How News Coverage of Mental Illness and Violence Affects Us: Issues, Ethics and Solutions
This paper was written June 5, 2020 for JOUR 351 Mass Media Ethics taught by Dean Wright at Western Washington University.
Introduction
In 2018, 14 teenagers and three adults were killed when a former student returned to Marjory Stoneman Douglas High School in Parkland, Florida with an AR-15. After the initial shock of the shooting, a cascade of news articles dug into the shooter’s background and reported on the voices of politicians, grieving families, and survivors who clamored about what was to blame. Some blamed gun regulations. Some blamed mental illness. In more recent news, parents of victims sued a mental health facility that treated the shooter for years, claiming that the facility should have warned the school about the shooter’s mental issues and violent tendencies. Nine days ago, on May 27, 2020, courts ruled against the suit. Regardless of the ruling, this case once again brought up the violence of the shooting and connected it to mental illness.
Serial crime, mass shootings, domestic violence incidents, suicides. All of these are often the topic of news stories. All are often tied to mental illness in those stories. This paper will explore how news coverage of mental illness in the United States disproportionately connects it with violence and what the effects of this are on society and individuals. It will also discuss the ethics of covering mental illness as a reporter and what we can do to make coverage of mental illness less problematic.
News Links Mental Illness to Violence
In 2016, a team of researchers affiliated with Johns Hopkins University published a survey of articles mentioning mental illness from six high-circulation United States newspapers. The survey, “Trends in News Media Coverage of Mental Illness in the United States: 1995-2014,” found that 55% of the articles linked mental illness to violence of some sort. Interpersonal violence was mentioned in 38% of the articles and self-directed violence, typically suicide, was mentioned in 29%. In contrast, 14% of stories mentioned successful treatment or recovery from mental illness. The survey also found little to no change in these ratios from the first decade in the survey (1995 to 2004) to the second (2005 to 2014). The exception to the otherwise stagnant ratios was the frequency that mass shootings were mentioned in articles, increasing from 9% of all surveyed articles in the first decade to 22% in the second, which may be more related to an increase in mass shootings in the United States than reporter choice.
In addition to tracking the rate that mass shootings were mentioned in conjunction with mental illness, the study also logged how often other types of interpersonal violence were mentioned. Gun violence (not including mass shootings) was mentioned most, accounting for 27% of mentions of interpersonal violence. Mass shootings were the next most frequent, followed by domestic incidents at 14% and school shootings at 9%. If you take a more bird’s eye view on this, the vast majority of articles that mention mental illness and violence, link it to the sort of large-scale gun violence that affects innocent lives. Possibly because of the effect stories about that sort of gun violence make on the national news scene, articles linking mental illness to interpersonal violence are 17% more likely to be found on the front page than in the ‘90s. Worse than the increased negative exposure to stories that create unspoken connections between violence and mental illness, is the 38% of stories surveyed that directly stated that mental illness increases a person’s chance of being violent toward others. Only 8% of stories surveyed stated the opposite, that most people with a mental illness are, in fact, not violent or dangerous. Given these findings, the researchers concluded, “coverage has continued to emphasize interpersonal violence in a way that is highly disproportionate to actual rates of such violence among the US population with mental illness.”
A Very Casual Study of Current News
Since the survey only included data up to 2014, I undertook a (very casual) survey of my own in the hopes that coverage has shifted some in the intervening six years. Cautiously, I conclude that it has not. I used Google News to search for articles mentioning “mental illness+news” from the first three days of June. I also searched for articles mentioning specific mental illnesses, including schizophrenia, depression, and OCD. With the pandemic and protests at the forefront of the news cycle currently, the results were flooded with articles on rising rates of depression and anxiety or recommendations on how to cope given the current circumstances. The next largest group of articles were on new psychological scientific discoveries and emerging treatments. After sifting through those articles to find ones about individuals, the articles I found were universally negative and mentioned violence.
Even the articles related to current events and science were usually negative. Many were focused on depression from isolation and anxiety and hopelessness about the state of the economy. Others were about race-related grief, fear, anger and guilt. One story in particular, “Floridians with no History of Depression are Suffering Amid Coronavirus,” checked all the negative boxes on my list, with negative statistics, general pessimism, the possibility of self-directed violence due to depression about pandemic-caused economic woes, and absolutely no seeds of hope. The stories that were closest to positive were the ones detailing new research and treatments. Even then, they tended to focus on how many people were suffering from a condition rather than framing it as how many people could be helped by a new treatment.
