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Polling public opinions : a pilot study in marketing mental health Toh, Jo-Anne 1987

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POLLING PUBLIC OPINIONS: A PILOT STUDY IN MARKETING MENTAL HEALTH By J O - A N N E TOH B . A . , The U n i v e r s i t y of B r i t i s h Columbia, 1981 B .S .W. , The U n i v e r s i t y of Regina, 1985 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SOCIAL WORK i n THE FACULTY OF GRADUATE STUDIES THE SCHOOL OF SOCIAL WORK We accept t h i s t h e s i s as conforming to the required standard THE UNIVERSITY OF BRITISH COLUMBIA J u l y 1987 © Jo-Anne Toh 1987 In presenting this thesis in partial fulfilment of the requirements for an advanced degree at the University of British Columbia, I agree that the Library shall make it freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the head of my department or by his or her representatives. It is understood that copying or publication of this thesis for financial gain shall not be allowed without my written permission. Department of Social Work The University of British Columbia 1956 Main Mall Vancouver, Canada V6T 1Y3 Date J u l y 10, 1987  DE-6(3/81) ABSTRACT This paper provides preliminary information on consumer opinions and perceptions on various mental health i s s u e s . Recognizing that c i t i z e n in-put i s an e s s e n t i a l marketing t o o l f o r responsive and accountable program planning, the Canadian Mental Health A s s o c i a t i o n - B.C. D i v i s i o n , i s i n the process of acquiring consumer data as part of i t s information bank. This p i l o t study has provided a 'dry run' of what i s expected f o r future research p r o j e c t s . Through telephone interviews with 46 Vancouver C i t y telephone suscribers and mail-out questionnaires to 46 community service: personnel, the Canadian Mental Health Association was able to acquire some relevant information to a i d i n i t s decision-making process f o r planning mental health educational programs. The majority of survey respondents, f o r example, f e e l that information on coping with s t r e s s i s the most important to them while information on the more serious, mental disorders, such as schizophrenia, i s l e a s t important. This has important implications f o r program planning i f the organization i s to e n l i s t p u b l i c support and market i t s services to a broader c l i e n t e l e . Focusing on promoting mental health and f u n c t i o n a l competence versus mental i l l n e s s focused i s recommended i f the Canadian Mental Health Association hopes to a t t r a c t normal population groups as i t s consumers. Furthermore, learning through f r i e n d s h i p and f a m i l i a l support i s the most desirable, and helping p r o f e s s i o n a l s should not place too much emphasis on pamphlets alone as an educational t o o l . Other implications a r i s i n g from the consumer data are discussed i n t h i s paper. For the most part, the consumer data has served to v e r i f y assumptions about what decision-makers already know ... but the research process i s able to ground such assumptions into f a c t ... and t h i s helps to further l e g i t i m i z e and speed up a c t i o n . This p i l o t study serves as an i n i t i a l s t a r t i n g point f o r the organization i n i t s attempt to incorporate consumer research as part of i t s o v e r a l l planning process. i TABLE OF CONTENTS Abst rac t i L i s t of Tables v L i s t of Appendices v Acknowledgements v i In t roduct ion v i i I. CONSUMER RESEARCH AS A MARKETING TOOL 1 . INTRODUCTION 1 . MARKETING IN THE HUMAN SERVICES 2 . MARKETING COMPONENTS 3 . CONSUMER RESEARCH 4 . THE PROBLEM 6 . RESPONSE TO THE PROBLEM 8 . USES OF CONSUMER DATA 10 . THE VALUE OF CONSUMER RESEARCH TO SOCIAL WORKERS . . . 12 . CONCLUSION 14 I I . INTERACTION OF PRACTICE & RESEARCH 16 . INTRODUCTION 16 . THE INTEGRATED PRACTICE & RESEARCH PROGRAM 16 . THE SETTING 17 . RESEARCH PARTICIPANTS 20 . RESEARCH PARADIGMS 23 . THE RESEARCH CONSULTATION PROCESS 26 . LIMITATIONS & SUCCESSES OF COLLABORATIVE PROCESS . . . 34 . IN RETROSPECT 41 i i I I I . THE RESEARCH PROJECT IN CONTEXT 47 . INTRODUCTION . . 47 . RESEARCH ISSUES 47 . OBJECTIVES OF THE STUDY 48 . KNOWLEDGE-BUILDING FUNCTION OF RESEARCH 49 . THEORETICAL ORIENTATION & DEFINITION OF CONCEPTS . . . 50 . RELEVANT RESEARCH 55 IV. THE RESEARCH DESIGN 61 . INTRODUCTION 61 . RESEARCHER'S CONTROL OVER PHENOMENA STUDIED 61 . SAMPLING DESIGN 61 . CHOICE OF METHODOLOGICAL ORIENTATION 65 . DATA COLLECTION 66 . PRE-TEST 68 . VALIDITY & RELIABILITY OF MEASURES 68 . ETHICAL CONSIDERATIONS 71 . DATA ANALYSIS ± 71 . LIMITATIONS OF THE STUDY 73 V. SURVEY RESULTS 75 . INTRODUCTION 75 •. RESPONSE RATE 75 . DEMOGRAPHICS 77 . FAMILIARITY WITH THE CANADIAN MENTAL HEALTH A S S O C . . . 78 IMPORTANCE OF MENTAL HEALTH INFORMATION 80 . INFORMATION SYSTEMS 88 . THOUGHTS & OPINIONS ON MENTAL HEALTH & ILLNESS 93 . COMMUNITY SUPPORT 99 i i i VI. IMPLICATIONS OF CONSUMER DATA . INTRODUCTION 102 . CONCLUSION #1 and IMPLICATIONS 102 . CONCLUSION #2 and IMPLICATIONS 103 . CONCLUSION #3 and IMPLICATIONS 104 . CONCLUSION #4 and IMPLICATIONS 106 . CONCLUSION #5 and IMPLICATIONS 108 . CONCLUSION #6 and IMPLICATIONS 110 . RECOMMENDATIONS FOR FUTURE RESEARCH 112 . AIMING IN THE RIGHT DIRECTION 117 . IT 'S A BEGINNING 119 BIBLIOGRAPHY 121 i v L I S T OF TABLES Table 1: AGE BREAKDOWN OF TELEPHONE RESPONDENTS 77 Table 2: SELF-RATINGS OF IMPORTANCE OF MENTAL HEALTH INFORMATION FOR TELEPHONE INTERVIEW RESPONDENTS 81 Table 3: SIGNIFICANCE OF RELATIONSHIP BETWEEN IMPORTANCE ON MENTAL HEALTH INFORMATION AND SOCIO-DEMOGRAPHIC VARIABLES 83 Table 4: SELF-RATINGS OF IMPORTANCE OF MENTAL HEALTH INFORMATION FOR COMMUNITY SERVICE PERSONNEL 84 Table 5: MEAN SCORES ON IMPORTANCE OF MENTAL HEALTH INFORMATION FOR EMPLOYEES OF DIFFERENT COMMUNITY AGENCIES 86 Table 6: STATISTICAL SIGNIFICANCE OF DIFFERENCES IN MEANS AND VARIANCES BETWEEN THE GENERAL PUBLIC AND COMMUNITY SERVICE SAMPLES 87 L I S T OF APPENDICES Appendix 1: REQUEST FOR ETHICAL REVIEW FORM 126 Appendix 2: AGENCY CONSENT LETTER 130 Appendix 3: CERTIFICATE OF APPROVAL FOR RESEARCH 131 Appendix 4: LETTER OF INTRODUCTION TO GENERAL PUBLIC 132 Appendix 5: LETTER OF INTRODUCTION TO COMMUNITY SERVICE PERSONNEL 133 Appendix 6: GENERAL PUBLIC QUESTIONNAIRE 134 Appendix 7: COMMUNITY SERVICE PERSONNEL QUESTIONNAIRE 139 ACKNOWLEDGEMENTS Many in d i v i d u a l s have contributed to the production of t h i s work, and t h e i r support and assistance i s g r a t e f u l l y acknowledged here. Thanks to the Canadian Mental Health Association - B.C. D i v i s i o n f o r allowing me the opportunity to undertake my practice-research with t h e i r agency; more s p e c i f i c a l l y , thanks to Helene Burke, Suzanne Wigen, Andrea Porter and e s p e c i a l l y Chloe Lapp f o r making my learning experience a very enjoyable one. Dr. John Crane and Mr. Roop Seebaran are than k f u l l y acknowledged f o r providing i n t e l l e c t u a l stimulation, answering questions and o f f e r i n g t h e i r guidance throughout the year. To my parents, who have always supported by academic endeavours, t h e i r thoughtfulness and caring i s much appreciated. F i n a l l y , to my husband Rick, I couldn't have done i t without h i s support, encouragement and understanding, I extend my h e a r t f e l t thanks. v i INTRODUCTION Information about consumers and p o t e n t i a l consumers can be used as a valuable marketing t o o l i n the health and s o c i a l s e r v i c e s . Consumer data can be used to guide decisions about a broad range of issues such as program design, service d i s t r i b u t i o n and methods of service d e l i v e r y . As such, the strategy of conducting consumer research can be used to generate public support while also generating u s e f u l information for program planning. Chapter I of t h i s paper introduces consumer research within the broader context of marketing. Marketing involves numerous components of which research i s but one element. Human service agencies tend to neglect consumer research, despite i t s relevance i n developing objective and responsive community programs. While some attempts have been made to address t h i s problem, improvement i s s t i l l needed. Chapter I further discusses the uses and benefits of consumer data and i t s value to s o c i a l work. The Canadian Mental Health Association - B.C. D i v i s i o n , i s one non-profit voluntary organization which recognizes the need to acquire the opinions, a t t i t u d e s and perceptions of i t s consumers and p o t e n t i a l consumers. As such, the author undertook the r o l e of research consultant and enabler i n t h i s agency, with the task of c o l l e c t i n g consumer data as a p i l o t study f o r the organization. Chapter II provides a d e s c r i p t i o n and analysis of t h i s v i i integrated community practice-research process. Chapter I II sets t h i s research project i n context. The issues of concern are: what are the opinions and perceptions of the organization's p o t e n t i a l consumers that can help guide program planning? What d i r e c t i o n should the organization take i n terms of future d i r e c t i o n f o r mental health education? S p e c i f i c objectives of the p i l o t study are i d e n t i f i e d i n t h i s chapter. A t h e o r e t i c a l o r i e n t a t i o n and d e f i n i t i o n of concepts relevant to the research are also discussed, along with a d e s c r i p t i o n of previous research r e l a t e d to t h i s study. An overview of the research design i s presented i n Chapter IV. The sampling design, methodological o r i e n t a t i o n and data c o l l e c t i o n method are d e t a i l e d i n t h i s chapter. Other issues such as pre-testing, v a l i d i t y and r e l i a b i l i t y , e t h i c a l considerations and data analysis plan are also included here. F i n a l l y , l i m i t a t i o n s of the study are i d e n t i f i e d . Chapter V i s a summary of the survey r e s u l t s . The r e s u l t s are presented i n a format that sets out to answer s p e c i f i c questions which the study was designed to address: 1) Is the pu b l i c f a m i l i a r with C.M.H.A.? 2) What mental health information i s important to users and p o t e n t i a l users and how, i n t h e i r view, can i t best be provided? 3) What are the most d i f f i c u l t problems i n l i v i n g experienced by the people i n the community? 4) What are the public's thoughts and opinions about mental health and i l l n e s s ? 5) Is there community support f o r mental health education and information programs? v i i i F i n a l l y , Chapter VI attempts to draw conclusions from the consumer data and presents possible implications f o r program planning and marketing s t r a t e g i e s . Some recommendations f o r future research are suggested, but the d i r e c t i o n f o r future research w i l l l a r g e l y depend on what d e c i s i o n -makers f e e l i s important given f i n d i n g s from t h i s study, a v a i l a b l e resources and other p r i o r i t i e s . For the most part, C.M.H.A. - B.C. D i v i s i o n i s headed i n the r i g h t d i r e c t i o n i n planning mental health educational programs ... but much more needs to be done. i x I. CONSUMER RESEARCH AS A MARKETING TOOL INTRODUCTION The need to provide a c c o u n t a b i l i t y and to acquire information f o r developmental planning i s the basis behind a growing trend i n the a p p l i -c ation of s o c i a l research and evaluation i n the human service s e t t i n g . The human service professions, however, unlike the business professions, often neglect to seek advice or feedback from consumers or p o t e n t i a l receivers of s e r v i c e . The deliberate search f o r consumer ideas and opinions i s an e f f e c t i v e marketing t o o l f o r promoting programs and se r v i c e s . The purpose of t h i s section i s to introduce the general concept of marketing i n the human services, and the relevance of consumer research as a component of marketing. The problem, however, i s that acquiring consumer opinion, a t t i t u d e and perceptions has not been a major p r i o r i t y f o r p r a c t i t i o n e r s . While there has been a growing concern and response i n t h i s area, greater e f f o r t s are required to improve p u b l i c communica-t i o n between service providers and r e c e i v e r s . Researching the consumer has other major implications beyond a marketing function. Issues of acc o u n t a b i l i t y , c r e d i b i l i t y , f i n a n c i a l and community support, as well as program effectiveness are addressed when program planners and administra-tors turn to t h e i r consumer and ask such questions as "what are your 2. opin ions and percept ions i n t h i s area? What should our organ iza t ion be concerned with?" As p r a c t i t i o n e r s , s o c i a l workers have an i n c r e a s i n g r e s p o n s i b i l i t y to engage i n or at l e a s t support consumer research and t h i s i s b r i e f l y d iscussed i n t h i s s e c t i o n . MARKETING IN THE HUMAN SERVICES A marketing approach to program d e l i v e r y i s a r e l a t i v e l y new idea i n the hea l th and s o c i a l s e r v i c e s . Marketing has normally been assoc ia ted with ' s e l l i n g ' and therefore a l i e n to the ' n o b l e ' mission of n o n - p r o f i t o rgan iza t ions (Roberts & Roberts, 1985). However, economic r e s t r a i n t s of the 80 1 s i n Canada and elsewhere have meant that p lanning and s t r a t e g i c management have become very important i ssues i n the human s e r v i c e s . Market ing, i n t h i s sense, has assumed a new o r i e n t a t i o n . Marketing i s used f o r the purpose of ach iev ing o r g a n i z a t i o n a l o b j e c t i v e s . It i s not , as P h i l l i p K o t l e r d e c l a r e s , huckster ism; the r e a l meaning i s the concept of s e n s i t i v i t y serv ing and s a t i s f y i n g human needs (Kot le r , 1975). K o t l e r def ines marketing as the a n a l y s i s , p lanning , implementation and c o n t r o l of c a r e f u l l y formulated programs marketing has become very much a system for the implementation of o b j e c t i v e s . It i s a systematic approach to e s t a b l i s h i n g , c u l t i v a t i n g and mainta in ing mutual ly b e n e f i c i a l r e l a t i o n s h i p s with those people you wish to reach (Kot le r , 1975). There-f o r e , ra ther than concerned with s e l l i n g , marketing has become a mangement fun c t ion which takes p lann ing , o r g a n i z i n g , and funding cons idera t ions i n t o account . It requi res a n a l y s i s and understanding of the needs, percept ions and preferences of ta rget markets. By marketing ' v i a b l e ' p r o j e c t s , o rgan iza t ions are given a more l eg i t imate and p o s i t i v e image. As a management f u n c t i o n , marketing i s a set of a c t i v i t i e s concerned wi th r e s e a r c h , p lanning , program development and implementation. More impor tant ly , i t i s a br idge l i n k i n g the o rgan iza t ion with i t s ex terna l environment (Lovelock & Weinberg, 1984), thereby acknowledging consumers, p o t e n t i a l consumers and other const i tuents as va luable resources to the o r g a n i z a t i o n . MARKETING COMPONENTS Accord ing to Rubright and MacDonald (1981), marketing genera l l y c o n s i s t s of n ine components: 1. s e l e c t i n g and prepar ing the marketing pro jec t 2. i n t e r n a l and ex te rna l research 3. the market aud i t 4. s e t t i n g o b j e c t i v e s 5. t a r g e t i n g 6. s t r a t e g i e s 7. s p e c i a l promotional t o o l s 8. i n t e r n a l adjustments 9. e v a l u a t i o n / r e c y c l i n g Marketing i s a broad and complicated process and i s an equa l ly lengthy subject a r e a . It i s not w i th in the scope of t h i s paper to encompass the e n t i r e process of market ing. Instead, the externa l research element of the marketing plan i s the major focus of t h i s paper. The ex te rna l research aspect of marketing a lso conta ins many d i f f e r e n t perspect ives and components. Research can take the form of c o l l e c t i n g and ana lyz ing e x i s t i n g data , i n f o r m a l l y tu rn ing to var ious agencies and 4. o rgan iza t ions as a source of in fo rmat ion , approaching, exp lor ing and observ ing the c h a r a c t e r i s t i c s of d i f f e r e n t groups and i n d i v i d u a l s i n the p o p u l a t i o n . Information can be obtained i n a number of d i f f e r e n t ways, but u s u a l l y the methods chosen are determined by the resources of the agency i n need of the in fo rmat ion . CONSUMER RESEARCH Only by a c q u i r i n g an extensive knowledge about consumers i s i t p o s s i b l e to i n f l u e n c e and persuade them i n var ious ways. Needs assessments, community surveys , p o l l i n g , analyses and in terv iews are a l l embodied i n the ex te rna l research component. These research methods p lay an important r o l e i n he lp ing planners and admin is t ra tors to understand cur ren t , p o t e n t i a l and former consumers. It a l s o helps to provide informat ion on consumers' awareness of and a t t i t u d e s toward the o rgan iza t ion and i t s o f f e r i n g s . Such informat ion i s a key f a c t o r to i n f l u e n c i n g the choice and nature of product markets (Lovelock & Weinberg, 1984). In a community survey of 176 respondents, informat ion was c o l l e c t e d about the r e l a t i v e sa l i ence f o r the p u b l i c of concerns at var ious s o c i o p o l i t i c a l l e v e l s (P lantz , 1980). Respondents were asked to express t h e i r hopes and fears r e l a t e d to personal and fami ly c o n s i d e r a t i o n s , neighborhood and community c o n d i t i o n s , and l a r g e r s o c i e t a l i s s u e s . The ob jec t ive of the community survey was to demonstrate that the a p p l i c a t i o n of the acquired c i t i z e n in format ion , from a s o c i a l marketing perspec t i ve , could be used i n the design of promotional s t r a t e g i e s f o r human se rv ice programs. Measuring public opinion would therefore provide a d e s c r i p t i o n of public support which i s necessary i n the development of responsive programs. Plantz states that i f human service program promoters are to be e f f e c t i v e i n e l i c i t i n g public support f o r t h e i r programs, then according to s o c i a l market p r i n c i p l e s , they must i d e n t i f y those program values or benefits that are most s a l i e n t f o r the p u b l i c . Research findings from the Plantz study i l l u s t r a t e d that concern f o r s e l f and primary r e l a t i o n s h i p s dominated both hopes and fears of respondents, while concern f o r broader s o c i o p o l i t i c a l issues were expressed only by a small minority. From these fin d i n g s , Plantz recommended that promoters of human service programs, seeking supportive public behavior, should devise promotional strategies that do not depend on the salience of broader so c i o -p o l i t i c a l concerns f o r the p u b l i c . Instead of promoting programs on the basis of t h e i r s o c i e t a l impact, promotional st r a t e g i e s f o r human service programs might focus on the p o t e n t i a l personal benefits to be gained. A marketing approach, through consumer research, can guide decisions about a broad range of issues such as program design, service d i s t r i b u t i o n and methods of service d e l i v e r y . Such a strategy aims to generate public support while also generating u s e f u l information f o r program planning. Public support can be tran s l a t e d as f i n a n c i a l contributions, votes, commitments of time, verbal approval or some other behavior. Support from the public i s e s s e n t i a l f o r the implementation and ultimate success of human service programs. THE PROBLEM Marketing i s not a widely accepted p r a c t i c e i n the human services and therefore external research has not been a high p r i o r i t y as a strategy to planning. Even research f o r the sake of acquiring u s e f u l information, independent of any marketing i n i t i a t i v e s , i s seldom conducted i n health and s o c i a l service s e t t i n g s . Consumerism has not yet been f u l l y recognized i n these arenas. Consequently there i s a need to t r y out ways of obtaining c i t i z e n in-put i n t o s o c i a l programs i n general, and mental health education i n p a r t i c u l a r . This section presents arguments f o r t h i s type of undertaking, and some reasons why c i t i z e n in-put has seldom been obtained. A continuing dialogue between c i t i z e n s and professionals i s necessary i n order to maintain o b j e c t i v i t y i n i d e n t i f y i n g needs which are responsive to the community. Given the continuing decline of resources, a greater number of health and s o c i a l service agencies must begin to c l o s e l y s c r u t i n i z e t h e i r p r i o r i t i e s and r e s p o n s i b i l i t i e s . It has become e s s e n t i a l that these organizations ask themselves i f they are addressing the needs and i n t e r e s t s of the c l i e n t population. E s t a b l i s h i n g communication with the consumer, v i s - a - v i s community need assessments, surveys and p o l l s , w i l l a s s i s t these agencies to formulate more e f f i c i e n t and accountable community programs. Reid and Smith (1978) define consumer data as the a t t i t u d e s , opinion and perceptions of program r e c i p i e n t s ... and that such data are obtained d i r e c t l y from the consumer through questionnaires, interviews and the l i k e . ; , and are d i r e c t expressions of the consumer's point of view. Consumer research serves to give the c i t i z e n decision-making power i n program planning; but more importantly i t serves to give the program planner greater power to take a c t i o n . Usua l ly there has been an imbalance i n power and informat ion between prov iders and consumers i n the hea l th and s o c i a l s e r v i c e s . P r o f e s s i o n a l s i n the system tend to implement programs and s e r v i c e s they perceive as appropr iate based on t h e i r experience or e x p e r t i s e . Or these p r o f e s s i o n a l s , i n t h e i r enthusiasm to i d e n t i f y a need, may o f ten overestimate i t s s i z e or mistake i t s character (Ross i , Freeman and Wright, 1979). In re ference to Community Mental Health Centres , D i n k e l , Zinober and F l a h e r t y (1981) asser t that c i t i z e n p a r t i c i p a t i o n has been a neglected p o t e n t i a l to program planning and e v a l u a t i o n . They underscore the need to inc lude c i t i z e n i n - p u t to program planning because: 1) the values and percept ions of c i t i z e n s and p r o f e s s i o n a l s can d i f f e r and c o n f l i c t , and 2) there may be a tendency f o r p r o f e s s i o n a l s to b ias programs toward t h e i r own s e l f i n t e r e s t s . Consequently, c i t i z e n in -pu t w i l l address d i f f e r e n c e s and balance b iases which w i l l lend to more ob jec t i ve and responsive community programs. M u l t i p l e s tudies have demonstrated that op in ions and perspect ives of c l i e n t s , careg ivers and others d i f f e r regarding var ious agency s e r v i c e s , goals and other o r g a n i z a t i o n a l aspects (Windle & P a s c h a l l , 1981). Genera l ly , c i t i z e n p a r t i c i p a t i o n has been argued to a s s i s t i n devolv ing power to c i t i z e n s and reducing a l i e n a t i o n , as we l l as improving e f f e c t i v e n e s s . Nevertheless, community in -pu t and a r e s p o n s i b i l i t y to acquire consumer data i s r a r e l y a p r i o r i t y f o r most human s e r v i c e agenc ies . A c q u i r i n g consumer data shows an e f f o r t on the part of human serv ice agencies to r e l a t e e f f e c t i v e l y to the environment they serve . In a survey of 220 community mental heal th c e n t r e s , C ibulka (1981) concluded that these mental 8. hea l th centre boards have not p laced great e f f o r t on the funct ion of p u b l i c communication with community and c i v i c o r g a n i z a t i o n s , l o c a l p r o f e s s i o n a l o r g a n i z a t i o n s , other human s e r v i c e o r g a n i z a t i o n s , res idents and consumers. Regretably , C ibulka remarks, p u b l i c communication has not been one of t h e i r major r e s p o n s i b i l i t i e s (C ibu lka , 1981: 31) . Many obs tac les can be i d e n t i f i e d as prevent ing these organ iza t ions from conduct ing consumer research . The lack of time and f i n a n c i a l resources preclude many organiza t ions from implementing any such a c t i v i t i e s . The growing demand f o r se rv ice output and other more c r i t i c a l r e s p o n s i b i l i t i e s are major obstac les to any commitment to conduct research of any na ture . The lack of adequate manpower and exper t ise a l s o hinder any mot ivat ion to a s s e s s i n g the a t t i tude and op in ion of the consumer. S i m i l a r i l y , where research exper t ise i s a v a i l a b l e , working r e l a t i o n s h i p s between p r a c t i t i o n e r s and researchers have not always enjoyed the most p o s i t i v e or utmost s u c c e s s . As such, the outcome of these e f f o r t s have not always been maximized to t h e i r g rea tes t p o t e n t i a l . RESPONSE TO THE PROBLEM An i n c r e a s i n g s e n s i t i v i t y to the s e r v i c e needs of the community has developed i n recent years , and human se rv ice prov iders have endeavoured to respond to those needs more e f f e c t i v e l y . The e x i s t i n g range of l i t e r a t u r e on needs assessments, fo r example, i s an i n d i c a t i o n that assess ing community needs i s a growing p r a c t i c e i n response to more e f f e c t i v e s e r v i c e d e l i v e r y ( J a f f e , 9. 1982; Moroney, 1977; Neuber, A t k i n s , Jacobson & Reuterman, 1980; Warheit , B e l l & Schwab, 1976; Witken, 1984). Organ iza t ions , as such, are beginning to respond to the issue of acknowledging community i n - p u t i n program planning and goal s e t t i n g . There i s a wide range of meaning a t t r i b u t e d to the term 'needs assessment' and, i n f a c t , some say that almost anything can pass f o r a needs assessment (Royse & Druse, 1982). A needs assessment can c o n s i s t of ep idemio log ica l surveys , s o c i a l i n d i c a t o r a n a l y s i s , key informant in te rv iews , community forums, ra tes under treatment methods; c l i e n t or general populat ion surveys . Needs assessment i s not a un i ta ry concept , but one that encompasses a v a r i e t y of techniques and can be used f o r a v a r i e t y of purposes. C o l l e c t i n g data d i r e c t l y from the consumer i s on ly one method of a c q u i r i n g important in fo rmat iona l i n - p u t f o r p lanning and admin is t ra t ive purposes. Despite the d ive rse methologies and inherent problems i n s p e c i f i c a l l y c o n c e p t u a l i z i n g needs assessments, there i s consensus that the process i t s e l f i s considered analogous to problem d e f i n i t i o n . One does not 'assess n e e d s ' , but under-takes to look at problems problems i n r e l a t i o n to resources , i n d i v i d u a l and group d e s i r e s , and p r i o r i t i e s (Stewart, 1979). The emphasis on needs assessments and i t s subsequent outgrowth of l i t e r a t u r e on the subject was in f luenced by the Community Mental Health Centre Amendments of 1975 i n the United S t a t e s . This Amendment requi red that a l l community mental hea l th centres spend at l e a s t 2% of t h e i r t o t a l budget i n c a r r y i n g out eva luat ion (Thackeray, Skidmore & F a r l e y , 1979). While there i s no such l e g i s l a t e d eva luat ion program i n B r i t i s h Columbia f o r mental hea l th s e r v i c e s , i t i s expected that eva lua t ions be c a r r i e d out on a yea r ly b a s i s . Continued funding fo r se rv ices i s dependent upon annual appra isa ls of the s e r v i c e . A p p r a i s a l s of s e r v i c e , however, o f ten c o n s i s t of measuring system outputs , count ing numbers of r e c i p i e n t s and b e n e f i c i a r i e s , and assess ing c o s t - s a v i n g s by a l t e r i n g e l i g i b i l i t y requirements (Graycar, 1979). As such, eva lua t ions need not be be very comprehensive and there fore may ignore c l i e n t feedback as an e s s e n t i a l feature of e v a l u a t i o n . Consul t ing with the l a r g e r community beyond the c l i e n t populat ion i s even fur ther warranted. Organ iza t ions , as mentioned p r e v i o u s l y , o f ten lack the t ime, f i n a n c i a l and p r o f e s s i o n a l resources to conduct comprehensive assessments. Despite the r e a l and attempted moves by many agencies to conduct consumer research , improvement i n t h i s area i s s t i l l needed. USES OF CONSUMER DATA Consumer data can serve to address s e v e r a l i ssues r e l a t e d to the p lanning and admin is t ra t ion of programs and s e r v i c e s i n the human s e r v i c e s . Increas ing pressure on program admin is t ra tors to provide a c c o u n t a b i l i t y data fo r present and proposed programs have meant that a s s e s s i n g consumer needs and p u b l i c support i s a necessary f u n c t i o n . When t h i s informat ion i s presented to the community through r a d i o , newspapers and other p u b l i c p resenta t ions , a f u r t h e r measure of a c c o u n t a b i l i t y i s e s t a b l i s h e d . Consumer data can a lso be used as a t o o l i n the compet i t ion of r e s o u r c e s . D inke l e t . a l . (1981) r e f e r to t h i s as an advocacy r o l e of informat ion where c i t i z e n s can provide c r e d i b i l i t y to the need fo r p a r t i c u l a r s e r v i c e s . Program admin is t ra tors and decis ion-makers are sometimes seen as advocat ing f o r a p a r t i c u l a r program/service f o r t h e i r o w n . s e l f - i n t e r e s t s . A c q u i r i n g the op in ion and perspect ive of the c i t i z e n consumer adds a more c r e d i b l e dimension to the need f o r s e r v i c e . Consumer i n - p u t can be a h i g h l y u s e f u l means of l o c a t i n g t rouble spots i n a program or i n p rov id ing conf i rming evidence about suspected areas o f d i f f i c u l t i e s (Reid & Smith, 1978). Furthermore, c l i e n t suggestions about program development or improvement can e s p e c i a l l y be h e l p f u l i n p rov id ing a d i f f e r e n t viewpoint apart from the b iases of the p r o f e s s i o n a l . In t h e i r e f f o r t to c o l l e c t in format ion from c i t i z e n s , agencies r e f l e c t the image of wanting to improve t h e i r programs based on the feedback they r e c e i v e . Such informat ion can help to guide program managers to improve the e f f e c -t i veness of t h e i r programs. Issues of a c c o u n t a b i l i t y , c r e d i b i l i t y , f i n a n c i a l and community support are a l s o addressed through consumer research . Consumer research can a s s i s t to address more s p e c i f i c i ssues which c e r t a i n organ iza t ions may be concerned w i t h . Some of these i ssues are presented as f o l l o w s : What groups i n the popula t ion need s e r v i c e ? Which segments of the popula t ion should the agency be addressing What are the organ iza t ions strengths and weaknesses? How i s the o rgan iza t ion perce ived by the community? What does the c l i e n t r e a l l y need or want? What should be changed to make t h i s program more e f f e c t i v e ? What future d i r e c t i o n s should the o rgan iza t ion take i n terms of p rograms/serv ices /p roducts? What should the organ iza t ion be concerned with? What are the peop le 's op in ions and a t t i t u d e s ? What s t ra tegy should the o rgan iza t ion use to develop fu ture programs to reach c l i e n t s ? Program planners and admin is t ra tors are the major stakeholders involved with the issues i d e n t i f i e d above. To show that they are concerned with such q u e s