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Objective: Having found no discussions of self-depictions offered by psychiatric patients in the mass media we sought such items in a prospective national sample of print media and analysed how those speakers portrayed themselves. Method: As part of a larger study of media depictions of mental illnesses in print media all items with any mental health or illness aspect that appeared in a New Zealand publication over a four-week period were collected. The resulting collection of 600 items ranged from news briefs to full-page newspaper articles. From that set we selected and analysed items in which a person identified as having been a psychiatric patient or as having a mental disorder was either quoted by the reporter who had interviewed them, or personally described their experiences. Employing both propositional analyses and discourse analysis we explored how the speakers were positioned and identified patterns or themes in their construction of living with a mental illness. Results: Only five articles (0.8%) met our criteria for a person with a mental disorder being reported directly. In those items the journalists had positioned the speakers as credible, expert sources who, in representing their lives and experiences, drew on five clusters of resources, that we titled: Ordinariness/Living Well; Vulnerability; Stigma; Crisis; and Disorder/ Treatment. Ordinariness/Living Well foregrounded the role of personal strengths in living well and in overcoming adversity, particularly that associated with being stigmatized. We identified that theme as central to the ways in which these speakers depicted themselves as recognizably human and understandable. Conclusion: The findings are preliminary but these depictions are different from those reported by most researchers. Unlike those depictions, these speakers provided accessible and recognizably human self-portrayals. That finding intensifies our concern that most researchers appear to be unaware that these consumer voices are largely absent from mass media depictions of mental illnesses.

Objective: Because there are no published reports of depictions of mental illness in print media based on national samples, we set out to prospectively collect and analyse a near complete New Zealand sample of print media. Methods: A commercial clipping bureau was contracted to provide cuttings of all items with any mental health or illness aspect over a four week period. These items were analysed for potentially positive and negative depictions and how mental illness was represented within each item. An independent search for additional newspaper items concerning one prominently featured topic indicated that the rate of identification of relevant stories was at least 91%. Result: The collection consisted of six hundred print items which were most commonly news or editorial pieces (n = 562, 93.7%). Negative depictions predominated, with dangerousness to others (n = 368, 61.3%) and criminality (n = 284, 47.3%) being the most common. Positive depictions, including human rights themes, leadership and educational accomplishments occurred in 27% (n = 164) of all items. Generic mental illness terminology without reference to specific diagnostic categories was present in 47% of all items (n = 284). Conclusions: Negative depictions that predominate confirm the stereotypic understanding of mental illness that is stigmatizing. These findings underscore the challenge facing us as mental health professionals attempting to change attitudes towards mental disorders when the stereotypes are so regularly reinforced.

Objective: To determine best practice management strategies in the clinical application of civil commitment. Method: All relevant literature on the topics of ‘civil commitment', ‘coercion’ and ‘procedural justice’ were located on MEDLINE and PsychUT databases and reviewed. Literature on the use of Ulysses contracts and advance directives in mental health treatment was integrated into the findings. Results: Best practice evidence that guides management strategies is limited to the time of enactment of civil commitment. Management strategies involve enhancing the principles of procedural justice as a means of limiting negative patient perception of commitment. In the absence of evidence-based research beyond this point of enactment, grounds for the application of the principles of procedural justice are supported by reference to ethical considerations. Ulysses contracts provide an additional method for strengthening procedural justice. Conclusions: Procedural justice principles should be routinely applied throughout the processes of civil commitment in order to enhance longer term therapeutic outcomes and to blunt paternalism.

Objective: There is a dearth of studies examining how dangerousness is constructed in media depictions of mentally ill individuals who are frequently portrayed as acting violently. The aim of the present study was to identify the contribution of diverse technical, semiotic and discursive resources utilised in portraying a character with a mental illness in a prime-time drama as dangerous. Method: Discourse analytic techniques, involving systematic, repeated, critical viewings, were applied to a single program drawn from a sample of prime-time television drama episodes touching on mental illness. Results: Nine devices (appearance, music and sound effects, lighting, language, intercutting, jump-cutting, point of view shots, horror conventions and intertextuality) were identified as contributing to the signified dangerousness of person receiving care in the community for a mental illness. Conclusions: These techniques combine in signifying mental illness and a person suffering from it as dangerous. The findings suggest that mental health professionals working to reduce the stigma of mental illness need to have a reasonably sophisticated understanding of the practices and priorities of television production if they are to collaborate effectively with producers to create dramas that convey more human and sympathetic understandings of mental illness or to combat the negative effects of such portrayals.

Objective: The aim of this paper is to examine the base for integrating biomedical, psychological and social strategies in the management of schizophrenia. Method: A review of the literature on schizophrenia with particular emphasis in management considerations.Results: Effective treatment components include psychoeducation, medication strategies, carer-based stress management training, community-based intensive treatment, living skills training, and specific drug and cognitive-behavioural strategies for residual symptoms.Conclusions: Treatment for schizophrenia is best provided by integrating the various and specific psychosocial intervention strategies in addition to the optimal use of medication. Methods for implementing these strategies in outpatient settings include the use of a comprehensive assessment and treatment plan, the training of mental health professionals, and periodic review with assessment packages.

We aimed to determine the attitudes and behaviours of mental health professionals (MHPs) including psychiatrists towards identifying and reducing their own patients' risk for sexually transmitted diseases and unwanted pregnancies.102 of all of the 162 mental health professionals serving predominantly chronically psychiatrically ill adult outpatients and inpatients in Waitemata district responded to an anonymous questionnaire (response rate = 63%), concerning their own attitudes and behaviours towards identifying and counselling patients on their risk for sexually transmitted diseases and unwanted pregnancies.Mental health professionals reported that, on average, they had counselled 14% of their own male patients and 21% of their own female patients on sexually transmitted diseases, including AIDS prevention, and that more of their own patients were at risk than were counselled. They also reported that they had counselled 5% of their own male patients and 17% of their own female patients about family planing. Forty-two per cent of mental health professionals indicated that they had insufficient knowledge about sexually transmitted diseases to educate patients, 72% indicated that when it came to risky sexual behaviours chronic psychiatric patients were much the same as other people, and 33% or more felt uncomfortable discussing topics of condom use and patients' sexual preferences.These results suggest that family planning and sexually transmitted diseases risk preventive interventions for psychiatric patients need to overcome mental health professionals' own barriers to risk prevention.The authors aimed to determine the attitudes and behaviors of mental health professionals (MHPs), including psychiatrists, towards identifying and reducing their own patients' risk for sexually transmitted diseases (STDs) and unwanted pregnancies. 102 of all of the 162 MHPs serving predominantly chronically psychiatrically ill adult outpatients and inpatients in Waitemata district responded to an anonymous questionnaire (response rate = 63%) concerning their own attitudes and behaviors towards identifying and counseling patients on their risk for STDs and unwanted pregnancies. MHPs reported that, on average, they had counseled 14% of their male patients and 21% of their female patients on STDs, including AIDS prevention, and that more of their patients were at risk than were counseled. They also reported that they had counseled 5% of their male patients and 17% of their female patients about family planning. 42% of MHPs indicated that they had insufficient knowledge about STDs to educate patients, 72% indicated that when it came to risky sexual behaviors chronic psychiatric patients were much the same as other people, and 33% or more felt uncomfortable discussing topics of condom use and patients' sexual preferences. These results suggest that family planning and STD preventive interventions for psychiatric patients need to overcome MHPs' own barriers to risk prevention.