The portrayal of mental health in Irish mainstream news media

Abstract

Objectives:

The portrayal of mental health in the mainstream news media is an important topic for discussion. Concerns about stigmatisation of those suffering from mental ill-health have been expressed for many years, leading to numerous anti-stigma campaigns. Previous Irish studies demonstrated an improvement in the tone and content of articles over time. This study aims to re-evaluate this topic, 19 years after it was last studied.

Methods:

Four Irish papers including the tabloid, broadsheet, online and compact paper with the highest readership were analysed daily for a 12-week period. Using pre-determined definitions based on previous studies, all articles or headlines incorporating psychiatry-related material were examined for tone, content, utilisation of terminology, reference to self-harm, suicide and violence.

Results:

In total, 735 articles (2.19/paper/day) were identified and analysed. The majority of articles were found to have a supportive or factual tone. A higher proportion of judgemental or sensationalist articles were found in the tabloid newspaper. An improvement was noted compared to previous Irish studies. A decrease in articles written by mental health professionals was noted. Only 5% of articles portrayed psychotic disorders, with many of these referring to violence. Compliance with relevant guidelines for reporting of suicide was good overall.

Conclusion:

There has continued to be an improvement in the tone and content of articles since previous Irish studies. The introduction of guidelines within this time may have played a significant role. Psychotic illness received limited coverage and was more likely to be portrayed in a stigmatising manner, guidelines relating to this could be of benefit. Engagement between psychiatrists and the media is important to improve the portrayal of psychotic illness and enhance awareness.

Keywords

Mental disorders suicide communication media mental health social stigma mass media

Introduction

The media have a vital role in the public portrayal and understanding of mental health. The mainstream news media in particular have been shown to shape the attitudes of the general public towards mental illness and may serve as a gauge reflecting public opinion (Hildersley et al., 2020). Traditionally the media portrayal of mental health, in particular, mental illness has been criticised for being stigmatising and sensationalist, propagating stereotypes and misinformation about those with mental illness (Day & Page, 1986; Hart & Phillipson, 1999; Wahl et al., 2002).

Despite the proliferation of digital media, newspapers have continued to have a consistent place in the news habits of Irish consumers. Over the past 5 years, there has been an increased use of social and digital media as primary news sources, and a reduction in television as the main news source (Kirk et al., 2020). However, trust in established news brands is higher than levels of trust in social media and digital sources (Kirk et al., 2020).

The relationship between mental health and the print media in the Irish context was highlighted by Casey (1994), examined initially by Meagher et al. (1995) then by O’Connor and Casey (2001). Meagher et al. (1995) reviewed the most popular Irish daily tabloid and broadsheet, and a Sunday tabloid and broadsheet from July to December 1993. In total, the authors identified 380 articles (average of 1.04 articles/newspaper/day) relating to mental health and assessed each one for page profile, article type, author, topic covered and predominant tone.

Later, O’Connor and Casey (2001) reviewed all daily broadsheets, one daily tabloid and three Sunday broadsheets for 6 months in 1999. This identified 582 articles (0.62 articles/newspaper/day). These were evaluated under the following subheadings: item type (news, feature and gossip column), subject of item, profession of author (journalist and health professional), tone of item, page of item and topic, among others. Both studies found that the majority of articles relating to mental health were either supportive or neutral in tone and that the negative articles were more likely to be in tabloid newspapers. These findings compared favourably to international studies at the time. Scott (1994), compared three broadsheets and three UK tabloid newspapers for 3 months, reporting the tone and attitude of articles describing mental health problems were predominantly negative.

Ohlsson (2018) analysed two prominent Swedish newspapers over a 1-year period in 2009. Several negative themes emerged from this analysis including the association between mental illness and criminality, prejudicial language, controversy concerning the concept of mental health and antipsychiatry sentiment. A more neutral theme that emerged included the potential impact of mental health as a wider public health issue.

