Why words matter | Daily News
Psychiatry and the Media - Towards Better Communication:

Why words matter

Mental health is a vital component of our health. The World Health Organisation constitution states “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” A mentally healthy person is able to cope with normal stresses of life while working productively to make a contribution to the community. However the burden of mental disorders is growing across the globe with a significant impact on every aspect of human life and the society.

How do we foster social well-being with the assistance of the media was the focus at the 15th Annual Academic Sessions themed “Psychiatry and the Media -Towards Better Communication” held recently organised by Sri Lanka College of Psychiatrists.

Mental Turmoil

Sri Lanka College of Psychiatrists President and Faculty of Medicine Colombo University, Professor in Psychiatry, Raveen Hanwella shed light on the difference between mental ill health and mental disease, both at the individual as well as the community level.

“The definitions of the two terms though related are conceptually different and the interventions suitable for mental ill health are not suitable for mental disease. The Diagnostic and Statistical Manual version 5 (DSM 5) published by the American Psychiatric Association is the most up to date manual that classifies mental diseases. In this book around 157 types of mental diseases are identified. A mental disease is an illness that affects the way people think, feel, behave or interact with others. There are three major mental diseases – depression, bipolar disorder, schizophrenia. The other common disorders include dementia and other anxiety disorders,” Professor Hanwella said.

He explained that in medicine, there are three types of prevention, primary, secondary and tertiary. “Primary prevention aims to prevent the disease even before it occurs. Next as the secondary prevention a psychiatrist will look at mitigating the impact of the disease that had already occurred. Then in tertiary prevention we try to soften the impact of the mental illness,” Professor Hanwella said.

Unfortunately for most major psychiatric disorders, there are no known effective primary care interventions. “We cannot prevent a person from developing a major depression, schizophrenia or a bipolar disorder. The best we can hope for is secondary prevention where we diagnose the disease at the earliest opportunity and start treatment followed by tertiary prevention to minimise the impact of the disease,” Professor clarified.

He further said it is a common misunderstanding, that interventions effective in improving mental health will also be effective in the treatment of mental disease. “Music therapy, art, yoga and meditation may improve mental health but they cannot be used as effective treatments for mental diseases. Treatment for mental disorders is to seek psychiatric assistance as early as possible. Unfortunately, patients who have a mental disease, perhaps due to stigma or lack of understanding, may seek alternative therapies with non-psychiatrists hoping for relief from their distress. This is a dangerous practice and should be discouraged,” Professor Hanwella added.

Effective treatment

Elaborating more on mental illnesses Sri Lanka College of Psychiatrists President-elect and Professor in the Department of Psychiatry, Kelaniya University, Shehan Williams said mental disorders has no single cause. “Breaking of a love affair, domestic issues, studying too much cannot bring about mental illness. There are multiple causations for mental illnesses which includes genetic, biological, psychological, and environmental factors,” he said.

Professor said these biochemical imbalances in the body or the brain identified as a mental illness can often be treated. “With the availability of alcohol and substances we find lot of young people coming out with mental disorders. Neurological change paves way to mental disorders and these disorders are the leading cause of disability worldwide. Untreated mental illness can cause severe emotional, behavioural and physical health problems,” he explained.

He further said it is the responsibility of all people to shatter the stigma and seek assistance of psychiatrist to treat mental disorders. “When diagnosed early and treated properly, many people fully recover from their mental illness and can effectively return to their normal activities,” Professor Williams stated.

Children’s mental health

According to WHO, worldwide 10-20 per cent of children and adolescents experience mental disorders. Half of all mental illnesses begin by the age of 14 and three-quarters by mid-20s. Neuropsychiatric conditions are the leading cause of disability in young people in all regions. If untreated, these conditions severely influence children’s development, their educational attainments and their potential to live fulfilling and productive lives. Children with mental disorders face major challenges with stigma, isolation and discrimination, as well as lack of access to health care and education facilities, in violation of their fundamental human rights.

The World Health Organization’s (WHO) Global Strategy for Women’s, Children’s and Adolescents’ Health calls for the provision of nurturing care to all children. This means a stable, protective and emotionally supportive environment set up by parents and other caregivers that promote the child’s good health and learning. Given the additional challenges that they experience, parents of children with developmental delays or disorders should be specifically supported in providing nurturing care within a ‘whole family’ approach.

Consultant child and adolescent psychiatrist, Lady Ridgeway Hospital, Dr. Sudarshi Seneviratne explained that stigma in a child will be carried on with him to school, school van and peers. “Children mostly experience development disorders which are treatable through behaviour therapy, parent training and family therapy. Medication will start only if necessary and they are not addictive, thus consulting a psychiatrist is nothing to be feared,” she said.

