How Leeds primary care trust tackles mental health stigma

This article describes the innovative approach taken by Leeds Primary Care Trust and the city’s social services, the voluntary sector and service users to tackle negative portrayal of mental health in the media. An evaluation has shown that, by working with media producers and increasing the media skills of service users, more intelligent, positive coverage can be achieved.

One of the many barriers to inclusion that mental health service users face is stigmatising press and broadcast coverage. But Pauline Bispham and Ian Cameron have a vision to promote compassionate, informed journalism on the subject

The prime minister has described how tackling social exclusion is at the heart of this government’s mission.(1) There is also acknowledgement that adults with mental health problems are one of the most excluded groups in society. The proposed action focuses on securing employment for those with severe mental health problems as the key to breaking the cycle of disadvantage. This approach is to be welcomed.

However, an earlier government report highlighted that stigma and the resulting discrimination are the greatest barriers to social inclusion for this group.(2) Without a significant shift in the way our society responds to mental health issues, the government’s aspirations will be doomed.

Crucially the media have a role in fuelling stigma of people with mental health problems. Forty per cent of the public associate mental illness with violence – a belief fuelled by media coverage.(3) A recent survey by the SHIFT anti-stigma campaign showed that homicides and crimes were the most common themes in print and broadcast items on mental health.(4) Focus groups of broadsheet and tabloid readers merely reinforced earlier findings that some methods of reporting increased fear. The notorious Sun headline, “Bonkers Bruno locked up”, highlighted the derogatory way some parts of the media view mental health.

In response, agencies and individuals involved in mental health services in Leeds took a bold decision to work together tackle this. In 2003 a media officer was recruited to promote positive images of mental health and reduce negative and stigmatising coverage. The person hired to lead this drive had experienced severe depression. The vision was to promote more intelligent, informative, compassionate journalism.

To increase confidence in handling the media, 60 service users took part in training courses, which included input from local journalists, on the type of articles or broadcasts they would welcome. Deciding whether to engage directly with the media is also part of the training. Mental health service users have expertise in their own experience so, to offer fresh perspectives, it is important that their views should get media coverage. The successes and achievements of those living with mental health problems need to be highlighted to counter the stereotypes of violence or helplessness. The media officer went public about her own experiences in the local press, complete with large picture, as a vehicle for discussing society taboos on mental health. Considering how one will be supported before, during and after media contacts is part of the training. One-day media courses were followed by more specific sessions on writing skills and radio skills in collaboration with the BBC.

Media Minders

Since then, Leeds has set up a Media Minders group of service users and mental health professionals to watch what is covered in the press and on radio and TV. We write letters of praise or complaint depending on the angle on mental health. We have also produced a booklet to encourage people to respond.(5)

In evaluating the work, we have achieved a 60 per cent success rate with articles and broadcast ideas taken up by the media. We researched coverage of mental health issues in the two regional newspapers. This showed that, in 2003 and 2004, 18 per cent of items on mental health included the opinions of users and carers compared with only 6 per cent of articles in 2002. At a local and regional level we have found more willingness to cover mental health, even in positive editorials calling for the end to stigma and ignorance.

This approach has included forging links with local universities that offer degrees in journalism. We ran sessions with Leeds University undergraduates to raise their awareness of positive and intelligent reporting on mental health issues.

Intelligent, compassionate and informative journalism means a willingness to discuss difficult issues – and radio is a powerful medium. By linking into a community station, we created opportunities for school students to develop their presenting and interviewing skills and raise awareness of mental health issues.

Actor Steve Huison, who played the depressive Lomper in The Full Monty, promoted a play on Radio Leeds on the subject of psychosis, funded by Leeds PCT. The interviewer then talked about his own experience as a carer to his mentally ill father for 20 years.

Signs of progress

The evaluation showed that this type of work is best based in the voluntary sector, where a degree of independence from statutory services will allow more grassroots working and greater freedom of expression.6 At times, there have been tensions around satisfying the expectations of some service users who feel the media should be used to challenge service delivery, and around the concerns of the statutory services that their moves to modernise will not be fully represented in articles written and interviews given.

Nationally, there has been progress. The Shift survey has shown that all types of media carried some sensitive, balanced and thoughtful coverage of mental health issues. However, there is now a risk of a division into “acceptable” (depression and stress) and “unacceptable” (severe and enduring) mental health issues. We need to move away from constructing stories from a public safety perspective to recognising serious mental illness as a major public health issue affecting more than half a million people in England. At the same time, recovery is a story that also needs telling.

In recent years there have been significant changes in the media, from the proliferation of multi-channel television and 24-hour news channels to immediate news access online or through mobile phones. There have been many predictions of the imminent demise of the printed word and the disappearance of newspapers. Over the next few years there will be more demands on people’s time and continued circulation decline.

At the same time, audiences have become more fragmented and there is a greater tendency to pull information rather than have it pushed towards one. There is much talk of citizen journalism using podcasts, blogs and the YouTube site.

But evidence suggests that newspapers are likely to co-exist with the new media in the same way that radio and cinema have co-existed with television. And amid this change, challenging the myths about mental health is still crucial. So is encouraging intelligent, informed debate.

We have shown that local action through funding and supporting people with experience of mental health problems can make a difference. This is going to be a long haul. The challenge now is to include redressing the negative portrayal of mental health in the media, both locally and nationally, as an intrinsic part of tackling social exclusion. If not, future inquiries will continue to bemoan the lack of progress on the government’s mission against social exclusion.

Dr Ian Cameron is director of public health at Leeds Primary Care Trust. He has had extensive involvement in the commissioning of mental health services and in mental health promotion.

Pauline Bispham is media officer for Positive Mental Health at Leeds Primary Care Trust. She has worked in the public and voluntary sectors in roles embracing economic development, policy development, public relations and public health.

Training and learning
The authors have provided questions about this article to guide discussion in teams. These can be viewed at www.communitycare.co.uk/prtl and individuals’ learning from the discussion can be registered on a free, password-protected training log held on the site. This is a service from Community Care for all GSCC-registered professionals.

References
(1) Reaching Out: An Action Plan on Social Exclusion, Social Exclusion Task Force, 2006
(2) Mental Health and Social Exclusion, Social Exclusion Unit, June 2004
(3) Glasgow Media Group, “The impact of the mass media on public images of mental illness: media content and audience belief“, Health Education Journal, 53, p271-281, 1994
(4) Mind over Matter: Improving Media Reporting of Mental Health, CSIP/SHIFT, 2006
(5) Mental Health and the Media – Have Your Say, Leeds primary care trusts and Leeds Council, June 2006
(6) Tackling Stigma and Discrimination: Evaluating the Role of the Media Officer for Positive Mental Health, Leeds primary care trusts and Leeds Council, June 2006

This article appeared in the 22 February issue under the headline “The media get the message”