Litología identificada en la zona de estudio

Reflecting social stereotypes was commonplace in the focus groups, which would indicate that participants were expressing themselves freely without fear of Ôlooking badÕ among their peers. However, discriminating against mentally disabled children was something that did cause further discussion among participants, and those participants brave enough to actually share their fears or reflected social stereotypes faced strong censure from others in the group.

Ò- does it have to be near our house? I donÕt know what to say, it will be difficult to decide

xviii

Story details available at: http://www.landbou.com/News24/World/News/0,,2-10-1462_1415098,00.html, the Swedish focus groups were conducted on the 29th and the 30th of September 2003, the murders described here occurred on 11th September 2003. For a description of the impact such cases have had in Sweden see Lars Bevanger (2004) ÒSwedish Psychiatry in the DockÓ BBC News (19 January 2004) [online] http://news.bbc.co.uk/1/hi/world/europe/3408957.stm

- it is racist to say that you donÕt want it?

- these people donÕt belong to the margin of society, it is wrong to feel like thatÓ

Greece/male/20-30/single/no Children/standard education

7.8.9 Discussion

The questions about how focus group participants felt about plans to build a home for people with mental illness in their neighbourhood formed part of a larger discussion about Not-In- My-Back-Yard NIMBY issues, and trust in information provided by government and public agencies. In addition to asking about how the focus groups felt about building a home for people with mental illness in their neighbourhood, they were also asked similar questions about plans to build a mobile phone mast and a chemical plant making everyday items, like plastic or pharmaceuticals.

In a survey published in 1997, over two-thirds of the mental healthcare providers in England and Wales experienced local opposition to community mental health facilities in the previous 5 years.293 Most of the organisations also reported that the extent of opposition had increased over time. The Scottish Association for Mental Health, a voluntary sector organisation, recorded incidents of local opposition to community mental health projects in Scotland, which indicated a similar degree of resistance in Scotland.294

The differences in the way the term Òhome for people with mental illnessÓ was understood between groups means that care must be taken when interpreting the analysis, and in particular when attempting to deduce any differences between countries.

Angermeyer et al.295 examined publicÕs preference for social distance from people with schizophrenia. Social distance was assessed using a 5-point Likert scale for the extent someone was willing to have a social relationship with a person with a mentally ill person as a landlord, co-worker, neighbour, member of the same social circle, personal job broker, in-law or child care provider. Gender and educational status were not predictive of desire for social distance. There was an association with age: the older the respondent, the stronger the tendency to shun a person with mental illness. Beliefs about the aetiology of the mental illness and poor prognosis were also predictive. However the most important determinants of desire for social distance were perceptions of unpredictability of behaviour and dangerousness.

Angermeyer et al.296 also examined the association between desire of social distance and pity and with perceived need for help for people with mental illness. There was a positive association between perceived dependency and pity. However, there was also a positive correlation between perceived dependency and fear. Thus Angermeyer et al. concluded that the effect of perceived dependency on other emotional reactions was contradictory and evoked mixed feelings, and could positively as well as negatively affect peopleÕs desire for social distance.

As part of a survey conducted in Germany on knowledge and attitudes about schizophrenia297, 7,246 people were as asked during a telephone interview about their acceptance of a group home for 6-8 schizophrenia patients in their neighbourhood. 7.6% of interviewees would be supportive, 57.1% were indifferent, 30.7% would be worried and 4.6% would oppose the proposal. Of those 4.6% who opposed the plans, 53.8% said that they would try to prevent people from schizophrenia from moving into their neighbourhood. Anxiety and opposition

was highest among women and older age groups. Indeed women and older people also tended to display more anxiety about schizophrenia in other personal relationship and work contexts.

A survey conducted in Canada298 using similar methodology and questions also found that a majority (67.1%) of the 1653 respondents claimed to be indifferent about having a group home for 6-8 people with schizophrenia in their neighbourhood. However a larger minority of Canadian respondents were in favour (25.3%), with 7.6% opposed. Women were less likely to be indifferent than men (27.5% of women were in favour and 9.2% opposed). Logistic regression found that the oldest age group were almost three times more likely to express high social distance compared to their youngest counterparts. Those with the highest knowledge of schizophrenia were 10 times more likely to express highly tolerant attitudes, compared with those with the least amount of knowledge.