Hildersley et al. (2020) demonstrated a significant improvement in the stigmatising content of articles relating to mental health in English papers between 2008 and 2019. However, the proportion of stigmatising articles relating to schizophrenia actually increased in the latter years.

An analysis of articles relating to mental health from UK newspapers between 2008 and 2019 demonstrated that tabloid newspapers were 32% more likely to be stigmatising compared to broadsheet newspapers (Li et al., 2021). In particular, they found that tabloid newspapers were more likely to stigmatise those with serious mental illness.

This type of analysis has not been repeated in an Irish context in nearly 20 years (O’Connor & Casey, 2001). In this time, guidelines have been developed to support media organisations in reporting stories concerning mental health (World Health Organization, 2008). We aimed to re-assess this important topic.

Methods

The following newspapers were selected for daily analysis for the 12-week study period: The Irish Times, The Irish Independent/Sunday Independent, The Irish Sun and thejournal.ie. The Irish Times was chosen as Ireland’s daily quality paper/broadsheet with circulation of 58,131 copies (Doyle, 2019).

The Irish Independent/Sunday Independent was chosen as it had the highest readership at the time with circulation of 83,900 copies for the daily paper and 165,334 for the Sunday paper (Doyle, 2019). The Irish Independent/Sunday Independent was not considered a tabloid or broadsheet (Mercille, 2017), and is described below as the ‘compact’ paper.

The Irish Sun was included as the most popular tabloid at the time (Kirk et al., 2020). Given the emergence of online readership, ‘thejournal.ie’ was also included as the most read digital paper (Newman et al., 2018). These were chosen as they were felt to be highly relevant and capture a cross-sectional view of Irish Readership.

The selected newspapers were read page by page by three researchers for 12 consecutive weeks from Monday 29th August 2018 until Sunday 18th November 2018 (inclusive). The Irish Times was read Monday to Saturday each week, The Irish Independent Monday to Saturday and the Sunday Independent on Sunday, the Irish Sun and the Journal.ie were read Monday to Sunday.

A template was created for data collection to identify and analyse relevant articles, as well as highlight articles that would need to be discussed amongst all contributors.

Coding of articles

Similar to O’Connor and Casey (2001) and Meagher et al. (1995) each print media source was examined for issues directly relating to psychiatry or mental health. As with the previous Irish studies, we included all articles related to mental health and mental illness including substance abuse disorders, personality disorders, self-harm and suicide.

Articles utilising psychiatric terminology, not depicting topics related to psychiatry or mental health (including ‘depressed’, ‘delusional’, ‘psychotic’, etc.) were also included. All sections of the newspaper were examined including the main news, letters and supplements.

Extensive analysis of each article was conducted by three reviewers and each paper was independently read by two reviewers.

Similar to Meagher et al. (1995), data was collected on: predominant tone, illness or wellness, page profile, type of article, author and topic. In addition, articles were coded as being related to adults, minors or both, similar to Slopen et al. (2007). Given evidence by Niederkrotenthaler et al. (2010) demonstrating the role of the print media in terms of promoting a positive message in mental health, articles were also divided into those depicting mental illness or wellness.

Assessment of tone was conducted in a manner similar to Day and Page (1986) with tone coded as factual, judgemental, supportive or sensationalist. A factual tone was defined as the presentation of information using neutral adjectives (O’Connor & Casey, 2001). A judgemental tone was defined as the information being presented in a negative way with no alternatives suggested and a sensationalist tone was defined as the use of dramatic language, or not based on fact (O’Connor & Casey, 2001). A supportive tone was identified if adjectives used portrayed individuals suffering from mental illness in a positive or heroic light (Day & Page, 1986).

Thematic analysis

Each article referencing mental health also underwent a thematic analysis using Framework Analysis as described by Ritchie et al. (2013)

Use of derogatory or inappropriate terms was highlighted during analysis. As described by Thornicroft et al. (2013), this included the use of language about people with mental illness which may evoke prejudice or which reduced them to their illness that is ‘schizophrenic’.

