses named


None (n=38)
-0.13
(095)
1 (n=36)
-0.17
(0.97)
2(n=48)
-0.04
(1.00)
3 or more (n=67)
0.21
(0.81)
P
NS
Definition, distinction and example of mental handicap <
Incorrect (n=141)
-0.03
(0.94)
Correct (n=50)
0.11
(0.91)
P
NS
Belief about intelligence
Less intelligenVdon't know
-0.28
(0.89)
No difference/more intelligent
0.08
(0.93)
P
<0.05

Mean

(s.dJ

Goodwill

Mean

(s-d)

0.86
0.08
-0.18
-0.50
< 0.001

(0.96)
(0.66)
(0.71)
(0.61)

-0.05
006
-0.12
0.11
;! NS

(054)
(0.81)
(0.79)
(0.80)

0.11
-0.49
< 0.001

(0.91)
(0.59)

-0.07
0.25
i <0.05

(0.86)
(0.68)

0.73
-0.20
<0.001

(1.09)
(0.74)

-0.08
0.03
NS

(1.02)
(0.77)

Analysis; Student's t-test and one wayANOVA.

Knowledge of mental illness


Naming of mental illnesses
Twenty-one per cent of respondents couldn't name any
types of mental illnesses; 19% could only name one and
60% could name two or more. The mean number of
correct mental illnesses ^cited was 2.1 (s.d,-L8).
/ Schizophrenia was by far the most commonly
know.n-.type of JnentalJllness (74%). This was
followed by depression (39'%), manic-depression
(19%) and paranoia (13%). It is noteHortby that some
people cited Munchausen's syndrome by .proxy as a
mental illness as they had heard of this in the media in
relation to the Beverley AUitt case. (In April 1993,
Beverley Allitt was found guilty of murdering four
children, attempting to murder three and injuring six.
She was~reported as having Munchausen's syndrome
by proxy (Dyer, 1993).) This, and other cases, may have
accentuated some people's fears about the mentally ill
being a danger to their children (see previous paper).
Knowledge of mental handicap and its distinction from
mental illness

Forty-six per cent of respondents were able to give the


correct definition of mental handicap (a definition was
deemed correct if the respondent included some notion
of low IQ, including "learning difficulties", or that it
was both from birth and a permanent state); 49% were
able to give a correct

example of mental handicap .(most cited Down's


syndrome); and 52% were able J.O , distinguish
correctly between mental illness and mental handicap.
Only 25% of respondents, however, could do all three
correctly.
Belief that the mentally ill may be less intelligent
Most respondents (74%) thought that the mentally ill
were no more or less intelligent than other respondents.
A further 9% thought they were less intelligent, 9%
didn't know and 8% thought they were more intelligent.
An example of a comment from a respondent who
believed the mentally ill were more intelligent is as
follows: "They're more intelligent. Some of them like
books they study so much it overpowers them".
The association between knowledge of the mentally ill
and Fear and Exclusion, Social Control and Goodwill

Respondents who could name one, two or .atJeast. three


mental illnesses showed less Social Control than those
who could not name any (effect sizes 0.88, 1.18 and
1.55 respectively;^" <0.001). There was no. association
with Feaf, and Exclusion or Goodwill (Table 1).
Respondents who could correctly define mental
handicap, give an example and distinguish it from
mental illness showed less Social Control (effect size
=0.68) and more Goodwill (effect size =0.38). There
was no association with Fear and Exclusion (Table 1).

COMMUNITY KNOWLEDGE OF MENTAL ILLNESS

193

Table 2
Ability to name at least two mental illnesses v. sociodemographic group, knowing somebody with mental illness and
having suffered from mental illness
Group
Able to name Group
Able to name
rf.P
two mental
two mental
illnesses
illnesses
Non-Caucasians (n=12)
27% 38% 41% Caucasians (n=201) Sodal
71% 72% 71% x^ai.seiid.t^.tO.ool
Sodal dassB-V(/=72)
32% f 52%
class I and II (n=138) A'
65% 70% 64% ]C^23Wd.i:P=<0.00\
O'tevel/betow (n=78)
( 54% 33%
level/above (n=135) Aged
67% 88%
X^I&Bftlcl.t^.cO.OOI
Aged over 50 (n=34)
56%
under 50 (n=T79) Less than
^=12.98;
3reater than 5 years in
5 years in street No children
1d.t;P=<0.001
street Children in
in the household (n=135)
t^m,'\iii;P=<0.<n
household (ff=78) Don't
Know somebody (ff=170)
^ZOOild.tiNS
know anybody (<7=43)
Suffered mental illness
X2=17.03;1d.t;^=<

