Introduction
Considerable research has explored the impact of media on attitudes and knowledge regarding mental health, help-seeking and services (Niederkrotenthaler et al., 2014; Waldmann et al., 2020). Media campaigns have been shown to impact help-seeking behaviours and attitudes towards those with mental illness. However, research has generally concentrated on deliberate mental health-focused media campaigns (e.g. Booth et al., 2018) or the effect of media on perceptions of those with mental illness. Yet attitudes towards services can either be a facilitator or barrier to help-seeking (Lynch et al., 2018). Therefore, the depiction of services, stakeholders and service providers in news media and the impact this may have on attitudes is an area that deserves examination.
Maio et al. (2018) noted that vicariously formed attitudes (i.e. attitudes among those without direct experience) are influenced by prior beliefs, perceived expertise of the source and mood. Mass media is an important influence on attitudes and beliefs. Bandura (2001) noted that humans have a ubiquitous capacity to learn through observation and as a result, are susceptible to influence by mass media. Srivastava et al. (2018) argued that the impact of media on beliefs is increasing as it takes a greater role in our lives, with increasing exposure to mass media through personal devices and social media.
Schultz (2005) proposed that public attitudes towards clinical psychologists are particularly susceptible to media influence as mental health professionals are frequently depicted in media. However, unlike other commonly depicted professions such as physicians and lawyers, for whom attitudes are buffered through lived experience, much of the population has no experience of clinical psychology services and attitudes are therefore more influenced by vicarious sources. Similarly, Wedding (2017) argued that fictional depictions (particularly in television and film) of psychologists have a key influence on public beliefs about psychologists. This vulnerability to vicarious media influences likely also applies to other mental health specialists such as psychiatrists, clinical social workers and mental health nurses who are infrequently encountered by the general population. Research continues to point to the impact of media on attitudes and beliefs regarding mental health services (Cameron, 2019), and perhaps even on treatment outcomes (Morrison et al., 2021).
Research has also considered the relationship between media representation and services and service users. Orchowski et al. (2006) reviewed portrayals of talk-therapists in film and found that a limited number of archetypes were common. They noted that although it is sensible for the film industry to use clear and entertaining archetypes, it is unhelpful for professionals (and perhaps by extension, service users who hold unrealistic or fearful beliefs). Research has demonstrated that despite media presentations of services being appealing for entertainment, those who are exposed to greater quantities of such media report more fearful views of such services and are less likely to have positive views about accessing services (Maier et al., 2014; Vogel et al., 2008).
Although there is considerable evidence linking popular media to beliefs and attitudes towards services (Maier et al., 2014; Orchowski et al., 2006; Von Sydow & Reimer, 1998), these findings tend to relate to North American populations. Local and culturally specific media influences may add crucial context to the formation of attitudes and beliefs through New Zealand (NZ)-specific and targeted media campaigns such as Sir John Kirwan’s discussion of his battle with depression (Wardell, 2013). Similarly, NZ’s cultural contexts and how these are reflected in media should be considered. For example, Māori are overrepresented in mental health statistics (Bennett & Liu, 2018) and therefore issues dealing with culturally appropriate services may impact representations of mental health and services in NZ.
News Media
Due to the perceived credibility of sources, news media is a particularly important area with regard to impacts on attitudes and beliefs regarding mental health and services. McGinty et al. (2016) conducted a content analysis (CA) of 19 years of USA news media and found that most articles tended to frame mental health in relation to violence. Although some articles discussed treatment for mental health, they tended to focus on newsworthy issues such as (lack of) service availability and barriers to accessing or benefitting from treatment. That study concluded that news media used a limited set of frames for mental health related stories. Other identified themes in news media include depiction of individual struggles with mental health in a way that attempts to normalise mental distress and show that recovery is possible (e.g. Parrott et al., 2021). Regarding news media portrayals of treatment and services, Pathak et al. (2021) found that UK portrayals of medication tended to be unfavourable, whereas portrayals of talk-therapy tended to be more neutral. However, extant research regarding news media in NZ has tended to explore portrayals of mental health issues and suicide (e.g. Coverdale et al., 2002; Thom et al., 2012), and neglected portrayals of services.
