How Media & Movies Shape Our Perception Of Serious Mental Illness

Transcription

1 How Media & Movies Shape Our Perception Of Serious Mental Illness Georgia Stevens, PhD, APRN, PMHCNS-BC Director, P.A.L. Associates Partners in Aging & Long-term Caregiving Washington, DC Mary Ann Boyd, PhD, DNS, PMHCNS-BC Professor Emerita Southern Illinois University Edwardsville Edwardsville, IL Otsuka Pharmaceutical Development & Commercialization, Inc Otsuka Pharmaceutical Development & Commercialization, Inc., Rockville, MD May 2018 Lundbeck, LLC. MRC2.CORP.D advice or professional diagnosis. Users seeking medical advice should consult with their physician or other healthcare professional.

2 Speaker Profiles Georgia Stevens, PhD, APRN, PMHCNS-BC Position: Dr. Stevens is the Director of P.A.L. Associates; Partners in Aging & Longterm Caregiving in Washington, DC. She also provides staff training and ongoing evaluation of adult and geriatric patients with serious psychiatric mental illness as a long term nurse educator & care consultant. Education: Dr. Stevens earned an BS in nursing from Duke University (Durham, NC), an MSN in Psychiatric Nursing Gerontology from Catholic University of America (Washington, DC) and an PhD in Nursing from the University of Maryland (Baltimore, MD) Mary Ann Boyd, PhD, DNS, PMHCNS-BC Position: Dr. Boyd is the Director of Mental Health Consultants, LLC. She serves as Clinical Faculty for the School of Nursing at Saint Louis University in St. Louis, MO and as a Nurse Educator for the VA Medical Center in St. Louis. She is also Professor Emerita for the School of Nursing at Southern Illinois University Edwardsville (Edwardsville, IL) Education: Dr. Boyd earned an BS in nursing from Indiana University (Bloomington, IN) followed by an MSN from Washington University (St. Louis, MO) a PhD from Saint Louis University and an DNS from Indiana University (Indianapolis, IN). 2

3 This program was developed with the support of Otsuka Pharmaceutical Development & Commercialization, Inc. and Lundbeck, LLC. The speakers are compensated contractors of Otsuka Pharmaceutical Development & Commercialization, Inc. 3 advice or professional diagnosis. Users seeking medical advice should consult with their physician or other healthcare professional.

4 PsychU Virtual Forum Rules of Engagement: Otsuka Pharmaceutical Development and Commercialization, Inc. (OPDC) and Lundbeck, LLC. have entered into collaboration with Open Minds, LLC. to explore new ways of bringing/increasing awareness around serious mental illness. OPDC/Lundbeck s interaction with Open Minds is through PsychU, an online, non-branded portal dedicated to providing information and resources on important disease state and care delivery topics related to mental illness. One of the methods employed for the sharing of information will be the hosting of virtual fora. Virtual fora conducted by OPDC/Lundbeck are based on the following parameters: When conducting medical dialogue, whether by presentation or debate, OPDC/Lundbeck and/or its paid consultants aim to provide the viewer with information that is accurate, not misleading, scientifically rigorous, and does not promote OPDC/Lundbeck products. OPDC/Lundbeck and/or their paid consultants do not expect to be able to answer every question or comment during a PsychU Virtual Forum; however, they will do their best to address important topics and themes that arise. OPDC/Lundbeck and/or their paid consultants are not able to provide clinical advice or answer questions relating to specific patient s condition. Otsuka and Lundbeck employees and contractors should not participate in this program (e.g., submit questions or comments) unless they have received express approval to do so from Otsuka Legal Affairs. OPDC and Lundbeck operate in a highly regulated and scrutinized industry. Therefore, we may not be able to discuss every issue or topic that you are interested in, but we will do our best to communicate openly and directly. The lack of response to certain questions or comments should not be taken as an agreement with the view posed or an admission of any kind. 4

5 Objectives Review the trends of media coverage and cinematic portrayals of mental illness Discuss definitions of stigma within mental healthcare and impact on individuals living with mental health conditions Examine considerations for change in the stigmatized narrative of mental health in the media and provide examples of success 5

6 PORTRAYAL OF MENTAL ILLNESS IN THE MEDIA AND MOVIES This Photo by Unknown Author is licensed under CC BY 6

7 Polling Question What percentage of media coverage of individuals with serious mental illness do you find to be negative? A. 0% to 25% B. 25% to 50% C. 50% to 75% D. > 75% This Photo by Unknown Author is licensed under CC BY 3.0; 7

