More us than them: positive depictions of mental

illness on Australian television news

Connie Henson, Simon Chapman, Lachlan McLeod, Natalie Johnson,

Kevin McGeechan, Ian Hickie

Objective: The aim of the present study was to review television news coverage of mental
illness including self-depictions from people with mental illness, and views expressed by
mental health experts and politicians in all 538 news and current affairs items related to
mental illness broadcast on free-to-air Sydney television, May 2005
October 2007.
Methods: Content and frame analysis was done of news actors (those with mental
illnesses, experts and politicians) of whether depictions were positive ‘one of us’, or
negative ‘one of them’.
Results: Only 6% of all items with a main focus on a specific health condition, focused on
mental health. Individuals with mental illness were present in 264 (49%) of 538 items, with
most (174, 66%) of these self-depictions categorized as either neutral or positive. Experts
and politicians overwhelmingly represented and described people with mental illnesses in
neutral or positive ways (95% and 84%, respectively). Overall news angle included 299
items (55%), which were categorized as positive ‘recovery focused’ items. Another 156
items (29%) were neutral, and 62 items (12%) were classified as negative. Twenty-one
(4%) had unclear or mixed themes.
Conclusions: The present findings differ from previous descriptions of media depiction of
mental illness, which have been largely negative. The present study provides support for
the importance of involving those with histories of mental illness in news coverage.
Key words: Australia, depression, mental illness, news media, stigma, television.

Australian and New Zealand Journal of Psychiatry 2009; 43:554 560

Historically, the public portrayal of mental illness
has been dominated by depictions of violence, isola-
tion, loss, misery, homelessness, personal failure and
ineffective health and social services. Media framing
of health issues influences both public and political
Simon Chapman, Professor and Director of Research, Fellow,
University Senate (Correspondence); Connie Henson, Student; Lachlan
McLeod, Student; Natalie Johnson, Student; Kevin McGeechan,
Lecturer
School of Public Health, University of Sydney, Sydney, NSW 2006,
Australia. Email: sc@med.usyd.edu.au
Ian Hickie, Professor and Executive Director, Brain and Mind Research
Institute
Brain & Mind Research Institute, University of Sydney, Sydney, New
South Wales, Australia
Received 26 June 2008; accepted 13 January 2009.
opinion and may thus impact on health and social
policy [1,2]. Framing includes both the content as well
as how an issue or person is positioned [1,3].
Although many frames can be used in structuring
health-related items, news utilizes several time-
honoured genres including celebrity illnesses; gawp
stories (depictions of eccentricity, abnormality and
bizarre behaviour); moral tales and falls from grace;
scientific marvels; danger in the familiar; and the
wisdom of commonsense cures (‘grandma was right’
stories) [4,5].
Research has consistently documented a tendency
for both print and television media to reinforce
negative stereotypes of people with mental illness
[5
7]. This has been described as a form of institu-
tionalized stigma [7,8] and may erode efforts to build

