Mental Illness & Suicide in the Media. A Mindframe Resource for the Courts

Transcription

1 Mental Illness & Suicide in the Media A Mindframe Resource for the Courts

2 c) Commonwealth of Australia ISBN: Online ISBN: This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced by any process without written permission from the Commonwealth. Requests and inquiries concerning reproduction rights should be directed to the Commonwealth Copyright Administration, Attorney Generals Department, Robert Garran Offices, National Circuit, Canberra, ACT 2600 or posted at The opinions expressed in this document are those of the authors and are not necessarily those of the Commonwealth. Content developed by the Hunter Institute of Mental Health in consultation with an Advisory Group of experts, for the Mental Health and Suicide Prevention Programs Branch, of the Australian Government Department of Health and Ageing. Designed by Advocart Pty Ltd Publications approval number: P The project website at contains the most up to date information and advice on how to obtain additional copies of the resource.

3 Foreword In Australia, one in five people will directly experience a mental illness in their lifetime and recent data suggests about 1800 people take their own life each year. The media has an important role to play in influencing community attitudes towards and perceptions of both mental illness and suicide. The courts are an important news source for most media organisations. Information is accessible, timely, and viewed as having high human or dramatic interest. Often, court stories involve themes of fear, horror or shock, and much information can be deeply personal and intimate. Through court and inquest proceedings journalists are privy to details about a person s mental health status, specific details about a suicide death, and claims made by witnesses, victims and experts called to give testimony. Australian research 1 has indicated that the most problematic type of news coverage of mental illness and suicide results from information collected at courts and coroners courts, or from the police. While magistrates, coroners and other court officials may not talk directly to the media or seek out media coverage on a regular basis, their general dealings with journalists may have an impact on the way a story is developed. Mental Illness & Suicide in the Media: A Mindframe Resource for Courts has been produced as part of the Australian Government s Mindframe National Media Initiative. This Initiative aims to encourage responsible, accurate and sensitive coverage of suicide and mental illness through a range of complimentary projects working with the media in Australia. This resource provides practical advice and information for judges, magistrates, coroners, media liaison officers and other court staff to support their work with the media. This may be through indirect means, such as statements and remarks made in court, or directly through comments or information provided to the media. As representatives of peak media bodies, suicide prevention and mental health organisations and the Australian Government, we commend this resource to you. National Media and Mental Health Group, April 2008

4 About this resource This resource contains practical information for courts to support their direct and indirect interactions with the media. It contains suggestions for providing or managing information about mental illness or suicide that are consistent with best practice guidelines for reporting. I don t want to be told what to say and do, but I do want to be informed about what I say and do. This resource has been developed as part of the Mindframe for Police and Courts Project. It was developed by the Hunter Institute of Mental Health in consultation with an Advisory Group of experts, with funding from the Australian Government Department of Health and Ageing as part of the Mindframe National Media Initiative. The development of this resource has been informed by consultations with a variety of stakeholders across Australia, including: n Media liaison officers in departments of justice; n Individual judges, magistrates and coroners; n Administrators of courts; n Media professionals; n Mental health and suicide prevention experts; n Members of the National Media and Mental Health Group. This resource is also available in electronic form at

5 Contents 1. Introduction 1 2. Mental Illness in the Media 5 n Evidence of Impact... 6 n Key Issues to Consider Judicial Officers... 8 n Key Issues to Consider Other Officers of the Court n Mindframe Considerations for Media Professionals Suicide in the Media 15 n Evidence of Impact n Key Issues to Consider Judicial Officers n Key Issues to Consider Other Officers of the Court n Mindframe Considerations for Media Professionals About Mental Illness 25 n Specific Mental Illnesses n Mental Illness in Australia n Common Myths about Mental Illness About Suicide 35 n An Overview of Suicide in Australia n Common Misconceptions about Suicide Media and the Courts Further Information 51 n Helplines & Contacts n References... 58

6 Acknowledgements This resource was developed by the Hunter Institute of Mental Health, in partnership with an Advisory Group of experts, for the Mental Health and Suicide Prevention Programs Branch of the Australian Government Department of Health and Ageing. People involved in the development of this resource include: Jaelea Skehan, Martin O Connor, Michael Romeo, Amy Visser & Trevor Hazell (Hunter Institute of Mental Health); Jane Johnston (Griffith University); Terry Anderson (South Australia Courts); Elizabeth Gaynor (Victoria County Court); John Arms (NSW Coroner s Courts); Sue Hunt, Annabel Dobson & Kirrily Cornwell (Department of Health and Ageing). The project team also acknowledges the involvement of the following people in the consultation and review process for these resources: Michael Johnson & Hugh Jorgenson (ACT Magistrates Court), John Merrick (NSW State Coroners Office), Magistrate Wayne Evans & Magistrate Jeff Linden (Magistrates Courts NSW), Chief Magistrate Brian Martin (NT), Dr Celia Kemp (NT Coroners Court), Lorelei Fong Lim (NT Justice), Dianne Pendergast & Louise Logan (Queensland Adult Guardian), Paul Rutledge (Queensland Department Public Prosecutors), Susan Gardiner (Queensland Guardianship and Administration Tribunal), Wendy Grenfell (Queensland Health), Marcus Richard (Queensland Office of Public Advocate), Mark Johns (SA State Coroner), Magistrate Bill Ackland (SA), Jim Connolly (Tasmania Courts Administration), Arnold Schott (Tasmania State Coroner), Graeme Johnstone (Victoria State Coroner), Louise Glanville (Victoria Attorney General s office), Maria Lusby (Victoria Judicial College), Chief Judge Michael Rozenes (Victoria County Court), Sue James (WA Department of Justice), and Cathy Heycock (SANE Australia). The project team recognises the advice and support from the National Media and Mental Health Group that provides guidance to all projects funded under the Mindframe National Media Initiative: Ms Heather Forbes & Ms Rhianna Patrick (Australian Broadcasting Corporation), Dr Matthew Dobson (Australian Communications and Media Authority), Ms Alina Lieurance (FreeTV Australia), Commercial Radio Australia, Mr Warwick Costin & Mr Rex Jory (Australian Press Council), Mr Michael Winter (Australian Writers Guild), Ms Georgina McClean (SBS), Mr Clive Skene (Flinders Medical Centre), Ms Barbara Hocking (SANE Australia), Ms Julie Foster (beyondblue), Ms Janet Meagher (Australian Mental Health Consumer Network), and Mr Simon Tatz (Mental Health Council of Australia).

7 Introduction The media has an important role to play in influencing community attitudes towards and perceptions of both mental illness and suicide. Research 2 about the way the Australian media portrays suicide and mental illness indicated that the most problematic type of news coverage about these issues resulted from information collected by journalists at courts and coroners courts, or from the police. While magistrates, coroners and other members of the court rarely talk directly to the media, courts remain a major source of information for journalists. Along with police stations, the courts are routine sites for gathering news, and media organisations invest considerable resources in this type of journalism 3. Court proceedings are scheduled, so they become part of the regular news diary. Courts and court information is easily accessed by editors and journalists, it can be planned for and predicted, and is efficiently and effectively monitored. Courts are a valuable source of information for the media about incidents and cases where mental illness or suicide may be raised. In fact, having mental illness raised in court may make a particular case more newsworthy. Similarly, suicide deaths that result in a coronial inquiry may be of more interest to journalists, due to speculation about the cause of death or possible breaches in duty of care. Often crime and court stories involve themes of fear, horror or shock, and much information can be deeply personal and intimate. Australian research found that these framing devices are not only identified in major Australian newspapers and broadcast media, but also appear in regional news 4. In addition, sensational or inappropriate language in the headline or broadcast leads in these types of stories is common. Schizo teen jailed 10 years. A schizophrenic teenager who battered his friend to death with a lump of timber has been jailed for 10 years by a Sydney court. Northern Territory News (2007, 11 August, p.15) 1

8 I always find it Courts and coroners courts often give journalists interesting reading access to quite shocking and graphic or bizarre details, such as the manner of a death or the about or watching circumstances leading up to an incident. Sometimes programs about people shocking detail may be justified by the need to draw who suicide. In a way I attention to the seriousness of a particular case. look up to people who kill However, it is possible that vulnerable groups could themselves. I think, well, interpret this information in a different way. so many other people do This resource provides practical advice and it, maybe I ll do it as well. information for judges, magistrates, coroners, media liaison officers and other court staff to support their work with the Australian media. This may be through indirect means, such as statements and remarks made in court, or directly through comments or information provided to the media. The key sections of this resource are those that specifically outline the Issues to Consider when working with the media about mental illness or suicide. The orange tabbed sections at the front of the resource summarise key points related to Mental Illness in the Media and Suicide in the Media. In response to needs identified in consultations about the development of this resource some additional sections have been added. The green tabbed sections provide some general facts, statistics and information About Mental Illness and About Suicide. The final yellow tabbed sections contain basic information about Media and the Courts, along with Further Information about the Mindframe website and some other useful websites and contacts for further information. The resource has been developed following consultation with a range of court representatives in each state and territory. The information is supported by a more comprehensive website at 2

9 The Mindframe National Media Initiative The Mindframe National Media Initiative (Mindframe Initiative) is funded by the Australian Government Department of Health and Ageing and guided by the National Media and Mental Health Group. The Initiative aims to influence media coverage of issues related to mental illness and suicide by encouraging responsible, accurate and sensitive portrayals. The strategy includes a number of complementary projects and resources, working with a variety of sectors in Australia, as outlined in Figure 1. Projects and resources funded under the Mindframe Initiative include: n The Media Monitoring Project 2001, 2007 providing critical reviews of the international literature and investigating the extent and nature of reporting in Australia through a 12- month baseline study in 2001 and a 6-year follow-up study in 2007; n The Mindframe Media and Mental Health Project developing and promoting resources and professional development opportunities for media professionals to encourage accurate and sensitive reporting of suicide and mental illness; n The Response Ability Project developing and disseminating curriculum resources for the university training of journalism students and support for Australian universities implementing the materials; n SANE Australia s Media Centre supporting both media and the mental health sector in the development of stories about suicide and mental illness, including the community action site, StigmaWatch; n Mindframe for the Mental Health Sector developing and promoting resources and professional development opportunities for the mental health and suicide prevention sectors; n Mindframe Stage and Screen developing and promoting resources for scriptwriters and other people involved in the development of Australian film, television and theatre; n Mindframe for Police and Courts developing and disseminating resources and professional development opportunities for police and the courts. More information on all projects and resources funded under the Mindframe Initiative are available from 3

