In another lifetime, I did PR for Big Pharma and flacked for some of the biggest names in academic medicine and patient advocacy. That’s what landed me in healthcare journalism nearly 20 years ago. Today, I’m also an emergency department RN, weathering the impact of developments in the healthcare marketplace—in the real world, in real time, with real people. The good people at CJR.org have now decided to add my voice to the Second Opinion roster. My charge—to monitor media coverage of public health, quality of care, and determinants of health. This first post touches on all three.
Hats off to NPR’s “Tell Me More” host Michel Martin for avoiding the sensationalism often associated with mental illness on a Jan. 23 broadcast, which offered reasonable experts having a reasonable discussion on the relationship between mental healthcare and gun violence. Despite its news hook—which ties into to both horrific mass shootings and the ensuing heated political debates over gun control—Martin’s program adds to a decades-long trend toward more intelligent, less stigmatizing coverage of mental illness.
Hats off, too, to Huffington Post’s Jeffrey Young for a fact-packed Jan. 31 article that covered similar terrain, and to The New York Times’s Erica Goode and Jack Healy for their well-balanced piece today on the implications of proposed changes in mental health policy. Goode, it’s worth noting, is one of a handful of veteran healthcare journalists who have been covering this story in some form for more than 20 years. During that time, she and her colleagues have relied on a group of experts and advocates who have dedicated their lives to changing the way we think and talk about mental illness. Young, in his article, and Martin, in her program, did the same.
Martin, Michael Fitzpatrick of the National Alliance on Mental Illness (NAMI), and Dr. Carl Bell of the University of Illinois School of Public Health launched their discussion with an excerpt of President Obama’s recent remarks on gun violence legislation, punctuated by a well-documented conclusion: People with mental illness are more likely to be victims of crimes than perpetrators. By using that clip, Martin made it easier for listeners to keep open minds about what they were about to hear, and establish a picture of people with mental illness that extends beyond James Holmes, the Aurora shooter. [Full disclosure: I worked for NAMI in the early 1990s.]
HuffPost’s Young included similar statistics—and added that “people with mental illnesses are responsible for no more than 5 percent of all violent acts in the United States.” Nevertheless, the public health impact of mental illness and gun violence can’t be ignored when some killers’ histories reveal varying levels of unsuccessful interfaces with the mental health system, as Goode and Healey also acknowledged.
That is a responsible way to tackle the violence issue—and it leads to the conclusion that, as the headline of Young’s piece declares, “Mental health solutions alone can’t thwart gun violence.”
It’s also a responsible way to talk about mental illness more broadly. One of the welcome developments that sets today’s media coverage of mental illness apart from previous work is its apparent disdain for the mythology and misinformation promulgated by the Citizens Commission for Human Rights, an anti-psychiatry group backed by the Church of Scientologists. CCHR has spent years and massive amounts of cash trying to discredit a wealth of published scientific research demonstrating that mental illnesses such as schizophrenia, bipolar disorder, and major depression are diseases of the brain, not the mind, and deserve to be treated the same way as other medical conditions.
Martin’s NPR segment in particular was notable for reflecting a public education effort that, although inhibited by the historic stigmatization of people with these illnesses, has been vital in securing access to and insurance coverage for quality mental healthcare. That is the main thrust of advocates’ fight for a more cohesive community mental health system and to sharpen the teeth of a federal mental health parity law enacted in 1997 and updated in 2008 that enables people with brain diseases to have the same access to care as those with diabetes, heart failure, asthma, or any other chronic illness.
These developments would have been impossible without “normalizing” mental illness in day-to-day conversation, according to NAMI’s Fitzpatrick. He and Bell focused on the importance of early identification of at-risk individuals and early intervention in their care. That mirrors similar language in the White House’s rhetoric on the role of better, earlier mental healthcare in violence prevention (though, as Young’s HuffPost story emphasizes, an exclusive emphasis on mental illness is “unlikely to achieve a significant reduction in gun violence”). And it’s echoed in the language of every iteration of mental health parity legislation debated and enacted by Congress. In many cases, responsible media coverage has helped to accelerate the pace of “normalization”—a dynamic that echoes public discussion of other medical concerns.
Early identification. Early intervention. Sound familiar? Those are precisely the words used by advocates and researchers—and picked up by the media—to destigmatize cancer and AIDS. (For some of you younger folks, it’s true—people thought you could “catch” cancer and it was rarely discussed in public.) Just look at the effects of that normalization during the past 30 years: billions in public funding poured into research, education, and treatment; sophisticated legislation protecting cancer patients and their families; empathetic media coverage that is open to the insights of advocates and researchers.
There’s a clear path that will allow the media to continue to do the same for mental illness. Like Michel Martin, choose reasonable people to interview about relevant topics, such as the relationship between mental health and gun violence—which we may soon be learning more about, after the Obama administration’s directive to lift the ban on CDC-sponsored gun violence research. Find success stories of treatments and services that work instead of sensationalizing an isolated case or event. There’s a mountain of peer-reviewed research out there; learn how to use it accurately. Be judicious in covering the ever-growing supply of personal narratives. Check out some of the great work done by Carter Center’s Mental Health Journalism Fellows. And for goodness’s sake, quit using the word “schizophrenia” unless you’re talking about the actual disease. That’s just being lazy.