# 2009 The Royal Australian and New Zealand College of Psychiatrists

 C. HENSON, S. CHAPMAN, L. McLEOD, N. JOHNSON, K. McGEECHAN, I. HICKIE
community support for policies designed to reduce
the isolation and discrimination experienced by
people with mental illness and their families [9
11].
Further negative depictions may result in a greater
tendency to inappropriately perceive those with
mental illnesses as dangerous [12]; a preference not
to live near someone with a mental illness [13]; a
lower endorsement of community care options [13];
and employer reluctance to hire people with mental
illnesses [6,14].
In response, globally, we have seen a range of
population-based health promotion, illness aware-
ness, syndrome prevention and health-care reform
initiatives [1
6,13,15
21]. All of these initiatives focus
on reducing stigmatizing attitudes and related societal
barriers to health care, employment, educational
opportunities and other social services. Active en-
gagement of the mass media is seen as essential to
those processes. To date, there has been little
evidence, however, of impacts on the representation
in the media of people who are affected by these
conditions.
Previous research has documented the extent to
which the term ‘mental illness’ itself engenders fear
and stereotypes of chronic disability [22
24]. Inter-
nationally, emphasis has been placed largely on
changing community attitudes towards those with
psychotic disorders, modifying the media portrayal of
suicide and other, rarer adverse events [8,25]; the
central role of key professional groups and other
national health agencies [2,26]; and the utilization of
guidelines for better reporting [12,27,28].
By contrast, recent Australian campaigns have
emphasized active promotion of positive personal
experiences and genuine engagement of broad com-
munity support, as the fundamental means for
changing media portrayals of mental illness
[1,13,29,30]. At the point of initiation of beyondblue:
the national depression initiative, there was good
evidence that Australians did not rate mental dis-
orders among the nation’s major health issues [9,31].
Communication of the day-to-day impacts of living
with a common mental disorder such as anxiety,
depression or alcohol or substance misuse, and the
potential benefits associated with evidence-based
treatments, had not been widely promoted [11,32].
Further, a key decision was made to focus national
attention on common (anxiety, depression), rather
than psychotic disorders [33].
Through the efforts of beyondblue and its asso-
ciated patient participation framework ‘blueVoices’
[34], a primary emphasis was placed on active
promotion of positive experiences and recovery
555
from anxiety and depression [34
36]. These used
first-person accounts by a wide range of community
leaders, serving and ex-politicians, media personal-
ities, celebrities, sportspersons, artists and family
members. This effort has had substantial effects
on those communities exposed to these strategies
[37
40].
The present study describes television coverage of
mental health/illness and assesses progress on calls
for more first-person news accounts from those with
mental illness. It also examines discourse about
mental illness by mental health experts and politi-
cians. No previous study in Australia and few
international studies have specifically examined the
depiction of mental illness by those who have
experienced it or have examined news depictions of
other news actors such as mental health experts or
politicians.
The specific objectives of this study were to (i)
describe recent television news and current affairs
coverage of mental illness to determine how the free-
to-air news media in Australia represents mental
illness; (ii) determine the extent to which people
with mental illness were represented and how they
were depicted; and (iii) determine the presence and
content of the views of mental health experts and
politicians within reports.
Methods
The televised sample was drawn from the University of Sydney’s
School of Public Health digital database, which comprises news
and current affairs items related to health aired on all five free-to-
air Sydney television stations [38]. Between May 2005 and October
2007, 538 items with a main focus on mental health were identified.
Items were determined to be about mental health if a condition/
illness/treatment initiative related to mental health was the focus or
if the item was about mental health services. Mental health items
represented 4% of the total (13 356) of all health-related items, and
6% of the (8976) items with a main focus on a specific health
condition as opposed to generic material about health.
A content and frame analysis coding system was designed and
used to code the items for channel, programme type, age group and
gender represented in the item, presence of specific information
related to mental health resources, reference to suicide, news actor
depiction of mental illness and news angle, or the overall theme of
the item.
A coding scheme for news actor-depictions was developed using
an iterative process of observing these depictions, identifying
common themes and then collapsing more specific depictions of
the people with mental illnesses such as successful/recovered,
threatening, and bizarre into two broad categories: ‘one of us’
(positive or neutral depictions), which included representations of
556 POSITIVE DEPICTIONS OF MENTAL ILLNESS
people with mental illness as no different than the rest of the
population other than having an illness; and ‘one of them’,
(negative depictions), which included representations of people
with mental illness as bizarre, threatening or a burden on society.
When an item included interviews with more than one person with
