10.4185/RLCS-2017-1156en | ISSN 1138 - 5820 | RLCS, 72-2017 | |
Coverage of mental health in the Colombian Press, an ongoing contribution
Manuela Vallejo, Salomé Mejía, Nathalia Ramírez, María del Mar González Orejuela, Nathalia Suárez Díaz, Juan Manuel Álvarez, Laura Orjuela, Melanie Cedeño, María Paula Rada Hidalgo, Sandra Juliana Tenjo, María Camila Martínez, Universidad de La Sabana, Cundinamarca, Colombia.
Traslation by Yuhanny Henares (academic translator, Universitat de Barcelona)
Due to the special characteristic in Colombia, generated by a long internal conflict, which lasted more than 50 years and had left consequences in a considerable part of population, mental health has gained a great relevance in the country, in such a way that the national government issued the Law 1616, dated January 21, 2013 (Presidency of the Republic, 2013), dedicated exclusively to this issue.
Different studies in the world have made evident the outstanding role mass media play in the management of mental health themes, because the way they describe mental health has direct incidence in the people’s attitude (Angermeyer and Matschinger, 1999; Thorton and Wahl, 2006; Roth, 2004; Pirkis, Bloon, Francis and MacCallum, 2006; Pirkis and Francis, 2012) and have documented the relationships between stigmatizing representations of mental health and a negative perception of society before individuals suffering these diseases. Klin and Lemish (2008) state that descriptions made by media about mental health and those suffering mental illnesses are full of inaccuracies, exaggeration and misinformation. The patient is introduced not only as peculiar, but also as different and dangerous.
Pearson (2011) states that this stigmatization is not caused by the bad faith of journalists but by the difficulty they have in language use, a result of the lack of clarity of public healthcare systems when it comes to talk about mental health. Based on this author, without policies, definitions, nor clear procedures, it is very little what journalists can do about it.
Other researchers (Cloverdale, Nairn and Claasen, 2002; Wahl, Wood and Richards, 2002; Stuart, 2003; Corrigan, 2004; Muñoz, Pérez-Santos, Crespo, Guillén and Izquierdo, 2011) have studied the contents published by newspapers about mental health, to understand what kind of information people receives about the issue and they have met with those managing informative organizations to try to improve informative practices regarding mental health coverage. One of the most outstanding concerns in these studies, is the negative impact that a bad coverage can generate in society, because it has been demonstrated that mass media influence public policies, when they pressure governments by imposing one themes over others in media agendas (Slopen, Watson and Corrigan, 2007).
With these ideas in mind, diverse initiatives have raised so to improve the image that media project about mental illnesses and reduce the social stigma they generate. Strategies such as Time to change (2014), in England; SEE MEE (2014), in Scotland; NAMI (2014) in the United States, The Response Ability Project (Skehan, Sheridan and Hazel, 2009), in Australia, or 1 out of 4 (2014), in Spain, they have tried to change contents in mass media so that they present successful cases of recovery and integration of mental patients, so that they use an accurate and no stigmatizing language, so that they orientate about how to treat individuals suffering mental illnesses, and have gathered mental health professionals and journalism teachers so that they work jointly to create a curriculum that improves journalists education in mental health. Moreover, through scholarships and awards, such as the ones offered by the program Rosalynn Carter Fellowships for Mental Health Journalism (2014), good practices in the informative treatment of mental illness is identified and acknowledged.
Different studies have indicated that the mass media are precisely the ones with the responsibility to achieve, through the adequate coverage, that the public policies and laws regarding mental health could be enhanced and here comes the need to make journalists sensitive about it (Muñoz, Guillén and Pérez-Santos, 2013; Paterson, 2006; López, 2007).
In Latin America, works such as Rodríguez, De la Torre and Miranda (2002) have mentioned the need to improve mental illness understanding through community education, community organization and social participation, so to promote the creation of policies for treatment and destigmatization of the disease. However, the research about the issue in this region is rather scarce. Existing works handle about healthcare communication or informative treatment of other kinds of illnesses (Alcalay and Mendoza, 2000; Obregón y Waisbord, 2010; Pardo, 2010; Morales y Vallejo, 2010), but not specifically mental disorders.