Oliver et al. (2020) interviewed a small sample of stakeholders, including service users, professionals and media staff, regarding their beliefs about mental health reporting in NZ news media. They found that respondents emphasised the important influence of news media on attitudes and observed some improvements in representations over time. However, those researchers found that services and professionals were not well represented, and noted risks that poor representation could lead to avoidance of seeking help and increased stigmatic attitudes. Oliver and colleagues concluded that there is an ongoing opportunity for news media to have a positive or unhelpful impact on those who would seek mental health services, and that more nuance in stories and wording are needed. Similarly, updates to NZ guidelines for media reporting have noted that unhelpful language and images regarding services may affect help-seeking (Mental Health Foundation of New Zealand, 2023); however, there is still a gap in research regarding how NZ news media discusses mental health, particularly services.
Beliefs and attitudes have an important impact on behaviour. Popular media represents an important touchstone to subjects such as mental health and treatment/services, and therefore media should remain a focus for researchers seeking to better understand areas where beliefs may be barriers to healthcare. Research has shown that news media tends to present limited themes in relation to services (McGinty et al., 2016) and poorly represent services and clinicians (Oliver et al., 2020). However, detailed analysis of the types of presentations of mental health and services in NZ news media is lacking. Therefore, the present research sought to examine how issues of mental health and mental health services are presented in NZ news media.
Method
Design
As the purpose of this study was to explore how mental health was presented in NZ online news media, an exploratory inductive design was adopted in which thematic analysis (TA) (Braun et al., 2019) was used to generate and identify consistent themes in news articles relating to mental health. TA has been shown to be useful in studies seeking to understand how topics are discussed in news media (e.g. Balanovic et al., 2018).
A preliminary analysis of potential news articles relating to mental health using content analysis (CA) (see White & Marsh, 2006) was undertaken to provide a dataset of potentially relevant news articles. Using CA to identify a data pool replicated the method used by Goodwin et al. (2014), and allowed additional understanding of trends in reporting while providing a re-producible method.
Data Collection
NZ news article search engine, ‘Newztext’ (https://knowledge-basket.co.nz/), which accesses an archive of full-text news articles and allows customised/filtered searches, was used to conduct the CA based on previous studies assessing NZ news media (e.g. Frewin et al., 2009). For this study, the online news platforms ‘Stuff’ (www.stuff.co.nz) and ‘The NZ Herald’ (www.nzherald.co.nz) were selected as they were among NZ’s most popular online news sources (Myllylahti, 2017). Furthermore, online news media was selected because of the reach of such media (Myllylahti, 2017) and for convenience.
Search criteria were defined through an iterative process. The initial criteria included a keyword search of ‘mental health’; however, this resulted in sparse data. The final keyword search of "Mental Health" ~ 5 provided articles where the text included the words ‘mental’ and ‘health’ within five words in any part of the article (e.g., ‘Mental distress and health services’). The initial date range for this search covered 3.5 years of articles between January 2016 and July 2019. Additional data from January to December 2022 were included to consider more recent news media (including post-COVID-19 pandemic news articles).
Quantitative data resulting from the CA indicated variability in the number of articles meeting the search criteria across the timeframe. Articles were selected from 4 months of data (February 2019, May 2019, January 2022 and May 2022) as these months represented relatively low and high quantities of articles. Initial stages of analysis suggested relative homogeneity among articles in peak months (i.e. multiple articles reporting on the same or similar news issues); therefore, both high and low quantity months were included in the final analysis to increase the heterogeneity of articles for analysis. The CA provided a corpus of 13,689 articles meeting the search criteria, indicating an average of 248 articles per month. Figure 1 presents the trends in quantity of articles meeting search criteria, and the two periods from which data were taken.
Data Analysis
The 20 most relevant articles (as per Newztext results with clearly unrelated articles omitted) were taken from each of the selected months. After removal of duplicate articles, 77 articles were included in the TA. Each article was given a reference number for ease of analysis and reporting.
Data analysis followed Braun et al.'s (2019) six phases of TA. Familiarisation comprised scanning headlines for relevance, followed by repeatedly reading selected articles. Initial codes were generated by noting patterns in data (e.g. ‘role-modelling help-seeking’) throughout all articles. Forty-eight initial codes were eventually collated in a Microsoft Excel spreadsheet.