a mental illness, only the first person to appear in the item was
included in the analysis.
Similarly, the news angle coding was developed using an iterative
process of classifying news items for primary, explicit themes and
then collapsing more specific themes into seven broad categories
(two positive, two neutral, two negative and one category for mixed
angles) of what each story was essentially about (Table 1).
Coding was conducted by two of the authors (LM, NJ), each
coding different items. Eight additional coders were recruited and
provided with coding definitions of the aforementioned categories.
These additional coders then coded 15 randomly selected examples
of TV items. To establish inter-rater reliability for codes requiring
subjective judgement, kappa statistics were calculated.
Results
An overall kappa score for the three news-actors (person with a
mental illness, experts in mental health, and politicians) for eight
raters was 0.60 and ranged from 0.56 for self depiction to 1.00 for
both experts and politicians. For news angle, the kappa score for
eight raters was 0.62.
Relative to actual burden of disease in Australia, mental illness
was underrepresented on free-to-air television. Mental disorders
account for 13% of the total burden of disease for all age groups in
Australia and up to 36% for 15
44-year-olds [41], while only 6% of
the items with a focus on any specific health condition were related
to mental illness.
Of the 538 items, 285 (53%) were news items, with the remainder
being current affairs, breakfast television and documentary pro-
grammes. There were 172 items (32%) broadcast on the Nine
Network; 125 (23%) on the Seven Network; 104 (19%) on the
ABC; 78 (14%) on Network Ten and 59 (11%) on SBS. A x2 test
showed that frequency of items between the five channels was not
evenly distributed (x2  74.4, df  4, p B 0.001).
Table 1. Categories
Positive: Ordinary citizens or prominent persons with or
who have recovered from mental illness (‘us’)
Neutral: Scientific progress: items reporting on new
treatments for mental illnesses. Government, employers
or institutional practices to blame: all items focussing on
blame for mental illness or poor treatment of people with
mental illness.
Negative: Mental illness as bizarre or dangerous (‘them’):
items describing or depicting people with mental illness
as different from the rest of the population, potentially
uncontrollable and threatening. Mental illness ends in
tragedy: items in which mental illness leads to an
unhappy outcome such as suicide.
Mixed: items with multiple angles
A specific mental illness such as depression or schizophrenia was
highlighted in 232 items (43%), and suicide was mentioned in 189
items (35%). Two hundred and sixty-seven items (50%) empha-
sized a specific age group. Adults featured most frequently, being in
222 items (83%), followed by adolescents (19 items, 7%), while
children accounted for 17 items (6%) and older adults featured in
only nine items (3%).
Similar to findings from previous research [42], only 67 items
(13%) included some reference to resources such as phone numbers
or websites for organizations offering support services. This
information was more common in the current affairs items (60
items) compared with news items, which were typically of much
shorter duration.
Positive depictions
Identification of the news angles that attracted the most coverage
(Table 2) showed that positive human interest stories made up over
half of the items. One hundred and ninety-five (36%) were
categorized as ‘Ordinary citizen with, or who has recovered from,
mental illness (us)’. Another 104 items (19%) depicted prominent
people’s experiences of mental illness and/or recovery, giving a
total of 56% of positive recovery-focused items.
In addition to human interest stories, 29% of items were broadly
neutral in their overall depiction of mental illness. These included
‘Government, employers or institutional practices to blame’, which
comprised 109 (20%) of the items. This category typically reflected
views of people with mental illnesses in stories depicting or alleging
unjust treatment by either the government or a business. Although
categorized as neutral in the study, items coded in this category
frequently depicted people with mental illnesses as deserving of
appropriate treatment, thus adding further to those items that
presented mental illness in a positive or sympathetic light. Nine per
cent of items were ‘scientific progress’ stories.
Negative depictions
Two categories conveyed negative views of mental illness. The
first included 42 items (8%) in which mental illness was depicted as
bizarre or dangerous (‘them’). Additionally, 20 items (4%) were
classified as ‘mental illness ends in tragedy’. These primarily were
reports of suicides and other negative consequences of mental
illness. A further 21 items (4%) had either an unclear or mixed
news angle.
The specific way in which three different news-actors (individuals
with mental illness, experts, and politicians) represented those with
mental illness was analysed using two broad categories: ‘one of us’
(positive or neutral depictions) and ‘one of them’ (negative
depictions). Individuals with mental illnesses were present in 264
items (49%). Of the 264 individuals with mental illness represented,
177 (67%) were male and 87 (33%) were female. Most (174 items,
66%) of these self-depictions were categorized as representing
persons with mental health disorders who were ‘one of us’, with the
depictions being either neutral or positive. Ninety of the self-
representations (34%) depicted persons with mental illness as ‘one
of them’ or somehow different from the rest of us either because
 C. HENSON, S. CHAPMAN, L. McLEOD, N. JOHNSON, K. McGEECHAN, I. HICKIE 557

