Abstract
Media portrayal of mental health/illness is an important focus of Australia's National Mental Health Strategy, as evidenced by resources promoting responsible reporting (Achieving the balance [1] in 1999 and Reporting suicide and mental illness [2] in 2002).
These developments reflect concerns with the nature of reporting of mental health/illness (particularly news and current affairs reporting in broadcast and print media) identified in the scientific literature. In a recent review, Francis et al. [3] comprehensively searched for and critically appraised relevant studies examining media portrayal of mental health/illness. Of the studies concerning news and current affairs reportage, only one was conducted in Australia [4], few considered more than one form of media, most involved restricted samples of items and none considered the quality of reporting using explicit criteria. These limitations aside, the studies suggested that the media tend to portray mental illness in a negative fashion, frequently linking it with violence, dangerousness and crime [4–15]. This finding is supported by a New Zealand study, which post-dates the Francis et al. review [16].
In an effort to overcome some of the limitations identified in the review, we examined the extent, nature and quality of non-fiction reporting of mental health/illness in Australian broadcast and print media, in the context of Achieving the balance [1].
Method
Items relating to mental health/illness were retrieved from newspaper, television and radio sources between 1 March 2000 and 28 February 2001 by a media retrieval agency. Trained readers/ viewers/listeners scanned selected media, retrieving items that included any of the following:
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Items were retrieved from all major national metropolitan daily newspapers (15), all suburban/regional newspapers in Victoria (146), and major suburban/regionals in other states (23) and all Australian radio stations (67 government funded; 158 non-government funded) and television stations (18 government funded; 88 non-government funded). Newspaper items were collected from anywhere in the paper; radio and television items were collected from news and current affairs programs only.
Three coders extracted identifying/descriptive information from each media item and assigned quality ratings to a stratified random sample of 10% of items (selected using a computer program which flagged randomly selected items). In the case of newspaper items, coders used full press clippings for extracting both the identifying/ descriptive information and for assigning quality ratings. In the case of television/radio items, they used broadcast summaries (which included a précis of the item's content) to extract identifying/descriptive information, but had full transcripts or audio/video tapes at their disposal for the quality ratings. Coders made their quality ratings using a ninedimension instrument based on criteria in Achieving the balance [1]. Each dimension was phrased as a question, to which coders responded ‘yes’, ‘no’, ‘unsure’ or ‘not applicable’. To guide the coders in their decision-making, the criteria underpinning each dimension were provided. The dimensions and the relevant criteria drawn from the guidelines were as follows:
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To maximize consistency between coders, comprehensive example-based training was provided and formal meetings were held to cross-check responses and clarify the use of definitions and criteria. Since the quality ratings were most susceptible to subjectivity, interrater reliability was assessed for a stratified random sample of 100 items drawn from those chosen for the quality ratings. All three coders rated each of the items once. Kappa values were significant (p < 0.05) for seven of the quality-rating dimensions, and agreement between coders was generally good (0.40–0.75) or excellent (< 0.75).
Results
Extent and nature of media reporting of mental health/illness
In total, 13 389 media items relating to mental health/illness were collected (4351 32.5% newspaper articles, 1237 9.2% television items and 7801 58.3% radio items).
Overview
Sixty-six per cent of newspaper items appeared in metropolitan papers; 34.0% in suburban/regional papers. The majority (92.6%) were in the body of the paper, with only 3.8% on the front page. Over 3/4 (76.9%) were prepared by the paper's own reporter, with the remainder being prepared by an agency (2.6%), another source (6.8%) or an unknown source (13.6%). Most (81.7%) were news items, but 9.3% were features, 5.9% letters, 0.7% editorials and 2.4% some other kind of item.
Television items were generally short segments (range = <1–55 minutes, median =2 minutes). Most (85.7%) appeared on non-government funded stations, but 14.3% appeared on government funded stations. The majority (89.7%) were broadcast in the evening, with 8.5% appearing in the morning and 1.7% in the afternoon. Almost 4/5 (79.3%) were news items; the remainder appeared on current affairs shows.
Radio items also tended to be short (range = <1–57 minutes, median =2 minutes) and broadcast on non-government funded stations (71.9%, compared with 28.1% on government funded stations). However, they more commonly occurred in the morning (53.6%, compared with 29.8% in the afternoon and 16.5% in the evening). The majority of radio items (59.8%) were broadcast on current affairs programs rather than news bulletins (40.2%), often taking the form of talk-back.
Content
Table 1 shows that media coverage most frequently focused on policy/program initiatives (29.0%), such as government funding initiatives and mental health programs facilitated by community groups. The next most common content category related to causes/ symptoms/treatment of mental illness and mental health problems (23.9%). Media items in this category looked at issues such as recognition of symptoms associated with mental illnesses, treatment/management options for mental health problems and the aetiology of particular mental illnesses.