Themes were generated through code review and tentative collation. Data excerpts fitting tentative themes were collated and reviewed for appropriateness. Theme names were iteratively generated and checked against the data to ensure fit. Finally, themes were named, defined and presented with data to evidence the theme. This was written in a descriptive fashion (Braun & Clarke, 2012) whereby the data ‘speaks for itself’ in a way that clearly evidenced the identified theme.
Results
Four themes were generated and are presented with supporting data examples below. The implications of these themes are presented in the Discussion section.
Theme 1: Positive Attributes in People with Mental Distress
Stories of individuals often focused on recovery and hope by presenting issues that seemed hopeless but were overcome through courage, honesty and openness. These attributes were framed as causal factors enabling someone in a dire situation to move through to a desired outcome, presenting such individuals as role-models. This theme highlighted individual autonomy in overcoming mental distress; that is, if you are brave, honest and open, you may feel better. Mike King, a public figure, comedian and 2019 New Zealander of the Year, was one such role model.
Article 1: (…) ‘It’s that courage and resolve that makes him so relatable to at-risk rangitahi (youth) that others can’t reach, Mike King is a great New Zealander of the Year’, Bennett said.
Article 1: (…) He discovered booze at 13. Drugs followed.
Although humour was his ticket to social acceptance and would become his livelihood, he spoke of being an angry man struggling with his demons, which included two suicide attempts.
It wasn’t till he was 45 that he sought help for his mental well-being. He got clean, ditched the drink and drugs and went on to start his radio show, the Nutters Club, on which callers discuss mental health issues. (…)
(Stuff – Mental health advocate Mike King named 2019 New Zealander of the Year – 13 Feb 2019)
In the above extract, King’s relatability was linked to his courage and resolve and his humour was indicated as the source of his acceptability. Although seeking help was described as part of his recovery, individual characteristics were positioned as paramount in his achieving mental well-being.
Naomi Osaka, a former world rank one tennis player, was depicted as a role-model living with mental distress, even when she rejected that label.
Article 11: (…) Last April, having won her biggest title at Indian Wells, Osaka revealed: ‘Yesterday I woke up and I was really depressed, but I don’t know why. Like, I’m so sad right now’.
Admissions like these are uncomfortable but potentially game-changing in a sport that has traditionally had an awkward relationship with mental health. (…)
(…) Removing the stigma around mental health is precisely why Osaka’s candour is so important.
Seeing a player of her standing speak in these terms will help normalise the discussion. (…)
Article 11: (…) When asked last year what tips Osaka would give to young athletes, she said: ‘The only advice is, don’t look up to me’.
The reality is that they could do far, far worse.
(New Zealand Herald – Osaka’s refreshing honesty opens up a new game on mental health – 23 Feb 2019)
Candour in the context of experiencing sadness or depression was framed as a positive and helpful attribute, which implied that talking about problems alleviates them and reduces stigma. Despite Osaka’s explicit comment of ‘Don’t look up to me’, her humility, candour, and success as a tennis star who experienced depression were identified as what made her a role-model.
In this theme, news reporting presented individual stories of role-models and their recovery or ability to live with mental distress. Personal attributes and choices were highlighted as important in recovery and role-modelling.
Theme 2: Mental Health Need Outweighs Capacity
Mental health issues and suicidality were often reported to be common or increasing, and as a known and troubling societal problem. Some articles linked increasing incidence to sluggish funding changes.
Article 31: (…) Funding for the mental health and addiction treatment sector has not kept pace with demand. A 2018 report from the Mental Health Commissioner said that the number of people checking in for those services had increased by 73 per cent in the last three years, while funding had only gone up 40 per cent. (…)
(New Zealand Herald – Big Budge Hopes for alcohol and drug treatment sector – 29 May 2019)
The noted demand for services highlighted the increasing frequency of problems, and this claim was strengthened using statistics given by a credible expert. The statement was then used to ground the argument that funding is insufficient.
As well as expert opinions, news articles canvassed local public opinion, highlighting that the frequency of mental health issues and suicide was not a niche issue, but one the public recognised and had personal experience with. The following excerpts were from articles that interviewed and quoted ‘members of the public’.
