Opening Minds Opening Doors Media Guidelines Final

“OPENING MINDS – OPENING DOORS”

How To Make A Difference When Reporting on Mental Health Issues

Prepared by the

World Federation for Mental Health 6564 Loisdale Court, Suite 301 Springfield, VA 22150 USA +703.313.8680 [email protected]

www.wfmh.org

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OPENING MINDS-OPENING DOORS: HOW TO MAKE A DIFFERENCE WHEN REPORTING ON MENTAL HEALTH ISSUES “There is tremendous potential for journalists to improve the public's understanding of mental health issues and to play a critical role in reducing stigma and discrimination against people with mental illnesses." - Former First Lady Rosalynn Carter As professional communicators writing about science, medicine and health issues, you are in a unique position to shape the public image of people with disabilities. The words you choose to use can create either a sensitive image or a damaging view that reinforces the many myths and mistreatments surrounding people with mental illnesses. To remove the discrimination and challenge the myths that surround mental illness, it is vital that your information on issues such as diagnosis, treatment, medication and discrimination be accurate and promotes a sense of fairness and understanding. Positive language empowers individuals to learn and treat those with disabilities with the respect and dignity all people deserve. Mental health is the key ingredient to overall wellness and productivity. However, we must understand the subject and discuss it openly in order to give mental health and mental illnesses the proper attention they need. When they do receive attention, mental health and mental illness need to be presented in a positive manner to reduce misconceptions and ignorance. Therefore, there is a great need for accurate information and increased understanding, - especially through respected media sources that are able to reach and influence many people on a regular basis. The World Health Organization states that: • • • • • •

450 million people worldwide are affected by mental, neurological or behavioural problems at any time. About 873,000 people die by suicide every year. Mental illnesses are common to all countries and cause immense suffering. People with these disorders are often subjected to social isolation, poor quality of life and increased mortality. These disorders are the cause of staggering economic and social costs. One in four patients visiting a health service has at least one mental, neurological or behavioural disorder but most of these disorders are neither diagnosed nor treated. Cost-effective treatments exist for most disorders and, if correctly applied, could enable many of those affected to become functioning members of society. Barriers to effective treatment include lack of recognition of the seriousness of mental illness and lack of understanding about the benefits of services. Policy makers, insurance companies, health and labor policies, and the public at large – all discriminate between physical and mental problems.

This document contains some suggested guidelines and information to help writers and journalists make positive choices in terms of language and image portrayal when writing about mental health and mental illness. These guidelines will inform writers about preferred terminology and offer suggestions for appropriate ways to describe people with mental illness. Journalists have the ability to create change and understanding by what they write and report. Therefore the more information they have available, the better able they will be to promote fairness, understanding and proper treatment of people with a mental health problem or serious mental illness. The World Federation for Mental Health is dedicated to educating the public and empowering change. This document will help journalists and reporters form a better understanding of mental health and those with mental illness. It can serve to enhance the ability of those reporting on situations relating to mental health and mental illnesses that arise in their community and to encourage fair and accurate reporting on the subject.

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ISSUES TO CONSIDER WHEN REPORTING ON MENTAL HEALTH AND MENTAL ILLNESSES

 Know, and use, the facts. Mental health problems and mental illnesses can impact all aspects of people’s lives, including family, work, school and social life. A community that doesn’t understand these disorders will make it more difficult for individuals to get help and lead productive and satisfying lives.

 Your reporting impacts lives. Promoting understanding in your community can encourage results in more people with mental health problems to be accepted and supported by their peers and neighbors.

 Media guidelines and codes of ethics provide for the right to privacy. Consider how your story may affect the individual’s life. Follow your media outlet’s code of conduct on interviewing people with disabilities.

 There is more to a person with a mental illness than their condition. If it’s not relevant to your story, don’t mention it.

