Mental illness has had a turbulent relationship with the media, with insightful, provocative, and illuminating coverage frequently dwarfed by stigmatising, belittling and misleading reports of both patients and therapies.

A series of campaigns (the most recent being Time to Change launched in 2007) have attempted to improve the quality of reporting, particularly by focusing on the language used by the media, including a suggested set of media guidelines. There have been many successes, and coverage became less stigmatising between the 1990s and mid-2000s (Goulden R. et al, 2011), but there are still many frustrating examples of inaccurate and even harmful coverage.

Mental illness seems to have less stigma now than ever before; the world has moved on. This recent study by Rhydderch et al (2016) compared UK newspapers, to see whether their stigmatising language had moved on with it.

Methods

Between 2008 and 2014 the authors selected 27 newspapers (including the daily and Sunday equivalents of the Telegraph, Mail, Times, Guardian, Sun, Mirror, Express, Independent and Star along with eight of the largest regional papers) and on two randomly chosen days of each month they checked for stories relating to mental illness. Due to a lack of resources they skipped 2012 completely, but that still left them with nearly 4,000 newspaper days, each of which could have contained multiple articles.

The researchers had a range of criteria for choosing which articles were relevant to their study (for example they excluded cases where someone said ‘the government is schizophrenic about this issue’ or ‘I’m feeling a bit depressed about this’). The authors also cut out anything that was mainly focused on developmental disorders such as autism or neurodegenerative diseases such as Alzheimer’s.

This left nearly 5,000 suitable articles which were listed by article type (news/feature/opinion), date, newspaper origin, whether diagnoses were mentioned and if a person or source was directly quoted or not.

Each article was then scored as stigmatising, anti-stigmatising or neutral:

• Stigmatising meant pejorative language or the suggestion that people with mental illness were a danger to others.
• Anti-stigmatising articles promoted mental health or discussed injustice or stigma (presumably in a positive way).

The articles from each year were compared back to the 2008 baseline (using univariate logistic regression models) to see whether there had been any changes between years or over time.

Results

The researchers found a significant increase in the number of articles covering mental illness between 2008 and 2014 (although I could not find the analysis that supported this statement) and that there had been a significant decrease in the proportion containing ‘danger to others’ (OR = 0.49, P < 0.001) and ‘personal responsibility’ (OR = 0.59, P < 0.001) when comparing just 2014 with 2008.

There was no significant increase in anti-stigmatising articles between 2008 and 2014, though it was close (OR = 1.21, P = 0.056), nor a significant drop in the proportion of stigmatising ones (OR = 0.90, P = 0.312). Furthermore, the authors found that there was no consistency over time; the proportion of stigmatising versus anti-stigmatising articles kept changing.

Conclusions

The single strongest conclusion is that there has been a rise in the number of articles covering mental illness since 2008. The other findings, such as a decrease in stories mentioning dangerousness or mental illness being self-inflicted, or the increase in articles portraying people as incapable were either not consistent over time or not statistically significant.

Strength and limitations

I was fascinated to read this study as it’s on a topic that I live and breathe: mental illness in the news. Through my work at the Science Media Centre I am in constant contact with the specialist science and health journalists who cover new mental health research and announcements. As a result, the overall finding of an increase in coverage of mental illness does not surprise me in the slightest; there has been a seismic shift from mental illness being barely mentioned, and then often in a detrimental fashion, to being everywhere from news and documentaries to our soaps, dramas and films. In the words of one journalist, mental illness has gone from being a ‘worthy’ subject that ought to be covered, to a public interest issue that needs to be covered.

The study was designed to test whether there had been an increase in the number of articles (bingo) and the proportion that they felt were stigmatising or not. I am not sure I agree entirely with what makes an article stigmatising, but more importantly I didn’t feel that the study was nuanced enough to answer the question that mattered most to me: how to further reduce any stigmatising effect, but then I am coming at this from a different angle to the researchers.

An article was defined as less stigmatising if a person with mental illness was quoted as a source. For a feature article I think it absolutely right that the patient voice is heard, but for a news article this does not necessarily concern me. A news piece about a development in cancer normally quotes the researchers who did the work, an independent scientist and then maybe, if there’s space, a charity that will say how this affects the patient group. Research into mental illness should be no different.