Article 29: (…) ‘Everyone knows somebody affected by mental health challenges. If someone needs help, they should get help’. (…)
(Bay of Plenty Times – Waiariki MP Tamati Coffey – 31 May 2019)
Article 26: (…) ‘Everyone has been personally touched or known someone affected by mental health issues’, (…)
(The Daily Post – Boost for mental health ‘overdue’ – 31 May 2019)
Articles frequently focused on a lack of service access and capacity, and described long wait times and difficulty accessing support, even when desperately needed. One metric used by news media was the length of waiting lists, with the severity of need juxtaposed with the span of wait times.
Article 31: (…) Odyssey chief executive Fiona Trevelyan said referrals had increased 34 per cent from 2017 to 2018.
‘This is impacting the length of time people have to wait for admission. The median length of time for 2017 and 2018 was 2.5 to 3 months. The first four months of 2019 the median has increased to 104 days’. (…)
(New Zealand Herald – Big Budget hopes for alcohol and drug treatment sector – 29 May 2019)
As well as resulting from growing rates of mental health problems, articles contextualised service issues as relating to staffing challenges.
Article 16: (…) In PSAID (Psychiatric Services for Adults with an Intellectual Disability), staff turnover climbed to 36 per cent in the 2017/18 financial year. In the same period, there was an average of 152 hours of sick leave per full-time role, equating to nearly four weeks of leave.
(Stuff – Mental health patients in seclusion given cardboard box as toilet – 2 Feb 2019)
This article suggested that the lack of appropriate service capacity and staffing issues was a compounding issue. That is, stretched services resulted in burnt out and overworked staff who may be more likely to resign or be unable to work because of becoming unwell.
Mental health and services were causally linked to government policy and political promises. Articles frequently pointed to the lack of appropriate services and attributed this issue to government policy (or lack thereof). In the following example, chair of a primary health organisation (PHO), Luke Bradford, commented on his beliefs about upcoming government funding decisions in relation to mental health.
Article 36: (…) Bradford said the PHO would like to see primary mental health initiatives funded to address the findings of the Government’s inquiry into mental health and addiction last year. (…)
(…) He said community-based health services provided better outcomes, but these services required appropriate funding to ensure the practices aren’t put under strain. (…)
(Bay of Plenty Times – Maori and mental health priorities – 27 May 2019)
In this theme, increasing mental health need was linked with lack of service capacity. Interestingly, and perhaps in contrast to the previous theme that noted the importance of self-efficacy on mental health outcomes, this theme placed the responsibility for existing problems and improvement of services with the government. However, perhaps confusing the issue, the government was depicted simplistically as a unified power structure rather than as a complex and dynamic set of systems with differing priorities and responsibilities in relation to services.
Theme 3: Inappropriate Care and Service Provision
Previous themes highlighted the commonality of mental health issues, the lack of mental health service capacity and the need for effective government input. In this theme, outcomes of inappropriate care and service provision resulting in disastrous consequences were highlighted, with seminal events causally linked to inappropriate care or services. For example, improper care from senior front-line care professionals was reported.
Article 60: (…) A doctor who treated Gray in 2013 prescribed methadone at more than triple the recommended dose. A nurse who cared for a man shortly before he died in a mental health ward has raised various issues about his treatment, saying it felt like she had to fight to get him admitted to a high-needs unit. (…)
(…) Those issues arose from a culture of gatekeeping at the mental health unit by a senior doctor and a charge nurse. (…)
(Stuff – ‘It felt like a fight’: Many issues before man died in mental health ward – 30 May 2022)
Inappropriate care was linked to staff/service culture and to mental health and addictions among individual staff.
Article 62: (…) A doctor caring for a man, who later died in Palmerston North’s mental health ward, regularly prescribed opioid medication at rates far above national recommendations. She may also have been under investigation in the United States for similar behaviour at the time she was hired to work in New Zealand, while she also suffered her own addiction issues. Shaun David Gray died in April 2014 in Palmerston North Hospital’s mental health ward, commonly known as ward 21. (…)
(Stuff – Doctor treating man who died in mental health ward prescribed high methadone doses – 30 May 2022)
Stories describing improper care often referred to the wider District Health Board (DHB, now Te Whatu Ora), positioning the DHB as the key decision-making entity in relation to failed service provision.
