‘Read All About It’ first appeared in Mental Health Today inJuly 2011. To subscribe to the magazine click here.
The portrayal of mental health in the media in the UK and US haschanged in the past 25 years, but there is still much negativereporting, as Mary O’Hara found out in a recent researchproject.
Stigma. It’s a concept with a long, enduring history and onethat conjures up strong reactions from those who experience it inany of its many guises.
Be it stigma emanating from friends, family, employers, thewider community or, as many people attest, from mass media – if theperson on the receiving end of it has a mental illness the evidencesuggests it can be not only deleterious but can seriously impederecovery.
In many instances, people report that living with stigma -defined in the dictionary as “a mark of shame, infamy, ordegradation” – can be worse than dealing with the illness itself.Numerous studies in the UK and beyond, including a series begun in2005 by Shift, the now defunct Department of Health anti-stigmaunit, have concluded that the way mental illness is reported in themedia can contribute to negative public perceptions andsubsequently to high levels of discrimination across society.
Nevertheless, the role the media plays in perpetuating stigma isthe subject of considerable debate – a clear indication that itwarrants much further in-depth study. When it comes to analysingcoverage of mental illness in and of itself, at first glance thereseem to be some basic truths. Existing research on the nature ofcoverage suggests that a significant proportion can be negative,inaccurate, exaggerated – say, for example, by repeatedly linkingmental 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 intoit more a few years ago I realised how limited our knowledgeactually is of mental health reporting. Reading through weightypieces of research literature often left me with more questionsthan answers – the kind of questions that many mental healthcampaigners, service users and professionals told me they were alsoeager to have answered.
Questions like: just how negative, or for that mattersensationalist, is coverage of mental illness overall and exactlywhat form does this take? Which conditions are written about mostand what aspects of mental ill health causes and treatments arecovered? How has coverage altered, if at all, over time? Iscoverage in Britain similar to or markedly different from that ofother nations and if so, in what ways?
In order to more fully understand what gets reported it seemedthat more research was essential. How, you might legitimately ask,is it possible for us to draw conclusions about the ways mediacoverage might contribute to stigma if we lack a comprehensivepicture of the nature of that coverage in the first place?
Research needed
So, two years ago, thanks to a grant from the UK educationalexchange programme the Fulbright Commission, I began a sabbaticalfrom my job as a social affairs writer at the Guardian to conductresearch alongside world-renowned expert on stigma, ProfessorStephen Hinshaw, author of Mark of Shame, at UC Berkeley inCalifornia. Working with a team of researchers we carried out acomparative study of coverage of mental health in the UK and USmainstream press over the past quarter century, including a smallsample of articles from as far back as 1900. It was the firstresearch of its kind in the world – and produced some remarkableresults.
Research parameters
The research generated a vast amount of data that it would beimpossible to go through in all its detail here (you can find moreat www.gresham.ac.uk)
As with all research of this nature, we first had to set out someclearly defined parameters. Time and resources were limited so weconcentrated on mainstream press – national and major regionaldaily newspapers. Despite declining circulations in recent years itremains the case, as outlined for example by the Pew ResearchCentre for Excellence in Reporting, that newspapers are extremelyinfluential in setting wider news agendas.
Newspapers are also often the focus of many complaints by mentalhealth campaigners for poor reporting. For example, the use of theword “schizo” by some tabloids in reference to people withschizophrenia has been criticised time and again. Third, we chose aUS/UK-based comparison due to the shared language and mediacultures of the two countries. Finally, we sought to measureto what degree headlines – often believed to be the primary sourceof stigmatising language – differed from the articles attached tothem. That is, as the ‘advertisement’ for a story to what degreemight headlines distort overall coverage?
Random sampling was used to identify stories related to mentalhealth across a number of years between 1985 and 2009 – the lastfull year of available archives at the time the research wasconducted – from nine newspapers across both countries.
Findings
The first noticeable finding was around the tone of articles andheadlines. The research measured tone on a four-point scale:neutral, positive, negative and sensationalist. It was found thatthe proportion of overtly sensationalist coverage – that iscoverage which is negative but distinguished by hyperbole andpejorative or offensive language like “schizo” or “nutter” – wasrelatively small.
In the US just 6% of all articles and 1% of all messagestransmitted in headlines matched the criteria for sensationalistwhile in the British press just 2% of articles and 7% of headlinesdid.
In terms of trends over time, neither the US nor the UK had anysensationalist articles in 2009, although the UK press did have asmall number of sensationalist headlines. This could be interpretedas an indicator of improvement in coverage, but other findings ontone suggest a more complex picture. For example, in theresults for the British press there was a marked difference betweentabloids and broadsheets.
Almost two-thirds (67%) of all broadsheet articles between 1985and 2009 in Britain were either neutral or positive – in factalmost half (45%) were positive. But when tabloids are included,45% of all coverage is negative. This is significant for a numberof reasons. Bearing in mind that the circulations of tabloidsvastly outnumber those of broadsheets – The Sun on its own sells anaverage of two million copies – then the number of people readingnegative articles and being exposed to negative headlines issubstantial and may not be offset by the high levels of positivecoverage in the lower-circulating broadsheets.
