FTS SAMHSA

Moderator: Jane Tobler
March 26, 2010
2:00 pm CT

Coordinator: Welcome and thank you for standing by. At this time all participants are in a listen-only mode until the question and answer session.

Today's conference is being recorded. If you have any objections, you may disconnect at this time.

The PowerPoint presentation, PDF version, the audio recording of the teleconference, and a written transcription will be posted to the SAMHSA ADS Center Web site at http://www.promoteacceptance.samhsa.gov/teleconferences/archive/default.aspx

Our presentation today will take place during the first hour and will be followed by a 30-minute question and answer session at which time you may press star 1 to ask a question.

I would like to now turn today's call over to Ms. Jane Tobler. Thank you, you may now begin

Jane Tobler: Hello and welcome to "The Power of the Media and Its Impact on Mental Health Recovery."

Today's teleconference is sponsored by the Substance Abuse and Mental Health Services Administration's ADS Center, also known as the SAMHSA Research Center to Promote Acceptance, Dignity and Social Inclusion Associated with Mental Health.

SAMHSA is a lead federal agency on mental health and substance use and is located in the U.S. Department of Health and Human Services.

The views expressed in this teleconference do not necessarily represent the views, policies, and positions of the Center for Mental Health Services, the Substance Abuse and Mental Health Services Administration, or the U.S. Department of Health and Human Services.

My name is Jane Tobler and I'll be moderating the teleconference today.

I would like to introduce you to our first presenter, Otto Wahl, who is a professor in the Department of Psychology and the Graduate Institute of Professional Psychology at the University of Hartford.

Otto is the author of Media Madness: Public Images and Mental Illness, and Telling is Risky Business: Mental Health Consumers Confront Stigma. Otto's work includes numerous research articles and presentations related to stigma and media depictions of mental illnesses.

Otto has received numerous awards for his work to combat the stigma of mental illness and today will share with us the media depiction of mental illnesses, the reality, and why it matters. Otto...

Otto Wahl: I'm pleased to be with you today to talk about the power of the media and its impact on mental health recovery. I believe this is a very important topic and one which should be of interest to be people in both the mental health and media field.

Let me start by addressing a fundamental question. Why are we concerned about mass media and their relationship to mental health recovery?

Well, first of all, we know that mass media reach vast audiences on a daily basis. The statistics you see here give some idea of how thoroughly mass media reach into our lives on a daily basis.

Second, mass media is not only pervasive but considerable research has shown that media presentations influence the way viewers and readers think about their world, from how dangerous a place the world is, to what professions are most common, to how males and females dress and interact.

Another set of research findings has established that people's response to someone with a mental health diagnosis is often based on the ideas they have about mental disorders and are not based on the behaviors they actually encounter.

Finally, when we ask where these ideas about mental illness come from, the most frequently cited source of information is mass media. So the ideas about mental illnesses to which people are responding are often those that come from mass media.

It is very important, therefore, to understand what information and images are being conveyed about mental illnesses, how those pervasive images may affect people with mental illnesses, and how we can interact with professionals in the media to ensure accurate and respectful depictions.

As we consider media images let me first be clear that there is much that is positive in media depiction of mental illnesses. Entertainment media have provided many powerful and sympathetic portrayals of people with mental illnesses such as the Academy Award-winning picture, "A Beautiful Mind," and the moving depiction of a mother with schizophrenia in Kansas.

News reports also have provided much useful information such as The New York Times piece on schizophrenia and this front-page series in the Billings Gazette on the challenges of providing or finding mental health services across a large urban area.

Investigative reporters have repeatedly brought to light abuses in the mental health system that it is important for us to know about. This includes the Hartford Courant's uncovering of the many deaths of psychiatric patients that occur each year while in restraints; The New York Times' exposure of unnecessary surgeries given to psychiatric patients in the community; and The Oregonian's disclosure of neglect at Oregon State Hospital.

Unfortunately these valuable media contributions tend to be more the exception than the rule.

For example, mass media tend to inaccurately show people with mental illness as violent and dangerous. Research has shown that the most common portrayal of a character with mental illness in novels, film, and TV is as a villain, often one who kills heartlessly and repeatedly.

One study found that people depicted with mental illnesses were 10 times more likely to be shown as violent criminals than non-mentally disordered television characters.

In news media as well, dangerousness has been found to be the most common theme of stories about mental illness, often with sensational fear-inducing headlines like those shown here. This is an instance where media's image is much different than the reality.