10 Figure 1: Resources and projects under the Mindframe Initiative Response Ability for Journalism Education - Resources for university training of journalism students Mindframe Media and Mental Health Project - Resources for media professionals Mindframe for the Mental Health Sector - Resources for the mental health and suicide prevention sector The Media Monitoring Study, 2001, 2007 National Media and Mental Health Group Including representatives from the Australian Government Department of Health and Ageing, peak media bodies and mental health and suicide preventation organisations. Mindframe Stage and Screen - Resources for Australian film, television and theatre Mindframe for Police - Resources for police officers Mindframe for Courts - Resources for judicial and other officers of the courts SANE Australia s Media Centre & StigmaWatch program 4

11 Media Reporting of Mental Illness Research has indicated that for many people the media is their primary source of information about mental illness 5. According to national and international research, mental illness tends to be portrayed negatively in the mass media. While Australian research 6 has demonstrated that media reporting of mental illness may be improving, examples of inappropriate reporting can still be seen. Negative reporting of mental illness appears to influence community attitudes, which in turn may lead to stigma and discrimination 7. Instances of negative reporting impact significantly on people experiencing mental illness and may reduce appropriate help-seeking behaviour, resulting in untreated illness and possibly contributing to suicidal thinking and behaviour 8. We re a long way off people accepting that mental illness is just another illness. There is still a stereotypical stigma attached to it that is negatively reinforced every time there is bad reporting. 9 Australian research has shown that coverage of mental illness that results from information collected at courts or from the police is the most problematic type of news coverage 10. Many news stories from the courts about mental illness focus on violence. These stories relate to specific and relatively rare circumstances, but audiences are likely to draw generalised inferences about people diagnosed with a mental illness as a result. As is the case in the general community, members of the media may hold misconceptions about mental illness that may influence the frame they use for a particular story. It is important, therefore, that people involved in the judiciary understand the potential impact of reporting mental illness in certain ways and are aware of the principles of best practice reporting promoted through the Mindframe Initiative. What follows in this section is: a summary of research evidence regarding the impact of media reporting; issues to consider for judicial officers about indirect communication with the media; issues to consider for other officers of the court about direct communication with the media; and an outline of the issues media professionals are asked to consider when reporting mental illness. 5

12 Evidence of Impact: Media Reporting of Mental Illness Research has demonstrated that the media has an important role to play in informing and influencing community attitudes towards mental illness and people affected by mental illness. A summary of findings from a critical review of the national and international literature 11 is provided below. The media is an important source of information for many people about mental health and mental illness. n A German study found that the media is the most important source of information for many people on mental health and illness and that negative media reports were more commonly recalled than positive ones 12. n A number of American studies also found that the media is an important source of information about mental health issues 13, 14. Mental illness tends to be portrayed negatively in news media, with coverage promoting negative images and stereotypes. n An Australian study found that electronic and print media coverage often reflects and perpetuates the myths and misunderstandings associated with mental illness 15. n A study of newspaper items on mental illness in a New Zealand newspaper in 1997 found that mental illness was portrayed negatively and that people with a mental illness were portrayed as a danger and a threat to the community Courts are an important source of information for media stories involving mental illness. Australian research has shown that the most problematic type of news coverage about mental illness results from information collected at court or from the police 17. Many of these stories focus on violence and relate to specific and relatively rare circumstances. Audiences, however, are likely to make generalisations about people with a mental illness as a result.

13 Negative reporting of mental illness has a direct effect on attitudes. n Individuals citing the media as the most important source of their information had more negative attitudes towards mental illness 18. n Media accounts of mental illness that instil fear have a greater influence on public opinion than direct contact with people who have a mental illness 19. n A number of studies demonstrated that exposure to negative stories, both fictional and nonfictional, had a direct effect on attitudes which was not altered by subsequent exposure to positive stories 20, 21. n A German study found that students who read negative articles about mental illness expressed more negative attitudes toward people with a mental illness 22. Negative portrayals impact directly on people living with a mental illness. n Three quarters of consumers of mental health services in a UK study felt that media coverage was unfair, unbalanced or very negative, while 50% believed media portrayal of mental health issues had a negative effect on their mental health 23. n A survey by SANE Australia found that 95% of consumers believed that negative portrayals of mental illness had an effect on them and 80% reported that the effect was negative. Consumers described direct effects including distress, perceptions of stigma and self-stigma 24. A more comprehensive summary of the research evidence is available from 7

14 Key Issues to Consider Courts are a valuable source of information for the media about incidents and cases where mental illness may be raised. In fact, having mental illness raised in court may make a particular case more newsworthy. Through court proceedings journalists are privy to details about a person s mental health status, past mental ill health and claims made by witnesses and experts called to give testimony. While magistrates and other court officials may not talk directly to the media or seek out media coverage on a regular basis, their general dealings with journalists may have an impact on the way a story is developed. This section is broken into two parts: n PART 1 summarises some key issues to consider for judicial officers to guide their indirect contact with the media around mental illness. n PART 2 summarises some key issues to consider for other officers of the court to guide their direct interactions with the media around mental illness. These issues to consider support the guidelines provided to Australian journalists about the reporting of mental illness (see page 14). Issues to Consider: Judicial Officers n Consider the potential impact of the story and whether to make official comment. n Consider whether journalists will be able to understand and correctly interpret the impact of mental illness on the proceedings and the judgement. n Check that your language is appropriate and that it does not stigmatise mental illness. n Be mindful not to reinforce common myths and stereotypes about mental illness. Issues to Consider: Other Officers of the Courts n Consider the potential impact of the story and whether to make official comment. n Where appropriate, provide information about treatment and support options for people living with mental illness. n Check that your language is appropriate and that it does not stigmatise mental illness. n Be mindful not to reinforce common myths and stereotypes about mental illness. n Refer journalists to Mindframe. 8

15 Part 1: For Judicial Officers Consider the potential impact of a particular story and whether to make official media comment. n Consider if you are able to provide comment or advice to media professionals. Do you need advice or support from the Media Unit? n Does the story have the potential to contribute to better understanding of mental health and mental illness in the wider community? There may be the potential to include information that will assist in understanding how mental illness is dealt with in the courts. n If the story is more generally about mental illness, you may want to refer the journalist to the expert comment section of the Mindframe website at Consider whether journalists will be able to understand and correctly interpret the impact of mental illness on the proceedings and the judgement. n When issuing judgements, consider whether it is possible to place statements relating to mental illness in a context that minimises misinterpretation by members of the court, including journalists. n Journalists are asked to question whether mental illness actually contributes to a news story in a significant way. Ensure that you provide enough information through remarks and statements to assist them in making this judgement call. n Is there any capacity for you to remind journalists present in court about their responsibilities when reporting mental health and illness? This may prompt some journalists to do further research before compiling the story. 9

16 In sentencing and remarks from the bench, check that your language is appropriate and that it does not stigmatise mental illness. n A key part of court reporting involves quoting remarks made from the Bench. The language used when reporting on mental illness can contribute to stereotypes, myths and stigma. Journalists are unlikely to edit direct quotes from sentencing remarks and judgements even when they recognise that the language may not be helpful. n It is important that the language used is consistent with suggestions provided to the media. Your comments potentially reach many members of the community. Avoid negative language, e.g. mental patient, lunatic, schizo, psycho etc. Avoid labelling a person by their mental illness e.g. a person is not a schizophrenic, they are currently experiencing, being treated for or have a diagnosis of schizophrenia. Be careful not to imply that all mental illnesses are the same and ensure that correct terminology is used in relation to specific diagnoses. Do not use diagnostic terms unless the diagnosis has been confirmed by a medical professional. Be aware of the language you use when referring to someone leaving hospital e.g. a person is discharged from hospital not released and they leave or go missing, they do not escape. Be mindful not to reinforce common myths and stereotypes about mental illness. n While news stories that emanate from court proceedings relate to specific and relatively rare circumstances, audiences are likely to draw from them general inferences about people living with a mental illness and the risk they may pose to the public. n The type of information presented in court, and subsequent media reports, may reinforce stereotypes such as those that link mental illness with violence or suggest people with mental illness are unable to work, parent or lead fulfilling lives. n Ensure not to make generalisations about mental illness broadly or specific mental illnesses. 10

17 Part 2: For Other Officers of the Court Consider the potential impact of a particular story and whether to make official media comment. n Find out what the journalists needs, including the angle for the story. Is the issue about a judgement in a particular case, or more generally about the interface between mental illness and the courts? n Consider whether the story has the potential to contribute to better understanding of mental health and mental illness in the wider community. There may be an opportunity to include information that will assist in understanding how mental illness is dealt with in the courts. n While you always have the option of saying no you may also want to consider the impact of not participating in a story. That is, the story may still be run without expert comment and advice. This may sometimes be worse than participating. n If the story is more generally about mental illness, you may want to refer the journalist to the expert comment section of the Mindframe website at Where appropriate, provide information about treatment and support options for people living with mental illness. n Stories that involve mental illness may prompt someone who is concerned about themselves or someone they know to seek help. Media stories sourced to the courts rarely have information about where to seek help or where to access further information for people who may be directly or indirectly affected by mental illness. n Where possible provide media professionals with helpline numbers and suggest that the information is included in the report. It is important to provide support information relevant to the audience of each story. For most reports it will be appropriate to cite a national helpline such as the one provided by SANE Australia on SANE (7263). However, you may also want to consider contact details for particular population groups provided on page

18 In interviews or any other interactions, check that your language is appropriate and that it does not stigmatise mental illness. n The language used when reporting on mental illness can contribute to stereotypes, myths and stigma. Journalists may be unlikely to edit direct quotes from interviews, press releases or transcripts. n It is important that the language used is consistent with suggestions provided to media professionals. Remember that your comments potentially reach many members of the community. Avoid negative language, e.g. mental patient, lunatic, schizo, psycho etc. Avoid labelling a person by their mental illness e.g. a person is not a schizophrenic, they are currently experiencing, being treated for or have a diagnosis of schizophrenia. Be careful not to imply that all mental illnesses are the same and ensure that correct terminology is used when a diagnosis is referred to. Do not use diagnostic terms unless the diagnosis has been confirmed by a medical professional. Be aware of the language you use when referring to someone leaving hospital e.g. a person is discharged from hospital not released and they leave or go missing, they don t escape. Victim impact statements are very powerful and often used by journalists to add emotion and human interest to a story. These statements may include comments about the mental health of either the accused or the victim themselves. These statements may provide an opportunity to highlight the impact of traumatic events on someone s mental health, where the victim details how the event has affected them and their family. These statements, however, may also perpetuate fear and misunderstanding about mental illness, especially where an offender is described using derogatory language that implies the existence of a mental illness. 12

