Commentary on: Chambers M, Guise V, Välimäki M, et al. Nurses’ attitudes to mental illness: a  comparison of a sample of nurses from five European countries. Int J Nurs Stud 2010; 47: 350–62

Haddad, M.

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Haddad, M. (2010). Different attitudes towards mental health revealed in a survey of nurses across five European countries; more positive attitudes found in Portugal, in women and in those in senior roles. Evidence Based Nursing, 13(4), 115 - 116. doi: 10.1136/ebn1090 <http://dx.doi.org/10.1136/ebn1090>City Research OnlineOriginal citation: Haddad, M. (2010). Different attitudes towards mental health revealed in a survey of nurses across five European countries; more positive attitudes found in Portugal, in women and in those in senior roles. Evidence Based Nursing, 13(4), 115 - 116. doi: 10.1136/ebn1090 <http://dx.doi.org/10.1136/ebn1090>Permanent City Research Online URL: http://openaccess.city.ac.uk/1063/ Copyright & reuseCity  University  London has developed City  Research Online  so that  its  users  may access the research outputs of City University London's staff. Copyright © and Moral Rights for this paper are retained by the individual author(s) and/ or other copyright holders. Users may download and/ or print one  copy  of  any  article(s)  in  City  Research  Online  to  facilitate  their  private  study  or  for  non-commercial research. Users may not engage in further distribution of the material or use it for any profit-making activities or any commercial gain. All material in City Research Online is checked for eligibility for copyright before being made available in the live archive. URLs from City Research Online may be freely distributed and linked to from other web pages. Versions of researchThe version in City Research Online may differ from the final published version. Users are advised to check the Permanent City Research Online URL above for the status of the paper.EnquiriesIf you have any enquiries about any aspect of City Research Online, or if you wish to make contact  with the author(s) of this paper, please email the team at publications@city.ac.uk.Qualitative115Evidence-Based Nursing October 2010 | volume 13 | number 4 |Cross sectional surveyDifferent attitudes towards mental health revealed in a survey of nurses across five European countries; more positive attitudes found in Portugal, in women and in those in senior rolesMark HaddadAttitudes to mental illnessExamining the attitudes of nurses is a well-trod route for nurse researchers: such papers are common in our jour-nals, describing nurses’ perspectives on topics from com-plementary medicine to assisted suicide. These studies may involve focus groups, interviews or non-validated question sets; alternatively they may be scale develop-ment studies or may use validated scales to examine atti-tudes in a particular area.The paper by Chambers and colleagues is an example of the latter: it uses the Community Attitudes to Mental Illness questionnaire (developed in Canada in the late 1970s in response to deinstitutionalisation) to identify the attitudes of nurses working in mental health inpatient and community settings in fi ve European countries.Measuring attitudes is important in the fi eld of men-tal health. Mental health problems are common and associated with stigma – that is, problems in the areas of knowledge (ignorance), attitudes (prejudice) and behav-iour (discrimination). The widespread  misunderstanding and negativity about mental ill health and the merits of treatment affects help-seeking and the general response that people with these problems elicit from others. There are indications that the  attitudes of clinicians may infl u-ence their recognition of mental problems, and the way they treat people with these  diffi culties.People’s attitudes to mental health problems have attracted considerable research attention with gen-eral population studies conducted in many nations. In England, the adult population has been regularly surveyed on this topic since 1993 (usually annually), allowing monitoring of public attitudes towards mental illness and tracking changes over time.1 In the European Union, per-ceptions about people with mental health problems have been identifi ed by a special edition (2006) of the annual Eurobarometer survey series that interviewed represen-tative population samples across each of the 25 Member States and candidate countries, totalling nearly 30 000 adults.2 These surveys provide a mixed picture: people’s views are generally tolerant and supportive of integrating people with mental illness into their communities – but there remain considerable negative elements: for instance in the EU, over a third of respondents think that people with psychological problems constitute a danger to oth-ers, and 14% of people feel that people with psychological 10.1136/ebn1090Institute of Psychiatry at King’s College London, London, UKCorrespondence to:Mark HaddadSection of Primary Care Mental Health, PO28, Institute of Psychiatry at King’s College London, London SE5 8AF, UK; mark.haddad@iop.kcl.ac.ukCommentary on: Chambers M, Guise V, Välimäki M, et al. Nurses’ attitudes to mental illness: a comparison of a sample of nurses from five European countries. Int J Nurs Stud 2010;47:350–62.06_ebnurs1085-1090-1092-1099.indd   Sec1:115 9/8/2010   11:03:12 AMQualitative116 Evidence-Based Nursing October 2010 | volume 13 | number 4 |problems have themselves to blame, while in England a third of people select being ‘prone to violence’ as the best descriptor for a person who is  mentally ill. In general, women hold more positive attitudes than men, as do older compared to younger people; and higher social grade is also associated with more positive attitudes.In Australia, surveys of the public conducted over several decades have contributed to the development of mental health literacy programmes to improve knowl-edge and beliefs about mental health and mental disor-ders; such initiatives have subsequently been conducted in many other countries including the USA, UK, Germany and Norway and have led to specifi c training courses (Mental Health First Aid).3Nurses attitudes in five countriesIn this study, Chambers and colleagues from Finland, Portugal, Lithuania, Ireland and Italy, collected responses from registered nurses via paper and electronic surveys. Nurses’ responses to the 40-item CAMI questionnaire together with demographic and related information were used to explore attitude differences within the sample. The researchers obtained an excellent overall response rate (74%) for the survey, and total participant numbers (810) were suffi cient for the planned analyses.The chief fi nding to emerge was that nurses’ attitudes differ between the nations surveyed with most positive views evident in Portugal and least positive in Lithuania. The respondents’ attitudes are described as generally positive and similar to those of psychiatrists, but the presentation of fi ndings limits comparison of responses between this group and other professionals.How does this link to what we know?This study has drawn attention to an important topic: the attitudes of health professionals are a key attribute and potential determinant of clinical behaviour. Using a standardised measure, the authors have identifi ed that the country in which nurses practice is the most infl uential factor in predicting their views. Nurses from Lithuania reported the most restrictive and authori-tarian attitudes and were most concerned about risks posed by people with mental problems. The attitudes to people with mental health problems identifi ed in the Eurobarometer study compare very closely with this key fi nding. This EU-wide study revealed that from 29 countries polled, Lithuania consistently endorsed views at the negative (bottom fi ve) range.2 This adds weight to the view that the socio-political climate and culture of regions and nations are strong determinants of toler-ance and stigma, and that work to extend acceptance must involve whole communities.Competing interests None.References 1. CSIP/Department of Health. Attitudes to Mental Illness 2009 Research Report. London: Department of Health, 2009. http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_100651.pdf 2. European Commission. Mental Well-being. EC Directorate General SANCO and Coordinated by Directorate General Communication. 2006. http://ec.europa.eu/health/ph_information/documents/ebs_248_en.pdf 3. Kitchener BA, Jorm AF. Mental health fi rst aid training for the public: evaluation of effects on knowledge, attitudes and helping behavior. BMC Psychiatry 2002;2:10.06_ebnurs1085-1090-1092-1099.indd   Sec1:116 9/8/2010   11:03:12 AM

Different attitudes towards mental health revealed in a survey of nurses across five European countries; more positive attitudes found in Portugal, in women and in those in senior roles

Different attitudes towards mental health revealed in a survey of nurses across five European countries; more positive attitudes found in Portugal, in women and in those in senior roles

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