She advised the parents to be responsible in letting children use social media. “Addiction to social media has negative impacts on children. They face self esteem issues, difficulty in concentrating, social anxiety and irregular sleep patterns. These issues occur before addiction. Fortunately in Sri Lanka we don’t see much addiction to substance but at present children are addicted to social media. Parents should be more responsible in handling the children,” Dr. Seneviratne said.

Inadequate response

WHO says health systems have not yet adequately responded to the burden of mental disorders. As a consequence, the gap between the need for treatment and its provision is wide all over the world. In low- and middle-income countries, between 76 per cent and 85 per cent of people with mental disorders receive no treatment for their disorder. In high-income countries, between 35 per cent and 50 per cent of people with mental disorders are in the same situation.

The organisation points out the poor quality of care for many of those who do receive treatment as a compounding problem is. In addition to support from health-care services, people with mental illness require social support and care. They often need help in accessing educational programmes which fit their needs, and in finding employment and housing which enable them to live and be active in their local communities.

WHO’s response

WHO’s Mental Health Action Plan 2013-2020, endorsed by the World Health Assembly in 2013, recognizes the essential role of mental health in achieving health for all people. The plan includes four major objectives:

More effective leadership and governance for mental health;

The provision of comprehensive, integrated mental health and social care services in community-based settings;

The implementation of strategies for promotion and prevention; and

strengthened information systems, evidence and research.

Responsible reporting

Meanwhile, annual academic sessions also looked at how media should report on mental illnesses and suicide without creating a stigma, rejection and discrimination.

Senior Lecturer/ Honorary Consultant Psychiatrist and Head, Department of Psychiatry, Faculty of Medicine, Peradeniya University, Dr. Pabasari Ginige said media portrayal and reporting of mental illness are incredibly powerful in educating and influencing the public.

“When reported well, media can be a tremendous tool to raise awareness, challenge attitudes, offer great insight and help dispel myths. However sensational journalism and overplaying risks, misery and chaos promote fear and mistrust and widens the gap between understanding facts and myth,” she explained.

She added studies show a strong association between nonfictional media reporting on suicide and imitative suicidal behaviours. “The greater the amount of suicides media covers, greater will be the chance of finding the imitation effect. Female suicides demonstrated more imitative effects while the younger and middle age groups are more vulnerable to imitate compared to the older age groups,” she pointed out. Dr. Ginige encouraged the press to rethink and refine the way the mental health issues and suicides are covered. “Journalist should choose the right language to describe people with mental health issues. Using inaccurate terms can reinforce stereotypes and stigma. Images used along with the report can also be just as damaging as the words or the headlines. Some images can be considered `triggering’ for people. Images that show how people self harm may lead to the imitation of self harming behaviour,” she said.

Dr. Ginige advised media to be extra vigilant when using online sources for a suicide story as instantaneous and ‘viral’ circulation of information are abundant online.

Sex and media

National Institute of Mental Health, Consultant Psychiatrist, Dr. Kapila Ranasinghe spoke on the issues in reporting sexual health and violence issues. “Media coverage of human sexuality including sexual crimes has an impact on the knowledge, beliefs, attitudes and behaviours of the public regarding these phenomena. Unfortunately, when it comes to sexual violence, mainstream media is guilty of promoting ideas and behaviours that sustain sexual violence prone culture. Violence with passion, portraying women as sex objects or suggesting that sex drive is an out of control force is problematic. Sexual violence is often treated with humour in media and it diverts the respect or attention that should be given to the incident,” he explained.

Dr. Ranasinghe said that predominant ideas about sexual violence are incorrect. He said a common belief is that if a woman is wearing provocative clothing, then she is partly responsible if she is sexually assaulted. “It is a vicious cycle when we believe myths. We blame survivors and aren’t holding perpetrators accountable, and then we reinforce a status quo. Survivor is a term for an individual who has experienced an act of sexual violence. This could mean any form of sexual assault, stalking or sexual harassment. The word survivor is often used in place of `victim’ in order to empower those affected by it,” he pointed out.

Finally Dr. Ranasinghe said that media needs self discipline. “I believe we have a professional obligation to assess, the best we can, the vulnerability of individuals as we write stories about the most painful and difficult elements of their lives. As journalists you write the story and move on but those who are connected to the story will be forever connected. So we have a duty to show great care and concern,” he concluded.

District General Hospital, Chilaw, Consultant Psychiatrist, Dr. Prabath Wickrema and Peradeniya University, Professor of Psychiatry and Consultant Psychiatrist Thilini Rajapakse also conducted a practical session on reporting suicide.

Ultimately, there is a great opportunity for media to better educate and inform the public about mental health issues which has traditionally been neglected and side-stepped. It is important to do research. Communicate with people impacted by mental health problems. Follow the reporting guidelines, particularly on the more sensitive subjects of suicide and self-harm. Then it is hoped that the myths, misconceptions and misreporting of mental illness will be replaced with a more educated public that feels more confident in talking about their own mental health.


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