19 Be mindful not to reinforce common myths and stereotypes about mental illness. n The type of information presented in court, and subsequent media reports, may reinforce stereotypes such as those that link mental illness with violence or suggest people with mental illness are unable to work, parent or lead fulfilling lives. n Consider whether it is appropriate to provide some context surrounding an incident. For example, where violence occurs it is often in the context of drug use, distressing hallucinations or treatment that has been ceased or ineffective. Some stories gain additional prominence and national attention because of a seemingly extraordinary frame, usually taken from court testimony or comments from a judge. A mentally ill man who believed he was an alien due to be picked up by a spaceship killed his father and his faithful dog by repeatedly stabbing them, a judge said yesterday. (Kalgoorlie Miner, 29 June 2000) Refer journalists to Mindframe. n Are the journalists covering the courts or conducting an interview aware of the Mindframe guidelines for reporting mental illness available from n Is there an opportunity to recommend that journalists access the site for appropriate helpline numbers that they can add and contact details for mental health organisations that may be able to assist with the story? n It is recommended that the Mindframe website be added to the bottom of all correspondence with media professionals that may involve mental illness. n You may want to designate at least one person who can discuss ways of reporting mental illness with media professionals who approach your jurisdiction and ensure they are aware of the Mindframe resources for media professionals. This may be a public affairs unit or an identified media liaison representative. 13

20 Mindframe Considerations for Media Professionals Reporting Suicide and Mental Illness: A Mindframe resource for media professionals makes a number of suggestions for editors and journalists to consider when reporting mental illness. These issues to consider are informed by research evidence related to the impact of media portrayal of mental illness, and are summarised below. n Consider whether the person s mental illness is relevant to the story and whether it needs to be included. In particular, whether it needs to be referred to in the headline or lead. n Ensure any references made to mental illness are accurate and in context. n Be mindful of language used in relation to mental illness: Avoid negative language such as psycho, schizo, mental patient or lunatic asylum. Avoid referring to someone as a victim, suffering from or afflicted with mental illness. Avoid language that labels a person or suggests mental illness is a life sentence. Ensure that medical terminology is not used out of context, e.g. schizophrenic policy. n Be mindful of stereotypes such as those that link mental illness with violence or suggest people who have mental illness are unable to work, parent or lead fulfilling lives. n Be careful not to imply that all mental illnesses are the same. The term mental illness covers a wide range of symptoms, conditions and effects. n Ensure that informed consent has been gained before interviewing people affected by mental illness. n Include helpline numbers and information about options for those seeking help. n Seek advice from recommended health experts. A complete outline of issues to consider for media professionals can be accessed from the Mindframe website at 14

21 Media Reporting of Suicide The media has an important role to play in influencing social attitudes to suicide and potentially the actions of vulnerable people. Australian and international research shows that reporting of suicide can have an impact on vulnerable people 25. People in despair may be influenced by media reports of suicide, particularly where they identify with the person in the report, or where suicide is romanticised, glamorised or otherwise portrayed as an acceptable course of action. I think it s how you [report suicide], because I think that the offset against things like copycats is the information that you give [people] so that they are better informed 26. Media codes of practice state that, in general, suicides will not be reported. However, there will be times when a death will be reported if it is considered to be in the public interest. This might include the death of a prominent person, a death in a public place, or a death that is in some way related to other political or social issues, such as a death in custody. While media generally take a responsible approach to reporting suicide, examples of inappropriate reporting can still be seen. A significant number of news items about suicide result from information gathered at coroners inquests and other courts 27. Often, specific details of method or location of death are included in the proceedings of an inquest, and can then find their way into media reports. Coroners, magistrates, court administrators and media liaison officers need to have an understanding of the potential impact of reporting suicide in certain ways. This may inform the way in which they relate to journalists in both formal (e.g. media statements) and informal (e.g. court proceedings) ways. What follows in this section is: a summary of research evidence regarding the impact of media reporting; issues to consider for judicial officers about indirect communication with the media; issues to consider for other officers of the court about direct communication with the media; and an outline of the issues media professionals are asked to consider when reporting suicide. 15

22 Evidence of Impact: Media Reporting of Suicide Research has demonstrated that while increased rates of actual suicide have been associated with some reporting, examples of decreased rates of actual suicide following reports have also been found. A summary of findings from a critical review of the national and international literature 28 is provided below. A number of characteristics have been associated with increased rates of suicide. Reporting of celebrity suicide. n A series of American studies found increased rates of suicide in months in which front page newspaper articles of celebrity suicide appeared 29, 30. n A Canadian study found an increase in suicide rates in the month following the reported death of a prominent person in Quebec. 31 High profile reporting of suicide. n A number of studies have found increased rates of suicide in the months that front-page reports of non-celebrity suicides appeared 32, 33, 34. Description of method and location. n Higher rates of suicide by a particular method have been found to follow the appearance of newspaper stories on a suicide by these methods 35, 36, 37, 38. n An Austrian study conducted after the suicide death of a celebrity found a correlation in suicide method in those areas with high newspaper distribution post suicide 39. Where vulnerable people identify with the person who is the subject of the story. n A US study found an increase in the rate of death by suicide among older people following reporting of suicide in this population group 40. n An Australian study found an increase in the number of males who died by suicide following newspaper reports of suicides with the peak being three days after reporting 41. n A US study found that suicide stories to which a local audience has the greatest exposure are likely to produce contagion and that, in particular, local television news is a potent influence

23 Prolonged or repetitive reporting of a suicide. n An Australian study found evidence for a dose response effect, where the greater the coverage of a particular suicide the greater the risk of an increase in subsequent suicides 43. Courts are important sources of information for media stories about suicide Many newspaper and broadcast news stories about suicide result from information collected by journalists at courts or coroner s courts or from the police 44. These stories are the most problematic in terms of following media guidelines for reporting of suicide, due to the use and placement of the word suicide in headlines and broadcast leads, details of the method of suicide, and the prominence given to the story. Other characteristics of reporting have been associated with decreased rates of suicide. Portrayal that positions suicide as a tragic waste and an avoidable loss and focuses on the devastating effects on others. n An Australian study of reporting following Kurt Cobain s suicide found rates among young Australians aged were significantly lower in the month following the reporting of his death than for corresponding months in previous years. Significantly, the media were highly critical of Cobain s decision to end his life 45. n A US study showed rates of completed and attempted suicide by young people fell following the broadcast of telemovies showing the impact of suicide 46. Reporting that does not describe method or location of death. n Austrian studies found that the number of completed and attempted suicides in the Vienna subway dropped after the introduction of media guidelines led to less frequent reporting of suicides by that method and in that location 47, 48, 49. A more comprehensive summary of the research evidence is available from 17

24 Key Issues to Consider Courts are a valuable source of information for the media about incidents of suicide that they may deem to be newsworthy. Through court proceedings and inquests journalists are privy to details about the circumstances surrounding a death. As such, courts may be called upon by the media to make comment about particular cases or issues from time to time. While coroners and other court officials may not talk directly to the media or seek out media coverage, their general dealings with journalists in the courtroom may have an impact on the way a story is developed. This section is broken into two parts: n PART 1 summarises some key issues to consider for judicial officers to guide their indirect contact with the media around suicide. n PART 2 summarises some key issues to consider for other officers of the court to guide their direct interactions with the media around suicide. These issues to consider support the guidelines provided to Australian journalists about the reporting of suicide (see page 24). Issues to Consider: Judicial Officers n Consider the potential impact of the story and whether to make official comment. n Avoid specific description of the method and location of suicide and consider how to manage this information in the courtroom. n Check your language does not glamorise or normalise suicide. Issues to Consider: Other Officers of the Courts n Consider the potential impact of the story and whether to make official comment. n Avoid specific description of the method and location of suicide. n Consider how to include information that may improve community understanding. n Check your language does not glamorise or normalise suicide. n Include information that promotes help-seeking behaviour. n Refer journalists to Mindframe. 18

25 Part 1: For Judicial Officers Consider the potential impact of the story and whether to make official media comment. n Consider if you are able to provide comment or advice to media professionals. Do you need advice or support from your media liaison unit? n Think about whether the story is likely to have benefits for the community. That is, does it provide an opportunity to increase community understanding, highlight groups at risk or promote help-seeking behaviour in some way? If this is the case, consider in what ways you may be able to have input. n If the story is generally about suicide or suicide prevention, you may want to refer the journalist to the expert comment section of the Mindframe website. Avoid specific description of the method and location of suicide and consider how to manage this information in the courtroom. n Where possible, avoid or minimise any detailed discussion of method or location of suicide. Reporting that includes detailed description or images of method and/or location of a suicide has been linked in some cases to further suicides using the same method or location. n Consider whether summary remarks and official statements need to include detailed descriptions of the method and/or location of suicide. Use alternatives that do not provide specific details. For example: Say the person took a cocktail of medications that should not be available over the counter. the person fell to their death from a spot close to the CBD that should have been fenced. the person took their own life in a hospital room because appropriate mechanisms to ensure safety were not in place. Rather than outlining the specific medications that were taken and where they were sourced. they jumped from a known suicide spot, the Skyline building on Smith Street, which still only has a 3 ft safety fence. she used her bed sheet to hang herself from the ceiling fan because the hospital failed to remove hanging points. 19

26 n Consider how to manage details of the method or location that are raised as part of the proceedings. Is there an opportunity to remind journalists about their codes of practice that discourage any detailed description of method or location of a suicide death? n When making recommendations about duty of care that may involve suicide methods, or highlighting the need for preventative measures at suicide spots, consider whether providing details may do more harm than good. For example, media stories highlighting the need for further fencing at a particular location may in fact increase rates of suicide from that location. n Be mindful that for many Aboriginal and Torres Strait Islander communities there are cultural protocols around naming and showing pictures or video of a person who has passed away. Consider how to manage this information in the courtroom. Check your language does not glamorise suicide or present it as normal or an option for dealing with problems. n Have you considered the impact of verbal and written language you use about suicide? The language used in media reports can contribute to suicide being presented as glamorous, normal or as an option for dealing with problems. n Consider how you might manage inappropriate language raised in the courtroom. Always use appropriate language when talking about suicide from the bench. For example: Use non fatal or attempt on his/her life took their own life or died by suicide statements such as increasing rates or cluster of deaths Rather than unsuccessful suicide successful suicide or committed suicide suicide epidemic which is sensationalist and inaccurate n Avoid simplistic explanations that suggest suicide might be the result of a single factor or event. This may be difficult when discussing a specific case, but ensure comments do not generalise one case to all cases. 20

27 Part 2: For Other Officers of the Court Consider the potential impact of the story and whether to make official media comment. n Find out what the journalist needs. Is the issue about an inquest or case or more generally about suicide or suicide prevention? Consider if you are the most appropriate person to be commenting on the issue under question. n Avoid engaging in repetitive, prominent or excessive reporting of suicide, which may normalise suicide. This has been linked to increased rates of actual suicide. This does not, however, mean that all suicide reports should be avoided. n Think about whether the story is likely to have benefits for the community. That is, does it provide an opportunity to increase community understanding, highlight groups at risk or promote help-seeking behaviour in some way? If this is the case, consider in what ways you may be able to have input. n While you always have the option of saying no you may want to consider the impact of not participating in a story. That is, the story may still be run without expert comment and advice. n If the story is generally about suicide or suicide prevention, you may want to refer the journalist to the expert comment section of the Mindframe website at n You may want to designate at least one person who can discuss ways of reporting suicide with media professionals who approach your jurisdiction and ensure they are aware of the Mindframe resources for media professionals. This may be a public affairs unit or an identified media liaison representative. When deciding whether to participate in a story you may want to consider what type of media is making the approach and whether you are best placed to provide them with information. Do they require general information or information related to a specific case before the courts or coroner? 21

