Registered recognition, declarative tolerance and public importance of mental health issues, but also more conservatism. This is reported in a new second wave of experimental research by the Skin Foundation – a platform for mental health, conducted by Gallup International Balkan agency three years after the first study in 2020.
Despite the rather high levels of recognition of mental health problems and the declared good level of tolerance in Bulgaria, the last three years have had their effect on the attitudes of Bulgarians. Less public visibility, more conservatism, closing in on oneself and in the closest circle of friends show the results of the second wave of the survey conducted three years later. Our society demonstrates a narrowing of the boundaries of what is shared. More waves of research are needed to establish whether the changes recorded over the three year period are a return to more traditional attitudes to mental health issues or a new trend in our society – a focus on the safe, the well-tested, the stable, in anticipation of calmer times. The previous wave of research also fell into the Kovid pandemic, which has also had its impact.
These are some of the findings and hypotheses of a short experimental study conducted by Gallup International Balkan, together with the Skin Foundation – a platform for mental health, on the occasion of Mental Health Day. The study focuses on milder forms of mental disorders, addictions, etc.
Mental disorders – contact with the subject
32% of respondents in the current wave of the survey answered positively when asked if they knew people with mental disorders. 45% said they did not know any and 18% were unsure how to answer. This indicator can also be seen as an indirect guide to the prevalence of the problem – in view of the fact that the question implies both an assessment of society and the environment around us, as well as an introspection. Of course, given the sensitivity of the subject, the possibility of variations in the sincerity of the answers should also be taken into account.
It appears that among women, awareness or perhaps recognition of mental health issues is relatively higher (36%). Affirmative responses among men were nearly ten points lower at 27%. People aged 36 to 45 were most likely to respond affirmatively when asked if they knew people with mental health problems (38%), while the youngest and oldest respondents were less likely to say they knew people with mental health problems. Such responses could be linked to the different dynamics of the lives that respondents from different age groups lead – exposure to stimuli, access to information and interactions, etc.
The level of education and other social factors also influence public attitudes on this indicator. For example, people in villages and small towns are more likely to say yes. In this case, the size of the community also has an influence in terms of the fact that in small settlements personal space is more limited and people tend to pay more attention to their neighbour. On the other hand, people in larger settlements, and especially in the capital, live in a situation in which the dynamics and isolation of the individual lead either to the acceptance of mental disorders as normal/common, or to an atomisation in which mental disorders are a circumstance that could be concealed or ignored.
The most general attitude towards mental disorders is also evident in the experimental question, in which respondents were asked to choose only one of the two options “if a person admits to having a mental disorder, others will shun them” or “if a person admits to having a mental disorder, others will help them”. Nearly two-thirds (58%) of respondents chose the first option, and just over two-fifths (42%) thought that help was the more likely response of others if someone admitted to having a mental disorder.
Data from the current wave of the survey shows a marked difference in attitudes compared to the survey conducted in 2020. Back then, 45% of respondents believed that admitting to mental health problems would cause shunning and social isolation, but over half (55%) were likely to indicate that sharing about such a problem would lead to empathy and help. These results suggest further analysis and a need for public discussion. In practice, no societal group or stratum stands out where the expectation of help is leading.
Although visibly (and largely expectedly) women, residents of larger cities and respondents with higher education were more likely to choose the option related to help, and for these groups the larger clusters were registered around the claim that sharing about a mental disorder would lead to avoidance. Against a background of much greater publicity about the conditions that social isolation caused during the Coved-19 pandemic and the promotion of mental health issues and different types of disorders, Bulgarians demonstrated a more conservative orientation in their attitudes. The results also point to a certain amount of pragmatism in public perceptions in our country – perhaps the reason is the rise in stress levels in our society and the perception of insecurity in recent years.
Other experimental indicators, repeated by the agency in the current wave of research, further reinforce the observation of rather reduced public sensitivity: when a person feels they have a mental health problem, they should try to solve it themselves – 20% (16% in 2020. ); it is shameful to go to a psychiatrist – 18% (13% in 2020); it is not normal for men to cry – 32% (25% in 2020); attempting suicide is a sin – 28% (18% in 2020), etc.
Recognition of the problem among society
Against the backdrop of recorded more conservative attitudes, aloofness and less social sensitivity, our society is more likely to recognise and identify different mental disorders. This indicates that it is probably not a matter of misunderstanding the problem and unfamiliarity with the manifestations of mental illness in general. Asked to choose from a list of options and for each to indicate whether or not they thought it was a mental disorder, respondents recognised mental disorders and were able to distinguish them from various momentary emotional states of the individual.
Scores on these indicators remain without significant differences within the range recorded three years ago: schizophrenia, the tendency to self-harm and the state of depression are the easiest to recognise. This is followed by post-traumatic stress disorders, conditions such as eating disorders, obsessive compulsive disorder, etc. At the other ‘pole’ are, predictably, states of falling in love, anger, sadness, nostalgia – which remain, as one might expect, outside the spectrum of mental illness.
