The World Health Organization reported that about 450 million people worldwide suffer from some form of mental disorder or brain condition, and that one in four persons meet criteria for mental disorder at some point in their life [1] . Globally, it is an ongoing concern that the subject of psychiatry, psychiatrists, mental health professionals and the mentally ill patients are affected by the negative prejudices and the cultural stereotypes of the general public. Health care professions are not immune to social prejudices and surprisingly share the general public’s attitude attributed to people with mental illness [2] . Nurses play a key role in caring for the mentally ill in sickness and in rehabilitating the mentally ill after an episode of illness. In addition, majority of patients and their families who are seeking help for their mental illness rightfully expect the hospital and nursing staff to be cognisant of their needs and treat them as unique individuals without any prejudice and discrimination [3] [4] .

Nurses need to be self-aware of their own stigma in order to avoid inadvertently discriminating against their patients through inappropriate distancing, inadequate teaching, or other nursing actions based in fear. Fear is a major cause of discrimination and stigma [5] . Direct contact with people who are stigmatized is an effective method of decreasing fear, increasing tolerance, and changing negative attitudes [5] . Being acquainted with someone with mental illness has also been shown to positively influence attitudes [6] .

The attitudes and knowledge of the health professionals on mental illness have been argued to be a major determinant of the quality and outcome of care for mentally ill [7] . Students starting the nursing course bring with them stereotypes and prejudice in relation to mentally-ill people, thus show lack of knowledge as to their possibilities of recovery and social living. Nursing students are likely to share the view that people experiencing a mental illness are dangerous, unpredictable, more prone to violence and at least partially responsible for their illness [2] . Exploration of stigmatizing attitudes in young people is of critical importance due to indications that, despite adolescence being the period of peak onset of mental disorders, help-seeking rates remain lower than those in other age groups [8] [9] . Some studies have examined young people’s stigmatizing attitudes towards people with mental disorders, including beliefs about those with the disorders (known as personal or, alternatively, public stigma) [10] [11] , participants’ beliefs about the attitudes of others (perceived stigma) [10] [12] , or a desire for social distance [13] .

Negative perceptions of mental illnesses have multiple ramifications for people with mental illness. It prevents people with mental illness from fully living, studying or working in the community. It is a barrier to proper care and it may even make the public less willing to pay for the care of people with mental illnesses; and contributes to the sense of hopelessness, isolation and low self-esteem for people with mental illness [14] .

Alexander and Link [15] in their study reported that the participants with more overall contact with the mentally ill, “regardless of type”, viewed the mentally ill as less dangerous and “reported less desired social distance” (p. 284-285). Attitudes and beliefs about mental illness are shaped by personal knowledge about mental illness, knowing and interacting with someone living with mental illness, cultural stereotypes about mental illness, media stories, and familiarity with institutional practices and past restrictions (e.g., health insurance restrictions, employment restrictions; adoption restrictions) [16] [17] .

Stigma has been described as―“a cluster of negative attitudes and beliefs that motivate the general public to fear, reject, avoid, and discriminate against people with mental illnesses” [18] (p. 4). When stigma leads to social exclusion or discrimination (experienced || stigma), it results in unequal access to resources that all people need to function well: educational opportunities, employment, a supportive community, including friends and family, and access to quality health care [16] [17] [18] [19] . Those who do initiate treatment for their mental illness often fail to adhere to their treatment schedule [20] . A major factor contributing to reluctance to seek and maintain treatment is the continued stigmatization of mental illness [21] [22] [23] .

Social avoidance is common among people with mental illness and various studies suggested that the general population may accept people with mental illness socially, but tend to withdraw from more personal relationships such as working or living together [24] [25] . As a result, people with mental illness face social isolation, social distance, unemployment, homelessness, and institutionalization [26] . Negative perceptions of mental illnesses have multiple ramifications for people with mental illness. It prevents people with mental illness from fully living, studying or working in the community. It is a barrier to proper care and it may even make the public less willing to pay for the care of people with mental illnesses; and contributes to the sense of hopelessness, isolation and low self-esteem for people with mental illness [14] .

Attitudes and perceptions towards mental illness are colored by one’s cultural values and beliefs. However, there is a paucity of studies on public perceptions and attitudes towards mental illness in non-Western countries: a recent survey of 61 of such studies, found that only nine were from non-Western countries [27] . Although the tendency for health care students to avoid mental health as a career specialty is not limited to occupational therapy, it is of particular concern to a holistic profession with a long and proud tradition in mental health care. Some authors have suggested that negative attitudes toward mental illness may be one factor in students’ decisions not to enter mental health practice [28] [29] [30] .

Consistent with Link and Phelan’s [19] stigma model, laboratory research has documented that when participants are informed that another individual is mentally ill, negative attitudes are expressed. In particular, a label of mental illness evokes perceptions of dangerousness and unpredictability (e.g. [31] [32] [33] ). The second step in Link and Phelan’s [14] model of social stigma is stereotyping. As noted previously, based on a label of mental illness, people may perceive the described individual as dangerous. Despite the public’s increased familiarity with mental health issues, the association between mental illness and dangerousness persists, which has a strong negative influence on tolerance [11] [23] [32] [33] . In fact, there is evidence that this negative stereotype of dangerousness is actually more widely endorsed by society today than it has been in the past [34] . In particular, alcohol and drug problems, as well as schizophrenia, seem to connote increased perceptions of dangerousness [11] [33] . Furthermore, several studies have demonstrated that these negative stereotypes about mental illness translate into tangible consequences, such as job and housing discrimination [32] [35] [36] [37] [38] .

A cross-sectional survey research design was used which allowed for the utilizing of quantitative data collection and data analysis. A total of 110 undergraduate students were selected using the stratified random method. Data for the study were collected through the use of a questionnaire. The data were coded and entered into SPSS version 20.

To be able to select a representative sample for the study, a sampling frame was obtained from the first, second and third year students. Gerrish and Lacey added that this “increases the precision of the estimates of error compared with simple random sampling and gives more confidence in the results” [39] (p.145). This was achieved by grouping the population according to strata (year groups). Within each stratum, the participants were further grouped by gender [40] [41] .

Inclusion and exclusion criteria. Only the undergraduate full-time students in the bachelors of science nursing program who have at least completed the first year, second year and commenced the first semester of their third year will be included in the study. Students in year 4, critical care, midwifery and the nurse anesthetist program was excluded from the sampling frame.

Ethical approval was obtained from the Research Ethics Committees of the University of Technology, Jamaica.

To describe the participants, 5 demographic items were included in the questionnaire.

Gender. Of the 110 participants in the study 5 (4.5%) were males, while 105 (95.5%) were females.

Eighty or (72.5%) of the respondents were between the ages of 18 and 25 years, 25 (22.7%) 26 - 35 years; 5 (4.5%) 36 - 45 years.

Gender by marital status. 90 (81.8%) of the respondents were single at the time of this study. This is followed by 10 (9.0%) who indicated that they were in a common-law relationships, and 10 (9.0%) were married.

Gender by student status. Most of the respondents 60 (54.5%) were in the third year, 30 (27.2%) second year and 20 (18.2%) of their programme when the study was conducted.

Research Question. What are the views of undergraduate students towards individuals identified as having a mental illness? (Table 1).