t i o n s , and t h e i r w i l l i n g n e s s to seek answers to them, fur ther l e g i t i m i z e s f i n a n c i a l and community support . S i m i l a r i l y , the r e c e i v e r s of s e r v i c e are a l s o involved with and a f f e c t e d by these i s s u e s . Unless c l i e n t s and consumers are w i l l i n g to p a r t i c i p a t e i n the p r o v i s i o n of informat ion needed by admin is t ra tors and researchers , two-way dia logue cannot be s u c c e s s f u l l y ach ieved . Therefore , f o r c i t i z e n s to express t h e i r a t t i t u d e , op in ions and p e r c e p t i o n s . i n an open and honest manner a l s o i n d i c a t e s a concern on t h e i r par t f o r the issues under s tudy . THE VALUE OF CONSUMER RESEARCH TO SOCIAL WORKERS In the broader context of research , most s o c i a l work p r a c t i t i o n e r s have p r e f e r r e d to opt out from t h i s area of p r a c t i c e . S o c i a l workers are b e t t e r known f o r t h e i r c l i n i c a l s k i l l s , community development s k i l l s , or a d m i n i s t r a -t i v e s k i l l s . S o c i a l work p r a c t i c e has u s u a l l y been regarded as a d i s t i n c t e n t i t y from s o c i a l r e s e a r c h . Problems i n the adequate p r o v i s i o n of s e r v i c e s to c l i e n t s can r e s u l t without an attempt to in tegra te at l e a s t some research p r i n c i p l e s in to p r a c t i c e on the par t of the p r a c t i t i o n e r . In a study to evaluate a group of a n t i -de l iquency p r o j e c t s , an a c t i o n - r e s e a r c h organ iza t ion was formed to provide the human dimension f o r urban renewal by p lanning and conducting a broad ly de f ined program of community development (Aronson & Sherwood, 1977). A d i s c u s s i o n of the study focussed on the r e l a t i o n s h i p between the research u n i t and the people respons ib le f o r des ign ing and implementing the m u l t i -s e r v i c e programs (not a l l s o c i a l workers) . It was found that the grea tes t source of d i s c o r d among researchers and designers of programs "was the l a t t e r ' s preoccupat ion with the components of programs without re ference to t h e i r ob jec t i ves . . . i t seems only l o g i c a l to s p e c i f y the changes that w i l l be sought before d e v i s i n g s t r a t e g i e s to produce those changes, the des igner of programs t y p i c a l l y begins with the d e t a i l s of the program without f i r s t d e f i n i n g the kinds of changes that are the i n t e r v e n t i o n t a r g e t s " (Aronson & Sherwood, 1967:91). These f i n d i n g s would seem to i n d i c a t e that s o c i a l workers, as program p lanners , can l ea rn to design b e t t e r programs with some understanding of research p r i n c i p l e s . P r a c t i t i o n -ers o f ten experience d i f f i c u l t y i d e n t i f y i n g s p e c i f i c goals f o r the i r 'p rogram e s p e c i a l l y goals that can be de f ined i n terms that can be o p e r a t i o n a l i z e d and measured. The Aronson and Sherwood study f u r t h e r confirmed that the researchers encountered l i t t l e empathy or understanding from the human s e r v i c e p r a c t i o n e r s . Attempts to obta in c l i e n t in format ion f o r eva luat ion purposes were met with r e f u s a l s f o r fear of v i o l a t i n g c o n f i d e n t i a l i t y between the c l i e n t and s o c i a l s e r v i c e worker. Researchers a l s o experienced some o p p o s i t i o n or r e s i s t e n c e when they attempted to e s t a b l i s h new programs without c o n s u l t i n g program d e s i g n e r s . This fu r ther a f f e c t e d the eventual success of such programs. "Much of the tens ion between researchers and p r a c t i t i o n e r s r e s u l t e d from the f a i l u r e to convince the p r a c t i t i o n e r s that what was being evaluated was the impact of a program and not t h e i r a b i l i t y or competence (Aronson & Sherwood, 1967:94). The r e s e a r c h - p r a c t i c e gap between p r a c t i t i o n e r s and researchers i s not a new phenomena and improvements i n t h i s area have been addressed i n the l i t e r a t u r e (Patton, 1978; Tash & S t a h l e r , 1982; Weiss, 1972). The major i ty of s o c i a l workers w i l l , at some point i n t h e i r c a r e e r s , encounter some aspect of research p r a c t i c e : e i t h e r as researchers them-s e l v e s , as subjects of research , or as the r e c e i v e r s of research recommended program changes. It i s there fore e s s e n t i a l that s o c i a l workers understand the dynamics of research , i t s concepts and p r i n c i p l e s . As research and eva lua t ion are becoming i n e v i t a b l e components of the human s e r v i c e s , s o c i a l workers w i l l f i n d themselves becoming more entrenched i n research p r a c t i c e . Because of the interdependence between r e s e a r c h , program design and implementat ion, s k i l l s i n c o l l a b o r a t i o n as we l l as i n research are important i s s u e s to human se rv ice p r a c t i t i o n e r s . S o c i a l workers, as advocates on beha l f of c l i e n t s and disadvantaged groups, are respons ib le f o r i n i t i a t i n g change i n the i n t e r e s t of the people they s e r v e . Consequently, promoting and encouraging research to assess consumer op in ion and perspect ives can be used as a c a t a l y s t i n the development of r e s p o n s i b l e and responsive s o c i a l programs. Integrat ing research: s k i l l s with other p r a c t i c e s k i l l s serves to broaden one 's a b i l i t i e s as a s o c i a l worker. Information c o l l e c t e d from people a f f e c t e d by a given program or s e r v i c e , or the lack of s e r v i c e , can be used as a t o o l f o r m o b i l i z a t i o n and a c t i o n . CONCLUSION Consumer research has the p o t e n t i a l of p r o v i d i n g a c c o u n t a b i l i t y , c r e d i b i l i t y , f i n a n c i a l and community support , as w e l l as u s e f u l in format ion f o r program p lanning to those organ iza t ions that are w i l l i n g and able to engage i n such an undertaking. S o c i a l workers, as p r a c t i t i o n e r s , have a r e s p o n s i b i l i t y t o ensure t h a t the viewpoints of t h e i r c l i e n t s are heard; consequently, research can become an e f f e c t i v e t o o l i n the a c q u i s i t i o n of these view-p o i n t s which can help t o p r e c i p i t a t e a c t i o n . Consumer research i s not an i n n o v a t i v e i d e a , but a much neglected one i n the human s e r v i c e s e t t i n g . As resources continue to d e c l i n e , a marketing approach to the h e a l t h and s o c i a l s e r v i c e s w i l l g a i n g r e a t e r ground. By l e a r n i n g something about i t s marketplace t h a t i s , about consumers and p o t e n t i a l consumers human s e r v i c e o r g a n i z a t i o n s are i n a b e t t e r p o s i t i o n t o formulate more e f f i c i e n t s t r a t e g i e s i n promoting t h e i r image and t h e i r products. I I . INTERACTION OF PRACTICE & RESEARCH INTRODUCTION The purpose of t h i s chapter i s to provide a d e s c r i p t i o n and a n a l y s i s of the in tegra ted M.S.W. p r a c t i c e and research process undertaken by t h i s w r i t e r i n the 1986-87 academic term at the U n i v e r s i t y of B r i t i s h Columbia. This combination program provided an oppor tuni ty to incorporate both community work s k i l l s and research s k i l l s . The f i n a l wr i t ten product of any research p ro jec t almost always excludes a background d e s c r i p t i o n of the s o c i a l , p o l i t i c a l and environmental dynamics that are a c t i v e determinants of the research process and f i n a l outcome. The fo l low ing s e c t i o n accounts f o r these f a c t o r s by d e s c r i b i n g the agency and key p layers invo lved , d i s c u s s i n g var ious conceptual models of research gu id ing the process , and summarizing h i g h l i g h t s of the c o n s u l t a t i o n process from t h i s p a r t i c u l a r case s tudy. F i n a l l y , l i m i t a t i o n s and successes of the research p r a c t i c e are i d e n t i f i e d , fo l lowed by a d i s c u s s i o n of 'what should or could have been done' i n r e t r o s p e c t . THE INTEGRATED PRACTICE & RESEARCH PROGRAM In c o n s u l t a t i o n with p r a c t i c e f a c u l t y , the student was to locate a f i e l d p r a c t i c e s e t t i n g i n which there was an opportuni ty to car ry out a research study i n an area of i n t e r e s t to the s tudent . The f i e l d p r a c t i c e assignment invo lved the fo l low ing (Crane, 1986): 1) Work with an agency or community group i n the s e t t i n g to formulate a researchable problem of s u i t a b l e scope; 2) Carry out the research , i n c o n s u l t a t i o n with t h i s group; 3. Help the group i d e n t i f y the p o l i c y and programming i m p l i c a t i o n s of the research and plan f o r u t i l i z a t i o n of the r e s u l t s ; 4. Help with d isseminat ion of the r e s u l t s . The ob jec t i ve of t h i s in tegra ted program opt ion was to prepare students to use p r a c t i c e s k i l l s to he lp community groups acquire informat ion through research , and to implement the in format ion such that i t s relevance would be maximized f o r on-going u t i l i z a t i o n . THE SETTING THE ORGANIZATION: The Canadian Mental Heal th A s s o c i a t i o n - B . C . D i v i s i o n * i s the p r o v i n c i a l o f f i c e which provides l eadersh ip to twenty-three branch organ iza t ions and over f i v e hundred vo lunteers throughout B r i t i s h Columbia i n the f i e l d of mental h e a l t h . The p r o v i n c i a l s t ruc ture f a c i l i t a t e s the shar ing of in format ion and other resources on a province-wide b a s i s . It increases the o v e r a l l c a p a b i l i t y of C .M.H.A. i n the province through t e c h n i c a l p r o j e c t s , funding and p u b l i c i t y . The d i v i s i o n a l o f f i c e a lso acts as a resource to i t s branches by p rov id ing t e c h n i c a l ass is tance and c o n s u l t a t i o n i n var ious areas of admin is t ra t ion and development. THE MANDATE: The mandate of C .M.H.A. i s broad and d i v e r s e , simply because of the complexity of mental hea l th i s s u e s . The i r r e s p o n s i b i l i t i e s range from advocat ing f o r improved care and r e h a b i l i t a t i o n of the mental ly i l l * S h a l l be r e f e r r e d to as C.M.H.A. i n t h i s paper to p u b l i c educat ion, prevent ion and mental hea l th promotion. The mandate i s ra ther comprehensive i n order to mainta in the i n t e r e s t s of and draw the experiences from a wide v a r i e t y of c l i e n t s and serv ice p r o v i d e r s . Inc reas ing ly , however, i t s greatest cont inu ing r e s p o n s i b i l i t y i s p r o v i d i n g informat ion to the general p u b l i c through a broad-based pub l i c awareness and educat ion campaign. The d i v i s i o n a l o f f i c e i s e s p e c i a l l y a c t i v e i n t h i s area whi le a l s o encouraging i t s branches to inc lude educat iona l s e r v i c e s as an i n t e g r a l part of i t s programming. THE PROBLEM: In r e l a t i o n to the background problem area i n chapter 1, C.M.H.A. - B . C . has acknowledged a need to consul t with i t s consumers to ensure the development of e f f e c t i v e and responsive educat iona l programs. There i s uncer ta in ty as to what in format ion the p u b l i c i s look ing f o r , how they would p r e f e r to rece ive such in format ion and what they a l ready know or don ' t know. Consumer data would provide C.M.H.A. with knowledge about i t s target group, t h e i r o p i n i o n s , and p e r s p e c t i v e s . As a p lanning t o o l , the acquired informat ion should he lp guide the organ iza t ion i n program development and future p lann ing . As an admin is t ra t i ve t o o l , the consumer research might r e f l e c t a measure of a c c o u n t a b i l i t y and c r e d i b i l i t y which w i l l fu r ther promote f i n a n c i a l and community support . By checking t h e i r repor ts and assumptions against samples of consumer da ta , the q u a l i t y and conf idence of the o r g a n i z a t i o n ' s e x i s t i n g data base could be enhanced. ORGANIZATIONAL STRUCTURE: C . M . H . A . - B . C . D i v i s i o n has a s t a f f of th ree : the execut ive d i r e c t o r , one o f f i c e r f o r vo lunteer development, and one s e c r e t a r y . The execut ive d i r e c t o r i s r e s p o n s i b l e for admin is t ra t ion and program planning fo r B . C . D i v i s i o n and i s d i r e c t l y respons ib le to the Management Committee and Board of D i r e c t o r s . The o f f i c e r f o r volunteer development serves as l i a i s o n and provides t e c h n i c a l support to e x i s t i n g and developing branch o f f i c e s . The management committee i s the p o l i c y -making body of the -organizat ion a c t i n g on behal f of the p r o v i n c i a l board of d i r e c t o r s , who meet on ly three times annua l ly . The management committee oversees the admin is t ra t i ve funct ions of B . C . D i v i s i o n . Given the l i m i t e d s t a f f and resources of B . C . D i v i s i o n , a great deal of i t s programs and s e r v i c e s r e s t with vo lunteer committees which are formed to address a p a r t i c u l a r i s s u e or to implement a p a r t i c u l a r program. Committee members are chosen on the b a s i s of t h e i r exper t ise i n a given area and may be representa t ives from other community agenc ies . The execut ive d i r e c t o r serves as s t a f f support to each of these working committees and repor ts any re levant progress to the management committee. CULTURE OF THE ORGANIZATION: As a n o n - p r o f i t o r g a n i z a t i o n , the n a t i o n a l , p r o v i n c i a l and l o c a l branches of C .M.H .A . have a long h i s t o r y of vo lunteer ism as the major impetus behind i t s e x i s t e n c e . C .M.H.A. r e l i e s heav i l y on i t s vo lunteers who range from d i r e c t o r s and committee members to f r o n t - l i n e support and c l e r i c a l s t a f f . Th is emphasis on volunteer ism i s i n keeping with i t s phi losophy to invo lve members of the community as a community- based o r g a n i z a t i o n . B . C . D i v i s i o n has an on-going mandate to st imulate vo lunteer a c t i v i t y whi le promoting i t s o r g a n i z a t i o n a l g o a l s . EXPERIENCE OF THE ORGANIZATION: C .M.H.A . - B . C . D i v i s i o n experienced some admin is t ra t i ve d i f f i c u l t i e s which r e s u l t e d i n a h ia tus f o r the o r g a n i z a t i o n between 1983-84. The secre ta ry and a few remaining board members cont inued to manage the e s s e n t i a l funct ions of the o r g a n i z a t i o n . The present execut ive d i r e c t o r , the o f f i c e r f o r vo lunteer development, and the management committee are a l l r e l a t i v e newcomers to the o rgan iza t ion with minimal background experience i n the mental hea l th f i e l d . Under new management, the agency i s s u c c e s s f u l l y r e - e s t a b l i s h i n g i t s e l f and i s c r e a t i n g a st ronger and more v i s i b l e presence i n the community. The present o r g a n i z a t i o n a l s t a f f had no previous experience with survey research , but recognize the importance and b e n e f i t s of conduct ing same. While C.M.H.A. has had student f i e l d placements i n the pas t , the recent s t a f f had no previous experience working with or superv is ing s tudents . RESEARCH PARTICIPANTS It i s necessary to i d e n t i f y the key p a r t i c i p a n t s p r i o r to an overview of the research c o n s u l t a t i o n p r o c e s s . A d e s c r i p t i o n of the r o l e s assumed by these p a r t i c i p a n t s w i l l provide a d d i t i o n a l i n s i g h t to the development of the research p r o j e c t . ADVISORY COMMITTEE: Because the student was not f a m i l i a r with the o r g a n i z a -t i o n , the execut ive d i r e c t o r formed the necessary research adv isory committee. The educat ion coord inator from a l o c a l C .M.H.A. branch was asked to p a r t i c i p a t e because of her involvement i n the subject under s tudy. Funding was requested from Mental Health Serv ices to cover overhead expenses, and consequently a government representa t ive who was i n t e r e s t e d i n the research was asked to provide feedback throughout the course of the p r o j e c t . Unfor tunate ly , because the government representa t ive was located i n V i c t o r i a , meetings could not be e a s i l y arranged with t h i s person. The student up-dated and consul ted with t h i s i n d i v i d u a l through occas iona l telephone c a l l s and wr i t t en m a t e r i a l , but contact was kept to a minimum. In r e t r o s p e c t , i t i s f e l t a greater e f f o r t should have been made to consul t with t h i s i n d i v i d u a l as i t could have p o s i t i v e l y in f luenced future funding f o r research p r o j e c t s . A c o n f l i c t of i n t e r e s t s i n the purpose of the research due to d i f f e r e n t mandates was d i f f i c u l t to reso lve by long d i s t a n c e . While the student attempted to accommodate the i n t e r e s t s of both p a r t i e s i n v o l v e d , the government representa t ive subsequently acknowledged the sponsoring agency as the key informat ion u s e r . As the research progressed, other i n d i v i d u a l s assoc ia ted with the o r g a n i z a t i o n were consul ted i n the quest ionna i re c o n s t r u c t i o n s tage . The o f f i c e r f o r vo lunteer development and two board members became more f l u i d p a r t i c i p a n t s of the advisory committee. The adv isory committee, as key resource people , helped to provide p r o f e s s i o n a l exper t ise i n focus ing on re levant research quest ions to which they wanted answers. As i n d i v i d u a l s with d i f f e r e n t i n t e r e s t s and l e v e l o f knowledge, the in format ion needs of each committee member had to be c o n s i d e r e d . However, major c o n s i d e r a t i o n was given to the needs of the sponsor ing agency as the key in format ion u s e r . THE EXECUTIVE DIRECTOR: The execut ive d i r e c t o r was i d e n t i f i e d as the major user of the research da ta , and c l o s e c o n s u l t a t i o n was maintained with t h i s i n d i v i d u a l throughout the research p r o c e s s . It was the execut ive d i r e c t o r who expressed the need f o r a survey and who provided the major support and guidance fo r the student researcher . The a c c e s s i b i l i t y of the execut ive d i r e c t o r i n the s tudent 's f i e l d placement s e t t i n g cont r ibuted to in formal d i s c u s s i o n and c o n s u l t a t i o n which was not p o s s i b l e with the advisory committee. While the adv isory committee was formed to provide a d d i t i o n a l ideas and in format ion , the execut ive d i r e c t o r was the p r i n c i p l e force behind the r e s e a r c h . U t i l i z a t i o n of the research r e s u l t s and recommendations would remain l a r g e l y with the execut ive d i r e c t o r f o r f o l l o w - u p . THE STUDENT: The student became invo lved i n many aspects of the o rgan iza t ion at the beginning of the term, with the i n t e n t i o n of l ea rn ing about the o rgan iza t ion and ga in ing a v a r i e t y of p r a c t i c e exper ience. At the onset of the program, the student assumed the t r a d i t i o n a l r o l e of a student i n a f i e l d placement: l ea rn ing and exper ienc ing through p r a c t i c a l involvement by at tending meetings and becoming invo lved i n var ious committees and p r o j e c t s . Because of other i n t e r e s t s and r e s p o n s i b i l i t i e s , the research aspect of the p r a c t i c e was not s t r o n g l y pursued at the beginning of the term. The student consul ted with the execut ive d i r e c t o r concerning the problem area and issues f o r research . Copies of the wr i t t en research proposal were sent to the adv isory committee f o r feedback. The student assumed the more a c t i v e r o l e of research consul tant dur ing the second part of the academic term when more frequent committee meetings were arranged. As i t was d i f f i c u l t to maintain other r e s p o n s i b i l i t i e s with the o rgan iza t ion given time l i m i t a t i o n s and academic demands, the student found i t necessary to withdraw from other committments. The research p r o j e c t became more t ime-consuming dur ing the development of the interv iew schedule and dur ing the implementation of the survey. As enabler and researcher , the adv isory committee l e f t much of the c o n t r o l of the research to the s tudent . When compromises could not be f u l l y reached or d e c i s i o n s cou ld not be a c c u r a t e l y s p e c i f i e d , the student had to assume r e s p o n s i b i l i t y to make such d e c i s i o n s due to time l i m i t a t i o n s . FACULTY AND PEERS: The f a c u l t y at the u n i v e r s i t y was a v a i l a b l e f o r t e c h n i c a l support and guidance throughout the course of the r e s e a r c h . D i rec ted reading t u t o r i a l s were assigned a c c o r d i n g l y . Consu l ta t ion per iods were a l s o arranged with student co l leagues dur ing pre-arranged seminars. RESEARCH PARADIGMS Paradigms provide a conceptual and p h i l o s o p h i c a l framework which guide a c t i o n . They break down the complex i t ies of the r e a l wor ld , compartemental izing ideas from a broader p e r s p e c t i v e . Paradigms provide l eg i t imate r u l e s , b a s i c p r i n c i p l e s and b e l i e f s which regu la te processes and procedures. Pa t ton 's U t i l i z a t i o n - F o c u s e d Model f o r d i r e c t e d s o c i a l change (Patton, 1978) served as the dominant paradigm f o r t h i s p a r t i c u l a r research p r o c e s s . However, i t would be u s e f u l to introduce three a d d i t i o n a l paradigms as over lapping t h e o r e t i c a l models i n f l u e n c i n g the r e s e a r c h . Reference i s made to each of these models i n the f o l l o w i n g s e c t i o n d e s c r i b i n g the research p r o c e s s . RATIONAL MODEL: The r a t i o n a l model i s perhaps the most f requent ly c i t e d normative approach to the research p r o c e s s . The sequent ia l s t ruc ture of the r a t i o n a l approach conta ins four consecut ive steps (Mart in, 1982): 1) 2) formulate a t h e o r e t i c a l problem s e l e c t appropr ia te research method, design and conduct study analyze and i n t e r p r e t r e s u l t s use r e s u l t s to conf i rm/deny theory . 3) 4) The r a t i o n a l model, s ta tes Mart in (1982), has a l o g i c a l j u s t i f i c a t i o n and It assumes that the research process i s a purposive , ob jec t i ve and r a t i o n a l a c t i v i t y which operates i n a h i g h l y sequent ia l and l o g i c a l manner. GARBAGE CAN MODEL: Mart in (1982) d i s c u s s e s a more accurate and r e a l i s t i c d e s c r i p t i o n of the research process i n i t i a l l y introduced by Cohen, March and Olsen (1972). According to t h i s model, the process of dec is ion-making i s conceptua l i zed as a garbage c a n . The garbage can model recognizes tha t an o rgan iza t ion " i s a c o l l e c t i o n of cho ices look ing f o r problems, i ssues and f e e l i n g s look ing f o r d e c i s i o n s i t u a t i o n s i n which they might be a i r e d , i s o l u t i o n s look ing fo r i ssues to which they might be the answer, and d e c i s i o n -makers look ing f o r work" (Cohen e t . a l . 1972:2). Insight in to t h i s model prov ides a more r e a l i s t i c and i d e n t i f i a b l e understanding of the ac tua l research p r o c e s s . "Decis ion s i t u a t i o n s or o rgan iza t ions . . . are charac te r i zed by i n c o n s i s t e n t and i l l - d e f i n e d p re fe rences , unclear technology, and f l u i d p a r t i c i p a t i o n i n the decis ion-making process" (Mart in, 1982:21). In the academic wor ld , methodological textbooks of ten present the r a t i o n a l approach of doing r e s e a r c h . Consequently, students of ten get 'hung up' on f o l l o w i n g the ' i d e a l ' model, f e e l i n g f r u s t r a t e d when, i n r e a l i t y , a c t u a l p r a c t i c e f a i l s to conform to the i d e a l . The garbage can model confirms to the student that research (or any other) d e c i s i o n s and ac t ions are not n e c e s s a r i l y r a t i o n a l , sequent ia l or p e r f e c t . i s perhaps an i d e a l i z e d guide as to how research ought to be conducted. INCREMENTAL MODEL: DeYoung and Conner (1982) s ta te that decis ion-making i n organ iza t ions i s incrementa l . The incremental model recognizes that whi le informat ion i s important, i t does not p lay a c e n t r a l r o l e i n d e c i s i o n -making. Instead, p o l i t i c s i s a key f a c t o r : "dec is ions are based on current s i t u a t i o n a l demands . . . choice among a l t e r n a t i v e s i s not n e c e s s a r i l y based on theory or past research but ra ther on the experiences of the decis ion-maker and the demands of the s i t u a t i o n " (DeYoung & "Conner, 1982:433). In app ly ing t h i s to the research p lanning process , the incremental model understands that planners or decis ion-makers do not c l a r i f y g o a l s ; they evolve s lowly over time out of prev ious experience and d e c i s i o n s of the moment. Unl ike the r a t i o n a l model which i s h i g h l y s t ruc tured and g o a l -o r i e n t e d , the incremental model acknowledges f l e x i b i l i t y and change given current s i t u a t i o n s and c o n f l i c t s . UTILIZATION-FOCUSED MODEL: Pa t ton 's (1978) u t i l i z a t i o n - f o c u s e d model share many s i m i l a r i t i e s and p r i n c i p l e s with the l a t t e r two models descr ibed above. DeYoung and Conner, i n f a c t , r e f e r to Pa t ton 's model severa l times i n t h e i r d i s c u s s i o n of incremental r e s e a r c h . The emphasis of Pat ton 's model i s on the u t i l i z a t i o n of research f i n d i n g s which w i l l consequently lead to d i r e c t e d s o c i a l change. The u t i l i z a t i o n - f o c u s e d model d isrobes the r a t i o n a l and s c i e n t i f i c method of research to present a more amenable and r e a l i s t i c process a process which i s more re levant and a p p l i c a b l e i n the o r g a n i z a t i o n a l s e t t i n g of the r e a l wor ld . While i t i s important to acqui re the b a s i c knowledge of t r a d i t i o n a l research methodology, t h i s model d e t r a c t s from the sequent ia l and l o g i c a l approach. Instead, i t asser ts that s c i e n t i f i c systems of d e f i n i t i o n s and c l a s s i f i c a t i o n are perceptua l , a r t i f i c i a l and a r b i t r a r y and are determined by p o l i t i c s , persuas ion , paradigms and preference (patton, 1978:237). The u t i l i z a t i o n - f o c u s e d model does not concern i t s e l f with theory v e r i f i c a t i o n , o b j e c t i v i t y or measurement p r e c i s i o n ; i t s emphasis i s that the research process and f i n d i n g s have the a b i l i t y to reduce uncer ta in ty and thereby p r e c i p i t a t e a c t i v i t y . Given the many dimensions which i n f l u e n c e decis ion-making and subsequent a c t i o n , the context and shareholders of the research process must be a c t i v e , r e a c t i v e and adapt ive . In r e a l i t y , a s i n g l e t h e o r e t i c a l paradigm i s seldom used to accura te ly guide a p a r t i c u l a r p rocess , and as such, severa l over lapping models have been presented . In the fo l lowing s e c t i o n , h i g h l i g h t s from t h i s case study are d i s c u s s e d . Reference i s made to each of these models i n va r ious p a r t s , with p a r t i c u l a r emphasis on Pa t ton 's u t i l i z a t i o n - f o c u s e d model. THE RESEARCH CONSULTATION PROCESS ESTABLISHING THE PERSONAL FACTOR: With an i n t e r e s t i n the area of mental hea l th educat ion, the student contacted the Canadian Mental Health A s s o c i a t i o n - B . C . D i v i s i o n about the p o s s i b i l i t y of a f i e l d placement. C o i n c i d e n t a l l y , the execut ive d i r e c t o r had r e c e n t l y expressed to the Management Committee the need f o r the agency to conduct research . A cont rac t was subsequently e s t a b l i s h e d between the agency, the student , and the School of S o c i a l Work. "The f i r s t step i n the u t i l i z a t i o n - f o c u s e d approach . . . i s the i d e n t i f i c a t i o n and o r g a n i z a t i o n of re levant decis ion-makers and informat ion users of the eva luat ion (Patton, 1978: 61). 27. Organizat ion of the adv isory committee as other p o t e n t i a l in format ion users was l e f t to the d i s c r e t i o n of the e x e c u t i v e - d i r e c t o r . Roles and r e s p o n s i b i l i t i e s of committee members were not c l e a r l y i d e n t i f i e d at the beginning of the p rocess . Terms of reference and expectat ions were not e s t a b l i s h e d . Because the e x e c u t i v e - d i r e c t o r was r e a d i l y a c c e s s i b l e and a v a i l a b l e i n the f i e l d s e t t i n g , the student neglected to a c t i v e l y consu l t with other committee members dur ing the i n i t i a l stages of p lann ing . The execut ive d i r e c t o r int roduced the student to the management committee and the board of d i r e c t o r s , a l l of whom were i n favor of the research p r o j e c t . As such, the student was g iven r e c o g n i t i o n and c r e d i b i l i t y at the beginning of the c o n s u l t a t i v e p rocess . Committee members were p e r s o n a l l y contacted at d i f f e r e n t times throughout the research process f o r t h e i r i n - p u t and feedback. Meetings became more regu la r and cons is ten t dur ing the second term as d i r e c t i o n and expectat ions became c l e a r e r from the s tudent 's p e r s p e c t i v e . The student had the opportuni ty to become more f a m i l i a r with the organ iza t ion as the term progressed through exposure to the s e t t i n g and involvements with d i f f e r e n t aspects of the o r g a n i z a t i o n . 