Still, those articles were vastly more positive than the few about individuals I found. For each individual described as having a mental illness, not one had a positive outcome. All four involved interpersonal violence and two involved the death of the mentally ill person. In one, the family of Miles Hall is holding a tribute for the black 23-year-old who was killed by police after he threatened relatives during a mental health crisis in a distorted echo of recent events. In another story, “Supe Calls for Hearing on COVID-19 Inpacts on Homeless Mental Health After Glen Park Killing,” a community official connects mental illness, homelessness and the murder of a local elder. A third article reports a murder-suicide by a man with a laundry list of mental health issues including depression, possible OCD, issues from alcohol abuse, and “‘horrific’ sleep deprivation.” The final story, “NSW ‘Killer Thought he was Queen’s Agent’,” describes a man with chronic delusional disorder who killed a stranger while believing that he was a secret agent for the British queen. In each of these stories, mental illness is directly linked to at least one death.
Admittedly, there is a connection between some psychological conditions, like intense schizophrenia and antisocial personality disorders, and interpersonal violence, especially the sort that makes the news. “Mental Illness and Violence: Lessons from the Evidence” notes that “young adult perpetrators of mass shootings often meet criteria for [severe and persistent mental illness] at the time of the shootings.” Given the possibility for violence with severe mental illness, and, as mentioned in “Mental Illness and Violence,” the fact that almost half the population will deal with some symptoms of mental illness at some point in their life, “the journalist’s search for a mental illness explanation of aberrant acts will almost always succeed.”
Despite that, only 4% of interpersonal violence is actually attributed to mentally ill people (McGinty). One reason is that people with severe mental illnesses that can be connected to violence only make up a small portion of the mentally ill population, let alone humanity as a whole. For example, people with schizophrenia make up .25% to .64% of the US population according to the National Institute of Mental Health, and that includes minor schizophrenia that is not at the level where violence becomes more likely. In fact, people with mental illnesses are more likely to be the victims of violence than perpetrators. The article “Study: People with Mental Illness are Five Times More Likely to be Murdered” from The Atlantic summarizes the findings of a Swedish study that followed seven million adults over seven years. It discovered that people with mental illness are 4.9 times more likely to be victims of homicide than the general population and hypothesized that they are also four times more likely to be non-fatally victimized.
Consequences of Connecting Mental Illness and Violence
The disproportionate and flawed linking of mental illness to violence in news coverage increases misunderstanding of mental illness, creating stigma and fear. “Perceived Media Influence, Mental Illness, and Response to News Coverage of a Mass Shooting” studied people's responses to the coverage of the 2007 Virginia Tech University mass shooting. When the paper was published in 2017, this was the deadliest school shooting in American history with 33 dead (including the shooter) and 15 wounded. In the media coverage, the shooter’s previous hospitalization for mental illness and accounts of “disturbing behaviours” witnessed by others before the shooting were discussed extensively, though his official diagnosis wasn’t made public. Coverage clearly connected mental illness and danger and for many people without experience with mental illness, whether their own or that of family and friends, that reinforced stereotypes and made them afraid. Then, as the study’s authors put it, “fear motivates self-protection,” which comes in the form of avoiding potential threats and othering of groups perceived as a threat. Simply, fear leads to stigma.
Stigma has several effects. For one, social stigma is correlated to less support for policies helping people with mental illnesses among the public (McGinty). Second, it affects how likely people with mental concerns are to get help. “Perceived Public Stigma and the Willingness to Seek Counseling: The Mediating Roles of Self-Stigma and Attitudes Toward Counseling” outlines the effect that external stigma has on internalized stigma. The study found that the degree of internalized stigma a person holds is what predicts how willing they are to get counseling, and that more external stigma often leads to more internalized stigma. In this way, attitudes of people who do have mental illness experience may also be affected by the increase in public stigma that comes from news coverage linking mental illness and violence. In addition, people with mental illness are less willing to do things that support their mental illness and more likely to “refrain from seeking social support” if they perceive that the coverage has increased others’ negative perceptions of mental illness. It may also cause people to keep the fact that they’re dealing with a mental illness or receiving treatment a secret (Hoffner). This impact on people’s willingness to seek social support because attitudes about mental illness have been negatively affected by news coverage may be equally, or more impactful on their mental health than less willingness to seek professional help.