The most recent national study about the state of mental health in Colombia is dated on 2015 (National Mental Health Survey, 2015), when 16.147 individuals were surveyed (divided in four age groups: from 7 to 11 years old; from 12 to 17; from 18 to 44 and from 45 years old and older), living in 13.555 homes. The survey shows as main results that 4 out of 100 teenagers (12 to 17 years old) presented more than 5 anxiety symptoms, and 14 out of 100 presented more than 4 depression symptoms. Among the population from 18 to 44 years old, there were signs of mental problems such as anxiety, depression or psychosis in 9.6% of interviewees. And the most frequent problems among individuals between 18 and 44 years old there is alcohol abuse, which presented a value of 12 %, while in older than 45 years old, there was a prevalence of 6 %.
Anyways, to increase the quality if information that citizens receive about the subject through mass media is a relevant and urgent task, because a good mental health coverage not only guarantees the inclusion but also makes understanding the illness easier and acknowledges the society’s responsibility in diagnosis and treatment. In other words, a better-informed society about its mental health problems, is a healthier society.
Therefore, the main goal of this work is to stablish the relevance in mass media and quality of journalistic information about mental health, published in daily Colombian press, from the answer to two research questions: what is the relevance the press grants to mental health issues? And what is the quality of information about mental health published by the Colombian press?
A descriptive-correlational study was carried out, using the contents analysis technique, to the total of the journalistic notes about mental health (excluding publicity) published in the selected daily national and regional press, for a year counting from July 1, 2013 to June 31, 2014.
Thanks to the agreement stablished with the media monitoring company Siglo Data – MMI, there were covered 12 complete months of newspapers of general information, two national wide and five regional wide, selected by recording the largest number of readers in their respective cities, based on the Media General Study, first wave 2013: El Tiempo (1.137.500 daily readers national wide) and El Espectador (250.300 at national level); Vanguardia Liberal, from Bucaramanga (77.100); El Heraldo (130.200), Barranquilla; El Colombiano (157.300), from Medellín; La Patria (61.200), from Manizales, and El País (178.100), from Cali.
In total, 545 journalistic notes were analysed, with direct reference or that mentioned the following terms somewhere: suicidal behaviour (suicide or suicide attempts); anxiety, depression, eating disorders (anorexia, bulimia); bipolar disease, schizophrenia; addictions (alcoholism, drug addiction), mental health, mental illness.
Considering the specific objectives set forth and the research issues derived thereof, the following category system was determined:
To determine the relevance every mass media grants to the journalistic notes, the publication frequency of each one of them was recorded and an adaptation of the Richard Budd’s Scale of Attention (1964) was used, which grants a binary score of 0 -1, to the following variables: Size: One point if the article is three columns or more; Location on page: One point if the journalistic note is located in the superior half of the page; Number of page: one point if it is located in an odd page; Cover: Budd grants one point if the note appears on the Cover; Graphic accompaniment: if notes are illustrated by pictures or graphs, they will have one point; Summary: Journalistic notes with summaries in the headline are granted one point. Considering the foregoing scores, Budd’s Scale was comprised by 6 levels, as follows: 0= No interest; 1= Low interest; 2= Middle to low interest; 3= Middle interest; 4= Middle to high interest; 5= High interest; 6= Maximum interest.
To stablish the quality of informative contents about mental health covered by the press, the reference used was the criteria of Journalistic Added Value of the Faculty of Communications of Pontificia Universidad Católica de Chile, VAP-UC (Pellegrini and Mujica, 2006), determining the following variables: journalistic genre, type of headline (evaluative or informative), sources management (number and type of sources based on their substratum and filiation), bias (existence of different points of view); contextualizing (presence of background, consequences, recommendations of prevention and treatment or indications of how the problem should be treated). To stablish the clarity of the message, we worked based on Fog’s concept (2007), which determines whether a specialized or processed language was used so that an inexpert reader in the healthcare context could understand it.