8 National Trends in Media Coverage of Mental Illness United States: TV & Newspaper Coverage ( ) 1 Most frequently mentioned: Violence (55%) and Type of Treatment (47%) Only 14% described successful treatment/recovery : media descriptions of mass shootings by individuals with mental illness significantly increased Canada: TV Coverage ( ) 2 Significant linear increase of positively-oriented coverage Link of mental illness to violence significantly decreased Remained over 50% of coverage Canada: Newspaper Coverage ( ) 3 Increase in articles with positive tone nearly doubled (18.9% to 34.8%) Stigmatizing content reduced by a third (32.7 to 22.3%) 1. McGinty EE, et al. Health Aff (Millwood). 2016;35(6): Whitley R, Wang JW. Soc Psychiatr Epidemiol. 2017; 53(2): Whitley R, Wang JW. Can J of Psychiatr. 2017;62(4):

9 National Trends in Media Coverage of Mental Illness UK: Four UK national newspapers ( ) 1 Increase in reporting on issues related to mental health/illness Pejorative terms (i.e. schizophrenic ) were used, in a number of the articles, to describe the person with a mental health condition Both the words violence and drugs were linked to mental health/mental illness Japan: Newspaper & TV Coverage ( ) 2 Articles for schizophrenia contained more negative words (e.g., criminal or violent) than depressive disorder or diabetes (31.5%, 16.0%, and 8.2%, respectively) This Photo by Unknown Author is licensed under CC BY-NC-SA 1. Murphy NA, et al. J Ment Health. 2013;22(3): Koike S, et al. Schizophr Bull. 2016;42(3):

10 Media Coverage of Schizophrenia U.S. Newspaper Articles (N=1,802) 1 : Use of the term schizophrenia used metaphorically in higher rates (28%) compared to physical illness such as cancer (1%) 1 Australian Phone Interview (N=5,220) 2 : Recall of media reports about a person with schizophrenia was associated with beliefs about dangerousness Effect mitigated by knowing someone with a mental health problem and having higher education Review of 181 US newspapers covering Auditory Visual Hallucinations (AVH) suggested 3 : Are not present in healthy individuals Were a symptom of mental illness Were associated with criminal behavior, violence, and suicidality 1. Duckworth K, et al. Psychiatr Serv. 2003;54(10): Reavley NJ, et al. Soc Psychiatry Psychiatr Epidemiol. 2016;51(9): Vilhauer RP. Int J Soc Psychiatry. 2015;61(1):

11 Cinematic Depictions of Schizophrenia May be Stereotypic and Misinformed English-language movies ( ) featuring at least one main character with schizophrenia analyzed for depictions of schizophrenia 1 : Most characters displayed positive symptoms of schizophrenia Delusions were featured most frequently, followed by auditory and visual hallucinations A majority of characters displayed violent behavior toward themselves or others, and nearly one-third of violent characters engaged in homicidal behavior. About one-fourth of characters committed suicide Misinformation and negative portrayals of schizophrenia in contemporary movies are common This underscores the importance of determining how viewers interpret media messages and how these interpretations inform attitudes and beliefs 1. Owen, P. Psychiatr Serv. 2012;63:

12 Portrayals of Mental Illness in Video Games 50 highest-selling video games in each year from out of 96 video games depicted at least one character with mental illness 42 characters identified as portraying mental illness, with most characters classified under a homicidal maniac stereotype This Photo by Unknown Author is licensed under CC BY-NC-ND 1. Shapiro S, Rotter M. J Forensic Sci. 2016;61(6):

13 STIGMA IN THE MENTAL HEALTH CARE SETTING This Photo by Unknown Author is licensed under CC BY-NC-ND 13

14 Polling Question What percentage of your patients/clients experience or have internalized shame about their mental health condition? A. 0% to 20% B. 20% to 40% C. 40% to 60% D. > 60% 14

15 Stigma and Stigmatization Structural Stigma 1 Discriminatory laws, policies and community attitudes toward a particular group (especially minority) Public Stigma 2 Discrimination when general public endorses negative stereotypes Leads to loss of service and rights; rejection & social distance Self-Stigma 2,3 Person internalizes public attitudes & negative stereotypes (agree & apply to self) Why try? Leads to loss of self-esteem and self-efficacy Consequences 4 Negative behaviors, emotional reactions that indirectly interfere in health care and serve as barriers to access and treatment 1. Hatzenbuehler M. Am Psychol. 2016;71(8): Corrigan P. Psychiatr Serv. 2015;66: Corrigan P, et al. J Ment Health. 2016;25(1): Carrara B, et al. Arch Psychiatr Nurs. 2018;32(2):