In terms of lacking detail, a key example is a limitation that the authors mentioned themselves; the fact that they didn’t assess headlines and images. We know these are extremely powerful and yet they are almost never chosen by the journalist writing the article. The authors’ suggestion of training journalists may therefore have little impact on what could be key influencers of an article’s tone. It is admittedly difficult to influence picture desks and sub-editors, but as previous work has shown with suicide, newspapers will sometimes take this extremely seriously.

The news is extremely heterogeneous; articles on the same pages are written in different styles and critiqued by readers accordingly. The researchers categorised articles as news, feature or opinion piece, though there was no mention of any effect so presumably they found nothing of significance. I would dearly have loved to see this taken one step further to compare specialist science and health reporters with others. The specialist reporters come back to these issues time and time again, so by working with them it is likely to have the greatest long-term impact on the quality of coverage. At the very least, by pointing out to newspapers that their specialists ‘get it right’ and other journalists are less likely to, they are more likely to ensure the specialists have an influence on the rest of the newsroom. We know of just this happening following the MMR debacle.

In their introduction the authors mentioned that articles discussing psychopharmacological treatments were more critical than those discussing cardiac medications, portraying them as ineffective or harmful (Sartorius N et al. 2010 which references Hoffmann-Richter U et al. 1998 and Hillert A. et al, 1996). I would love to know whether this has changed, though suspect it has not, wrapped up as it is in fears around over-medicalisation, over-prescribing and an over-reliance on pharmacology that seems to divide the public and patient community. Combining ‘treatment’ with ‘article author’ could be an extremely useful insight.

Finally, the authors suggest ‘further training aimed at journalists as means to encourage a more holistic portrayal of the individual’ and I have a lot of sympathy with this. However, the community also needs to be aware of the pressures that the media are under in terms of time, competition, and lack of resources. It is a struggling industry and making it as easy as possible for the journalists to get it right is perhaps a better tactic than simply telling them what they should be doing better.

Summary

This study shows an increase in media coverage of mental illness since 2008, and the glimmers of a change in how stigmatising that coverage is, though it is hard to see a definite trend.

Media coverage undoubtedly has an incredibly important role to play in how the public views mental illness, and I completely subscribe to the idea that with increased knowledge and exposure, understanding increases and stigma drops.

There may be some who feel the public would be better served with Mental Health Correspondents to go alongside Health ones, but that would only have a further stigmatising effect, suggesting there is something different and special about mental illness. If mental illness is seeking parity with ‘physical’ illness then it should accept it will receive the same media treatment as other topics do. The growing media interest in mental illness means that articles will move from being features and sympathetic articles to hard-news pieces with increased scrutiny of NHS facilities, research developments and patient lobbying. These stories will have to compete for space and attention with stories on cancer, Ebola, Zika, IVF and Boaty McBoatface, but also with royal births, failing football teams and immoral business practices. This should be seen as good news.

There’s a long way to go, but in the media, the topic of mental illness is finally coming of age.

Links

Primary paper

Rhydderch D, Krooupa A-M, Shefer G, Goulden R, Williams P, Thornicroft A, Rose D, Thornicroft G, Henderson C. (2016) Changes in newspaper coverage of mental illness from 2008 to 2014 in England (PDF). Acta Psychiatr Scand 2016: 134 (Suppl. 446): 45–52 DOI: 10.1111/acps.12606

Other references

Goulden R, Corker E, Evans-Lacko S, Rose D, Thornicroft G, Henderson C. (2011) Newspaper coverage of mental illness in the UK, 1992-2008. BMC Public Health 2011 11(796) http://www.biomedcentral.com/1471-2458/11/796 (PDF)

Sartorius N, Gaebel W, Cleveland H-R, Stuart H, Akiyama T et al. (2010) WPA guidance on how to combat stigmatization of psychiatry and psychiatrists. World Psychiatry (9)131-144

Hillert A, Sandmann J, Ehmig SC et al. (1996) Psychopharmacological drugs as represented in the press: results of a systematic analysis of newspapers and popular magazines. Pharmacopsychiatry 1996 (29)67-71

Hoffmann-Richter U, Wick F, Alder B et al. (1999) Neuroleptics in the newspaper. A mass media analysis. Psychiatr Prax 1999 (26)175-80

Photo credits

• Kate Ter Haar CC BY 2.0
• Jeff Eaton CC BY 2.0
• Pascal Maramis CC BY 2.0
• nvainio CC BY 2.0