If further research was to be done on, say, the impact ofnegative coverage on attitudes to mental illness, it might want tolook closely at this finding. When it came to how headlines comparewith articles the UK had almost the same proportion of negativeheadlines (47%) as articles (45%). But in the US headlines tendedto be more negative – 58% versus 35% – suggesting that headlinesare used more to hype stories in America than they are in Britain.Nevertheless, overall a higher proportion of UK articles werenegative compared to their US counterparts (45% versus 35%).
Long-term trends
In terms of trends over the 24-year-period we examined theproportion of negative articles in the UK press – tabloids andbroadsheets combined – declined between 1985 and 1995 suggesting alonger-term change in favour of neutral or positive reporting.However, the proportion of negative articles in 2009 was identicalto that in 1995 signifying that earlier progress in reducing thevolume of negative coverage may have stalled.
In addition, if just looking at tabloids, there is no indicationof a reduction in negative reporting over the entire time frame ofthis study. These findings on tone could have potentially seriousimplications for future campaigning around mental health and themedia. For a start they prompt a number of critical considerationssuch as how campaigners should engage with editors and journalistsin the future. If one goal for campaigners is to see fewer negativeor sensationalist articles – the idea being that such reportingcontributes to stigma and stereotyping – then do they need torethink how they go about convincing media companies of this?Certainly this study suggests that there is much more work to bedone.
Other key findings
- Reinforcing previous research, the most common messagecommunicated in headlines analysed for our study was ‘risk ofviolence’. In the UK it accounted for 15% of all messagesidentified 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 writersmay have more time to research and write nuancedarticles.
- UK newspapers – including broadsheets – were much more likelythan their US counterparts to use inflammatory or pejorativelanguage.
- Depression is the most common condition mentioned in bothcountries.
- There is no evidence to suggest that the proportion of coveragededicated to depression has changed over time despite the numbersof celebrities and public figures (such as Stephen Fry) becomingmore vocal about their own diagnoses.
- Schizophrenia is the second most mentioned condition inheadlines – but in a very small number. Most headlines did notrefer to specific conditions but made general references to termssuch as ‘mental health’.
- Post-traumatic stress disorder (PTSD) is mentioned more in theUS press than in Britain and usually in relation to themilitary.
- Of the 18 possible topics that could be identified by thisresearch ‘suicide’ was by far the most mentioned in headlines innewspapers in both countries. It was the second most mentionedtopic in articles.
- The second most mentioned topic in headlines was ‘mental healthservices’ – for example references to cuts to service provision -and third was ‘wellbeing’. These were the top three topics inheadlines in both countries – and over time.
- Headlines reporting suicide – which was defined as any coverageof acts of suicide, attempted suicides or suicide-related services,studies or policy – were much more likely to be negative than forthe general sample of headlines. In the UK, 68% of suicide-relatedheadlines were negative compared with 47% for the wholesample.
- References to stigma and discrimination are rarely mentioned inheadlines or articles.
- Stories about overcoming adversity appear more in the USpress.
- UK coverage – especially more recently – is much more likely torefer to celebrities or public figures.
- The proportion of coverage referring to ‘first-person’experience of mental health is more common in the UK and hasincreased over time.
- References to one of the most sensitive areas of mental healthpolicy – the experience of ethnic minorities in the mental healthsystem – is rarely mentioned in coverage. This suggests that themedia is not reflecting the serious issues this throws up.
Conclusions
Summing up an ambitious piece of research like this is not easy.It generated an enormous amount of valuable, rich data that we hopeother researchers will use to probe this issue even further.
In an ideal world we would have been able to measure thefindings against, for example, general health or science reportingto see if it is any better or worse. Indeed it would have beeninformative to examine any number of other interesting comparisonssuch as whether press reporting differs from magazines.
As it stands, what this research constitutes is a first steptowards a clearer understanding of coverage and the ways in which(at least one very significant part of) the media handles mentalillness. What the findings demonstrate is just how much morework is required on this complex and important subject.
Positive response
Service users and campaigners have welcomed this research, butwere worried by the findings.
“This study confirms that the UK media is guilty of presenting adistorted view of mental health problems,” said Alison Kerry ofmental health charity Mind.
“It also highlights a worrying trend that reporting in thetabloid press is becoming increasingly negative in tone. It isshocking that in the 21st century mental health issues can still bereported on with such disdain.”
Service user and director of fellow charity Stand to Reason,Jonathan Naess, added: “This important research shows just howlittle progress had been made over many generations and that newapproaches are needed.
“News agendas still need drama, celebrity and infamy as hooksfor stories, but space is opening up for compelling positivestories from people living lives that are more representative ofour collective experience.”
Matilda MacAttram of Black Mental Health UK concluded: “Thisimportant research shows just how little progress had been madeover many generations and that new approaches are needed. Thisresearch gives credence to the [view] that robust statistical datacan inform the way the media deal with this issue.”