16 The Evolution of Stigma in Mental Health Definitions of stigma overlap with the concepts of social exclusion and discrimination 1 Contemporary conceptualizations require 3 components 1 : 1. A mainstream negative stereotype 1 For example, people who have mental health conditions are weak, irrational, manipulative, dangerous 2. Evidence/signs that a person has a mental health condition 1 For example, diagnosis, uncommon behavior, or a suspicion 3. Avoidance, mistreatment, or discrimination against the person 1,2 Can be intentional behaviors like friendliness, or subconscious nonverbal behavior such as eye contact Stigma is a dynamic social/interactional process 1,2 The stigmatized person is labeled as different, linked to negative stereotypes, Persons with stigmatizing beliefs may exhibit behaviors that forge a separation, and the recipient responds accordingly 1. Horsfall J, et al. Issues Ment Health Nurs. 2010;31(7): Dabby L, et al. Can J Psychiatry. 2015;60(10):

17 Attitudes Among Mental Healthcare Professionals Pessimistic views held by mental healthcare providers may be based on clinical experience with patients in the most distressed phase of mental illness and those who are challenging to treat 1 3 Stereotypical views in this population may invoke feelings of uselessness, helplessness, or hopelessness, which may impact both professional and patient 1 Without effective diagnosis and treatment options, mental disorders are seen as untreatable, resulting in patients being undervalued and perceived as not able to contribute to society 4 Studies have reported a greater degree of stigma towards enduring mental illness versus short-lived psychotic episodes 5 Greater negative attitudes from staff working in inpatient services versus those in outpatient services has also been reported 6 1. Horsfall J, et al. Issues Ment Health Nurs. 2010;31(7): Schulze B. Int Rev Psychiatry. 2007;19(2): Dabby L, et al. Can J Psychiatry. 2015;60(10): Ngui EM, et al. Int Rev Psychiatry. 2010; 22(3): Rao H, et al. J Psychiatr Ment Health Nurs. 2009;16(3): Mårtensson G, et al. J Psychiatr Ment Health Nurs. 2014;21(9):

18 Mental Health Patient Perspectives on Stigma 1 Attitudes/routine practices may be experienced as stigmatizing Specifically, mental healthcare consumers have reported feeling stigmatized by: A lack of interest in them and their mental health history Being held to a standard psychiatric treatment Being diagnosed in a way that conveys an expectation of negative prognosis Not being sufficiently informed about and/or included in treatment decisions Receiving poor quality mental health services Image based on: Schulze; Schulze B. Int Rev Psychiatry. 2007;19(2):

19 Stigma: Effects and Perpetuations For individuals living with mental health conditions, stigmatization forms a barrier to recovery and social integration 1,2 A major reason identified by consumers of mental healthcare for not seeking or continuing with treatment is the stigma that they encounter 3 The stigma, myths, and misconceptions surrounding mental illness contribute to the discrimination and human rights violations experienced by people living with mental health conditions 4 In addition to individuals living with mental health conditions, their families and mental health professionals can also be the targets of stigmatization 5 There is increasing recognition that clinicians play an important role in perpetuating or mitigating stigma in the health care setting 2 This is important, as evidence suggests that patients living with mental health conditions receive fewer physical and laboratory examinations, are provided with less preventative healthcare, and receive fewer therapeutic interventions 2 Psychiatry itself is an important target of anti-stigma initiatives 5 1. Mårtensson G, et al. J Psychiatr Ment Health Nurs. 2014;21(9): Dabby L, et al. Can J Psychiatry. 2015;60(10): Ross CA, Goldner EM. J Psychiatr Ment Health Nurs. 2009;16(6): Ngui EM, et al. Int Rev Psychiatry. 2010; 22(3): Schulze B. Int Rev Psychiatry. 2007;19(2):

20 10 Ways to Combat Discrimination With Compassionate Language 1 The choice of what picture you will paint with words is yours we ask only that you consider altering your color palette. Image from: DBSA Website 1 1. Depression and Bipolar Support Alliance (DBSA). 10 Ways to Combat Discrimination with Compassionate Language. DBSA Website. Available at: Accessed September