28 Avoid specific description of the method and location of suicide and instruct media to be cautious with this information. n Details regarding the method and location of a suicide may be an important part of a coronial inquest, and included in documents and statements relating to the proceedings. Take any opportunity to remind journalists about their codes of practice that discourage any detailed description of method or location of a suicide death. n Consider alternative suggestions for ways to talk about the method and location that do not provide specific details (see page 19 for some examples). n For suicide deaths involving an Aboriginal or Torres Strait Islander person, be mindful of releasing their name or details to the media. Where the information is made public, request that media professionals respect appropriate cultural protocols. Consider how to include information that will improve community understanding. n Placing stories about suicide in the context of risk factors can assist in breaking down myths about suicide, and promote a better understanding of it as a wider community issue. This may be done directly through your work with the media, or in partnership with mental health and suicide prevention experts. n Avoid simplistic explanations that suggest suicide might be the result of a single factor or event. This may be difficult when discussing a specific case, but ensure comments do not generalise one case to all cases. n Provide suicide prevention information such as risk factors and warning signs and encourage its inclusion in the story (see pages 41-43). n Provide information in simple terms and without jargon. 22 Consider the impact of a media story on people bereaved by suicide. If the media wish to interview those who have been bereaved by suicide, be aware that these people may be quite vulnerable. People bereaved by suicide may be at risk of experiencing mental health problems and possibly taking their own lives. They may be particularly vulnerable in the first year following the death and on anniversaries after that time. Sometimes, the media may seek to access the bereaved at court or inquest locations. In these cases, they may need particular support from grief counselling services to deal with the distress of these interviews.

29 Include information that promotes help-seeking behaviour. n Vulnerable people may be distressed by reports of suicide and in some cases may be prompted to harm themselves. As such, it is important that helpline numbers are included with all reports about suicide. n Where possible provide media professionals with helpline numbers and information and suggest that the information is included in the report. Some numbers and services are provided on page 53. Alternatively refer the journalist to the Mindframe website. n Preparing a list of contacts that you or your jurisdiction could use in stories will assist when deciding which details to give to media professionals. This may be particularly useful when information is required within a short deadline. For most reports, a helpline such as Lifeline on will be appropriate. It is important, however, to provide support information relevant to the audience for each story. n Aboriginal and Torres Strait Islander people may prefer to see a health worker at their local Aboriginal Medical Service. See the VIBE website at n For Australians from culturally and linguistically diverse backgrounds it would be useful to include contact details for the relevant state transcultural mental health services as well as the national Telephone Interpreter Service ( ). Information is available from Multicultural Mental Health Australia on or n For young Australians it would be more useful to provide the Kids Helpline on , or websites such as Refer journalists to Mindframe. n Are journalists covering the inquest or conducting an interview aware of the Mindframe guidelines for reporting suicide available from n Is there an opportunity to recommend they access the site for appropriate helpline numbers they can add and contact details for mental health and suicide prevention organisations that may be able to assist with the story? n It is recommended that the Mindframe website be added to the bottom of all correspondence with media professionals that may involve suicide. 23

30 Mindframe Considerations for Media Professionals Reporting Suicide and Mental Illness: A Mindframe resource for media professionals makes a number of suggestions for editors and journalists to consider when reporting suicide. These are based on research evidence into the impact of media portrayal of suicide, are consistent with industry codes of practice and are summarised below. n Consider whether the story needs to be run and how many stories relating to suicide there have been in the last month, so as to avoid a succession of stories or a high volume. n Refrain from using language that may glamorise or sensationalise suicide. Avoid using the word suicide in a headline or lead, using phrases such as took their own life as an alternative. Refrain from using terms such as unsuccessful suicide, successful suicide or committed suicide. Avoid sensational statements like suicide epidemic. Statements such as increasing rates or a cluster of suicides are more accurate. n Avoid detailed descriptions or visuals of the method and location of a suicide, and make comment on the wastefulness of the act. n Take extra care when reporting celebrity suicide. This coverage has the potential to glamorise and normalise suicide and may prompt copycat behaviour. n To reduce prominence, locate stories about suicide in the inside pages of a paper and further down the order of reports in TV or radio news. n Follow media codes of practice around privacy, grief and trauma when reporting personal tragedy. n Seek advice from recommended health experts and place the story in context by providing information about underlying causes and risk factors. n Include helpline numbers and information about options for those seeking help. A complete outline of issues to consider for media professionals can be accessed from the Mindframe website at 24

31 About Mental Illness This section includes some facts and statistics about mental illness as well as short descriptions of the more common illnesses. Comprehensive facts and statistics are available from the Mindframe website at Clinical Definitions Mental health is a positive term referring to a state of emotional and social wellbeing in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively or fruitfully, and is able to make a contribution to his or her community 50. A mental illness (or mental disorder) is a diagnosable illness that significantly interferes with an individual s cognitive, emotional or social abilities. There are different types of mental illnesses and each of these will occur with a different degree of severity. A mental health problem also interferes with a person s cognitive, emotional or social abilities, but may not meet the criteria of an illness. Mental health problems often occur as a result of life stressors, and are usually less severe and of shorter duration than mental disorders, although they may develop into mental disorders. Legal Definitions Mental illness The legal definition of mental illness is more restricted. Mental Health Acts across Australia consider that a person s clinical diagnosis of mental illness can result in involuntary treatment if, owing to their illness, there are reasonable grounds for believing that care, treatment or control of the person is necessary, for their own protection from serious harm, or for the protection of others from serious harm. Mentally disordered A person may be mentally disordered, even in the absence of a diagnosed mental illness, if their behaviour for the time being is so irrational as to justify a conclusion on reasonable grounds that temporary care, treatment or control of the person is necessary for their own, or others protection. 25

32 Specific Mental Illnesses Depression Mood disorders are those where a person s mood is distorted or inappropriate to their circumstances. The most commonly experienced mood disorder is depression. Clinical depression is more than just temporary unhappiness or feeling down. It is an illness that may be felt as a sadness that does not go away and/or an ongoing loss of pleasure and enjoyment in most activities. Major depression will be experienced by one in five adults at some point in their lives and accounts for more days lost to illness than almost any other disorder, physical or mental 51. Up to two fifths of Australia s young people experience depressed moods in any six-month period. Some of the symptoms that often occur with major depression include: sleep disturbance, loss of energy and concentration, feelings of worthlessness, hopelessness and guilt, inability to cope with decisions, weight loss or gain, and thoughts of death. Sometimes depression develops after a major event, such as a loss of a loved one or a separation. Depression may also occur after repeated stress or ongoing abuse. However, it can also occur without apparent cause and in people who have coped well with life previously. Sometimes depression will lift after only a few weeks. In other cases, the depression will continue for months or years, perhaps requiring hospitalisation, and affecting the person s life and relationships. There are a number of treatments for depression, including professional counselling, psychotherapy and antidepressant medication. The vast majority of people experiencing a major depression will recover fully, sometimes without treatment. However, effective treatment can greatly assist people to recover much faster and can lessen the pain and the cost that may be associated with the illness. Bipolar disorder Bipolar disorder, previously known as manic depression, is characterised by recurrent episodes of extreme mood variation from major depression to very elevated mood (mania). The extent of mood range varies between people. Some experience both mania and depressed 26

33 mood, others only the highs without depression. Episodes of both depression and mania can range from mild to severe. A person may also experience symptoms of psychosis (see page 29). The symptoms of mania include: feeling very high and happy, increased energy and reduced need for sleep, rapid speech and thought, reduced inhibitions, grandiose plans and beliefs, and a lack of insight that these behaviours or beliefs are unusual. These symptoms can be damaging to people s lives and relationships. People with bipolar disorder can have to contend with large debt, broken relationships and damaged reputations as a result of out-of-character behaviour during a manic episode. Bipolar disorder is likely to be caused by several factors, including biochemistry, genetic inheritance, stress and sometimes seasonal effects 52. Between episodes of low or high mood, people experience normal mood variation and are able to live full and productive lives. For some people, extreme mood swings occur regularly. For others, the highs or lows may be occasional with years of stable moods between. Treatment for bipolar illness includes medication, psychological therapies and lifestyle changes. Anxiety Disorders Anxiety is a persistent sense of stress, fear or worry in the absence of a rational reason for these feelings. A person is said to be experiencing an anxiety disorder when they have an intense and paralysing sense of fear or a more sustained pattern of worrying, to the extent that it interferes with their everyday life. Some people experience physical sensations of fear, such as shortness of breath, a tight chest, racing heart or even dizziness. Approximately 20% of people will develop an anxiety disorder at some point in their lives 53. This can occur at almost any age. Many factors influence the development of an anxiety disorder, including genetic makeup, life experiences, developmental stage, family history, and factors such as stress and physical health. In some cases anxiety may be the result of a highly traumatic experience, such as torture or abuse. Many people with anxiety disorders also experience depression. There are several different types of anxiety disorders. These share common symptoms, although the contexts in which the symptoms are experienced vary. The more common forms of anxiety disorders include: generalised anxiety disorder, panic disorder, phobic disorders, post-traumatic stress disorder and obsessive-compulsive disorder. 27

34 Anxiety symptoms can be treated using Cognitive Behavioural Therapy (CBT) or other psychological therapies. CBT works by focussing on changing the way a person thinks in order to modify how they respond to anxiety-provoking situations. Medication, such as antidepressants, can also be useful for people experiencing severe anxiety. Psychotic Disorders Several mental illnesses are grouped under the term Psychotic disorders, which are characterised by some form of psychosis. Psychosis involves a loss of contact with, or distortion of, reality, which may include hallucinations or delusions, disorganisation of thought and lack of insight. These symptoms may cause difficulties in social situations and inability to cope with day-to-day living requirements. Examples of psychotic disorders include: Schizophrenia, Schizoaffective disorder, Schizophreniform disorder, Brief psychotic disorder, Delusional disorder, Shared psychotic disorder, Substance induced psychosis, and Psychosis due to a general medical condition. The most common psychotic disorder is Schizophrenia. It is a serious mental illness which affects almost one person in The term covers several related disorders, all with overlapping symptoms. Each individual can have a unique combination of signs and symptoms and, therefore, a unique experience of the disorder. The first onset of schizophrenia is typically in adolescence or early adulthood for males and a little later in females 55. The onset may be rapid, developing over several weeks, or it may be slow, over months or years. Some people experience only one or more brief episodes and recover fully. Others may have to deal with the illness throughout their lives. The symptoms of schizophrenia are grouped into two categories 56. The term positive symptoms refers to an excess or distortion of everyday thought processes or perception (the process of acquiring, interpreting, selecting, and organising information gathered from the five senses). Negative symptoms refers to the onset of a loss or absence of everyday abilities. Mental health clinicians use the umbrella term psychosis to describe the mental state of a person experiencing acute symptoms of schizophrenia. A psychotic episode is a term that describes a period of time whereby the positive or psychotic symptoms are highly active. 28