Table 3
Ability to distinguish between mental illness and mental handicap and give an example of mental handicap v.
sociodemographic group, knowing somebody with mental illness and having suffered from mental illness
Sioup
Able to
Group
Able to
f.P
distinguish
distinguish
'ton-Caucasians (f>=52)
social dass ffl-V (n=72) 0
level/below (n=78)
\gedover50(/7=34) 3reater
than 5 years in street
(n=114) children in
household (/i=78) )on't know
anybody (f=43) tat suffered

12% 8% 9%
6% 19%
19% 14%
24%

Caucasians (/=163) Sodal


class land II (n=140) A
level/above (n=137) Aged
under 50 (n=181) Less than 5
years in street (n=101) No
children in household (n=137)
Know somebody (/)=T72)
Suffered mental illness (n=24)

Respondents who thought that the mentally ill nay


be less intelligent showed more Fear and Exclusion
(effect size =0.36) and more Social Control (effect
size= 1.00). There was no associa-ion with Goodwill.
Social Control was associated with all three knowedge variables and effect sizes were large whereas
'Joodwill and Fear and Exclusion were associated
with )nly one and effect sizes were modest.
knowledge about mental illness in different
ociodemographic groups
,

Groups which had shown independent associations see


previous paper) with higher Fear and Exclusion those
with children in the household), higher Social control
(lower social class, people of non-Cauca-ian ethnic
origin (Africans, Asians and Carib->eans), people
aged over 50, people who had lived onger on the
street, people with children in the lousehold, and
people who had not suffered from a riental illness) or
lower Goodwill (lower educational svel, Asians) were
compared with the rest of the espondents to
determine^whether they were less inowledgeable.

^e^id.ti/'^o^
f^WS-.Mt-.f^^.Wn
X2=1R20;1d.t;/^<
0.001 ^=7.66; 1d.t;/'=<
0.01 J^ZWdi.HS
^.Wiil-.HS
^=331;1d.t;NS
/=0.35;1d.t;NS

Respondents were less likely to be able to name at


least two mental illnesses correctly if they were of lower
social class, of lower educational level, non-Caucasian,
older or longstanding residents in the street. People who
had not suffered from a mental illness or who did not
know anybody who had suffered from a mental illness
were also less likely than other people to be able to
name at least two mental illnesses correctly. There was
no difference in knowledge of names of mental illness
in respondents with or without children (Table 2).
Respondents were less likely to be able to define and
give an example of mental handicap, and distinguish
mental handicap from mental illness, if they were of
lower social class, of lower educational level, nonCaucasian or older. There was no association with
having children, having suffered from mental illness,
knowing somebody who had suffered from a mental
illness or length of time in the street (Table 3).
Respondents were more likely to think that the
mentally ill may be less intelligent if they were of lower
social class, of lower educational level, non-Caucasian,
older or longstanding residents in the street. There was
no difference in the belief that the

194

WOLFF ET AL

Table 4
Belief that the mentally ill may be less intelligent v. sociodemographic group, knowing somebody with mental illness
and having suffered from mental illness
Group
% believe the Group
% believe the ^.P
mentally ill
mentally ill
less
less intelligent
intelligent
Non-Caucasians (n=52)
39% 32%
Caucasians (n=162)
12% 11%
X^IReftld.t;^ 0.001
Social class 111-V (n=72)
33% 50%
Sodalclasslandll(/)=139) A
10% 12%
^14.37,-ld.t;^^
0' level/below (n=78) Aged 24% 20%
level/above (n=136) Aged
12% 18%
0.001 ;
over 50 (n=34) Greater
23% 18%
under 50 (n=1SO) Less than 17% 17%
C2=18.80;1d.t;/=<
than 5 yeais in street (f?
5 years in street (n=101) No
0.001 ^ZJWiit.f^^.Wn ]
=T13) Children in
children in household (n=137)
^SWiii:P=<0.06
household (n=77) Don't
Know somebody (ff=171)
X^OI^Id.t.-NS
know anybody (n=43) Not
Suffered mental illness (n=24)
X^O.^Id.t.NS ^O.OZsuffered mental illness
ld.tiNS