Article 63: (…) Counties Manukau DHB is investigating whether it failed in its care of mental health patient Jamie Way, who went missing for three weeks after he was discharged. Jamie Way, 53, was found by police on May 18 in the Auckland Botanic Gardens in Manurewa, where it was believed he stayed since he went missing on April 26. Jamie had been experiencing significant mental distress, including having suicidal thoughts, when he asked his sister Tracey to admit him to a mental health facility on April 15. (…)
(Hawkes Bay Today – Counties Manukau to investigate patient’s care – 31 May 2022)
In these examples, the inappropriateness of care was made explicit by directly contrasting symptoms or risks with the actions of staff and services, with their apparent mismanagement linked to disastrous outcomes.
Theme 4: Mental Health Impacts of the COVID-19 Pandemic
The final theme related to the impact of the COVID-19 pandemic. Data within this theme were diverse, but consistent in attributing or linking the COVID-19 pandemic and governmental changes relating to the pandemic to poorer mental health. These articles tended not to directly link the virus with mental health, but rather linked broader outcomes of the virus with poorer mental health.
The NZ government’s mandated ‘lockdowns’ in response to the pandemic were linked with negative mental health outcomes, as were changes to travel and immigration rules including mandatory and limited places in ‘managed isolation and quarantine’.
Article 46: (…) There’s also heightened apprehension among students. Many have spent two years moving in and out of lockdowns, particularly in Auckland. A report by 10 paediatricians report the harms from this disruption include poorer mental health, loss of learning and relationships, poverty, overcrowding and worrying high levels of family violence and abuse. (…)
(The New Zealand Herald – Lessons about Omicron – 30 Jan 2022)
While governmental efforts such as lockdowns to reduce the likelihood of encountering the virus were noted to negatively impact mental health, having to work and risk exposure to the virus was also reported to have a negative impact on mental health.
Article 49: (…) And here we have this extremely infectious disease, combined with the number of people that we do come into contact with. A lot of our staff will be getting sick. I don’t think that we’ll be able to cope. It will be a huge problem. The mental health of many of his co-workers had suffered so much many were looking at quitting, Justin said. I’m seeing people showing signs of stress and if they’re not breaking down at work, then I’ll hear about them breaking down at home. (…)
(Stuff – ‘It will be bedlam’: Supermarket workers fear the impact of Omicron – 30 Jan 2022)
The impact of COVID-19 on mental health extended beyond directly impacting the mental health of staff to impacting the mental health of service users by reducing mental health service availability.
Article 72: (…) Hetaraka noted workforce issues, particularly in the rural Mid and Far North, had caused difficulties in providing services to young people. There have been fewer services available for young people in the past two years due to COVID-19, with minimal face-to-face in our schools and youth hubs for the Northland Youth Health Service. (…)
(The Northern Advocate – Mood disorders hit 20% of young Northlanders And that is just the number seen and officially diagnosed – 31 May 2022)
In this theme, the influence of COVID-19 and responses to the pandemic were emphasised. These articles framed mental health as a state that may become better or worse in relation to stressors and difficult situations, and COVID-19 was framed as a situation resulting in many unusual stressors.
Discussion
This study examined mental health reporting in two popular online NZ written news media sources. Four themes were generated. A wider, over-arching theme of critique of the availability, capacity and appropriateness of services could be extrapolated from these findings. These outcomes were consistent with McGinty et al. (2016), who demonstrated that across 19 years in US news media, issues with service provision were consistently discussed and the news media tended to discuss mental health drawing from a limited set of themes. However, in contrast to US data, violence and mental illness were not clear themes in this study. This difference may reflect a move towards reducing stigmatising news articles in NZ, or complex issues of gun violence rates and attributions for violence in the US (Grinshteyn & Hemenway, 2016).
Frequent problem-focused discussion of services in news media may reflect the ‘newsworthiness’ of problems or demonstrate common beliefs about services. However, this focus may also contribute to beliefs about and attitudes towards help-seeking (Corrigan et al., 2013). That is, frequent news descriptions of services as having long waiting times, being underfunded and even providing inappropriate care could contribute to a sense of fatalism or helplessness towards help-seeking (e.g. Hayes & Clerk, 2021).