Before data gathering, there was a training were a note from every selected media (7 in total) was codified by the individuals collecting data for the project. There were no differences in codification, therefore, it was stablished that there was consensus in instructions and the variable matrix.
From the 545 journalistic notes about mental health that were found in the seven newspapers analysed, 38.7 % were published by El Tiempo, followed by El Espectador with 18.5%; Vanguardia Liberal, with 15%; El Colombiano with 11.7%; El País with 7.3%; El Heraldo with 4.4% and La Patria with 4.2%.
Mental health themes published more often by newspapers, in order: addictions (65.5%); suicidal behaviours 22.4%; depression (4.6%); schizophrenia (2.8%); mental health (1.8%); eating disorders (1.7%); bipolar disease (1.3%).
There is a statistically significant relationship between the mental health issue and mass media, but on the seven newspapers there is predominance of addictions, followed by suicidal behaviour. None of the media published about the totality of the themes analysed in this study, as seen on Graph 1.
Regarding the interest given by newspapers to mental health issues, most were in the middle to high range of interest (22.6%), followed by those considered as middle to low interest (21.1%), and middle interest (18.5%). In the inferior scales, of low and null interest, there were registered 15.2% and 4.2% respectively, while the ranges of high interest and maximum interest, 15.8% and 2.6% respectively.
The relationship among the mental health issue and section were media publish it, is also relevant. As it was supposed, the greatest frequencies of publication of this kind of issues are in the healthcare section, where all subjects are handled except eating disorders and there is predominance of notes regarding addictions. It is eye-catching that the Opinion section is in second place, because it reflects that mental health, especially regarding addictions, encompasses a special attention for those who, from their columns or from the media editorial team, orientate the public opinion in a more direct manner.
Other sections (sports, jet-set, among others) occupy the third place, followed by judicial sections, where most of suicidal behaviours are registered. Local/ regional and national sections, also registered a relevant number of notes, especially regarding addictions, as seen in graph 2.
P=0.000; Contingency coefficient= 0.582
Regarding informative handling of mental health issues, we analysed variables such as clarity of the message in the sense that the language used in text wording could be easy to understand for individuals who are not expert in the subject, through the use, of a language processing technical terms by the journalist and that makes them accessible to the whole population.
In 522 cases, journalists go to popular language, that is, without the use of scientific or specialized terms. Only 15 journalistic notes make an adequate processing of terms so that they are understood by people, but additionally providing medical concepts, these articles handled issues such as suicidal behaviours and addictions, specially. On the other hand, information about bipolar disease are worked in the analysed media from an eminently scientific language, as seen on graph 3.
The foregoing variable is related with two essential elements in the construction of information: the journalistic genre and the type of headline. There was a statistically significant relationship between subjects and journalistic genres used, predominating informative (news), except in cases about eating disorders, which were worked from interpretative genres such as chronicle, interview or report, and articles talking about schizophrenia, which were treated mainly from opinion genre. See graph 4.
On the other hand, the type of headline, has almost total coincidence with the journalistic genre of every note: informative headlines for news, and evaluative headlines, which may lead to misinterpretations, for interpretative and opinion genres. See graph 5.
P=0.004; Contingency coefficient= 0.185
Regarding construction of information, variables such as the number and type of sources consulted were analysed, the balance in the presentation of different perspectives about narrated facts and the contextualization, which not only includes background and consequences of presented information but, in the case of healthcare issues, it should present recommendations about prevention and possible treatments.
35.2% of 545 notes analysed showed only a single source of information, followed by a 34.5% which showed two sources. 15% registered three or more sources in almost the same proportion, 14.9% didn’t evidenced declared sources. Government sources are mentioned in 20.7% of journalistic notes analysed, public official sources in 43.3%, private official sources (non-governmental organizations and companies for example) in 20.6%, to expert sources in 38.7% and testimonial sources (protagonists or witnesses to facts) in 34.3%.