mentally ill may be less intelligent in respondents with


or without children, those who had suffered from
mental illness or knew somebody who had suffered
from a mental illness (Table 4).
Thus, all the groups with more negative attitudes,
except those with children, showed lack of knowledge
of mental illness on at least one of the knowledge
variables.
Multiple
regression
analysis,
however, ),eyealedthat knowledge variables had an
independenTeftect on Social Control only, and not on
Fear and Exclusion or Goodwill.
In the previous paper, regression analysis showed
that the contribution of various sociodemographic
variables on Social Control were as follows: social
class (Beta =0.40, P= 0.001); ethnic origin (African:
Beta=0.27, J'>=0.001; Asian: Beta=0.19, P=0.00l;
Caribbean: Beta=0.18, /'=0.001); age (Beta=0.15,
P=0.05); length of time in the street (Beta =0.20, P =
0.01) number of children under the age of 18 in the
household (Beta = 13, P=0.05); and having suffered
from mental illness (Beta=0.13, P=0.05) (Multiple J?
=0.72, F= 24.01, d.f. =8, ^<0.001).
When knowledge variables such as the belief that the
mentally ill may be less intelligent (Beta =0.15,
P<0.01) and the number of mental illnesses named
(Beta = 0.12, P < 0.05) were introduced into the multiple regression analysis of sociodemographic variables
and Social Control, age no longer exerted an
independent effect and the contribution of social class
and ethnic origin was reduced (social class
(Beta=0.35, /'<0.001); ethnic origin (African:
Beta=0.22, P<O.Q5; Asian: Beta=0.15, P<O.Ql;
Caribbean; Beta=0.13, P= 0.001); length of time in the
street (Beta =0.25, P< 0.001) number of children under
the age of 18 in the household (Beta =0.12, P=0.05);
and having suffered from mental illness (Beta =0.12,
P=0.05) (Multiple J?=0.74, F= 23.21, d.f.
=9, /'<0.001). The ability to define and give an example
of mental handicap and distinguish mental

handicap from mental illness snowed no associations


with any of the three attitude factors.
Identification of mental illness
* Most respondents
(78%) thought they could tell if somebody was
mentally ill. The most common ways of telling were by
strange, or odd behaviour (73%), odd speech (63%), the
way they dress (32%), facial expression (25%) and
aggression (24%).
Causes of mental illness
The most commonly cited causes of mental illness were
environmental (83%). Most respondents cited stress as
the main cause. They tended to break this down into
relationship, family, work and financial problems and
bereavement. Other causes cited included heredity
(39%), organic causes (22%), accidents (11%) and
substance abuse (21%). Most respondents (73%)
believed that mental illness could be passed-down in
families.
Where to get help

Most respondents (70%) said that they would contact a


GP if a friend or neighbour was showing ^igns.of
mental illness. Other important contacts were: social
worker (26%), hospital (24%), police (22%), the
patient's family (22%), and one of the patient's friends
(14%). Africans and Caribbeans were twice as likely to
say they would contact the police than others (36% v.
18%; ^=6.59; d.f. = 1; />=0.01). Women were more
likely to contact the GP than men (75% v. 61%;
X2 = 4.67; d.f = 1; P = < 0.05). Respondents of a lower
educational level (basic education) were more likely to
contact a hospital than those of a higher ('A' level and
above) educational level (34% v. 18%; ^=6.39;
d.f.=l; P= <0.05). Respondents of a lower social class
(III-V) were more likely to contact a hospital

COMMUNITY KNOWLEDGE OF MENTAL ILLNESS

than those of a higher (I & II) social class (34% v. 19%;


^= 5.28; d.f.=l;P=< 0.05).
Treatment of mental illness
Most respondents knew of drug treatment (75%) and
psychotherapy (59%). Few respondents (12%) cited
social treatments for mental illness. Eighty per cent
thought that mental illness could be controUed by
treatment, 43% thought it co.uld cure mental illness
(Caribbeans were less likely to say that treatment cures
mental illness than other groups (16% v. 48%; ^=
11.66; d.f. = 1; = <0.001)) and 15% thought it made it
worse,( often by over-sedating the patient and making
them 'like a zombie'. Respondents aged under 50 were
more likely to say that treatment makes mental illness
worse than those of aged 50 or over (17% v. 3%;
X2=11.69;d.f.=l;JO==<0.05).
Aggression and the mentally ill