The reality is that the vast majority of people with psychiatric disorders are not dangerous and violent. The reality is that the vast majority of violent crimes are committed by people without mental illnesses.

The reality is that people with mental illnesses are more likely to be victims. One study found them to be 10 times more likely to be victims of violence than persons without a mental illness.

In fact, far from being the dangerous maniacs of Hollywood fiction, most people with mental illnesses are caring, law-abiding citizens who are our friends and relatives and neighbors and co-workers. The people in these pictures are real people with mental illnesses.

Mass media also has a tendency to inaccurately show people with mental illnesses as unlikely to recover. Those villains in films and television we are told must be locked away indefinitely because they cannot be treated.

Mentally ill characters in treatment often show little improvement. And even in news reports people with psychiatric disorders are most often shown as homeless and helpless on our streets.

Stories of people leading successful lives with mental illness are seldom provided. Yet people with mental illnesses do recover and do make valuable contributions to our communities.

This includes people like President Abraham Lincoln who endured bouts of depression, Nobel Prize Winner's John Nash who had schizophrenia, and Ernest Hemingway, whose severe depression resulted in his suicide at age 61.

Buzz Aldrin, the second man to walk on the moon was hospitalized for his serious depression after his return to earth. And psychologist Kay Jamison became a bestselling author when she revealed her lifelong struggle with bipolar disorder.

Plus, there are millions of others who live satisfyingly ordinary lives despite their mental illnesses.

Persons with mental illnesses are also often shown as a source of humor and ridicule in the media. Comedy shows and films suggest that these serious illnesses are bundles of humorous idiosyncrasies.

Cartoons and jokes, many of a kind that would be clearly seen as in bad taste if they concerned other serious disabilities, provide models of insensitivity and disrespect, as do marketing efforts that try to capitalize on language and images related to mental illnesses.

The reality of course is that mental illnesses are serious and painful conditions, not trivial, humorous quirks.

The reality is that people living with mental illnesses are worthy of the same respect and sensitivity accorded those with other serious disorders. And as this poster notes, respectful language and behavior is important for maintaining dignity and acceptance for all including those with psychiatric disorders.

It is important to recognize the concern about tendencies in the media such as those I have just described is not just an academic desire for accuracy or an extension of political correctness. These patterns of depiction may have damaging consequences.

Persistent and consistent negative images of mental illness may perpetuate inaccurate beliefs and negative reactions to those with psychiatric disorders. A recent survey of a representative sample of the public found that almost half were unwilling to work closely on a job with someone with depression.

Despite the reality of low violence among people with psychiatric disorder, the percentage of the public associating mental illness with violence was found to have doubled since 1956.

And it is believed that the pervasive media connection of violence and mental illness is a significant contributor to the growth of this misperception. Negative public attitudes also translate to discriminatory behavior and to restricted opportunities.

A few years ago we conducted a survey of the experiences of those living with mental illnesses, obtaining input from about 1,400 individuals all across the United States. Sixty percent of those we heard from said they had been shunned and avoided when their mental illness diagnosis became known. At a time in their lives when they may have most needed acceptance and support, they found instead rejection and exclusion.

Employers, unrealistically fearful of risks to other employees, are reluctant to hire a person with a mental health treatment history. Thirty-one percent of our respondents reported that they had been turned down for a job for which they were qualified when their treatment history was revealed.

Twenty percent of our respondents reported difficulty persuading landlords to rent to them. And fear of people with psychiatric disorders has fueled the "not in my backyard" mantra so commonly heard when group homes are introduced to the community.

Finally, it is important to remember that those with psychiatric disorders are in the audiences of mass media presentations and they are sensitive to the ways they are depicted.

Indeed 77 percent of our survey respondents said they had been hurt or offended by media depiction.

For those who wish to learn more about the issue, I recommend the following resources.

Two are books about media depiction of mental illnesses and the third is a Web site maintained by a mental health consumer that has information and video examples of media depiction.

Again, there are many positive contributions from mass media, but the greater number of negative depictions and the impact they have on the attitudes and behaviors of their audiences is a source of concern.

Those who share such concerns will want to work to improve media depictions of mental illness. I hope you are among those who will do so. Thank you.

Jane Tobler: Thanks Otto for that introduction on the media's depiction of mental illness, the reality, and why it matters.

Our next presenter is Bob Carolla, the Director of Media Relations for the National Alliance on Mental Illness, or NAMI.

