Some Factors Affecting College Students' Willingness to Interact with Hospitalized Mental Patients

Since the Mental Health Service Acts of 1963 and 1965, increasing numbers of psychiatric patients have been discharged back into communities for continuing treatment. Many comi~unities have reacted negatively to this influx of ex -patients. Since the nature of the public's reaction affects the establishmen t of community facilities as we ll as the course of ex-pati en ts' stays in the community, it is important for mental health professionals to better understand public r eac tion to menta l patient s. Since multiple factors influence behavior, the primary purpose of the present investigation was to simultaneously in vestiga te, through the use of a multivariate design, a varie ty of subject , situational and patient variables that affect people 's reactions toward mental patients. A second purpose wa s to develop an instrument to measure people's behavior toward menta l pa ti ent s. A Behavioral-Intentions measure wa s developed to assess people's willingness to int erac t with hospitalized menta l patients. In order to determine the usefulness of the Behavioral-Intention measure as a substi tute for subjects ' actual behavior, subjects' overt behavior was also recorded and the degree of the relationship between s~bjects' Behavioral -I ntention scores and their overt behavior was assessed . Subjects were 45 male and 45 female undergraduate students (Total= 90) . Subj ec ts ' attitudes to war d mental patients were assesse d using the semantic differential. The Behavioral-Intention measure consisted of eight hypothetical situations in which subjects rated their willingness to interact with hospitalized mental patients on a six-point scale. Subjects were contacted by the experi menter two weeks after completing the Behavioral-Intention measure and asked to engage in one of the activities described on the Behavioral-Intention meas ure. Subjects' responses were recorded on the Overt Behavior measure. The factors of subject sex and attitude toward mental patients, patient socio-economic st a tus and the social inti macy and potential disclosure of the encounter wer e analyzed using a 3 x 2 x 2 x 2 x 2 analysis of variance. The Behavioral-Intention measure was employed as the dependent measur e. The relationship bet wee n the Behavioral-Intention (BI) and Overt Behavior (OB) mea sure was assessed using Gamma, which indicates the probability of like ordering. People were significantly more willing to meet with a patient in situations of low intimacy as compared to situations of high intimacy. People with positive attitudes were significantly mor e willing to meet with patients as compare d to people wi th neutral or negative attitudes regardless of whether the meeting was to remain confidential or be publicized. When the meeting was to be publicized, only people with negative attitudes indicated significantly less willingness to meet with a patient as compared to when it would remain private. Women indicated si gn ific an tly less willingness to engage in an activity with patients when the activity would be publicized as co mpared to when it would remain confidential. Men however, showed no difference in th ei r willingness to interact with patients depending on the potential disclosure of the mee ting. No main effect sex difference was found. Finally, the socio-economic status of the patient did not influence people's willingness to interact with a patient. In add ition, men and women with neutral attitudes responded differently whe n contacted by the experimenter and asked to come in to meet a patient. Women, once contacted, were more likely to attend the meeting , wherea s men were more likely to refuse to attend. The Gamma co-efficient of .411 was found for the relationship between the BI and OB meas ures. Although considerable variance is still unaccounted for by this relationship, this magnitude of as sociation is noteworthy given the complexities of the social situation; it compares favorably with other BI-OB relationships reported in the literatu re an d it indic ate s that the BI measure was a reasonable dependent measure for this study.

This Dissertation is brought to you for free and open access by DigitalCommons@URI. It has been accepted for inclusion in Open Access Dissertations by an authorized administrator of DigitalCommons@URI. For more information, please contact digitalcommons@etal.uri.edu.   Crocetti, 1962;Rootman & LaFave, 1966).
The second, more pessimistic group supports the conclusion that although the public may have more knowledge and may accept the medical model of mental illness, there has been little or no impro v ement in the public's basic negative attitudes and patterns of rejection (Bord, 1971;Lamy, 1966;Nunnally, 1961;Phillips, 1963Phillips, , 1966Phillips, , 1967Tringo, 1970).
Rabkin (1974,1975) has provided a thorough and detailed review of this literature and has s ummarized several major conclusions. First, the evidence does seem to indic a te that people a re better informed about mental illness, and either believe, or know that it is correct to say, that "mental illness is an illness like any other." However, the common i mage of the mental p a ti e nt continues to be negatively toned and exmental patients are si mply not perceived with the same trust, good will, and restoration of the former "normal" status that is assigned to exmedical patients.
Along with being held in low esteem, certain laboratory studies (Farina & Ring, 1965;Farina, Holland & Ring, 1966;Ring & Farina, 1969) have indicated that an individual who is known to have a history of psy-  (Bord, 1971;Phillips, 1966Phillips, , 1967. These studies indicated that as the level of inti macy of the social situation incre ases, people's verbal rejection of the ment ally ill als o incr ea ses. These studies, as well as the racial studies cited previously, su gge sted that the l e vel of social distance of the i n t era ction influences people's behavior and should be inv estigated further. In addition, the racial studies, especially that of Green (1967), sugge sted that the condition of the discl osur e of the interaction also influ ence s people's behavior and may interact with social distance.
Therefore, these two variables were included in the present investig a tion.

