Sunday, October 11, 2015

Changing the Dialogue in Mental Health Reporting

Pulitzer Prize winners, former cable news executives and local treatment providers recently gathered in Atlanta to discuss the media's depiction of mental illness, and what the industry can do to paint a more accurate portrait of those with disorders.

From left to right: Dr . Ray Kotwicki, Misty Williams, Andy Miller and Rebecca Palpant Shimkets at the Carter Center presentation "Words Matter: Talking About Mental Health" in Atlanta on Oct. 5. (Photo Credit: James Swift) 
By: James Swift

ATLANTA- In hindsight, the timing of the Oct. 5 Carter Center discussion “Words Matter: Talking About Mental Health” seemed eerily prescient. The talk was held just four days after the Umpqua Community College shooting in Roseburg, Oregon, in which nine people were killed.

As often the case when such tragedies arise, the shooter’s mental health history had become a much-speculated topic in national media accounts.

Atlanta Journal-Constitution health care reporter Misty Williams recalled a recent Los Angeles Times report in which a law enforcement official, just hours after the shooting, was quoted as stating the gunman had an unspecified mental illness.

“It was making a huge assumption without having actual knowledge of did this guy actually have a mental illness,” she said. “The media can run a little bit too quickly ahead of the story without really checking and seeing whether mental illness played a factor, especially in these horrific shootings.”

The media’s tendency to overgeneralize, sensationalize and sometimes misrepresent both mental disorders and those with mental illnesses resulted in the creation of the Carter Center’s Journalism Resource Guide on Behavioral Health. The resource, developed via funding from the Substance Abuse and Mental Health Services Administration, offers suggestions to reporters on how to more accurately discuss a litany of behavioral health topics as well as reduce the misconceptions surrounding individuals with diagnoses such as attention deficit disorder/hyperactivity disorder, generalized anxiety disorder and schizophrenia.

“When we talk about mental health and mental illnesses, we need to remember, first and foremost, that these diseases are embodied in people,” said Rebecca Palpant Shimkets, associate director for the Rosalynn Carter Fellowships for Mental Health Journalism at the Carter Center Mental Health Program. “They are our friends, our mothers, our fathers and loved ones … they aren’t just their illness, they are a person first.”

When Words Harm

Former CNN President Tom Johnson was the moderator
of the Carter Center's "Words Matter: Talking About
Mental Health" panel discussion. It is a subject he knows well:
he told attendees at the Atlanta Press Club-sponsored event
that he has battled depression for almost 30 years. 
Panel moderator Tom Johnson has had a long, successful career in the news business. The Macon, Georgia, native was the publisher of both the Dallas Times Herald and the Los Angeles Times before being handpicked by Ted Turner to take over the reins as director of CNN in 1990.

Since 1986, however, Johnson waged a secret battle. Despite his ascension in the media, he struggled daily with depression. His own mental health experiences, he said, has made him keenly aware of the stigma many with behavioral health illnesses, both diagnosed and undiagnosed, encounter on a regular basis.

Beyond being assailed with pejoratives like “lunatic” and “psycho,” he said those with mental illnesses often fear “opening up” about their disorders, believing such revelations may cost them promotions, security clearances and even their very jobs.

Georgia Health News editor Andy Miller – who said his own interest in covering mental health stemmed from seeing an illness manifest in his brother when he was in his early 20s – remembered hearing an MSNBC anchor use the term “crazies” in coverage of the Oregon shooting. While he understands the anger following such disheartening events, he said that kind of “misstated” terminology does little to deter those with malicious intents and only serves to further marginalize and shame those with illnesses.

Furthermore, he said many news reports don’t take into consideration the wide variance in how pronounced specific disorders may be for individuals – and the vital role access to treatment plays in determining the severity of the mental illness.

“You can have the same diagnoses on the top of a chart but how it affects someone could be vastly different,” he said, “and we can’t get around the idea of insurance coverage and being able to pay for treatment versus those who don’t have coverage … the different outcomes of those two groups can be very stark.”

Dr. Ray Kotwicki, chief medical officer of the Atlanta-based nonprofit treatment organization Skyland Trail, said a growing body of scientific literature indicates there is much more to mental illness than just neurology.