28. IDENTIFYING THE ISSUES FOR RESEARCH: Given the broad scope of the o r g a n i z a t i o n ' s mandate, d i f f e r e n t needs of committee members, the r e l a t i v e newness of s t a f f and some confus ion over program d i r e c t i o n , the process of i d e n t i f y i n g s p e c i f i c research issues was vague and compl ica ted . As research consu l tan t , the student would attend to the var ious concerns of the in format ion u e r s , and attempt to frame quest ions in to a coherent context f o r r e s e a r c h . Issues of choice and d i r e c t i o n were shared with dec is ion-makers . Issues f o r research emerged out of the d i f f e r e n t i n t e r e s t s of committee members. Cons idera t ion was given to the b iases of the funding body r e p r e s e n t a t i v e , to the key informat ion user , and to the student researcher . Issues remained broad given d i f f e r e n t needs and an i n a b i l i t y to c l e a r l y i d e n t i f y or narrow s p e c i f i c problems. Despite the lack of in fo rmat ion , great complexity and m u l t i p l e u n c e r t a i n t i e s , i t was s t i l l necessary to make a d e c i s i o n regarding research i s s u e s . Decision-makers resor ted to ' s u b j e c t i v e r a t i o n a l i t y ' : s i m p l i f y i n g the decis ion-making process through s a t i s f i c i n g or making a d e c i s i o n which i s 'good enough' (Patton,1978: 125). As the c o n s u l t a t i o n process continued and the researcher acquired more in format ion , research issues were modif ied or changed a c c o r d i n g l y . S p e c i f i c research quest ions were f i r s t r a i s e d , which then had to be f i t t e d i n t o general i ssues f o r r e s e a r c h . Fol lowing t h i s , a broad t h e o r e t i c a l framework had to be developed from the l i t e r a t u r e to j u s t i f y the problem as a subject f o r i n v e s t i g a t i o n . In the garbage can model, the sequence of problems, r e s o u r c e s , methodological choices and s o l u t i o n s are i n constant f l u c t u a t i o n rather than i n a f i x e d r a t i o n a l o rder . The sequence of the steps i n the r a t i o n a l model can be scrambled, and i n some c a s e s , reversed (Mart in, 1982). DESIGN AND MEASUREMENT DECISIONS: The organ iza t ion i n i t i a l l y requested a l a r g e - s c a l e survey extending to var ious communities throughout the p r o v i n c e . The in ten t ion was to use vo lunteers to a s s i s t the researcher i n implementing the survey at d i f f e r e n t branch o f f i c e s . A one-shot study was conceptua l i zed which would produce in forma-t i o n as a means to an end. In the r a t i o n a l model of the research process , r e s u l t s are the endpoint and are expected to make an impact by p r o v i d i n g so lu t ions to problems. Both the student and the o rgan iza t ion were inexper ienced and un fami l i a r with research d e s i g n . As such, f e a s i b i l i t y over the s i z e and scope of the research was not i n i t i a l l y quest ioned . The research proposal i d e n t i f i e d three communities and four d i f f e r e n t target groups to be surveyed. The i n i t i a l process was delayed and in f luenced by high expectat ions and a lack of general under-standing about the r e a l i t i e s of research . Consul ta t ion with academic adv isors and student peers a s s i s t e d to narrow the scope of the r e s e a r c h . The recommendation to conduct a p i l o t study was agreed upon by the committee. Ongoing c o n s u l t a t i o n with students and f a c u l t y provided u s e f u l feedback and guidance to the more t e c h n i c a l aspects of the research p r o c e s s . Classroom c o n s u l t a t i o n a l s o provided an opportuni ty to o b j e c t i v e l y p r e - t e s t the survey instrument f o r a d d i t i o n a l i n - p u t . It was necessary to negot ia te the target group fo r the survey and the survey methodology. Decision-makers pre fe r red to survey a popula t ion group which was qui te broad and genera l , but t h i s group was d i f f i c u l t to access given time and manpower l i m i t a t i o n s of the s tudent . F l e x i b i l i t y of the student and the committee i n an a c t i v e , r e a c t i v e and adaptive r e l a t i o n s h i p r e s u l t e d i n a compromising and s a t i s f y i n g outcome. According to the r a t i o n a l model, the nature of the t h e o r e t i c a l problem should determine the choice of methodology (Mart in , 1982). However, the methodology, sampling populat ion and subsequent r e s u l t s were i n f l u e n c e d and determined by a v a i l a b l e resources , the p re fe r red ta rge t group, and e t h i c a l c o n s i d e r a t i o n s , which are mentioned l a t e r i n t h i s paper. The design of the in terv iew schedule and s p e c i f i c research quest ions were in f luenced by the data c o l l e c t i o n method, f o r ... example: quest ions had to be kept short and simple f o r telephone in te rv iews . The q u a l i t y of the measurement instrument was therefore a f f e c t e d by t h i s f a c t o r , as we l l as by confus ion over goals and time c o n s t r a i n t s . "Design and data c o l l e c t i o n d e c i s i o n s are fa r from being n e u t r a l , ob jec t i ve or r a t i o n a l such d e c i s i o n s are p o l i t i c a l , sub jec t ive and s a t i s f i c i n g " (Patton, 1978: 202). 31. As the research process cont inued, i t became c l e a r that the research pro jec t would not provide end-so lu t ions to s p e c i f i c problems. The garbage can model permits empi r i ca l r e s u l t s to funct ion as a s t a r t i n g p o i n t , ra ther than l a b e l l i n g r e s u l t s as ' s o l u t i o n s ' (Mart in, 1982). Although a l l research p a r t i c i p a n t s probably envis ioned how the research process should have evolved and what could have emerged from the r e s u l t s , i t i s l i k e l y that these expectat ions d i d not f u l l y consider p o l i t i c a l in f luences or r e a l i s t i c l i m i t a t i o n s : i . e . - c o n f l i c t i n g values and pre ferences , e t h i c a l c o n s i d e r a t i o n s , uncer ta in ty of in format ion , lack of c l e a r d i r e c t i o n , and time c o n s t r a i n t s . In r e a l i t y , the process of making research d e c i s i o n s was one of " d i s j o i n t e d incremental ism, muddling though and s a t i s f i c i n g i n cont ras t to r a t i o n a l goal maximization" (Patton, 1978: 126). UTILIZATION OF RESULTS: The key to u t i l i z a t i o n - f o c u s e d research i s that plans are d iscussed f o r u t i l i z a t i o n even before the data i s c o l l e c t e d (Patton, 1978). In the e a r l y conceptua l i za t ion stages of the research , u t i l i z a t i o n was d iscussed ra ther genera l l y and vaguely. However, expectat ions were expressed that h o p e f u l l y research r e s u l t s would lead to s p e c i f i c changes and d i r e c t a c t i o n . The o v e r - r i d i n g need to c o n s u l t with the p u b l i c was the major concern of the sponsoring agency. Depending upon the research r e s u l t s , suggestions f o r u t i l i z a t i o n inc luded us ing the c o l l e c t e d da ta : i n funding proposa ls ; i n a press re lease fo r p u b l i c i t y ; i n an a c c o u n t a b i l i t y repor t to funders; or as a d d i t i o n a l in format ion to guide program planning or lobbying government f o r a c t i o n . As the research design changed, so d i d the issues and the scope of the survey. However, p lans f o r u t i l i z a t i o n remained the same. Although the sampling s i z e and other aspects of the research s h i f t e d from i n i t i a l expecta t ions , t h i s d i d not a f f e c t the eventual u t i l i t y of some of the research r e s u l t s . For example, par ts of the c o l l e c t e d data were used i n a funding proposal s h o r t l y a f t e r the survey was completed. "Decision-makers are l e s s concerned about methodological and research q u a l i t y and more concerned that at l e a s t some re levant data i s produced" (Patton, 1978: 253). Adhering to the incremental and u t i l i z a t i o n - f o c u s e d model, the author played an a c t i v e r o l e i n the d isseminat ion of r e s u l t s . F indings were presented to the adv isory committee who were asked to provide feedback and f u r t h e r recommendations. The author a l s o provided some i n s i g h t and perspect ives r e s u l t i n g from the c o l l e c t e d d a t a . Further d i s c u s s i o n s were held i n d i v i d u a l l y with the execut ive d i r e c t o r , who was to present f ind ings to the management committee. At the time of t h i s w r i t i n g , the author had not yet documented f i n a l conc lus ions and recommendations. It i s expected, however, that a separate repor t may be prepared f o r the sponsoring agency. The committee w i l l be convened f o r fur ther d i s c u s s i o n of the f i n a l wr i t ten document. It i s not expected that the time f a c t o r of two to three months w i l l be a b a r r i e r to u t i l i z a t i o n . U t i l i z a t i o n of r e s u l t s are being planned and are tak ing p lace even before d isseminat ion of the f i n a l r e p o r t : some q u a n t i t a t i v e data has been and w i l l be used i n funding p roposa ls ; i n c o n s u l t a t i o n with the author, the execut ive d i r e c t o r has prepared a b r i e f news re lease about the p re l im inary research f i n d i n g s . The purpose of the news s to ry i s to demonstrate a c c o u n t a b i l i t y and incresed v i s i b i l i t y f o r the o r g a n i z a t i o n , whi le a l s o serv ing to inform and educate the p u b l i c ; the educat ion coord ina tor i s expected to fo l low-up on c o l l e c t e d data concerning in ter -agency networking f o r a d d i t i o n a l a s s i s t a n c e i n program p lann ing; the research f i n d i n g s have helped to conf i rm c e r t a i n s p e c u l a -t i o n s and/or shed l i g h t to new informat ion which w i l l be u s e f u l f o r future a c t i o n or dec is ion-making; f o r example: decis ion-makers have gained a be t te r understanding of the p o t e n t i a l consumer, have confirmed susp ic ions about p u b l i c f a m i l i a r i t y with the o r g a n i z a t i o n , have a b e t t e r sense of fu ture d i r e c t i o n f o r r e s e a r c h . "Information f o r p r e d i c t i o n i s in format ion f o r c o n t r o l thus the power of eva lua t ion" (Patton, 1978: 50) . While the data c o l l e c t e d i s i n t e r e s t i n g , not a l l the in format ion is" u s e f u l . Some in format ion w i l l lead to a c t i o n , some in format ion w i l l lead to new d i s c o v e r i e s , some informat ion w i l l merely b o l s t e r a preconceived v iewpoint . Research f i n d i n g s are but one of many i n - p u t s in to the p o l i t i c a l decis ion-making process of p lann ing . The other i n - p u t s inc lude the opin ions and out looks of other p o l i t i c a l c o n s t i t u e n t s , the i n t e r e s t s of other groups, and the ideo log ies of the decision-makers themselves. As such, "concrete and observable e f f e c t on s p e c i f i c d e c i s i o n s and program plans r e s u l t i n g from research f i n d i n g s and recommendations w i l l not be immediate . . . change i s smal l and slow" (Patton, 1978: 30) . While i t i s u s e f u l to have a thorough understanding of the r a t i o n a l approach to research , i t does not f u l l y prepare the researcher to the obvious r e a l i t i e s of the ac tua l p rocess . A look at other research models i s e s p e c i a l l y u s e f u l to the student researcher and other p r a c t i t i o n e r s to be t te r prepare them fo r the r e a l i t i e s ahead. A l t e r n a t i v e , open-system models appear to conf i rm to research p a r t i c i p a n t s that i t i s not out of the ord inary to experience an incrementa l , garbage can model of r e s e a r c h ; that despi te the gaps, u n c e r t a i n t i e s , imperfect ions and f r u s t r a t i o n s re levant in format ion can s t i l l be obtained and put to use because i t i s the people , and not the method or q u a l i t y , that w i l l make the d i f f e r e n c e . LIMITATIONS AND SUCCESSES OF COLLABORATIVE PROCESS The p r a c t i c e - r e s e a r c h opt ion of the M.S.W. program provided an oppor tuni ty f o r the student to apply p r a c t i c a l s k i l l s while l ea rn ing about r e s e a r c h . At the same t ime, i t provided an oppor tun i ty f o r a community-based agency to i n t e r f a c e with the academic i n s t i t u t i o n while b e n e f i t i n g from the product ion of research . Working and p lanning i n c o l l a b o r a t i o n with the needs, va lues , and l i m i t a t i o n s of others w i l l obv ious ly have i t s drawbacks and rewards. From the viewpoint of the student , the l i m i t a t i o n s and successes of the research c o n s u l t a t i v e process i s d iscussed below. LIMITATIONS: a) F a m i l i a r i t y with the Organizat ion According to the u t i l i z a t i o n - f o c u s e d model of research , the r o l e o f the research evaluator i s to provide i l l u m i n a t i o n s and perspect ives to decis ion-makers and informat ion u s e r s . The evaluator i s expected to a s s i s t i n the formulat ion of o r g a n i z a t i o n a l problems and provide program d i r e c t i o n . It i s assumed that the researcher w i l l have s u f f i c i e n t background knowledge about the organ iza t ion that w i l l he lp to enhance one 's r o l e as enabler and i l l u m i n a t o r . Because the student was not f a m i l i a r with the organ iza t ion i n the e a r l y stages of p lann ing , i t i s f e l t that the a b i l i t y of the student to he lp the agency def ine t h e i r problem and knowledge needs was somewhat l i m i t e d . The muddling through process of i d e n t i f y i n g issues and c l a r i f y i n g ob jec t i ves was fu r ther hindered by the f a c t that the student d i d not f u l l y understand o r g a n i z a t i o n a l dynamics, program cont ingenc ies , or pas t /p resen t d i f f i c u l t i e s . Given time c o n s t r a i n t s , d e c i s i o n s had to be made and a c t i o n had to be taken. However, i t i s f e l t that i n i t i a l d i f f i c u l t i e s i n i d e n t i f y i n g o r g a n i z a t i o n a l problems and needs cou ld have been reduced with the advantage of previous experience or knowledge about the sponsoring agency. C e r t a i n l y , a be t te r understanding of the formal and informal o rgan iza t iona l arrangements would have helped to maximize one 's conf idence and i n f l u e n c e . b) Research C o n s u l t a t i o n E x p e r t i s e The lack of research s k i l l s and adequate background knowlege of the o r g a n i z a t i o n created an i n i t i a l b a r r i e r f o r the student to overcome i n the e a r l y stages of the research p r o c e s s . The student was l e a r n i n g about the t e c h n i c a l i t i e s of research and about o r g a n i z a t i o n a l dynamics at the same time the student was to provide research c o n s u l t a t i o n . The e f f e c t i v e n e s s of the student i n the r o l e of researcher and consu l tan t was somewhat c u r t a i l e d by these two f a c t o r s . c) O r g a n i z a t i o n a l Exper t i se & Resources Crane (1987: 13) po in ts to a r e l e v a n t change i n assumption needed i n the u t i l i z a t i o n - f o c u s e d model o f r e s e a r c h : that the " tasks of fo rmula t ing research q u e s t i o n s , development o f working designs i n a complex environment, instrument development and t e s t i n g , software and a n a l y s i s s e l e c t i o n and development can r a r e l y be performed adequately by p r a c t i t i o n e r s , no matter how e n t h u s i a s t i c and w e l l prov ided with c o n s u l t a t i o n " . Such a statement would conf i rm the exper iences of t h i s c o n s u l t a t i v e p r o c e s s . P r a c t i t i o n e r s have s t rong 'do ing s k i l l s ' versus 'p lann ing s k i l l s ' . As such, i t can o n l y be expected that there w i l l be some confus ion over o r g a n i z a t i o n a l d i r e c t i o n , an i n a b i l i t y to focus on problemat ic i s s u e s , and a l ack of c o n t r u c t i v e i n - p u t to the more t e c h n i c a l demands of r e s e a r c h . One p lan f o r u t i l i z a t i o n emerging from t h i s research invo lves the implementation of a fo l low-up s tudy . Change i s incremental and develops s lowly as more knowledge i s a c q u i r e d : an a d d i t i o n a l study u t i l i z i n g the in format ion acquired from t h i s p i l o t study can produce even more re levant in format ion to guide f u r t h e r a c t i o n lead ing to a more developmental approach of r e s e a r c h . Fol low-up r e s e a r c h , however, w i l l be determined by fu ture resources and oppor tun i t i es f o r the agency. When the student researcher leaves the s e t t i n g , the o r g a n i z a t i o n w i l l lose the major manpower and organ izer needed to implement f u r t h e r r e s e a r c h . The l i k e l i h o o d that a fo l low-up study w i l l be conducted w i l l depend on the mot ivat ion of the agency to r e c r u i t the necessary personne l , on other p r i o r i t i e s of the agency, and on a v a i l a b l e time and r e s o u r c e s . It i s d i f f i c u l t to implement fo l low-up research i f the bas ic resources f o r t h e i r implementation are e i t h e r minimal or absent . d) Meeting Other P r i o r i t i e s / O b j e c t i v e s No matter how i n t e r e s t i n g or important the research p r o j e c t may be , there are always other r e s p o n s i b i l i t i e s to consider and o b j e c t i v e s to f u l f i l l . This i s e s p e c i a l l y t rue i n the human s e r v i c e s e t t i n g where research has not always, and s t i l l i s not , recognized as a h igh p r i o r i t y a c t i v i t y . Consequent ly , i t i s d i f f i c u l t to j u s t i f y d i r e c t i n g one 's energy and constant thought processes to the demands of research ; decis ion-makers cannot always be expected to provide u s e f u l or i n s i g h t f u l feedback. At the beginning of the term, the student had other items on the agenda f o r f i e l d p r a c t i c e and t h i s i n i t i a l l y a f f e c t e d the i n t e n s i t y of the research c o n s u l t a t i o n process . I t became evident that other involvements with the agency was not p o s s i b l e . Due to time l i m i t a t i o n s and other demands, not a l l p r a c t i c e ob jec t ives ( i . e . hands-on experience with other agency p r o j e c t s ) cou ld be s a t i s f a c t o r i l y ach ieved . It was d i f f i c u l t to maintain a happy balance between 'other community work' and research p r a c t i c e . In r e t r o s p e c t , the student attempted to engage i n ' too many other t h i n g s ' . 38. e) Time Time cons t ra in ts played a key f a c t o r to every stage of the research p r o c e s s . . . a d i s c u s s i o n of d e c i s i o n s or i ssues could not always be adequately achieved given the r e a l i t i e s of t ime. A d d i t i o n a l l y , the demand fo r time from decision-makers was not as extensive as the student would have p r e f e r r e d , but respect f o r t h e i r other r e s p o n s i b i l i t i e s had to be c o n s i d e r e d . The academic calendar does not permit the student to engage i n a c t i v e u t i l i z a t i o n of r e s u l t s to maximize i t s re levance . The student plays a key r o l e i n the d isseminat ion of in fo rmat ion , but i t i s f e l t fu r ther u t i l i z a t i o n through a c t u a l p r a c t i c e (eg. i n t h i s case , ensur ing that f o l l o w -up research i s i n i t i a t e d ) i s not p o s s i b l e . The i n i t i a l percept ion of research he ld by the student and other p a r t i c i p a n t s i s an important f a c t o r i n determining one 's expectat ions and exper iences . The student , f o r example, i n i t i a l l y conceptua l i zed the research process based on the r a t i o n a l , s c i e n t i f i c model. Th is narrow percept ion in f luenced expectat ions and increased f r u s t r a t i o n s i n the e a r l y stages of p l a n n i n g . The a l t e r n a t e , open-system of research acknowledges that l i m i t a t i o n s , i r r e g u l a r i t i e s and confus ion are a l l a normal and expected par t of the p rocess . L i m i t a t i o n s are on ly based on our percept ion of the i d e a l , maximal s i t u a t i o n . An awareness of the p o l i t i c a l processes i n f l u e n c i n g the ac tua l course of outcomes gives one a be t te r perspect ive to e x i s t i n g c i rcumstances. While l i m i t a t i o n s cannot always be reso lved or avo ided , they can at l e a s t be acknowledged and, i f p o s s i b l e , acted upon the next time 1 round. SUCCESSES: a) P r a c t i s i n g Appl ied Research The opportuni ty f o r a student to engage i n app l ied s o c i a l research i n c o l l a b o r a t i o n with a community-based agency provides an inva luab le l e a r n i n g exper ience . Pure academic research does not permit one to grasp the s k i l l s of l e a r n i n g to share c o n t r o l over content , pace, r e p o r t i n g and uses of one 's r e s e a r c h . The p r a c t i c a l experience provides the student with a be t te r i n s i g h t to the ac tua l research process that can, i n t u r n , be c a r r i e d over to fu ture research p ro jec ts i n the work s e t t i n g - It fu r ther provides the student an opportuni ty to enhance p lanning and c o n s u l t a t i v e s k i l l s . S k i l l s i n research requ i res more than t h e o r e t i c a l and t e c h n i c a l knowledge. Diplomacy and the a b i l i t y to work with others i s just as important . The pragmatic nature of the research c o n s u l t a t i v e process al lows the student to l ea rn whi le exper ienc ing . b) Educat ing the Organizat ion Qua l i t y research requ i res s p e c i a l t r a i n i n g t r a i n i n g which many p r a c t i t i o n e r s i n the human s e r v i c e s do not possess . Creat ing a l i n k with the u n i v e r s i t y can provide the opportuni ty to r e f i n e one 's research a b i l i t i e s . Despite the garbage can approach to the research des ign , the student and human s e r v i c e p r a c t i t i o n e r s learn together as they up-grade t h e i r knowledge and s k i l l s i n research through ac tua l ' d o i n g ' . As one committee member commented, "having the opportuni ty to p a r t i c i p a t e i n t h i s p a r t i c u l a r method of assess ing community needs (as the most u s e f u l experience gained i n research process) . . . being able to substant ia te my more in formal methods of assess ing mental hea l th needs f o r educat ional p l a n n i n g " . Research i s becoming an i n e v i t a b l e component o f responsive and accountable program p l a n n i n g . The c o l l a b o r a t i v e process prov ides an opportuni ty f o r agency personnel to become be t te r acquainted wi th research dynamics and techn iques . The student acts as the knowledge broker b r i d g i n g the gap between admin is t ra tors and the academic community. c) Manpower f o r Non-Pro f i ts The opportuni ty fo r a student to undertake research i n an o r g a n i z a t i o n a l s e t t i n g g ives the agency a d d i t i o n a l manpower to 'get th ings r o l l i n g ' . Research i s acknowledged as important , but i s not of ten a p r i o r i t y f o r many organ iza t ions given l i m i t e d s t a f f , exper t ise and other agency demands. The c o n t r i b u t i o n s of a student , guided by academic support , provides the much needed manpower, exper t ise and i n c e n t i v e f o r n o n - p r o f i t s to at l e a s t begin p r a c t i s i n g r e s e a r c h . d) P o s i t i v e Working Re la t ionsh ip The r e l a t i o n s h i p between the student , the adv isory committee and agency s t a f f cont r ibuted to a p o s i t i v e exper ience from the perspect ive of the s tudent . The s tudent 's in -pu t and suggest ions were respected . The student was acknowledged as a worthwhile and c r e d i b l e resource and researcher and was given c o n t r o l over the research p r o c e s s . Committee members and agency s t a f f were r e a d i l y a c c e s s i b l e and a v a i l a b l e to the student. A d d i t i o n a l l y , the student made every e f f o r t to accomodate committee needs w i th in reasonable l i m i t s . C e r t a i n l y the p r o f e s s i o n a l working r e l a t i o n s h i p between the student and the agency s t rong ly in f luences o n e ' s percept ion of the experience and the extent to which research r e s u l t s w i l l be u t i l i z e d . / e) Empowering Decision-Makers The f a c t that the research produced some re levant informat ion f o r decis ion-makers i n d i c a t e s i t s s u c c e s s . Patton (1978) debunks the ' i d e a l ' view of u t i l i z a t i o n as one of immediate major impact on concrete d e c i s i o n s . Instead, u t i l i z a t i o n can be more a c c u r a t e l y descr ibed as one p iece of in format ion that feeds in to a slow, evo lu t ionary process of change. Information leads to knowledge, knowledge reduces uncer ta in ty . . . thus reduct ion of uncer ta in ty empowers the users of in format ion (Patton, 1978). B i t s and p ieces of the research data w i l l be used at d i f f e r e n t times by the dec is ion-makers , arming them with persuasive ammunition to guide future p lanning and a c t i o n . The success of the c o l l a b o r a t i v e process s t rong ly l i e s with the a b i l i t y fo r a l l research p a r t i c i p a n t s to a c t i v e l y work with and support each o t h e r . Moreover, i t fu r ther l i e s with the determinat ion and a b i l i t y of the p a r t i c i p a n t s to forge ahead desp i te setbacks and f r u s t r a t i o n s . O v e r a l l success of the p ro jec t can be determined by the outcome of research r e s u l t s and i t s u t i l i z a t i o n . Knowing that the research has r e s u l t e d i n some a c t i o n and has reduced some uncer ta in ty i n d i c a t e s a sense of accomplishment . . . however s m a l l . IN RETROSPECT Given an overview of t h i s case study and an a p p r a i s a l of the l i m i t a t i o n s and successes of the c o l l a b o r a t i v e process t h i s student , i n r e t r o s p e c t , f e e l s severa l th ings cou ld or should have been done to enhance the research p r o j e c t . This i s not to imply that the c o l l a b o r a t i v e process was not worthwhile on the cont ra ry , the successes of the experience fa r outweigh any l i m i t a t i o n s . However, no p r o j e c t i s pe r fec t and one can only l ea rn by recogn iz ing shortcomings and o v e r s i g h t s . This case study may or may not . be s i m i l a r to other experiences i n the p r a c t i c e - r e s e a r c h opt ion of the M.S.W. program, there fore the issues presented below are a r e f l e c t i o n o f the personal i n s i g h t s and experiences of t h i s student o n l y . The value of these issues to the broader context of the program w i l l be l e f t f o r others to c o n s i d e r . 1) C l a r i f y i n g Expectat ions The student attempted to engage i n too many p r a c t i c e a c t i v i t i e s which a f f e c t e d the research e a r l y i n the term. While there i s no s p e c i f i c d i s t i n c t i o n between research p r a c t i c e and community work, there needs to be a c l e a r e r d e f i n i t i o n of what the School expects from research p r a c t i c e and 'o the r ' p r a c t i c e . For example, i t would have been more b e n e f i c i a l to de f ine expectat ions i n terms of ' p r o j e c t s ' ra ther than 'number of h o u r s ' . From t h i s s tudent 's exper ience, involvement i n one other pro jec t ( i . e . another working committee) apart from research r e s p o n s i b i l i t i e s was f e l t to be an adequate ba lance . 2) A c t i v e Involvement i n R e c r u i t i n g & Consu l t ing Committee Members The student f a i l e d to assemble together the adv isory committee f o r c o n s u l t a t i o n e a r l y i n the p lanning p r o c e s s . The a c c e s s i b i l i t y of the execut ive d i r e c t o r , the d i f f e r e n t work l o c a t i o n s of each committee member, the l ack of c l e a r expectat ions and r o l e s , are f a c t o r s which cont r ibuted to t h i s o v e r s i g h t . Furthermore, because the student d i d not a c t i v e l y p a r t i c i p a t e i n contac t ing and r e c r u i t i n g committee members; t h i s somewhat in f luenced a f e e l i n g of detachment and i n i t i a l hes i tancy to approach un fami l i a r i n d i v i d u a l s . An i n i t i a l in t roductory meeting arranged by the execut ive d i r e c t o r would have a s s i s t e d to overcome t h i s i n i t i a l problem. A d i s c u s s i o n of committee r e s p o n s i b i l i t i e s , expected time commitments, and perhaps an overview of r a t i o n a l versus a l t e r n a t i v e models of research might be inc luded i n the agenda f o r the f i r s t committee meet ing. 3) F a m i l i a r i t y with Organizat ion and with S o c i a l Planning The student was n e i t h e r f a m i l i a r with the o r g a n i z a t i o n , with program p lann ing , or with other aspects of community work. The c l i n i c a l and casework background of the student d i d not adequately prepare the student as researcher or s o c i a l p lanning c o n s u l t a n t . I t i s f e l t that some f a m i l i a r i t y with the o r g a n i z a t i o n , or at l e a s t f a m i l i a r i t y with the problem area , would have helped to enhance the s tudent ' s a b i l i t i e s as c o n s u l t a n t . However, as educat ion i s supposed to provide oppor tun i t i es fo r new lea rn ing exper iences, the lack of knowledge i n u n f a m i l i a r t e r r i t o r y i s probably more the r u l e than the except ion . One can on ly a c t , react and adapt to a g iven s i t u a t i o n . 4) Stronger L ink Between Facu l ty and Agency Both the student and the agency experienced some d i f f i c u l t y i n the i n i t i a l p lanning stages r e : i d e n t i f y i n g and focus ing issues and goals f o r r e s e a r c h . Given the newness of s t a f f , and the r e l a t i v e inexperience of both the student and s t a f f i n research , des ign , i t i s f e l t more regu la r f a c u l t y in -pu t with the student and agency, e s p e c i a l l y e a r l i e r i n the p lanning process , would have provided a c l e a r e r sense of d i r e c t i o n . Facu l ty would a s s i s t i n n e g o t i a t i n g and c o n s u l t i n g i n conjunct ion with the s tudent . As such, the student should have taken more i n i t i a t i v e f o r convening such meetings as the need a r o s e . 5) Understanding the Organiza t ion Because of the o r g a n i z a t i o n ' s s t rong emphasis and r e l i a n c e on vo lunteer ism, c o n s i d e r a t i o n should have been given to r e c r u i t i n g volunteers f o r a t a s k -or ien ted research committee. The execut ive d i r e c t o r , as the key d e c i s i o n -maker and informat ion u s e r , would assume the r o l e of s t a f f support and agency adv isor i n terms of o r g a n i z a t i o n a l needs. A t a s k - o r i e n t e d committee would be r e c r u i t e d on the b a s i s of prev ious research experience and an i n t e r e s t and committment i n vo lun teer ing f o r the o r g a n i z a t i o n . The student would s t i l l serve as enabler and research consu l tan t , equa l ly shar ing i n research tasks whi le a l s o assuming other r e s p o n s i b i l i t i e s . With a vo luntary t a s k - o r i e n t e d committee i n p l a c e , fo l low-up research i s more l i k e l y to be implemented once the student leaves the s e t t i n g . R e c r u i t i n g the necessary vo lunteers with the des i red s k i l l s and i n t e r e s t would be the 'community work' r e s p o n s i b i l i t y of the s tudent . Therefore , an understanding of the c u l t u r e and s t ructure of the o r g a n i z a t i o n should have been considred p r i o r to r e c r u i t i n g the research committee. Never the less , whi le a vo luntary t a s k - o r i e n t e d committee would be the d e s i r e d i d e a l e s p e c i a l l y as a method of i n v o l v i n g consumers i n o r g a n i z a t i o n a l p lanning fo r a community-based agency time c o n s t r a i n t s of the student and other unforseen d i f f i c u l t i e s would have to be c o n s i d e r e d . 