Within themes relating to issues with services, no content directly related to cultural considerations and whether services were appropriate for Māori. Despite overrepresentation of Māori in NZ mental health statistics, the themes represented in this study appeared to be culturally agnostic. However, provision and design of appropriate services for Māori is a considerable gap in NZ services (Bennett & Liu, 2018). The lack of cultural consideration when discussing services suggested an ongoing tendency towards assimilation and populism in NZ news media (Maydell et al., 2021), perhaps whereby ‘cultural issues’ are considered a specific topic of news, rather than an important topic to be considered in all news areas.
The finding that services are presented with a negative lens or without context was consistent with the concerns noted about NZ news media depictions by Oliver et al. (2020). Similarly, these findings support Oliver and colleague’s finding that services were presented without necessary nuance. These presentations of services as either inappropriate or insufficient may contribute to negative public beliefs and attitudes towards services. In contrast to negative depictions of services, individuals who overcame mental health difficulties through their own attributes and through seeking help, presumably through these flawed services, were presented in a positive light.
The theme ‘Positive attributes in people with mental illness’ aligned with previous literature demonstrating common occurrence of case study type articles focused on recovery and personal strengths (Parrott et al., 2021). Historically, research regarding NZ news media has explored and critiqued stigmatisation of individuals with mental illness through unhelpful reporting (e.g. Blood & Holland, 2004; Coverdale et al., 2002). This contrast in reporting suggested that the presentation of individuals with mental illness in news media has shifted over time, which may reflect direct guidance on reporting standards such the Mental Health Foundation of NZ’s (2023) media guidelines. These guidelines recommend reducing stigma through inclusive language, encouraging hope and considering culture.
A contrast between negative depictions of services and service capacity and individual autonomy in recovery was apparent but created several dilemmas for news media consumers. For example, help-seeking and recovery was presented as possible through encouraging stories of individuals seeking such help and making changes, yet services were presented as inaccessible and even unhelpful. Similarly, change was presented as within the realm of the individual, yet blame was laid at the door of the government. Possible implications of these dilemmas may be that those who have overcome mental distress are designated as different or exceptional, and those without such personal advantages and privileges must rely on the unreliable services. Notably, professionally successful and famous individuals were presented in case study-type articles of positive attributes in recovery from mental distress.
The presence of a theme relating to positive attributes in those who seek help and recovery may result in reduced stigma towards those who experience mental illness (McGinty et al., 2015). In relation to help-seeking, it may be that these recovery stories suggest hope and encourage help-seeking. Alternatively, these articles may result in further feelings of guilt and shame in those who continue to suffer with mental illness, particularly among those with a strong internal, global sense of blame. Similarly, the implications of the combination of these case study type articles and the negative, contrasting themes may contribute to notions of individual responsibility and even blame in contexts where systemic and cohesive approaches to care are appropriate. What goes unmentioned are contextual and relational nuances; individual recovery is attributed to individual traits and decision making, while familial, friend-based, communal, occupational and state-based support and affordances are less emphasised.
Linking of mental health and the COVID-19 pandemic in news media was unsurprising given the sheer quantity of articles relating to COVID-19 (Etta et al., 2022). Ironically, recent research has suggested that the proliferation of alarming news media relating to COVID-19 can have a harmful impact on mental health (Su et al., 2021). However, as noted by McGinty et al. (2016), news articles tended to have a limited set of frames/themes. In these articles relating to COVID-19, as with the rest of the themes, the discussion of mental health appeared superficial, with little exploration of what was meant by mental health; therefore, perhaps mental health here acted simply as a token with which to denote news in relation to the pandemic (and other topics). This finding, along with increased reporting regarding government responsibility at times of government budget and upcoming elections as per the CA, provided evidence to suggest that topics such as mental health are presented in the context of other newsworthy events, which may influence beliefs differently over time.
Deficit-focused descriptions of services may increase stigma towards people experiencing mental illness (McGinty et al., 2015). There has been insufficient research exploring impacts of negative news media presentations of services and help-seeking, but it is possible that negative beliefs and attitudes could result. Previous research regarding the formation of attitudes found that expert opinions, which are commonly used in news media, have major effects on attitudes and beliefs (Albæk, 2011; Maio et al., 2018). Specifically, it seems plausible that negative information may result in potential service users expecting rejection or poor service, and therefore opting not to seek help, which could have harmful outcomes.
