Does the Community Care? A Study of the Views and Attitudes of People in Contact with Former Long-stay Patients Discharged from a Northern Ireland Hospital

Author(s): Roger Manktelow
Commissioner(s): Northern Health and Social Services Board and Queen's University Belfast
Document Type: Report
Publisher: Health and Health Care Research Unit, Queen's University Belfast
Place of Publication: Belfast
Year: 1992
Subject Area(s): Social Care, Health

Abbreviations: CAMI - Community Attitudes Towards the Mentally Ill, CMH - Community Mental Health

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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