The Sun’s 2003 front page headline “Bonkers Bruno Locked up” attracted widespread censure (Cook, 2003), and was criticised as indicative of the tone of press coverage of celebrities with mental illness. The episode led to the replacement of the headline about the former heavyweight boxer with the anodyne “Sad Bruno in Mental Home” and a vow from The Sun’s editor Rebekah Wade to attend mental health training (ibid). More recently, use of the terms “nut”, “psycho”, and “schizo” have been criticised (Batty, 2008), and the social inclusion quango “Shift” have urged journalists to use less stigmatising terminology when reporting on the mentally ill.

Earlier this year, ex-footballer Paul Gascoigne’s declining mental health was reported in The Sun as “ ‘Mad’ Gazza on suicide watch” (Perrie, 2008 ). Rather than simply indicating that sensitivity training has led to a greater awareness of the use of inverted commas, the report is a factual account of Gascoigne having the M word inked on his forehead. Indeed, as the swift retraction of the Bruno headline suggests, there does appear to be an appetite for reduced use of negative and stigmatising terminology in the reporting of mental illness. The somewhat more objective “suicide watch” used in the Gascoigne story is a term currently in vogue. Lexis-Nexis shows 30 uses of the term in the national press in 1997, 163 five years later and 254 in 2007. The term appears to denote extreme mental distress by referring to treatment or intervention rather than slang terminology for diagnosis. A search of Google news underlines this fashionability: It has been used by the UK press in the past month alone in stories about Britney Spears, Joseph Fritzl, Karen Matthews, Jade Goody, Blake Fielder-Civil. While “suicide watch” may be an improvement on “nut” or “schizo”, it is not a term I have heard used in a professional capacity in almost 20 years of working in mental health. ‘Close observation’ is the term used in UK psychiatry, but is markedly less sensational despite being more accurate. It seems that the press has hardly become the embodiment of nuance in its reporting of mental illness.

Alongside the use of negative slang terminology there is a wealth of literature describing how newspapers emphasise violent behaviour when reporting mental illness (e.g. Anderson, 2003). It is true that a small minority of people with some forms of mental disorder, particularly those with personality disorder and those who also misuse drugs, do pose a greater risk of violence. Indeed, a recent report by the Sainsbury Centre for Mental Health (2008 ) reminds us that most forms of mental illness are especially high amongst UK prisoners, though of course this does not prove any causal link between mental illness and crime. The absolute risk of posed by those with mental illness is very small with the chance of you or I being the victim estimated by psychiatrists to be similar to that of being hit by a lightning strike (Walsh & Fahy, 2002). In the US, Slopen et al (2007) report that nearly two-thirds of a sample of stories about mental illness in adults in high-circulation newspapers were related to violent crimes. This is despite the fact that, when asked, the overwhelming majority of US newspaper editors (94%) believed that few mentally ill people are dangerous (Grierson & Scott, 1995). Thornicroft (2006) describes how this picture is mirrored in Canada, Australia, New Zealand, and the UK where newspaper coverage of mental illness was judged to be more negative than that of physical/medical illness. Medical stories focus on ‘bad doctors’ whilst mental illness stories tend to focus on ‘bad patients’ (ibid), and broadsheets are as negative in their coverage of mental illness as tabloids (ibid).

A special case: the high security hospitals

There is one area where the press might perhaps legitimately defend its’ reporting of mental illness as synonymous with violence. There are three high-security special hospitals for mentally disordered offenders in England – Rampton, Broadmoor and Ashworth (Carstairs hospital in Lanark serves Scotland and Northern Ireland). The three hospitals hold approximately 1000 patients (Abbot et al, 2005) who have a mental disorder, a criminal conviction, and are classified as ‘dangerous’: they pose both an immediate and gravethreat to others (Prins, 1997). Patients are by definition prone to violent or other dangerous acts such as arson. Security measures include locked doors, high fences, limited access to contraband items, and regular searching of personal items and mail. The special hospitals are staffed by trained nurses and doctors rather than by prison guards, although many staff are represented by the Prison Officers Association which remains the largest trades union across the high security forensic psychiatric care sector (POA, 2008). Patients are all compulsorily detained under section of the Mental Health Act 1983, with further restrictions ensuring no release without prior Home Office approval. Some of the patients are well known to the British public because of their notoriety, including moors murderer Ian Brady, Peter Sutcliffe (the Yorkshire ripper), and serial child murderer Beverley Allitt. The first aim of the current study is to ascertain – given their historical voracity for stories about the special hospitals’ notorious inmates – whether press coverage of them is typified by use of negative, slang terms for mental illness.