Any articles relating to suicide were examined separately and compared with international guidelines for reporting of suicide in the media (World Health Organization, 2008). Local guidelines for the media reporting of suicide were also reviewed by all collaborators prior to data collection. Data was collected on a number of articles, main focus (completed suicide, attempted suicide, suicidal ideation and suicide prevention and research), method and prominence as described by Niederkrotenthaler et al. (2010).

Data analysis

Data was analysed using statistical software for the social sciences (SPSS) version 27.

Results

In total, 735 articles (2.19 articles/paper/day) were identified over the 12-week period from all four media sources. Of these, the tabloid paper accounted for 32%, the compact paper 29%, the broadsheet paper 21% and the online paper 18%. These results are described in Table 1.

Table 1.

Analysis of each media source by total number of articles, predominant tone, depiction of child/adult and depiction of illness/wellness.

Media source	The Sun (tabloid)	The Irish independent (compact)	The Irish times (broadsheet)	Thejournal.ie (online)	All sources
	N (%)	N (%)	N (%)	N (%)	N (%)
Total number of articles	235 (32)	215 (29)	153 (21)	132 (18)	735 (100)
Supportive tone	122 (52)	78 (36)	85 (56)	76 (58)	361 (49)
Factual tone	88 (37)	126 (59)	60 (39)	49 (37)	323 (44)
Judgemental tone	16 (7)	8 (4)	4 (3)	3 (2)	31 (4)
Sensationalist tone	9 (4)	3 (1)	4 (3)	4 (3)	20 (3)
Article primarily relating to adult mental health	217 (92)	178 (83)	132 (86)	120 (91)	647 (88)
Article primarily relating to child	15 (6)	32 (15)	21 (14)	8 (6)	76 (10)
Article relating to both adult and child mental health	3 (1)	5 (2)	0 (0)	4 (3)	12 (2)
Depiction of illness	210 (89)	168 (78)	135 (88)	117 (89)	630 (86)
Depiction of wellness	24 (10)	44 (20)	17 (11)	13 (10)	98 (13)
Depiction of both illness and wellness	1 (<1)	1 (<1)	0 (0)	2 (2)	4 (<1)
Depiction of neither illness and wellness	0 (0)	2 (1)	1 (1)	0 (0)	3 (<1)

Tone of articles

The tone of all articles is summarised in Table 1. The majority of articles from all sources had a supportive (49%) or factual (44%) tone. Of all the articles deemed to have a sensationalist or judgemental tone, 49% (25/51) were from the tabloid paper.

Depiction of adult or child mental health issues/mental illness

Child and adolescent mental health received significantly less attention than adult mental health, accounting for only 10% of all articles. However, the broadsheet and compact papers provided more coverage of the topic compared to the tabloid and the online media (Table 1).

Portrayal of illness/wellness or both

Of the 735 articles from all sources, the majority (86%) described illness. The tabloid and online papers had the highest proportion of articles referencing illness (89%). The compact paper had the highest proportion of articles describing wellness (20% of all articles). See Table 1 for further results.

Page profile of articles

The page profile of the 603 print articles analysed from the three print newspaper sources is outlined in Table 2. The online media source was excluded from this analysis. Overall, the mean page number of articles for the print sources was 14.76 and median 11.00 (SD = 12.28 95% CI [13.78, 15.74]). The broadsheet was more likely to publish articles relevant to mental health in the earlier pages with the mean page number of 5.01 and median 4 (SD = 2.59, 95% CI [4.44, 5.59]) for the main subsection of the paper.

Table 2.

Page profile of articles referencing mental health from The Irish Times, The Irish Independent and The Irish Sun.

