By something as a way of a general disclaimer, I will say that this is something of a stream of consciousness, based simply on my own impressions as a member of the public. By all means feel free to criticise roundly what I’ve said in the comments below.
A decade ago, the Richardson Committee presented their report to the Government recommending a complete overhaul of the English mental health legal framework (pdf). It was highly progressive, recommending a rights-based framework with an emphasis on patient involvement and autonomy, putting the individual at the heart of the system. It aimed to combat stigma and social exclusion, and recognised that people with mental health problems are people first and foremost. Alas, it was not to be. The Labour government, driven in a large part by the public, dismissed the proposals, and made it clear that their preoccupation for legal reform was the risk people with mental health problems apparently posed to the general public. It appears very little has changed.
The University of Manchester recently released a report (pdf) into figures for suicide and homicide amongst people with mental health problems. Though passed by in most of the media, preoccupied with the sale of Royal Mail, the Sun thought it fit to report it thus:
The issues with this headline are almost too many to list (thought the Independent and the Guardian both do an admirable job). Most obviously, it is sensationalist, and reports only half of the report, choosing to focus only on the homicides than the suicide rate – which, as Time for Change note, is sadly a much bigger risk to people with psychosocial disabilities; 90% of suicides in the UK are by people with mental health problems. The debacle of the ASDA ‘mental patient’ halloween costume, and similar offerings from Tesco’s and Amazon, demonstrates that there is still an underlying fear that people with psychosocial disabilities are likely to turn into ‘mad axe murders’ at any given second, and The Sun’s headline does absolutely nothing to dispel this belief, even if the actual article itself was more nuanced and suggested that it was the system that had failed, rather than the individuals themselves being inherently dangerous (though I’m not sure that I’d want to see their ideas of an improved system). When a 3rd of the population believe that people with mental health problems are likely to be violent, when in actual people with mental health problems account for only 5% of homicides, this kind of reporting is completely irresponsible.
However, in the aftermath of the ASDA debacle, I noticed something that I found slightly troubling. I can’t claim to have done a rigorous search on this, so this is simply my impression of what I have seen as a member of the public, not as a mental health researcher, but the prominent responses were primiarily from people who had depression. Rightly, they were angry at being characterised as ‘mad axe murderers’ – but I couldn’t help thinking that, actually, they were not being characterised as so. While it would be wrong to say there is no stigma around depression, and that we are all open and understanding about it, it is not depression that the general public think of when they think of ‘mad axe murderer’, or the stereotyped mental patient in strait jackets and padded cells. Depression is not ‘madness’ in the eyes of the general public: it is psychosis, and personality disorders, and it is this group who are damaged by those costumes, and the Sun’s reporting.
However, it is not this group who have been targeted in the campaigning. The prominent celebrity voices, working hard to normalise mental illness have been Ruby Wax, Stephen Fry, and Alistair Campbell, all who have experienced, or continue to experience, some kind of affect disorders. Where is the voice for psychosis, or personality disorder? The latter is still associated with the cold, heartless killers so popular in our detective TV shows, the former perhaps most closely correlated with ‘madness’. These are seen as unpredictable, ‘scary’ disorders, and it is these which people most closely associate with the ‘psycho killer’ headlines of old, and which were most closely targeted by the ‘mental patient’ costumes, and the Sun headline this week – not depression. Despite this, however, the voice of these individuals is less prominent. Wikipedia lists a number of celebrities who are said to have/have had schizophrenia, yet none of them has the same profile as Wax, Fry or Campbell in terms of advocacy for normalisation and open dialogue for the disorder. The reporting of Stephen Fry’s account of his attempted suicide was, in the main, done sensitively and commended; in contrast, Amanda Byne’s increasingly erratic behaviour has been documented salaciously, in a manner reminiscent of Britney Spears’; her diagnosis with schizophrenia has been greeted with sympathy, but the run up to her committal in a secure facility was covered with both a tone of incredulity and wariness.
The national media has a lot to answer for in terms of how it reports stories around the ‘dangerousness’ of people with mental health problems – but equally the focus on ‘safe’ disorders from campaigns is perhaps missing an important point. People do not fear people with depression – they fear depression itself, and the campaigns have done a remarkable job opening dialogue and normalising depression. Now, we need to do the same work with other disorders; fear only goes away with greater understanding, and a greater public discourse around fear of the perceived ‘danger’ of people with mental health problems to others needs to begin.
Amanda Keeling, PhD Student, School of Law, University of Nottingham, firstname.lastname@example.org