Item characteristics of media items surveyed for portayal of mental health/illness†
Mental health care or service provision was another frequent topic (17.5%), which covered issues such as the opening of new mental health services or current availability of services. Individuals' experiences of mental illness or mental health problems were also a common focus of media coverage (17.2%), as were research initiatives in mental health (16.9%).
Less frequent subject categories included opinion pieces about mental health/illness (8.5%) and statistical overviews of mental disorders in the population (7.0%). Items that used mental health language out of context or inappropriately (e.g. use of pejorative terms such as ‘mad’, ‘crazy’, or ‘insane’) represented a relatively small proportion (4.0%). A small group of items referred to mental disorders in the context of crime (5.6%).
Geographical location of story
Table 1 also shows that the majority of items (84.1%) mentioned a geographical reference point in Australia. Only 9.7% of items cited an overseas location and 7.8% of items did not relate to a specific geographical location.
At-risk groups
Overall, references to groups at risk of developing mental health problems were uncommon (Table 1). Young people (≤ 24 years) were the most frequently mentioned group, but even they featured in only 6.7% of items. Ethnicity was the least commonly referred-to demographic characteristic, representing 0.2% of items. Women (2.9%) were mentioned only slightly more than men (2.7%), and media coverage focused more frequently on residents in rural areas (1.9%) than in major urban (0.4%), other urban (0.6%) or remote locations (0.3%). A relatively large proportion of items (6.8%) referred to ‘other’ at-risk groups (e.g. new mothers at risk of postnatal depression and professionals at risk of work-related mental health problems).
Quality of media reporting
The 10% sample selected for quality rating contained 1343 media items, of which it was possible to rate 1130 (84.1%). Of these, 404 (36.0%) were newspaper items, 113 (10.1%) were television items and 606 (54.0%) were radio items.
Only those items that elicited a response of ‘yes’ or ‘no’ for a particular dimension of quality are presented here. It should be noted that such responses were more applicable to some dimensions than others, so ‘n’ does not always equal 1130. For example: ‘Is the headline inaccurate or inconsistent with the focus of the item?’ was only relevant to newspaper items. Responses of ‘yes’ and ‘no’ indicated poor and good quality, respectively, except in the case of the ‘help services’ dimension, where the direction was reversed.
Is the headline inaccurate or inconsistent with the focus of the item? (n = 401)
The vast majority of items (95.7%) did not have headlines that were inaccurate or inconsistent with the focus of the item, thus 4.3% did.
Is the headline or content unnecessarily dramatic or sensationalized (n = 1128)
In total, 70.5% of items were not found to be unnecessarily dramatic or sensationalized, while 29.5% were judged to be so. The majority of these included the use of terms such as ‘suffering’, ‘victim’, ‘afflicted’, ‘dangerous and debilitating’, ‘devastating’, ‘silent burden of disease’, ‘misery’, and ‘tragic affliction’. More extreme examples of sensational and dramatic language were less common, but included phrases such as ‘mental prison’, ‘satanic desecration spree’, ‘a threat to society’, ‘unhinged’, ‘a stabbing frenzy’ and ‘evil gun-toting sadist’.
Does the item use language that is outdated, negative or inappropriate? (n = 1128)
The majority of items (80.1%) did not use outdated, negative or inappropriate language, however, a minority (19.9%) did. Examples included: ‘cracked up’, ‘crazy lunatics’, ‘he went insane’ and ‘a psycho’.
Is medical terminology used inaccurately or not in the correct context? (n = 1040)
Only a small proportion of items (3.2%) used medical terminology inappropriately. Examples included the use of broad, overly inclusive phrases such as ‘everyone is depressed now’, ‘Minister for Depression’, and ‘the world is depressed’.
Does the item reinforce negative stereotypes about mental illness? (n = 1031)
The majority of items (85.6%) did not reinforce stereotypes about mental illness. The 14.4% of items that did, frequently made references to violence, crime and unpredictability. Some items made generalizations about people with mental illnesses, using terms such as ‘mentally ill offenders’, or stating that people with mental illnesses ‘should not be let loose in the community’.
Does the item emphasize the illness rather than the person? (n = 732)
The majority of items (80.1%) did not emphasize the illness rather than the person; however, a minority (19.9%) labelled individuals by their diagnoses (e.g. ‘anorexics’, ‘depressive’, ‘chronic schizophrenic’ and ‘psychotic people’).
Does the item imply that all mental illnesses are the same? (n = 969)
The majority of items (83.3%) did not imply that mental illnesses are all the same. The 16.7% that did tended to use undifferentiated terms such as ‘the mentally ill’.
Does the item provide information on help services and mental health referral services? (n = 1127)
Only a minority of items (6.4%) included contact details for help services (e.g. information about telephone help lines, internet sites, community organizations or support groups); 93.6% did not.
Does the item disclose that a particular individual has a mental illness, identifying the person by name? (n = 599)
The majority of items (71.5%) did not disclose that a particular individual had a mental illness, identifying them by name. However, a significant minority (28.5%) did, and in many cases it was difficult to determine whether the individual's consent had been given. Items that revealed an individual's identity were commonly court reports or stories about celebrities' experiences of mental illness.