Bob supervises NAMI's StigmaBusters program. He's a frequent consumer spokesperson and has worked closely with SAMHSA's Campaign for Mental Health Recovery, including the Voice Awards and the ADS Center. He also is a member of the editorial board of bp Magazine.

For 10 years, he served as Senior Legislative Assistant to former U.S. Senate Majority Leader George Mitchell, handling a range of issues including the Americans with Disabilities Act.

Bob will talk about changing the balance of power and how the media can impact mental health recovery. Bob...

Bob Carolla: It's a pleasure to be here and yes, I'll be talking about changing the balance of power which means taking some power back.

And one key lesson I've always learned is no one really can give you power, you have to take it and be assertive in doing so.

Built on the remarks that Otto made helping us to define stigma, the one point that I really want to emphasize is that stigma is something that is imposed by others. It's not something that is part of the illness itself; they do not necessarily go hand-in-hand.

It does not have anything to do with our individual self-worth or dignity, but it is part of a culture that we live in which imposes something on us. And it's—we speak in terms of the media—but I think it's also important to keep in mind that the media is a plural term.

It is the distinctions between it are between news and entertainment media which I think is what we're primarily going to be talking about in this Webinar. But it also extends to advertising, to the naming of retail products, as well as many things that are found floating on the Internet.

I mentioned the U.S. Surgeon General's Report on mental health which is, was, issued just about 10 years ago. It's very important for us.

Besides being a landmark document, the very first time that a Surgeon General had issued a report on mental health, it also stands as a document with authority; greater authority than certainly NAMI or any of our other organizations might individually be able to hold.

And for the very first time it defined stigma as being part of a public healthcare concern for, in terms of stigma being a principal barrier to, people who may be encountering a mental illness needing to reach out and seek help but who are held back because of the stigma.

Further, it talks in terms about some of the examples such as housing and employment discrimination that may result from stigma as Otto had covered. But it there's varying degrees of stigma.

But I think one of the things that came out of the Surgeon General's Report, too, was an ability as a society to start talking about it. And in talking about it in terms sometimes where—because we're talking about something that is within our culture—stigma—it doesn't necessarily have to be as pointed as trying to have a conversation, talking with someone and raising at least the, you know, needing to say, well you're being ignorant or prejudiced or that you're discriminating.

It's a more neutral term; it's a more neutral way of really being able to talk about a problem that is shared by all of us as well, and also shapes all of us as well.

As I said, part of my presentation is about trying to take some power and trying to shift the balance of the power.

There's many different strategies and tactics that can be used. The ones that I'll mention are praise, protest, personal contact, and partnership.

Praise may be self-obvious. Everyone likes to be praised when they do a good job. So if you see a reporter who's written a good article in your local newspaper, send them a note. Not—it can be a letter to the editor, but it can be a personal note to the reporter directly, praising them.

Some local organizations annually give media awards to notable reporters and that's good as well. And SAMHSA—and I'll mention this really at our end—SAMHSA has also pioneered the strategy of bestowing Voice Awards on people in Hollywood who—the screenwriters and producers—who really have supported and put forward positive portrayals and compassionate portrayals of people with mental illnesses.

The other one which I tend to oversee in my StigmaBusters role is the one of protest. And protest means speaking up, complaining, objecting, or challenging stigma whenever it occurs.

And especially doing so in a public manner, the effect of which may not be to change minds, at least not with the person or organization that might be the source of stigma, but it at least draws a line and sometimes changes behavior because it's a line that, for whatever reason, someone may not want to cross again, either because they don't want to be embarrassed or otherwise.

Oftentimes people will say well isn't there anything that we can do legally to stop what we don't like? And, you know, the short answer on that is that with the exception of the Americans with Disabilities Act which goes to specific conduct in the face of employment discrimination or access discrimination, we really live in a society where we have the First Amendment of the government does not regulate speech.

There certainly are ethical and moral principles involved. We like to think that when a person has a right to free speech they also have a responsibility to exercise it.

But essentially we live in a society that's governed by the free market of ideas. And so if someone is saying or portraying something in a way that we don't like, our principle recourse really is to speak out and to offer a counterpoint to it and that's part of the competition of ideas.

Personal contact is probably the most effective form of, as a strategy to overcome, stigma.

People react to what they see in front of them and if they see a consumer who can talk about their illness and their recovery and who also defies the stereotype, that is a very powerful impression and it actually has the most lasting impression.

