One in five adults in the United States (U.S.) has some form of mental illness. Majority of people who are diagnosed with mental illness do not seek help for their problems. Among those who start treatment, one in five discontinue treatment prematurely. Negative attitudes toward patients with mental illness have been identified by people with mental illness as one of the barriers for seeking care and dropping out of treatment prematurely. The attitudes of the general public toward people of mental illness are generally negative: people with mental illness are perceived as dangerous to others or themselves, unable to make sound financial decisions, incapable of making decisions about their treatment, and not trustworthy. In spite of the training, healthcare providers’ attitudes toward people with mental illness mirror those of the general public. However, to date, no study has explored U.S. nurses’ attitudes toward people with mental illness.
Methods
This study took place in a 270-bed psychiatric hospital. All nurses (RN) employed in the hospital were eligible to participate. Ninety-one RNs filled out the surveys, representing a 65% response rate. The attitudes toward mental illness were assessed using the 12-item Devaluation – Discrimination (DD) questionnaire (4-point Likert-type scale). Six of the twelve items are reversed-scored. The scores of each item were added and then divided by twelve. Scores above 2.5 indicate beliefs in devaluation and discrimination. This questionnaire has been frequently used in stigma research and has demonstrated high reliability (alpha = .81 in this study).
Findings
The mean score on the DD questionnaire for all the respondents was 2.6, indicating almost a neutral attitude. Further examination of the responses indicated that closer contact with people with mental illness was associated with stronger beliefs in devaluation and discrimination of people with mental illness. Respondents employed in administrative staff member, who spent less to no time with mentally ill patients, endorsed opposite beliefs than the respondents employed in clinical staff positions, where they spent most of their work days in direct patient contact. Administrative staff members believed that most people would accept a former patient as a close friend, while the clinical staff members endorsed the opposite beliefs (p = .001). Administrative staff members agreed with the statement that people with mental illness were as intelligent as people with no mental illness while clinical staff members disagreed with that statement (p = .03). Administrative staff members endorsed beliefs that most people would take a former patient as seriously as anyone else, while clinical staff member considered the opposite (p = .002). Even though both groups believed that employers would hire a former patient with mental illness if he or she was competent for the job, administrative staff member expressed a stronger belief than the clinical staff members (p = .009).
All respondents endorsed stronger beliefs in devaluation and discrimination of people with mental illness with more intimate contact. Most respondents (76%) believed that people would not allow a former patient to take care of their children, or work as a school teacher (74%) even if the person recovered from his or her illness. Most of the respondents (64%) considered that young people would not want to date a person with mental illness, even if she or he recovered. Respondents did not endorse beliefs in devaluation and discrimination of people with mental illness regarding general beliefs. Most respondents endorsed the belief that employers would hire a former patient if he or she was qualified for the job (60%), and that most people would treat a former patient as an “average” person (53%). Majority of the respondents (58%) did not believe that having a mental illness was a sign of a personal failure.
Conclusion
Nurses in this study did not endorse strong beliefs in devaluation and/or discrimination of people with mental illness. Further research is recommended to determine if nurses employed in a non-psychiatric setting would endorse similar beliefs. It is also recommended to explore if closer professional contact with people with mental illness is associated with stronger beliefs in devaluation and discrimination of people with mental illness.