6) Sharing P o l i t i c a l Processes with Peers The student i s exposed to a v a r i e t y of p o l i t i c a l experiences i n the c o l l a b o r a t i v e process: choices have to be negot ia ted , l i m i t a t i o n s have to be imposed, and d e c i s i o n s have to be made. While students had the opportuni ty to share t h e i r more t e c h n i c a l research process with peers , d i s c u s s i n g the more p o l i t i c a l process was minimal ( i . e . one p r a c t i c e -research seminar) . The opportuni ty f o r more extensive seminars and d i s c u s s i o n i n t h i s area could broaden the s t u d e n t ' s understanding i n decis ion-making processes , o r g a n i z a t i o n a l dynamics, management techniques, c o n f l i c t r e s o l u t i o n and c o n s u l t i n g s k i l l s . Students, t h e r e f o r e , can share t h e i r experiences from the agency s e t t i n g i . e . problems encountered, what was done, to reso lve the problem, what could have been done, how issues were i d e n t i f i e d , e t c . and learn from each o ther . As such, an equal emphasis would then be p laced on t e c h n i c a l research s k i l l s as w e l l as other p r a c t i c e s k i l l s . In r e t r o s p e c t , i t i s f e l t that t h i s student should have c l a r i f i e d expecta t ions , should have consul ted more with committee and f a c u l t y members, should have become f a m i l i a r with a l t e r n a t e open-system models of research much e a r l i e r i n the research process , could have produced a be t te r q u a l i t y ques t ionna i re , could have acquired more u s e f u l data , could have done more to disseminate the r e s u l t s . . . but p o l i t i c a l and personal dynamics can on ly r e s u l t i n s a t i s f i c i n g ra ther than maximizing. The a c t i o n process of research can be perceived as r e a l l y one of r e a c t i o n and adaption that i s , " t r y i n g to make the best of th ings u n t i l uncer ta in ty i s s u f f i c i e n t l y reduced or externa l cons t ra in ts have been s u f f i c i e n t l y removed to permit a r e a s s e r t i o n of a c t i v i s m " (Patton, 1978: 127). Th is p r a c t i c e - r e s e a r c h , undoubtedly, has generated more informat ion and improved s k i l l s that can be c a r r i e d over to a c t i v a t e a more developmental , incremental l ea rn ing and p lanning p r o c e s s . I I I . THE RESEARCH PROJECT IN CONTEXT INTRODUCTION Chapter One d iscussed the re levance of consumer research fo r n o n - p r o f i t o r g a n i z a t i o n s , while Chapter Two provided a case study of the personal and p o l i t i c a l dynamics of t h i s r e s e a r c h . 1 The fo l low ing chapter sets t h i s research p ro jec t i n context : It presents the issues se lec ted f o r research fol lowed by a short explanat ion of the r a t i o n a l e fo r s e l e c t i o n of these i s s u e s . The s p e c i f i c ob jec t ives of the research p r o j e c t are i d e n t i f i e d ans set f o r t h , along with a statement of s p e c i f i c quest ions which guide quest ionnai re c o n s t r u c t i o n . The Community Mental Heal th Model to primary prevent ion and major concepts are introduced to provide a t h e o r e t i c a l framework gu id ing the r e s e a r c h . F i n a l l y , a d i s c u s s i o n of other re levant research i s presented to provide an i n d i c a t i o n of what has a l ready been done i n the f i e l d and how they might r e l a t e to t h i s p a r t i c u l a r s tudy. RESEARCH ISSUES As expla ined i n the previous chapter , the Canadian Mental Health A s s o c i a t i o n B . C . D i v i s i o n i s recognized as assuming a growing r e s p o n s i b i l i t y i n the p r o v i s i o n of mental hea l th in format ion to the general p u b l i c through a broad-based p u b l i c awareness and educat ion campaign. As a marketing and management t o o l , the organ iza t ion acknowledges the need to consul t with i t s p o t e n t i a l consumers i n order to gain a be t te r understanding of the marketplace. As such, the major i ssues of concern a r e : What are the opin ions and perspect ives of our p o t e n t i a l consumers that can help guide program planning? What d i r e c t i o n should the o r g a n i z a t i o n take i n terms of fu ture d i r e c t i o n f o r mental hea l th education? Through the a c q u i s i t i o n of consumer da ta , the o rgan iza t ion rece ives a d d i t i o n a l in -pu t in to t h e i r dec is ion-making and planning p r o c e s s . Furthermore, i t w i l l in f luence the s e l e c t i o n and development of fu ture product markets. As mentioned e a r l i e r , the organ iza t ion i s uncer ta in as to what d i r e c t i o n to take; they do not know what the p u b l i c wants, what the p u b l i c knows or doesn ' t know. At p resent , d i r e c t i o n f o r p lanning remains broad and general which i s adequately r e f l e c t e d by the i ssues s e l e c t e d f o r research . It i s f e l t that a p i l o t study w i l l he lp shed some l i g h t i n t o t h e i r u n c e r t a i n t i e s ; and that the p re l im inary informat ion w i l l a s s i s t to guide both short and long term planning f o r mental hea l th informat ion and educat ion programs. OBJECTIVES OF THE STUDY The purpose of the research , given the above i s s u e s , i s to provide the Canadian Mental Health A s s o c i a t i o n B . C . D i v i s i o n with in format ion about i t s p o t e n t i a l consumers. S p e c i f i c quest ions gu id ing instrument c o n s t r u c t i o n , which the study w i l l be designed to address , are as f o l l o w s : Is the p u b l i c f a m i l i a r with C .M.H .A .? What mental hea l th in format ion i s important to users and p o t e n t i a l users and how, i n t h e i r view, can i t best be provided? What are the most d i f f i c u l t problems i n l i v i n g experienced by the people i n the community? . What are the p u b l i c ' s thoughts and opinions about mental hea l th and i l l n e s s ? Is there community support f o r mental hea l th education and informat ion programs? Given c e r t a i n l i m i t a t i o n s imposed upon the research , i t i s not expected that the r e s u l t s w i l l generate 'end s o l u t i o n s ' to the quest ions asked. The p i l o t study, i n s t e a d , w i l l provide a beginning po int f o r fu r ther planning and r e s e a r c h . Consequently, a summary of goals i d e n t i f i e d f o r the p i l o t study i n c l u d e : 1) p rov id ing C.M.H.A. with in format ion about i t s marketplace and recommendations f o r marketing s t r a t e g i e s ; 2) appra is ing the worth of c o l l e c t i n g s p e c i f i c informat ion p r i o r to undertaking a l a r g e r study which i s more c o s t l y ; 3) i d e n t i f y i n g p o s s i b l e d i f f i c u l t i e s that could be encountered i n a l a r g e r study; and 4) p rov id ing recommendations f o r future r e s e a r c h . In a d d i t i o n , the research w i l l a lso serve to provide the organiza t ion with a measure of a c c o u n t a b i l i t y and c r e d i b i l i t y to e x i s t i n g and p o t e n t i a l supporters KNOWLEDGE-BUILDING FUNCTION OF RESEARCH The p a r t i c u l a r funct ions that research serves i n knowledge-bui lding i s one f a c t o r that in f luenced the design of the sample survey. The general o b j e c t i v e of t h i s p a r t i c u l a r research , g iven i t s nature and s p e c i f i c purposes, i s to provide both exp lora tory and d e s c r i p t i v e in format ion . The study i s exploratory i n nature because i t i s i d e n t i f i e d as a p i l o t study: the r o l e of exploratory research i s l a y i n g the groundwork for more d e f i n i t i v e studies ... decisions are made i n the absence of much knowledge, the r e s u l t s of an exploratory study can help inform a c t i o n (Reid & Smith, 1981). S e l l t i z , Wrightsman and Cook (1976) state that the major emphasis of exploratory studies i s on discovery of ideas and i n s i g h t s . As such, the research design must be f l e x i b l e enough to permit the consideration of many d i f f e r e n t aspects of a phenomenon. In one way or another, a l l research can serve a d e s c r i p t i v e function since i t can provide at l e a s t some information about the c h a r a c t e r i s t i c s of the phenomena studied (Reid & Smith, 1981). Because t h i s study aims to acquire information about consumer needs, a t t i t u d e s and perceptions, the knowledge-b u i l d i n g function of t h i s research i s a l s o d e s c r i p t i v e i n nature. D e s c r i p t i v e studies set out to portray the c h a r a c t e r i s t i c s of a p a r t i c u l a r i n d i v i d u a l , s i t u a t i o n , or group and also sets out to determine the frequency to which something occurs ( S e l t i z , Wrightsman & Cook, 1976). Description, states Warwick & Lininger (1975) lays the groundwork for the pursuit of other objectives as well, i n c l u d i n g explanation and evaluation. THEORETICAL ORIENTATION AND DEFINITION OF CONCEPTS The nature of public education and information i n mental health i s best understood within the broader t h e o r e t i c a l framework of primary prevention. However, before discussing primary prevention and introducing some major concepts guiding the research, i t i s relevant to describe the prevalence of the background problem to which education and informat ion programs are perceived as i n t e r v e n t i o n s t r a t e g i e s . The f o l l o w i n g statements convey the alarming inc idence of mental i l l n e s s i n our s o c i e t y (Canadian Mental Health A s s o c i a t i o n , 1984): Mental i l l n e s s i s now the most urgent hea l th problem i n Canada. It c la ims more v i c t i m s than any other d i s e a s e . In any given day, near ly h a l f the h o s p i t a l -beds i n Canada are occupied by the mental ly or emot ional ly i l l . Emotional problems cos t Canadian business and indust ry i n excess of $50 b i l l i o n annua l l y . Emotional problems s t r i k e more Canadians every year than a l l other hea l th problems i n Canada ( inc lud ing heart d isease and cancer ) . One i n every three Canadians w i l l s u f f e r temporary emotional problems i n t h e i r l i f e t i m e . Approximately 50% of those seeking hea l th care i n Western s o c i e t i e s s u f f e r from i l l n e s s e s such as s t r e s s , hypertension and psychosomatic d i s o r d e r s (DeMarco & Heughan, 1986: 316). The above statements would j u s t i f y the conc lus ion that mental d isorders present a major p u b l i c hea l th and s o c i a l problem, r e q u i r i n g measures to reduce the burden created by mental i l l h e a l t h . The c o n t r i b u t i o n s of primary prevent ion aims to reduce the inc idence of mental d i s o r d e r s whi le enhancing the l e v e l of one 's p o s i t i v e mental h e a l t h . A d e f i n i t i o n of these concepts are presented below: MENTAL DISORDER - A behav iora l or p s y c h o l o g i c a l syndrom or pat tern which r e s u l t s i n e i t h e r p a i n f u l symptoms ( d i s t r e s s ) or impairment i n one or more areas of func t ion ing ( d i s a b i l i t y ) . The d i s o r d e r i s the r e s u l t of b i o l o g i c a l , behav iora l of p s y c h o l o g i c a l dys func t ion (Mental Health S e r v i c e s , 1985). MENTAL HEALTH - A mul t i -d imens iona l concept which r e f e r s to an i n d i v i d u a l ' s i n t e r a c t i o n with s e l f , others and the environment. Mental Health i s a dynamic s ta te of personal adjustment which inc ludes a d i s c r e t e and p o s i t i v e sense of i d e n t i t y . It presupposes the development of personal p o t e n t i a l and an adjustment to the world which promotes e f f e c t i v e n e s s and happiness (Mental Health S e r v i c e s , 1985). PRIMARY PREVENTION - Encompasses those a c t i v i t i e s d i r e c t e d to s p e c i f i c a l l y i d e n t i f i e d vulnerable h igh r i s k groups w i th in the community who have not been l a b e l l e d as p s y c h i a t r i c a l l y i l l ; or to groups about which no assumption of r i s k i s enter ta ined . . . measures are designed and undertaken to avoid the onset of emotional d is turbance and or enhance the l e v e l of p o s i t i v e mental h e a l t h . Programs f o r promotion of mental hea l th are p r i m a r i l y educat iona l rather than c l i n i c a l i n concept ion and operat ion with t h e i r u l t imate goal being to increase p e o p l e ' s c a p a c i t i e s f o r d e a l i n g with c r i s e s and f o r tak ing steps to improve t h e i r own l i v e s (Goldston, 1977; R a n d a l l , 1981). COMMUNITY MENTAL HEALTH MODEL FOR PRIMARY PREVENTION A t h e o r e t i c a l framework, known as the Community Mental Health Model, prov ides the ideo logy and phi losphy behind the impetus f o r primary prevent ion . Th is model i s charac te r i zed as a c t i v e - p r e v e n t i v e i n approach with a popula t ion focus (Nelson, Potasniak & Bennet, 1983). The community model i s d i r e c t l y opposi te the dominant medical model of s e r v i c e d e l i v e r y which i s p a s s i v e -r e c e p t i v e and i n d i v i d u a l l y focused . The medical model recognizes i n t e r v e n t i o n techniques as l a r g e l y f o c u s i n g upon c o n t r o l l i n g mental i l l n e s s and not prevent ing i t . Major c h a r a c t e r i s t i c s of the community mental h e a l t h model inc lude the fo l low ing (Nelson e t . a l . , 1983): Serv ices would be a v a i l a b l e to a l l members of the community, so that the whole popula t ion i s perce ived as c l i e n t s of community mental h e a l t h , and not jus t those who are l a b e l l e d 'mental ly i l l ' . This ensures a commitment to r a i s i n g the l e v e l of mental hea l th of the e n t i r e community. A prevent ive approach would a c t i v e l y involve i n d i v i d u a l s i n the process of assuming r e s p o n s i b i l i t y f o r the maintenance of t h e i r own w e l l - b e i n g . It promotes the idea that consumers of hea l th s e r v i c e , and not the p r o v i d e r s , ho ld the key to h e a l t h . Prevent ion i s perce ived as a method of s o c i a l i n t e r v e n t i o n i n an attempt to ward o f f or c o n t r o l the ser iousness o f i l l n e s s ra ther than wai t ing f o r treatment a f t e r i l l n e s s s t r i k e s . Prevent ion i s d i r e c t e d to normal and a t - r i s k groups as we l l as toward a range of formal and in formal c a r e - g i v e r s i n the community. P r o f e s s i o n a l s w i l l c o l l a b o r a t e with other community members to provide se rv ices to the l a r g e r community. These major c h a r a c t e r i s t i c s of the community mental hea l th model are key c o n s i d e r a t i o n s i n the development of the research des ign , e s p e c i a l l y i n the s e l e c t i o n of the survey p o p u l a t i o n . The word 'p revent ion ' can be mis leading as i t tends to imply that something i s being prevented. Instead, t h i s concept can be be t te r def ined through a d e s c r i p t i o n of the major ob jec t ives of prevention/promotion a c t i v i t i e s (Lor ion , 1983; Ferguson, 1984): to reduce emotional d i s t r e s s , maldadaptation and maladjustment to reduce he lp lessness and use less tension develop heal thy and p o s i t i v e coping s k i l l s and problem-s o l v i n g s k i l l s improve f u n c t i o n a l competence. Primary prevent ion , the re fo re , attempts to lower the rate of new cases of mental d isorder i n a populat ion by counteract ing harmful in f luences before they p r e c i p i t a t e or cause i l l n e s s , and/or r a i s i n g the i n d i v i d u a l ' s competence i n coping with d i f f i c u l t i e s . Numerous methods are a v a i l a b l e to p r a c t i s i n g primary prevent ion and mental hea l th promotion. Pub l ic information and education methods are the prime focus of t h i s study, and these i n t e r r e l a t e d concepts are def ined below: MENTAL HEALTH EDUCATION OF THE PUBLIC - Mental hea l th educat ion of the p u b l i c has three d i f f e r e n t emphases: 1) Educat ion about mental hea l th - informing people i n general about the f a c t s bear ing on mental hea l th i n t h e i r communities so that they may work to improve re levant c o n d i t i o n s ; 2) Education about mental i l l n e s s - focus ing concern on the c a r e , treatment and r e h a b i l i t a t i o n of the mental ly i l l as w e l l as those i n s t i t u t i o n s designed to provide such s e r v i c e s ; and 3) Educat ion f o r mental hea l th - he lp ing i n d i v i d u a l s to manage t h e i r own l i v e s be t te r and to achieve be t te r mental , emotional and s o c i a l adjustment. Th is would inc lude educat ion about p a r e n t - c h i l d r e l a t i o n s h i p s , marriage and the fami ly , s t r e s s , and so on (Sauber, 1973). PUBLIC INFORMATION METHODS - Pub l ic in format ion methods invo lve the d isseminat ion of mental hea l th in format ion to re levant c a r e - g i v e r s and p o p u l a t i o n s i n the community. Th is method i s used f o r the purpose o f : 1) Informing the p u b l i c about a v a i l a b l e treatment and prevent ion s e r v i c e s ; 2) Increasing a community's knowledge and acceptance of the mental ly i l l ; and 3) In f luenc ing p u b l i c p o l i c i e s that r e l a t e to mental hea l th (Ket terer , 1981). Mental hea l th informat ion and educat iona l measures can only attempt to increase understanding and r e l i e v e the burden created by the problem of •not knowing 1 or 'not u n d e r s t a n d i n g ' . These measures can help to change a t t i t u d e s , which i n turn w i l l not only f o s t e r the e f f e c t i v e n e s s of e x i s t i n g s e r v i c e s , but a lso eventua l ly cont r ibu te to reducing the s i z e of the problem created by mental i l l hea l th (Freudenberg, 1979). RELEVANT RESEARCH Information and education measures represent one of the important t o o l s i n p r e v e n t i o n . Numerous s tud ies have been conducted which have l ed to a cur ren t s ta te of knowledge i n mental hea l th educat ion of the p u b l i c . Some are mentioned here . As s p e c i f i e d e a r l i e r , one of the main concerns of publ ic , educat ion and i n f o r -mation i s to increase a community's knowledge and acceptance of the menta l ly i l l . A t t i t u d e s toward the mental ly i l l have been the subject of extensive research s ince about 1950. The Cumming and Cumming (1957) study concluded that the community educat ional program they designed f a i l e d to reach i t s goal of d imin ish ing peop le 's f ee l ings of d istance and estrangement from former mental p a t i e n t s . They found that , on the whole, the people i n the community studied d i d not wish to have very much contact with mental i l l n e s s e i t h e r on the personal or s o c i a l l e v e l b e l i e v i n g that the mental ly i l l "always shows some s igns" (Cumming & Cumming, 1957: 108-109). Since the Cumming and Cumming study, J . Rabkin (1974), i n a review of the l i t e r a t u r e , documents a t rend fo r i n c r e a s i n g l y accept ing a t t i t u d e s toward the mental ly i l l between the 1950's to 1970's. An a t t i tude survey conducted by Bentz and Edgerton (1970) found that "the general p u b l i c have more r e a l i s t i c informat ion and a t t i tudes about mental i l l n e s s . . . are optomist ic about prevent ive and treatment e f f o r t s " and concluded that "educat ional campaigns over the past few years have had a tremendous in f luence fo r changing a t t i tudes toward mental i l l n e s s and phenomena re la ted to i t s cons idera t ion" (Bentz & Edgerton, 1970: 472-473). Furthermore, success of educat ional e f f o r t s i s more l i k e l y i f the p u b l i c ' s past experience with mental hea l th advice and the a v a i l a b l e se rv ices has been reasonably good (Sauber, 1973). Aside from educat ional endeavours, another f a c t o r found to determine one 's response i n accept ing and t r u s t i n g the mental ly i l l has been the degree of exposure to the mental ly i l l . That i s , the more extensive personal experience with i n d i v i d u a l s who requ i re p s y c h i a t r i c c a r e , the more favorable the a t t i t u d e and acceptance (Trute & Loewen, 1978). Research has ind ica ted that l o c a l res idents of ten have minimal knowledge about mental hea l th serv ices o f fe red i n t h e i r community ( E l i n s o n , P a d i l l a & Perk ins , 1967; Ke t te re r , 1981). Consequently, p u b l i c information s t r a t e g i e s can serve to be an e f f e c t i v e method of communicating re levant knowledge about a v a i l a b l e treatment and prevent ion s e r v i c e s to the general p u b l i c . In t h e i r community-survey of 1500 housing u n i t s i n New York C i t y , E l i n s o n e t . a l . (1967) a l s o found tha t , i n terms of o r i e n t a t i o n toward f i n d i n g h e l p , more people are i n c l i n e d to turn to fami ly and f r i e n d s f o r i n i t i a l advice f o r mental or emotional t r o u b l e s . Eva lua t ive s tudies measuring the e f f e c t i v e n e s s of education and in format ion programs have of ten been n e g l e c t e d . Baron (1980) c r i t i c i z e s the lack of concern on the par t of p u b l i c educators f o r systematic eva lua t ion of t h e i r p u b l i c education campaigns. He argues that t h i s has been no o v e r s i g h t , and that the lack of systematic eva lua t ion has l e f t p r a c t i t i o n e r s uncer ta in as to what types of approach are most e f f e c t i v e (Dear, T a y l o r , Bestvater & Breston, 1985). The Information & Act ion Program was one undertaking aimed to evaluate the long term impact of an ambit ious p u b l i c educat ion campaign designed to increase community acceptance o f the menta l ly i l l (Dear e t . a l . , 1985). A geographic representa t ion of var ious communities were surveyed both before and a f t e r an a d v e r t i s i n g campaign i n order that the e f f e c t i v e n e s s of the media campaign could be measured. Even p r i o r to the campaign, the Phase I survey a l ready ind ica ted a g e n e r a l l y p o s i t i v e a t t i t u d e toward the mental ly i l l . However, the high l e v e l of awareness of media messages measured i n the Phase II survey confirmed the b e n e f i t s and u t i l i t y of a media-based campaign: the major i ty of the survey sampled f e l t that the media had a p o s i t i v e i n f l u e n c e , and that the messages were e f f e c t i v e i n serv ing to fu r ther educate the p u b l i c about the problems and needs f a c i n g the mental ly i l l i n the community. There was strong consensus, however, that fu r ther promotional i n i t i a t i v e s were needed stemming from the c o n v i c t i o n that educat ion promotes greater understanding, acceptance and support . Mental hea l th educat ion of the p u b l i c , apart from attempts to change a t t i t u d e s towards i l l n e s s , i s a l s o concerned with e f f o r t s to improve p e o p l e ' s c a p a c i t i e s to develop s a t i s f y i n g l i v e s . Educat iona l a c t i v i t i e s , t h e r e f o r e , inc lude fami ly l i f e and human r e l a t i o n s h i p programmes (Freudenberg, 1979) thus extending t h i s i n t o t each ing / in fo rming the p u b l i c about coping s k i l l s when exper ienc ing s t r e s s f u l l i f e events . Pub l ic hea l th educat ion was found to be e f f e c t i v e i f c e r t a i n p r i n c i p l e s were observed. From a s e r i e s of s tud ies c o l l e c t i n g o p i n i o n s , knowledge and a t t i t u d e s about mental h e a l t h phenomena, Nunnally (1961) concluded and' recommended that i t i s necessary to arouse p u b l i c i n t e r e s t and mot ivat ion as a re levant communication s t r a t e g y . Nunnally a l s o suggested that before s t r a t e g i e s f o r communicating about a p a r t i c u l a r t o p i c can be e s t a b l i s h e d , i t i s necessary to determine where that t o p i c res ides i n terms of p r i o r i t y or need. Pub l i c i n t e r e s t i n mental hea l th t o p i c s can vary c o n s i d e r a b l y . The p u b l i c i s mainly i n t e r e s t e d i n mental hea l th in format ion that w i l l r e l i e v e immediate personal threa ts through p r o v i s i o n of s o l u t i o n s f o r handl ing problems (Nunnal ly, 1961). On the whole, Nunnally found that mental hea l th t o p i c s have moderately h igh i n t e r e s t v a l u e , competing w e l l aga inst other subject matters such as p h y s i c a l hea l th in format ion and entertainment t o p i c s . S i m i l a r i l y , i n an extensive review of e x i s t i n g research , Davis (1965) concluded that "audiences appear eager to rece ive mental hea l th in format ion because they have few f i r m e x i s t i n g ideas and a great i n t e r e s t i n the area" and furthermore "simple mass-media techniques appear to be as e f f i c i e n t as more complicated and s o p h i s t i c a t e d v e h i c l e s f o r conveying in format ion (Davis, 1965:138). Mass media i s of ten s t y l i z e d to f i t the requirements of f i c t i o n and drama, thus conveying ideas about mental hea l th that are l e s s than c o r r e c t (Nunnal ly, 1961). On the other hand, mass media communication has been found to be a h i g h l y popular means of d isseminat ing h e a l t h informat ion as i t tends to reach a la rge major i ty of the popu la t ion (Feldman, 1966). In terms of s p e c i f i c sources of media, there i s a h igh c o r r e l a t i o n between newspaper and magazine use and l e v e l of educat ion; that i s , the higher the educat ion the more l i k e l y one i s exposed to a c q u i r i n g hea l th informat ion through newspaper and magazines. Conversely , l i s t e n i n g to the rad io and watching t e l e v i s i o n requ i res no great i n t e l l e c t u a l a b i l i t y and would, understandably, reach a greater propor t ion of the l e a s t educated group i n the populat ion (Feldman, 1966). Consequently, whi le mass media has had a detr imenta l e f f e c t to producing negat ive a t t i t u d e s or erroneous informat ion about mental h e a l t h , i t can a l s o be used to e f f e c t i v e l y provide the p u b l i c with be t te r in format ion and developing be t te r a t t i t u d e s . The exp lora tory and d e s c r i p t i v e func t ion of t h i s research w i l l serve to provide informat ion about p o t e n t i a l markets fo r pub l i c mental hea l th educat ion , and w i l l l ay the groundwork f o r more d e f i n i t i v e s tudies fo r program p l a n n i n g . The purpose of p u b l i c mental hea l th educat ion i s explained by the broader t h e o r e t i c a l framework of primary p revent ion ; guid ing p r a c t i c e p r i n c i p l e s are o u t l i n e d through a d e f i n i t i o n of s p e c i f i c concepts fo r p r a c t i c e . Relevant research r e l a t e d to t h i s study provides an i n d i c a t i o n of e x i s t i n g knowledge about the marketplace and about e x i s t i n g market s t r a t e g i e s fo r developing p u b l i c educat ion mater ia l and programs. While the sample populat ion of t h i s research may or may not be s i m i l a r to other research popu la t ions , the i n t e n t i o n i s to l o c a l i z e c e r t a i n f i n d i n g s f o r a more accurate d e s c r i p t i o n of the popula t ion of concern . I V . THE RESEARCH DESIGN INTRODUCTION The research design i s a d e t a i l e d p lan o u t l i n i n g how observat ions w i l l be made . . . such as who w i l l be s t u d i e d , how these people w i l l be s e l e c t e d , and what informat ion w i l l be gathered from or about them (Monette, S u l l i v a n & Dejong, 1986: 9 ) . This next chapter descr ibes the research design plan of t h i s s tudy . A d d i t i o n a l l y , g iven resource and f e a s i b i l i t y c o n s t r a i n t s , l i m i t a t i o n s of the research i s a l s o d i s c u s s e d . RESEARCHER'S CONTROL OVER PHENOMENA STUDIED This i s a n a t u r a l i s t i c study (Patton, 1980) as the research was conducted i n the respondent 's own environment. There was no attempt to manipulate the respondents or to in f luence them i n any way. Respondents were f ree to make whatever comments and suggestions they wished wi th in the context of the quest ion format. SAMPLING DESIGN One of the major c h a r a c t e r i s t i c s of the Community Mental Health Model i s to make s e r v i c e s a v a i l a b l e to the whole p o p u l a t i o n ; that i s , so that normal groups i n the populat ion are a l s o r e c e i v e r s of s e r v i c e . A second c h a r a c t e r i s t i c i s that p r o f e s s i o n a l s w i l l c o l l a b o r a t e with other community members and formal c a r e - g i v e r s to provide s e r v i c e s to the l a r g e r community. Given these two g u i d e l i n e s , the sample populat ion comprised of two groups: (1) the genera l p u b l i c ; and (2) community se rv ice pe rsonne l . 1) THE GENERAL PUBLIC DESCRIPTION: The general p u b l i c i s descr ibed as a heterogeneous group. I nd iv idua l u n i t s of t h i s group are c h a r a c t e r i z e d as over 18 years of age, male or female, about which no assumption i s made or previous knowledge i s known about s p e c i f i c socio-economic , geographic or demographic v a r i a b l e s . A d d i t i o n a l l y , because the general p u b l i c i s def ined i n a very broad and vague sense, i t i s assumed they can a l s o be descr ibed as normal and a t - r i s k groups i n the populat ion who may wel l be p o t e n t i a l or a c t u a l consumers o f mental hea l th in format ion . OBTAINING THE SAMPLE: A survey sample of telephone s u s c r i b e r s was chosen from the Greater Vancouver Telephone D i r e c t o r y . As i t was necessary to s e l e c t a survey populat ion as f ree as p o s s i b l e from any b iases or assumptions about socio-economic or other c h a r a c t e r i s t i c s , yet a c c e s s i b l e at low c o s t , t h i s resource appeared to be the best c h o i c e . It should be noted that 'genera l p u b l i c ' i s a broad concept which i s d i f f i c u l t to def ine as one i d e n t i f i a b l e group. While i t i s not accurate to equate telephone s u s c r i b e r s with the general p u b l i c as a whole, the b i a s towards 'non-poor ' respondents i s b e l i e v e d to be r e l a t i v e l y smal l due to general use of te lephones. As such, the survey sample of telephone s u s c r i b e r s are i d e n t i f i e d as the 'genera l p u b l i c ' f o r the purpose of t h i s study, but caut ion i s advised against g e n e r a l i z i n g t h i s group as represent ing the whole genera l p o p u l a t i o n . L i m i t a t i o n s are d iscussed i n the fo l lowing s e c t i o n . A sample s i ze of 100 respondents was drawn from the d i r e c t o r y f o r the p i l o t s tudy. Random sampling was used by s e l e c t i n g i n d i v i d u a l respondents at regu lar in terva ls , from a f i x e d p o s i t i o n . That i s , the f i r s t name was chosen from every a l t e r n a t i n g colum on every t h i r d page of the telephone d i r e c t o r y . Places of business and i n d i v i d u a l s l i v i n g outs ide the Vancouver C i t y area were excluded from the sampling l i s t . A f i n a l sample l i s t of 124 Vancouver C i t y Telephone Suscr ibers was drawn from the d i r e c t o r y . From t h i s f i n a l l i s t , every 5th name was e l iminated to provide a survey sample of 100 randomly chosen respondents. LIMITATIONS OF SAMPLING METHODOLOGY: The telephone d i r e c t o r y i s one of the most popular sources f o r sampl ing, but i t does have i t s l i m i t a t i o n s . In the f i r s t p l a c e , telephone s u s c r i b e r s are not a c r o s s - s e c t i o n of the popula t ion of any community because the lowest economic groups who cannot a f f o r d telephones are omi t ted . Secondly, u n l i s t e d telephone s u s c r i b e r s are a l s o not inc luded and s u s c r i b e r s with u n l i s t e d numbers could c o n s t i t u t e a h i g h l y s e l e c t group i n the p o p u l a t i o n . Research has found, f o r example, that u n l i s t e d telephone s u s c r i b e r s are more anxious and evidence greater psychosoc ia l dys funct ion than t h e i r l i s t e d counterparts ( S t e f l , 1984). I t i s a l s o w e l l known that telephone s u s c r i b e r s are genera l l y home-owners and tend to be over - represented compared to r e n t e r s . Therefore , a sample of telephone s u s c r i b e r s i s b iased i n favour of the s tab le groups i n the popu la t ion (Parten, 1950). These l i m i t a t i o n s present problems f o r secur ing a representa t ive sample of the popula t ion of i n t e r e s t . Random d i g i t d i a l i n g cou ld have e l iminated the l a t t e r two l i m i t a t i o n s by i n c l u d i n g u n l i s t e d s u s c r i b e r s and renters us ing a c o i n c i d e n t i a l d i a l i n g method. However, g iven the u n i v e r s i t y ' s e t h i c a l research g u i d e l i n e s , i t was necessary to contact a l l respondents i n advance of the telephone in te rv iews . 