35 The positive symptoms of a psychotic episode include: Thought disorder Thought disorder is a term that describes a persistent underlying disturbance of conscious thought and is classified largely by its effects on speech and writing 57. Affected persons may: speak incessantly, invent words, use speech that reflects ideas switching from one train of thought to another or respond to questions with longwinded, unfocused or irrelevant answers. Delusions A delusion is a fixed, false personal belief held with absolute conviction despite all evidence to the contrary. The belief is often pathological in nature, is outside the person s normal cultural practices and dominates their thoughts and behaviours 58. Delusions are categorised according to their content. For example, delusions of persecution where there is a belief that another person or force is in some way interfering with the individual s life. Hallucinations Hallucinations are false perceptions in the absence of a real external stimulus, affecting any of the five senses. The most common are auditory hallucinations which take the form of voices 59. This occurs in 60 70% of people diagnosed with schizophrenia. Voices usually occur in the third person and provide a running commentary, arguing with the person or repeating the person s thoughts. Visual hallucinations occur in about 10% of people with schizophrenia, but are more indicative of an organic disorder. Psychosis usually occurs in three stages: 1. The Prodromal Phase. A period of early symptoms and signs of schizophrenia that precede an acute fully developed psychotic episode. During this period (varying from weeks to years) a person experiences changes in their thoughts, feelings, behaviours and perception. 2. The Acute Phase. A period when positive symptoms of schizophrenia emerge. Most people come to the attention of mental health services and begin treatment at this stage. 3. The Recovery Phase. A period (6-8 months following acute treatment) when positive symptoms of the acute phase begin to dissipate, and negative symptoms become more prominent. No cure is known for schizophrenia, but great advances have been made in early management and long term control of the illness. Early detection of the initial symptoms (early psychosis) and their management with medication, psychotherapy, social support and family programs can help to return the person to optimal functioning. 29

36 Personality Disorders Personality Disorders are diagnostic categories used to describe specific types of personality problems. Clinicians use this term to describe patterns of thinking and behaviour that are extreme, inflexible and maladaptive 60. Personality disorders may cause major disruption to a person s life and are usually associated with significant distress to the self or others. A person with a personality disorder has longstanding and persistent difficulties resulting from the way they feel about and view themselves, others and the world in general 61. They often experience themselves as unworthy or different, experience others as uncaring or even hostile and may view the world as a dangerous place devoid of any real meaning or sense of purpose 62. As a result of these ways of viewing themselves and the world, relationships whether intimate or in work or social settings are often fraught with difficulty. These difficulties are often so great that education, work and day-to-day living are disrupted to the point that significant social disadvantage may occur. People with personality disorders experience an inner fragility and lack the resilience to cope with many of life s difficulties. Not only can stressful or adverse life events have a devastating impact on their wellbeing, but so too can the responses of others towards them. Responses or actions of others which seem to confirm their sense of unworthiness or their expectation that others will treat them badly, for example, may lead to emotional responses of depression, anxiety, or even rage. These painful emotional experiences frequently lead to self-harm or suicide attempts. Substance abuse, compulsive behaviour or idiosyncratic preoccupations are other ways that people with personality disorders attempt to deal with their internal distress. Treatment of personality disorders has generally been viewed as more difficult compared to other disorders. There is now, however, strong evidence for the benefit of certain types of therapies 63. These are generally long-term and involve the development of a relationship with a therapist in which difficulties and their origins can be explored and understood, or in which new strategies, coping skills and alternative behaviours can be learnt. 30

37 Mental Illness in Australia In 1997 the Australian Bureau of Statistics (ABS) conducted the National Survey of Mental Health and Wellbeing 64. Findings of the adult survey are summarised below. n Almost one in five Australians (17.7%) had experienced a mental illness at some time during the 12 months before the survey. n Men and women experienced similar rates of mental illness. The incidence of mental illness was higher for men and women living alone than those living with other people. Similarly, rates of mental illness were higher among people who were separated or divorced (24% for men and 27% for women). n Women were more likely than men to experience anxiety disorders (12% compared with 7.1%) and mood disorders (7.4% compared with 4.2%). Men were more than twice as likely as women to have substance abuse disorders (11% compared with 4.5%). n People unemployed or not in the paid workforce had the highest rates of mental illness, a prevalence rate of 26.9% for unemployed men and 26% for unemployed women, compared with prevalence rates of 15.1% for men and 14.7% for women in full-time paid employment. n Anxiety disorders were most common, and affected one in ten adults, followed by mood disorders 5.8% (of which depression is 5.1%), and substance use disorders 7.7% (of which 6.5% is alcohol related). n Women were more likely than men to use services for mental health problems. Mental Illness and the Law Research has found that, due to a range of reasons, people living with a mental illness may have particular barriers preventing them from participating in the legal system 65. These barriers can be problematic for people appearing as witnesses or victims of a crime, as well as for those who may be accused. The research indicated that people experiencing a mental illness often face difficulties in their day-to-day life. They are more likely to receive a low income, leading to problems with housing and homelessness. Additionally, the symptoms of some types of mental illnesses may manifest 31

38 as unusual behaviour, which may bring people displaying such symptoms to the attention of police. In extreme cases, such behaviour might result in charges such as offensive language and conduct, resisting arrest and assaulting police. This type of behaviour may be especially common in those with a coexisting substance abuse problem. The particular barriers faced by people living with a mental illness are many and varied. Some of the key issues highlighted by research include: n People with a mental illness may find the legal process particularly stressful, especially courtroom situations. They may already experience significant stress in their lives, arising from family, financial and housing problems and may find the extra stress involved in the legal process overwhelming. n Some mental illnesses are characterised by cognitive impairment, including memory loss and problems with planning and concentrating. This can lead to problems with keeping appointments and understanding legal proceedings and documents. n People with a mental illness are often viewed as less credible by those in the legal sector. They may also be viewed as less credible by police when making statements relating to being the victims of crime, which may be taken less seriously as a result. 32 Disability caused by mental illness Mental illness can be more disabling for some people than many chronic physical illnesses. Disability refers to the degree to which an illness interferes with a person s ability to work, take care of themselves or carry on relationships. International research 66 looked at the amount of disability caused by a number of physical and mental health problems. From that research, some illustrative examples can be made: n The disability caused by moderate depression is similar to the disability from relapsing multiple sclerosis, severe asthma, chronic hepatitis B or deafness; n The disability from severe post-traumatic stress disorder is comparable to the disability from paraplegia; n The disability from severe schizophrenia is comparable to the disability from quadriplegia. In the Australian context, mental illnesses rank as the third biggest health concern after heart disease and cancer.

39 Common Myths about Mental Illness Myth: People who are mentally ill are violent. n Research indicates that people receiving treatment for a mental illness are no more violent or dangerous than the general population 67. n People living with a mental illness are more likely to be victims of violence, especially self-harm. It has been calculated that the lifetime risk of someone with an illness such as schizophrenia seriously harming or killing another person is just.005%, while the risk of that person killing themselves is nearly 10% 68. n There appears to be a weak statistical association between mental illness and violence in certain subgroups, for example people not receiving treatment who have a history of violence, and those who abuse drugs or alcohol. n The correlation between episodes of violence in people experiencing mental illness is comparatively weaker than violent behaviour in the context of alcohol abuse and violent behaviour in young males between the ages of 15 and Myth: Mental illness is a life sentence. n Depending on the age of onset and the severity of the mental illness, generally speaking, most people will experience complete recovery, especially if they receive help early. Some people may require ongoing treatment to manage their illness. n Some people have only one episode of mental illness and recover fully. For others, episodes of mental illness occur occasionally with years of wellness between episodes. For a minority of those with a more severe illness, periods of acute illness will occur regularly and, without medication and effective management, leave little room for recovery. n Though some people experience significant disability as a result of a mental illness, many go on to live full and productive lives while receiving ongoing treatment. 33

40 Myth: Mental illnesses are all the same. n There are many types of mental illnesses and many kinds of symptoms or effects. n Though a particular mental illness will tend to show a certain range of symptoms, not everyone will experience the same symptoms for example many people with schizophrenia may hear voices, while others may not. n Simply knowing a person has a mental illness will not tell you how well or ill they are, what symptoms they are experiencing, or whether they may recover or manage the illness effectively. n Mental illnesses are not purely psychological and can have many physical features. While a mental illness may affect a person s thinking and emotions, it can also have strong physical effects such as insomnia, speech impediment, weight gain or loss, increase or loss of energy, chest pain and nausea. Myth: Some cultural groups are more likely than others to experience mental illness. n Anyone can develop a mental illness and no one is immune to mental health problems. n People born in Australia have slightly higher rates of mental illness than those born outside Australia in either English-speaking or non English-speaking countries. n Many people from culturally and linguistically diverse and refugee backgrounds have experienced torture, trauma and enormous loss before coming to Australia. These experiences can cause significant psychological distress and vulnerability to mental illness. n Cultural background affects how people experience mental illness and how they understand and interpret the symptoms of mental illness. 34

41 About Suicide Suicide is a prominent health concern in Australia. A suicide death can have devastating impacts on family, friends, colleagues, and potentially the whole community. This section contains information about suicide, suicide risk and a brief overview of Australian facts and statistics. Comprehensive facts and statistics can be found on the Mindframe website at For more information about suicide prevention in Australia, download the Living Is For Everyone (LIFE) Framework at the LIFE website Definition of Terms Terms that are commonly used when discussing suicide include: Suicide death a death is classified as a suicide when a coroner determines that it has occurred as a result of self-inflicted harm where the intention was to die. Attempted suicide self-inflicted harm where death does not occur but the intention of the person was to die. There are three types of attempted suicide: without injury, with injury, and with a fatal outcome (suicide). Self-harm any behaviour that involves deliberate injury to oneself. Self-harm may be an attempt at suicide although it is not necessarily so. It is usually a response to distress. Suicidal behaviour acts such as suicide and attempted suicide. This also includes suicide related communications such as verbal or nonverbal statements expressing suicidal intent. Suicidal ideation/thoughts thoughts about, or plans for, taking one s own life that may or may not lead to a suicide attempt. Suicide intent - implies a conscious desire or wish to die or escape from life. Suicide intent does not necessarily denote that an individual has undertaken an analysis or has knowledge of the medical lethality of different methods or means. 35