Now the problem is, is that tied in to personal contact is the whole issue of image. And that's where we're in competition against very powerful forces because any time there's an image on television or in a movie that's stigmatizing, that impression in some ways has almost a surrogate personal contact even though it really may be something that could be entirely in fiction.

The fourth "P," partnership—what we're doing right now is part of partnership, working with SAMHSA as a federal agency, but also the various organizations that are members of different organizations who are part of this call.

Working with the Entertainment Industry Council, which SAMHSA has worked with, NAMI has worked with, as well as others, trying to get screenwriters to pay close attention to factual portrayals.

So you take your allies where you find them and you work with them as a way of leveraging more power and more accurate portrayals and compassionate portrayals of people from our community.

Stigma can also be identified through any number of different elements—I call them our stigma red flags. And it's helpful to keep in mind that sometimes something may have the elements of stigma in it but it may not actually be stigmatizing in context or in its actual impact.

It's oftentimes a balancing test which is where it sometimes gets confusing. One thing I would make as an example for example, that out of all of the possible sources is that several years ago the television show "NYPD Blue" started developing some thought lines which actually were very positive ones.

Now it was still a cop show; it still talked about episodes of violence. The language in it was, you know was not necessarily kind— lots of references to wackos and psychos and so forth.

But where they started to stand stigma on its head was that in the course of investigating a case of violence and initially looking at a suspect who was a man with schizophrenia, as the plot unraveled or unrolled it turned out that the person wasn't the suspect, it was actually a pivotal witness who had the—was able to provide a recollection that led to chasing down the bad guy so to speak. And it came out as the plot evolved in a very compassionate way.

Was that stigmatizing? There certainly was stigmatizing language. It certainly talked about violence but it used the stereotype to flip it around and actually turn a character into—really into one of the heroes of the episode.

So I mentioned this—red flags, always wave them and always consider the context in which they may occur.

Now how does stigma really feel? Now I'm speaking as someone who's lived with bipolar disorder and was diagnosed maybe about 15 years ago. And I can talk about how it feels.

One can feel isolated, rejected, sometimes mocked, marginalized, and causing, which tends to have a self-fulfilling prophecy. If one feels marginalized, one often starts to withdraw more.

And we end up absorbing the stigma and in many cases integrating it into our own identity which drags us even lower. That's how it feels.

And as a result stigma can at the very least slow a person's recovery or it can endanger it or block it completely. And we end up in some cases living the stereotypes.

From my personal experience, besides talking about feelings, I'll just want to walk through two examples.

One is an example that comes from my work with the StigmaBusters Program here at NAMI. There was a television show at one point which had an episode...in an episode had one of the lead characters killed by someone with a mental illness.

The person with the illness itself was framed in some way compassionately, but basically it did fall into the stereotype of a person with schizophrenia encountering another person and killing them, particularly a beloved character of the show.

And it's important not to read too much in terms of cause and effect in cases like these because there are many factors that are involved.

But what happened in this case—and I'm deliberately not mentioning the television show—but after the show—the episode aired, an e-mail was sent to one of my co-workers where someone who had just seen it was very discouraged, talking about how stigma really meant that there wasn't hope that people would see her any differently than for her illness, and it really fed into a sadness that was there.

We saw the e-mail message the next day when we came in and sent a reply to it, basically offering some, just basically words of encouragement and, you know, mentioning what NAMI was doing trying to push back against stigma. And we at least wanted to reach back and touch the person back and give some encouragement.

Well later in the day we received a reply to our response and it was from the brother of the young woman who unfortunately told us that his sister had died from suicide the previous night.

And as we sort of put together the time stamps on the messages and so forth, you know, we realized that probably within the first hour or so after the television episode had aired, it clearly had impacted her mood.

And clearly she had reached out, apparently not just to us but to others expressing her mood and then not long after that, took her own life.

Again, stigma didn't necessarily—wasn't necessarily wasn't the causative factor but it also shows how it can shape the—it can shape the room that we're in and the context that we're in at any one point in time.

So the other example is a personal story, about a bit over 10 years ago—and it was before I came to work with NAMI, although in some ways I think it probably was what led me here.

Newsweek ran a story. It was about President Clinton and the impeachment process [and his] roots in Arkansas, which [sic.] it talked about Arkansas having a culture and it made a reference to hillbillies and manic depressives, which was partly a reference to some other actual characters or personalities that were looming large at that time.