Media guidelines regarding language and imagery in NZ warn against negative and stigmatising reporting (Mental Health Foundation of New Zealand, 2023). However, the impact of reporting on inadequate services or framing services/clinicians as inappropriate and leading to disastrous outcomes is neglected in current guidelines. Based on current research, reporting remains largely negative. However, the negative framing appears to have shifted over time from stigmatising those with mental health issues to depicting problems with services (Coverdale et al., 2002; Oliver et al., 2020).
Applications of this research should be directed towards how services are discussed in news media. The finding of themes relating to issues with services and increasing unmet demand for services suggests an overabundance of negative reporting on services. Therefore, further consideration should be given to the impact of reporting on services, and further monitoring of media articles to assess impacts of recently updated guidelines should be conducted. In addition, issues of culture should be part of discussions of mental health, rather than a topic that is overlooked or discussed in isolation. Representations of individuals who have overcome mental health challenges should be presented in balanced ways that value community support and professional support, without over-emphasising concrete personal characteristics, which many of our most vulnerable may believe they lack.
Clinicians must consider the influence of news media on client attitudes, beliefs and behaviours. Beliefs about services may range from tangible, explicit fears of involuntary treatment and extreme treatment methods (e.g. Gallagher et al., 2022), to more implicit attitudes that impact behaviour. It remains important that these concerns are explored and addressed with clients from the outset, as they may be engagement and treatment interfering. For example, a client who has beliefs that services are grossly underfunded (while likely correct) could respond by minimising their own problems in the belief that others are more deserving of limited treatment resources. Alternatively, a client may respond by emphasising or exaggerating their difficulties because of the same belief and fear that they will miss out. It may be useful for clinicians to pre-emptively explore with their clients how the client expects the appointment (or treatment) will go and whether they have any concerns that can be allayed early on.
Although articles discussing service deficits and failures may be accurate and newsworthy, it must be considered whether they are helpful. Previous research, both internationally and locally, has indicated that the public would like more information and knowledge of services (Elliot, 2016; McKelley & Rochlen, 2007). Therefore, providing more nuanced reporting on mental health services could help fill this need. Just as articles depict ‘positive attributes in people with mental illness’, some articles could provide case-study type accounts of services and service providers in ways that highlight the positive work that occurs as well as the contexts of service limitation and necessary individual engagement.
Despite the somewhat critical discussion of news media reporting on mental health, there remains an important journalistic public service role in highlighting mental health service failures. This role may lead to improvements in services through holding the government and state sector to account. Greater detail or context on reporting of service failures may ameliorate possible negative impacts on potential service user attitudes, while still highlighting gaps and failures requiring improvement.
This research provides a foundation for understanding how mental health is presented in NZ news media. Although there is some evidence linking media to attitudes and beliefs in NZ (Gallagher et al., 2022), further research should explore relationships between news reporting and public attitudes, beliefs and behaviours. Research exploring public beliefs and attitudes regarding services, people with mental health and responsibility for providing services may be compared with results of the present study. In addition, further research may test the stability of these findings and assess trends in themes over time by using longer term data.
Regarding limitations of this study, although TA allowed the identification of common themes, there were interesting data that were not elevated to the level of a theme. Given existing deficits in knowledge, memorable and novel news stories may have a strong impact on the understanding of services (Elliot, 2016). Further research could therefore explore what type of news stories had the most impact on public attitudes. Another limitation of the present study was the exclusive use of online news media, which was limited to a snapshot across time. Other influential sources of news media, including print text, radio and social media sources, were not examined in the present study and may be productively explored in further research.
Conclusions
Despite considerable research interest in the influence of news media and mental health stigma, there has been a lack of research into broader news media reporting on mental health and services. The present research indicated frequent, deficit-focused depictions of services in NZ news media, a trend that is consistent with international data. Media guidelines should consider the impact of news media on services and service users, as beliefs and attitudes affect help-seeking behaviours. News media must be considered as an important source of information and one which has a vital role in holding governmental and state powers to account, and therefore should be regulated and researched appropriately. Services are likely to be under-resourced, fallible and stretched; however, they also provide important and helpful treatment. These imperfect halls of healing may be better understood and less feared by public (and perhaps professionals who are considering working therein) with careful and balanced reporting that seeks to present the good along with the bad.