Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)




Dr. S.M. Taylor


This study examines the causal processes underlying individual non-user responses to community mental health care. With the containing trend toward community-based delivery of mental health services in the United States and Canada it is essential to understand the response of non-users to potential mental health facilities near their home.

The analysis is based on a simple yet comprehensive conceptual model of the individual response process. The desirability of a future mental health facility near a person's home is regarded as primarily a function of attitudes toward that mentally ill and perceived mental health facility impacts. Attitudes toward the mentally ill are themselves regarded as a function of personal non-attitudinal characteristics. Facility impacts are viewed as a function of facility characteristics and characteristics of the local neighbourhood. The latter also influence facility desirability.

These relationships are stated in a causal model of the response process which is described by a set of nineteen hypotheses. Each hypothesis describes a specific relationship in the model. The empirical validity of the causal model and the hypotheses are tested using data collected in an extensive questionnaire survey of metropolitan Toronto, Ontario residents. Respondents were randomly chosen from census enumeration areas with and without existing mental health facilities. The sample was stratified by two levels of geographic location and three levels of social class.

The intervariable correlations and direct effects estimated by path analysis generally support the hypotheses, with some exceptions. Several neighbourhood variables were found to have non-significant effects on perceived mental health facility impacts and facility desirability. This was due to a mismatch in the units of analysis. Neighbourhood variables were measured at the census tract or enumeration area level and attitudes toward facilities were measured at the individual level. Awareness of a neighbourhood mental health facility did not significantly influence facility impacts or facility desirability.

Personal non-attitudinal factors were found to have significant effects on attitudes toward the mentally ill. Attitudes toward the mentally ill were, in turn, the most powerful predictor of perceived facility impacts. Completing the causal sequence, attitudes toward the mentally ill and perceived facility impacts exert strong antecedent influences on facility desirabilty.

Although the direct influence of neighbourhood factors on facility desirability is limited, their indirect effects via perceived facility impacts increases the total influence of several of these variables quite markedly. Facility impacts also act as an intervening variable for the influence of attitudes toward the mentally ill on facility desirability. Distance from home has a significant effect on facility desirability. Closer locations are viewed as less desirable rather than more undesirable.

A post hoc test of the specification assumptions underlying the structure of the causal model confirms the major relationships between attitudes toward the mentally ill, perceived facility impacts and facility desirability. Individual non-attitudinal factors are found to have pervasive influences on reactions to facilities. Hence, the intervening role of attitudes toward the mentally ill between personal factors and reactions to facilities is undermined.

Overall, the results indicate that personal non-attitudinal factors, attitudes toward the mentally-ill and perceived facility impacts exert significant direct influences on facility desirability. From a theoretical point of view, these findings constitute a significant advance, clarifying many of the questions and ambiguities characterising previous research. In terms of practical implications, the results suggest, among other things, that the widespread acceptance of community mental health care is dependent upon fostering, by means of public education campaigns, positive attitudes of non-users to the mentally ill and the facilities that serve them.

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