2) COMMUNITY SERVICE PERSONNEL DESCRIPTION: Community s e r v i c e personnel can be descr ibed as homogeneous i n that the organiza t ions surveyed are a l l i n the he lp ing p r o f e s s i o n s . The organ iza t ions were chosen on the b a s i s o f t h e i r d i r e c t contact with c e r t a i n normal and a t - r i s k groups i n the p o p u l a t i o n , and on the b a s i s that these organ iza t ions could a l s o be consumers of mental hea l th in format ion as w e l l as p r o v i d e r s . The community serv ice popula t ion was d i v i d e d i n t o four d i f f e r e n t groups: Schools (8) - inc luded secondary s c h o o l s , a nat ive educat ion centre and a community c o l l e g e . Community & Neighborhood Organizat ions (15) - charac te r i zed as p r o v i d i n g s o c i a l and r e c r e a t i o n a l a c t i v i t i e s to s p e c i f i c groups i n the popula t ion as w e l l as to the general p u b l i c . Organizat ions l i s t e d i n t h i s category inc luded community c e n t r e s , neighborhood a s s o c i a t i o n s , d r o p - i n centres and churches . S o c i a l Serv ice & Health Agencies (30) - i d e n t i f i e d as those organ iza t ions and/or p r o f e s s i o n a l s whose mandate i s to meet s p e c i f i c p h y s i c a l and/or c e r t a i n emotional needs of the p o p u l a t i o n . Respondents l i s t e d i n t h i s category inc luded fami ly p h y s i c i a n s , h o s p i t a l s , psycho log is ts and s o c i a l s e r v i c e departments. * Employee Ass is tance Programs (98) - EAP's c o n s i s t of company-based or community-based agencies who provide educat ion and/or c o u n s e l l i n g to b r i n g about changes i n th ink ing and behavior that are more hea l thy and l e s s c o s t l y to both the i n d i v i d u a l and the employer (Goldmon, Reyes, Young, Barsamian, Thomas & Thuss, 1984). OBTAINING THE SAMPLE: The schools and some community/neighborhood o rgan iza t ions and s o c i a l s e r v i c e / h e a l t h agencies were randomly chosen from the Vancouver Telephone D i r e c t o r y . Other agencies were chosen on the b a s i s of preference from the sponsoring agency. The a v a i l a b i l i t y o f a p r o v i n c i a l l i s t of E A P ' s , together with contact names, addresses and p o s t a l codes, r e s u l t e d i n t o t a l * S h a l l be re fe r red to as EAP's i n t h i s paper i n c l u s i o n of a l l EAP's i n t o the survey sample. LIMITATIONS OF SAMPLING METHODOLOGY: It i s f e l t that ob ta in ing the sample of community se rv ice personnel was done ra ther haphazardly with l i t t l e systematic p lann ing . I n i t i a l l y , a smal l sample was intended f o r t h i s group. However, g iven the recent a c c e s s i b i l i t y of the EAP l i s t i n g , the f a c t that Mental Health i n the Workplace i s a growing program f o r the sponsoring agency, and the a v a i l a b i l i t y of funds to enlarge the sample f o r mailed q u e s t i o n n a i r e s , the researcher was f l e x i b l e to the needs of the agency. Obv ious ly , the greatest l i m i t a t i o n i s the over - representa t ion of EAP's over other o rgan iza t ions sampled. Consequently, r e s u l t s may be b iased to the opin ions and percept ions of t h i s p a r t i c u l a r group over the other groups sampled. CHOICE OF METHODOLOGICAL ORIENTATION The methodological o r i e n t a t i o n of t h i s research i s q u a n t i t a t i v e i n na ture . The study i s guided by a f i x e d conceptual framework — a quest ionna i re - - with a set of s p e c i f i c quest ions constructed i n advance. Observat ions are p laced i n numerical form, and t h i s numerical data i s assembled, c l a s s i f i e d and tabula ted so that some meaning or in format ion i s obtained (Monnette e t . a l . , 1986). Because of the sample s i z e and des ign , minimal involvement with the survey 'populat ion i s necessary; q u a l i t a t i v e a n a l y s i s a l lows the researcher to reach a l a r g e r and more d ive rse popula t ion of respondents i n a manner where data can be c o l l e c t e d and analyzed i n a r e l a t i v e l y s t ra igh t - fo rward and systemat ic manner. DATA COLLECTION A standardized survey instrument was designed fo r both the general p u b l i c and community se rv ice personnel (See Appendix 6 & 7) . Some quest ions were s i m i l a r on both instruments f o r the - purpose of comparing opin ions between the two groups. However, f o r the most par t each instrument was designed with the i n t e n t i o n of a c q u i r i n g re levant informat ion s p e c i f i c to the d i f f e r e n c e s of these two groups. That i s , some quest ions that were asked of the general p u b l i c was not appropr ia te or re levant to ask the community s e r v i c e personnel and v i c e - v e r s a . As such, the d i f f e r e n c e s between the two quest ionna i res best served the in format ion needs of the sponsoring agency. THE GENERAL PUBLIC: Methods of data c o l l e c t i o n a lso d i f f e r e d between the two groups. Telephone in terv iews were conducted with the general p u b l i c as i t i s we l l known that people o f ten re fuse or neglect to complete and re turn a mailed quest ionnai re (Monnette e t . a l . , 1986). With in te rv iews , response ra tes are genera l l y h igher because of the personal con tac t . Telephone interv iews can g e n e r a l l y be conducted q u i c k l y and economical ly with a f a i r l y good response r a t e . The in terv iew i s much more f l e x i b l e than the quest ionna i re as the in terv iewer has the opportuni ty to exp la in any ambigui t ies that emerge. A L e t t e r of In t roduct ion (Appendix 4 ) was i n i t i a l l y sent to each of the 100 respondents, e x p l a i n i n g the purpose of the survey and informing them to expect a c a l l i n the near future f o r a 10-15 minute telephone in terv iew. The i n t r o d u c t o r y l e t t e r served to save time by not having to repeat the purpose of the research upon telephone contac t ; i t a l s o served to add more c r e d i b i l i t y to the telephone survey. Fol low-up c a l l s were made to those i n d i v i d u a l s who could not be i n i t i a l l y reached. There are c e r t a i n l i m i t a t i o n s invo lved i n the telephone in terv iew method. Interviews have to be qu i te-Short i n dura t ion so that only a b r i e f number of items can be i n v e s t i g a t e d . Furthermore, the time l i m i t a t i o n r e s t r i c t s the volume of informat ion that can be obta ined , e s p e c i a l l y from open-ended quest ions that cannot be explored to any great depth. The telephone in terv iew method a l s o i n f l u e n c e s the type of quest ions asked and the method of asking them. Questions have to be kept r e l a t i v e l y simple and uncompl icated. COMMUNITY SERVICE PERSONNEL: Mai led quest ionna i res were sent to the community s e r v i c e personne l . It was assumed that t h i s group would generate a greater ra te of re turn given a p r o f e s s i o n a l i n t e r e s t and concern i n the subject matter; therefore responding to mai led quest ionna i res with more enthusiasm than the general p u b l i c group. The mailed quest ionna i res would e l iminate the extensive time f a c t o r requ i red of telephone i n t e r v i e w s . Another advantage i s that i t would e l imina te in terv iewer b i a s e s . Mai led quest ionna i res a lso al low respondents to complete the quest ionna i re at t h e i r convenience given other demands and p r i o r i t i e s i n the work s e t t i n g . Stamped, s e l f - a d d r e s s e d envelopes were inc luded f o r convenience. Given time l i m i t a t i o n s of the study, no fo l low-up was conducted f o r the mailed q u e s t i o n -n a i r e s , however the cover l e t t e r (Appendix 5 ) d i d s t r e s s the t i g h t schedule of the research pro jec t to encourage respondents to complete the quest ionna i re as soon as p o s s i b l e . There are c e r t a i n l i m i t a t i o n s imposed upon the use of mai led q u e s t i o n n a i r e s . F i r s t l y , there i s always the problem of n o n - r e t u r n s . There i s no way of a s s e s s i n g the c h a r a c t e r i s t i c s of those organ iza t ions who f a i l e d to respond to the ques t ionna i re , and to what extent t h e i r opinions and percept ions may d i f f e r from those who d i d respond. Those who answer the quest ionna i res may d i f f e r from the non-respondents thereby b i a s i n g the sample. There i s a l s o the p o s s i b i l i t y of m i s i n t e r p r e t i n g the quest ion or misreading the i n s t r u c t i o n s , which i s exac t ly what happened i n some responses i n t h i s c a s e . Some respondents f a i l e d to abide by the i n s t r u c t i o n s of checking on ly one answer to s p e c i f i c quest ions , r e s u l t i n g i n two or three checks to one quest ion and b i a s i n g the f i n a l r e s u l t s . There i s a l s o the problem of some respondents n e g l e c t i n g or sk ipp ing over c e r t a i n ques t ions , and as such, no fo l low through i s p o s s i b l e to c l a r i f y evas iveness . PRE-TEST General p u b l i c quest ionna i res were p r e - t e s t e d with student peers , f r i e n d s and other agency personne l . A f i n a l p r e - t e s t was conducted with f i v e respondents chosen from the sampling l i s t . A f t e r each p r e - t e s t , changes and improvements were made a c c o r d i n g l y . Given time l i m i t a t i o n s , the community se rv ice personnel quest ionna i re was p r e - t e s t e d only with v a r i o u s agency s t a f f and research committee members. Since one purpose of t h i s p i l o t study i s to assess the adequacy of the research instrument, conc lus ions and recommendations f o r f u r t h e r i m p r o v e m e n t / c l a r i f i c a t i o n w i l l be d iscussed i n the f i n a l chapter of t h i s paper. VALIDITY & RELIABILITY OF MEASURES Most measurements used i n both survey instruments were f a i r l y s t r a i g h t - f o r w a r d i n v o l v i n g s i n g l e i n d i c a t o r s of a v a r i a b l e . As such, these d i r e c t measures are recognized as both v a l i d and r e l i a b l e (Monnette e t . a l . , 1986). Face v a l i d i t y was strengthened through d i s c u s s i o n and by gather ing opin ions from other p a r t i c i p a n t s invo lved i n the research p r o c e s s . R e l i a b i l i t y was probably enhanced through the use of p r e - s t r u c t u r e d instruments. Consequently, in te rv iewer behavior was kept r e l a t i v e l y uniform throughout the telephone interv iews and could be more e a s i l y d u p l i c a t e d . Probing was kept to a minimum i n the telephone interv iews to avoid in terv iewer b ias and to keep the dura t ion of the in terv iews wi th in a reasonable time l i m i t . While the in terv iewer attempted to take verbatim notes to open-ended ques t ions , t h i s was not always p o s s i b l e and i t i s recognized that some b i a s may have occured i n s e l e c t i n g 'h igh p o i n t s ' of what was s a i d . Three s c a l e s were devised f o r the genera l p u b l i c ques t ionna i re : 1) Importance on Mental Health Issues 2) Myths About the Mental ly 111, and 3) Community Acceptance S c a l e . The f i r s t s c a l e was a l s o used i n the community s e r v i c e q u e s t i o n n a i r e . Because of the great d i f f i c u l t y i n d e f i n i n g hea l th without r e s o r t i n g to the concept of the absence of i l l n e s s , there has been a tendency i n the mental hea l th f i e l d to s e l e c t s p e c i f i c areas of endeavour which there i s reason to hope w i l l prevent some i l l n e s s and at best enhance mental hea l th (Cumming and Cumming, 1957). For example, programs on coping with d i v o r c e / s e p a r a t i o n , s t r e s s , or enhancing s e l f - c o n f i d e n c e are undertaken i n the b e l i e f that they w i l l u l t i m a t e l y lower the inc idence of mental i l l n e s s and perhaps enhance mental h e a l t h . Information on s p e c i f i c forms of mental i l l n e s s e s , such as s c h i z o p h r e n i a , paranoia and var ious ea t ing d isorders are expected to educate formal and informal c a r e - g i v e r s to improve understanding, strengthen support systems, and ease c l i e n t t r a n s i t i o n s to community l i f e thereby improving mental h e a l t h . These assumptions form the b a s i s of s p e c i f i c mental h e a l t h issues i n c l u d e d . i n t h i s f i r s t s c a l e . Furthermore, i ssues chosen were a l s o s p e c i f i c subject matters of concern to the sponsoring agency many of the t o p i c s a l ready being d iscussed and disseminated through var ious in fo rmat iona l sources v i a the o r g a n i z a t i o n . As such, each item inc luded i n the s c a l e was j u s t i f i e d and assessed f o r content v a l i d i t y . A l i k e r t - t y p e sca le was used to measure the degree of importance assigned to each mental hea l th i t em. Responses to t h i s sca le were d i v i d e d i n t o f i v e l e v e l s of i n t e n s i t y va ry ing from extremely important to not important at a l l . The source of items used f o r the s c a l e on Myths About the Mental ly 111 was der ived from a p u b l i c a t i o n developed by the Nat iona l I n s t i t u t e of Mental Health (1985) e n t i t l e d "The Fourteen Worst Myths About Recovered Mental P a t i e n t s " . While the range of v a r i a t i o n f o r responses to each item should have been broader than the a c t u a l three p o s i t i o n s prov ided , c o n s i d e r a t i o n had to be given to avoid the r e p e t i t i o n o f another 5-point s c a l e . It was f e l t that respondents might lose i n t e r e s t and a t t e n t i o n to the in terv iew i f r e p e t i t i v e 'numer ica l ' sca le responses were requested; there fore a s h i f t to a ' y e s / n o / d o n ' t know' category was used to provide v a r i a b i l i t y to responses . The Community Acceptance Scale was der ived from a previous study (Johnson & B e d i t z , 1981) and was supported by r e l i a b i l i t y and v a l i d i t y a n a l y s e s . The study recommended that the dichotomized range be expanded to avoid s o c i a l d e s i r a b i l i t y b i a s , and a t h i r d category , ' d o n ' t know', was there fore inc luded to p a r a l l e l the above mentioned Myth S c a l e . ETHICAL CONSIDERATIONS Once the research design was complete, a Request f o r E t h i c a l Review Form was submitted to the U . B . C . Behaviora l Sciences Screening Committee fo r Research Involv ing Human Subjects (Appendix 1 ) . Subsequent approval was given to conduct the research as o u t l i n e d (Appendix 3 ) . In accordance with U . B . C . research e t h i c s , se lec ted respondents f o r telephone interv iews were i n i t i a l l y contacted by l e t t e r p r i o r to ac tua l telephone con tac t . The l e t t e r of : i n t r o d u c t i o n i d e n t i f i e d the researcher and agency i n v o l v e d , explained the purpose of the study, s t ressed the c o n f i d e n t i a l nature of the study, and the time commitment requi red f o r the i n t e r v i e w . The l e t t e r a l s o acknowledged . that respondents were f ree to re fuse to p a r t i c i p a t e i n the study (Appendix 4 ) . A cover ing l e t t e r o u t l i n i n g s i m i l a r d e t a i l s was a l s o attached to the mai led quest ionna i res sent to the community s e r v i c e personnel (Appendix 5) . DATA ANALYSIS A simple way of reducing and summarizing data i s through frequency d i s t r i b u t i o n s i n e i t h e r raw or percentagized forms (Warwick, 1975). Frequency d i s t r i b u t i o n tab les were computer generated fo r each v a r i a b l e , and these are summarized i n paragraph form i n the fo l low ing chapter which d iscusses survey r e s u l t s . Frequency tab les have been compiled and presented in t h i s next chapter where a p p r o p r i a t e . Mean scores were used to descr ibe d i f f e r e n c e s f o r i n t e r v a l l e v e l data , s p e c i f i c a l l y i n the Importance on Mental Health Issues S c a l e . Mean scores were a l s o used to assess the average value measuring myths and community acceptance. The a n a l y s i s of var iance (ANOVA) s t a t i s t i c was used to descr ibe s p e c i f i c d i f f e r e n c e s between the general p u b l i c and community s e r v i c e personnel . ANOVA was a lso used to measure e f f e c t s of c e r t a i n independent v a r i a b l e s to dependent v a r i a b l e s : f o r example - the l e v e l of s i g n i f i c a n c e to which degree of importance on parent ing informat ion i s re la ted to sex, age, or m a r i t a l s t a t u s . Open-ended quest ions were t r a n s c r i b e d by choosing major themes from the raw data and c a t e g o r i z i n g i n d i v i d u a l responses in to an es tab l i shed theme. A margin of e r ro r i s u s u a l l y inc luded i n the presenta t ion of p o l l i n g r e s u l t s . However, i t was decided not to inc lude conf idence i n t e r v a l s r e f l e c t i n g the margin of e r r o r as i t would be mis leading due to the high non-response r a t e . The process of a n a l y s i s can of ten become a lengthy and complicated one. Numerous s t a t i s t i c a l methods can be used to provide i n t e r e s t i n g informat ion and a n a l y s i s of c o l l e c t e d da ta . It becomes necessary to p ick and choose which s t a t i s t i c s are more re levant than o t h e r s . It can on ly be judged t h a t , g iven s p e c i f i c goals and values of the researcher , the s t a t i s t i c s chosen f o r a n a l y s i s w i l l adequately represent the needs and i n t e r e s t s of the in format ion users and other research p a r t i c i p a n t s . 73. LIMITATIONS OF THE STUDY Several l i m i t a t i o n s are inherent i n t h i s study given c e r t a i n l i m i t a t i o n s of resources and f e a s i b i l i t y . Some l i m i t a t i o n s i n scope and g e n e r a l i z a b i l i t y have a l ready been mentioned given c o n s t r a i n t s of sampling methodology and the method of data, c o l l e c t i o n used . The f i n a l sample s i z e of the general p u b l i c populat ion was smal l (N =-46). Sample s i z e s fo r the community se rv ice personnel was a l s o smal l and d ispropor t iona te (N = 6 s c h o o l s ; 46 E A P ' s ; 9 S o c i a l Se rv ice /Hea l th Agencies; 5 Neighborhood/Community O r g a n i z a t i o n s ) . Consequently, whi le s u f f i c i e n t data was c o l l e c t e d to make the study worthwhile, care must be taken to r e f r a i n from o v e r - g e n e r a l i z a t i o n of the r e s u l t s based on the sample s i z e of t h i s s tudy . While random sampling of the general p u b l i c serves to enhance g e n e r a l i z a b i l i t y , f i n a l c h a r a c t e r i s t i c s of the populat ion sampled are s t i l l b iased and t h i s w i l l be d iscussed l a t e r . As mentioned e a r l i e r , extensive surveys have been conducted measuring p u b l i c a t t i t u d e s , percept ions and opin ions about var ious subjects on mental hea l th (Nunnally, 1961; E l i n s o n e t . a t . , 1967; Dear e t . a l . 1985). These s tudies have invo lved lengthy and exhaustive measurement instruments, e s p e c i a l l y i n determining pub l i c knowledge and community acceptance of the mental ly i l l . As such, the sca les used i n t h i s study cannot compare to the mature and extensive measurement instruments that should be used to assess a more accurate d e s c r i p t i o n of the phenomena under concern. Therefore , caut ion i s advised against g e n e r a l i z a t i o n s about f i n a l conc lus ions made concerning p u b l i c adherance to myths and community acceptance of the mental ly i l l . The l i m i t a t i o n s of t h i s study do not a l low f o r more comprehensive assessments i n these a r e a s . i There are three sources of response b i a s i n the study of mental hea l th (Gove & Geerken, 1977): 1) the tendency f o r people to answer quest ions i n e i t h e r a p o s i t i v e or negative way i r r e s p e c t i v e of the content of the quest ions; 2) the tendency to choose the s o c i a l l y d e s i r a b l e response to quest ions; and 3) the degree of a person 's need f o r approval from others (Monnette e t . a l . , 1986:158). There i s a l s o the problem of non-response which fu r ther l i m i t s the g e n e r a l i z a b i l i t y of t h i s s tudy. How do respondents d i f f e r from non-respondents, and to what extent could these d i f f e rences b ias the r e s u l t s ? While measures can be taken to inc lude informat ion about non-respondents (Monnette e t . a l . , 1986: 149), i t i s o f ten c o s t l y and time-consuming and beyond the resources and f e a s i b i l i t y of t h i s study. These sources of response and non-response b ias could subsequently in f luence f i n a l r e s u l t s and can on ly be acknowledged wi th in the context of t h i s study. Again , any g e n e r a l i z a t i o n s made must give c a r e f u l c o n s i d e r a t i o n to these b iases and l i m i t a t i o n s . V . S U R V E Y R E S U L T S INTRODUCTION A summary of the r e s u l t s from the c o l l e c t e d data are contained i n t h i s next s e c t i o n . The presenta t ion of f i n d i n g s w i l l be fo l lowed by a d i s c u s s i o n of conc lus ions and recommendations i n the f i n a l chapter of t h i s paper. RESPONSE RATE n = 46 n = 24 n = 14 n = 10 n = 4 n = 2 N = 100 A 46% response rate was obtained from the general p u b l i c sample. The major i ty of respondents who refused simply and p o l i t e l y stated they were not i n t e r e s t e d i n p a r t i c i p a t i n g . For those who d id o f f e r s p e c i f i c reasons f o r r e f u s i n g , 4 respondents c i t e d i l l h e a l t h , 3 were too busy, 2 f e l t they TELEPHONE SURVEY: Agreed to be interv iewed Refused to be interviewed Respondent moved or phone disconnected Could not be reached Could not speak E n g l i s h Incomplete Interviews c o u l d n ' t o f f e r any op in ion i n the a rea , 2 others d id not want anything to do with surveys, and one respondent d i d not want to d iscuss the s u b j e c t . Two-thirds of those who refused were male. The t o p i c of mental hea l th tends to create anxiety i n some people and, whi le not v e r b a l l y s t a t e d , i t i s p o s s i b l e t h i s could account f o r some of the r e f u s a l s . Some i n d i v i d u a l s are a l s o wary of interviews that may get too personal e s p e c i a l l y i n the area of mental h e a l t h . While some respondents d i d i n i t i a l l y sound somewhat h e s i t a n t to agree to the in terv iew, the in terv iewer was able to reassure them that quest ions were not personal i n nature, re - i t e r a t i n g the purpose of the survey, and conf i rming that they d i d have the r i g h t to re fuse to answer any quest ions asked. Th is procedure appeared to reduce i n i t i a l hes i tancy i n some cases and the in terv iewer was able to proceed with the in te rv iew . The non-Eng l ish speaking immigrant popula t ion was c l e a r l y not we l l represented i n the survey sample. The more mobi le populat ion a lso c o n s t i t u t e d a l o s s i n the representat iveness of the p o p u l a t i o n . These l i m i t a t i o n s were expected" given the sampling and survey methodology used. SURVEY OF COMMUNITY SERVICE PERSONNEL: P a r t i c i p a t e d : 8 Schools n = 6 98 Employee Ass is tance Programs n = 50 30 S o c i a l s e r v i c e / H e a l t h Agencies n = 9 15 Community/Neighborhood Organizat ions n = 5 N = 151 n = 70 While the schools and EAP's fared a be t te r ra te of re turn than s o c i a l s e r v i c e / hea l th and community/neighborhood o rgan iza t ions , these l a t t e r two groups s t i l l responded above the unacceptably low 20% l e v e l (Monnette e t . a l . , 1986). Babbie (1983) suggests that a 50% rate i s adequate fo r a n a l y s i s . Given that the t o t a l response rate f o r both survey groups was 46%, t h i s i s considered s a t i s f a c t o r y f o r the s tudy. DEMOGRAPHICS From the general p u b l i c group, 44% of the sample populat ion were male and 56% were female. The age range of respondents i s descr ibed below: TABLE 1: AGE BREAKDOWN OF TELEPHONE RESPONDENTS n = 46 AGE GROUP 18-24 25-29 30-39 40-49 50-59 60-69 70+ # of Respondents 11 5 10 7 6 3 4 % of Respondents 24% 11% 21% 15% 13% 7% 9% The above s t a t i s t i c s i n d i c a t e the major i ty of respondents were of the younger age bracket and t h i s r e f l e c t s the c o l l e g e / u n i v e r s i t y educat ion of 61% of the respondents. The remaining 37% of the respondents completed high school educat ion and 2% completed elementary l e v e l educat ion. The m a r i t a l s tatus of 48% of the populat ion were found to be s i n g l e whi le 37% of the populat ion were marr ied, 4% were d ivorced /separa ted , 4% were widowed and another 7% were l i v i n g common-law. The mar i t a l s tatus and age bracket of the general p u b l i c populat ion are cons is ten t with the extremely high percentage of the popu la t ion , 83%, who have no c h i l d r e n under 18 years of age. The ma jor i ty of the general p u b l i c p o p u l a t i o n , 61%, were employed and on ly 2% unemployed, 17% of the respondents were students , 13% were r e t i r e d and another 7% were homemakers. In terms of occupat iona l s t a t u s , the unemployed were obv ious ly under-represented i n t h i s sample. Respondents were asked what magazines and newspaper they read most o f ten: 28% do not read any magazines, but 17% of the respondents read TIME magazine r e g u l a r l y and 9% of the respondents read MACLEANS magazine. Th i r teen percent of the respondents do not read any newspaper, but 57% read THE SUN, 24% read THE PROVINCE, 4% read THE TORONTO GLOBE & MAIL, and the remaining 2% read other newspapers such as the community/neighborhood newspaper. In summary, a p r o f i l e of the dominant s o c i a l c h a r a c t e r i s t i c s of the genera l p u b l i c sample popula t ion can be descr ibed as young adul ts with post -secondary educat ion between the ages of 18-39, who are s i n g l e and employed. FAMILIARITY WITH THE CANADIAN MENTAL HEALTH ASSOCIATION (C.M.H.A.) GENERAL PUBLIC: When asked i f they had ever heard of the Canadian Mental Health A s s o c i a t i o n , 72% s a i d ' y e s ' . However, only 30% stated they were f a m i l i a r with what the A s s o c i a t i o n does. Even of the 30% who responded i n the a f f i r m a t i v e , some respondents f a i l e d to accura te ly descr ibe C.M.H.A. a c t i v i t i e s . For example, s i x respondents confused C.M.H.A. with the A s s o c i a t i o n f o r the Menta l ly Retarded who are we l l known f o r t h e i r c l o t h i n g d r i v e s . Another respondent, whi le d e s c r i b i n g C.M.H.A. as a p h i l a n t h r o p i c , benevolent o r g a n i z a t i o n , thought the A s s o c i a t i o n had "something to do wi th the a c c r e d i t a t i o n of p s y c h o l o g i s t s " . Those respondents who were able to c o r r e c t l y i d e n t i f y var ious C.M.H.A. a c t i v i t i e s mentioned advocacy f o r the mental ly i l l , pamphlets on s t r e s s , support groups, a c t i v i t y cen t res , respons ib le f o r the care of those a l ready d i s t u r b e d . ' A s s i s t i n g the menta l ly i l l ' or ' he lp ing mental ly handicapped people ' appeared to be the common theme from those who s ta ted f a m i l i a r i t y wi th the A s s o c i a t i o n ' s a c t i v i t i e s . Only two respondents progressed beyond t h i s d e s c r i p t i o n by acknowledging C.M.H.A. as " t r y i n g to promote a greater understanding of mental hea l th i n the community" and to "encourage mental h e a l t h " . COMMUNITY SERVICE PERSONNEL: 87% of the community se rv ice agencies have heard about C.M.H.A. However, only 29% of the t o t a l respondents were f a m i l i a r with the resources and programs provided by the A s s o c i a t i o n . When broken down in to agency responses, 83% of the s c h o o l s , 72% of the E A P ' s , 50% of the s o c i a l s e r v i c e / h e a l t h agenc ies , and 80% of the community/ neighborhood organ iza t ions were not f a m i l i a r with what C.M.H.A. does. A t o t a l of 81% f o r both groups sampled (n = 116) have heard about C . M . H . A . , but only an average of 30% of the sampling populat ion were f a m i l i a r with what the A s s o c i a t i o n does. While there i s a s i g n i f i c a n t d i f f e r e n c e between the two groups i n terms of having heard about the A s s o c i a t i o n that i s , community s e r v i c e organ iza t ions are more l i k e l y to have heard about C .M .H .A . than the general p u b l i c (ch i -square = 9.03, d . f . = 2, prob. = .01) there i s no d i f f e r e n c e between group membership and f a m i l i a r i t y with what the A s s o c i a t i o n does (ch i -square = .278 - 1 , d . f . = 1, prob. = .87) . In other words, community se rv ice personnel do not s i g n i f i c a n t l y d i f f e r from the general p u b l i c i n terms of f a m i l i a r i t y with C.M.H.A. a c t i v i t i e s . IMPORTANCE OF MENTAL HEALTH INFORMATION GENERAL PUBLIC: Only 8% of the general p u b l i c th ink about t h e i r mental hea l th a great d e a l , 24% th ink about t h e i r mental hea l th f a i r l y o f t e n , a major i ty of 44% th ink about t h e i r mental hea l th only o c c a s i o n a l l y , and 24% never th ink about t h e i r mental h e a l t h . While the major i ty of respondents tend not to pay a great dea l of a t t e n t i o n to t h e i r mental h e a l t h , 67% s t i l l thought i t was important f o r them to l ea rn about mental hea l th problems and how to dea l with these problems. Table 2 descr ibes the degree of importance placed on s p e c i f i c mental hea l th in format ion f o r the people surveyed. St ress and s e l f - c o n f i d e n c e c o n s i s t e n t l y ranked the h ighest under 'extremely important ' and the lowest under 'not important at a l l ' . While the average scores f o r each subject area do not d i f f e r s i g n i f i c a n t l y , the higher averages obtained f o r s t r e s s and s e l f - c o n f i d e n c e v a l i d a t e t h e i r p o s i t i o n of importance against other subject a r e a s . Schizophrenia and s e p a r a t i o n / d i v o r c e ranked the h ighest under the 'not important at a l l ' category , r e s p e c t i v e l y s c o r i n g 50% and 57%. While schizophrenia remained cons is ten t by p l a c i n g as one of the lowest i n the 'extremely important ' category , s e p a r a t i o n / d i v o r c e d i d not fo l low t h i s same p a t t e r n . I f , however, scores from the upper end of the sca le were added together , s e p a r a t i o n / d i v o r c e TABLE 2: SELF-RATINGS OF IMPORTANCE OF MENTAL HEALTH INFORMATION FOR TELEPHONE INTERVIEW RESPONDENTS n = 46 NOT IMPORTANT AT ALL SOMEWHAT IMPORTANT IMPORTANT VERY IMPORTANT EXTREMELY IMPORTANT AVERAGE SCORE * STRESS 4.3% 13.0% 26.1% 28.3% 28.3% 3.6 SELF-CONFIDENCE 17.4% 15.2% 23.9% 17.4% 26.1% 3.2 SEX EDUCATION 23.9% 6.5% 30.4% 15.2% 23.9% 3.0 PERSONAL CRISIS 19.6% 15.2 30.4 10.9% 23.9% 3.0 DEPRESSION 26.1% 19.6% 10.9% 26.1% 17.4% 2.9 PARENTING 37.0% 10.9% 15.2% 10.9% 26.1% 2.8', AGING & RETIREMENT 30.4% 19.6% 19.6% 10.9% 19.6% 2.7 CARE-GIVING IN THE HOME 32.6% 17.4% 19.6% 10.9% 19.6% 2.7 GRIEF & MOURNING 30.4% 15.2% 21.7% 15.2% 17.4% 2.7 FAMILY VIOLENCE 47.8% 2.2% 13.0% 13.0% 23.9% 2.7 PHOBIA 33.3% 24.4% 20.0% 4.4% 17.8% 2.5 DRUG & ALCOHOL 43.5% 10.9% 17.4% 8.7% 19.6% 2.5 SCHIZOPHRENIA 5.0.0% .16.7% 11.9% 11.9% 9.5% 2.5 SUICIDE 45.7% 13.0% 8.7% 21.7% 10.9% 2.4 EATING DISORDERS 39.1% 17.4% 15.2% 19.6% 8.7% 2.4 FAMILY & MARRIAGE 41.3% 19.6% 10.9% 17.4% 10.9% 2.3 SEPARATION/DIVORCEj 56.5% 10.9% 15.2% 0 17.4% 2.1 * maximum of 5 would c l e a r l y rank the lowest which i s cons is ten t with i t s lowest average s c o r e . It i s i n t e r e s t i n g that no respondents r e p l i e d 'very important ' f o r s e p a r a t i o n / d i v o r c e , yet those who d i d respond favorably d i d so at the extreme end of the s c a l e . Given the demographic p r o f i l e of the survey popula t ion where the major i ty of respondents are s i n g l e , i t i s assumed that the subject of separa t ion / d i v o r c e i s not important to them. Those