A. significant proportion (43%) viewed the mentally ill


as being more aggressive. A further 42% thought there
was no difference, 13% didn't know and 2% thought
they were less aggressive. It is noteworthy that the
mean Fear and Exclusion score was similar in the
groups who thought they were more aggressive and
those who didn't know. This is consistent with the
hypothesis that there is an element of'fear of the
unknown' in people's responses toward the mentally ill.
Respondents who felt that the mentally ill may be more
aggressive showed more Fear and Exclusion (effect
size =0.63) and more Social Control (effect size =0.56)
than those who did not. There was no association with
Goodwill. There was no association between any of the
sociodemographic variables and the belief that the
mentally ill were more aggressive except educational
level. Seventy-one per cent of respondents of a lower
educational level ('0' level and below) and 47% of
higher educational level ('A' level and above) believed
that the mentally ill may be more aggressive (y1^ 11.36;
d.f,= 1; P= <0.001).
Experience of mental illness
The majority of respondents (80%) knew of somebody
who had had a mental illness; 30% of respondents said
either themselves or somebody in the family had
suffered from mental illness; and 13% said they had
suffered from a mental illness themselves. There was
an. association between knowing somebody with a
mental illness or having suffered from a mental illness
and less Social Control (see previous paper).

195

Source of information about mental illness


Many respondents received most of their information
about mental illness through personal experience of
somebody with a mental illness (33%) and through the
media (32%). A further 10% acquired their information
through friends and relatives and 26% from other
sources such as from their academic studies or through
their work.
Reaction toward the mentally ill
About two-thirds of respondents thought that other
people would treat psychiatric patients negatively
(usually by being wary or avoiding them). A typical
example is as follows: "(People would treat them
differently), especially if children were involved.
Children would most probably be told to keep well
away. People would point them out as those people
being mentally ill. As soon as that hostel over the road
was built, everyone knew about it and everyone had
their own views on it, some good but the majority bad".
A significant minority of respondents (42%) said
they, themselves, would treat a former psychiatric
patient differently (or were unsure or gave a qualified
answer). Of those who said they would or might treat
patients differently, most said they would treat them in a
negative way such as being wary of them: "Most
probably deep down in the back of my mind I'd be
frightened that they might try and attack me if I said the
wrong thing". Only a few said that they would make a
positive effort: "I think I'd probably go over the top to
try and be normal. I'd probably make a real effort to say
hello in the morning and that sort of thing."
The majority of respondents (60%) said they would
have neighbours with psychiatric illness as friends and
only 1% said they would have, no contact with them at
all. People who said they would have them as friends
showed less Fear and Exclusion (effect size =0.67; P=
< 0.001) and more Goodwill (effect size =0.28; P=
<0.05). Some respondents (23%) thought that they
might have problems with neighbours with psychiatric
illness, 6% said it depends and 71% thought they would
have no problems. Most respondents (90%) said that
they had no reservations about working with somebody
who has had a mental illness. There was an association
between expressing reservations and more Fear and
Exclusion (effect size =0.88;
P= <0.001). There was no association with sociodemographic characteristics such as having children.
Most respondents (87%) did not think that people
were to blame for being mentally ill. There

WOLFF ET AL

196

was an association between expressing the view that


they may be to blame and more Social Control (effect
size = 1.23). Non-Caucasians, respondents of a lower
social class and those of a lower educational level were
more likely to say that the mentally ill were to blame
for their illness. There was no association with age,
having children, length of time in street, having
suffered from mental illness or knowing somebody who
had suffered from a mental illness (table available from
authors).
Respondents who thought that most people would
object to ex-long-stay psychiatric patients living in the
neighbourhood showed more Fear and Exclusion
(effect size=0.76; P= <0.001) than those who didn't.
Only 9% said that they would object to ex-long-stay
psychiatric patients living in the neighbourhood and a
further 18% had reservations. However, the vast
majority (73%) had no objections at all. Those who said
they would or might object showed more Fear and
Exclusion (effect size=D.97; P=< 0.001). Respondents
with children were over three times more likely to say
that they would object to ex-long-stay psychiatric
patients living in the neighbourhood (17% v. 5%;
^= 12.86; d.f.=2; P= <0.01).
Mental illness came third (13%) in respondent's first
choice of charity, behind sick children (43%) and
cancer (38%). Diabetes fared worst of all with only 5%
of respondents ranking it first. Respondents who ranked
mental illness first showed less Social Control than the
other groups (effect size =0.45; P= <0.05).
Discussion

