Placing Schizophrenia In The Spanish Media Agenda

As part of the implementation of the WPA's program "Schizophrenia: Open the Doors'' in Spain, the team coordinating it, led by the author of this chapter, has followed the coverage of mental health issues in general, and schizophrenia in particular, in the Spanish press. This press coverage analysis was undertaken to allow the evaluation of the program's media campaign, and the detection of sources of stigmatization.

The Spanish press coverage started on November 1998 and continues at the time of going to press. Some of the observations made up to March 2001 seem to support the idea put forward in this chapter that the active participation of psychiatrists in media campaigns can improve the public perception of mental health issues and reduce the stigma associated with mental disorders.

In Spain, 35.4% of the population older than 14 years old, totaling 34.5 million persons, read the daily newspapers. These reading habits place Spain in the fifth place in the European Union regarding the levels of circulation of the print media. The leading country is Germany, followed by the UK and France.

The press coverage analysis covered a range of publications including all seven national general information dailies and their regional editions and supplements, 91 regional and local newspapers, and up to 151 magazines and other publications of all sectors and topics.

The objective of this analysis was to evaluate the effects of the media campaign designed as part of the "Schizophrenia: Open the Doors'' implementation steps for Spain. In this program's action plan, according to the new strategic model developed, the media were to be used selectively and mainly as vehicles to reach the program's target audiences: patients, their relatives and the mental health professionals closest to the disorder.

Of course, the full results of this analysis focus on schizophrenia and how it is portrayed in Spanish media. Nevertheless, some of the more general conclusions can be used as an example of the prominence mental health is taking in the media agenda and how psychiatrists can positively influence the content of this information. Furthermore, the first signs of how this influence persists and affects later coverage are now, once the first phase of the media campaign is ending, starting to become apparent.

The high number of news articles about mental health published in the Spanish press during the period studied (November 1998-March 2001) is the first sign of the prominence of this topic: 2090 news items were compiled. Nevertheless, the impact of these information pieces might be small if they appeared in specialized publications or magazines with small circulation figures. In the case of mental health coverage during this period, this does not seem to be the case: 36.9% of the news items were published in regional newspapers and 30.5% in the national press.

The interest of media in these topics has been growing steadily in Spain: in the two whole years monitored (1999 and 2000), the increase in the number of articles was 30.6%. But not all topics have shown the same growth: in 2000, schizophrenia had become the most prominent topic, with a total of 271 articles, an increase of 52% over 1999. During the same period, a topic of general interest, depression, showed a decrease in coverage. The total number of articles about depression in 2000 was only 46% of the total coverage reached in 1999. The coverage of schizophrenia was even higher than the number of items dedicated to "mental disorders'' in general (those articles about mental health issues in general, not relating to any particular illness), a topic that was covered by 261 news items in 2000.

This happened while the media campaign of the program "Schizophrenia: Open the Doors'' was under way in Spain. This campaign consisted of a series of media briefings in 14 Spanish cities, during which psychiatrists involved in the program acted as spokespersons in the media. They presented the program, transmitting the campaign's key messages, such as the fact that 80% of people suffering from schizophrenia can overcome the disorder, the existence of new treatments and the advance they represent, and how the myths about the disorder help to stigmatize the people suffering from it. These press conferences, held between June and November 2000, generated directly a total of 81 news items, reaching a total audience of 8 209 375 people.

In order to guarantee the coherence of messages and facilitate the transmission to the media, the psychiatrists involved in the program had received media training with specific materials. The focus chosen to design these materials was in line with the way the media were to be approached. Since the program's objective was to feed through the media accurate information in order to increase knowledge of schizophrenia among key target audiences, the materials to be handled and distributed to the media had to be basically informative, as had to be the role of the spokespersons.

This increase in positive coverage and the success of the activities designed to distribute the program's messages through the media cannot be evaluated alone, but must be compared with the opposite effect that stigmatizing information may have. Indeed, that sort of coverage exists and persists in the Spanish press. In 2000, 53 articles were published that had stigmatizing potential, mainly because they associated schizophrenia with violence or crime. This number was even higher than in 1999, when a total of 20 stigmatizing items were published; but while in 1999 the appearance of this information was balanced throughout the year (60% during the first semester, 40% during the second), the distribution was different in 2000. Between January and June 2000, 80% of the stigmatizing articles were published. During the second semester, coinciding with the development of the media campaign, only 11 (20% of the total) stigmatizing items appeared.

Indeed, one of the program's goals is to decrease or counteract this sort of coverage. But, realizing that this is a long-term objective, the Spanish implementation strategy implied that, even if this negative coverage persisted, an adequate positive coverage (that is, the publication of "controlled" information) would counteract this information. We seemed to see this happening when we compare the coverage of 1999 and that of 2000. These data also suggest that a higher number of positive articles can cause a decrease in the publication of stigmatizing news items, perhaps because at the same time that this controlled information flow is generating immediate coverage, it is also serving as a learning experience for the media. Journalists become more aware of the topic and of how to treat it, and this higher sensitivity brings lasting effects.

A selection of three news stories may illustrate this point (Figure 11.1). First of all, a typical story in which mental disorders are associated with criminal acts. On January 9, 1999, the national daily La Razón published a news story with the headline "A schizophrenic patient attacks his doctor with sword and puts him in coma''. The story occupies one-third of a page and reports the crime in detail (why the doctor was at the patient's home, how he was taken to the hospital). There are no other references to schizophrenia but the ones that describe the subject, nor any other hypothesis of the person's motivation to commit the crime. Therefore, it seems that describing someone as "schizophrenic" was, for this newspaper, enough to explain the cause of a terrible incident.

The second example is from the news conference held in Cádiz, a city in southern Spain, on January 26, 2001. The spokesperson on this occasion was Prof. J.J. López-Ibor, Jr. The context of this conference is particularly rele-

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