Perceptions and expectations of hospitalisation and attitudes towards mental illness : a study of first admission psychiatric patients in Edinburgh, Scotland and St John's Newfoundland

Attitudes and perceptions of patients admitted to a psychiatric facility for the first time were investigated with a view to considering the applicability of psychiatric/sick role and labelling perspectives to the subjective experience of becoming a psychiatric patient. In-depth semi-structured interviews were conducted with 100 first admission patients admitted to the Royal Edinburgh. Hospital, Edinburgh, Scotland, and Waterford Hospital and the General Hospital Health Sciences Centre Psychiatric Unit, St John's, Newfoundland. The subjects were interviewed within the first few days of their stay in hospital. The thesis examines: these subjects' perceptions of the process leading to their psychiatric admissions; their views of the causes, course and nature of mental illness and of their own conditions; their expectations and perceptions of the psychiatric facilities and their understanding of their role as psychiatric patient; and their attitudes towards the stigma associated with mental illness and psychiatric hospitalisation and their plans to deal with this issue. The following emerged: a majority of the subjects entered hospital willingly, described mental illness and the mentally ill in an 'informed' way or in a way not implying socially unacceptable behaviours or conditions, and did not plan to actively conceal that they had been patients in a psychiatric hospital. There was a relationship between some of the views expressed. A core group of 32 held all three of these positions and these subjects had a higher level of education, were older and more were currently in employment compared to the rest of the sample. The subjects responded differently to the label of mental illness. However each response indicated an attempt to maintain a positive self identity. In addition a wider range of disorders were identified as in need of psychiatric attention than the literature would suggest. Most subjects were satisfied with the hospital environment. A passive view of the patient role was widespread but this did not indicate resistance. A psychiatric/sick role perspective better explains these subjective experiences of becoming psychiatric patients than does labelling theory. However there was a wide recognition of stigma. Almost half of those advancing an 'informed' view of mental illness planned to conceal that they had been in hospital because they might be stigmatised. This may reflect a realistic appraisal of the existence of discrimination