21 10 Ways to Combat Discrimination With Compassionate Language (continued) 1 Defy Definitions Use of mental illness imply a perpetual state of abnormality whereas mental health conditions often present episodic challenges Choose Thoughtfully Many negative phrases historically associated with mental health have become part of the common vernacular but can be harmful Don t Make Assumptions Refer to individuals as people living with (or experiencing) mental health challenges Avoid Distancing Use language that references people or individuals, instead of them, those, or the mentally ill Separate the Person From the Condition Avoid reducing an individual to their condition (for example, he is bipolar ) 1. Depression and Bipolar Support Alliance (DBSA). 10 Ways to Combat Discrimination with Compassionate Language. DBSA Website. Available at: Accessed September Image based on: DBSA Website 1 21

22 10 Ways to Combat Discrimination With Compassionate Language (continued) 1 Allow for Personal Choice DBSA acknowledges the individual right to terminology of choice, but encourages more wellness-focused language Accept Responsibility Choose language that is accurate, respectful, and caring Avoid Sensationalizing Avoid emphasizing the most shocking and tragic aspects of a situation. Don t use headlines designed to shock and evoke fear Portray People Realistically Avoid showing a person only in an acute episode or in shock-value behavior. Represent the broad experience of people living with mental health conditions 1. Depression and Bipolar Support Alliance (DBSA). 10 Ways to Combat Discrimination with Compassionate Language. DBSA Website. Available at: Accessed September Don t Assume Mental Health Is a Factor in Violent Crime For mass shootings, avoid insinuating/stating that a shooter has a mental health condition when there is no or questionable substantiation Image based on: DBSA Website 1 22

23 ALTERING THE STIGMATIZED NARRATIVE ON MENTAL HEALTH IN THE MEDIA 23

24 Polling Question Do you believe media and movies can be used to better educate on conditions of serious mental illness? A. Yes B. No C. Best left to the professionals D. They are just entertainment 24

25 Positive Impact: Media Pilot study to assess if brief anti-stigma intervention (TV report) may have long-term effects 1 Persistent impact on reducing discrimination After watching a documentary film on people with schizophrenia less stigmatization was reported versus the control group 2 Systematic review (27 studies) found anti-stigma interventions for media professionals have some effect in improving reporting style 3 Intervention examples: contact-based educational approaches and the provision of guidelines by authoritative institutions Need for more positive and recovery-oriented impressions through mass media, as well as the importance of realistic depictions of people with mental illness in media 1. Bosoni N, et al. Int J Soc Psychiatry. 2017;63(3): Thonon B et al. J Behav Ther Exp Psychiatry. 2016;50: Maiorano A, et al. Can J Pyschiatry. 2017;62(10):

26 Positive Impact: Media Increased Awareness and Compassion for Individuals with Depression and Suicidality Case Study in the Media: Renowned comedian and actor Robin Williams suffered from severe depression, believed to be the leading contributor to his suicide 1 As of the end of 2015, no other case study seemed to have addressed or explored the links between the cause (or causes) and events leading to suicide. 1 His case exemplifies four major risk factors for suicide: Major depression Substance abuse Relationship troubles Financial problems Increased number of US suicides beyond predictive trends following his death 2 This Photo by Unknown Author is licensed under CC BY-NC-ND 1. Tohid H. Trends Psychiatry Psychother. 2016;38(3): Fink D, et al. PLoS ONE 2018;13(2): e

27 Positive Impact: Cinema Since the first use of film in cinema, it has been considered a mirror that reflects society 1 One Flew Over the Cuckoo s Nest This Photo by Unknown Author is licensed under CC BY-SA Provoked debates on the ethical aspects of the treatment of patients with mental illness The movie established a need to look at the entirety of a patient as an individual and need for empathy from treatment team As Good As It Gets Portrayed the minutiae of the complexities of OCD Helped to increase the awareness of OCD with widespread media coverage, helping those with the disorder to seek treatment OCD, Obsessive Compulsive Disorder 1. Tripathi M, et al. World Neurosurg. 2017;101:

28 The Importance of Dignity and Rights in Mental Healthcare 1 Dignity and rights for people affected by mental health conditions are the counterpoint to a legacy of stigma, shame and discrimination that has caused social isolation, chronic underfunding of services, unnecessary levels of disability, and unacceptable levels of premature death. Public awareness must be led by people who have experienced these impacts personally, along with their supporters, allies and related professionals. - Destination Dignity Coalition Image from: Destination Dignity; Destination Dignity Coalition. March for Dignity and Change in Mental Health. Destination Dignity Website Available at: Accessed September

29 DISCUSSION 30

30 QUESTIONS 31

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