This is related to the bias or lack of existence of different points of view in the construction of the informative note. 74.1% of analysed notes has only a single point of view, 19.4% a point of view with marginal reference to another version and 6.4% mixes points of view.
Consultation to experts is done in almost all subjects, except for the bipolar disease, but the fact that 61.3% of journalistic notes do not consult experts is too high. Reference to experts predominates in the texts about addictions, suicidal behaviour and depression, being the latter where more than half of notes use expert sources, as observed in graph 6.
P=0.017; Contingency coefficient= 0.166
Regarding contextualization, 65.5% of journalistic notes analysed report background of facts, consequences in 66.2%, prevention recommendations in 28.8% and possible treatments in 25.7%.
There is a statistically significant relationship between mental health issues and mention of treatment, which is especially relevant in depression, where it is in more than half of cases, as shown in graph 7.
Even though the role of mass media in health promotion tasks have been widely documented (Wilde, 1993; Pereira, 1994; Obregón, Vega and Lafaurie, 2003; Collignon, Valdez, Obregón and Vega, 2003; Revuelta, 2006) and that regarding mental health information about prevention, treatment and successful cases of integration is rather relevant to reduce social stigma over individuals with mental disorders (Ramos, Saltijeral and Saldívar, 1995; Rubin, 2006; Saukoo, 2006; Boundry, 2008, López, 2007; Ray and Hinnant, 2009), there are scarce publications about the issue in the Colombian press. In average, less than 1.5 of daily journalistic notes related to the issue were published in an entire year in severe media, that is, barely 0.2 in every newspaper.
A first glance at the location where mental health notes were published, shows that, 38.7% in El Tiempo newspaper and 18.5% in El Espectador, tell us that newspaper of national coverage seem to have a wider coverage of the subject than regional newspapers. This percentage could indicate, not a lower incidence of the illness in the regions, but a lack of interest from these media, which grant priority to other kind of news.
The mental health subjects with more presence in the Colombian press are addictions, where we relate drug addiction and alcoholism, and suicidal behaviour, which could be related to the significant increase of cases in Colombia about these aspects and the subsequent concern of opinion leaders and governors to find a solution for said problems. For example, as commanded by the Bogotá’s mayor’s office, Camad were implemented in 2012, Mobile assistance centres from drug dependent individuals, and from the national government, the need to grant a greater coverage to the treatment of mental illnesses through the mandatory healthcare system was suggested. The Law of Mental Health was issued therefrom. These two initiatives, besides other cases, were the origin of several journalistic notes.
Mental health issues, including chronic diseases such as depression, eating disorders, bipolar disease or schizophrenia, are practically indifferent for Colombian newspapers, whereas in a complete year analysed there were less than 25 journalistic notes published in each one of these subjects.
Schizophrenia, for example, would have completely gone unnoticed, if it weren’t for the fact that, during the period of data gathering, the publication of a book from the Colombian writer Piedad Bonet was registered, where she tells about the illness and the subsequent suicide of his son, who suffered schizophrenia. The fact narrated by the writer moved the country and allowed granting visibility to an illness that is rarely mentioned in Colombian media, especially from the opinion genre, where not only literary critics pronounced but also psychologists and psychiatrists, warning about the scarce orientation provided for families and for patients themselves about how to treat this disease.
Subjects about addictions 65% and suicidal behaviour 22.4%, seem to occupy the complete attention of media, however, it is important to note that most of notes talk about facts that occurred and not their causes, which makes it difficult to determine whether addictions or suicides are a product of other mental illnesses such as depression, schizophrenia, eating disorders, bipolar disease, just to mention some of them.
This seems to reconfirm the study of Boudry (2008) who, using the Sapir-Whorf hypothesis, that says the language determines how people categorize and see the world, wrote about the coverage of suicide in United States newspapers and said that words chosen conveyed that suicide was the result of a personal problem and not an illness beyond what was happening.
Besides, it is very significant that, from the 545 journalistic notes only 15 have made an adequate processing of terms so that the illness handled is understood by readers. This reveals a lack of knowledge about the subject from journalists and, likewise, a disability to delve into it and offer the reader a wider perspective, beyond mere facts.
