Stigma is a formidable obstacle in the progress of mental health treatment. Media outlets are the leading genre by which public opinion is formed, yet discomfort with media interactions is often the explanation for lack of participation in advocacy (1–7). Advertisements alone often contain both factual information and persuasive messages and use every major medium to deliver these messages. In 2006, U.S. spending on advertising reached $155 billion (8). Although studies have discussed the effect of media on health and public opinion (1–7), little is published about teaching media techniques to psychiatric residents. In a 1999 article, Kutner and Beresin (9) described an example of formal media training in the Massachusetts General/McLean Hospital Training Program. The program’s “Transition to Practice Curriculum” included opportunities to teach residents about mass media, to help them develop effective communication skills during interviews, and to conduct mock interviews. In 2000 Kutner and Beresin (10) outlined specific communication skills for psychiatrists to use in media interactions.
In this article we will review another innovative program that changes attitudes toward and understanding of mental illness among journalism students. The program also improves knowledge and confidence in media interactions among psychiatric residents. A curriculum was designed and carried out over 6 months involving a didactic workshop and collaboration through a competitive project.
This collaborative activity in systems-based learning shows how attitudes and knowledge may be altered among representatives of the media and psychiatry. Increasing public exposure to reliable, essential health information on mental illness is a necessary step in overcoming stigma.
A state association grant from APA funded a collaborative effort among the University of South Carolina School of Medicine, the School of Journalism and Mass Communications, and the Medical University of South Carolina to develop a joint endeavor in addressing mental illness in the state. We reviewed the medical literature utilizing OVID, MEDLINE, and PUBMED from 1990 to 2006 and searched psychology, allied health, and business literature in the EBSCOhost database using the key terms “media,” “psychiatry,” “residency,” and “education.”
The educational intervention included a workshop for undergraduate journalism students in their junior year or above and psychiatric residents in postgraduate year 2 (PGY-2) or above. We developed attitudinal surveys from a small focus group of psychiatric residents and journalism graduate students. The survey used a Likert scale of 1 to 5 (1=strongly disagree, 5=strongly agree) and the questions were based on comments and concerns that the focus group believed would be significant. We surveyed the attitudes of journalism students toward psychiatry and mental illness and of psychiatric residents about the media before and after participation in the workshop. Copies of these instruments are available from the authors upon request. The program went through an institutional review board exemption.
The weekend workshop included leaders from each discipline providing introductory seminars in their areas of expertise. Psychiatry faculty provided three 1-hour seminars to overview schizophrenia, depression, and attention-deficit/hyperactivity disorder. Discussions included epidemiology, assessment, and treatment issues related to patients overall and specifically to South Carolina. Journalism faculty presented three 1-hour seminars on designing a media campaign, interacting with the media, and developing speaking points. The various faculty modeled appropriate, unbiased, and professional interactions between the two disciplines through panel discussions within the workshop and practice interviews. At the end of the workshop, two integrated teams of journalism students and psychiatrist residents were asked to compete in developing a print or radio anti-stigma campaign over the following 3 months.
During the project, faculty from the school of journalism provided an additional media interaction lecture for the psychiatric residents that addressed fears of public interviews. Each team met biweekly over the 3 months and had a faculty mentor from the school of journalism to help develop and carry out the details of the anti-stigma campaigns. Sixteen psychiatric residents and five journalism students participated. Both teams were recognized at an awards dinner, and the winning team had its campaign funded to run in local print media during the next semester. Faculty from each department and a representative from the National Alliance on Mental Illness in South Carolina served as judges for the competition.
The journalism students (n=5) ranged in age from 19–23 years old, while the psychiatric residency cohort (n=14) ranged from 26–43 years old. Due to the small number of participants, a comparison group of journalism students (n=16) was used to equate preworkshop attitudes with the journalism cohort. The journalism cohort rated more knowledge and comfort overall regarding mental illness relative to the journalism comparison group after completion of the project. Of note is that the journalism cohort volunteered to be part of this project, which may account for the increased knowledge and comfort with the topic. Because of the low number of participants, statistical significance was not able to be demonstrated.
In both cohorts, each participant was asked before and after the project to complete a 10-question attitudinal survey relevant to his or her discipline. Four of the questions were exactly the same or mirrored one another.
In both pre- and postproject surveys, 100% of the psychiatric residents agreed with the statement, “A major problem for mentally ill patients is stigma.” Before the project only 60% of the journalism cohort “strongly” agreed with the statement; that number increased to 100% after the project. Preproject surveys demonstrated that 64% of the psychiatric resident cohort agreed with the statement, “I have the ability to affect society’s ideas about the mentally ill,” while 92% agreed that they had this ability at the conclusion of the project. In the journalism cohort, 100% agreed to this statement preworkshop, but only 60% agreed at the conclusion. Prior to the program, 93% of the psychiatric residents disagreed with the statement “Mentally ill patients are portrayed fairly in the media,” while only 75% disagreed at the conclusion. Only 20% of the journalism students disagreed preworkshop, but 80% disagreed after participation. In the psychiatric resident cohort, 14% of those entering the project agreed that they were comfortable talking with the media about mental health issues. At the end of the collaboration, 64% of psychiatric residents agreed. The journalism cohort demonstrated an increase from 80% to 100% agreement with the statement “I feel comfortable talking with a reporter (or conducting an interview) about mental health issues.” Other changes of note included an increase in the journalism student cohort from 80% to 100% in those having “a good understanding of mental illness.” The journalism cohort also established an increase from 80% to 100% in recognizing psychiatric disorders as “illnesses just like heart disease.”
At the completion of the project, each interdisciplinary team had developed an advocacy campaign addressing the topics of depression and schizophrenia, respectively. The “Faces of Schizophrenia” campaign was chosen and funded through the state association and targeted undergraduate students within the local university campus. The campaign ran for 3 months during the semester. Based on this outreach, two local consumer advocacy groups contacted our residency program with eagerness to collaborate on future projects. The departments of journalism and psychiatry, as well as these local advocacy groups, are now developing further anti-stigma campaigns within our state, including educational programs and awareness endeavors.
The outcome of this project demonstrates the significance of attitudinal change in those who are in training to care for and educate the public. Both groups achieved 100% agreement that stigma is a problem for mental health treatment. The journalism cohort seemed to be overconfident in affecting society’s ideas at the beginning of the project, which was decreased after participating in didactics that reviewed the prevalence of stigma in our community. The psychiatric resident cohort showed an increase in confidence to affect society based on this program. Regarding media portrayals of the mentally ill, both groups seemed to shift attitudes with less extreme ratings, suggesting that collaboration between groups had a neutralizing effect. Overall comfort in participating and conducting interviews regarding mental health increased for both cohorts. Although this was not addressed, differences in year of training for each profession may have affected the outcomes.
The relationship between psychiatry and the media is a conflicted one. On one hand, psychiatrists rely on journalists to inform the public about the needs of our patients and profession. On the other hand, the media often portrays a less than flattering or accurate picture of mental illness and its treatment. Our goal in this project was to assess if providing information and collaboration between disciplines would change the attitudes of journalists and psychiatrists-in-training. Through a relatively brief educational program and joint team projects, we demonstrated that attitudes between disciplines were changed. Future endeavors may include monitoring how actual media reports may change following such collaborations. The excitement of this collaboration has made public psychiatry a focus within our residency and a possible career choice for some. By targeting the individuals who will be addressing mental health issues in the future, a change in the local culture of psychiatry and media interactions may be possible. This project should challenge other psychiatric educators in developing similar collaborative efforts between the media and psychiatry in residency training.
At the time of submission, the authors disclosed no competing interests.