“Given the shroud of mysticism and moral indignation that a lot of people who have mental illness feel, and the misinformation that can be perpetuated through the media through the lack of science, I think facts are going to drive a change in the stigma,” he said. “We know through recent research that things like depression might actually involve the immune system … they have decreased heartrate variability and aberrations in inflammatory mediators that suggest to me this is a medical problem.”

Alas, while no one calls for cancer patients and those with diabetes to simply “motivate” themselves beyond their illnesses, Kotwicki said many people still believe those with mental health disorders have the ability to “snap out” of their conditions with enough willpower and encouragement.

That mentality, Kotwicki added, often dissuades people from seeking treatments.

“It’s the way that words are used that can set the stage for people to access care when they need it,” he said, “or contrarily, prevent them from securing care when they need it.”

Georgia Health News editor Andy Miller said watching his
brother's bout with a mental health disorder in his 20s sparked
his interest in reporting on the subject, which he said is often
misunderstood and misrepresented in the media. 
According to Johnson, who left the cable news juggernaut in 2001, journalists can make a tremendous impact by simply second guessing their sources and looking beyond the superficial layers of a story.

“It isn’t enough to talk to the first fire responder on the scene, or the first policeman on the scene,” he said, “or the first psychology or psychiatrist who just happens to be available, some of them, incidentally, who love the media exposure.”

With so much coverage of mass shootings, Johnson said it is often overlooked that the annual number of people who die by suicide is more than twice those who die by homicide. Similarly forgotten, he said, is that those with mental health disorders are actually four times likelier to be victims of crime than the general population.

For stories to alter public perception of mental illness and permeate the collective consciousness, Johnson said media company owners and publishers must first grasp the significance of mental health, not only as a public policy issue, but something that impacts their own bottom lines.

“Corporate America spends billions on insuring its equipment, its computers and its buildings, but is corporate America spending enough on its mental health programs?” he posed. “It is much better to have an employee who is being treated successfully come to work and put in a productive eight hours because they are now successfully on an antidepressant than to come to work and sit at a terminal and not really be functional.”

A Slew of Policy Questions

Among those attending the event was Hank Klibbanoff, former managing editor of the Atlanta Journal-Constitution and current Emory University professor. His book, The Race Beat, won the Pulitzer Prize for History in 2007.

Like Williams, he said he is a proponent of depicting mental illness in a fashion that is “frontal” without being hurtful. Recalling fellow Pulitzer Prize winner Jack Nelson’s exposé on abuses at Georgia’s Central State Hospital – at one point, the largest mental health facility in the nation – he said the media has certainly proved itself capable of eliciting seismic changes in how the mentally ill are systemically treated.

With mental health impacting everyone from soldiers to inmates, on a developmental continuum ranging from pediatrics to geriatrics, he emphasized the need for mental health professionals to aid and assist legislators to keep public policy from entering a “Twilight Zone where we stigmatize everybody, and anyone who acts a little quirky suddenly can’t get a gun.”

In terms of access to treatment, Kotwicki said there is still much to be done. Although the 2008 Mental Health Parity and Addictions Equity Act expands coverage of mental health and substance use disorder treatment, many seeking insurance for residential support and continuous outpatient services remain left in the cold.

Additionally, he said the Act does little to ensure people get “evidence-based-respectful-care” in a timely fashion even if they are covered.

He recalled Rosalyn Carter once describing the Los Angeles County Jail as the nation’s biggest mental health clinic – a statement that, considering the high percentage of inmates in the U.S. with mental health disorders, isn’t necessarily a remark made in jest.

From a public safety standpoint, he said he supports crisis intervention training, which educates first responders to differentiate individuals committing crimes out of “malice” from those committing crimes due to a symptom of mental illness. Tens of thousands of police officers, he said, are already involved in such programs throughout the United States. 

Johnson said he would like to see a brighter spotlight placed on teens and adolescents with mental disorders. “You talk to these kids and they may have anxiety disorders and they are dabbling in drugs, they may have depression and they are susceptible to suicide,” he said. “We have a lot of programs for alcohol and drug addiction, but we need a center so that parents can take their children, particularly for complex and very severe cases.”

