Attitudes Toward the Mentally III and Community Care Among Professionals and Their Students

Paul D. Mangum, M.S.* Kevin M. Mitchell, Ph.D.

ABSTRACT: On the premise that effective community care of the mentally ill is enhanced if relevant professionals share similar attitudes regarding the mentally ill and community as opposed to institutional care, such attitudes were examined among 117 faculty and graduate students in a major south- eastern land-grant university in clinical psychology, law, and social work. The relationship between age and these attitudes and the possibility of a generation gap between faculty and students regarding these attitudes were also examined. In terms of comparisons among disciplines, faculty and students in social work were more positive in their attitudes than their counterparts in clinical psychology and law. The greatest difference within disciplines usually was between first-year students and faculty. In addition, relatively more differences were found to exist between faculties and students in both clinical psychology and law than in social work. Finally, analysis of the data indicated that there were no statistically significant relationships between age and any of the attitude scores.

The primary purpose of the present study was to com- pare the attitudes of three relevant professional groups (clinical psychol- ogy, law, and social work) and their students toward the mentally ill and community care of the mentally ill. An assumption underlying the pres- ent investigation is that if the mentally ill are to be cared for effectively in the community, relevant professional groups must share certain at- titudes toward the mentally ill and community care that are basically hu- manistic and tolerant. It is our contention that such care will be dis- rupted if both conditions do not prevail in the community; that is, mental health attitudes must be enlightened and shared by key professional and citizen groups.

As a first step, the focus in the present study was on academic facul- ties and students at a major southeastern land-grant university. Al- though it is likely that university-based groups hold more liberal atti- tudes generally than persons in the community, the present focus was chosen because these data are essential to comparisons with community groups that will be made in later studies.

*This paper is based on a master's thesis by Mr. Mangum done under the direc- tion of Dr. Mitchell at the University of Georgia in partial fulfillment of the requirements for the M.S. degree. Dr. Mitchell is affiliated with the Department of Psychology, University of Georgia, Athens, Georgia 30601.

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Paul D. Mangum and Kevin M. Mitchell 351

THE SCALES

Three separate scales were used: (1) Opinions About Mental Illness (OMI), (2) The Community Mental Health Ideology Scale (CMHIS), and (3) The Community Oriented Programs Environment Scale (COPES). The OMI was developed originally by Cohen and Struening (1962) to measure attitudes toward mental illness on five fac- tors. Ellsworth (1965) added several items which led to three additional factors.

The second measure was the 38-item Community Mental Health Ideology Scale (CMHIS) developed by Baker and Schulberg (1967) to measure adherence to a community mental health ideology. It has suc- cessfully discriminated groups known to be highly oriented to commu- nity mental health ideology from random samples of mental health pro- fessionals (Baker & Schulberg, 1967).

The third scale was the Community Oriented Programs Environment Scale (COPES) which is an adaptation of the Ward Atmosphere Scale (WAS) developed by Moos and Houts (1968). The "ideal form" (Form I) was used in the present study. The primary difference between the WAS and COPES is that the latter was designed to measure attitudes about community programs for treatment of the mentally ill. The bulk of the changes consisted of rewording i tems--for example, using the term "member" instead of "patient" and "program" rather than "ward." For the sake of brevity, the three scales are not described in further detail. In addition, the results are given in outline form but all tables, statistics, and alpha levels are omitted. An expanded version of the paper can be obtained by writing Dr. Mitchell.

METHOD

Subjects The Ss included 117 faculty and students from the three disciplines at

the University of Georgia. They came from a larger stratified random sample of 300 who were asked to participate in the study. The Ss included: (1) 36 law students, of whom 16 were first year, 11 were second year, and 9 were third year, as well as 5 law faculty; (2) 15 social work faculty and 19 first year social work students; and (3) 8 clinical psychology fac- ulty and 34 students of whom 16 were first year, 8 were second year, 3 were third year, and 7 were fourth year.

follow:

RESULTS

The more salient statistically significant findings

1. There was no relationship between faculties" scores and age. Consequently, age was not covaried in any analyses.

2. The disciplines (faculty and students combined) differed on the CMHIS and five of eight scales of the OMI (Authoritarianism, Social Restrictiveness, and Ellsworth's Conven- tional Restrictiveness, Accountability, and Protective Benevolence). Social work was higher than both clinical psychology and law on the CMHIS and lower than both on the OMI's Conventional Restrictiveness and Accountability. In addition, social work was lower than

352 Community Mental Health Journal

clinical psychology on Protective Benevolence, and law was higher on Authoritarianism and Social Restrictiveness than both clinical psychology and social work. The first year stu- dents differed on the same scales except for Protective Benevolence. On each scale, law had the least favorable scores. In addition, clinical psychology was higher on Authoritarianism and Conventional Restrictiveness than social work.

3. Comparisons among faculties must be seen as highly tentative because of the small number of law faculty (n = 5). The more conservative nonparametric Kruskal-Wallis one- way analysis of variance (Siegel, 1956) was used to test for overall differences. Unfortu- nately, however, there exists no associated test allowing for multiple comparisons. Overall differences among the three faculty groups were found on the CMHIS and the OMI's So- cial and Conventional Restrictiveness. On the CMHIS, social work had the most favorable scores, but clinical psychology had the most favorable scores on both of the OMI scales. Law had the least favorable scores on all three scales.