Table 2. Types of news angles in the coverage of mental health

Type of news angle Positive/ Negative Example No. items (%)

Theme
Ordinary citizen with, or who has Positive Woman copes with symptoms of 195 (36)
recovered from, mental illness depression while effectively
(‘us’) managing work and family
responsibilities
Prominent person with mental Positive Minister acknowledges personal 104 (19)
illness depression and calls for more
attention to mental health
Government, employers or Neutral Government fails to provide 109 (20)
institutional practices to mental health services for refugees
blame
Scientific solutions Neutral New combination drug therapy helps 47 (9)
treat symptoms of depression
Mental illness as bizarre or Negative Children with mental illness are 42 (8)
dangerous (‘them’) uncontrollable and potentially
dangerous or young people depicted
as bizarre in behaviour and
appearance
Mental illness ends in tragedy Negative Young women commit suicide 20 (4)
Mixed or unclear 21 (4)
Total items 538 (100)

they were dangerous, bizarre, withdrawn or a burden on society
(Table 3).
Experts such as psychiatrists or psychologists overwhelmingly
represented and described people with mental illness as being like
‘one of us’. Of the 249 items that included an expert, 236 (95%)
spoke of people with mental illness as being in every way ordinary
and unremarkable, other than having a mental illness. Similarly,
politicians tended to depict people with mental illness as ‘one of us’.
In the 95 items that included the comments of a politician, 80
(84%) were categorized as being like ‘one of us’.
Discussion
Television news and current affairs coverage of
mental heath/illness in Australia represents only 6%
of items with a main focus on a specific health
condition but, unlike previous findings in different
settings and media [5,7,22], provides a predominantly
positive view of mental illness, with nearly 85% of the
news angles categorized as either positive or neutral.
Over half of all news stories (56%) included positively
rated human interest stories of coping and recovery
from mental illness by both prominent and everyday
people, in which the decisions, made by those being
interviewed, to be open about their illnesses, repu-
diated any notions of shame. A further 20% featured
themes that were sympathetic to those with mental
illness. A decline in the prevalence of negative themes
including associations with dangerousness, bizarre
behaviour or tragedy was apparent in this sample
(12% compared to previous studies in Australia,
which found 60% negative themes) [43]. This
finding suggests a trend towards a further reduction
in reinforcement of negative stereotypes about mental
illness in the media initially observed in a 2004 study
of Australian print media [42]. Overall, this sample of
television news and current affairs items represents
people with mental illness as part of the broader
Australian community and does not predominantly
associate mental illness with violence or bizarre
behaviour, as has been observed in previous studies.
The high percentage of people with mental illness
giving first-person reports (264, 49%) contrasts with
previous findings of 0.8% and 17.2% [42,44]. Similar
to previous findings [44], the present findings suggest
that when people with mental illnesses represent
themselves, the depictions are more often (66%)
positive. The most common self-representation of a
person with mental illness was a man depicting
himself as ‘one of us’. Male subjects were depicted
Table 3. Self-depictions of persons experiencing
mental illness
Gender Depicted as Depicted as Total
‘Us’ n (%) ‘Them’ n (%)
Female 64 (74) 23 (26) 87
Male 110 (62) 67 (38) 177
174 (66) 90 (38) 264
558 POSITIVE DEPICTIONS OF MENTAL ILLNESS
in 67% of the items that included first-person reports
compared to female subjects, who were depicted in
only 33% of the items, despite female subjects having
a slightly higher burden of disease associated with
mental disorders (47%:53%, male : female) in the
Australian population [41]. This suggests that female
subjects with mental illness may be slightly under-
represented in the media. Children, adolescents and
older adults were underrepresented and were featured
in only 6%, 7% and 3% of the sample, respectively,
while children account for 19% of the population and
older adults account for 13.4% [45].
Both experts and politicians were well represented
in the present study, with experts appearing in 46% of
the items and politicians appearing in 18%. Both of
these news-actors represented people with mental
illnesses in an inclusive manner, 95% and 84%
categorized as ‘one of us’ respectively, which differs
from previous research that concluded that the
inclusion of psychiatrists did not result in a positive
representation of mental illness [37]. The relatively
high number of items representing those with mental
illnesses as being no different from the rest of the
population (other than having a mental illness)
coupled with the reduction in negative themes such
as associations with danger and bizarreness is more in
line with Australia’s guidelines for reporting on
mental illness [21], may reflect an evolution in
industry norms being applied by news editors, and
be early evidence of a reduction in the institutional
stigma observed in the past [7,8].
Bell postulated that all news can be divided into