Skyland Trail President and CEO Beth Finnerty said her organization is in the process of building a new facility to treat young adults in the 18-25 age range. However, despite a growing movement within Atlanta to expand treatment access, she said options for younger people remain few and far between. “There is a severe shortage of services available for children and adolescents,” she stated.

Lyn Vaughan, a risk communicator and public information officer for Fulton County Health Services who once worked under Johnson as an anchor for Headline News, said there are some services for teens and children in the area, such as the Oak Hill Adolescent & Family Center and the Fulton County Clubhouse for Youth. Still, she agreed there needs to be more programming available to meet the mental health needs of the severely underserved population.

“Health Services recognizes that this is a problem,” she said. “So how do we partner with media and how do we partner with providers to make better use of all our services?”

Putting a Face to the Issue

Atlanta Journal-Constitution reporter Misty Williams
said those with mental health disorders are routinely
stigmatized. She recalled interviewing one man in Oregon,
whose mental health disorder  led some members of his
church to assume he was demonically "possessed." 
Only affording coverage to mental health issues in the wake of grim episodes like the Oregon massacre, Kotwicki said, reinforces the idea that those with mental health disorders are a cultural other.

“I think there is a defense mechanism of utility to say ‘this is them and this is me, and I’m nothing like them and they will never be me,’” he said. “I think it is about education and the anti-stigma efforts and knowledge and having dialogue, but there is something we are going to have to surrender as a community ... to say ‘bad things happen, we can’t understand why, but it doesn’t mean these are not people within my community.’”  

With mental illness impacting one out of five Americans, Williams – herself, a Carter Center Mental Health Journalism fellow – said the issue is an increasingly important one in the American health care discussion.

“Mental illness is so complex and it often entails really complicated health policy issues,” she said. “Even if you don’t know someone with a mental illness, it’s still an economic issue.”

To truly tell the tale of mental illness, however, she said reporters have to go out of their way to portray people with disorders as fully fleshed out individuals. “Finding people who are willing to share their stories in an open and honest way, it takes a lot of time, but it is incredibly important,” she said. “It really resonates with readers and helps them to connect something that might not affect them in a very real way to understand.”

That can pose some very specific challenges. When writing about those with illnesses – such as an interview she conducted with the mother of a 21-year-old who shot himself in the chest -- she said she strives to find a balance between “sensationalizing” and “sugar-coating” the story. She also said she usually reads back passages she penned to the families, which is something she never does for politicians and service providers.

While Miller said individuals with mental health disorders today are much likelier to go on the record about their experiences than two decades ago, the long-held “stigma” surrounding mental illness still persists.

Williams encountered that firsthand doing a story about Oregonians with mental health disorders who acquired health care coverage via their state’s Medicaid expansion.

“I was talking to one man and he grew up in a fundamentalist church, and some people in his church actually thought he was possessed,” she said. “As a teenager, his parents ignored it and he spent most of his teenage years holed up in the basement of his house, because his parents thought it would just be something they could ride out and it would just kind of pass.”

Sklyand Trail Chief Medical Officer Dr. Ray Kotwicki said
media interest in mental health disorders peaks in the
aftermath of mass shootings, then all but vanishes.
"We don't get interviewed when there aren't tragedies," he
Spelling out how misconceptions hurt those with mental illnesses – the alienation, the loss of friends, the feelings of unworthiness – can go a long way in changing public attitudes, Williams said.

Despite mental illness affecting millions of Americans, however, she said many politicians only address the subject as a way to circumvent discussion of more controversial policy issues, like health care reform and gun control. At the same time, they tend to oversimplify the issue, completely overlooking how things such as race, socioeconomics, gender and previous exposure to violence factor into a broader portrait of mental health.

“You get a lot of politicians who are suddenly saying ‘well, we need more resources for mental health,’” she said. “Well, they weren’t saying that before the shooting, and it’s probably going to tailor off.”

That’s one of the reasons why Kotwicki believes the national discussion surrounding mental health needs to take place outside the parameters of mass violence.

“The day after a school shooting, there is a line of media people waiting to talk to me about diagnosing the shooter,” he said. “We don’t get interviewed when there aren’t tragedies.”

Uncommon Journalism, 2015.

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