Using the media during Mental Health Week

The mass media is an important source of public information on mental health issues.A two-page insert in 11 local Ayrshire newspapers was purchased to coincide with the Mental Health Weeks in 1994 and 1995. Using a quota sampling technique, 379 adults were questioned on their views and recollection of the insertin 1994,and a further 365in 1995.Ithad been seen by 27% of 1994 respondents, and by 22% in 1995.Of these, 80%in each sample had read at least part. Local details were best remembered, and information on the nature of mental illness was regarded as the most helpful part of the insert. The newspaper articles provided a way of contacting a substantial proportion of the adult population of the area.

The closure of long-stay institutions has in creased the public profile of mental illness. Enormous publicity has been generated by suicides, assaults and murders involving men tally ill people (Torrey, 1994). Increases in community treatment allow the public increased exposure to mental health issues, but their personal experience may be outweighed by adverse media coverage of uncommon events (Berlin & Malin, 1991).
The Ayrshire and Arran Health Board area has had several discharge programmes, with accommodation being provided by voluntary organisations supported by the NHS, or by mainstream housing providers. In 1992-93 the discharge programme began to experience increased resistance from local communities. In one case, which attracted considerable local publicity, householders in an affluent area banded together to buy a house in order to block its acquisition for use with this client group.
In order to identify the barriers to a further shift to the community, the Health Board commissioned research from the University of Glasgow to review the attitudes of the public, and of professionals, service users and carers to wards mental illness and the services and accommodation required for those affected. The work confirmed the preference of users for community options, but revealed widespread concerns among the general public, particularly when asked about the possibility of a group home being established near to themselves.
In order to tackle these problems, the Health Board has, together with organisations in the local authority and voluntary sectors, devel oped a mental health promotion strategy which includes recognition of the need to inform public opinion and to challenge preconceived ideas. A pilot project was carried out during Mental Health Week 1994, and repeated in 1995.

Subjects, methods and findings
A two-page insert was purchased in the local newspapers in all local government districts in the Ayrshire and Arran Health Board area, a total of 11 newspapers, during Mental Health Week 1994 and again in 1995. The two-page spread included nine separate items. System Three Scotland, a market research organisa tion, was commissioned to evaluate the impact of the programme by carrying out street inter views beginning one week after the publication of the article (this was delayed to two to three weeks after Mental Health Week in 1995). A quota sampling technique was used to obtain samples of 379 adults in 1994 and 365 in 1995, which reflected the age, sex, social class and geographical distribution of the Board area as a whole.
In 1994 the insert had been seen by 27% of respondents, with 80% of these having read at least some of it and 8% having read it all. The following percentages refer to the 90 people who had read some or all of the insert. Of these people. 68% stated that they had found it either very or quite interesting. The part of the insert which was most often recalled was a section on local events for Mental Health Week, with 23% spontaneously citing it and a further 22% recalling it when prompted. The next most cited items dealt with local telephone numbers for mental health and support organisations, and that on "Things you didn't know about mental health". The least cited item discussed media coverage of mental health issues, with only 8% citing it even after prompting. The items rated as most useful were those discussing "what is a mental health problem?" and a selection of comments from service users, regarded as help ful by 85% and 80% respectively of those who had looked at it.
Results for 1995 were similar, although the street interviews were conducted two to three weeks after Mental Health Week, rather than the following week as had happened in 1994. An additional question on Mental Health Week itself was added in 1995. Of the 1995 sample, 42% stated that they had heard of Mental Health Week. More women than men reported knowing of the week (50% compared with 34%), and a larger proportion of people who knew someone with a mental health problem stated that they had heard of the week (46% compared with 39% of those who knew no one with a mental health problem). In order to elicit the degree of aware ness of the week, those who had heard of the event were asked when it took place. Of these, 10% gave the exact dates, while a further 26% thought it had occurred in the previous two to three weeks. The remainder (64%) were either unsure or gave an incorrect date.
In the 1995 group, 22% reported seeing the newspaper feature, with 81% of these having read at least some of it. Of those who read some of the feature, 78% found it either very or quite interesting, similar to the response in 1994. The two most useful, and best recalled, elements were "useful telephone numbers" and a list of local events. The events associated with the greatest reported interest were an art exhibition (35% very or quite interested): an information and publicity shop display (32% very or quite interested), and a Roadshow with West Sound, the local radio station (27% very or quite interested). Open Days attracted the least inter est, with less than 7% expressing interest in any of the local open days, such as those in hospitals, clinics, training or drop-in centres.
In 1994, information was collected on experi ence and attitudes, with 48% of respondents knowing someone with a mental health problem. Of those who knew anyone with a mental health problem, 15% agreed that "those with a mental illness should be kept in hospital", compared with 28% of those who did not know a sufferer. In addition, 37% of those aged over 55 years agreed with the statement compared with 14% of those aged 18-54 years. These differences were not statistically significant.
Results from 1995 were largely consistent with this. Of this sample, 84% agreed "mental health problems affect a lot of people directly", com pared with 82% in 1994. Eighty-three per cent agreed that the public "are often afraid of people with mental health problems", compared with 78% in 1994. The statement that "those with a mental illness should be kept in hospital" found 18% agreeing and 63% disagreeing, compared with 22% and 50% respectively in 1994.

Comment
Public attitudes towards the resettlement of hospital patients in the community, and the increasing use of community treatments, are important in many ways. Adverse media pub licity may cause calls for an increase in hospital provision and a decrease in community place ments. Professionals often avoid the media because of worries about misquotation and oversimplification. Despite this, there are exam ples of successful use of media routes to communicate information about mental health issues (Barker et al 1993;Wolff et al. 1996).
A media route was chosen for this project in an attempt to communicate with as many members of the public as possible, and because it Is influential in shaping public attitudes towards mental illness (Lopez, 1991). The evaluation indicates that at least a fifth of the Health Board's adult population read at least some of the newspaper insert in each year, and that most of those who did look at it found it of interest. Local details were the best remembered, but items on the nature of mental illness were regarded as the most interesting. Traditional events, such as open days, aroused minimal public interest. Events such as art exhibitions, radio roadshows and displays in shops were far more acceptable.
The findings indicate that, at least in Ayrshire, Mental Health Week has to develop further if it is to have a greater impact on the public. Open days and other traditional forms of involvement appear to have little appeal. More innovative and acces sible but time-consuming events, such as joint initiatives with local radio, are of wider interest.
Information will not, of itself, change attitudes. It does seem important, however, that the caring professions do not retreat from the media. Purchasing space in newspapers is one way to ensure that accurate details are transmitted. As a result of this work, the local Mental Health Media Group intends to place further articles in the press on mental health issues, and to seek to widen the type of event. Their content and structure will reflect the findings of the evaluation. Media campaigns, combined with appropriate evaluation and subsequent modification, may be one way of redressing the balance against sensationalist press coverage.