news about ‘us’ or about ‘them’ and that traditionally
people with mental illness have been relegated to the
‘them’ category [46]. Bell suggested that those with
mental illness have historically remained in the ‘them’
category, while many ethnic and racial minorities
have moved into the ‘us’ category. This is because
people with mental illnesses do not easily form
coherent communities, are often reluctant to identify
themselves and because there has been little advocacy
to make mental illness more of an ‘us’ issue.
The present findings appear to indicate that the
deliberate media strategies promoted by beyondblue,
MindFrame and other similar national strategies in
recent years have fundamentally changed the wider
community discourse about mental disorders. Promi-
nent people now show a willingness to acknowledge
their personal experiences with mental illness (19% of
the present sample featured prominent people with
mental illnesses). All campaigns in Australia now
place the person with the experience at the centre of
the story, rather than relying on professional, anon-
ymous or other dehumanized accounts. In this
sample, 49% of stories included self-representations
by people with mental illnesses.
The evidence from the present study, in combina-
tion with other evidence of the impacts of these
campaigns on changing social attitudes, increasing
illness awareness and improving community support
for the use of evidence-based treatments, could help
to shape similar initiatives in other countries as well
as other international collaborative projects. Specifi-
cally, the extent to which health experts, politicians
and high-profile members of the community are
prepared to join with people who experience common
mental disorders and continue to make themselves
readily available for public discussion is of the utmost
importance.
There is no doubt that the fundamental shift in the
public discourse in Australia away from the use of
generic terms such as ‘mental illness’; an emphasis on
less common forms of mental illness (particularly the
psychoses); and uncommon but tragic complications
such as suicide were both deliberate and controver-
sial. Specifically, this strategic shift ran the risk of
further isolating those affected by the psychotic
disorders. It seems clear, however, that the end result
of the deliberate approach to appeal to ‘every family’
[47] and support a broad inclusive approach has
actually been to assist later work with changing
engagement with other less common disorders such
as bipolar disorder and schizophrenia [11].
Importantly, this ‘every family’ approach was not
simply imposed by one illness-specific organization
(e.g. beyondblue) but was actively supported by the
national peak body, the Mental Health Council of
Australia (MHCA) [48]. The MHCA represents a
more diverse set of organizations and people likely to
be most affected by any significant change in direc-
tion or emphasis. The media campaigns were also
complemented by political advocacy aimed at devel-
oping broader engagement of the health, employment
and social services sectors. This not only drew
attention to deficits in care [10,48] but also high-
lighted opportunities for social and health invest-
ments [47].
Actual improvements in access to effective medical
therapies in the 1990s, and increased financial sup-
ports for psychological treatments in the last 5 years,
are also likely to have contributed to the positive
portrayals of the potential benefits of receiving care.
Media campaigns that are not conducted in associa-
tion with actual service reform may appear rather
shallow or contrived, particularly if they are largely
financed by governments. Media events that report
 C. HENSON, S. CHAPMAN, L. McLEOD, N. JOHNSON, K. McGEECHAN, I. HICKIE
real people receiving effective treatments and return-
ing to work and social function have the key element
of authenticity. This was characteristic of the key
media strategies of beyondblue, which relied very
heavily on conventional news reporting and had few
actual investments in paid advertising or direct
government sponsorship. Similarly, efforts by orga-
nizations such as MindFrame, which have specifically
targeted more effective and accurate reporting by
journalists, have likely contributed to more positive
depictions of mental illness in the news media.
In Australia there is still much work to be done.
Future efforts should increase the emphasis on
women, adolescents, children and older adults, each
of whom were underrepresented in the present media
sample. The new national youth mental health
foundation, headspace [49], is another significant
national investment that builds on earlier campaigns.
Other efforts include continuing to support people
with mental illness and their families with media
training and continuously providing information to
journalists regarding mental health issues that are
relevant for these groups. Advocacy efforts could also
be aimed at encouraging journalists to strengthen
public awareness by providing more specific informa-
tion about the options in available treatment, how to
access services and where to engage ongoing commu-
nity support.
Acknowledgements
Funding for the database was provided by a grant
from the Cancer Council NSW and for the study by
the Brain and Mind Research Institute.
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