Media source	N	Mean page number	SD	Median page number	Range page number	95% CI
All sources – All media sources excluding thejournal.ie	603	14.76	12.28	11.00	1–123	[13.78, 15.74]
All sources – Main paper	430	14.13	10.42	11.00	1–84	[13.15, 15.12]
All sources – Supplement	173	16.33	15.97	11.00	1–122	[13.92, 18.74]
The Irish Times – All articles Broadsheet paper	153	8.95	12.61	6	1–123	[6.94, 10.97]
The Irish Times – Main paper Broadsheet paper	81	5.01	2.59	4	1–14	[4.44, 5.59]
The Irish Times – Supplement Broadsheet paper	72	13.39	17.18	8	1–123	[9.35, 17.43]
The Irish Independent – All articles Compact paper	215	16.26	13.2	13	1–86	[14.48, 18.04]
The Irish Independent – Main paper Compact paper	116	16.42	12.31	15.50	1–84	[14.16, 18.69]
The Irish Independent – Supplement Compact paper	99	16.06	14.25	11.00	2–86	[13.19, 18.93]
The Irish Sun – All articles Tabloid paper	235	17.18	9.79	17.0	1–47	[15.92, 18.44]
The Irish Sun – Main paper Tabloid paper	218	16.32	8.80	16.00	1–42	[15.15, 17.50]
The Irish Sun – Supplement Tabloid paper	17	28.18	14.56	32.00	3–47	[20.69, 35.66]

Prevalence of front-page articles

A limited number of articles were published on the front pages during the study period. It was found the tabloid paper had 1 article published on the front page and 10 articles on the first three pages. The compact paper published no articles relating to mental health on the front page and six on the first three pages. About 4 articles were published by the broadsheet paper on the front page, with 21 on the first three pages. In total, less than 1% (5/603) of print articles received first page status, with 7% (42/603) printed on the first three pages of the main paper.

Author profile

Of the 735 articles analysed over the 12 weeks, only 2% (12/735) were by either mental health or other health professionals. All 12 of these articles were found in the compact paper and half were by the author of Casey (1994).

Analysis of topics portrayed

A description of topics found during our analysis is laid out in Table 3 and, where possible, classified by ICD-10 code. Of the topics that could be classified by ICD-10 code, the most prevalent were substance abuse disorders (21%), neurotic disorders, behavioural Syndromes (18%) The remainder included mood disorders, (14%), schizophreniform disorders (3%), personality disorders 1%, mental health legislation 1%, Developmental/childhood disorders (1%) and Mental retardation (less than 1%). Two articles (accounting for less than 1% of all articles) described topics not related to mental health but utilised psychiatric terminology (referring to a politician as ‘delusional’. etc.).

Table 3.

Topics portrayed relating to mental health in the analysed Irish media sources.

Primary ICD-10 diagnosis	The Irish SunTabloid	The Irish IndependentCompact	The Irish TimesBroadsheet	The Journal Online	Total
Primary ICD-10 diagnosis	N (%)	N (%)	N (%)	N (%)	N (%)
F10–19 Substance abuse disorders Alcohol and substance abuse	64 (27)	41 (19)	27 (18)	23 (17)	155 (21)
F20–29 Schizophreniform disorders Schizophrenia and psychotic disorders	8 (3)	4 (2)	7 (5)	2 (2)	21 (3)
F30–39 Mood disorders Depression, bipolar disorder and postnatal depression	32 (14)	25 (12)	16 (10)	32 (24)	105 (14)
F40–59 Neurotic disorders, behavioural syndromes Anxiety, PTSD and eating disorder	40 (17)	39 (18)	33 (22)	19 (14)	131 (18)
F60–69 Personality disorders	5 (2)	2 (1)	2 (1)	1 (1)	10 (1)
F70–79 Mental retardation	1 (0) 0	0 (0)	0 (0)	0 (0)	1 (<1)
F80–98 Developmental/childhood disorders ADHD and ASD	0 (0)	2 (1)	2 (1)	2 (2)	6 (1)
Unspecified mental health issues	45 (19)	74 (34)	37 (24)	26 (20)	182 (25)
Article unrelated to mental health	1 (0)	0 (0)	1 (1)	0 (0)	2 (<1)
Mental Health Legislation Mental Health Act 2001 and Criminal Law (Insanity) Act 2006	3 (1)	3 (1)	2 (1)	0 (0)	8 (1)
Article primarily related to suicide, homicide or murder-suicide	36 (15)	25 (12)	26 (17)	27 (20)	114 (16)
Total	235 (100)	215 (100)	153 (100)	132 (100)	735 (100)

Unspecified mental health issues accounted for 25% and 16% of the articles primarily focussed on suicide, self-harm, violence and homicide.