who d i d rank t h i s subject as extremely important may have d i r e c t l y experienced the s i t u a t i o n or have been i n d i r e c t l y a f f e c t e d by i t , as some respondents commented, through t h e i r own parents . Cons idera t ion must a l s o be given to response set i n the type of scores obtained f o r each i tem. Some i n d i v i d u a l s may tend to a s s i g n a h igh score or a low score to a l l i tems, regard less of a c t u a l personal need f o r in format ion i n the subject a r e a . Improving f u n c t i o n a l competence and coping s k i l l s as o b j e c t i v e s of primary prevent ion appear to be of greater i n t e r e s t to the 'normal ' ta rget p o p u l a t i o n . People f e e l that in format ion on the more ser ious mental hea l th problems (eg. s c h i z o p h r e n i a , . e a t i n g d i s o r d e r s , phobias) are l e s s important to them. Issues of more personal and immediate concern are more important than f u t u r e -o r ien ted or n o n - a s s o c i a t i v e subjects to the i n d i v i d u a l . In other words, the general p u b l i c populat ion f e e l that in format ion which i s c l o s e r to t h e i r own personal experiences i s more important to them than informat ion which i s not d i r e c t l y a f f e c t i n g them. ANOVA (ana lys is of var iance) s t a t i s t i c a l procedures were computer generated to compare mean scores with the socio-demographic v a r i a b l e s age, occupat ion , educat ion , m a r i t a l s t a t u s , having c h i l d r e n under 1'8 years of age, and gender. For the most p a r t , there was no r e l a t i o n s h i p between the degree of importance p laced on s p e c i f i c mental hea l th in format ion and socio-demographic v a r i a b l e s . Table 3 i n d i c a t e s the few cases were a r e l a t i o n s h i p was shown to e x i s t between mean scores and c e r t a i n socio-economic v a r i a b l e s . It should be kept i n mind that these r e s u l t s are a subset of a large s e r i e s of t e s t s : the p r o b a b i l i t y values should be viewed as t e n t a t i v e . TABLE 3: - SIGNIFICANCE OF RELATIONSHIP BETWEEN IMPORTANCE ON MENTAL HEALTH INFORMATION AND SOCIO-DEMOGRAPHIC VARIABLES n = 46 MENTAL HEALTH INFORMATION SUBJECT AREA RELATIONSHIP WITH VARIABLE F STATISTIC DEGREES FREEDOM PROBABILITY Parent ing Age 2.6 45 .03 Se l f -Conf idence Age 2.5 45 .04 Sex Educat ion Occupation 2.7 45 .04 Se l f -Conf idence Occupation 3.2 45 .02 Parent ing Have c h i l d r e n under age 18 5.8 45 .02 Sex Educat ion Have c h i l d r e n under age 18 5.3 45 .03 Depression Gender 5.1 45 .03 The 25 - 29 age group and those who have c h i l d r e n under 18 years of age are more l i k e l y to score h igher means fo r in format ion on p a r e n t i n g . Higher mean scores f o r informat ion on s e l f - c o n f i d e n c e are a l s o assoc ia ted with the younger age bracket (18-39) as opposed to the o lder age group. The unemployed, home-makers and students p lace more importance fo r informat ion on s e l f - c o n f i d e n c e than the employed and r e t i r e d group. Home-makers, students and those with c h i l d r e n under 18 years of age are a l s o more l i k e l y to score higher means f o r in format ion on sex educat ion . F i n a l l y , there i s a r e l a t i o n s h i p between gender and mean scores on depress ion : females place more importance on in format ion i n t h i s subject area than males. IMPORTANCE ON MENTAL HEALTH INFORMATION COMMUNITY SERVICE PERSONNEL: Each agency i n t h i s group w a s a l s o asked how important i t would be f o r t h e i r o r g a n i z a t i o n to have informat ion on s p e c i f i c mental hea l th t o p i c s . The r e s u l t s are shown i n Table 4. TABLE 4: SELF-RATINGS OF IMPORTANCE OF MENTAL HEALTH INFORMATION FOR COMMUNITY SERVICE PERSONNEL N NOT IMPORTANT AT ALL SOMEWHAT IMPORTANT IMPORTANT VERY IMPORTANT EXTREMELY IMPORTANT AVERAGE SCORE * STRESS 68 1.5% 1.5% 10.3% 22.1% 64.7% 4.47 DRUG & ALCOHOL 68 1.5% 4.4% 7.4% 23.5% 63.2% 4.43 DEPRESSION 68 5.8% 0 4.3% 36.2% 53.6% 4.32 FAMILY & MARRIAGE COUNSELLING 67 9.0% 1.5% 6.0% 20.9% 62.7% 4.26 DEALING WITH A PERSONAL CRISIS 66 3.0% 3.0% 15.2% 25.8% 53.0% 4.23 SEPARATION & DIVORCE 66 6.1% 6.1% 4.5% 27.3% 56.1% 4.21 SELF-CONFIDENCE 67 1.5% 3.0% 16.4% 31.3% 47.8% 4.21 FAMILY VIOLENCE & SEXUAL ABUSE 67 4.5% 4.5% 19.4% 35.8% 35.8% 3.94 SUICIDE 67 4.5% 10.4% 17.9% 25.4% 41.8% 3.89 PARENTING 66 9.1% 15.2% 10.6% 28.8% 36.4% 3.68 AGING & RETIREMENT 66 6.1% 16.7% 18.2% 33.3% 25.8% 3.56 GRIEF & MOURNING 68 8.8% 8.8% 27.9% 33.8% 20.6% 3.48 EATING DISORDERS 67 7.5% 14.9% 20.9% 35.8% 20.9% 3.47 SEX EDUCATION 67 14.9% 20.9% 20.9% 23.9% 19.4% 3.12 PHOBIAS 66 9.1% 27.3% 25.8% 22.7% 15.2% 3.07 CARE-GIVING IN THE HOME 65 21.5% 27.7% 24.6% 16.9% 9.2% 2.64 SCHIZOPHRENIA 66 22.7% 33.3% 16.7% 15.2% 12.1% 2.60 * maximum of 5 85. Given that the community s e r v i c e personnel were d i f f e r e n t i a t e d in to four groups, mean scores were c a l c u l a t e d f o r each group (Table 5 ) . As i n d i c a t e d by the s i g n i f i c a n c e t e s t s (F r a t i o s ) , there i s a s i g n i f i c a n t r e l a t i o n s h i p between the type of agency and the o v e r a l l average importance (mean score) p laced on p a r t i c u l a r types of mental hea l th in fo rmat ion . For example, schools and EAP's have a higher mean score on importance f o r in format ion on fami ly /mar r iage , s e p a r a t i o n / d i v o r c e , d e a l i n g with a personal c r i s i s and s t r e s s i n comparison to the mean scores i n these areas f o r s o c i a l s e r v i c e / hea l th and community/neighborhood o r g a n i z a t i o n s . This i s fu r ther substant ia ted 2 by the ETA s t a t i s t i c which i n d i c a t e s the s i g n i f i c a n c e of a s s o c i a t i o n between agency type and r a t i n g of importance on s p e c i f i c mental hea l th in fo rmat ion . R e l a t i v e l y speaking, the mental hea l th i ssues of s t r e s s , depress ion and d e a l i n g with a personal c r i s e s were a l l s i t u a t e d at the upper end of the Importance Scale on Table 2 and 4, i n d i c a t i n g both groups surveyed f e e l in format ion i n these areas are the most important . S i m i l a r i l y , both groups p laced ea t ing d i s o r d e r s and sch izophren ia at the bottom end of the s c a l e . On the whole, community s e r v i c e personnel p lace more importance on mental hea l th in format ion than the general p u b l i c . The o v e r a l l mean score fo r the former group was 3.74 out of a maximum of 5, whi le the l a t t e r group averaged a score of 2.97. Table 6 compares the mean scores between both group f o r each mental hea l th i s s u e , present ing the l e v e l of s i g n i f i c a n c e i n the d i f f e r e n c e between means and t h e i r v a r i a n c e s . The tab le i n d i c a t e s that the general p u b l i c and community s e r v i c e personnel d i f f e r s i g n i f i c a n t l y i n t h e i r mean scores fo r almost every subject area except sch izophren ia , c a r e - g i v i n g i n Ul o PJ "0 z M > IO 01 M f+ n H- > o z to n C/5 -3 w • • to to CD to Ul ui j • i • to i to Ul i to u> 1 •b 1 oi . . to to ui b to U> , • to I—' •J 03 to •b ~J • co v # to to lb en •J O ui i to . , ib o Ul i o CD u> -J Ul • I • u> o o\ i Ul to w OD i CO ; a• ' u> o - J to 01 to ib CO . Ul oI-1 ir> UI Ul , . U) M CTl CO CO m to . to lb t-1 o CO lb Ul , • to U) H -J CO •J to o • Ul o 01 to Ul -J - J lb . . lb oM o 00 -J Ul Ul • • U! O O o CD Ul b ~J to Ul M 01 Ul . . I-1 ^) lb CO u> .b u> lb to CO to 01 ui U l ui UI ib ib ib to ui 10 lb Ul lb to <-> z O PJ 2 H 3 O C S Z CD M O 1-3 50 K X o o o 50 D a - m b ib ib b u> lb to CO ui o ui to to lb U l to lb lb ib b X 01 PJ O > O f M HP > in O P J PJ 50 z < o M M o PJ PJ IP p) 2 •0 w TJ r n » o n: o >< o O P) o 33 PJ r > to 5 > w cnin to n PJ to CO to co to CO U l U l o ui •oi Ul b ib ib 01 lb Ul to 01 ui oi ui to ib Ol lb lb lb b b SCHIZOPHRENIA DEPRESSION SUICIDE PHOBIA EATING DISORDERS FAMILY & MARRIAGE SEPARATION & DIVORCE AGING & RETIREMENT CARE-GIVING IN THE HOME GRIEF & MOURNING PARENTING SEX EDUCATION DRUG & ALCOHOL DEALING WITH PERS. CRISIS FAMILY VIOLENCE' STRESS SELF-CONFIDENCE t-9 > a 2 co TABLE 6: STATISTICAL SIGNIFICANCE OF DIFFERENCES IN MEANS AND VARIANCES BETWEEN THE GENERAL PUBLIC AND COMMUNITY SERVICE SAMPLES 3ENERAL PUBLIC MEAN SCORE COMMUNITY SERVICE MEAN SCORE TEST (t) STATISTIC PROBABILITIES (MEANS) PROBABILITI] (VARIANCES) SCHIZOPHRENIA 2.5 2.5 - 1.0 .9430 .07 DEPRESSION 2.9 4.3 - 5.6 .0000 .0166 SUICIDE 2.4 3.7 - 4.8 .0000 .3017 PHOBIAS 2.4 2.9 - 1.7 .0882 .2954 EATING DISORDERS 2.4 3.3 - 3.5 .0007 .4130 MARRIAGE/FAMILY 2.4 4.1 - 6.2 .0000 .4461 SEPARATION/DIVORCE 2.1 4.0 - 6.5 .0000 .4533 AGING/RETIREMENT 2.7 3.4 - 2.4 .0193 .3775 CARE-GIVING IN THE HOME 2.7 2.5 .79 .4304 .2473 GRIEF & MOURNING 2.7 3.4 - 2.5 .0147 .1607 PARENTING 2.8 3.5 - 2.3 .0255 .3304 SEX EDUCATION 3.1 3.0 .36 .7175 .4851 DRUG & ALCOHOL 2.5 4.3 - 7.0 .0000 .0111 PERSONAL CRISIS 3.0 4.0 - 3.5 .0006 .4295 FAMILY VIOLENCE 2.6 3.8 - 4.0 .0001 .0242 STRESS 3.6 4.3 - 3.3 .0013 .4067 SELF-CONFIDENCE 3.2 4.0 - 3.3 .0013 .1446 OVERALL MEAN 2.97 3.74 the home and sex educat ion; however only the var iances between d e p r e s s i o n , d r u g / a l c o h o l a d d i c t i o n and fami ly v io lence are s t a t i s t i c a l l y s i g n i f i c a n t . INFORMATION SYSTEMS GENERAL PUBLIC: When asked who they would t a l k to i f they had a problem that was a f f e c t i n g them emot iona l ly , 51% of the respondents would f i r s t t a l k to a f r i e n d or fami ly member. Another 29% would go to t h e i r fami ly doc tor , 11% would go to a p r o f e s s i o n a l c o u n s e l l o r , and a remaining 9% responded i n the 'o ther ' category . In the l a t t e r category , two respondents mentioned s o c i a l s e r v i c e s , one respondent s a i d he would t r y to work i t out h i m s e l f , and another subject s t a t e d , "I would shut the problem out of my mind". A major i ty of the respondents, 33%, f e l t that t a l k i n g to people with s i m i l a r problems would be the best way of p rov id ing mental hea l th informat ion to them, 24% f e l t t e l e v i s i o n would be the b e s t , 15% was ra ted equa l ly f o r both educat iona l t a l k s and pamphlets, and 13% f e l t newspapers/magazines would be the best way of p rov id ing in format ion . The persona l , in formal support system i s the most p re fe r rab le fo r r e c e i v i n g informat ion on mental hea l th issues which i s cons is ten t with the f i n d i n g that most people would f i r s t t a l k to a f r i e n d or fami ly member about an emotional problem. At t imes, people are at a l o s s as to where to turn to i n times of need. When asked what they would do i f they d i d n ' t know where to turn f o r h e l p , 58% r e p l i e d they would ask somebody, such as a f r i e n d or fami ly p h y s i c i a n . 20% mentioned turn ing to a r e f e r r a l agency such as the C r i s i s Centre, 15% d i d not 89. know what to do, and only 8% mentioned turn ing to the telephone d i r e c t o r y . While the Greater Vancouver Telephone D i r e c t o r y provides a l i s t of community s e r v i c e s at the f ron t of the tex t with the names and numbers of agencies f o r s p e c i f i c sources of h e l p , the general p u b l i c do not appear to be too f a m i l i a r with t h i s s e r v i c e . Respondents were asked where they would go i f they needed informat ion on var ious mental hea l th subject matters they considered as most important . An average of 29% of the respondents d i d not know where to go f o r such in format ion , 42% of the respondents were able to i d e n t i f y general sources such as a f r i e n d , a clergyman, the l i b r a r y , a c o l l e g e course , or fami ly p h y s i c i a n . Another 29% i d e n t i f i e d more s p e c i f i c resources such as the Community Health C l i n i c , U . B . C . Health S e r v i c e s , M i n i s t r y of Human Resources or the C r i s i s Centre . Only one respondent mentioned C . M . H . A . , which was probably a r e s u l t of the in terv iew contact i t s e l f ra ther than previous knowledge of the A s s o c i a t i o n . The survey populat ion d i d not acknowledge any of the Mental Health C l i n i c s or C.M.H.A. as a r e f e r r a l resource fo r in fo rmat ion . Knowledge of any s p e c i f i c mental hea l th agencies a l s o appeared to be l i m i t e d . E ighty -seven percent of the respondents have known somebody who has su f fe red a mental i l l n e s s or an emotional problem. To the best of t h e i r knowledge, 58% of these respondents s a i d that the person d id rece ive p r o f e s s i o n a l h e l p . The ma jo r i t y , 33%, f e l t that the s e r v i c e was h e l p f u l to the person, 2% d i d know know, 11% f e l t the serv ice was somewhat h e l p f u l , and 15% d id not f e e l the p r o f e s s i o n a l s e r v i c e was h e l p f u l . Th is l a t t e r group provided comments such as "made matters worse, shock therapy screwed her up; don ' t b e l i e v e i n p s y c h i a t r i s t s ; e l e c t r o - s h o c k treatment does more damage; don ' t b e l i e v e i n c o u n s e l l i n g " . 20% of the respondents s a i d the people they knew s u f f e r i n g from a mental i l l n e s s or emotional problem d i d not rece ive p r o f e s s i o n a l h e l p . Reasons given i n c l u d e d : "scared to reach out ; re luctance of the person to admit they need he lp . . . want to say ' y e s , everyth ing i s great and wonderful ; scared to contact people because they might l a b e l you mental ly i l l " . D e n i a l , f ear and negat ive stigma continue to be major b a r r i e r s to seeking h e l p . COMMUNITY SERVICE PERSONNEL: Respondents were asked how C.M.H.A. could best provide mental hea l th in format ion to t h e i r o r g a n i z a t i o n . They were asked to choose one method from a l i s t of four c h o i c e s . Twenty-six of the seventy respondents f a i l e d to abide by these i n s t r u c t i o n s and checked more than one answer; these responses were omitted from the computer coded r e s u l t s . Of the remaining f o r t y - f o u r respondents, 59% be l i eve that pamphlets/brochures are the best way of p rov id ing informat ion to them, 21% s a i d a v a i l a b i l i t y of t r a i n i n g f i l m s / v i d e o c a s s e t t e s ; 18% s a i d workshops/seminars, and 2% f e l t that t e l e v i s i o n and rad io would be the best way of p rov id ing mental hea l th in format ion to them. Responses f o r the twenty-s ix miss ing cases were ca tegor -i zed manually: pamphlets/brochures were l i s t e d 17 t imes, t r a i n i n g f i l m s / v ideo casse t tes were l i s t e d 16 t imes, workshops/seminars were l i s t e d 7 times and t e l e v i s i o n / r a d i o was l i s t e d tw ice . These responses d i d not appear to a l t e r the previous order of• responses that i s , pamphlets/brochures were s t i l l the most p r e f e r r a b l e method of p rov id ing mental hea l th in format ion to community agencies . In p rov id ing mental hea l th in format ion and education to t h e i r c l i e n t s , 36% of the agencies f e l t that pamphlets would be the best method, 26% s a i d r e f e r r a l to appropr ia te resources , 23% s a i d s e l f - h e l p groups, 9% s a i d t e l e v i s i o n , and 6% f e l t that educat iona l t a l k s would be the best method. Again , 17 agencies i n a p p r o p r i a t e l y responded to the quest ion by checking more than one answer from the p o s s i b l e l i s t of f i v e choices and these answers were manually c a t e g o r i z e d . O v e r a l l , community s e r v i c e personnel b e l i e v e that pamphlets would be the best v e h i c l e fo r p rov id ing mental hea l th in format ion to t h e i r c l i e n t s . DIFFICULT PROBLEMS IN LIVING GENERAL PUBLIC: When asked to l i s t three of the most d i f f i c u l t problems experienced i n t h e i r l i f e , many respondents had t rouble i d e n t i f y i n g three problems. It i s l i k e l y that some d i d not want to revea l very personal i ssues to the in terv iewer ; i t i s a l s o l i k e l y that many of the respondents simply could not i d e n t i f y three problems i n t h e i r l i f e that a c t u a l l y stood out i n t h e i r mind. The death of a loved one (parent, spouse, c h i l d , f r i end ) was mentioned the greates t number of times by respondents as one of the more d i f f i c u l t problem experienced i n t h e i r l i f e . A second theme emerged i n the area of coping e s p e c i a l l y coping due to an i l l n e s s or acc ident i n the fami ly or due to an adjustment to a new l i f e . Work-related d i f f i c u l t i e s was the t h i r d most preva lent theme i d e n t i f i e d by respondents . D i f f i c u l t i e s with r e l a t i o n s h i p s , p h y s i c a l d i f f i c u l t i e s , f i n a n c i a l and s c h o o l - r e l a t e d d i f f i c u l t i e s were other themes i d e n t i f i e d by the general p u b l i c . While exper iencing the death of a loved one was expressed by many of the respondents as a d i f f i c u l t time i n t h e i r l i f e , in format ion on g r i e f and mourning was not a high p r i o r i t y i tem f o r t h i s popu la t ion . It i s l i k e l y that people have adequately dea l t wi th the past event and, as p r e v i o u s l y mentioned, they are more concerned with the present and more immediate experiences i n t h e i r l i v e s . COMMUNITY SERVICE PERSONNEL: Respondents i n t h i s group were asked to l i s t three of the most common problems experienced i n the d a i l y l i v e s of the people they serve . S t r e s s / a n x i e t y were problems most commonly encountered. D i f f i c u l t i e s with fami ly and m a r i t a l r e l a t i o n s h i p s was the second most prevalent theme, and a l c o h o l / d r u g abuse was the t h i r d most common problem l i s t e d by t h i s group. The area of s e l f - e s t e e m , personal i d e n t i t y and l i f e s k i l l s i n general was another common theme i d e n t i f i e d by community s e r v i c e pe rsonne l . Assuming that the c l i e n t e l e f o r the major i ty of the community s e r v i c e personnel are charac te r i zed as i n d i v i d u a l s who are a t - r i s k , i t would appear that perce ived problems i n l i v i n g d i f f e r to some extent between 'normal ' popula t ion groups and a t - r i s k groups i n the popu la t ion . While coping with a personal loss or with an i l l n e s s i n the fami ly were i d e n t i f i e d as two of the more d i f f i c u l t l i f e experiences f o r the major i ty of the general p u b l i c , the he lp ing pro fess ions d i d not encounter these same d i f f i c u l t i e s i n the c l i e n t e l e they s e r v e . While the community s e r v i c e personnel i d e n t i f i e d s t r e s s as the most common problem, the general p u b l i c was able to focus on the more s p e c i f i c s t r e s s - r e l a t e d problems: work- re la ted d i f f i c u l t i e s , r e l a t i o n s h i p problems, p h y s i c i a l and f i n a n c i a l d i f f i c u l t i e s . THOUGHTS & OPINIONS ON MENTAL HEALTH AND ILLNESS While i t would have been i n t e r e s t i n g to assess the thoughts and op in ions of community se rv ice personnel toward mental hea l th and i l l n e s s , i t was not f e l t as r e l e v a n t . Therefore , t h i s f o l l o w i n g s e c t i o n p e r t a i n s to the genera l p u b l i c group o n l y . 1) Conceptions About Mental Health When asked "What does mental hea l th mean to you?, 55% of the respondents were ca tegor ized as p rov id ing non-appropr ia te answers and 45% were ca tegor ized as p rov id ing appropr ia te answers. 'Appropr ia te ' was de f ined as those answers that drew s i m i l a r ideas from the d e f i n i t i o n of mental hea l th (Chapter I I I ) . The f o l l o w i n g are some of the statements o f f e r e d by the 45% appropr ia te answers: " s t a b i l i t y ; sound mind; being able to use a l l your c a p a c i t i e s ; a b i l i t y to cope we l l with l i f e s i t u a t i o n s and problems; people who can func t ion i n s o c i e t y comfortably; good hea l thy mind able to handle everyday problems; s ta te of w e l l - b e i n g ; mental s t a b i l i t y ; happiness and s e l f -conf idence; happy and enjoying l i f e " . Of the 55% categor ized as a t tach ing inappropr ia te responses to the meaning of mental h e a l t h , the fo l low ing responses were g iven: "people who f i n d themselves under great s t r a i n ; a person i s mental ly d i s t u r b e d ' d isease of the mind; people s t r u g g l i n g ; handicapped; people that are upset or have a chemical d i s o r d e r ; not mental ly s t a b l e " . The 14% of the respondents who answered "don' t know" were a l s o p laced under the non-appropr iate ca tegory . Respondents were asked, "do you th ink there are ways we can improve our mental hea l th?" 57% responded yes , 17% responded maybe, 17% responded don ' t know and 9% responded no. Given that 55% i n a p p r o p r i a t e l y def ined the concept , i t would appear c o n s i s t e n t that people who are not f a m i l i a r with the p r i n c i p l e s of mental hea l th are a l s o u n l i k e l y to be knowledgeable about p o s i t i v e mental hea l th p r a c t i c e s . While 57% of the respondents th ink we can improve our mental h e a l t h , many of them could not descr ibe what could be done to improve mental h e a l t h . For those who d id o f f e r suggest ions , a common theme of ' t a l k i n g th ings out ' emerged as the most popular response. "Talk about problems to a good f r i e n d ; t a l k to someone who can o f f e r he lp ; l e a r n to communicate b e t t e r ; reach out and ask f o r h e l p ; t a l k and get r i d of i t ( s t r e s s ) ; open up with emotions" were some of the responses p rov ided . 'Reading and l e a r n i n g ' was the second most prevalent suggest ion o f fe red by the general p u b l i c when asked what we could do to improve our mental h e a l t h . "Read more b o o k s . . . t r y to f i n d out more about i t ; keep l e a r n i n g ; l ea rn from everyday l i f e ; read s e l f - h e l p books" were the comments of some respondents. Other themes which emerged from the quest ion about mental hea l th p r a c t i c e inc luded d i e t / e x e r c i s e , p h y s i c a l h e a l t h , tak ing r e s p o n s i b i l i t y to change one 's l i f e s t y l e , and keeping busy or a c t i v e . 2) Re jec t ion of Myths About the Mental ly 111 Respondents were asked to r e p l y to a number of statements which are known to be prevalent myths about recovered mental p a t i e n t s . Resul ts are shown i n the fo l low ing t a b l e : TABLE 9: REJECTION OF MYTHS ABOUT THE MENTALLY ILL n = 46 AGREE DISAGREE DON'T KNOW One of the main causes of mental i l l n e s s i s the lack of personal s t rength and wi l lpower . 22% 70% 8% A major i ty of people with mental i l l n e s s 2» are u n p r e d i c t a b l e . 39% 39% 22% A person who has been mental ly i l l can 3« never be normal . 4% 96% 0 4 r A sch izophren ic i s a person with a s p l i t p e r s o n a l i t y . 46% 35% 19% 5^ If a person has been mental ly i l l f o r a long t ime, there i s n ' t much hope f o r recovery . 20% 54% 26% In the f i v e - i t e m r e j e c t i o n of myth s c a l e , the average scores could range from a low of 5 ( i f the respondent agreed to every statement) to a high of 15 ( i f the respondent d isagreed to every statement) . The problem of response pa t te rn anxiety was avoided by i n t e r s p e r s i n g the statements read to the respondent with statements from the community acceptance s c a l e , so that there was a mixture of h igh-va lued ' d i s a g r e e ' statements fol lowed by h igh-va lued 'agree ' statements. The average score f o r the myth sca le was 11.7 out of a p o s s i b l e high of 15. This i n d i c a t e s the survey populat ion as p o s i t i v e l y skewed toward the upper end of the s c a l e , so that g e n e r a l l y , the populat ion would tend to r e j e c t the commonly he ld myths about the mental ly i l l . The problem of response b i a s , however, almost always occurs i n t h i s type of research so that there must be some quest ion as to what people ' a c t u a l l y ' b e l i e v e and what they f e e l they ' s h o u l d ' b e l i e v e to be s o c i a l l y acceptab le . Given the i n f luence of response b i a s , the average r e j e c t i o n of myths score i s probably lower than a c t u a l l y i n d i c a t e d . Some myths s t i l l p r e v a i l such as u n p r e d i c t a b i l i t y of the mental ly i l l and the s p l i t p e r s o n a l i t y of s c h i z o p h r e n i c s . Therefore , whi le some notable gains have been made i n improving the knowledge and a t t i t u d e s of the general p u b l i c toward the mental ly i l l , there i s s t i l l room f o r improvement. As Nunnally (1961:47) would suggest , "much of the dread of the mental ly i l l might be removed i f the p u b l i c could l ea rn some meaningful pat terns and c o n s i s t e n c i e s of psychot ic behav ior , so that i t i s more understandable and more p r e d i c t a b l e " . 3) Sca l ing Community Acceptance TABLE 10: COMMUNITY SUPPORT SCALE n = 46 AGREE DISAGREE DON'T KNOW 1. I be l i eve that ex -pa t i en ts of a mental h o s p i t a l can func t ion w e l l i n the community. 85% 2% 13% 2. I would ob ject i f someone who had been prev ious ly menta l ly i l l moved next door to me. 11% 83% 6% 3. I can imagine myself become a c l o s e f r i e n d with someone who i s menta l ly i l l . 61% 15% 24% 4. I would ob ject i f a hal f -way house fo r mental ly i l l people was loca ted i n my neighborhood. 15% 74% 11% 5. If a mental ly i l l person asked f o r help i n ge t t ing a job where I work, I would be w i l l i n g to h e l p . 86% 7% 7% 6. I would r e g u l a r l y p a r t i c i p a t e i n programs i n my neighborhood which he lp mental ly i l l people . 41% 31% 28% Community support and acceptance i s expected i f mental ly i l l persons are to ease back in to community l i v i n g . Items from the above community acceptance sca le were d i f f e r e n t i a t e d i n t o a c t i v e and passive components to d i s c r i m i n a t e l e v e l of support . The pass ive requirement, f o r example, invo lves a consensus of p u b l i c op in ion and an absence of p r o t e s t . Act ive support , on the other hand, invo lves the personal involvement of community members i n he lp ing behaviors (Johnson & B e d i t z , 1981). With the except ion of statement #5, the two a c t i v e statements (#3 & 6) scored cons iderab ly lower than the pass ive statements. It would appear tha t , as observed by the Nat iona l I n s t i t u t e of Mental Health (1977), "the w i l l i n g n e s s to t o l e r a t e prox imi ty to former pa t ien ts i s not equiva lent to a c t i v e support def ined through behaviors" (Johnson & B e d i t z , 1981: 154). Most people are w i l l i n g to a c t i v e l y he lp a mental ly i l l person get a job where they work. Three explanat ions are o f fe red f o r the 86% s c o r e . F i r s t l y , a number of respondents who agreed they would he lp commented they would do so depending only upon the s k i l l of that person. Therefore , whi le some reserva t ions were placed on the s p e c i f i c s i t u a t i o n , these respondents genera l l y agreed to the statement and were consequently recorded as agreeing to h e l p . The ac tua l extent of h e l p , however, i s unknown. A second explanat ion i s what i s known as response b i a s . Rather than being perce ived as non-support ive to the in te rv iewer , respondents may have answered favorab ly because i t i s more s o c i a l l y acceptable to do s o . A t h i r d explanat ion f o r the 86% score i s the p o s s i b i l i t y that people would genuinely t r y to he lp a menta l ly i l l person f i n d a job at t h e i r p lace of work. In the s i x - i t e m community acceptance s c a l e , the average score could have ranged from a low of s i x to a h igh of e igh teen . For the populat ion surveyed, the community acceptance s c a l e averaged 15.5 out of a high of 18, which i n d i c a t e s the popula t ion as p o s i t i v e l y skewed toward the upper end of the acceptance s c a l e . Genera l ly , the sample popula t ion appears to be support ive of the mental ly i l l but aga in , the problem of response b ias should be considered as a l i m i t a t i o n to making any f i n a l c o n c l u s i o n s . 4) Conceptions About Mental I l l n e s s The general p u b l i c was asked, "What do you th ink of when you hear the words •mental i l l n e s s ' ? " . Responses were ca tegor ized in to three themes: 1) a t e c h n i c a l or ob jec t ive theme where subjects responded i n a matter of f a c t manner; conceptions drew s i m i l a r p a r a l l e l s to the d e f i n i t i o n of mental i l l n e s s (Chapter I I I ) . Responses inc luded short statements such a s , "a person who has t roub le f u n c t i o n i n g ; degrees of i l l n e s s e s ; unable to cope with d a i l y r o u t i n e s ; ser ious emotional problem; mental or emotional d i s o r d e r ; i n s t a b i l i t y " . The major i ty of responses were ca tegor ized i n t o t h i s t e c h n i c a l / o b j e c t i v e theme. 2) an almost equal number of r e p l i e s were ca tegor ized in to an image theme; people have a sub jec t ive a s s o c i a t i o n to the term mental i l l n e s s , such as "my daughter, my brother ; aunt" . Other people i n t h i s category portrayed other images: "people wandering around; unhappy people; somebody t h a t ' s c l i n g i n g to the edge; someone c r a z y " . 