Discussion
Our study provides substantial information about the extent and characteristics of media portrayal of mental health/illness in the Australian media. Its findings differ from what might have been expected from previous research and they have implications for strategies addressing media representations of mental health/ illness.
Coverage of mental health/illness in the Australian media was extensive, with over 13 000 items collected. This was unexpected, given the results of previous studies and may be partly due to the larger range of media types included in the current study, its more comprehensive data collection methods and its inclusion of a broader range of mental health topics. Alternatively, it may indicate that overall coverage of mental health topics in the Australian media is greater than that of other countries, or has increased since previous studies were conducted, perhaps suggesting a growing understanding of the significance of mental health problems.
There was variation in the extent of reporting of mental health/illness by media type, with most items coming from radio sources. Guidelines for reporting that are presented in both Achieving the balance [1] and Reporting suicide and mental illness [2] are largely applicable to newspaper sources. Written resources may be appropriate for print journalists/editors, who produce newspaper reports in advance with access to a variety of resources. Alternative strategies (e.g. training on presentation of information about mental health/illness) may be more relevant for other media professionals (e.g. talkback radio announcers), who may have little prior opportunity for accessing information.
Approximately one-third of all items referred to policy/program initiatives in mental health. By way of comparison, Hazelton's study of the Australian media found that items on ‘mental health reforms’ were common [4]. Reports about an individual's experience of mental health problems in the current study were less frequent, comprising 17.2% of all media coverage. Achieving the balance [1] and Reporting suicide and mental illness [2] focus largely on guidelines for the depiction of individuals with a mental illness in media items. Where coverage does not relate to individuals, these resources tend to be less applicable and may require refinement to ensure their relevance to a wider range of mental health topics.
Stories about mental health issues in the context of crime were relatively uncommon in the current study, representing only 5.6% of media coverage. This finding is at odds with the majority of previous research, which has suggested that themes relating to crime and violence are common in coverage of mental health/illness by the news media [4–6],[9].
Most media items were of good quality on eight of the nine dimensions measured. However, there were some areas that could be addressed in future media strategies. For example, more than 90% of media coverage did not include details of appropriate help services, which should be relatively simple for media organizations to remedy.
Other aspects of quality for which a substantial proportion of media items rated poorly were those related to sensationalism and respect for privacy. While most items that were rated according to these dimensions were found to be of good quality, almost 30% used overly dramatic language. A similar proportion identified particular individuals with a mental illness, although it is acknowledged that some of these may have done so with the permission of these individuals and may in fact have had a positive impact in terms of affirming the significance of their experiences. Future strategies designed to address media portrayal of mental health/illness should focus on methods to reduce sensationalist language and media guidelines should be clear with regard to individuals' rights to privacy.
The finding that the majority of media items rated well in terms of quality is at odds with the existing literature. Overwhelmingly, previous research has found that media coverage of mental health/illness to be associated with negative stereotypes and themes [4–15],[17]. For example, Hazelton [4] found that newspaper portrayal of mental health/illness largely conveyed negative images, with prominent themes of disorder, chaos and risk. Hazelton concluded that negative stereotypes and sensational or negative language were common in Australian newspaper articles on mental health issues in 1994, particularly those concerning de-institutionalization. We employed different analyses, but it is clear that sensational or negative terminology and imagery were not used in most items, including those from newspapers. This divergence might be explained by methodological differences between studies or by positive changes in reporting.
Study limitations
Our study was broader in scope than previous work and was designed to overcome past methodological issues, but it had limitations. First, the extent of media reporting may have been underestimated if items were missed by the retrieval agency (although it should be noted that the agency performed well against ad hoc checks in which items identified by an alternative retrieval service were used as the comparator). Second, the nature of media reporting may not be generalizable beyond the media sources selected for study. Generalizability may have been affected by over-sampling of suburban/regional newspapers in Victoria and the fact that about one-fifth of the 10% of items selected for quality rating were unavailable (and tended to be television and radio items broadcast on smaller stations for which it was not possible to retrieve full transcripts or video/audiotapes). Finally, the study relied on coders' interpretation of media items. Efforts were made to ensure consistency between coders, including uniform training, regular meetings to discuss issues of interpretation and interrater reliability checks, but coders may have interpreted information differently. Quality ratings required coders to distil the complexities of given items into single judgements. We acknowledge that different methodologies (e.g. a social constructionist approach [6], [12]) may have emphasized different aspects.
Future research
Our study raises a number of further questions. For example, future research could consider factors that may impact on quality, such as the breadth of coverage and the prominence of reporting. It could also examine the extent to which quality mediates the impact of reporting on public perceptions about mental health/illness.
Footnotes
Acknowledgements
The project received funding from the Mental Health and Special Programs Branch of the Commonwealth Department of Health and Aged Care and ‘beyondblue: the national depression initiative’. We acknowledge the input of members of the Media Reference Group.