Mental health: Reporting beyond the labels

By Hilary Abramson
Independent journalist

If you live with mental illness, tell the truth about it.  If you report on mental illness, watch what you say about it.

This was the core advice from panelists on "Mental health: Reporting beyond the labels " on April 17 at Health Journalism 2009 in Seattle.

"People with mental illness are more likely to be victims than perpetrators," said Jennifer Stuber, assistant professor of social welfare at the University of Washington.  But despite the research, many media depictions of these people continue to promote stereotypes of their being dangerous to themselves and others.

In announcing her university's new Web site for journalists covering mental illness in Washington, Stuber said that coverage matters particularly because it impacts public policy and people seeking help. She challenged journalists to "stop using labels such as ‘the schizophrenic,' which is extraordinarily dehumanizing. … Ask whether mental illness is really a part of the story.  Does the public information officer have the accurate information?  Realize that recovery is likely with treatment.  Be aware that people with mental illness face discrimination."

Diagnosed with bipolar disorder 32 years ago, panelist Randy Revelle could have been one of those people.  Today, as senior vice president for policy and public affairs for the Washington State Hospital Association, he is one of the most visible national advocates for insurance parity for mental illness.  Telling the truth about mental illness was easier for him than contemplating the stigma of it, he said.  He was a member of the Seattle City Council in 1977, when he traveled to the nation's capital to testify twice in one week.

After his second Congressional appearance, Revelle could only speak gibberish. 

"I was terrified," he said, describing three subsequent weeks of psychotic episodes that included being convinced that his 2-year-old daughter was delivering a baby and that neighborhood dogs were wolves about to attack both his children.

"The worst episode was when I grabbed a fireplace poker and came within inches of killing my daughters."

Revelle's father, a King county superior court judge who later advised his son never to deny his mental illness, told a hospital doctor that either he admit his son or face jail. 

"I could get admitted under my insurance coverage for a bad back," said Revelle, "but not for a ‘bad' brain." 

Convinced by his psychiatrist that he had a one in four chance of having psychotic episodes if he went off Lithium, Revelle reported that he has never missed a day.

Although Congress enacted a law last year for mental health parity for Americans lucky enough to have medical insurance, Revelle said that "all insurance plans still discriminate against people living with mental illness."

The "bad news," he reported, is that the federal law represents "pure discrimination against with mental illness."  It only achieves "limited" equal coverage for mental as physical illness, because it is voluntary, offers an incentive to drop coverage, and does not protect small business employees.  The good news is that 38 states such as Washington have more comprehensive insurance parity for what the panelists called "the most common and disabling disease."

With or without insurance coverage, adolescents (12 to 15 years of age) are at more risk than previously thought due to changes in the brain, according to Elizabeth McCauley, professor of psychiatry and behavioral sciences at the University of Washington. 

"About 10 to 15 years ago, we really thought that the brain went through incredible plasticity from three to five years of age," she said.  Today, neuroscience research identifies structural changes, expansion of "cortical linkages" even into late adolescence and "possibly into the early 20s." 

Puberty stimulates changes in the brain that regulate appetite and emotions. "Kids are all turned on like a driver at the wheel with no experience." 

Research indicates a 200 percent to 300 percent increase in mortality and morbidity rates in childhood to late adolescence.  About 60 percent to 70 percent of youngsters who experience high stress and mental illness such as depression respond to treatment, said McCauley, but there is a high relapse rate. "About 58 to 61 percent report bias against meds."

Journalists could help, she concluded, if they would "reduce the focus on stigma of mental illness and educate parents and teens in how common it is among teenagers. Successful treatments have become more short-term. It is important to normalize-not minimize-mental illness."