Use of derogatory terminology

The use of derogatory language in the articles examined was assessed and coded under the following headings: inappropriate labelling of patients, use of outdated terminology, grossly stigmatising or offensive language, invalidating statements and articles which were felt to be misleading or deliberately dramatised (see Table 4).

Table 4.

Derogatory use of language and themes associated.

Theme	Source	Language used
Inappropriate labelling of patients	Broadsheet paper	‘Alcoholic’, ‘Vagrant’, ‘Addicts’ (n = 8)
	Compact paper	‘Like schizophrenics’, ‘anorexic’ (n = 2), ‘alcoholic’(n = 2), ‘Addict’ (n = 7), ‘Dry Drunk’
	Tabloid paper	‘Alcoholic’ (n = 3), ‘Drinker’, ‘Addict’ (n = 7), ‘Junkie’ (n = 2), ‘paranoid schizophrenic’, ‘bipolar mother’, ‘druggies’
	Online paper	‘Addict’, ‘Junkie’ (n = 2)
Use of outdated terminology	Broadsheet paper	‘Committed suicide’ (n = 2), ‘Sectioned’
	Compact paper	‘Mental hospital’, ‘Sectioned’
	Tabloid paper	‘Nervous breakdown’ (n = 3), ‘Committed suicide’ (n = 2)
	Online paper	‘Mental Breakdown’, ‘Mental asylum’
Offensive language/terminology	Broadsheet paper	‘Like zombies, addicts, they spray their blood around’ ‘Jekyl and Hyde monsters’ ‘possibly half mad, certainly obsessed’, ‘Sick anorexic giraffe’, ‘A few jabs in the backside’
	Compact paper	‘Crazy-town’, ‘Unhinged’, ‘Like skeletons- addicts’ ‘Maniac’, ‘ADHD Americans scream at each other’, implication that obligatory psychiatric evaluation was usually reserved for ‘sex offenders and paedophiles’
	Tabloid paper	‘Looked like an addict’, ‘Crazy-town’, ‘The right cocktail of whatever she needed to be on’, ‘Crazy man’, ‘Heroin chic’, ‘Psycho’ (n = 3), ‘Nuts’, ‘Crazed’, ‘Mental’, ‘Maniac’ (n = 2)
	Online paper	‘Suicide spot’
Invalidating statements	Broadsheet paper	‘Shit-life syndrome’, ‘Numb his PTSD with a hedonistic Vegas binge’, ‘suicidal issue’
	Compact paper	‘Force feeding’ (n = 2)
	Tabloid paper	‘Force feeding’, ‘Booze problems’, ‘She’s so neurotic’, ‘she jumps from one worry to another’, ‘the blues’
	Online paper	Equating anxiety with annoyance
Misleading/dramatisation	Online paper	Misleading photo depicting mechanical restraint, ‘suicide forest’, ‘suicide hotline’

All media sources were found to label patients by their mental illness or mental health difficulty. This most commonly occurred in the articles describing substance abuse disorders, where the terms ‘addict’, ‘alcoholic’ and ‘junkie’ were used frequently. The tabloid newspaper was found to label patients more than other sources.

All media sources used outdated terminology. The phrase ‘committed suicide’ was used by both the broadsheet and tabloid papers. The term ‘sectioned’ was used by both the broadsheet and compact papers, while the phrase ‘nervous/mental breakdown’ was used by both the tabloid and online media.