42 An Overview of Suicide in Australia Despite some concerns about its accuracy, the main source of Australian data on suicides is the Australian Bureau of Statistics (ABS). They release new data on an annual basis. Unless otherwise stated, the statistics provided in this document are from ABS publications 70. How many people die by suicide in Australia? n Suicide is a prominent public health concern in Australia. For the past decade, more than 2000 people have taken their life each year (with numbers dropping below 2000 in 2006 with 1799 deaths recorded). These figures may be an underestimation. n For the past decade suicide represented 1-2% of all deaths registered in Australia. n Although suicide attempts are more common in women than men, generally men take their own lives at a rate four times that of women. Is the problem getting worse? n Suicide rates for both males and females have generally decreased since the mid-90s, with the overall suicide rate decreasing by 34% between 1997 and n Despite the common belief that there is a youth suicide epidemic, suicide rates among young males have fallen considerably over recent years (by about 50% since 1997), and suicide in children under the age of 15 is a rare event in Australia. n Despite these decreases, suicide remains a major external cause of death, accounting for more deaths than transport accidents between 1995 and n Although accurate suicide statistics are difficult to obtain for Aboriginal and Torres Strait Islander people, figures reveal that the percentage of all deaths attributable to suicide is generally much higher for these populations and may be increasing. 36

43 Do rates vary between states and territories? n Combining suicide data over a 5-year period provides a more reliable picture of differences across the states and territories due to the relatively small number of suicides in some states and territories in any one year. n In recent years ( ) Tasmania and the Northern Territory had the highest rate of suicide, followed by South Australia. In contrast, New South Wales and Victoria had the lowest rates of suicide and the ACT and Queensland had fluctuating rates. Are the rates different for males and females? n Suicide rates for males are higher than those for females and have been higher since at least the 1920s. More women than men, however, attempt suicide 71. n The ratio of male to female suicides rose from 2:1 in the 1960s to over 4:1 in the mid 1990s. In recent years, the suicide rate for males has reduced slightly to almost 4 times that of females, and is consistent across most age groups. n Between 1997 and 2006, the suicide rate fell by 34%, with this rate of change similar for males (35%) and females (31%). Do rates vary across age groups? n From 1990 until 1997, 20 to 24 year old men were consistently the most likely of all age groups to die by suicide, with rates reaching 42.8 per 100,000 in However, between 1998 and 2005 the highest rates have been observed for males aged in the year age groups. In 2006 the highest rate was observed in men aged over 85 (although the rates are inflated by the small population) followed by the 35 to 54 year age groups. n From 1990 onwards, there has not been any one age group of females that has consistently had a higher rate of suicide than other age groups. n The largest drop in suicide rates between 1997 and 2006 was observed for 15 to 24 year olds, with a fall of 56% in suicide rates for this group. 37

44 Figure 2. Suicide Rates, All Ages, , by Sex Rate per 100, Males Females Are the patterns the same for Aboriginal and Torres Strait Islander people? n Accurate suicide statistics and population estimates are difficult to obtain for Aboriginal and Torres Strait Islander people. Due to both the relatively small numbers and low coverage in some areas of Australia, the ABS only publishes data for NSW, QLD, SA and NT. Thus data on suicide rates are likely to be, at best, minimum figures and the information must be interpreted cautiously. n The percentage of deaths attributable to suicide is much higher among Aboriginal and Torres Strait Islander people (about 4%) than other Australians (about 1.5%). n Suicide is more concentrated in the earlier adult years for Aboriginal and Torres Strait Islander people than for the general Australian population, with recent data indicating the highest rates for both males and females in the year age group. 38

45 Do rates vary among people from culturally and linguistically diverse backgrounds? n One quarter of suicides in Australia occur among people who have migrated to Australia, with 60% of these being from non-english speaking countries. However, rates vary according to country of origin, gender and age 73. n First generation migrants in Australia show similar suicide rates to those in their country of origin. n Rates are generally higher among people born in English-speaking countries, and those from western, northern and eastern Europe, and lower among people from southern Europe, the Middle East and Asia 74. n Overall, males born outside of Australia have a lower suicide rate than Australian-born males, while the rate is higher for females born overseas than for Australian-born females. The rate is also higher for people of both genders aged over Do rates vary between urban and rural areas? n There is some evidence that suicide rates in rural and remote areas are significantly greater than in urban populations. This may be especially true among young men in remote regions 76. n Possible factors contributing to higher rates in these areas include isolation, rural poverty, increased risk-taking behaviour and access to lethal means (eg firearms). It has also been suggested that a culture of self-reliance, that does not encourage help-seeking behaviour, may be one of the most important contributing factors to youth suicide in rural areas 77. What are the most common methods of suicide? n Since the late 90s, more than 40% of suicide deaths have been from hanging, making this the most common method. n Males who die by suicide are more likely to do so via hanging than females, with approximately 50% of male suicide deaths due this method since 2001, compared with 40% of female suicide deaths. 39

46 n Females who take their own lives do so via drug poisoning in more than a quarter of cases, whereas for males, this method constitutes less than 10% of suicide deaths. n Suicides by firearms were far more common among males in the mid 1990s, but the numbers per year are now less than half. This is most likely due to restrictions on firearm ownership in place since Are people in custody more at risk? n People in any form of custody have suicide rates more than three times higher than the general population. n The Royal Commission into Aboriginal Deaths in Custody found that Aboriginal and Torres Strait Islander people were not more likely to die in custody than non-indigenous people 78. High numbers of Aboriginal and Torres Strait Islander deaths in custody were related to the high rates of incarceration in this population group. What are some of the impacts of suicide? n A death by suicide can have devastating impacts on family, friends, colleagues, health professionals, emergency services, and potentially the whole community. People who have been directly affected by suicide may themselves experience mental health problems, and are at increased risk of taking their own lives. n People who identify with the person who has taken their own life (as someone in a similar life stage or circumstance to themselves) may be adversely affected by their death and consider suicide themselves as a result. What is the relationship between self-harm and suicide? n The relationship between self-harm and suicide is complex. Most commonly the motivation for self-harming behaviour is to cope with, or to gain a sense of relief from painful emotions and distressing personal experiences, not to result in death 79. n Any action that is deliberately intended to cause death is best regarded as a suicide attempt 80. Any deliberate attempt on one s life that results in death is best understood to be a suicide. 40

47 n According to published research, more than half of individuals who self-harm do not have suicidal thoughts at the time of self-harm and self-harm has been described as a way to avoid suicide 81. n This being said, acts of self-harm need to be taken seriously. Individuals who self-harm may be considered at higher risk of further, more severe self-harm and later suicide 82. Self-harm and suicide attempts can be performed by the same individual and in some cases the intent may not be completely clear. What are some risk factors for suicide? There is no single cause for suicidal behaviour and each person s situation is unique. Suicide is a complex phenomenon and rarely occurs as the result of a single event. However, research has revealed a number of common risk factors, which may increase the likelihood of someone taking their own life: n Individual factors such as being male, experiencing physical health problems and stressful life events such as bereavement or relationship breakdown. Young gay, lesbian or transgender people may also have an increased risk of suicide; n Mental illness such as depression, substance abuse, psychotic disorders and a history of previous suicide attempts; n Family-related factors such as family breakdown, family conflict, child custody issues, abuse or family history of suicide; n Social factors such as socio-economic disadvantage, unemployment, being Aboriginal or Torres Strait Islander, school disengagement, incarceration, and social and geographical isolation (especially remote communities); n Environmental factors such as access to methods of suicide and exposure to suicide methods via the media or peers. Suicide sometimes occurs in clusters within a local area, when people identify with the distress of someone who has taken their own life. 41

48 People who are more at risk of suicide include: n people who have previously attempted suicide; n people with mental disorders; n people with alcohol or drug abuse problems; n males (particularly those aged years); n young Aboriginal or Torres Strait Islander males; n people who are in any form of custody; n people in remote communities; n people bereaved by suicide. Are there protective factors for suicide? Similar to risk factors, there are no clear universal protective factors that may decrease the likelihood of a person taking their life. Some known factors include: n being connected or belonging to a family, school or other community, such as a sporting or recreation group; n having at least one significant person to relate to and bond with (whether that is a family member, a friend or other person); n having personal coping skills and resilience to deal with difficult situations; n a sense of meaning, spiritual faith or belief that suicide is wrong; n economic security, particularly in older people; n good physical as well as mental health; n early detection and treatment for mental illness and emotional problems; n restricted access to means, such as firearms, prescription medications and certain geographical locations. 42

49 Risk and protective factors are often at opposite ends of the same continuum. For example, social isolation (risk factor) and social connectedness (protective factor) are both extremes of social support. Risk and protective factors may be modifiable (things that are changeable) or non-modifiable (things that are unchangeable). For example, in some areas of Australia isolated older men may be more likely, according to statistics, to take their own life. Nothing can be done about their age or gender (non-modifiable factors), but it is possible to change their social isolation (modifiable factor). Figure 3. Examples of typical triggers or precipitating events to suicide.* Risk factors Warning signs Tipping point Imminent Link n Mental health problems n Male n Family discord, violence or abuse n Family history of suicide n Alcohol or other substance abuse n Social or geographical isolation n Financial stress n Bereavements n Hopelessness n Feeling trapped like there s no way out n Increasing alcohol or drug use n Withdrawing from friends, family or society n No reason for living, no sense of purpose in life n Prior suicide attempt n Uncharacteristic or impaired judgement or behaviour n Relationship ending n Loss of status or respect n Debilitating physical illness or accident n Death or suicide of relative or friend n Suicide of someone famous or member of peer group n Argument at home n Being abused or bullied n Media report on suicide or suicide methods n Expressed intent to die n Has plan in mind n Has access to lethal means n Impulsive, aggressive or anti-social behaviour * Adapted with permission from the LIFE Framework,

50 Common Misconceptions about Suicide Myth: Most suicides occur without warning. n Although there may be some cases where suicide occurs without warning, many people that attempt or die by suicide give verbal or non-verbal clues before the incident. n Often there has been a history of personal problems, mental health issues, suicide threats or prior attempts. n Many people thinking about suicide will tell someone and some will seek professional help. Myth: People who attempt suicide are just selfish or weak. n People who attempt suicide are often experiencing extreme negative feelings (depression, guilt, fear, anxiety) and may believe there is no other solution. n People in this situation need professional and personal support, not judgement. Myth: People who talk about taking their own life are just seeking attention. n Any suggestion of suicidal thoughts or threats of suicide should always be taken seriously. n A person who threatens or attempts to take their life is in need of support, whether or not they are serious about ending their life at that particular time. n Addressing the underlying problems may reduce the risk of future attempts. Myth: Talking about suicide with someone at risk will give them the idea and increase the chance they will take their own life. n Many troubled people may be relieved if the issue is raised in a caring and non-judgemental way, allowing them to talk one-on-one about their feelings and to seek help. n However, specifically raising the issue of suicide in a group setting (eg a school classroom), or in the media without providing an opportunity to talk about the issue one-on-one is not recommended. 44