 Use appropriate, non-judgmental language and terminology that is respectful to the person. APPROPRIATE TERMINOLOGY AND USE OF LANGUAGE The use of degrading and unfair terms promotes misunderstanding, discrimination and false portrayals of people with mental disabilities. Following is some preferred terminology to promote equality and understanding. Consider this language in your speech, your writing, and your descriptions. Use “person with a mental illness” OR say “person diagnosed with schizophrenia” and “person who has a psychiatric disability” instead of “the mentally ill” or “psychotic person” or the “schizophrenic.” Words such as “crazy,” “lunatic,” “psycho” are very offensive and should never be used to describe a person with a mental health problem. Whenever possible, use “discrimination” instead of “stigma.” Over the years the term ‘stigma’ has sometimes ended up causing more separation and mistreatment. The word “discrimination” shows the differences in the ways people are treated. Say the “person has depression” instead of “burdened with,” “afflicted with,” “victim of.” Using the latter terms promotes a sense of weakness; in reality, people with mental health problems are usually no “weaker” than are people who experience other serious health problems such as diabetes, heart disease, and cancer. Say “person who has died from suicide” instead of “committed suicide.” ‘Committed’ leads people to think of being incarcerated or put somewhere against their will. Suicide is a very important health concern and should not be viewed as a sinful or criminal behavior. Say “person with a disability” instead of “the disabled.” The total being of an individual with an illness or injury is not usually affected by the condition. There is much more to a person with a disability – their personality, their work, and their family. Labeling an individual with a disability, as “a disabled person” is somewhat like describing a person with red hair – you would not say “the red-hair person.” but rather “the person with red hair.”

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IMPORTANT DEFINITIONS OF MENTAL HEALTH PROBLEMS AND ILLNESSES Anxiety Disorders: Anxiety disorders range from feelings of uneasiness to immobilizing bouts of terror. Most people experience anxiety at some point in their lives and some nervousness in anticipation of a real situation. However if a person cannot shake unwarranted worries, or if the feelings are jarring to the point of avoiding everyday activities, he or she most likely has an anxiety disorder. (USDHHS/SAMHSA) Attention-deficit/hyperactivity disorder (ADHD): Attention-deficit/hyperactivity disorder, sometimes called ADHD, is a chronic condition and the most commonly diagnosed behavioral disorder among children and adolescents. It affects between 3 and 5 percent of school-aged children in a 6-month period (U.S. Department of Health and Human Services, 1999). Children and adolescents with attention-deficit/hyperactivity disorder have difficulty controlling their behavior in school and social settings. They also tend to be accident-prone. Although some of these young people may not earn high grades in school, most have normal or above-normal intelligence. (USDHHS/SAMHSA) Behavioral Therapy: As the name implies, behavioral therapy focuses on behavior-changing unwanted behaviors through rewards, reinforcements, and desensitization. Desensitization, or Exposure Therapy, is a process of confronting something that arouses anxiety, discomfort, or fear and overcoming the unwanted responses. Behavioral therapy often involves the cooperation of others, especially family and close friends, to reinforce a desired behavior. (USDHHS/SAMHSA) Bipolar Disorder: Extreme mood swings punctuated by periods of generally even-keeled behavior characterize this disorder. Bipolar disorder tends to run in families. This disorder typically begins in the mid-twenties and continues throughout life. Without treatment, people who have bipolar disorder often go through devastating life events such as marital breakups, job loss, substance abuse, and suicide. (USDHHS/SAMHSA) Bipolar/Manic Depression: Bipolar Disorder is characterized by repeated mood swings between depression and mania (elevation of mood and increased energy and activity). Between episodes the person can be asymptomatic. Manic episodes usually begin abruptly and last for between 2 weeks and 4-5 months (averaging 4 months). Depressions tend to last longer (averaging 6 months), though rarely for more than a year. Episodes of both kinds often follow stressful life events, but the presence of such stress is not required. The first episode may occur at any age from childhood to old age. The frequency of episodes and the pattern of remissions and relapses are variable, although remissions often get shorter as time goes on and depressions often become more frequent and longer lasting after middle age. (ICD-10, WHO) Borderline Personality Disorder: Symptoms of borderline personality disorder, a serious mental illness, include pervasive instability in moods, interpersonal relationships, self-image, and behavior. The instability can affect family and work life, long-term planning, and the individual's sense of self-identity. (USDHHS/SAMHSA) Conduct Disorders: Children with conduct disorder repeatedly violate the personal or property rights of others and the basic expectations of society. A diagnosis of conduct disorder is likely when these symptoms continue for 6 months or longer. Conduct disorder is known as a "disruptive behavior disorder" because of its impact on children and their families, neighbors, and schools. (USDHHS/SAMHSA) Depression: Depression is a disorder of mood, characterized by sadness and loss of interest in usually satisfying activities, a negative view of the self and hopelessness, passivity, indecisiveness, suicidal intentions, loss of appetite, weight loss, sleep disturbances, and other physical symptoms. Some or all of these symptoms may be present in people suffering from depression. Other common symptoms are: (a) reduced concentration and attention; (b) reduced self-esteem and self-confidence; (c) ideas of guilt and unworthiness (even in a mild type of episode); (d) bleak and pessimistic views of the future;