Grossly offensive language was found in all four media sources. This was most common in the tabloid paper which used the terms ‘crazed’, ‘maniac’ and ‘mental’ on multiple occasions in articles relating to mental health. The broadsheet paper used the phrase ‘sick anorexic giraffe’ to depict a patient with severe eating disorder and ‘a few jabs in the backside’ for a patient requiring involuntary psychiatric treatment. The phrase ‘jekyl and Hyde monsters’ was also used by the broadsheet paper to describe those suffering with addiction.

While the online media source used the least grossly offensive statements, there were several articles which dramatised or misled the reader, including a misleading photo depicting mechanical restraint, and references to both a ‘suicide forest’ and ‘suicide hotline’.

Statements which were grossly invalidating towards mental health issues and mental illness were also utilised seen in all sources. The broadsheet paper referenced ‘shit-life syndrome’ and ‘to numb his PTSD with a hedonistic Vegas binge’. Both the compact and tabloid papers made several references to ‘force feeding’, and the tabloid paper wrote, ‘she’s so neurotic, she jumps from one worry to another’.

Depiction of violence or homicide

Of all articles from all sources, 13% (92/735) referenced violence or homicide (see Table 5). In articles which referenced violence, the majority of articles in three papers described the mental health of alleged perpetrators. The exception to this was the online paper, which described the mental health of victims in 59% (10/17) of articles. A remaining 41% (7/17) referred to the mental health of the perpetrator or alleged perpetrator of violence.

Table 5.

Depiction of violence, homicide, self-harm and suicide by media source and % of total articles from each media source.

	The Irish SunTabloid	The Irish Independent Compact	The Irish TimesBroadsheet	Thejournal.ieOnline	Articles from all sources
	N (%)	N (%)	N (%)	N (%)	N
Violence
Homicide	9 (4)	7 (3)	11 (7)	2 (2)	29
Murder suicide	2 (1)	2 (1)	1 (1)	2 (2)	7
Murder suicide (terrorism	1 (0)	1 (0)	5 (3)	1 (1)	8
Violence	10 (4)	4 (2)	9 (6)	6 (5)	29
Sexual assault	2 (1)	3 (1)	5 (3)	3 (2)	13
CSA	2 (1)	0 (0)	1 (1)	3 (2)	6
Total	26 (11)	17 (7)	32 (21)	17 (14)	92
Suicide/self harm
Suicide with no method	42 (18)	12 (6)	16 (10)	15 (11)	85
Suicide with method	11 (5)	3 (1)	2 (1)	4 (3)	20
Self-harm	0 (0)	0 (0)	2 (1)	4 (3)	6
Total	53 (23)	15 (7)	20 (12)	23 (17)	111
Total-violence and self-harm/suicide	79 (34)	32 (15)	52 (34)	40 (30)	203

The broadsheet paper described violence in 32 articles. Of those, 91% (29/32) referred to the mental health of an alleged perpetrator, 6% (2/32) to the mental health of a victim and 3% (1/32) to the mental health of both victim and alleged perpetrator. The tabloid newspaper, referred to the mental health of the alleged perpetrator in 89% (24/27) of cases. Of those, only 9% (3/27) of articles referred to the mental health of the victim. The compact newspaper described the mental health of the alleged perpetrator in 82% (14/17) of cases with 18% (3/17) of describing the mental health of victims.

Of the 21 articles portraying psychotic disorders in our study, two thirds (14/21) referred to violence/homicide in those suffering from mental illness.

Depiction of self-harm and suicide

Each article which referred to or reported suicide or self-harm, was compared with the guidelines available at the time. In total 15% (111/735) articles referenced suicide or self-harm. Further analysis of articles pertaining to self-harm and suicide are demonstrated in Table 5.

Of the 105 articles which referenced suicide, 81% (85/105) named no method or details, while only 19% (20/105) named a specific method. Of these, 55% (11/20) were found in the tabloid paper. Of all articles which referenced suicide, none were found to give detailed descriptions about a site or method.

In 95% (100/105) of articles, appropriate supportive services were signposted on the same page as the articles. In five cases (three in the compact paper and two in the tabloid), no supportive information was offered.