Characteristics of Mental Patients
Auth ors such as Rabkin (1975)  The theory proposed by Ajzen and Fishbein (1970, 1972, 1973 contends that behavioral-intentions ( and corresponding overt behavior) are a function of the weighted sum of two components: attitude toward the act an d normative beliefs.
What is of particular i mport an ce for this discussio n is that it is as su med that b ehaviora l intentions are high ly predictive of ac tual behavio r. In their 1973 article, these authors rev iewed the relationship between beh aviora l-intentions and overt b ehavior examine d in seven studie s ( although two of these obtained only a self-r eport measu re for the overt beh avior score ). The correlation bet we en the b eh av ioral-int ention me a sure a nd the overt b eh a vior mea sure will incre as e ac cording to the d e gree of si milarity bet we e n the h y pothetical situ a tion ( as sessed by the behavioral-intention mea su r e) an d t h e ac tu a l situ a tion in whi ch subjects p a rticip a ted. The c orre la tion b e t wee n the overt b e havior ass ess ment a nd t he corresponding behavioral-intention score will therefore provide an indication of the ap pr o pri a ten e ss of u sing b eh av ioral-in t en tion me asu res a s s ubstitutes for meas ur emen ts of a ctual b eha vior.
In an y ca se, a ny inv e sti ga tion th a t use s a b eh av i ora l-in ten t io n meas ure s hould a tte mpt to obt a in an sema ntic di f f ere ntial eva l ua t iv e sca l e s with Thu r s ton e attitude sca les.
Product -m oment corr e l a tions for v arious con ce pts ran g ed be t ween . In a ddition, subj e cts r ate d six other conc e pts (using the s ame f ive Eva lu a ti v e sc al e s): "Ph ys i c i a n," "T eac her," " Ru ss i a n," "C anad i a n," "Cri minal" a nd " Re t ar d e d P erso n . " Only t h e t wo c once pts of "Hos pit a li ze d Men ta l Pa ti e nt " a nd "In sa n e Perso n" we re u se d in the prese nt s t udy bu t t h ey were embedded among t he o t he r co n cepts in orde r to decrease the deman d characteristics of the t esting situ a tion.

Following
Osg ood, Suci an d Tannenbaum (1957) Tne patien t is from a we ll-to-do f ami ly an d is presen tly st ay ing in a private, p sychiatric hospital .
Lowe r SES: The patient is from a rat he r poor family an d is presently staying in a public, state-run psychiatric hospital.
The score of one was ass i gne d to the "e x tr eme ly unwilling" 35 pole and the s co re of six was assigned to the "e x tre me ly willing" pole.
To control for order effects, four forms of the behavioral-intention measu re were administere d. 1 Refusa l over the phone to participa te in activ ity.
2 Acceptance ove r the phone to participate but failure to appea r a t appo int ment for activity.

3
Pre s ence at appointmen t for activi t y but failure to take information concernin g voluntee r program s. She th e n passed out the questi onnair e containing the semantic differential and the b eha vioral-int entio n mea sure an d said: I wo uld like you to help me in two ways today, First, I am inter e sted in wha t people think and feel about certain kinds or cl as ses of people.
I wo uld like you to indic a te your feelings on the first questionnaire .
The experi menter gave the instructi on s for the use of the semantic differential a nd wa ited for all student s to co mplete it. Then she said: Presently, I am consulting with several psychi a tric hospitals throughout the state and I am working with hospitalized men tal p at i en ts as they pr epa re f or dis ch a rge.
I am int e rested in ge tting a n id ea of how ava il able students wo uld be to mee t and t al k with men tal p a tients .  Both the disclosure ma in effect and the attitude ma in effect must be interpreted in light of the disclosure by attitude interaction .
In order to a nalyze the interaction, the simple effect s t est s we re performed for disclosure at each level of attitude ( see Table 3  The si mp le effects t e sts for attitude a t the two levels of discl osure were also perfor me d (see Figure  2) . The si mp le effec ts t es t fo r attitude at the pri v a t e l ev e l of disclosure was significan t,      Table  5).

Relation of Overt Behavio r and Sex of Subject
In order to further explore the overt behavior--attitude rela-     Table 8 Summary tudes we re more willing to mee t with patients as co mpar ed to people with neutral or ne g ative attitudes r eg ardless of specific aspec ts of the enc ounter (e.g., such as the po tential disclosure of the meeti ng).
· whe n the mee ting wa s to be publicized, the more positive the attitude held by a person , the more wi ll ing wa s tha t individua l to mee t wi th a patient. However, only students with negati ve attitudes to wa rd the mentally ill indica ted less wi ll ingness to meet with hospitalized mental patients when the inter ac tion would be publ ici ze d as c ompare d to whe n it would remai n private.
The possibility of disclosure did no t affec t the co mmit men t of students with positive or neutral attitudes. The effect of the t yp e of disc lo sure on studen ts wi th negativ e attitudes may directly refl e ct their conc er n over public knowledge of their interaction with stigmatized people whom they hold in low regard.
People who th ems elves stigmatize the men tall y ill may therefore fear "sti gma ti za tion through associati on." In addition, it can be as su me d that people wit h negative at t itude s towar d the menta ll y ill were more worried a bout possib le negative an d unpredi ct a ble actio ns on the part of patients. Giv e n th es e expecta tions, they would be more worried abo ut th ei r abi lity to deal with men tal patien ts an d s ubs eque ntly more conc erne d with the possibility of the public disclosure. Con verse ly, people with positive an d p e rhaps neutral attitudes may have b ee n l es s worri e d abou t wha t could go wrong in the interaction, l es s worrie d abou t th e ir ab ility to handle the situation an d wer e the r ef ore l es s concerne d abou t the pub lic discl osu re of the in t era ction. On the next page yo u will be ask~d to indicate y ou r impressions, using these adjective scales , of variou s kind s or cl asses of people.
There will be s eve ral adjective sc a les for each concept. The concept to be rated will appear at the top of e ach page. Please r ea d all adjectives carefully.
We realize that there · are differences between diff e r ent indivi dual s in any grou p.
We also recognize tha t you may not be acqua inted with person s of certain group s. Th e r efore , we a re only ask ing you for your general impressions.