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(e) ideas or acts of self-harm or suicide; (f) disturbed sleep; (g) diminished appetite. (ICD-10, WHO) Dually Diagnosed: A person who has both an alcohol or drug problem and an emotional/psychiatric problem is said to have a dual diagnosis. (USDHHS/SAMHSA) Generalized Anxiety Disorder: The essential feature is anxiety, which is generalized and persistent but not restricted to, or even strongly predominating in, any particular environmental circumstances (i.e. it is "freefloating"). As in other anxiety disorders the dominant symptoms are highly variable, but complaints of continuous feelings of nervousness, trembling, muscular tension, sweating, lightheadedness, palpitations, dizziness, and abdominal discomfort are common. Fears that the sufferer or a relative will shortly become ill or have an accident are often expressed, together with a variety of other worries and forebodings. This disorder is more common in women, and often related to chronic environmental stress. Its course is variable but tends to be fluctuating and chronic. (ICD-10, WHO) Mental Health: Though many elements of mental health may be identifiable, the term itself is not easy to define. The meaning of being mentally healthy is subject to many interpretations rooted in value judgments, which may vary across cultures. Mental health should not be seen as the absence of illness, but more to do with a form of subjective well being, when individuals feel that they are coping, fairly in control of their lives, able to face challenges, and take on responsibility. Mental health is a state of successful performance of mental function, resulting in productive activities, fulfilling relationships with other people, and the ability to adapt to change and to cope with adversity specific to the individual’s culture. (ICD-10, WHO) Mental health problems: Mental health problems are real. They affect one's thoughts, body, feelings, and behavior. Mental health problems are not just a passing phase. They can be severe, seriously interfere with a person's life, and even cause a person to become disabled. Mental health problems include depression, bipolar disorder (manic-depressive illness), attention-deficit/ hyperactivity disorder, anxiety disorders), eating disorders, schizophrenia, and conduct disorder. (USDHHS/SAMHSA) Mental Illness: Mental illness refers collectively to all diagnosable mental health problems that become “clinical,” that is where a degree of professional intervention and treatment is required. Generally, the term refers to more serious problems, rather than, for example, a mild episode of depression or anxiety requiring temporary help. (ICD10, WHO) Obsessive Compulsive Disorder: Obsessive Compulsive Disorder is a chronic, relapsing illness. People who have it suffer from recurrent and unwanted thoughts or rituals. The obsessions and the need to perform rituals can take over a person's life if left untreated. They feel they cannot control these thoughts or rituals. (USDHHS/SAMHSA) Panic Disorders: People with panic disorder experience heart-pounding terror that strikes suddenly and without warning. Since they cannot predict when a panic attack will seize them, many people live in persistent worry that another one could overcome them at any moment. (USDHHS/SAMHSA) Paranoia and Paranoid Disorders: Symptoms of paranoia include feelings of persecution and an exaggerated sense of self-importance. The disorder is present in many mental disorders and it is rare as an isolated mental illness. A person with paranoia can usually work and function in everyday life since the delusions involve only one area. However, their lives can be isolated and limited. (USDHHS/SAMHSA) Phobias: Phobias are irrational fears that lead people to altogether avoid specific things or situations that trigger intense anxiety. Phobias occur in several forms, for example, agoraphobia is the fear of being in any situation that might trigger a panic attack and from which escape might be difficult; social phobia is a fear of being extremely embarrassed in front of other people. (USDHHS/SAMHSA)

