Background to
the Research
- Since
the policy of reducing the number of long-stay patients began in Northern
Ireland in 1987, the extent to which former patients have integrated
with the wider community has depended on the attitudes of the people
amongst whom they live. The aim of this preliminary report was to investigate
the response of a segment of the local community in Newtown to the discharge
of long-stay patients from hospital.
- Only
102 long-stay patients were discharged from hospital over the five years
1987-1992, hence the majority of the population are unlikely to have
experienced direct contact with this group. The project focused therefore,
on the attitudes, behaviour and reactions of those members of the community
in Newtown who had contact with former patients.
Research
Approach
- The study
sample was selected on the basis of including 'in contact groups' which
varied in the type and the degree of contact experienced. These forms
of contact were: living in neighbourhoods containing a CMH facility;
being a befriender of a former patient and being a relative of a former
patient. Also included were a group of pupils from local schools all
of whom had learned about mental illness in an educational programme.
The sample consisted of 114 individuals in total.
- The interview
schedule comprised two parts: Part 1 was structured and Part 2 semi-structured.
Data collection was over a three month period between December 1990
and February 1991.
Main
Findings
Knowledge
and Opinions About Community Care and Local Services for Mentally Ill
- Questions
about the policy of community care for the mentally ill, local services,
gaps in services and the mental hospital produced a range of opinions.
One in ten respondents had no knowledge of community care or local services
for the mentally ill.
- Over
a third had no knowledge of gaps in services and a quarter of the sample
had had no contact with a mental hospital in any capacity. On the other
hand, a quarter of the sample gave ideological support to the policy
of community care and knew local voluntary services for the mentally
ill. Two thirds of the sample contributed valuable suggestions to fill
gaps in services and a similar proportion had experience of a mental
hospital.
- The overall
picture is of a public with relatively little knowledge of community
care policy, although this impression may have been caused by public
ignorance of the term 'community care'.
- When
asked their impression of a typical psychiatric hospital, half of the
sample viewed it in negative terms, suggesting that there is still a
long way to go before psychiatric hospitalisation is no longer viewed
as a discrediting experience.
- The fact
that respondents are overwhelmingly positive towards their local CMH
facilities is encouraging and indicates an acceptance of community care
for people with mental illness in the local area. The level of support
for an existing facility is higher than that reported for a hypothetical
facility.
- The majority
of the sample viewed residential neighbourhoods as the most suitable
location for CMH facilities, suggesting that present policy has the
support of the local people as represented by the sample.
Attitudes
Towards People with Mental Illness
- Respondents'
responses to the forty statements which make up the CAMI Scale are positive
on all four scales. This was particularly marked on the benevolence
dimension and least so on the authorisation scale. Overall, the study
found attitudes towards people with mental illness to be overwhelmingly
positive.
- Overall,
the respondents strongly rejected institutional care and expressed a
desire for improvements in the quality of life for people with mental
illness.
- A significant
association was found between type of sub-group and attitudes expressed
in a number of statements. For example, it was clear that relatives
gave more support to the need for early hospitalisation, the differences
between people with mental illness and others and their lack of responsibility.
These attitudes may be a reflection of their own experiences of mentally
ill behaviour in their family.
- Respondents
were markedly less positive on statements about bringing people with
mental illness into their personal and family life. This neutral response
may cloak a desire to maintain social distance from people with mental
illness.
- School
pupils were more cautious about the location of CMH facilities in residential
areas. They were less in contact with former patients than the other
sub-groups, so it may be that their attitudes are more in line with
those of the general population.
- People
who lived in neighbourhoods containing a facility showed a strong level
of support for community mental health ideology. The neighbourhood population
studied were predominantly married, with young children, Social Class
III to IV, and living in public housing. This indicates that such neighbourhoods
are likely to represent supportive host communities.
The Social
Life of the Former Patient
- The nature
of interaction between former patients and their neighbours is influenced
by the former's social skills and the latter's knowledge of the individual
as an ex-patient. Contact chiefly occurred outside their homes, for
instance, to and from work and at the shops. Although these were exceptions,
there were two examples of closer friendship between former patients
and local patients i.e. attending church and going to bingo together.
Residents described former patients as 'good neighbours' and gave examples
of their helpfulness.
- When
volunteers gave friendship to former patients, there were special difficulties
resulting form the condition of chronic mental illness. On the one hand,
these included an unpredictable response from the former patient, sustaining
the friendship over time and providing opportunities for satisfactory
activity. On the other hand, there were problems with setting limits
on the amount of contact and avoiding being over-burdened by confidences.
- Families
provided one of the main forms of social contact for former patients.
However, the extent of contact was influenced by the course of the mental
illness at home prior to hospitalisation. Relatives were concerned about
the issues of medication and activity, income maintenance and staff
supervision in the community.
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