Second print July 2011

First print October 201Second print July 2011

Consultant Psychiatrist

VSO would like to thank all those who have advised on the development of the

handbook and without whom it would not have been possible. We are particularly

thankful to Dr M. Ganesan, Dr Neil Fernando and Dr Sunera Fernando. We also

extend a thanks to VSO volunteers Fiona Barton, Jenny Hulin, Sarah Ward and

Rebecca Thould for their contributions.

Acknowledgement

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Mental health, as defined by the World Health Organization, is a “a state of

complete physical, mental, and social well-being, and not merely the absence of

disease”. This encompasses the promotion of well-being, prevention of mental

disorders and treatment and rehabilitation of people affected by mental disorders.

Many may not be aware that mental health is a challenge that Sri Lanka faces,

especially post conflict. Correct reporting, the stories and features on mental

health could certainly have an immense impact in this situation.

The media is a powerful platform and plays a vital role in creating awareness and

providing information about the reality of mental health and mental illness. As

journalists we must understand the stigma that may be created through negative

reporting which can hinder people from seeking treatment, affect relationships,

and even make it difficult to obtain employment. However, with responsible media

coverage we can help readers understand that mental illnesses are real and

treatable.

“Mental Health and the Media” is a guide which simplifies and clarifies the ethics

that need to be maintained in reporting mental health stories with understanding

and empathy. The handbook explains the impact media has on society and

provides guidelines for reporting on health issues in a clear and precise manner.

I am pleased to recommend this guide to our journalists so that they will become

better professionals in their chosen vocation.

Kumar NadesanPast ChairmanSri Lanka Press Institute

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Violence and Mental Illness

Fear of mental illness is sometimes based on the belief that people with a mental health problem are likely to be violent. In fact, people with severe mental illnesses

3are more likely to be the victims than perpetrators of violent crime . One study found one in four persons with mental illnesses were attacked in the course of a

4year and were 11 times more likely to be victimized than the general population .

Random attacks on members of the public by people with a mental illness are very rare. But sometimes media stories stoke up people's fears by reporting incidents without setting them in context. Emotive language like 'deranged', 'psycho' or 'madman' reinforces the misguided stereotype that people with mental illness are dangerous.

The words used to describe people with mental illnesses have an immense impact on public opinion and beliefs about mental illness. Psychiatric hospitals are not prisons, so people receiving treatment there should not be referred as 'inmates'. Using this word reaffirms the idea that people with mental health problems are dangerous. Alternatively, refer to them as 'residents' or 'patients'. When people with mental illnesses are treated and leave the treatment facility they are discharged like any other patient and not 'released'.

People with a mental health problem are people first and should not be defined by their diagnosis. It strips people of their humanity to call them 'schizophrenics' or 'epileptics' and stops others seeing them as human beings like themselves. So avoid labelling people. Refer to them as people with schizophrenia or epilepsy.

Sunil 44, is a painter from Matara and is married with three children.

“It all happened four years back. Until then we were a happy family. I had many paint jobs. I was considered as one of the best painters in the area. Suddenly I fell sick and attempted suicide using my wife's sarees. When my father died at this time I stopped talking. I don't remember many things thereafter.

“I got to know from my mother and the neighbours that my wife was the one who had restored me back to health. She had taken me to consult doctors and to Basic Needs, a Community Mental Health project, that visited and treated me in my home. They gave me medicine. Nobody knows what happened but I began to speak after one year.

“Now I'm back at work. I take care of my family again. I'm proud and I'm happy. Mental illness could affect anybody. What mattered most is “care”. I must thank my wife for her dedication”

Mythbusters

•“Mental health problems are rare”

False. Mental health problems affect an estimated 1 in 10 people.

•“I won't get a mental health problem”

Anyone can experience mental health problems, whatever their class, sex, occupation or how much money they have.

•“Mentally ill people are more violent”

Random attacks on members of the public by people with a mental illness are very rare. In fact, people with mental illnesses are more likely to be the victims rather than perpetrators of violent crime.

•“You can never recover from a mental health problem”

False. Of those experiencing mental ill health, more than 80% will go on to make a full recovery. Social stigma is one of the biggest barriers to recovery.

•“If you have a mental health problem in Sri Lanka you have to be put in Angoda mental hospital”

False. Mental health problems can range from mild to severe. Treatment for mental health problems in Sri Lanka is changing. Many people can access help and support as out-patients from their local clinic or hospital. Only a small number of people with a mental illness need to be admitted to a hospital, and a smaller number still will be treated at the National Institute of Mental Health in Angoda.

•“Mental illness is cured with thovils and traditional remedies”

False – Major mental illnesses such as schizophrenia, depression and bipolar disorder require medication to restore the imbalance of chemical substances in the brain that cause these disorders.

In 2009, Basic Needs Sri Lanka ran a series of media workshops with journalists to raise awareness of mental health issues. During the workshops, journalists themselves developed a voluntary code of conduct they committed to following when reporting, writing and broadcasting programmes related to mental health. The journalists committed to:

1. Use our powers of influence and creativity to enhance the mental health of

all Sri Lankans.

2. Present mental health issues in a sensitive and considerate way.

3. Act in a responsible way when reporting on suicide. Specifically:

•not to refer to the method used in the act of suicide or make

assumptions as to the reasons for suicide.

•not to imply that suicide was the best solution to the problem.

•not to portray those who have attempted suicide as heroes or

deserving of sympathy.

•to try to reveal the real reasons for committing suicide, talking to

experts where necessary.

•Report contact numbers for obtaining assistance when feeling

suicidal.

4. Expose and eradicate the myths related to mental health and mental

illness in a positive and logical manner.