3) a smal l number of responses e l i c i t e d a t t i t u d e s or f e e l i n g s : "shock; p i t y the people; f e e l bad f o r those people; f e e l sor ry . . . i t ' s t r a g i c when somebody's l i k e t h a t " . Three respondents r e p l i e d "don' t know" to t h i s q u e s t i o n . For the most p a r t , people do not have o v e r t l y r e p u l s i v e ideas about the mental ly i l l ; but popular s t e r e o t y p i c a l images s t i l l p e r s i s t . B e l i e f s and a t t i t u d e s toward the menta l ly i l l are not negat ive per se ; improvement i n t h i s area has been made as a r e s u l t of increased community awareness and educat ion programs. COMMUNITY SUPPORT GENERAL PUBLIC: The ma jor i ty of the sample popu la t ion , 76%, f e l t that educat ion i n mental hea l th could be improved, 12% f e l t i t could not be improved, and another 12% stated they d i d not know. A common theme of 'awareness' and ' a c c e s s i b i l i t y to in format ion and resources ' were the most predominant among those who were able to provide suggestions f o r improvement. Education through the school system was a t h i r d common theme: "what you are doing has got to be good . . . a l o t of people that needs he lp out there . . . personal approach i s b e t t e r , one - to -one . Personal v i s i t s to young people i n the classroom i s be t te r than pamphlets which people don ' t r e a l l y r e a d " . In terms of awareness, one respondent commented, "people should be made more aware of how common these problems are . . . many w i l l say ' i t ' s i n t e r e s t i n g but i t doesn ' t apply to me' . People are ashamed of mental i l l n e s s , i t ' s l i k e the plague. We're not prepared to face ourse lves . . . t h e r e ' s tremendous ignorance about mental i l l n e s s " . COMMUNITY SERVICE PERSONNEL: When asked i f t h e i r o rgan iza t ion would l i k e to have more informat ion and educat ion on mental hea l th and mental heal th problems, 81% responded ' y e s ' . Of these who responded i n the a f f i r m a t i v e , 83% of the schoo ls , 84% of the E A P ' s , 56% of the s o c i a l s e r v i c e / h e a l t h agencies and 100% of the community/neighborhood organ iza t ions a l l sa id ' y e s ' . I t i s l i k e l y that s o c i a l s e r v i c e and hea l th agencies are l e s s i n c l i n e d to want more informat ion i n mental hea l th i f they are a l ready p rov id ing same. While 57% of the agencies would p r e f e r to have more in format ion on the resources a v a i l a b l e fo r ass is tance and support , 17% responded equa l ly to the need f o r in format ion on the symptoms of mental i l l n e s s and informat ion on prevent ion i n mental i l l n e s s , 7% s a i d in format ion on how to become more understanding and accept ing toward the mental ly i l l i s most p r e f e r r a b l e , and 2% of the agencies pre fe r informat ion on the causes of mental i l l n e s s . The need f o r in format ion on the resources a v a i l a b l e i s cons is ten t with the f i n d i n g that 61% of the t o t a l respondents were not f a m i l i a r with any other mental h e a l t h educat iona l programs i n t h e i r community. Respondents were asked to s ta te the one most important mental hea l th s e r v i c e C.M.H.A. could provide f o r the community. Seven of the seventy respondents checked more than one response and were therefore excluded from the computer coded r e s u l t s . Of the remaining 61 responses, 53% s a i d i n f o r m a t i o n / educat ion , 41% s a i d development of community resources , 12% s a i d r e h a b i l i t a -t i o n and 5% sa id advocacy and lobbying government would be the most important mental hea l th s e r v i c e . The seven miss ing cases were ca tegor ized manually with in format ion /educat ion and development of community resources both l i s t e d 5 times and advocacy/ lobbying government l i s t e d 3 t imes. One respondent commented that " a l l the s e r v i c e s are important" and there fore d i d not choose any answers from the l i s t p rov ided . Of the agencies surveyed, 51% presen t l y do not provide any mental hea l th educat iona l programs or in format iona l m a t e r i a l . Of these agencies , 27% would be i n t e r e s t e d i n doing so i n the fu tu re , 21% would 'maybe' be i n t e r e s t e d and 3% would not be i n t e r e s t e d i n p rov id ing mental hea l th educat ion or in fo rmat ion . It i s f e l t that agency l i a i s o n and cooperat ion w i l l he lp to enhance e f f o r t s to provide mental hea l th educat iona l programs and resources . of the agencies surveyed, 21% would be i n t e r e s t e d i n working with C.M.H.A. to plan such programs and resources , 52% would 'perhaps' be in te res ted and 28% would not be i n t e r e s t e d . The above opinions and feedback from the general p u b l i c and community s e r v i c e personnel would i n d i c a t e that there i s general support and agreement to C . M . H . A . ' s endeavours i n the area of mental hea l th educat ion and in format iona l programs. However, whi le pass ive support i s u s e f u l and important , a s s e s s i n g and r e c r u i t i n g a c t i v e support can be e s p e c i a l l y b e n e f i c i a l . There i s p o t e n t i a l to incorporate t h i s r e c r u i t i n g st rategy i n future community surveys . V I . IMPLICATIONS OF CONSUMER DATA -INTRODUCTION A summary of survey r e s u l t s was presented i n the preceeding chapter . In essence the acquired data has provided a d d i t i o n a l i n s i g h t and understanding i n t o the opinions and percept ions of the consumer and p o t e n t i a l consumer of mental hea l th in format ion . But what f i n a l conclusions can be drawn from the da ta , and what i m p l i c a t i o n s do they have i n planning and developing marketing s t ra teg ies fo r e f f e c t i v e and responsive programs? Furthermore, what can the organ iza t ion do next i n the way of future research? This chapter w i l l address these proposed q u e s t i o n s . CONCLUSION #1: The name 'Canadian Mental Health A s s o c i a t i o n 1 generates a high l e v e l of p u b l i c awareness. While there i s strength assoc ia ted with the agency name, a major weakness i s the low p u b l i c f a m i l i a r i t y with the o r g a n i z a t i o n ' s a c t i v i t i e s . Furthermore, whatever f a m i l i a r i t y i s acknowledged tends to focus on the ' i l l n e s s ' aspect rather than o v e r a l l mental h e a l t h . IMPLICATIONS: People recognize the C.M.H.A. name and t h i s i s important f o r ga in ing the t r u s t of the consumer who w i l l then perce ive the A s s o c i a t i o n as prov id ing r e l i a b l e and c r e d i b l e in format ion . C.M.H.A. - B . C . D i v i s i o n has a l ready e s t a b l i s h e d an ob jec t ive of producing and d i s t r i b u t i n g a minimum of four press re leases per calendar year . Th is i s an e f f e c t i v e s t rategy f o r r a i s i n g the awareness and v i s i b i l i t y of the o rgan iza t ion whi le a l s o serv ing to educate the p u b l i c . It i s understandably d i f f i c u l t to concentrate on one s p e c i f i c focus given the broad mandate of C.M.H.A. As a marketing p r i n c i p l e however, i t i s necessary to focus one 's e f f o r t s to e s t a b l i s h st rong p u b l i c recogn i t ion i n one 's p roducts . Whatever image i s created w i l l determine which members i n the community w i l l perce ive themselves as l i k e l y consumers and subsequent supporters of the o r g a n i z a t i o n . I f C.M.H.A. i s l a r g e l y perce ived as a se rv ice f o r the menta l ly i l l , a s t ronger focus on p o s i t i v e mental hea l th and enhancing f u n c t i o n a l competence i s requi red to a t t r a c t the i n t e r e s t and consuming behavior o f normal groups i n the p o p u l a t i o n . CONCLUSION #2: Stress i s the most important mental hea l th issue to the general p u b l i c sample populat ion and community se rv ice pe rsonne l . In terms of p r i o r i t y , both groups a lso rate in format ion on the more ser ious d i s o r d e r s ( i . e . schizophrenia) as l e a s t important to them. Issues of a more personal and immediate concern are more re levant to the normal populat ion group than e x t r i n s i c and f u t u r e - o r i e n t e d i s s u e s . IMPLICATIONS: In seeking support ive p u b l i c behavior , a focus on what consumers perce ive as important to them i s an e s s e n t i a l s t r a t e g y . In order to e s t a b l i s h a r e l a t i o n -sh ip with s p e c i f i c target groups i t i s necessary to design compet i t i ve ly v i a b l e products i n response to that market. While an abundance of mate r ia l may a l ready e x i s t on the subject of s t r e s s , there i s some quest ion as to the a c c e s s i b i l i t y , a f f o r d a b i l i t y and awareness of these resources t h i s cou ld be an area to i n v e s t i g a t e fo r fu ture r e s e a r c h . At present , C.M.H.A. has not developed any informat ion or educat iona l programs on s t r e s s . As such, the o rgan iza t ion may want to explore s t r a t e g i e s f o r packaging and d isseminat ing informat ion on s t r e s s and s t r e s s management on a broad-sca le b a s i s . Walsh (1981) r e f e r s to marketing as of ten depending on ' o p p o r t u n i s t i c s e r e n d i p i t y ' or tak ing the opportuni ty to make the most of a given s i t u a t i o n . If , f o r example, s t r e s s and sex education are h igh i n t e r e s t t o p i c s and high p r o f i l e media i tems, i t would be rewarding to take advantage of the s i t u a t i o n e i t h e r by developing market products or at l e a s t producing a news re lease that e d i t o r s are sure to p u b l i s h because of the i n t e n s i t y of the subject at a given moment i n t ime. S t ra teg ies which are undertaken dur ing o p p o r t u n i s t i c moments can serve to educate the pub l i c whi le promoting the v i s i b i l i t y of the o rgan iza t ion but without the i n i t i a l e f f o r t of having to a t t r a c t the p u b l i c ' s a t ten t ion or i n t e r e s t . At present , developing in format ion /educat ion programs on s t r e s s and other t o p i c s that are more s a l i e n t to s i m i l a r p u b l i c groups (eg. depress ion , dea l ing with a personal c r i s i s ) can be used to e f f e c t i v e l y draw p o t e n t i a l consumers from the l a r g e r p o p u l a t i o n . CONCLUSION #3: The f i n d i n g s from t h i s research supports previous f i n d i n g s (Bentz & Edgerton, 1970; Dear e t . a l . , 1985; Rabkin, 1974) that p u b l i c b e l i e f s and a t t i t u d e toward the mental ly i l l have improved over time and are genera l ly p o s i t i v e . The e f f e c t of community awareness and education programs and increased exposure/proximity to the mental ly i l l are f a c t o r s c o n t r i b u t i n g to t h i s improvement. Never the less , c e r t a i n stereotyped images and myths about the u n p r e d i c t a b i l i t y and s p l i t p e r s o n a l i t i e s of the mental ly i l l continue to p e r s i s t probably as a r e s u l t of media i n f l u e n c e s . Furthermore, passive support of the mental ly i l l i s more evident than ac t ive support . .IMPLICATIONS: While broad-based educat ion campaigns are e f f e c t i v e i n educat ing the p u b l i c about the mental ly i l l (Davis, 1965), accord ing to the r e s u l t s of t h i s survey such informat ion i s not as s a l i e n t to the p u b l i c as other informat ion needs. D i rec t exposure to the p s y c h i a t r i c pa t ien t i n a ro le that can be perce ived as being w i th in normal l i m i t s represent ing 'normal behavior ' i s a s t ra tegy that w i l l increase community acceptence of the mental ly i l l and improve understanding of t h e i r b e h a v i o r s . D i rec t exposure, f o r example, would invo lve encouraging employers to h i r e more p s y c h i a t r i c pa t ien ts i n the workplace. I f , as ind ica ted i n t h i s study, people are w i l l i n g to help a mental ly i l l person f i n d work at t h e i r p lace of employment, the extent of a c t i v e support can be ascer ta ined through a survey of employers with fo l low-up contact with those who agree to h e l p . While such a s t ra tegy i s not as h igh key as a media-based campaign, i t i s more aggress ive . Media-based campaigns, i n s t e a d , can focus on issues which are more s a l i e n t to the broader p o p u l a t i o n . Because media continues to por t ray negat ive images of the mental ly i l l , i t i s important tha t , as an advocate f o r the mental ly i l l , C .M.H.A. be prepared to i ssue media re leases that aim to c o r r e c t mispercept ions or uninformed s t o r i e s reported through the media. A communications o f f i c e r or a p u b l i c i t y committee i n p lace can serve to promote the o rgan iza t ion and i t s a c t i v i t i e s at s t r a t e g i c moments when the opportuni ty a r i s e s . CONCLUSION #4: Mental hea l th s t i l l has negat ive connotat ions assoc ia ted to i t ; people are not c l e a r on what mental hea l th i s or what c o n s t i t u t e s post ive mental heal th p r a c t i c e . F u r t h e r -more, mental hea l th does not generate a great dea l of thought or personal concern: the major i ty of the general p u b l i c 'on ly o c c a s i o n a l l y ' or 'never ' th ink about t h e i r mental h e a l t h . Mean scores i n d i c a t e that community se rv ice groups are more i n t e r e s t e d consumers of mental hea l th informat ion than the general p u b l i c . As Walsh (1981:274) comments, "marketing ideas to our col leagues i s the easy p a r t . It i s apply ing the process to our cons t i tuen ts that the greater chal lenge l i e s " . The general p u b l i c populat ion f e e l s that mental hea l th informat ion i s important to them, but that i t i s not very or extremely important . The middle ground a t t i t u d e of the general p u b l i c might suggest a passive acceptance to any type of in format ion given our informat ion-based s o c i e t y . IMPLICATIONS: The term 'mental h e a l t h ' i s not used i n any frequent or cons is ten t b a s i s i n the var ious in format iona l mater ia l produced by C.M.H.A. (eg. the Coping s e r i e s ) By exposing the term on a more casual and regular b a s i s wi th in the context of the educat iona l messages, people w i l l become accustomed to a s s o c i a t i n g 'mental h e a l t h ' with aspects of everyday l i v i n g (eg. s t r e s s i n the workplace, paren t ing , coping with growing o l d e r ) . Rather than p e r c e i v i n g mental hea l th i n a negat ive manner, increased u t i l i z a t i o n of the term might generate a greater sense of understanding in to what mental hea l th i s and how i t i s incorporated i n t o one 's own personal l i f e . It i s u s e f u l to consider the p r i n c i p l e s of primary prevent ion and community mental hea l th p r a c t i c e when d e v i s i n g in format ion /educat ion programs. One such p r i n c i p l e invo lves the a c t i v e p a r t i c i p a t i o n and r e s p o n s i b i l i t y of i n d i v i d u a l s f o r the maintenance of t h e i r own w e l l - b e i n g . However, personal c o n t r o l and r e s p o n s i b i l i t y over one 's own mental hea l th cannot be encouraged i f people give only minimal c o n s i d e r a t i o n to t h e i r own mental hea l th and have inadequate knowledge about p o s i t i v e mental hea l th p r a c t i c e . In promoting mental hea l th in format ion , the goal i s not to e l i c i t pass ive acceptance but to t r i g g e r a c t i v e behav ior . Consequently, e f f e c t i v e marketing s t r a t e g i e s must consider arousing p u b l i c i n t e r e s t and mot ivat ion i n a d d i t i o n to informing and educat ing . In terest and mot ivat ion w i l l be determined by the degree of importance i n d i v i d u a l s a t tach to c e r t a i n hea l th mat ters . Greene and Simons-Morton (1984) i d e n t i f y two v a r i a b l e s personal c o n t r o l and hea l th importance as p rov id ing a general background of readiness or apathy toward hea l th educat ion . Taking these v a r i a b l e s i n t o c o n s i d e r a t i o n , they o f f e r the fo l low ing g u i d e l i n e s that can be app l ied to a wide v a r i e t y of s i t u a t i o n s i n hea l th educat ion: 1) Provide the learners with a r e a l i s t i c a p p r a i s a l of the r i s k s assoc ia ted with poor hea l th behavior 2) Help the learners develop a r e a l i s t i c view of t h e i r s u s c e p t i b i l i t y to the hea l th threat i n quest ion 3) Help the learners develop conf idence i n the e f f e c t i v e n e s s of the recommended hea l th p r a c t i c e 4) Help the l ea rners c o r r e c t any exaggerated views they may have of the r i s k s and d i f f i c u l t i e s the recommended behavior may invo lve 5) Provide frequent reminders of the need and opportuni ty f o r s p e c i f i c hea l th ac t ions 6) Encourage the learners to p lace high value on t h e i r hea l th 7) Help people recognize t h e i r own power to change t h e i r l i v e s . The above gu ide l ines provide p r a c t i c a l s t r a t e g i e s that can be appl ied to the planning and development of mass media mate r ia l or educat ional programs. Unless people are made aware that they are s u s c e p t i b l e to s p e c i f i c i l l n e s s e s or problems, they w i l l not perce ive such d i f f i c u l t i e s as important to them. Furthermore, un less they f e e l they are i n charge and can make th ings happen, they are genera l l y not motivated to take a c t i o n hence apathy r e s u l t s . These f a c t o r s should be considered when developing e f f e c t i v e market products that aim to motivate p o t e n t i a l consumers. CONCLUSION #5: While the major i ty of the general p u b l i c sample popula t ion p re fe r to rece ive mental hea l th informat ion through personal and informal methods, community serv ie groups pre fe r to provide such informat ion to t h e i r c l i e n t s through the d i s t r i b u t i o n of pamphlets and brochures. Percept ions p e r t a i n i n g to the best method of meeting informat ion needs appear to d i f f e r between these two groups. Community se rv ice personne l , however, b e l i e v e that i s i s equa l ly important f o r C.M.H.A. to engage i n both community development and p u b l i c educat ion . There i s consensus among both groups as w e l l that informat ion about a v a i l a b l e resources i s poor ly l a c k i n g . IMPLICATIONS: Pamphlets, by themselves, are not e f f e c t i v e educat ional t o o l s (Goldston, 1969) and community se rv ice groups should not p lace too much emphasis on wr i t ten mate r ia l a lone . The p u b l i c p re fe rs personal and informal contact as a method of l e a r n i n g and subsequent support . Media, such as a u d i o - v i s u a l m a t e r i a l s or pamphlets, can be used i n conjunct ion with e x t e r n a l , environmental support that r e i n f o r c e s a des i red behavior and provides incen t ives f o r change. S e l f - h e l p groups can be one kind of environmental support ; or a c t i v a t i n g fami ly support and encouragement can a l s o be e f f e c t i v e . U t i l i z i n g educat ion m a t e r i a l s , as Goldston (1969) suggests , does not automat ica l ly r e s u l t i n changes i n behavior , regard less of the a l l u r e of the media. By i n t e g r a t i n g mental hea l th educat iona l a c t i v i t i e s with media programs, the informat ion can be more meaningful to i n d i v i d u a l s and there fore lead to a c t i o n toward optimal mental h e a l t h . The f i n d i n g that fami ly and f r i e n d s are more important sources of s o c i a l and emotional support than are p r o f e s s i o n a l s i s substant ia ted by other research ( G o t t l i e b , 1983; Campbell & O ' N e i l l , 1985). E f f e c t i v e prevent ive s e r v i c e s should therefore e x h i b i t much more concern with s o c i a l networks and in formal h e l p - g i v i n g . Mul t i -media campaigns such as "Fr iends Can Be Good Medicine" (Tay lor , Lam, Roppel & B a r t e r , 1984) have been implemented to promote personal r e l a t i o n s h i p s a long with p h y s i c a l and mental h e a l t h . The p o s s i b i l i t y of des ign ing s i m i l a r hea l th campaigns that i s , encouraging the p u b l i c to consider the value of i n i t i a t i n g , mainta in ing and strengthening personal r e l a t i o n s h i p s can serve to be a v i a b l e and a t t r a c t i v e s t ra tegy to promoting mental hea l th and i n c r e a s i n g the v i s i b l i t y of C.M.H.A. to p o t e n t i a l consumers. The development of s e l f - h e l p groups, neighborhood-based he lp ing networks, and the use of vo lunteers can strenghten a community's a b i l i t y to meet the needs of i t s members i n a personal yet in formal manner. Community o r g a n i z a t i o n , i n t h i s respec t , i s a worthwhile endeavour fo r C.M.H.A. The b e n e f i t s of survey research can serve a dual purpose: a c q u i r i n g consumer data whi le a l s o e n l i s t i n g the support of vo lunteers who would be i n t e r e s t e d i n a s s i s t i n g C.M.H.A. wi th program planning and community development. Further a t ten t ion i s requ i red i n an attempt to promote be t te r knowledge of e x i s t i n g resources . While a d v e r t i s i n g p r o f e s s i o n a l and/or n o n - p r o f i t mental health services i s considered neither acceptable nor e t h i c a l , there needs to be some mechanism implemented to improve t h i s long-standing problem. One suggestion might be to enhance the v i s i b i l i t y of a c e n t r a l r e f e r r a l agency so that people at l e a s t know where to s t a r t looking f o r help. Pamphlets and handbooks on a v a i l a b l e resources already e x i s t so i t i s a matter of acquiring the adequate funding that w i l l help further promote the awareness and a c c e s s i b i l i t y of such material to the broader population. CONCLUSION #6: Telephone suscribers were chosen as the target population f o r t h i s study because i t was believed that t h i s group was t y p i c a l of a broader reference population the general p u b l i c . However, each study population has i t s own d i s t i n c t i v e features. The representativeness of telephone suscribers f o r t h i s study was biased toward the young, employed and well-educated group i n the population. Responses from community service personnel were biased toward the EAP group, although a breakdown of agency responses were able to d i s t i n g u i s h d i f f e r e n c e s among the four agency types. Some agencies place more importance on mental health information than others. The c h a r a c t e r i s t i c s of s p e c i f i c groups play a determining f a c t o r as to who are more l i k e l y to be i n t e r e s t e d consumers and supporters of s p e c i f i c mental health issues. IMPLICATIONS: The general public i s not an i d e n t i f i a b l e group with an i d e n t i f i a b l e need. In i t s broadest sense, the general public i s made up of people who follow a wide v a r i e t y of c u l t u r a l l y - b a s e d l i f e s t y l e s . In marketing p r i n c i p l e s , as i n survey sampling, i t i s e s s e n t i a l that the general public, or subpopulations to be served, be c l e a r l y defined. One agency cannot o f f e r a l l community mental health needs equally well to a l l c l i e n t s , just as a s i n g l e research project cannot expect to survey the whole population equally w e l l . Programs must r e f l e c t the d i f f e r e n c e s between community agenc ies , ta rget populat ions and needs. While t h i s study was able to descr ibe the c h a r a c t e r i s t i c s and needs of two survey groups, i t i s s t i l l necessary to i d e n t i f y 'who' C .M.H.A. wants to e s t a b l i s h as the ta rget of t h e i r educat ional e f f o r t s . D i f f e r e n t target markets needs d i f f e r e n t s e r v i c e s that must then be promoted through d i f f e r e n t media (Walsh, 1981). I f , f o r example, the ta rget market of C .M.H.A . i s E A P ' s , then target products w i l l d i f f e r from target products fo r community/ neighborhood organ iza t ions or of telephone s u s c r i b e r s . It i s important that the A s s o c i a t i o n focus on 'whose' i n t e r e s t , p a r t i c i p a t i o n and support i s wanted. The const i tuency of C.M.H.A. i n r e a l i t y i s everyone because mental hea l th should be everyone's concern . Never the less , due to other r e a l i t i e s such as funding c o n s t r a i n t s , manpower l i m i t a t i o n s , the need to focus p r i o r i t i e s and to develop v i a b l e programs f o r those who r e a l l y need i t — - i t i s necessary to i d e n t i f y at l e a s t key groups i n the popula t ion who w i l l use and b e n e f i t the most from the programs and s e r v i c e s provided by the A s s o c i a t i o n . Whose needs are you t r y i n g to s a t i s f y ? What i s the o b j e c t i v e of your e f f o r t s ? W.G. A l b e r t (1981: 184) provides an o u t l i n e of e s t a b l i s h e d p r i n c i p l e s which cannot be ignored i n any attempt at p u b l i c educat ion, of whatever s c a l e : 1) Exposure to the message or messages must be assured through c a r e f u l c o n s i d e r a t i o n of audience / target group c h a r a c t e r i s t i c s 2) A t ten t ion to the message must be assured through the use of appropr ia te media, communicators and message content 3) Acceptance of a message i s aided by: a) c r e d i b l e sources b) concise and simple content c) mot iva t ion , a rousa l and e n t e r t a i n -ment value d) r e p e t i t i o n , and e) s o c i a l / i n t e r p e r s o n a l support 4) The p r o b a b i l i t y of behavior change i s enhanced by message s t r a t e g i e s that provide e x p l i c i t i n s t r u c t i o n s f o r change 5) The p r o b a b i l i t y that behavior change w i l l be l a s t i n g i s improved when a s o c i a l l y support ive environment r e i n f o r c e s the change. The above set of conc lus ions and i m p l i c a t i o n s are not meant to be hard and f a s t r u l e s , nor are they meant to be simple so lu t ions to a s e r i e s of complex problems. Instead, they are suggest ions that w i l l serve to fu r ther enhance the incremental decis ion-making process f o r the research consumer. L i m i t a t i o n s of t h i s study as mentioned i n previous par ts of t h i s paper must again be r e - i t e r a t e d so that conc lus ions and g e n e r a l i z a t i o n s are taken with c a u t i o n . I t i s acknowledged tha t , whatever suggest ions and recommendations o f f e r e d here w i l l c o n s t i t u t e only a minor par t of the o v e r a l l p lanning p r o c e s s . Whatever d e c i s i o n s and f i n a l programs are implemented w i l l l a r g e l y be i n f l u e n c e d by other f a c t o r s : the a v a i l a b i l i t y of manpower and other resources , the ex is tence of other programs, the p r i o r i t i e s of the o r g a n i z a t i o n , and the values and preferences of dec is ion-makers . RECOMMENDATIONS FOR FUTURE RESEARCH Chapter V contained a summary presenta t ion of consumer opin ions and percept ions on var ious mental hea l th i s s u e s . This was fo l lowed, i n the preceeding s e c t i o n , by conc lus ions about the marketplace and i m p l i c a t i o n s f o r market s t r a t e g i e s and program p lann ing . F i n a l l y , i n keeping with the ob jec t ives of t h i s study, a l i s t of recommendations i s o f f e r e d which C.M.H.A. might f i n d u s e f u l f o r fu ture research p r o j e c t s . The adequacy of the research instruments was s u f f i c i e n t fo r the purposes of t h i s study but , as i n any research , there i s always room f o r improvement. For example: Some community se rv ice personnel f a i l e d to abide by the i n s t r u c t i o n s on the quest ionnai re and responded with more than one check mark i n the open b l a n k s . Question format should have asked respondents to i n d i c a t e t h e i r s e l e c t i o n by p l a c i n g a-.number i n a box corresponding to each a l t e r n a t i v e to fo rce respondents to give a s i n g l e response. Due to an o v e r - r i d i n g concern f o r c o n f i d e n t i a l i t y , community s e r v i c e personnel were not requested to put t h e i r name on the completed q u e s t i o n n a i r e . Th is r e s u l t e d i n some problems l o c a t i n g those respondents who r e p l i e d they would be i n t e r e s t e d i n working with C.M.H.A. While names and telephone numbers were matched between the sampling l i s t and returned responses i n d i c a t i n g t h e i r agency name, there was no guarantee that quest ionna i res were a c t u a l l y completed by those i n d i v i d u a l s to whom q u e s t i o n -na i res were mailed on the sampling l i s t . Future quest ionna i res should request the name and telephone number of respondents who acknowledge a w i l l i n g n e s s to h e l p . Question #13 on the general p u b l i c quest ionnai re asks respondents i f they f e e l mental hea l th educat ion cou ld be improved. Th is i s a l ead ing quest ion because, as one respondents commented, "anything can be improved" and should be re-worded to avoid b i a s i n g the r e s u l t s . Question #12 asks respondents where they would go to get in format ion on i f they needed i t . The blank was f i l l e d i n with whatever mental hea l th i s s u e each respondent rated as most important i n the preceeding s c a l e q u e s t i o n . The problem, however, was that respondents ra ted severa l i ssues e q u a l l y , and the in terv iewer had to randomly p ick and choose which mental hea l th i ssue to p lace i n the b lank . For a more cons is ten t and r e l i a b l e measure, the blank should be rep laced with a s e r i e s of two or three p r e -determined mental hea l th t o p i c s so that a l l respondents would be asked to respond to the same s e t of q u e s t i o n s . Measuring the a t t i t u d e s and community acceptance of the menta l ly i l l could we l l be developed i n t o a separate and more comprehensive survey i n i t s e l f . Such s t u d i e s , however, have been ex tens ive ly conducted. What i s l a c k i n g i s informat ion from the mental ly i l l themselves what are t h e i r experiences and percept ions based on t h e i r treatment from community members? What observat ions can more p a r t i c i p a t o r y research uncover i n communities that are p lanning hal f -way houses? A l te rna te research methods can serve to counter-check responses from the t r a d i t i o n a l approach which tends to be in f luenced by s o c i a l d e s i r a b i l i t y b i a s . An o v e r a l l r e v i s i o n of the survey instruments w i l l be determined by what decis ion-makers f e e l i s important , g iven the f ind ings from t h i s study, f o r future r e s e a r c h . This p i l o t study has i n i t i a t e d more quest ions than answers and future research quest ions may want to consider the f o l l o w i n g : Is there s u f f i c i e n t and adequate mater ia l on s t r e s s ? Consumers f e e l i t i s important to have such in format ion , but i s more needed? What resources are a l ready a v a i l a b l e to the p u b l i c ? Is C.M.H.A. w i l l i n g to address the more s a l i e n t t o p i c s of s t r e s s , s e l f - c o n f i d e n c e and d r u g / a l c o h o l a d d i c t i o n ? What are the p r i o r i t i e s of the organ iza t ion? What f a c t o r s w i l l motivate people to take more r e s p o n s i b i l i t y f o r t h e i r mental hea l th? How can programs be implemented to a c t i v a t e t h e i r i n t e r e s t ? How can C.M.H.A. work more coopera t i ve ly with community agencies i n p rov id ing mental hea l th in format ion to t h e i r c l i e n t s ? What community development programs can be developed to best meet the needs of s p e c i f i c ta rget groups? These are but a few quest ions that t h i s study has prompted and future research w i l l l i k e l y lead to more. To continue asking quest ions and to p e r s i s t e n t l y seek f o r t h e i r so lu t ions provides v i t a l i t y and innovat ion to programs i n response to changing needs. In cons ider ing future research methodology, the fo l low ing suggestions are prov ided: The 46% response rate from telephone interv iews would suggest that telephone surveys i s a reasonable and economical method of c o l l e c t i n g consumer da ta . This method a lso serves to educate the p u b l i c and create more v i s i b i l i t y fo r the o rgan iza t ion on a personal b a s i s . Care fu l c o n s i d e r a t i o n , however, should be given to adequate t r a i n i n g of in terv iewers i n a large sca le survey . The v a l i d i t y and r e l i a b i l i t y of survey r e s u l t s can be jeopardized with i n c o n s i s t e n t in terv iewer behavior and b i a s . There are c e r t a i n l i m i t a t i o n s i n surveying telephone s u s c r i b e r s through telephone in te rv iews . While computer-generated random d i g i t d i a l i n g w i l l inc lude non -suscr ibe rs and the more mobile groups i n the popu la t ion , there i s s t i l l the problem of over looking the lower income and non-Eng l ish speaking groups. Incorporat ing other data c o l l e c t i o n methods, such as group administered quest ionna i res to p r e - s e l e c t e d groups, can ensure an adequate c r o s s - s e c t i o n of a broader populat ion base . In surveying community se rv ice groups, ma i l -ou t quest ionna i res i s both convenient and t i m e - e f f i c i e n t . However, depending upon the numbers and the geographic d i s p e r s i o n of these groups to be surveyed, one-to-one in terv iews can be b e n e f i c i a l i n drawing tang ib le community support e s p e c i a l l y where C.M.H.A. branches are jus t i n the developing s tages . Where large numbers are surveyed and only minimal informat ion i s needed, p o s t - c a r d quest ionnaires ' -have been known to produce a good response rate (Abramson, 1984). C.M.H.A. - B . C . D i v i s i o n i s in te res ted i n conduct ing a la rge ' sca le survey that would be representa t ive of a l l parts of the province of B r i t i s h Columbia. There i s no i d e a l method or magical number to ensure p e r f e c t represen ta t ion . To s t r a t i f y a sample by c i t y s i z e ( large urban cent re , small urban cent re , r u r a l centre) and by region (east, c e n t r a l , west, north) i s one method of a c q u i r i n g a geographic representat ion of communities across the p rov ince . Within each popula t ion stratum, choosing at l e a s t one centre with a C.M.H.A. branch o f f i c e w i l l provide a mix of samples with and without C.M.H.A. branches. According to a s i m i l a r study (Dear e t . a t . 