Despite the infamy of some of their patients, a literature search (MEDLINE, PsychInfo, CINAHL, Communication & Mass Media Complete) located only one study reporting on media coverage of the special hospitals (Ness & Collins, 2003). The study presented an analysis of whether each story reported enhanced or detracted from the reputation of Rampton hospital. Perhaps surprisingly, the authors report that negative coverage was less prevalent than they had anticipated. Their relatively narrow study of one years press cuttings supplied little in depth information about how the press frames stories from, and positions its readers in relation to, the specials. A second aim of this paper is to tentatively explore how the press frames stories from the special hospitals. Two final overarching aims are to examine the role of journalism in the reporting of the special hospitals and to develop the topic for further exploration.

METHODOLOGY

The epistemological approach taken is rooted in positivism, defined by Wien (2005) as an attempt to present only that which is observable fact and not opinion, and is based on what can be measured and observed. Quantitative content analysis is the preferred method (Neuendorf, 2001), but the limitations of this are acknowledged and some qualitative analysis is undertaken, specifically ‘framing’ theory is used. Areas of interest for the content analysis include the amount and nature of coverage of the special hospitals both recently and ten years previously. A sample of identified stories were subject to further analysis to identify the frequency of the use of negative slang terms for mental illness. Further issues related to the role of journalism in reporting were also explored, including the use of named and unnamed sources by reporters. Theories of news values will be drawn on to explore the results.

RESULTS

An initial search of Lexis-Nexis suggests that stories about, or in some way related to, the special hospitals are common in the UK national press (184 stories for a 6 month period – full search details are presented below) For comparison Lexis-Nexis was also searched for the same period for stories about 3 of the 8 high security English prisons (Whitemoor, Belmarsh and Wakefield), where maximum operational capacity is double that of the special hospitals at 1938 (HM Prison Service, 2008). These prisons also hold a number of notorious prisoners (serial hostage-taker Charles Bronson, Soham murderer Ian Huntley, Great Train Robber Ronald Biggs, serial child murderer Robert Black, and extremist cleric Abu Hamza) so this would appear to be a fair comparison. There were 248 items for the period. Both searches, then, identified stories about their targets averaging over one per day over the period of interest.

The initial search described above was refined for more accurate identification of relevant stories. Lexis-Nexis was searched using the terms ((“broadmoor” or “rampton” or “ashworth”) AND “hospital”) anywhere in the story text for the period July 1 to December 31 2007 in all National English newspapers, daily and sunday editions (The Sun, News of the World, The Mirror, Sunday Mirror, Sunday People, The Daily Star, Daily Star on Sunday, The Mail, Mail on Sunday, Daily Express, Sunday Express, The Guardian, The Observer, The Independent, Independent on Sunday, The Times, Sunday Times, Daily Telegraph, Sunday Telegraph). This resulted in identification of 184 stories which were reviewed for relevance. Non-relevant and duplicate stories were excluded resulting in a total of 127 items. Similar terms were used to search a 6-month period from July 1 to December 31 1997 resulting in 127 stories, reduced to 98 following exclusion of non-relevant and duplicate stories. There was a 30% increase in stories related to the special hospitals over the ten-year period.

Both sets of stories were examined for use of the following terms:, “schizo”, “psycho”, “nut” or “nutter”, “loony”, and “fruitcake”, “maniac” and “monster”. There was one use of the term “schizo” in 2007 (“Schizo is accused of Rachel murder”, Sullivan, 2007) and none in 1997. The term “psycho” was rare, used three times in 2007 (e.g. “Dandruff psycho knifes 3”, Coles 2007) compared with four in 1997. “Nut” was used twice in 2007 (one in a direct witness quote) and twice in 1997 (though on both occasions in the context of articles about inappropriate language in mental health reporting). The terms ‘loony’ and ‘fruitcake’ were not found at all.

There were 22 uses of the word “maniac” in 2007 compared to zero in 1997. The term ‘monster’ had increased in use from 3 times in 1997 to 18 in 2007. Clearly, this is only a small sample but initial indications suggest that the use more general perjorative terms (“monster” or “maniac”) has increased in frequency whilst specific mental illness-based perjoratives (“psycho”, “nut” etc) have remained infrequent and static.

A sample (n=25) of the 127 (20%) 2007 news stories were further examined as to their content. Twenty of 25 (80%) items named one of five patients (and four of the five – Allitt, Brady, Sutcliffe, and Ian Huntley during a brief stay at Rampton – were very high profile patients) at one of the special hospitals. Due to the narrow time frame from which the sample was drawn some of these items were reports of the same incident in different newspapers. Nine (36%) stories mentioned one of the special hospitals only in passing (e.g. a Daily Telegraph story reported that Michael Stone, killer of Lin and Megan Russell – and never a patient at one of the special hospitals – had told a community nurse prior to his crime that he “wanted to be locked up in Broadmoor”; Edwards, 2007 ), whilst in 16 (64%) the named hospital was integral to the story, for example the story was about the hospital or one of its’ current patients and named his/her place of care.