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Posttraumatic Stress Disorder (PTSD): Posttraumatic Stress Disorder is an anxiety disorder that develops as a result of witnessing or experiencing a traumatic occurrence, especially life threatening events. PTSD can cause can interfere with a person's ability to hold a job or to develop intimate relationships with others. (USDHHS/SAMHSA) Schizophrenia: Schizophrenia is a chronic, severe, and disabling mental disorder that affects approximately 1 percent of the population at some point in their lifetime. The disorder often develops earlier in men, usually in the late teens or early twenties, while women typically develop the disorder in their twenties and early thirties. People with schizophrenia often experience hallucinations (usually hearing voices not heard by others) or delusions (believing that other people are reading their minds, controlling their thoughts, or plotting to harm them). Persons with schizophrenia usually have disturbed interpersonal relationships. They are often fearful and withdrawn, with disorganized speech and behavior. Treatment almost always includes medications. Newer medications are more effective than older ones and have fewer side effects. (ICD-10, WHO) Seasonal affective disorder (SAD): Seasonal affective disorder (SAD) is a form of depression that appears related to fluctuations in the exposure to natural light. It usually strikes during autumn and often continues through the winter when natural light is reduced. Researchers have found that people who have SAD can be helped with the symptoms of their illness if they spend blocks of time bathed in light from a special full-spectrum light source, called a "light box." (USDHHS/SAMHSA) Treatment: Relevant clinical and non-clinical care aimed at reducing the impact of mental disorders and improving the quality of life of patients. [Project Atlas, WHO]

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HELPFUL RESOURCES World Federation for Mental Health - http://www.wfmh.org World Health Organization - http://www.who.int Mental Help Net - http://mentalhelp.net/ Mental-Health-Matters - http://www.mental-health-matters.com/ Mental Health Resources in Japan - http://imhpj.org/links/links.shtml International Center for Disability Resources on the Internet - http://www.icdri.org/Mental %20Health/mental_health.htm National Institute of Mental Health - http://www.nimh.nih.gov/ US Substance Abuse and Mental Health Services Administration - http://www.samhsa.gov Re-Think (UK) – http://www.rethink.org/ The Mental Health Program, The Carter Center – http://www.cartercenter.org/healthprograms/program6.htm New South Wales Health Department (AU) – http://www.health.nsw.gov.au/

REFERENCES US Department of Health and Human Services, Substance Abuse & Mental Health Services Administration (SAMHSA) – National Mental Health Information Center. http://www.mentalhealth.org/resources/dictionary.aspx Internet Mental Health, European Description - The ICD-10 Classification of Mental and Behavioral Disorders - World Health Organization, Geneva, 1992 http://www.mentalhealth.com/p20-grp.html World Health Organization, Mental Health Facts. http://www.who.int/mental_health/en/ World Health Organization, Project Atlas, Definitions. http://www.who.int/mental_health/evidence/atlas/definitions.htm

The World Federation for Mental Health gratefully acknowledges the charitable contribution from Otsuka Pharmaceutical Company, Ltd. (Japan), to support the production of this document. 8

The World Federation for Mental Health is the only international membership organization in the mental health sector with a multidisciplinary constituency that includes professionals from all the mental health disciplines, mental health services users/consumers, family members/caregivers, and citizen mental health advocates. With organization and individual members and contacts in over 100 countries, the Federation strives to build and sustain a global information and advocacy network dedicated to the promotion of mental health, the prevention of mental and emotional disorders, the implementation of best practice recovery focused interventions for people with mental, emotional and psychosocial disorders, and the reduction of stigma and discrimination against mental illnesses and the people who experience them. The Federation is a non-governmental organization in special consultative status with the United Nations and its specialized agencies, including the World Health Organization. World Federation for Mental Health October 2004

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