And what do you do?

Mental Health Nursing,  Jan 2004  by Nightingale, Liz

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Attitudes to mental health can vary but are still marked by fear and prejudice. Mixed messages from The Sun over the coverage of boxer Frank Bruno's illness raise questions about how the campaign against stigma is taken forward. Liz Nightingale has some good news and some challenges about the way ahead

Telling people that you work in mental health can produce mixed responses. People's understanding of mental illness shows in their unconscious reactions. When someone is impressed by your choice of work, sharing of personal information usually follows and indicates the person has direct experience of mental illness. If they tilt and nod their head in a sympathetic fashion, it often means the words 'worthy' or 'noble' will soon follow, implying that you are saintly for working in the mental health field. A polite-but-scared facial expression strongly suggests fear based on ignorance and prejudice.

Even if none of these scenarios are familiar, stereotypes, misnomers and misrepresentation of mental illness are all too common. Even though people claim not to believe everything they read in the tabloids, the old adage 'I blame the media' applies to mental health like almost no other issue. After all, 40 per cent of the general public associate mental illness with violence and say their belief is based on the media.

Sixty per cent of people with mental health problems blame media coverage for discrimination they experience in their daily lives. Government figures published in June show there has been an increase of five per cent in the number of people that do not believe that society has a responsibility to provide the best possible care for mental health service users.

So for anyone connected with mental health, the recent media coverage of Frank Bruno's mental health problems has been as interesting as the actual story itself. The Sun's decision to change its headline from 'Bonkers Bruno Locked Up' to 'Sad Bruno In Mental Home' was doubtless driven by commercial pressures as complaints from readers poured in. The Sun's decision to change its front page headline became the story itself as columnists on the front, and back, pages of tabloids and broadsheets pontificated about mental health issues in an unprecedented manner.

It will take time to know whether Bruno's admission and discharge from hospital have lead to a permanent change in the status of mental health in newsrooms or if the media coverage was a one-off public sympathy vote for a national hero who needed help. Certainly The Sun has already echoed a sentiment expressed in much of the mainstream media by condemning the appeal board that discharged Anthony Hardy, the 'Camden Ripper'. There is still a long way to go before the general public will accept that schizophrenia and psychosis are not synonymous with violent crime.

It is easy to become despondent about the status of mental illness - below that of sexually transmitted diseases, as The Guardian's TV critic Gareth McClean once said. But the overwhelming show of public support for Bruno appears to have been a significant step forward in the fight against the three biggest mental health problems - prejudice, ignorance and fear.

These three issues are the main causes of mental health stigma - and ones which organisations like Rethink campaign to end. People tell us time and again that the stigma that surrounds mental illness can be worse than the illness itself. Bruno himself admitted during his TV interview with Trevor McDonald that he knew he needed help long before he got it. He did not seek help because he felt under pressure to maintain his image as a strong hero. The misnomer that people who experience mental illness are weak and should 'just pull themselves together' is just one of the ways in which stigma can stop people asking for help.

Bruno's experience mirrors that of the tens of thousands of people who are sectioned each year, numbering around one person every hour. Rethink's 'Reaching People Early' campaign is calling for an end to the average 18 month wait to get help with the symptoms of psychosis.

Stigma affects professionals too: mental health nurses can find themselves presented as incompetent softies letting their violent clients like Hardy roam free, or Nurse Ratchett-esque (One Flew out of the Cuckoo's Nest) brutes who throw patients across kitchen tables before injecting them.

So how can we end the stigma of mental illness? Attitudes towards mental illness are entrenched and often date back to school playgrounds, where hurtful insults like 'loony' and 'nutter' instil stigmatising attitudes in children. For centuries, people with mental illness have belonged to a group of 'others', threatening; dangerous; criminals, rather than being 'one of us'; an ordinary taxpayer who has a treatable illness.

Service users like Bruno who talk about their experiences in the media are helping to end this 'them and us' mentality. Rethink, like other organisations, runs a media volunteer scheme that puts journalists and broadcasters in touch with 'real experts' - around 200 people who have had direct experience of severe mental illness, either as service users or carers. We try to match the right person to each story, which has allowed coverage of issues including everything from hospital ratings for national broadcasters to first-hand accounts of mental illness for tabloid newspapers.