There is also uncertainty in the attitude towards stress and anxiety – over half of the respondents believe that these are not mental problems, but there is also a significant proportion – around and over a third who are of the opposite opinion. The increasingly active life style that modernity demands, the uncertainty of the social environment, and the crises of various orders in which our society, and the world around us, have become accustomed to functioning, probably have an influence in this respect. Thus, the conclusion that stress and anxiety are thought of as a systemic problem of modernity that everyone faces rather than a disorder remains valid three years after the initial wave of research.
Dependencies and degrees of optimism
Dependency in our society is recognised as a disease rather than, for example, a lack of will. Asked to choose only one of the two, 46% of respondents accepted the view that people with various addictions simply do not have enough willpower to quit, and 54% indicated that addicts suffer from a disease. However, the sensitivity to this question in this country has undergone a marked shift in recent years, with 37% (or 10 points less) answering ‘lack of will’ and 63% answering ‘illness’ to the same question in 2020.
Paradoxically, this change in attitudes – while not appreciable, but still noticeable – is somewhat in contrast to the observations above. Society in this country also seems to show a tendency to separate addictions according to their severity – according to the substance or activity used, the subject of the addiction. In general, the view that the various addictions could be overcome prevails, yet drugs fall into a separate category. The proportion of sceptics that drug dependence can be overcome is higher (51%) than that of optimists (40%).
Gambling addiction also provokes a high proportion of pessimism about its ability to be overcome (42%), yet those who are willing to accept that it can be overcome are more likely (48%). Just over a half, on the other hand, believe that alcohol addiction can be overcome (57%). The shares of optimistic responses are most significant when it comes to addictions to tobacco (71%) and food (72%).
There is a shift (albeit minimal in places) towards the more pessimistic view in responses to these indicators. The data should not be over-interpreted, but it is worth noting that it is in a situation of crisis and uncertainty in society that consumption of addictive substances increases – a cause for concern, especially when confidence that addictions are surmountable is on a downward trend. Relevant to a more positive outlook are educational status, income and general characteristics associated with more favourable life prospects.
Specialised assistance
Nearly two-thirds (62%) of respondents in our country believe that if a person has a mental or emotional problem, it is best to see a specialist. A fifth (19%) say it is best to rely on friends and family at such a time. Less than a tenth think it is a problem that is best for everyone to solve themselves (8%). A minimal proportion of Bulgarians see the best solution in turning to a religious organization. About one tenth could not decide.
Attitudes towards specialist help did not register any significant changes compared to the 2020 survey – going to a specialist remained in the top position as the best option (cited by 65% of respondents in 2020), followed by help from loved ones. Of course, both in 2020 and now, some declarativeness and social desirability of responses should be allowed for. Social status, income and education also matter for respondents’ attitudes.
Although no significant structural changes in attitudes stand out, there is nevertheless some shift in the opinions expressed in this indicator too, in favour of relying on family and friends for emotional or mental health problems and at the expense of specialist help. Thus, in this case, too, the hypothesis of closing in on oneself and one’s closest circle, and of a strengthening of social conservatism, also captured in attitudes towards other indicators, is admissible.
The above is also evident in the answers to the provocative question, in which respondents are asked to choose between pairs of statements – “going to a psychologist is a manifestation of whim” or “sometimes seeing a psychologist can be a necessity”. The proportion indicating the first option is relatively small at 15% and has remained in this range over the last three years. However, the survey now reports some growth in sceptics. A difference of three points is not significant and can be attributed to the current emotional state, the characteristics of the sample, the conditions of the particular moment in which the survey was conducted, etc. However, the marginal increase recorded is consistent with the general trend of changes in public attitudes recorded in the survey.
As regards children and the public’s predisposition to take them to a specialist if a problem, developmental delay or skill acquisition is noticed, attitudes remain virtually unchanged. Regardless of whether respondents were parents or not, when asked to imagine being in such a hypothetical situation, 46% said they would seek the help of a specialist, 17% would wait in the hope that the child would overcome the problems, around a tenth (12%) would seek the advice of other parents or talk to their own parents (8%). Respondents who have children under 18 are more likely to indicate the option ‘I will seek a specialist’.
Degrees of tolerance
In general, the Bulgarian society demonstrates tolerance towards various topics, problems and stereotypes related to mental health – at least on a declarative level. A more conservative reaction is maintained in the range between one tenth and around and just over a quarter of the responses of respondents, who tend to indicate, for example, that people who suffer from depression just need to tighten up (28%), people with mental disorders should be isolated from society (21%) or that any psychological problems are best solved with a stiff drink and a good night’s sleep (21%).
The public reactions to provocative experimental questions related to tolerance and mental health issues in the workplace were impressive. Again, there seems to be more of a shift in public opinion towards conservatism. If in 2020, for example, 39% thought that if a person takes antidepressants they should not share with colleagues because it is a personal problem, and 61% indicated the option that they should share with colleagues because they will help, now the ratio is respectively: 52% “personal problem” vs. 48% “colleagues will help”.