Fifteen of the 25 (60%) stories were written by nine named authors, one single writer (Jamie Pyatt, The Sun) was responsible for 5 items. Direct quotations from 7 sources were used by reporters in six of the 25 (24%) stories (not including quotes used from judges in open court). Four of the sources were unnamed (an “unnamed source”, “an insider”, “a source” and “a guard”), whilst three named sources included two family members of patients’ victims and one who lived in a house formerly occupied by a named patient. Interestingly, both named and unnamed sources were quoted extensively, beyond the establishing facts of the stories and into areas of opinion:

“It is a complete waste of taxpayers’ money.” (an unnamed source in a story about patients having acting lessons for one hour per week, Whitaker & Kay, 2007)

“Their victims and families will not be able to enjoy Christmas yet they will be better fed than most people in Britain, funded by the taxpayer.” (a source quoted in a story about ‘lavish’ Christmas meals at Broadmoor hospital, Pyatt, 2007)

“Monsters in there should not be allowed any form of entertainment. Why would anyone want to go in and look after these people?” (Winnie Johnson, mother of moors murder victim Keith Bennett in Whitaker & Kay, 2007)

This final quote is an interesting example of personalisation as a news value (Galtung & Rouge, 1965). Winnie Johson is the mother of Keith Bennett, an acknowledged victim of moors murderer and Ashworth hospital patient Ian Brady. There was no evidence presented in the story that Brady had been a recipient of the acting classes, but the news is ‘personalised’ by reference to a prominent individual associated with the hospital in question. Similarly, the item about Christmas meals (Pyatt, 2007) centred heavily on Peter Sutcliffe, although he is incidental to a story about all patients being given a choice of food. Note also that the news value of the stories is maximised by reference to an elite (or rather extremely notorious) person, though, again, there is no evidence that Brady or Sutcliffe were actually involved. Maximisation of the news value of the story is completed by its framing as a negative story (ibid). “Rehabilitation classes for mental health patients” would not have the same ring!

Finally, I wish to briefly examine the theory of ‘framing’ in order to add some qualitative analysis to the quantitative findings. The process of framing is assisted by two particularly important aspects (Pan & Kosicki, 1993: 55). Firstly, selection refers to the choice made about which aspects of a story to cover and, secondly, saliency refers to the accentuation of only certain dimensions of the selected aspects. In effect, this selection allows the press to ‘frame’ public policy issues as part of an ongoing narrative or discourse (ibid). As an example, in the UK, Paterson (2006) describes the process of the press ‘framing’ the unfolding story of the killing of Jonathan Zito by Christopher Clunis, a young black man with a history of mental illness, initially as a private tragedy and eventually to a failure of government health care policies towards the mentally ill. In the current investigation we can see that the public policy issue that commonly arises is that of ‘public money (taxation) funding perceived privilege, whether that privilege be food (as in Pyatt, 2007) or drama (as in Whitaker & Kay, 2007). This accentuation of the ‘waste of money’ bypasses other possible narratives: the difficulty for medical and nursing staff in providing care and treatment to people whose behaviour they find abhorrent, the possibility of rehabilitation for the hundreds of mentally ill patients who are not Allitt or Sutcliffe. Press coverage arguably constructs a simplistic discourse where we are invited to support the provision and delivery of second class services for some based on our moral abhorrence for the actions of a few.

There are some limitations that should be applied to the current findings. The content analysis at this stage is rudimentary and relies on a relatively small sample of identified stories. A more detailed coding system is required and some testing of the validity of coding categories and the reliability of coding between raters should be developed. In terms of epistemological approach, quantitative methodology allows us only to address relatively superficial questions about, for example, perjorative terminology. Questions about how that terminology arises or is constructed as perjorative is beyond the scope of the investigation, though some tentative qualitative analysis points to some interesting areas for further investigation.

CONCLUSIONS

Initial indications are that stories relating to the special hospitals are common and their frequency has increased over the past decade. Stories tend to focus on a very small number of highly notorious patients. The use of negative mental illness-related slang is in fact very rare; there is more use of ‘badness’ or ‘evil’ related language (‘monster’ or ‘maniac’), perhaps reflecting the press’ need for black and white story-telling: people are either mad or bad, and not, apparently, both.

 

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