'Read All About It' first appeared in Mental Health Today in July 2011. To subscribe to the magazine click here.
The portrayal of mental health in the media in the UK and US has changed in the past 25 years, but there is still much negative reporting, as Mary O'Hara found out in a recent research project.
Stigma. It's a concept with a long, enduring history and one that conjures up strong reactions from those who experience it in any of its many guises.
Be it stigma emanating from friends, family, employers, the wider community or, as many people attest, from mass media - if the person on the receiving end of it has a mental illness the evidence suggests it can be not only deleterious but can seriously impede recovery.
In many instances, people report that living with stigma - defined in the dictionary as "a mark of shame, infamy, or degradation" - can be worse than dealing with the illness itself. Numerous studies in the UK and beyond, including a series begun in 2005 by Shift, the now defunct Department of Health anti-stigma unit, have concluded that the way mental illness is reported in the media can contribute to negative public perceptions and subsequently to high levels of discrimination across society.
Nevertheless, the role the media plays in perpetuating stigma is the subject of considerable debate - a clear indication that it warrants much further in-depth study. When it comes to analysing coverage of mental illness in and of itself, at first glance there seem to be some basic truths. Existing research on the nature of coverage suggests that a significant proportion can be negative, inaccurate, exaggerated - say, for example, by repeatedly linking mental illness with violence - or in the most extreme examples, typified by inflammatory and offensive language.
Despite this growing body of research when I began looking into it more a few years ago I realised how limited our knowledge actually is of mental health reporting. Reading through weighty pieces of research literature often left me with more questions than answers - the kind of questions that many mental health campaigners, service users and professionals told me they were also eager to have answered.
Questions like: just how negative, or for that matter sensationalist, is coverage of mental illness overall and exactly what form does this take? Which conditions are written about most and what aspects of mental ill health causes and treatments are covered? How has coverage altered, if at all, over time? Is coverage in Britain similar to or markedly different from that of other nations and if so, in what ways?
In order to more fully understand what gets reported it seemed that more research was essential. How, you might legitimately ask, is it possible for us to draw conclusions about the ways media coverage might contribute to stigma if we lack a comprehensive picture of the nature of that coverage in the first place?
So, two years ago, thanks to a grant from the UK educational exchange programme the Fulbright Commission, I began a sabbatical from my job as a social affairs writer at the Guardian to conduct research alongside world-renowned expert on stigma, Professor Stephen Hinshaw, author of Mark of Shame, at UC Berkeley in California. Working with a team of researchers we carried out a comparative study of coverage of mental health in the UK and US mainstream press over the past quarter century, including a small sample of articles from as far back as 1900. It was the first research of its kind in the world - and produced some remarkable results.
The research generated a vast amount of data that it would be
impossible to go through in all its detail here (you can find more
As with all research of this nature, we first had to set out some clearly defined parameters. Time and resources were limited so we concentrated on mainstream press - national and major regional daily newspapers. Despite declining circulations in recent years it remains the case, as outlined for example by the Pew Research Centre for Excellence in Reporting, that newspapers are extremely influential in setting wider news agendas.
Newspapers are also often the focus of many complaints by mental health campaigners for poor reporting. For example, the use of the word "schizo" by some tabloids in reference to people with schizophrenia has been criticised time and again. Third, we chose a US/UK-based comparison due to the shared language and media cultures of the two countries. Finally, we sought to measure to what degree headlines - often believed to be the primary source of stigmatising language - differed from the articles attached to them. That is, as the 'advertisement' for a story to what degree might headlines distort overall coverage?
Random sampling was used to identify stories related to mental health across a number of years between 1985 and 2009 - the last full year of available archives at the time the research was conducted - from nine newspapers across both countries.
The first noticeable finding was around the tone of articles and headlines. The research measured tone on a four-point scale: neutral, positive, negative and sensationalist. It was found that the proportion of overtly sensationalist coverage - that is coverage which is negative but distinguished by hyperbole and pejorative or offensive language like "schizo" or "nutter" - was relatively small.
In the US just 6% of all articles and 1% of all messages transmitted in headlines matched the criteria for sensationalist while in the British press just 2% of articles and 7% of headlines did.
In terms of trends over time, neither the US nor the UK had any sensationalist articles in 2009, although the UK press did have a small number of sensationalist headlines. This could be interpreted as an indicator of improvement in coverage, but other findings on tone suggest a more complex picture. For example, in the results for the British press there was a marked difference between tabloids and broadsheets.
Almost two-thirds (67%) of all broadsheet articles between 1985 and 2009 in Britain were either neutral or positive - in fact almost half (45%) were positive. But when tabloids are included, 45% of all coverage is negative. This is significant for a number of reasons. Bearing in mind that the circulations of tabloids vastly outnumber those of broadsheets - The Sun on its own sells an average of two million copies - then the number of people reading negative articles and being exposed to negative headlines is substantial and may not be offset by the high levels of positive coverage in the lower-circulating broadsheets.