In both Germany297 and Canadia298, a majority believed that people with schizophrenia could be successfully treated outside of hospital in the community (68.1% in Germany, 65.4% in Canada). Similarly only a minority thought that people with schizophrenia are dangerous to the public because of violent behaviour (18.2%, Germany; 14.4%, Canada) or are a public nuisance due to begging or odd behaviour (12.9%, Germany; 18.4% Canada). Both sets of authors speculated whether their findings may be subject to a social desirability bias, with respondents giving answers that they though would be more politically correct, and hence concerns may be higher if there were actually plans for locating a home for people with schizophrenia within a respondentÕs neighbourhood.

However as Cowan has noted, there is a marked discrepancy between research studies on public attitudes to location of homes for people with mental illness and the experiences of organisations involved in consultation on, planning for and delivering community care.294 She suggested that this may be due to methodological limitations of such attitudinal studies such as the survey methods and attitude measurement scales used with hypothetical situations. Thus such studies fail to take into account the interactional complexity of attitudes expressed in real-life community care contexts and the way protagonists structure their arguments and rebuttals. Our European focus groups will also be limited by some of these methodological problems. Most notably, the scenario was hypothetical: the focus group participants were not being faced with a planning proposal for their own neighbourhood. However, the focus group methodology does allow debate and interchange of opinions between group members who hold different views.299 It also provides an opportunity for people to develop and explain their responses compared to a tick box or Likert type scale approach within quantitative research. Focus group participants may however feel reluctant to express views significantly different from the norm due to perceived group pressure.

Cowan294 attempted to explore more real public attitudes to locating homes for people with mental illness in, by studying public responses to such a proposal in a town in Scotland. She examined public documents such as correspondence in the local newspaper, and also conducted focus groups and interviews with people who supported and opposed the proposal. Opponents of the scheme raised the following objections: lack of prior consultation with local people and secrecy; unsuitability of the projectÕs location; and the type of residents who would live within the home. Opponents claimed that consultation would have provided more information about the scheme and hence allay public fears. However, the proposers of the scheme believed that calls for more consultation were really a means for attempting to veto the proposals. Opponents suggested that without the input of local residents, a location had

been selected in an area of Òvandalism and high volume pedestrian trafficÓ that was not suitable for patients and other residents. This line of argument was also seen within our focus groups, when some group participants suggested that people with mental illness would be more suitably located in more rural areas.

Angermeyer et al.300 examined the relationship between familiarity with mental illness and attitudes towards people with schizophrenia and depression. Familiarity was categorised according to whether the respondent themselves; a member of their family; or a friend/co- worker/acquaintance has undergone psychiatric treatment; or whether they had no personal experience of mental illness. Familiarity with mental illness inversely predicted the perception of dangerousness of people with schizophrenia and to a lesser extent also inversely associated with fear and social distance. Familiarity also was also inversely associated with perceived dangerousness of and desire for social distance from people with major depression. On the whole participants within our focus groups who had some degree of familiarity with mental illness tended to be more positive about locating a home for people with mental illness in their neighbourhood.

Lauber et al.301 also constructed a regression model examining factors influencing desire for social distance from mental illness using data collected in Switzerland. Four groups of predictor variables were found: the illness depicted (i.e. schizophrenia compared to depression); attitudes to general aspects of mental health; emotions towards those affected; and attitude toward consequences of mental illness. However, the regression model also found that survey respondents from the Italian-speaking part of Switzerland wanted greater social distance from the mentally ill.

Lauber et al.302 examined associations between linguistic areas in Switzerland with public attitudes on restriction on mentally ill people (withdrawal of the driverÕs licence, withdrawal of the right to vote and requirement to have an abortion). They found that living in the Italian or French part of Switzerland was a significant predictor of the acceptance of restrictions. Italian-speaking Swiss had stronger opinions than the French speaking but this was not significant.