1985), a sample s i z e of 100 responses f o r large urban cen t res , 75 responses f o r small urban cen t res , and 50 responses f o r the r u r a l centres would provide f o r a reasonable populat ion s i z e . While i t i s r i s k y to provide a number of 'how many people should be surveyed' f o r such a large sca le study, a b a l l - p a r k f i g u r e of approximately 1,000 (based on the Dear e t . a l . study, 1985) i s suggested. This estimated number, however, w i l l be determined by the purpose of the research , data c o l l e c t i o n methods, and a v a i l a b l e manpower and resources . It i s impossible to obta in an i d e a l sample, and l i m i t a t i o n s of the study should be acknowledged p r i o r to making any conc lus ions or g e n e r a l i z a t i o n s . E s t a b l i s h i n g a working research committee at the d i v i s o n l e v e l i s recommended to provide the necessary manpower to plan and conduct on-going r e s e a r c h . A committee s t ruc tu re would a l s o provide the needed support and guidance fo r branch l e v e l surveys . Committee members should inc lude re levant dec is ion-makers , in format ion u s e r s , and research consul tants to provide the necessary t e c h n i c a l e x p e r t i s e . In order to ga in the f u l l cooperat ion and p a r t i c i p a t i o n of a l l branches i n a p r o v i n c i a l survey, the research committee should consider the involvement of var ious branch personnel at d i f f e r e n t stages of the p lanning p r o c e s s . Ear ly and p e r i o d i c involvement i n the research process w i l l enhance one 's sense of belonging and commitment to the p r o j e c t . It w i l l fu r ther serve to educate the i n d i v i d u a l s i n survey research and encourage branch personnel to u t i l i z e survey r e s u l t s on a l o c a l b a s i s . It i s f e l t that any recommendations fo r more concrete suggest ions f o r future research would be premature at t h i s point i n t ime. Once a research committee i s e s t a b l i s h e d , i t i s hoped that the data and experiences from t h i s study w i l l be used to generate on-going d i r e c t i o n . The next time 'round can only get b e t t e r . AIMING IN THE RIGHT DIRECTION By l e a r n i n g something about i t s marketplace that i s , about consumers and p o t e n t i a l consumers C.M.H.A. i s i n a be t te r p o s i t i o n to formulate more e f f i c i e n t s t r a t e g i e s in promoting i t s image and i t s products . The o rgan iza t ion i s headed in the r i g h t d i r e c t i o n i n p lanning mental hea l th educat ional programs. For the most p a r t , the informat ion generated by t h i s research has a c c u r a t e l y achieved what the u t i l i z a t i o n - f o c u s e d research model (Patton, 1978) would con f i rm: that eva luat ion research g ives a d d i t i o n a l knowledge to support f a c t s a l ready known, broadening the scope and v e r i f y i n g s u s p i c i o n s . The Depression Program, " L i s t e n to Me", i s one example which i n d i c a t e s C.M.H.A. - B . C . D i v i s i o n i s accura te ly responding to consumer needs. Depression was one top ic which both survey groups in t h i s study ra ted as one of the most important. The s t ra tegy taken to incorporate a u d i o - v i s u a l mater ia l with classroom teaching serves to enhance the learn ing p r o c e s s . Furthermore, the emphasis on ' f r i e n d s h i p suppor t 1 i s an approach that would appeal to l e a r n e r s . The Mental F i tness campaign i s another program which would i n d i c a t e C .M.H.A . -B . C . D i v i s i o n i s cognizant of the needs and i n t e r e s t s of p o t e n t i a l consumers. In e n l i s t i n g the support of consumers from a broader popula t ion base, the o rgan iza t ion i s appeal ing to t h e i r needs by promoting mental hea l th and enhancing f u n c t i o n a l competence. The mass media campaign can s u c c e s s f u l l y educate the p u b l i c and increase t h e i r awareness about C .M.H.A. as 'mental h e a l t h ' focussed . P r o f e s s i o n a l s and other c a r e - g i v e r s , too , lack adequate in format ion and they are of ten neglected consumers of any community-based programs. By showing a s e n s i t i v i t y to t h e i r needs, C .M.H.A. i s e f f e c t i v e l y e n l i s t i n g t h e i r support to provide be t te r programs and s e r v i c e s to t h e i r c l i e n t s . Primary prevent ion and mental hea l th promotion are l i k e l y to become even more s a l i e n t t o p i c s once the p u b l i c becomes f u l l y aware of what mental hea l th i s , that they do have personal c o n t r o l over t h e i r mental h e a l t h , and that i t i s important to maintain t h e i r mental w e l l - b e i n g . C r i t i c s of primary prevent ion , however, have contended that the lack of demonstrated e f f e c t i v e n e s s of prevent ive e f f o r t s can only mean that they are merely shots i n the dark (Lamb & Zusman, 1979),:.and such c r i t i c i s m have severe ly in f luenced funding f o r prevent ive educat ional programs. Consequently, C.M.H.A. should place equal emphasis on eva luat ing the e f f e c t i v e n e s s of t h e i r educat ional e f f o r t s i t i s e s s e n t i a l that empi r i ca l support be documented to fu r ther enhance the c r e d i b i l i t y of o v e r a l l prevent ive programs. It i s evident from t h i s study that people are not as in te res ted i n l e a r n i n g about the more ser ious mental d i s o r d e r s . The a t t i t u d e s and community acceptance of the mental ly i l l are g e n e r a l l y p o s i t i v e but there i s s t i l l room f o r improvement. While C.M.H.A. attempts to focus on p o s i t i v e mental hea l th and appeal to consumers perce ived to be normal groups i n the p o p u l a t i o n , the needs of the mental ly i l l cannot be over looked. More low-key yet aggress ive s t r a t e g i e s can be used to educate the .publ ic about the mental ly i l l (give them what they need to know), while h igh-key educat iona l campaigns can be used to promote mental hea l th (give them what they want to know). A d e l i c a t e balance of both can be achieved through s t r a t e g i c a l p lanning and management. IT 'S A BEGINNING . . . This p i l o t study has served as an i n i t i a l s t a r t i n g point f o r a s e r i e s of other research which C.M.H.A. - B . C . D i v i s i o n hopes to eventua l ly undertake. The o rgan iza t ion i s to be commended f o r i t s endeavours to c o l l e c t consumer data f o r incorpora t ion as part of i t s in format ion bank fo r program p l a n n i n g . It represents a s e n s i t i v i t y to the needs and percept ions of the consumers and an e f f o r t to e s t a b l i s h a cont inu ing d ia logue between the rece ive rs and prov iders of s e r v i c e . Such an endeavour a l s o serves to enhance the accounta-b i l i t y and c r e d i b i l i t y of the o r g a n i z a t i o n i n the eyes of present and p o t e n t i a l suppor ters . I t i s evident from t h i s study tha t , desp i te the gaps and p i t f a l l s , survey research can produce worthwhile informat ion nothing e a r t h - s h a t t e r i n g , but u s e f u l nonethe less . 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SOCIAL R & D : RESEARCH & DEVELOPMENT IN THE HUMAN SERVICES. Englewood C l i f f s , N . J . : P r e n t i c e - H a l l , Inc. 1980. Royse, David & Kenneth Drude. "MENTAL HEALTH NEEDS ASSESSMENT: BEWARE OF FALSE PROMISES" i n COMMUNITY MENTAL HEALTH JOURNAL. V o l . 18(2), Summer 1982. 97-106. Rubin, Herbert & Irene Rubin. COMMUNITY ORGANIZING & DEVELOPMENT. Columbus, Ohio: M e r r i l Pub l i sh ing Co. 1986. Rubr ight , Robert & Dan MacDonald. MARKETING HEALTH & HUMAN SERVICES. R o c k v i l l e , Maryland: Aspen Systems Corp. 1981. Sauber, R ichard . PREVENTIVE EDUCATIONAL INTERVENTION FOR MENTAL HEALTH. Cambridge, Mass . : B a l l i n g e r P u b l i s h i n g C o . . 1973. • S e l l t i z , C l a i r e & L. Wrightsman, S. Cook. RESEARCH METHODS IN SOCIAL RELATIONS, 3rd E d i t i o n . U . S . A . : Ho l t ,R inehar t & Winston. 1976. S t e f l , Mary E. "TELEPHONE SURVEYS OF MENTAL HEALTH NEED AND THE UNLISTED SUSCRIBER" i n COMMUNITY MENTAL HEALTH JOURNAL. V o l . 20, No. 2, Summer 1984. 146-154. Stewart, R ichard . "THE NATURE OF NEEDS ASSESSMENT IN COMMUNITY MENTAL HEALTH" i n COMMUNITY MENTAL HEALTH JOURNAL. V o l . 15(4) 1979. 287-295. Tash, Wi l l i am & G. S t a h l e r . "ENHANCING THE UTILIZATION OF FINDINGS" i n COMMUNITY MENTAL HEALTH JOURNAL. V o l . 18(3) F a l l 1982. 180-189. T a y l o r , Robert & D . J . Lam, C . E . Rappel & J . T . Bar te r . "FRIENDS CAN BE GOOD MEDICINE: AN EXCURSION INTO MENTAL HEALTH PROMOTION" i n COMMUNITY MENTAL HEALTH JOURNAL. V o l . 20, No. 4 Winter 1984. 294-303. Thackeray, Mi l ton G. & R.A. Skidmore, W. F a r l e y . INTRODUCTION TO MENTAL HEALTH - FIELD & PRACTICE. Englewood C l i f f s , N . J . : P r e n t i c e - H a l l , Inc . 1979. Tones, B.K. "THE USE & ABUSE OF MASS MEDIA IN HEALTH PROMOTION" i n D.A. Leather , G . B . Hastings & J . K . Davies HEALTH EDUCATION AND THE MEDIA. Oxford, England: Pergamon Press L t d . 1981. T ru te , B. & A. Loewen. "PUBLIC ATTITUDES TOWARD THE MENTALLY ILL AS A FUNCTION OF PRIOR PERSONAL EXPERIENCE" i n SOCIAL PSYCHOLOGY. V o l . 13, 1978. Walsh, Joseph A. "TO MARKET, TO MARKET, TO SELL SOMETHING BIG" i n ADMINISTRATION IN MENTAL HEALTH. V o l . 8, No. 4, Summer 1981. 269-274. Warheit , George J . & R. B e l l , J . Schwab. "SELECTING THE NEEDS ASSESSMENT APPROACH" i n F. Cox, J . E r l i c h , J . Rothman & J . Tropman TACTICS AND TECHNIQUES OF COMMUNITY PRACTICE, 2nd e d i t i o n . I t a s c a , I l l i n o i s : F . E . Peacock P u b l i s h e r s , 1984. Warwick, Donald P. & C A . L i n i n g e r . THE SAMPLE SURVEY: THEORY & PRACTICE. U . S . A . : McGraw-Hil l Co. 1975. Weiss, Caro l H. EVALUATION RESEARCH: METHODS OF ASSESING PROGRAM EFFECTIVENESS. Englewood C l i f f s , N . J . : P r e n t i c e - H a l l , Inc. 1972. Windle C.& Pascha l l N. "CLIENT PARTICIPATION IN COMMUNITY MENTAL HEALTH CENTRE: INCREASING INCIDENCE, INADEQUATE INVOLVEMENT" i n COMMUNITY MENTAL HEALTH JOURNAL, V o l . 17, No. 1, Spr ing 1981. '66-76. Winston, Wi l l iam J . (ed.) HEALTH MARKETING QUARTERLY: MARKETING FOR MENTAL HEALTH SERVICES. V o l . 1, N o . 2 / 3 . Winter 1983/Spring 1984. Witken, B e l l e Ruth. ASSESSING NEEDS IN EDUCATIONAL & SOCIAL PROGRAMS. San F r a n s i s c o : Jossey-Bass P u b l i s h e r s . 1984. 127. 12 Summary of methodology and procedures. T h i s s t u d y i s a n a t u r a l i s t i c r e s e a r c h which i n v o l v e s i n v e s t i g a t i n g and a c q u i r i n g i n f o r m a t i o n w i t h o u t any form o f m a n i p u l a t i o n . T h i s r e s e a r c h w i l l b a s i c a l l y werve t o p r o v i d e f o r a d e s c r i p t i v e measurement f u n c t i o n t o knowledge b u i l d i n g . The s t u d y i s based on a community o r i e n t e d needs assessment model. U t i l i z i n g t h i s model, i n f o r m a t i o n i s c o l l e c t e d from 1) key i n f o r m a n t s and 2) g e n e r a l p u b l i c . Data w i l l be c o l l e c t e d from key i n f o r m a n t s and g e n e r a l p o p u l a t i o n through s t a n d a r d i z e d q u e s t i o n n a i r e w i t h a s e t o f s p e c i f i c c l o s e d - e n d e d q u e s t i o n s and a number o f open-ended q u e s t i o n s . Q u e s t i o n n a i r e s f o r key i n f o r m a n t s w i l l s l i g h t l y d i f f e r from q u e s t i o n s f o r g e n e r a l p o p u l a t i o n . The r e s e a r c h t o o l w i l l l a r g e l y p r o v i d e f o r q u a n t i t a t i v e measures t h r o u g h r a t i n g s c a l e s and f r e q u e n c y c o u n t s . While, d a t a a n a l y s i s w i l l p r i m a r i l y c o n c e r n i t s e l f w i t h s t a t i s t i c a l i n f e r e n c e s , some q u a l i t a t i v e d e s c r i p t i o n w i l l a l s o be i n c l u d e d . Data w i l l be c o l l e c t e d q u i c k l y and e a s i l y through, t e l e p h o n e i n t e r v i e w s w i t h the g e n e r a l p o p u l a t i o n . T h i s method o f da t a c o l l e c t i o n w i l l be used as i t i s c o s t - e f f e c t i v e and i t i s r e l a t i v e l y easy t o draw a l a r g e , g e o g r a p h i c a l l y d i s p e r s e d p o p u l a t i o n both o f whi c h meet the r e q u i r e m e n t s o f t h e Canadian Mental H e a l t h A s s o c i a t i o n . An i n i t i a l c o n t a c t l e t t e r w i l l be s e n t t o i n d i v i d u a l s chosen t o p a r t i c i p a t e i n the s u r v e y . Key i n f o r m a n t s w i l l be su r v e y e d w i t h m a i l - o u t q u e s t i o n n a i r e s . A f o l l o w -up t e l e p h o n e c a l l w i l l be made t o thos e r e s p o n d e n t s who do not r e p l y by a g i v e n d a t a , w i t h t he p o s s i b i l i t y o f i n t e r v i e w i n g them o v e r the phone i f p e r m i s s i o n i s g i v e n . A stamped, s e l f - a d d r e s s e d e n v e l o p e w i l l be i n c l u d e d i n the m a i l - o u t q u e s t i o n n a i r e f o r t h e i r c o n v e n i e n c e . DESCRIPTION OF POPULATION 13 How many subjects w i l l be used? • 100 key i n f o r m a n t s and 100 g e n e r a l p u b l i c How many m the control group? 14 Who is being recruited and what are the c r i t e r i a for the i r selection? V a r i o u s d o c t o r s , c l e r g y , s o c i a l s e r v i c e w o r k e r s , and o t h e r p e r s o n n e l i n the human s e r v i c e p r o f e s s i o n w i l l be chosen as key i n f o r m a n t s . The c r i t e r i a i s t h a t they w i l l be i n v o l v e d i n d i r e c t c a r e - g i v i n g r o l e s . The g e n e r a l p u b l i c w i l l be chosen from t h e Vancouver Telephone D i r e c t o r y , 128; 15 What subjects w i l l be excluded from par t i c i p a t i o n ? S u b j e c t s o u t s i d e t he Vancouver C i t y a r e a w i l l n o t be i n c l u d e d i n the s t u d y . 16 How are the subjects being recruited? (If I n i t i a l contact Is by l e t t e r or If a recruitment notice is to be posted, attach a copy.) NOTE that UBC policy absolutely prohibits i n i t i a l contact by telephone. The g e n e r a l p o p u l a t i o n w i l l be r e c r u i t e d from the Vancouver C i t y T elephone D i r e c t o r y on a s y s t e m a t i c random b a s i s c h o o s i n g e v e r y nth name on a l t e r n a t i n g columns from the D i r e c t o r y . The g e n e r a l p u b l i c w i l l be c o n t a c t e d by l e t t e r a p p r o x i m a t e l y one week p r i o r t o the t e l e p h o n e i n t e r v i e w s . 17 If a control group Is involved, and If their s e l e c t i o n and/or recruitment d i f f e r s from the above, provide detaiIs. n/a PROJECT DETAILS 18 Where w i l l the project be conducted? (room or area) From the C.M.H.A. o f f i c e and i n my own home. 19 Who w i l l a c t u a l l y conduct the study? The s t u d e n t . 20 Will the group of subjects have any problems giving Informed consent on their own behalf? Consider physical or mental condition, age, language, or other b a r r i e r s . P o s s i b l e language b a r r i e r from the g e n e r a l p u b l i c p o p u l a t i o n , depending on the l i k e l i h o o d o f c h o o s i n g an e t h n i c f a m i l y where no a d u l t member speaks E n g l i s h . 21 If the subjects are not competent to give f u l l y informed consent, who w i l l consent on their behalf? n/a 22 What is known about the r i s k s and benefits of the proposed research? Do you have additional opinions on t h i s 1ssue? T h i s proposed r e s e a r c h w i l l b e n e f i t C.M.H.A. by p r o v i d i n g community i n - p u t f o r program p l a n n i n g and g o a l s e t t i n g . a c c o r d i n g t o the needs and p e r c e p t i o n s o f p o t e n t i a l consumers. A t the same t i m e , i t w i l l p r o v i d e f o r a p r o c e s s o f c r e a t i n g a p u b l i c awareness on mental h e a l t h i s s u e s t h r o u g h the s u r v e y c o n t a c t . 129. 23iWhat discomfort or incapacity are the subjects l i k e l y to endure as a result of the experimental procedures? Respondents may not w i s h t o c o o p e r a t e w i t h the i n t e r v i e w upon t e l e p h o n e c o n t a c t . I f p e r m i s s i o n i s not g i v e n t o pr o c e e e d , t h e ' i n t e r v i e w w i l l be t e r m i n a t e d . 24 If monetary compensation is to be offered the subjects, provide d e t a i l s of amounts and payment schedu1es. n/a 25 How much time w i l l a subject have to dedicate to the project? The t e l e p h o n e i n t e r v i e w w i l l t a k e a p p r o x i m a t e l y 10 m i n u t e s t o c o m p l e t e . 26 How much time w i l l a member of the control group (If any) have to dedicate to the project? n/a DATA 27 Who w i l l have access to the data? The s t u d e n t r e s e a r c h e r , t h e f a c u l t y a d v i s o r , and the CMHA s u r v e y a d v i s o r y committee w i l l have a c c e s s t o the d a t a . 28 How w i l l c o n f i d e n t i a l i t y of the data be maintained? Names o f re s p o n d e n t s w i l l not be i n c l u d e d i n the f i n a l r e s e a r c h r e p o r t and res p o n d e n t s w i l l n ot be i d e n t i f i e d on th e completed q u e s t i o n n a i r e . f o r m 29 What are the plans for future use of the data (beyond that described in t h i s protocol)? How and when w i l l the data be destroyed? Data c o l l e c t e d w i l l be shredded and d i s p o s e d o f t h r e e months a f t e r t h e r e s e a r c h r e p o r t i s c o m p l e t e d . 30 Will any data which i d e n t i f i e s individuals be available to persons or agencies outside the University? n/a APPENDIX 2: AGENCY CONSENT LETTER 130. B R I T I S H C O L U M B I A D I V I S I O N 692 EAST 26th AVENUE VANCOUVER. B.C. V5V 2H7 TELEPHONE: (604) 873-1633 January 2 3, 19 87 Behavioral Sciences Screening Committee The Un i v e r s i t y of B r i t i s h Columbia Vancouver, B.C. Dear S c r e e n i n g Committee Members, .Re: Request f o r E t h i c a l Review T h i s l e t t e r i s to c o n f i r m t h a t Jo/Anne Toh has been g i v e n agency consent to conduct r e s e a r c h f o r the Canadian M e n t a l H e a l t h A s s o c i a -t i o n , B.C. D i v i s i o n . The s u r v e y r e s e a r c h w i l l c o n s i s t o f telephone i n t e r v i e w s t o randomly chosen respondents from the Metro Vancouver Telephone D i r e c t o r y . JoAnne i s p r o v i d e d w i t h on-going s u p e r v i s i o n and c o n s u l t a t i o n from our ad-hoc Survey A d v i s o r y Committee. Yours v e r y t r u l y , Chloe Lapp E x e c u t i v e D i r e c t o r CL/hb APPENDIX 4: LETTER OF INTRODUCTION TO GENERAL PUBLIC 132. 692 EAST 26th AVENUE VANCOUVER, B.C. V5V 2H7 TELEPHONE: (604) 873-1633 B R I T I S H C O L U M B I A D I V I S I O N CANADIAN MENTAL HEALTH ASSOCIATION •s a regste<M cnvuCM oigvwaiion tupoorted by voluntary contrOuiem Your name has been randomly chosen from the Metro Vancouver Telephone D i rec tory to p a r t i c i p a t e i n a telephone survey conducted by the Canadian Mental Health A s s o c i a t i o n , B . C . D i v i s i o n . This l e t t e r i s to exp la in the purpose of the research to you. We would simply l i k e to get your opinions i n a v a r i e t y of areas re la ted to mental h e a l t h . Your opin ions w i l l he lp the Canadian Mental Health A s s o c i a t i o n with planning i t s programs for the b e n e f i t of the community at l a r g e . Your i d e n t i t y w i l l be kept s t r i c t l y c o n f i d e n t i a l , therefore a l l informat ion w i l l remain anonymous. The telephone interv iew w i l l take approximately 10 minutes. You w i l l be contacted wi th in the next week. If you are not a v a i l a b l e , any other adul t member of your household can be in terv iewed. You do, of course, have the r i g h t to refuse to be interviewed and t h i s can be done so when you are contacted . You are a l s o f ree to refuse to answer any quest ions or to end the interv iew at any t ime. Should you or another adul t household member agree to cooperate with the in terv iew, i t w i l l be assumed that consent has been g i v e n . Should you have any quest ions concerning t h i s up-coming survey, you may contac t : Chloe Lapp, Execut ive D i r e c t o r , at the above address and telephone number. Thanking you i n advance f o r your cooperat ion , Yours s i n c e r e l y , Jo-Anne Toh Graduate Student i n S o c i a l Work U n i v e r s i t y of B r i t i s h Columbia APPENDIX 5: LETTER OF INTRODUCTION TO COMMUNITY SERVICE PERSONNEL 133. TELEPHONE: (604) 873-1633 C O L U M B I A D I V I S I O N CANADIAN MENTAL HEALTH ASSOCIATION t a '•oowrM QTUIUCM otgmuim tuooonad B» .oturary contrtxmxw The Canadian Mental Heal th A s s o c i a t i o n i s conduct ing a community needs assessment on mental hea l th educat ion . A sample of the genera l p u b l i c populat ion and a sample of community se rv ice personnel have been randomly chosen to p a r t i c i p a t e i n the s tudy. Because your agency provides a d i r e c t c a r e - g i v i n g s e r v i c e to the community, we b e l i e v e your op in ions w i l l be of great value to u s . The feedback provided by key informants such as y o u r s e l f w i l l he lp the Canadian Mental Health A s s o c i a t i o n with p lanning i t s programs f o r the b e n e f i t of the community at l a r g e . Please f i n d enclosed a copy of a quest ionna i re f o r you or one of your co l leagues to complete. Your i d e n t i t y w i l l be kept s t r i c t l y c o n f i d e n t i a l , there fore a l l in format ion w i l l remain anonymous. Due to l i m i t e d time c o n s t r a i n t s , we would apprec ia te a r e p l y as soon as p o s s i b l e . A stamped, s e l f - a d d r e s s e d envelope i s enclosed f o r your convenience. If , however, you do not have the time to r e p l y w i th in the next two weeks, a fo l low-up telephone in terv iew can be arranged. A copy o f the research r e s u l t s w i l l be a v a i l a b l e upon r e q u e s t . Should you have any quest ions concerning t h i s research , p lease f e e l f ree to contac t : Chloe Lapp, Execut ive D i r e c t o r , at the above address and telephone number. Thank you f o r your a s s i s t a n c e . Your i n - p u t i s a p p r e c i a t e d . Yours s i n c e r e l y , Jo-Anne Toh Graduate Student i n S o c i a l Work U n i v e r s i t y of B r i t i s h Columbia APPENDIX 6 GENERAL PUBLIC QUESTIONNAIRE F i r s t of a l l , have you ever heard about the Canadian Mental Health Assoc ia t ion? (DO NOT — i — N ° READ) 2 Sort of 3 Yes If SORT OF or YES: Are you f a m i l i a r with what the A s s o c i a t i o n does? (DO NOT - i - Non-appl icable * READ) 2 No 3 Yes: Can you descr ibe what you know about the organizat ion? What does "mental hea l th" mean to you? Would you say you th ink about your mental hea l th : 1 a great deal (READ) . 2 f a i r l y of ten 3 only o c c a s i o n a l l y , or 4 never Do you th ink i t i s important f o r you to learn about mental hea l th problems and how to deal with these problems? 1 No (DO NOT READ) Maybe 3 Yes How do you present ly learn about these th ings? If you had a problem that was a f f e c t i n g you emot ional ly , who would you t a l k to about i t ? 1 a doctor (READ) 2 a f r i e n d or fami ly member 3 a p r o f e s s i o n a l counse l lo r -4 other What would you do i f you d i d n ' t know where to turn to for help? (DO NOT READ) 1 Don't know A s k Somebody '2 Phone book 3 Re fe r ra l Service A l l people face problems i n t h e i r d a i l y l i v e s problems you have faced i n your l i f e ? What are three of the most d i f f i c u l t 2) 3) On a sca le of one to f i v e , with one as 'not important at a l l " and f i v e as "extremely important", how important i s i t fo r you to have information on: 1) Schizophrenia 2) Depression 3) Suic ide 4) Phobias 5) Eat ing Disorders 6) Family and Marriage Counse l l ing 7) Separation and Divorce 8) Aging and Retirement 9) Care -g iv ing i n the Home 10) Gr ie f and Mourning 11) Parenting 12) Sex Education 13) Drug and A lcohol Addic t ion 14) Deal ing with a Personal C r i s e s 15) Family V io lence and Sexual Abuse 16) Coping with Stress 17) Improving Se l f -Conf idence not important 1 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 extremely important 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 What i s the best way of prov id ing t h i s kind of information to you? (READ) 1 by educat ional t a l k s 4 through newspapers & magazines 2 through t e l e v i s i o n 5 t a l k i n g to other people with s i m i l a r „ ,_ , . , , problems 3 by reading pamphlets 136. 12. Where would you go to get information on (a) i f you needed i t now What about information on (b) ? (CHOOSE HIGH SCORES FROM (a) 1 don ' t know (b) 1 don ' t know 13. Do you f e e l education i n any of these areas could be improved? 1 No 2 Don't know 3 Yes > How do you f e e l i t could be improved? 14. What do you think of when you hear the words "mental i l l n e s s " ? #10) -^ 5 I would l i k e you to answer the fo l lowing set of statements with or ' don ' t know': AGREE ' a g r e e ' , ' d i sagree ' DISAGREE DON'T KN0V (a) One of the main causes of mental i l l n e s s i s the lack of personal strength and wi l lpower . (b) A major i ty of people with mental i l l n e s s are unpred ic tab le . (c) A person who has been mental ly i l l can never be normal. (d) A schizophrenic i s a person with a s p l i t p e r s o n a l i t y . (e) If a person has been mental ly i l l fo r a long t ime, there i s n ' t much hope fo r recovery . (f) I be l i eve that ex -pat ients of a mental h o s p i t a l can funct ion wel l i n the community. (g) I would object i f someone who had been p rev ious ly mentally i l l moved next door to me. (h) I can imagine myself become a c lose f r i e n d with someone who i s mental ly i l l . ; ( i ) I would object i f a half -way house for mental ly i l l people was located i n my neighborhood. (j) I f a mental ly i l l person asked fo r help i n ge t t ing a job where I work, I would be w i l l i n g to h e l p . (k) I would r e g u l a r l y p a r t i c i p a t e i n programs i n my neighborhood which help mental ly i l l people . 137. 16. Have you ever known anybody who has suf fered a mental i l l n e s s or an emotional problem? 1 No response (DO NOT 9 A T . ^ No READ) 3 Yes 17. I f YES: Did t h i s person rece ive p r o f e s s i o n a l help? 1 Non-appl icable 2 Don't know (DO NOT READ) 3 No 4 Yes 18. I f YES: To the best of your knowledge, was the serv ice h e l p f u l to t h i s person? ( D 0 N 0 T 2 NO READ) 1 Non-appl icable _ o 3 Somewhat 4 Don't know " 5 Yes 19. In y o u r . o p i n i o n , do you th ink there are ways you can improve your mental heal th? 1 No (DO NOT READ) 2 Maybe 3 Yes 2.0. If MAYBE or YES: ,Can you descr ibe what you might do to improve your mental heal th? 21. F i n a l l y , I have a few personal information quest ions: What magazines do you read? 1 none 2 2 2. What newspaper do you read? (DO NOT READ) 1 none 2 The Sun 3 The Province 4 Glote & Mai l _5 2 3. What age group do you belong t o : 1 1 8 - 2 4 (READ) 2 25 - 29 3 i n your 30's 4 40 's 5 50's 6 60's 7 70's 8 80 and over 138. 2 4. What i s your occupation? 1 student 2 employed - Occupation: (READ) 3 unemployed 4 homemaker 5 r e t i r e d 2 5. What i s your highest l e v e l of education? 1 no education (DO NOT 2 grade 1 - 8 READ) 3 grade 9 - 1 2 4 co l l ege or t e c h n i c a l l e v e l 5 u n i v e r s i t y l e v e l 2 6. Your mar i t a l s tatus i s : 1 s i n g l e 2 married (DO NOT 3 d ivorced READ) 4 widowed 5 common-law 2 7. Do you have any c h i l d r e n under the age of 18? 1 No (DO NOT „ READ) — Y 6 S 2 8. Gender: 1 Male 2 Female 2 9. F i n a l l y , do you have any quest ions you would l i k e to ask me or do you have any f i n a l comments about mental hea l th and i l l n e s s ? THANK" V H T T U t ? D V MT T / T J nnn m-i-Mi-m APPENDIX 7 139. COMMUNITY" SERVICE PERSONNEL QUESTIONNAIRE Have you ever heard about the Canadian Mental Health Assoc ia t ion? No Sort of Yes If SORT OF or YES: Are you f a m i l i a r with the resources and programs provided by the Assoc ia t ion? NO Yes: Can you please descr ibe or l i s t the resources and programs you are f a m i l i a r w i th . Would your organ iza t ion l i k e to have more information and education on mental hea l th and problems a f f e c t i n g mental heal th? No Maybe Yes If MAYBE or YES: How could the Canadian Mental Health A s s o c i a t i o n best provide t h i s information to you? (Check one only) workshops and seminars t e l e v i s i o n and radio pamphlets and brochures a v a i l a b i l i t y of t r a i n i n g f i lms and video casset tes other : 5. What do you be l ieve are the three most common problems experienced i n the d a i l y l i v e s of the people you serve? 1) 2) 3) 140. How could the Canadian Mental Health A s s o c i a t i o n best provide mental hea l th informat ion and education to your c l i e n t s ? (Check one only) educat ional t a l k s t e l e v i s i o n pamphlets s e l f - h e l p groups r e f e r r a l to appropriate resources On a sca le of one to f i v e (with "1" as NOT IMPORTANT AT ALL and "5" as EXTREMELY IMPORTANT), how important i s i t f o r your organ iza t ion to have informat ion i n each of the fo l lowing areas: (Please c i r c l e ) Not Important Extremely Important 1) Schizophrenia 1 2 3 4 5 2) Depression 1 ' 2 3 4 5 3) Su ic ide 1 2 3 4 5 4) Phobias 1 2 3 4 5 5) Eat ing Disorders 1 2 3 4 5 6) Family and Marriage Counse l l ing 1 2 3 4 5 7) Separat ion and Divorce 1 2 3 4 5 8) Aging and Retirement 1 2 3 4 5 9) C a r e - g i v i n g i n the Home 1 2 3 4 5 10) G r i e f and Mourning 1 2 3 4 5 11) Parent ing 1 2 3 4 5 12) Sex Education 1 2 3 4 5 13) Drug and A lcoho l Add ic t ion 1 2 3 4 5 14) Deal ing with a Personal C r i s i s 1 2 3 4 5 15) Family V io lence and Sexual Abuse 1 2 3 4 5 16) Coping with Stress 1 2 3 4 5 17) Improving Se l f -Conf idence 1 2 3 4 5 18) Other: 1 2 3 4 5 141. 8. What area would your organ iza t ion pre fe r to have more informat ion on: (check one) The causes of mental i l l n e s s The symptoms of mental i l l n e s s The resources a v a i l a b l e fo r ass is tance and support Prevention i n mental i l l n e s s How to become more understanding and accept ing toward the mental ly i l l 9. In your o p i n i o n , how do you f e e l present mental heal th education could be improved? 10. Does your organ iza t ion present ly provide any mental hea l th educat ional programs or in format iona l mater ia l? No > 11) Would you be in te res ted i n doing so i n the future? No Maybe Yes Yes > Please d e s c r i b e : 12. Are you f a m i l i a r with any other mental hea l th educat ional programs i n your community? No Yes > Please d e s c r i b e : 13. What i s the most important mental heal th se rv ice you th ink a l o c a l volunteer group, such as the Canadian Mental Health A s s o c i a t i o n , could provide fo r your community? (check one only) r e h a b i l i t a t i o n informat ion and education advocacy and lobbying government development of community resources other : 142. 14. Would your organiza t ion be in te res ted i n working with the Canadian Mental Health A s s o c i a t i o n to p lan fo r mental hea l th educat ional programs and resources? No Perhaps Yes 15. I f PERHAPS or YES: In what capac i ty could your organiza t ion contr ibute to t h i s planning process? 16. Name of your o r g a n i z a t i o n : 17. Your t i t l e or job p o s i t i o n : 18. We would appreciate any fu r ther comments or opinions you would l i k e to make concerning mental hea l th and mental i l l n e s s . THANK YOU FOR YOUR ASSISTANCE. YOUR COOPERATION IS APPRECIATED. 

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