Ethics of Reporting on Mental Illness
The main ethical dilemma of how to properly report stories involving mental illness can be framed as a conflict between two principles from the SPJ Code of Ethics: Seek Truth and Report it, and Minimize Harm. Following the first principle, a reporter should include all relevant details to a story, whether or not they are adding to a corpus of stigmatizing articles that disproportionately show mental illness as connected to violence. Following the second, a reporter might omit some details or frame the issue carefully as to not propagate stigma and negative patterns of mental illness representation in media. That being said, when not confined to binary thinking, there is an option in the middle that satisfies both: include all relevant facts and also context about mental illnesses, such as how very few people with mental illnesses are violent. Thinking about it, those are also part of the truth you should report.
There are also other ethical paradigms that this core dilemma can be analyzed through that raise new considerations. One, which is more of a wrong vs. wrong, frames the question as an individual vs. community dilemma, or more accurately a minority vs. larger society dilemma. On the side of the individual is a person with mental illness or the community of people with mental illnesses. On the side of the community is the larger group of people in the area who are invested in hearing the story. The individual is interested in limiting stigma, especially when “individual” means closer to “small group.” The individual is also interested in maintaining their privacy. Maintaining privacy can also be a concern for the people who know the person the story is about, as opening the door to reveal one person’s skeletons in the closet can also reveal shared skeletons. Typically, when there is a violent incident, especially one connected to serial or mass violence, the perpetrator’s background is included as part of the story, but bareing their mental health history and past traumas can also expose those of people whose lives intersect with theirs. The community is interested in knowing the story, both for lurid curiosity and community safety. In some cases, withholding details could keep the community from making itself safer from this or similar threats in the future. For example, knowing details about a school shooter could give the community places to start to prevent similar violence going forward.
Alternatively, the situation at hand could be one that puts mental health in a positive light. The individual and their close connections are still interested in privacy and the community in understanding what is happening. The difference is that stigma isn’t a concern any longer. In fact, both the individual and community could benefit from mental illness being associated with a positive situation, like recovery. This other consideration here is more of an ethical inconsistency than a dilemma. Why are we more okay with digging into a person’s background if there’s been an incident or death but not when it could help counterbalance negative representation?
A final ethical paradigm to use to analyze this dilemma is a short-term vs. long-term one. This one looks at the effects on the larger community of giving details connecting mental illness with violence. In the short term, the community gets closure, understanding of what happened and their understanding is satisfied. However, this might be a case of curiosity killing the cat with no eventual satisfaction to bring it back. In the long term, the community has to deal with the effects of stigma on society. Recalling that social stigma lessens willingness to seek professional help or social support and nearly half of people experience symptoms of mental illness in their lifetime, stigma’s effects could be felt in the larger community as a host of social ills, including broken relationships and families, substance abuse, increased violence and health issues (mental health and physical health have a symbiotic relationship). Utilizing ends-based thinking, not connecting mental illness to violence, or at least including vital context, is a pretty clear better choice here.
Like there is a more right choice when using that paradigm, it is also worth noting that there are some parts of this conversation that are not true right vs. right or wrong vs. wrong ethical dilemmas. For example, stating that mental illness increases the chance that a person will be violent without any qualifiers on which illnesses that applies to (depression doesn’t make people more likely to be violent) and how often that happens, is a wrong choice and not the better of two bad options.
Solutions: AP Style, Context and Positive Information
In 2013, the Associated Press Stylebook added an entry on mental illness. I didn’t notice the impact of the new guidelines on articles when I was doing my personal survey of news, but I’ll admit that the survey was far from thorough. In addition, it included articles from areas outside of the Associated Press’s direct influence. AP’s mental illness entry from 2019 includes instructions to get mental health information from the most direct source possible, the person the story is about is the best option if available. The stylebook especially warns to avoid “unsubstantiated statements by witnesses of first responders attributing violence to mental illness” and to use a disclaimer if they are used, especially if there is no other proof of mental illness to back it up. This was an issue in the articles I described earlier where a homeless man killed a local elder. The main source made claims about the homeless man’s mental health without solid outside verification. The same critique applies to coverage of the Virginia Tech shooting, where the evidence that the shooter was mentally ill were a past hospitalization for mental illness (which may have been for a completely different reason than whatever drove him to shoot people) and several strange things he said in days preceding the shooting, which could easily have been misunderstood or more concerning out of context. Given that, linking the shooting to his unidentified, potential mental illness is a questionable choice with what we know about stigma that arose from the coverage of the incident.