No articles were felt to normalise suicide or present it as a solution to problems. Only two articles were identified which were felt to sensationalise suicide, one referred to a ‘pact’ and the other to a ‘suicide forest’, both in the online media.

Discussion

In this study we aimed to re-evaluate Irish media. We found that mental health coverage had increased with an average of 2.19 articles per paper per day, compared to 1.04 (Meagher et al., 1995) and 0.62 (O’Connor & Casey, 2001).

Tone, profile and content of the articles

Similar to the two previous Irish studies, we found the tone of the articles to be predominantly supportive or neutral, and articles with a negative (judgemental or sensationalist) tone were more likely to be found in tabloid newspapers. However, we found that the overall proportion of negative articles in tabloid newspapers continued to decrease from 41% (Meagher et al., 1995) to 24.8% (O’Connor & Casey, 2001) to our finding of 11%. This compared favourably with a Canadian study by Whitley and Wang (2017) which demonstrated that during a 10-year period (2005–2015) 27% of articles had a stigmatising tone.

We found that there had been a reduction in front page status with less than 1% of articles, compared to 3% of broadsheet/Sunday papers and 7% of tabloids (O’Connor & Casey, 2001) and 6% of all articles (Meagher et al., 1995).

Reporting of self-harm/suicide

The media have important responsibilities when reporting suicide. Irresponsible reporting may contribute to imitation suicides, a term known as ‘the Werther Effect’ (Phillips, 1974). On the other hand, Niederkrotenthaler et al. (2010) describe how positive depictions of mental health, particularly relating to individuals overcoming suicidal ideation may have a protective effect, a term coined by the authors as ‘the Papageno effect’. We found the majority of articles continued to focus on mental ill health with only 13% of all articles focussing on wellness/overcoming mental ill health. The highest proportion of articles depicting wellness were found in the compact paper.

Overall, self-harm and suicide were common topics, depicted in 15% of all articles. This represented a reduction in overall proportion compared to Meagher et al. (1995) who found 23% of tabloid articles and 27% broadsheet portrayed suicide/suicidal acts. In most cases, the media guidelines pertaining to the reporting of suicide which were available at the time were adhered to (World Health Organization, 2008). Good compliance was found with the provision of appropriate supports. Sinyor et al. (2020) have shown an improvement of the media reporting of suicide following the publication of local guidelines. The new Media Guidelines for Reporting Suicide (Samaritans Ireland, 2020), which was published after the completion of our study is welcomed and will hopefully lead to further improvements in journalistic standards.

Portrayal of violence

A review by Jorm et al. (2012) found that the general public perceived those diagnosed with psychosis or schizophrenia as ‘dangerous’, but did not perceive those diagnosed with depression as posing a risk. Reavley et al. (2016) identified the media’s key role in public beliefs regarding the dangerousness of individuals with mental health problems, particularly those which may have lower prevalence, including psychotic disorders. Hildersley et al. (2020) found that despite the improvement in the media portrayal of overall mental illness in recent years, stigmatising articles relating to psychotic illness have actually increased. Our study demonstrated that those with psychotic disorders continue to be portrayed as violent in the media. This may represent an area that needs additional consideration in future guidelines and enhanced education of the public by mental health professionals and individuals with lived experience.

The majority of articles referencing violence in our study referred to the mental health of the alleged perpetrator, propagating the stereotype that those mental health issues may be associated with perpetrators of rather than victims of violence. The one exception was the online paper, which more often discussed the mental health of victims of violence, rather than of the alleged perpetrator.