The results show that most respondents have some


knowledge of mental illness and that the majority knew
of somebody who had suffered mental illness. Indeed,
our subjects showed greater understanding of the
distinction between mental illness and mental handicap
than those studied by Reda (unpublished) who found
that 35% could distinguish correctly. This may be
accounted for by the higher educational level (and
younger age) of our sample as we showed that
knowledge of the distinction is related to educational
level and age. However, we found that only 25% had a
deeper understanding and could give an example of
mental handicap.
Our finding that the vast majority of people believe
that environmental causes such as 'stress' are important
causes of mental illness is consistent with the findings
of other authors. MORI (1990) and Maclean (1969)
found that 66% and 83% respectively saw stress as a
major cause.

Previous studies have found that around 50% of


people have personal experience of the mentally ill
(Maclean (1969) found that 55% and Richards (1982)
found that 42% had experience of the mentally ill);
around 30% have relatives with mental illness, and
around 6% admit to having had suffered with mental
illness themselves (Maclean, 1969). Our figures are, on
the whole a little higher and may reflect a broader
definition of mental illness in our population, a higher
prevalence or a higher rate of reporting.
Our finding that women are more likely to contact a
GP than men is consistent with the findings of
Brockington et al (1993). We found that respondents of
African and Caribbean origin were more likely to call
the police. This may influence pathways into care in this
population.
There was a widespread belief that, the mentally ill
were more aggressive than other people (43% believed
this). This is in keeping with previous studies (Belson
(1957) Maclean (1969) and Bhugra & Scott (1989)
found that 40%, 33% and 17% respectively perceived
the mentally ill as dangerous).
It is interesting that a minority of respondents
believed that the mentally ill were more intelligent than
other people. They often described them as more
sensitive. This notion may well have its roots in the 18th
century Chcynian view of nervous disorders. In The
English Malady, Cheyne (1733) stated:
"The common Division of Mankind, into Quick Thinkers,
Slow Thinkers and No Thinkers, is not without Foundation in
Nature and true Philosophy. Persons of slender and weak
nerves are generally of the first class".
Reaction to mentally ill people
A minority of respondents (9%) had objections to expsychiatric patients living in their neighbourhood. This is
similar to the percentage found a decade previously by
Richards (1982). However, a much greater number say that
they may treat patients differently, often by being wary of
them. This may well have a bearing on patients' reintegration
into the community.
The relationship between knowledge and attitude factors
It was shown in the accompanying paper that there was an
association between certain sociodemo-graphic variables and
Fear and Exclusion (having children). Social Control (social
class, ethnic origin, age, length of time in the street, having
children and

COMMUNITY KNOWLEDGE OF MENTAL ILLNESS

having suffered from mental illness), and Goodwill


(educational level, ethnic origin). In this paper, we have
shown that Social Control is the main factor associated
with lack of knowledge and that high Social Control
groups (except those with children) have a lack of
knowledge about mental illness.
These findings support the hypothesis that one of the
underlying determinants of Social Control in these
groups is a lack of knowledge about mental illness.
However, these findings do not prove causality and
there may well be other confounding factors which
mediate this relationship.
Fear and Exclusion in respondents with children was
not related to lack of knowledge of mental illness or the
belief that the mentally ill were actually more
dangerous. People with children do not seem to have a
different view of the mentally ill but an accentuated
wariness because of their children's vulnrfability.
Conclusion

If there is a causal relationship between lack of


knowledge or experience of the mentally ill and
negative attitudes, it may well be that an educational
intervention will improve attitudes and this may
facilitate patients' rehabilitation. We are testing this
hypothesis by evaluating the effect of an educational
campaign on community attitudes and patients' social
integration.
Clinical implications
Any interventions aimed at changing attitudes
should take into account the negative attitudes of
people with children and non-Caucasians.
As negative attitudes are associated with lack of
knowledge, education may possibly improve attitudes and help patients' reintegration into the
community.
Socially controlling attitudes and lack of knowledge
in people of African and Caribbean origin may
have an influence on pathways into care and have
implications for their subsequent clinical
management.