It is eye-catching, that the issue about the bipolar disease is managed mainly from the informative genre, but with scientific language and without consultation of expert sources. It is expected that the scientific language is managed by experts in mental health, who eventually write opinion columns or articles, and not by journalists, whose role is precisely to make the language more understandable for readers after consulting expert sources.
This reveals an information comprised in the two opposed poles of language. Or the notes are too basic or too complex, there are no intermediate points. This lack of language mastering echoes Pearson results (2011), which were already mentioned.
Another possible research, from the discourse analyses, is to observe the type of language and the words with which mental health issues are presented, so to stablish whether stigmatizing behaviours are perpetuated on press or whether there is a contribution to fight against prejudices and discrimination, and in the same sense, stablish from patients and their families, how they receive information published by media about mental health, to what extent is it useful and what terms or expressions used are bothersome or offensive.
Most of notes were written using the informative genre. This trend reveals a lack of depth in the treatment of information, because stories generally stay on the plane of description of simple facts and do not move into the greater genres of research or narrative journalism. With the coming of the digital universe, possibility was opened so that written press could become the niche of analysis, contextualization and the narration of stories, and set aside the merely informative to the Web. Even though multimediality also offers great possibilities of journalistic deepening in digital projects, world press has been serious about its role to transcend the simple narration of facts. Based on this study, written Colombian press seems to be letting scape the informative opportunity to delve and research in matters regarding mental health.
However, at the same time it is interesting and encouraging, that the issue of eating disorders has been treated from interpretative genres, which offer a greater deepness and context. Saukoo (2006) already mentioned in a study about eating disorders in media, that there is a contemporary fascination by transformation and deformation of bodies, which also seems to reflect in what was found in this case.
A recurrent problem in Colombian media usually is the single-sourcing and the lack of contrast of points of views in the construction of information, as different studies have indicated (Hernández, Gómez, Gutiérrez and Arango, 2011; Alba, 2009). In the case of mental health issues, the problem repeats, but with the aggravation that in these kind of cases, the consultation of expert sources, besides those being directly related to facts, is especially important, to offer the people necessary orientation to adequately understand the problem, know how to treat it and avoid stigmatizing myths that tend to create social rejection towards those suffering these kinds of disorders.
This has a relationship with the need of a good contextualization in the journalistic notes that inform about mental health issues, since only an expert in the subject could provide recommendations about prevention and possible treatments for individuals affected by these diseases and disorders, so that useful information, far from speculation, is provided.
But, instead of mentioning journalists flaws in the management of information about mental health, it is necessary to start a joint work between experts in the management and treatment of mental illnesses and journalism professionals, so that a synergy is achieved so to improve the quality of information about the issue and a more positive perception of the mental illness patient in society.
At this point, it is necessary to make clear that newspapers analysed are those considered “serious”, which is different from “popular” newspapers, which offer a more sensationalistic treatment to the subjects they publish, are free or with very economic prices, and hence, record high consumption rates in Colombia. Including these kinds of media in future researchers will be interesting because they get to a huge part of population and the language used could be different given its sensationalistic nature.
This research was carried out thanks to the support of Siglo Data – MMI in gathering texts analysed and the funding of the Carter Center Mental Health Program.
The following students participated as research assistants: Manuela Vallejo, Salomé Mejía, Nathalia Ramirez, María del Mar Gonzáles Orejuela, Nathalia Suárez Díaz, Juan Manuel Álvarez, Laura Orjuela, Melanie Cedeño, María Paula Rada Hidalgo, Sandra Juliana Tenjo, María Camila Martínez.
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How to cite this article in bibliographies / References
L Gutiérrez-Coba, A Salgado-Cardona, V García Perdomo, Y Guzmán-Rossini (2017): “Coverage of mental health in the Colombian Press, an ongoing contribution”. Revista Latina de Comunicación Social, 72, pp. 114 to 128.
Article received on 5 December 2016. Accepted on 30 January.