I at that point had been newly diagnosed, still trying to feel my way through what being bipolar meant. It definitely, I definitely flinched when I read it, but then I also did something else and that was, I spoke up using my personal experience.

I wrote a letter not to the editor for publication, but to the publisher and I copied the letter to the editor. It was a one page letter so it was very, you know, fairly brief and polite saying, you know, this was really out of line. You're making a sweeping generalization and oh by the way, I have bipolar disorder myself and this is where, you know, what I've been doing with my life.

Well I sent it and I at least felt that I had at least, you know, sent the letter. I was stunned when a day or two later I received a phone call and it was the publisher of Newsweek apologizing, saying that I was exactly right.

That they had, obviously that it was something that they should not have done and the editor of Newsweek who had written the article was going to be calling me which about later in the day, the person did.

And I have to say both phone calls were very flattering. They were not what I had expected. The editor in his conversation also said, you know, we make mistakes and sometimes when we do we really do deserve to get called to account for it which he did.

And, you know, we're going to make, do our best to make sure that it doesn't happen again.

Well it was almost like, you know, I, gee I didn't know that one letter could make such a difference and but it did. And it made as much of a difference to me personally as it did to anything that may have shaped Newsweek's editorial policies.

I had a source of pride, I felt empowered and it helped me come to terms with being bipolar. It's, you know, I integrated it into my identity. In some ways I tell people these days that being bipolar is as much a part of me as it is, you know, being a lawyer.

In some ways being a lawyer carries more stigma than being bipolar but it at least is where I'm—it was a pivotal moment for me both in terms of realizing that I could speak out on behalf of people with mental illnesses but also a critical point in my own road to recovery.

Going back to the subject of protest, Newsweek was one letter that I wrote, but numbers can certainly make a difference as well. And that can be individual letters, it can be phone calls, it can especially in this day and age, be emails.

It can be contacts not just to magazines but perhaps to the advertisers of the television program if one doesn't like the steady plot line that a television program may be doing.

Keep in mind that protests, in terms of changing attitudes, may be the least effective. It primarily can sensitize people to the fact that there is a potential controversy. In some cases it can embarrass a product or the source of stigma or in the case of advertisers, bring pressure to bear from others.

But sometimes that's all we want is have them think twice next time before they embark on a portrayal that really only contributes to the stigma that is loose in the world.

If it is a battle that is fought publicly, be prepared in advance for the fact that you probably are not going to win it. You're going to raise the issue and you may be able to have a teaching moment public. But it's not necessarily going to be one that our side will win.

And this is sort of a rough rule of thumb but it's based on, in some cases, some actual poll surveying that newspapers have done in the middle of a controversy.

But for example when—and people may remember the case of the teddy bear in a straight jacket for Valentine's Day a few years ago and which became a national issue. And there was, of the arguments that were going back and forth in the news media and in the public, some were saying what's the big deal? This is really, you know, people get a life; get a sense of humor.

Probably about 60 percent of the public's thought that that was the case that it was an overblown protest and that it really, and what was the big deal?

There were maybe a core of 20 percent; people like ourselves who thought this is really, you know, this was a bear literally wrapped in a straight jacket as part of, to show that a person was crazy for you on Valentine's Day.

Maybe 20 percent shared the point of view of the mental health community starting out. Well there was another 20 percent that was at play. And I think that by the time that the debate ended, the division was maybe 60/40. Well that public, that moment of public education did help persuade some people and it also made even those who disagreed with us, more alert to the fact that there is an issue called stigma and it at least meant that there was some (unintelligible) to our points of view.

There have been breakthroughs in victories. I mentioned the Surgeon General's Report as being a critical landmark in the battles that we fought over the last 10 years or so.

The movie, "A Beautiful Mind," as Otto mentioned, received an Academy Award and was about the life of Nobel Prize winning mathematician John Nash.

The television show "ER" ran a series of episodes played by Sally Fields about a woman with bipolar disorder that was accurate and moving and even in her—what I would call her worst moments, it was not demeaning for her as a character.

Last year we saw the movie, "The Soloist," another breakthrough based on a true story about a man with, a talented man with some schizophrenia who was homeless who at least found a road toward recovery, although not complete recovery and yet who was a man of great dignity in how he viewed life.

Now I'll also mention that even as we've had breakthroughs—not that we're any different from any other community or even family—but nothing is perfect. No movie is going to be perfect.