51 Media and the Courts The courts and the media are very different. They have different cultural expectations, deadlines, commercial imperatives, historical development, language and protocols. This section provides a basic overview of the media and the courts, including why the courts are such a staple news source for journalists. Why the media interest in courts? News stories may be broadly categorised as routine, staged and spontaneous events. Court reporting is generally routine news, as it occurs on a predictable basis, with regular timing, sources, and venue. The courts have been described as a feast of stories among other things 84. We try to find on a daily basis a sort of representative smattering of very different matters that are being handled from the Supreme Court, to the local, to all the many tribunals. a forum for human issues where ordinary people are seen in extraordinary circumstances. Courts are extremely cost effective, protected, you re unlikely to be sued [they re] cheap, quick and dirty. Courts turn out some really good stories 85. There are several reasons why court reporting is a staple for most media organisations 86. n Unlike other rounds, where the reporter has to seek out opposing points of view, courts provide these in their adversarial context. Generally speaking, reporters will get their stories from within the court-room. 45

52 n The relative safe reporting environment afforded by the privilege of courts means reporters can report and write stories relatively simply, as long as they are fair and balanced in their reportage and avoid legislative prohibitions. n Often crime and court stories involve themes of fear, horror or shock, and much information can be deeply personal and intimate, therefore newsworthy. n High profile and interesting stories can often be planned for through examination of the court lists and knowledge of police charges. What makes news? Much of what goes on in court is not newsworthy. It is mundane and will not be of interest to the media. In addition, because news space varies, what makes news one day, may not make it the next. Two key elements of court cases that make them particularly newsworthy are conflict and deviant behaviours, which often occur in abundance. Court cases will often incorporate these news values or themes if they are to become news stories. Other news values include: n Prominence, high impact, controversy, protest, key decisions, violence, scandal, moral disorder, proximity, human interest and timeliness; n They may also include immediacy, dramatization, personalisation, simplification, titillation, non-conventionalism and novelty. Paranoid schizophrenic attacker wants more freedom. A paranoid schizophrenic who avoided jail after two frenzied stabbings has asked the Supreme Court for more freedom. Advertiser (2006, 19 December, p.23) War veteran s accused killer a schizophrenic. The man accused of killing a World War II veteran in an alleged unprovoked attack has been suffering from schizophrenia for 21 years, a court heard yesterday. Daily Telegraph (2006, 4 October, p.4) 46

53 Any of these news values, themes or elements may be obviously located in a story, even before the court case begins. Other times, these elements will emerge as the court case develops and the journalist witnesses a development or shift in the case. Sometimes a news angle will only emerge half way through a court case, when a comment, witness, finding or piece of evidence is brought in. The following table, adapted from the Australian Press Council report into newspapers in 2005, breaks down what makes news in a range of papers. It may come as no surprise that crime is the highest category of all categories of news, in all of the pages under analysis. Content analysis of Australian metropolitan & regional newspapers 2005 Content % of All (2448) % of Page 1 (299) % of Metro (1573) % Regional (442) % Sundays (435) Crime Federal politics Entertainment Accident/Emergency State politics Other (Source, Australian Press Council) 87. What is a court round? A journalist s round is the particular field they work in and report on. The round is intended to help the journalist develop a specialisation within the field, including greater knowledge and a range of key sources from which to draw. Courts are part of this rounds system. If the round system worked ideally, these reporters would all know the laws and restrictions pertaining to the courts. This is, however, not always the case. 47

54 Who covers the court round? The courts round is sometimes a training ground for young reporters. They bring to it what they have learned at university, in their cadetship training and their general knowledge. That is not to say that all court reporters are legal novices some have law degrees or extended legal knowledge. Nevertheless, the range of expertise amongst court reporters can be huge, especially in cases where the usual court reporter is absent, and a less experienced colleague may cover courts in their stead. This wide range of expertise, coupled with journalists often limited knowledge of complex issues such as mental health and suicide, can result in a severely restricted pool of knowledge to accurately cover coroners findings, committal proceedings, bail applications, pleas and so on in court cases which deal with these issues. Do journalists work together? Court reporting tends to be somewhat different to other journalistic rounds in that reporters often cooperate with each other, even when they represent different media outlets. The regular contact between journalists at the courtroom means that they will often rely on each other to fill in missed material, or for tips as to a good story. Nevertheless, competition amongst journalists exists in all rounds and courts are no different. Reporters will use a wide range of sources to find out what s going on in courts, confirm information and investigate. What types of media are more interested in the courts? Print media have a long history of covering courts, sharing the courts media rooms and dedicating one reporter to the round. Radio and television on the other hand tend to send reporters on a more ad-hoc basis, when a good story is expected in court. Knowing what s in a day s court line-up will usually come from police stories (earlier arrests) and police tip-offs as well as other sources like lawyers. 48 Print journalists often therefore have a great ownership of the round that they nurture and cover systematically which allows them to develop sources within the courts and often form positive working relationships.

55 How is the news story developed? Changes in technology have led to greater multiple-platform reporting, using online as well as traditional media. This means that one story can have several versions for a range of media which will be built up from earlier stories. It also means that the speed with which stories can be developed and released is greatly increased. In one recent example, a reporter was able to send notification of a verdict in a case by text message from the courtroom, meaning that a story brief was available on a newspaper s website within minutes of the verdict, beating radio. That story was later expanded as the journalist wrote the details of what had happened in the proceedings, but shows how quickly news media can reach an audience. The development of a news story will usually follow a set path where, once written and filed by the journalist, it is subedited for the print version of the paper (and/or the online version). At this point, the journalist usually has no control over the editing of their story. This can prove problematic in covering court stories because the story in its entirety can often provide context and important background which may, due to space, have to be reduced or removed. Figure 4. Flowchart of the court/news process (in a newspaper). Court list holds potential stories & the journalist begins research Story written by journalist based on court proceedings and interviews and filed to newspaper Story to subeditor edited to fit space and headlined Story selection at newspaper (depends on multiple factors) Story appears in newspaper (may not appear in all editions) 49

56 What about headlines? Headlines are also written by the sub-editor, beyond the control of the court reporter. While they should reflect the story s key point, these can sometimes be skewed toward a catchy phrase or word choice that is more sensational than the body of the story. It is worth remembering that journalists do not control this element of newspaper production despite being the public face of the story. The July 2000 judgement of a young woman found to have killed her son provides an example of different headlines: Stabbed toddler s mother freed: judge cites life of pain (Age, 7 July 2000) Judge lets killer mum walk free (Herald Sun, 7 July 2000) No jail for mother who killed in a state of crisis (Sydney Morning Herald, 7 July 2000) Who are key sources of information? Reporters rely heavily on sources, as well as first hand observation, in court reporting. The most common sources are: n Lawyers prosecutors and defence counsel; n Police Media Unit, police stories; n Court staff sheriffs, bailiffs, clerk of the court, judge s associates; n Court lists from daily newspapers or internet; n Informants or tip/offs; and n Other journalists in court and other media. Since the early 1990s an additional common source in many jurisdictions has been the Court Information Officer. Those jurisdictions without these officers have been noted to be at a disadvantage when it comes to court-media relations. The issue of access to information and meeting deadlines is crucial to getting a story right. In most cases, not providing information, or making transcript costs prohibitive, will not result in a story being abandoned. More likely, it will result in a story that is incomplete or inaccurate. Assisting the media to access accurate information is, therefore, key. 50

57 The Mindframe Website Mindframe Resources for Courts can be found at by clicking on the Courts tab. The website also provides information about other projects that form part of the Mindframe Initiative. The section for courts contains information about the impact of news reporting as well as further facts, statistics, descriptions of specific disorders, useful contacts, and a glossary of terms. It also provides examples and further clarification of issues to consider for judicial officers and other officers of the court. 51

58 Other Useful Websites Australian Indigenous Health Infonet Access to information, research and resources related to social and emotional wellbeing for Aboriginal and Torres Strait Islander people. Australian Network for Promotion, Prevention and Early Intervention for Mental Health (Auseinet) A comprehensive website and clearinghouse for research, resources and link relevant to promotion, prevention and early intervention for mental health in Australia. beyondblue: The National Depression Initiative Access to accurate and easy to read information about depression, anxiety and related disorders. headspace: Youth Mental Health Foundation Youth friendly site with information about mental health issues and local services for young people. Living is for Everyone (LIFE) Framework and website Updated information, and links for health professionals and the wider community to enhance the understanding and prevention of suicide and self-harm in Australia. The Media Monitoring Project I & II Studies assessing the extent and nature of reporting about suicide and mental illness in the Australian media over two 12-month periods, & Mental Health in Australia Information on the Australian Government s role and contributions to mental health reform activities in Australia and the agencies responsible for implementation. On the edge of justice: the legal needs of people with a mental illness in NSW This study, published by the Law and Justice Foundation of NSW in 2006, examines the legal and access to justice issues experienced by people with a mental illness. 52 SANE Australia General information about mental illness, including access to fact sheets, resources, Helpline Online, SANE s youth website, and the StigmaWatch program.