5. Help create a caring environment filled with love and understanding for

those living with a mental illness. Furthermore, exercise caution when

receiving information about a mental illness and seek expert advice from a

trustworthy source (government or non-government organization,

psychiatrist etc.) before publishing.

6. Respect the confidentiality of people being treated for a mental illness,

avoid revealing their identity or exposing them to humiliation or disgrace.

7. Get across messages that:

•anybody can get a mental illness, no matter what their differences

(gender, education level, economic status)

•people who have experienced a mental illness can recover completely or

control it with proper medication

•people who have experienced a mental illness are able to take

responsibility in society and live a normal life.

Information About Mental Health and Mental Illnesses

What is mental health?Good mental health is not just the absence of disease. It is defined by the World Health Organisation (WHO) as “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.”

Put simply, mental health affects all of us because it is about how we function as people. But for an estimated one in ten people in Sri Lanka who suffer from mental ill health, that basic function is a daily struggle for them and their families.

What causes mental ill health?Mental health problems can affect anyone of any age and background. It easy to understand how bullying, bereavement, abuse, war experiences, or being involved in a natural disaster might lead to some mental health problems. What is more difficult is to understand what factors lead some people to develop more serious problems while others do not.

The causes of more serious mental health problems and of mental illnesses are complex and are the subject of much debate, with differences between illnesses and between individuals. While there is little evidence for direct 'causes', there are some common 'trigger factors'.

Most people agree that mental illnesses are the result of the interplay of genetic vulnerability and life experience. Illness may be triggered by stressful events such as bereavement or physical illness, or by work, relationships or financial problems. Being bullied by classmates or colleagues, suffering domestic violence or feeling isolated because of difference in sexuality or life circumstances can be traumatic for some individuals. Some will have been traumatised by conflict, natural disasters, or civil disruption. For others, drug misuse or pregnancy and childbirth may appear to be the trigger. And for some there may be no obvious environmental or psychological cause for the illness or for a relapse.

The perceived cause of a mental health problem is a big source of stigma. Many people blame the individual themselves for becoming ill, either due to weakness or some wrongdoing. Some believe that spirits or curses have caused their mental ill health. And others think it is the family that is at fault. This stigma associated with mental illness may adversely affect the person's chances of finding a partner in marriage.

Mental illnesses are serious and affect a smaller number of people. It is estimated that 2 in every 100 people in Sri Lanka will experience a serious mental illness, such as

5schizophrenia or bipolar disorder .

Bipolar disorder

A person diagnosed with bipolar disorder may suffer serious mood swings that have a profound effect on their lives. They can be elated and disinhibited at times, full of energy and ideas which lead them to take unnecessary risks, such as driving too fast, not sleeping or giving away all their money. This elated or overactive state is referred to as “mania”. At other times, they may be severely depressed and unable to function. These periods of low mood can make the person feel despairing and sometimes suicidal. This disorder is sometimes called 'manic depressive illness'.

While many people with bipolar disorder say the periods of severe depression are harder to cope with than the periods of elation, family members are likely to find the periods of mania difficult due to the perceived shame and embarrassment that this behaviour might bring on the family. Mood stabilizing medication can be very effective in controlling these mood swings in patients with bipolar disorder.

Mental illness and women

Women face many situations, such as domestic violence and childbirth, that can make them more prone to develop mental health problems and mental illnesses. Women can also develop a mental illness during pregnancy and after childbirth (puerperal psychosis and puerperal depression) which is a time when these conditions may first emerge.

The media can help to reduce this stigma associated with mental illnesses and change lives of these people with a mental illness for the better.

K

Sri Lankan organizations and counselling services

Basic Needs - Sri Lanka

Sri Lanka Sumithrayo

Kalmunai Mental Health Association (KAMHA)

KAMHA is a community based charitable organisation which aims to provide a comprehensive range of affordable and accessible quality mental health services for people in the Kalmunai district. KAMHA have

Call: 0675675006 or 0672225393 Website: www.kamha.org

Nivahana Society of Kandy (NSK)

Shanthiham, Jaffna

acute inward patient unit, a rehabilitation unit, a Gender Based Violence unit and a specialised unit

for mother baby, adolescents and

geriatrics. KAMHA also support a Consumer organization named 'Vasantham'.

NSK is a Non-Governmental Organisation which aims to improve mental health in Central Province. Their work includes improving the quality and effectiveness of services through staff training and support; monitoring and evaluation; and project management. They also aim to raise awareness of mental health and provide support and counselling services for women in crisis.

Shanthiham seeks to be a centre for excellence in the psychosocial and mental health fields in the region. Their objective is to establish a Training Institute to train Counsellors and Psychosocial Trainers to meet the needs of the affected community in

North and East Sri Lanka. Shanthiham offers training of counsellors and community psychosocial workers; runs workshops, seminars and awareness programmes on mental health and mental well being; offers a range of community-based psychosocial

Email: nivahana_soc@sltnet.lk

'Shanthiham'Association for Health and Counselling,8/1, Katpagavinayakar Lane,Kachcheri Nallur Road,Jaffna, Sri Lanka

Email: psych@sltnet.lk

TP: 094 021 222 9720

TP & Fax: 094 021 222 3338

related activities, including counseling services and promotion of mental health services; publishes books, manuals and articles on mental health; runs activities promoting Human Rights; and runs a library of mental health and psychosocial resources.

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“The media is a powerful platform and plays a vital role in creating awareness and providing information about the reality of mental health and mental illness.

'Mental Health and the Media' is a guide which simplifies and clarifies the ethics that need to be maintained in reporting mental health stories with understanding and empathy.”

Kumar NadesanPast Chairman, Sri Lanka Press Institute