4. Regarding within discipline comparisons, the three groups of clinical psychology stu- dents differed on only two scales (Authoritarianism and Protective Benevolence). As a whole, the clinical psychology students were higher than their faculty on social and con- ventional restrictiveness, whereas the faculty scored higher on accountability.

5. The three groups of law students differed among themselves only on Authoritarian- ism. The combined sample of law students was significantly higher than their faculty on the OMI's Mental Health Ideology and Accountability, whereas the faculty was significant- ly higher on its Social Restrictiveness and Interpersonal Etiology.

6. The social work faculty and students differed significantly on only two scales. The students were more Socially Restrictive, whereas the faculty was higher on Interpersonal Etiology.

D I S C U S S I O N

Community Mental Health Ideological Scale T h e C M H I S c o n s i s t e n t l y w a s m o r e s ens i t i ve to be -

t w e e n r a t h e r t h a n w i t h i n g r o u p d i f f e rences . R e g a r d l e s s of h o w Ss w e r e

g r o u p e d , social w o r k , cl inical p s y c h o l o g y , and l a w w e r e f o u n d to r a n k in

t h a t o r d e r f r o m m o r e to less a d h e r e n c e to a c o m m u n i t y m e n t a l h e a l t h

ideo logy . O n the o t h e r h a n d , n e i t h e r s t u d e n t s b y levels n o r f a c u l t y and

t h e i r s t u d e n t s d i f f e r e d s ign i f i can t ly .

Opinions About Mental Health Illness R e g a r d i n g b e t w e e n g r o u p c o m p a r i s o n s , t h e t h r e e dis-

c ipl ines d i f f e r ed on five of t he e i g h t fac to rs . O n t w o ( A u t h o r i t a r i a n i s m

and Social R e s t r i c t i v e n e s s ) c l inical p s y c h o l o g y and social w o r k c l u s t e r e d

a p a r t f r o m law w h e r e a s on C o n v e n t i o n a l R e s t r i c t i o n , A c c o u n t a b i l i t y ,

and P r o t e c t i v e Benevo l ence , l aw a n d cl inical p s y c h o l o g y t e n d e d to c l u s t e r

a p a r t f r o m social w o r k . O f p a r t i c u l a r n o t e in t h e p r e s e n t s t u d y w a s the

f i nd ing t h a t t he d i sc ip l ines c l u s t e r e d d i f f e r e n t l y on the o r i g i n a l scales

t h a n on E l l s w o r t h ' s (1965) a d d i t i o n a l f ac to r s . T h u s n o t o n l y do Ells-

w o r t h ' s f ac to r s r e p r e s e n t d i f f e r e n t c o n s t r u c t s in a s t a t i s t i ca l s ense b u t

w e r e d i f f e r e n t i a l l y r e l a t e d to d isc ip l ine , a f i nd ing t h a t s u g g e s t s c l inical

i n d e p e n d e n c e as well .

M o s t of t h e s ign i f i can t d i f f e r e n c e s w h i c h o c c u r r e d a m o n g d i sc ip l ines

(five of e i g h t f ac to r s ) was a f u n c t i o n of t h e f i r s t y e a r s t u d e n t s w h o dif -

f e r e d a m o n g t h e m s e l v e s on f o u r f a c to r s in c o n t r a s t to t h e f acu l t i e s ( two

fac to rs ) and a d v a n c e d level c l in ical p s y c h o l o g y a n d l a w s t u d e n t s (one fac-

Paul D. Mangum and Kevin M. Mitchell 353

tor). One hypothesis is that attitudes about the mentally ill are more susceptible to change over time as a result of graduate level professional training than attitudes about community care of the mentally ill.

Regarding faculty-student differences, of particular interest were the strikingly opposite results for clinical psychology and law on the OMI. The clinical psychology faculty generally held more positive attitudes than their students, whereas the opposite was the case for law. Recog- nizing the limitations of the present sample with respect to both size and geographical location, the data suggest that professional training in law may be related to a decrease in positive attitudes toward the mentally ill, although it should be noted that no such trend exists with respect to at- titudes about community care of the mentally ill.

Finally, the three faculties were much more similar in their attitudes about the mentally ill than about community care. Very likely commu- nity care has been stressed less in law school than in clinical psychology and social work training programs, but it seems reasonable to expect that if training in the law included a stronger emphasis on the positive effects of community as opposed to institutional care of the mentally ill, the three faculties would come to share such a commitment.

REFERENCES Baker, F., & Schulberg, H. C. The development of a community mental health ideology

scale. Community Mental Health Journal, 1967, ,3,216-225. Cohen, J., & Struening, E. L. Opinions about mental illness in the personnel of two large

mental hospitals. Journal of Abnormal and Social Psychology, 1962, 64, 349-360. Ellsworth, R. B. A behavioral study of staff attitudes toward mental illness. Journal of Ab-

normal Psychology, 1965, 70, 194-200. Moos, R. H., & Houts, P. S. Assessment of the social atmospheres of psychiatric wards.

]ournal of Abnormal Psychology, 1968, 73,595-604. Siegel, S. Nonparametric statistics for the behavioral sciences. New York: McGraw-Hill, 1956.