59 National Counselling and Referral Lines Lifeline A 24-hour telephone counselling and referral service across Australia. Just Ask Mental health information line for rural communities. Kids Helpline A 24-hour free counselling service for young people aged between 5 and Mensline Australia A 24-hour counselling service for men. Mental Illness Fellowship Mental health information and referral. SANE Helpline SANE (7263) Mental illness information, support and referral throughout Australia. Vietnam Veterans Counselling Service A 24-hour emergency counselling service for veterans and their families. Salvo Care Line A crisis counselling service available throughout Australia. Suicide Helpline (VIC) A 24-hour telephone counselling and referral service for Victoria only. Crisis Care Information and links to counselling services for gay and lesbian people in Australia. ReachOut! Interactive website to help young people through tough times. Vibe Australia Healthy Vibe For details of Aboriginal Medical Services in Australia. 53

60 Expert Comment Australian Institute for Suicide Research and Prevention Suicide and self-harm research, suicide prevention, training. (07) or beyondblue The National Depression Initiative Depression and suicide, anxiety, bipolar disorder & postnatal depression. (03) or (youth) Black Dog Institute Depression, bipolar disorder, stigma and discrimination. (02) depressionet Depression and online support, mental illness, suicide and self-harm, stigma. (02) Lifeline Mental health and wellbeing, help seeking, suicide and self-harm, stigma. (02) or Mental Health Council of Australia Delivery and funding of mental health services, mental health policy, & stigma. (02) or Multicultural Mental Health Australia Mental health information and service delivery for people from culturally and linguistically diverse backgrounds. (02) Office for Aboriginal and Torres Strait Islander Health Information on services & wellbeing for Aboriginal and Torres Strait Islander people. (02) ORYGEN Youth Health Youth mental illness (mood, anxiety, eating, substances), suicide, self-harm. (03) SANE Australia Mental illness, suicide and self-harm, stigma and discrimination, media reporting. (03) or & 54

61 State Health Departments Mental Health Media Unit ACT - (02) (02) NSW - (02) (02) NT - (08) (08) Queensland - (07) (07) SA - (08) (08) Tasmania - (03) (03) Victoria - (03) (03) WA - (08) (08) Contacts in the Australian Media Name Website Phone Australian Communications and Media Authority (ACMA) Special Broadcasting Service (SBS) Australian Broadcasting Corporation (ABC) (02) Australian Press Council Commercial Radio Australia (02) Free TV Australia (02) Australian Subscription Television and Radio Association (ASTRA) (02)

62 Useful Contacts Add your local or other useful contacts here: 56

63 Useful Contacts Add your local or other useful contacts here: 57

64 References 1 Francis, C., Pirkis, J., Dunt, D., & Blood, R. W. (2001). Mental health and illness in the media: A review of the literature. Canberra: Commonwealth Department of Health and Ageing. 2 Francis, C., Pirkis, J., Dunt, D., & Blood, R. W. (2001). Op Cit. 3 Dare A., Pirkis J., Blood R.W., Rankin B., Williamson S., Burgess P. & Jolley D. (In Press). The Media Monitoring Project: Changes in Media Reporting of Suicide and Mental Health and Illness in Australia, 2000/ /07. Melbourne: Centre for Health Policy, Programs and Economics, The University of Melbourne. 4 Dare A., Pirkis J., Blood R.W., Rankin B., Williamson S., Burgess P. & Jolley D. (In Press). Op cit. 5 Benkert, O., Graf-Morgenstern, M., Hillert, A., Sandman, J., Ehmig, S.C., Weissbecker, H., et. al. (1997). Public opinion on psychotropic drugs: An analysis of the factors influencing acceptance or rejection. Journal of Nervous and Mental Disease, 185, Francis, C., Pirkis, J., Dunt, D. & Blood, R.W. (2001) Op Cit. 7 Ibid 8 Ferriman, A. (2000). The stigma of schizophrenia. British Medical Journal, 320, Hunter Institute of Mental Health (2007). Mindframe for Law Enforcement: Final Scoping Study Report. Available from 10 Dare A., Pirkis J., Blood R.W., Rankin B., Williamson S., Burgess P. & Jolley D. (In Press). Op cit. 11 Francis, C., Pirkis, J., Dunt, D., & Blood, R. W. (2001). Op Cit. 12 Benkert, O., Graf-Morgenstern, M., Hillert, A., Sandman, J., Ehmig, S.C., Weissbecker, H., et. al. (1997). Op Cit. 13 Granello, D., Pauley, P., & Carmichael, A. (1999). Relationship of the media to attitudes towards people with mental illness. Journal of Humanistic Counselling Education and Development, 38, Lopez, L. R. (1991). Adolescent s attitudes toward mental illness and perceived sources of their attitudes: An examination of pilot data. Archives of Psychiatric Nursing, 5, Hyler, S. E., Gabbard, G. O., & Schneider, I. (1991). Homicidal maniacs and narcissistic parasites: Stigmatisation of mentally ill persons in the movies. Hospital and Community Psychiatry, 42, Allan, R., & Nairn, R. G., (1997). Media depiction of mental illness: An analysis of the use of dangerousness. Australian and New Zealand Journal of Psychiatry, 31, Dare A., Pirkis J., Blood R.W., Rankin B., Williamson S., Burgess P. & Jolley D. (In Press). Op cit. 18 Granello, D., Pauley, P., & Carmichael, A. (1999). Op cit. 58

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66 37 Versey, M. J., Kamanyire, R., & Volans, G. N. (1999). Antifreeze poisonings give more insight into copycat behaviour (letter). British Medical Journal, 319, Chan, K.P.M., Yip, P.S.F., Au, J. & Lee, D.T.S. (2005). Charcoal-burning suicide in post-transition Hong Kong. British Journal of Psychiatry, 186, Etzersdorfer, E., Voracek, M., & Sonneck, G., (2004). A dose-response relationship between imitational suicides and newspaper distribution. Archives of Suicide Research, 8, Stack, S. (1990). Op cit. 41 Hassan, R. (1995). Effects of newspaper stories on the incidence of suicide in Australia: A research note. Australian and New Zealand Journal of Psychiatry, 29, Romer, D, Jamiewson, P.E. & Jamieson, KH. (2006). Are news reports of suicide contagious? A stringent test in six U.S. cities. In Journal of Communication, 56, Pirkis J. E., Burgess, P.M., Francis, R., Blood, W. & Jolley, D.J. (2006). The relationship between media reporting of suicide and actual suicide in Australia. Social Science & Medicine, 62, Dare A., Pirkis J., Blood R.W., Rankin B., Williamson, S., Burgess, P. & Jolley, D. (In Press). Op cit. 45 Martin, G., & Koo, L. (1997). Celebrity Suicide: Did the death of Kurt Cobain affect suicides in Australia? Archives of Suicide Research, 3, Gould, M.S., & Shaffer, D. (1986). The impact of suicide in television movies. New England Journal of Medicine, 315, Etzersdorfer, E., & Sonneck, G. (1988). Preventing suicide by influencing mass media reporting: The Viennese experience Archives of Suicide Research, 4, Etzersdorfer, E., Sonneck, G., & Nagel Kuess, S. (1992). Newspaper reports and suicide (letter). New England Journal of Medicine, 327, Sonneck, G., Etzersdorfer., E & Nagel Kuess, S. (1994). Imitative suicide on the Viennese subway. Social Science and Medicine, 38, The World Health Report. (2001). Mental Health: New understanding, new hope. Geneva: World Health Organisation. Retrieved February 5, 2006 from: 51 World Health Organisation. Retrieved 03 April, 2008 from management/depression/definition/en/ 52 Maj, M., Akiskal, H.S., Lopez-Ibor, J., & Sartorius, N. (2002). Bipolar Disorder - WPA Series Evidence and Experience in Psychiatry. London: Wiley. 53 Griez. E, Faravelli, C., Nutt, D. & Zohar, J. (2001). Anxiety Disorders- An Introduction to Clinical Management and Research. London: Wiley. 54 Millon, T. (2004). Personality disorders in modern life, 2nd ed. New Jersey: Wiley. 55 Magnavita, J. J (2004). Op Cit. 56 Magnavita, J. J. (2004). Handbook of Personality Disorders -Theory and Practice. London: Wiley. 60

67 57 Maj, M., Akiskal. H.S., Mezzich, J.E. & Okasha, A. (2005). Personality Disorders - WPA Series Evidence and Experience in Psychiatry. London: Wiley. 58 Ibid 59 Ibid 60 American Psychiatric Association (2004). Practice Guideline for the Treatment of Patients with Schizophrenia, 2nd Edition. APA Press 61 Ibid 62 Stefan, M., Travis, M. & Murray, R.M. (2002). An Atlas of Schizophrenia. London: Partheon. 63 Ibid 64 Australian Bureau of Statistics. (1997). National survey of mental health and wellbeing. Canberra, ACT: Australian Bureau of Statistics 65 Karras, M., McCarron, E., Gray, A. & Ardasinski, S. (2006) On the edge of justice: the legal needs of people with a mental illness in NSW. Sydney: Law and Justice Foundation of NSW. 66 Stouthard M.E.A., Essink-Bot M.L., Bonsel G.J., Barendregt J.J., Kramer P.G., vande Water H.P.A., Gunning-Schepers L.J., & van der Maas P.J. (1997). Disability Weights for Diseases in the Netherlands. Rotterdam: Erasmus University. 67 New South Wales Mental Health Sentinel Review Committee. (2003). Tracking Tragedy: A systemic look at suicides and homicides amongst mental health inpatients. NSW: Centre for Mental Health, Department of Health. 68 SANE Australia (2003). Factsheet 5. Violence and mental illness. Retrieved from: 69 Brennan, P. A., Mednick, S. A., & Hodgins, S. (2000). Major mental disorders and criminal violence in a Danish birth cohort. Archives of General Psychiatry, 57, Australian Bureau of Statistics. (2008). Causes of Death, Australia, ABS catalogue number de Looper, M. & Bhatia, K. (2001). Australian Health Trends, 2001 (AIHW Cat. No. PHE 24). Canberra, ACT: AIHW. 72 Australian Bureau of Statistics. (2008). Op Cit. 73 Cantor, C. & Neulinger, K. (2000) The epidemiology of suicide and attempted suicide among young Australians. Australian and New Zealand Journal of Psychiatry, 34, Steel, Z., & McDonald, B. (2000). Suicide in Immigrants Born in Non-English Speaking Countries: The latest research. Retrieved February 15, 2006 from: au/mmhapublications/synergy/winter2000/ McDonaldSuicide/view 75 McDonald, B., & Steel, Z. (1997). Immigrants and Mental Health: An epidemiological analysis. Sydney: Transcultural Mental Health Centre. 76 Australian Bureau of Statistics. (2000). Suicides Australia ABS Catalogue no Patterson, I., & Pegg, S. (1999). Nothing to do: The relationship between leisure boredom and alcohol and drug addiction. Is there a link to youth suicide in rural Australia? Youth Studies Australia, 18,

68 78 Final Report Of The Royal Commission Into Aboriginal Deaths In Custody Summary. Retrieved February 1, 2008 from austlii.edu.au/au/special/rsjproject/rsjlibrary/ rciadic/rciadic_summary/rcsumk01.html 79 RANZCP (2005). Self-harm. Australian Treatment Guide for Consumers and Carers. Melbourne: The Royal Australian and New Zealand College of Psychiatrists. 80 Ibid 81 Stanley, B., Gameroff, M., Michalsen, V & Mann, J. (2001). Are suicide attempters who self-mutilate a unique population? American Journal of Psychiatry, 158, Owens, D., Horrocks, J. & House, A. (2002). Fatal and non-fatal repetition of self-harm. British Journal of Psychiatry, 181, Commonwealth of Australia (2008). LiFE: A Framework for Prevention of Suicide in Australia. Canberra: Australian Government. 84 Johnston, J. (2004) Communicating courts: an analysis of the changing interface between the courts and the media, unpublished Ph.D thesis, Griffith University, Gold Coast. pp Ibid 86 Ibid 87 Australian Press Council, (2006) The state of the news print media in Australia. Retrieved February

69