Contributions by mental health professionals

Our study found that a limited number of articles were written by health professionals with only 2%, compared to 12.5% (O’Connor & Casey, 2001) and 5% (Meagher et al., 1995) in prior studies. This may be explained by the choice of newspapers in this study, which differed slightly to previous studies. O’Connor and Casey (2001) chose two daily broadsheets, three Sunday broadsheets and one tabloid, reporting most articles written by mental health professionals were found in the Sunday papers. Meagher et al. (1995) studied a daily tabloid and broadsheet as well as a Sunday tabloid and broadsheet, stating most articles by professionals were found in the broadsheets. This lack of specialist guidance may be reflected in the language utilised within the articles analysed in our study, with the generic concept of ‘mental health issues’ accounting for 25% of all articles. This ambiguous term encapsulates a wide spectrum of mental health difficulties without clear reference to diagnosis.

The concept of media health literacy is described by Levin-Zamir and Bertschi (2018), as having the means of utilising the media to educate people to interpret health information, empowering them to utilise this information for the improvement of their health and improve overall health literacy. Higher rates of health literacy regarding to mental health, have been shown to increase help seeking behaviour and willingness to disclose mental illness to others (Rüsch et al., 2011). According to Sørensen et al. (2015), 40% of Irish participants surveyed demonstrated problematic or inadequate general health literacy. The World Health Organization (2013) identified the mass media as a key factor in determining health literacy, through both direct and indirect communication regarding health behaviours, warning that indirect messaging may undermine positive health behaviour.

Internationally many have argued that psychiatrists should actively engage with the media (Bithell, 2011; Campbell et al., 2009). Chapman et al. (2017) reported that due to the reluctance of psychiatrists to engage with the media, reporters are left to interpret the possible significance of mental health difficulties or mental illness in an article, leading to possible misinformation and stigmatisation. In order to encourage better collaboration between the media and psychiatry, Campbell et al. (2009) advised that psychiatrists should be given training on engagement with media as part of their specialist training. The findings of this study underscore the need for health professionals to be more involved in media’s reporting of mental health issues. We believe the results of our study may raise awareness of this need, particularly with respect to the portrayal of psychotic illness.

Comparison with international studies

An English study by Hildersley et al. (2020) demonstrated an improvement in the trends of reporting with regard to mental health between 2008 and 2019. However, the authors found an increase in stigmatisation regarding psychotic illnesses, in particular schizophrenia. A wider study of UK based papers found tabloid newspapers to be more likely to portray stigmatising articles (Li et al., 2021).

Elsewhere in Europe, a Swedish thematic analysis by Ohlsson (2018) reporting stigmatising language in the portrayal of mental health. A Canadian study by Whitley and Wang (2017) demonstrated an overall improvement in the tone of articles between 2005 and 2015, with a reduction in stigmatising tone from 32.7% to 22.3%.

Strengths and limitations

A major strength of this study is that we replicated much of the methodology of the previous Irish studies, allowing direct comparison. We used pre-determined definitions for the tone of the articles, and each paper was independently read by two reviewers.

There are several limitations to the study. The study occurred over a relatively short time frame of 12 weeks. However, despite this, 735 articles we identified and analysed. A limited number of newspapers were included, effecting the generalisability of our findings. In order to produce generalisable findings, a lengthier study including a wider range or papers would be required.

Conclusion

This is an important study which assessed the portrayal of mental health in the print media almost two decades after it was last studied. The coverage of mental health within the media continues to improve in Ireland. The development of national and international guidelines may have played a significant role in this, although we could not establish direct causation with this methodology. Reporting in relation to suicidal behaviour was an area of notable improvement and articles in our study were mostly in keeping with media guidelines.

As with the previous Irish studies, there is no evidence to suggest that the media portrayal of mental health is particularly negative, in comparison to many of our international counterparts. Our findings suggest however that psychotic disorders continue to be portrayed in association with violence, which may further stigmatise those suffering from psychosis. We would suggest that media guidelines for the reporting of severe mental illness may complement the existing guidelines relating to suicidal behaviour and potentially reduce stigma towards those with psychotic disorders. As our study suggests that mental health is receiving wider coverage in recent years, we strongly suggest the psychiatrists become involved in educating and contributing to the media, particularly for articles relating to severe mental disorders.

Footnotes

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Margaret Gallagher

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