Limitations
Our population is not representative of the general
population, therefore any inferences drawn about
the population as a whole should be tentative.
The results may be biased by a social desirability
response set and people's stated attitudes may not
be correlated with actual behaviour.
The study has not elucidated the main determinants
of attitudes as total predictive power was small and
associations do not prove causality.

197

Appendix 1. Interview questions


(a) Demographic data: age, sex; marital status; composition of
household; number of children under 18;
occupation; social class; educational level; length of time in
the accommodation; housing tenure; ethnic origin.
(b) Knowledge of mental illness: Do you know the names of
any types of mental illness? (What are they?); Do you know
what mental handicap means? (What is it?); Can you give me
an example of mental handicap?; Do you think there is a
difference between mental illness and mental handicap? (What
is it?); Can you tell that somebody is mentally ill?; How would
somebody be able to tell if somebody is mentally ill? (Is it
things they say? Is it things they do? Is it the way they look?);
What do you think are the main causes of mental illness?; Do
you think that mental illness can be passed down in families?;
If a friend or neighbour of yours was showing signs of mental
illness, who would you contact for help?; What sort of
treatment is there for mental illness?; Are mentally ill people
more or less likely to be aggressive than other people?; Do you
think mentally ill people more intelligent, less intelligent or the
same as other people?; Where did you get most of your
information about mental illness?;
Do you know somebody who has had a mental illness? (Who
is it? What is your relationship with them?); Have you, or any
member of your family ever suffered from a mental illness?
(c) Reactions toward the mentally ill: If somebody who had
been a former psychiatric patient came to live in the
neighbourhood, do you think people would treat them
differently from other people? (In what ways?); Would you
treat them differently (In what ways?) Contact with neighbours
and expected contact with neighbours with psychiatric illness.
Problems with neighbours and expected problems with
neighbours with psychiatric illness? Would you mind working
with somebody who has had a mental illness? What do you
think about the idea that people might have themselves to
blame for being mentally ill? Would you/people in the
neighbourhood attend a club which ex-psychiatric patients
were also attending? Do you think other people would object
to ex-long-stay psychiatric patients living in the
neighbourhood? Would you object to ex-long-stay psychiatric
patients living in the neighbourhood? Would you talk to your
friends about a relative who is mentally ill? If you had got
some money to give to charity, which one of these charities
would you most likely give to? (Diabetes, mental illness, sick
children, cancer.)
(d) Knowledge of psychiatric hospital care: Do you know
somebody who is or has been in a psychiatric hospital? Have
you visited a psychiatric hospital?
(e) Attitude to psychiatric hospitals: What is your opinion
about psychiatric treatment in hospital? Would you encourage
a friend or a relative to go into a psychiatric hospital if they
experienced a mental illness? (0 Knowledge of the shift to care
in the community: Do you know of any alternatives to
treatment in psychiatric hospitals? Have you heard about the
policy to close psychiatric hospitals and move patients into the
community? If yes, where did you hear about this policy? If
yes,

198

WOLFF ET AL

where did you get most of the information about the policy? Is them occasionally? Would you have casual conversations with
anything like this happening in your area? If yes, where did neighbours who had suffered from mental illness? If
you hear about this? If yes, where did you get most of this somebody who had been a former psychiatric patient came to
information about it? Did they know about the hostel? If yes, live next door to you, would you visit them? (Responses: very
was it because of our survey? (g) Attitude to community care likely, likely, uncertain, unlikely, very unlikely.)
policy: What is your opinion of the policy to close psychiatric
hospitals? What do you think of the idea of long stay
psychiatric patients being discharged from hospital into small
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Geoffrey Wolff, MRCPsych, Institute of Psychiatry; Soumitra Pathare, MRCPsych, Tom Craig, PRCPsych,
Academic Department of Psychiatry, St Thomas's Hospital, UMDS; Julian Leff, FRCPsych, MRC Social,
Genetic and Developmental Psychiatry Research Centre (Social Psychiatry Section), Institute of Psychiatry
Correspondence: Dr Geoffrey Wolff, MRC Social, Genetic and Developmental Psychiatry Research Centre (Social Psychiatry
Section), Institute of Psychiatry, DeCrespigny Park, Denmark Hill, London SE5 8AF. E-mail:
gsw@scpu.mrc.ac.uk
(First received 4 April 1995, final revision 4 July 1995. accepted 18 October 1995)