Personal views: Us and them
Authors: Andy Bell
Journal: BMJ (2003)

Mental health has recently been big news again. Two entirely unrelated incidents have rekindled the media's interest in a topic that, for most of the year, receives scant attention. In both cases the suspects had histories of mental illness which, long before either stand trial for their alleged crimes, were discussed exhaustively in the national press.

Mental health is, with the partial exception of HIV, almost unique among health issues in the media. To understand this, it is important first to be aware of how media organisations work. Almost all UK media are businesses. They exist to make their proprietors money. Most media make the majority of their money from the advertising space they sell to other businesses which are, in effect, the paying customers to whom we, the audience, are the delivered product.

Advertising aims to address its audience as consumers, appealing to the aspirations and fears we have for ourselves and our families. It is in the economic interest of news organisations to appeal to that same ethic in the editorial content of the media they control.

Almost all media content can be classified into two kinds: “us” and “them.” In “us” coverage, the story is about things that happen to “ordinary” people: those with whom the presumed audience identifies. Most health coverage comes under this category. News about cancer, heart disease, or the ongoing woes of the NHS are predicated on the fact that these could personally affect any one of us, or our families, tomorrow.

“Them” coverage is about topics that are presumed not to be about the “average” consumer. Issues such as immigration or social security fall squarely into this category. Asylum seekers and poor people may have an impact on the presumed audience (they cost “us” more in taxes; they might mug or beg from us in the street; we might even pity them), but they are not a part of that audience. The same is true of most coverage of mental health. With notable exceptions, the assumption behind news stories about mental illness is that it is something that affects others. We, the audience, may feel sorry for them or may be afraid of them, but they are most certainly not “us.”

To understand the way in which mental health is mediated, then, it is often more helpful to look at the way in which issues such as race, rather than, say, cancer, are covered. As many studies of racism in the media have shown, commonplace myths about black and minority ethnic groups (not least those surrounding dangerousness and mental illness) are often painfully close to the surface.

Yet there are signs of change. Black people now form a significant proportion of the audience for, and staff of, many mass media. Their influence, as both consumers and workers, may not have rid the mass media of racism, but it has certainly curtailed some of the worst excesses.

For mental health, progress has been less impressive. Throughout the past decade, care in the community has been vilified widely for bringing dangerous people closer to “us” and our families. Figures such as Christopher Clunis, who, of course, also happens to be black, and Michael Stone may have hit the headlines (Clunis, who killed Jonathan Zito at a London Underground station, had a history of schizophrenia; and Stone, who murdered Lin and Megan Russell, was reported to have a severe personality disorder). Yet there is scant interest in the effect of community care on non-violent individuals.

The reasons for this are numerous. People with mental illnesses do not easily form coherent communities. Like sexuality, mental illness is something people are often reluctant to identify themselves with in the workplace. It arouses mixed emotions and is hard to empathise with. There is neither sufficient pressure from outside the media, nor enough willingness within, to make it an “us” issue.

Even the most empowered and empathic health correspondents are well aware of what will, and what will not, get past their editors. A story about, say, funding for mental health services, unless it focuses on the issues of dangerousness to other people, has little chance of gaining the same profile as a similar story about funding for cancer or emergency services. It simply would not appeal to that crucial sense of being something affecting “us” directly enough to be newsworthy.


This is a fairly bleak picture. Yet the mental health user movement is growing in self-confidence and media influence, most notably around the debate over the Mental Health Bill. By showing an awareness of the pressures journalists face, and by working as a coherent community, it can begin to change the public discourses that surround mental health. 


The assumption behind news stories about mental illness is that it is something that affects others