They are entertainment as a bottom line but sometimes there is diverse opinion even within our own community as to whether something is stigmatizing or not.

"A Beautiful Mind" and "The Soloist" are sort of two good bookend examples. There was controversy around "A Beautiful Mind" over what role really did medication perhaps take in playing a role in John Nash's recovery.

By the same token "The Soloist," Nathaniel Ayers, the real life person, was someone who had really rejected medication and who did not see himself as being mentally ill and there were some who thought that, well that really sends the wrong message too, but it's, that's where it stands.

But we just have to be prepared that there is going to be diverse opinion. What's important is the consensus and that's where the Voice Awards do come in. Because as part of the tactic of praise, it really does require us as a mental health community to form a community consensus as to what portrayals are worth, are really worth honoring.

And that's my part of the presentation.

Jane Tobler: Bob thank you so much for sharing that information, the strategies and the importance of speaking up.

Our final presenter today is Jennifer Stuber, a faculty member at the University of Washington's School of Social work. Her research is focused on the production, experiences of, and health implications of social marginalization which includes stigma, prejudice, and discrimination.

Jennifer was the lead editor of a special issue of Social Science & Medicine on stigma, prejudice, discrimination, and health.

Currently she leads a project called the Washington State Coalition to Improve Mental Health Reporting, which is designed to increase community engagement with the news media and to improve accuracy and language of news stories on mental health and mental illness.

She will share some of the great work they are doing and the lessons she and the coalition have learned. Jennifer...

Jennifer Stuber: Thank you. Good afternoon, it's a pleasure to be here. In my presentation I will discuss a new program we are developing in Washington State to educate news media about mental illnesses and recovery and to improve reporting on mental health issues.

Key to this program has been the development of a statewide coalition of more than 200 people with psychiatric disabilities, mental health professionals, and researchers.

The coalition, which was created with funding by Washington State's 5-year Mental Health Transformation Project, supports journalists in their efforts to report on mental health and illness by providing a media guide, credible news informants, story ideas, and factual information.

The program utilizes the anti-stigma strategies of praise, personal contact, partnership, and protest outlined in Bob's presentation.

Sorry, my slide just skipped at me. There we go.

The job of improving news reporting on mental health issues inevitably requires working with reality that most news stories are about a violent event where untreated mental illness may have played a role.

We are appealing to journalists to dig deeper and to provide greater context in public education when these events do occur.

Recent tragic events in Washington State are proving to be a source of entry into a conversation with journalists about the need for improved reporting.

Over the past year we have had conversations with over 30 journalists and editors in seven newsrooms across Washington State. In general our approach with journalists has been non-confrontational and is framed as a mutual learning opportunity.

We are finding there is receptivity to improving mental health reporting when the issue is framed in terms that news organizations and journalists understand.

What are these terms? First, reputable news organizations want their publications to be fair and balanced. So when you tell them that their coverage on mental illness is not balanced because of the focus on violence, this is a concern to them.

Second, it's part of the professional ethics of journalists to strive for accurate reporting. If you can point to concrete ways to improve the accuracy of news stories, they will listen.

Third, journalists do not want to tell boring stories which is in part why what bleeds leads has become industry practice. But they've also told us that groundbreaking research and treatment stories can be of interest if they are told through the eyes of individuals who have benefitted from them.

A defining moment of our project occurred during a visit to The Wenatchee World newspaper. The paper's publisher told us that he is receptive to improving mental health reporting because the paper's mission is to improve the local community.

After that visit the editorial page editor wrote a piece entitled, "We Don't Know Mental Illness," which discussed how the press has a lot to learn about mental illnesses.

We are not asking journalists to make a huge leap in taking on the tasks of improving news coverage. At least since the Civil Rights era of the 1960s, reporting guidelines and practices have encouraged reporters and editors to avoid stereotypical language and images when referring to racial and ethnic minority groups and to people with physical disabilities. However this work has not yet been extended to people living with mental health challenges.

So prior to building our Coalition, we did an analysis of local news media coverage. We thought if we're going to ask journalists to change their reporting practices we better have some idea of what the problems are.

From this analysis we published a media guide that addressed the issues we saw. We saw extensive feedback from local journalists on this guide before it was disseminated.

The media guide contains tips for reporting when a story includes violence in mental illness, for eliminating stigmatizing language and portrayals, for improving accuracy when reporting on mental illnesses, and suggestions for the newsroom. It can be found on the Coalition's Web site at http://www.mentalhealthreporting.org.