Another guideline from the AP Stylebook entry is to never assume that mental illness is a factor in a violent crime. Like “Mental Illness and Violence” pointed out, if a journalist is looking for that explanation, they’ll find it. It also points out that most violence is not the fault of mental illness and most mentally ill people aren’t violent. The stylebook also instructs journalists to only include a description of an individual as having a mental illness if it is “clearly pertinent to the story.” The study “Media Depictions and the Priming of Mental Illness Stigma” illustrates why this is important. The study had participants read stories about incidents and then summarize them from memory. When stories mentioned mental illness at all, participants were prone to assuming it was a cause for the incident. For example, in the retelling of an article that included a throw-away line saying that a person has a history of schizophrenia one participant wrote that “the schizophrenic guy had an episode of some sort.” Notice that the line mentioned a history of schizophrenia, not a current struggle with it, and that the schizophrenia didn’t actually have anything to do with the incident. In this case, the reporter should have never included the detail about schizophrenia. Very little of the blame belongs with the reader, it makes sense that a reader would assume that the mental illness has to do with the incident, why would it be mentioned otherwise? Still, just one mention of a mental illness in a story, whether the mental illness is connected to the incident or not, can “spark off stereotypical beliefs” and affect how readers remember the story, so reporters need to be careful.
These guidelines should help avert many of the issues about reporting on mental health, but there are still other things journalists could do better at to improve the representation of mental illness in news. The first thing is to always make sure to include context about mental illness, specifically the mental illnesses mentioned in the article. A good example of doing this context sandwich is the article from The Atlantic about people with mental illnesses being the victims of homicide more often than the general population. It mentions that there had been violent incidents recently that were connected to mental illness, but also includes a statement with stats showing exactly how uncommon that is. The second thing journalists could do is include resources and strategies to live with mental illness when one is mentioned. This is more common than other solutions as it just requires inserting a hotline number or link to another article. To make this more impactful, include information on positive outcomes from the resources you are including. Another thing to do is to consider framing articles about new treatments or facilities being built or new science more positively by focusing on potential positive outcomes rather than why they’re so desperately needed.
Generally including more positive framing and stories will possibly help the most. Traditionally speaking, someone’s recovery isn’t a particularly newsworthy incident, at least not in the immediately dramatic way that a death is. News’ bias toward conflict means that stories with violence get front-page treatment, where more positive, feel-good stories get shunted to the feature section. However, reversing that bias on occasion or purposely seeking out newsworthy, yet still positive, stories mentioning mental health could help shift the balance. An article that could fit the bill is “16-year old Teen with OCD Creates Book to Help Others with Disorder.” I found this article while doing my survey of articles, and while it is from outside my target date range, it is an example of a story about individuals with mental health that is positive and also newsworthy. In the story, a mother and daughter who both have OCD have written a children’s book to help kids with OCD understand what is going on in their heads and cope better.
Conclusion
More positive news about mental illness presents a counterpoint to all the negative portrayals of mental illness in the media and can have far-reaching effects. The study of articles mentioning mental illness from 1995 to 2014 says it this way: “depictions of people with mental illness receiving successful treatment and living productive lives decreases levels of social stigma.” As discussed earlier, levels of stigma affects internal stigma, which affects how willing people are to reach out for support, so reducing stigma could have a huge ripple effect. All in all, including more context, less negative framing and more positive outcomes for people with mental illness in the news stream can provide a counterbalance to all the negativity and stigma created by linking mental illness to violence, help them better understand the complex issues involved and give people hope.
References
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Articles Surveyed
Anderson, Elisha. “Attorney: Man Accused of Threatening to Kill Whitmer, Nessel has Mental
Health Issues.” Detroit Free Press, June 3, 2020.
Chetam, Kristen. “16-year old Teen with OCD Creates Book to Help Others with Disorder.” 7
News by CNN (Spartanburg, SC), March, 9 2020.
Cox, Michael. “Vulnerable Upminster Woman not Protected at Night before Son Killed her,
Coroner Says.” Romford Recorder (Romford, United Kingdom), June 3, 2020.
Prieve, Judith. “Family, Friends to Hold Tribute on Anniversary of Shooting Death of 23-year-old by Walnut Creek Police.” East Bay Times (San Francisco, CA), June 2, 2020.
Rhodes, Wendy. “Floridians with no History of Depression are Suffering Amid Coronavirus.”
The Florida Times-Union (Jacksonville, FL), June 1, 2020.
“Supe Calls for Hearing on COVID-19 Inpacts on Homeless Mental Health After Glen Park
Killing.” Bay City News Service (San Francisco, CA), June 3, 2020.
Westoll, Nick. “Regis Korchinski-Paquet’s Death Reinforces Need for Major Mental Health,
Policing Reforms: Advocates.” Global News (Toronto, Canada), June 2, 2020.
Zemek, Steve. “NSW ‘Killer Thought he was Queen’s Agent’.” Australian Free Press, June 3,
2020.