If further research was to be done on, say, the impact of negative coverage on attitudes to mental illness, it might want to look closely at this finding. When it came to how headlines compare with articles the UK had almost the same proportion of negative headlines (47%) as articles (45%). But in the US headlines tended to be more negative - 58% versus 35% - suggesting that headlines are used more to hype stories in America than they are in Britain. Nevertheless, overall a higher proportion of UK articles were negative compared to their US counterparts (45% versus 35%).
In terms of trends over the 24-year-period we examined the proportion of negative articles in the UK press - tabloids and broadsheets combined - declined between 1985 and 1995 suggesting a longer-term change in favour of neutral or positive reporting. However, the proportion of negative articles in 2009 was identical to that in 1995 signifying that earlier progress in reducing the volume of negative coverage may have stalled.
In addition, if just looking at tabloids, there is no indication of a reduction in negative reporting over the entire time frame of this study. These findings on tone could have potentially serious implications for future campaigning around mental health and the media. For a start they prompt a number of critical considerations such as how campaigners should engage with editors and journalists in the future. If one goal for campaigners is to see fewer negative or sensationalist articles - the idea being that such reporting contributes to stigma and stereotyping - then do they need to rethink how they go about convincing media companies of this? Certainly this study suggests that there is much more work to be done.
Other key findings
- Reinforcing previous research, the most common message communicated in headlines analysed for our study was 'risk of violence'. In the UK it accounted for 15% of all messages identified and 18% in the US.
- News stories are much more likely to be negative than features. This was the case in both countries suggesting that feature writers may have more time to research and write nuanced articles.
- UK newspapers - including broadsheets - were much more likely than their US counterparts to use inflammatory or pejorative language.
- Depression is the most common condition mentioned in both countries.
- There is no evidence to suggest that the proportion of coverage dedicated to depression has changed over time despite the numbers of celebrities and public figures (such as Stephen Fry) becoming more vocal about their own diagnoses.
- Schizophrenia is the second most mentioned condition in headlines - but in a very small number. Most headlines did not refer to specific conditions but made general references to terms such as 'mental health'.
- Post-traumatic stress disorder (PTSD) is mentioned more in the US press than in Britain and usually in relation to the military.
- Of the 18 possible topics that could be identified by this research 'suicide' was by far the most mentioned in headlines in newspapers in both countries. It was the second most mentioned topic in articles.
- The second most mentioned topic in headlines was 'mental health services' - for example references to cuts to service provision - and third was 'wellbeing'. These were the top three topics in headlines in both countries - and over time.
- Headlines reporting suicide - which was defined as any coverage of acts of suicide, attempted suicides or suicide-related services, studies or policy - were much more likely to be negative than for the general sample of headlines. In the UK, 68% of suicide-related headlines were negative compared with 47% for the whole sample.
- References to stigma and discrimination are rarely mentioned in headlines or articles.
- Stories about overcoming adversity appear more in the US press.
- UK coverage - especially more recently - is much more likely to refer to celebrities or public figures.
- The proportion of coverage referring to 'first-person' experience of mental health is more common in the UK and has increased over time.
- References to one of the most sensitive areas of mental health policy - the experience of ethnic minorities in the mental health system - is rarely mentioned in coverage. This suggests that the media is not reflecting the serious issues this throws up.
Summing up an ambitious piece of research like this is not easy. It generated an enormous amount of valuable, rich data that we hope other researchers will use to probe this issue even further.
In an ideal world we would have been able to measure the findings against, for example, general health or science reporting to see if it is any better or worse. Indeed it would have been informative to examine any number of other interesting comparisons such as whether press reporting differs from magazines.
As it stands, what this research constitutes is a first step towards a clearer understanding of coverage and the ways in which (at least one very significant part of) the media handles mental illness. What the findings demonstrate is just how much more work is required on this complex and important subject.
Service users and campaigners have welcomed this research, but
were worried by the findings.
"This study confirms that the UK media is guilty of presenting a distorted view of mental health problems," said Alison Kerry of mental health charity Mind.
"It also highlights a worrying trend that reporting in the tabloid press is becoming increasingly negative in tone. It is shocking that in the 21st century mental health issues can still be reported on with such disdain."
Service user and director of fellow charity Stand to Reason, Jonathan Naess, added: "This important research shows just how little progress had been made over many generations and that new approaches are needed.
"News agendas still need drama, celebrity and infamy as hooks for stories, but space is opening up for compelling positive stories from people living lives that are more representative of our collective experience."
Matilda MacAttram of Black Mental Health UK concluded: "This important research shows just how little progress had been made over many generations and that new approaches are needed. This research gives credence to the [view] that robust statistical data can inform the way the media deal with this issue."