This past year, we trained 200 Coalition members in seven media markets in Washington State with a six hour training course on how to engage local news media.

The course covers the importance of engaging with local news media, model language to use, and tools for engaging with news media including how to write a letter to the editor, and to pitch a news story.

Local news media were invited to these trainings as participants and to sit on a lunchtime panel. The trainings provided an opportunity for Coalition members and news media to have a dialogue about how to improve news reporting on mental health and illness.

Concurrent with the media trainings, we held meetings with journalists and editors in the newsrooms of The Seattle Times, The Wenatchee World, The Spokesman-Review, the Everett Herald, the Yakima Herald, and The News Tribune.

At these meetings we reached key journalists and editors within these news organizations to have a dialogue. We talked with editors and journalists about what is doable in terms of implementing changes in reporting practices within their organization.

There is receptivity to these ideas. Editorial boards and journalists in these newsrooms are having conversations now about what's appropriate language; about when mental illness is relevant to a news story; about headlines and other possible news stories that they can be writing.

The city editor of The Seattle Times told me the best way to improve reporting on mental health is to give journalists access to good news stories with a recovery angle. Experiential learning through access to news stories with a recovery angle is key.

Since there are few attempts to improve news coverage like this one, we feel it is important to evaluate the impact of the coalition's work. We are in the process of developing an evaluation strategy for the program.

The evaluation is pegged to the media guide that contains the specific practices we are asking journalists to change.

We are monitoring engagement that coalition members have with their local news media and improvements in news coverage among the journalists we have specifically targeted with the coalition's messages.

We will be completing an analysis of local news media coverage before and after the implementation of the coalition's strategy. The evaluation will track whether the language used in news stories has improved and whether the balance of news stories has changed.

Has the number of recovery and treatment stories increased relative to the number of negative portrayals of mental illnesses driven by tragedies?

Now the coalition's job is to monitor and respond constructively to news coverage. We have listservs of our coalition members organized by media markets and are making the coalition aware of their local news coverage.

We are working actively with coalition members to pitch news stories with a recovery angle across our state. A Web site is helping us.

The Web site contains the media guide, the media guide facts about mental health and illnesses, exemplar news stories and opinion pieces in our state, and links where journalists and coalition members can request technical assistance from us.

Again that Web site can found at http://www.mentalhealthreporting.org.

Here's an example of responsiveness in the form of protest. This was an editorial The Seattle Times published by a coalition member following their news coverage after an escape of a patient involuntarily treated at an in-patient psychiatric hospital.

The patient was on a community outing. The news story was picked up nationally.

The editorial talks about the ways in which the news coverage and headlines of this event were sensational and misinformed about the fact that recovery happens for everyone, even for people being treated in in-patient psychiatric hospitals.

Preemptive communications with journalists and copy editors by coalition members has since resulted in better coverage and more respectful headlines in subsequent news stories on this incident.

This negative news store became an opportunity to ask for fair and balanced reporting.

Christine Clarridge of The Seattle Times wrote this news story, "Acting Out Towards Healing," about a drama therapy program used in one of Washington's in-patient psychiatric hospitals.

This story was an opportunity to talk about why programs like drama therapy and community outings are a necessary part of treatment for patients. A lesson here is that one way to tell the recovery story is through innovative programs and treatments.

Journalists tell us that the best way to tell these stories is through individual stories and experiences.

Ms. Clarridge is receiving a community award given by a major mental health organization in our state tonight for doing this news story. She also received numerous thank-you notes from coalition members. It's important to praise journalists when they get it right.

A second way to pitch recovery stories is through upcoming events in your state. Here's an example of a story pitch which we worked on with a youth group in our state.

We heard the youth were planning to paint themselves green to run in the Bloomsday Race because two centuries ago, people with mental illnesses were splashed with green color to warn away others.

We identified a journalist at The Spokesman-Review newspaper we thought might be interested in this story and we put the youth in touch with her. This story had great visual possibilities, which has become important to all news media, especially broadcast.

The store was newsworthy because it was framed around an impending local event.

We are also working to pitch human interest stories with a recovery angle. To do this it is necessary to identify individuals in recovery with compelling personal stories who are willing to be interviewed.

This isn't always easy because there are inherent risks to the individuals who step forward because of the deep-rooted societal stigma and discrimination we've been talking about on this call.

Stephanie Lane was the head of our Office of Consumer Partnership within Washington State's Department of Social and Health Services. She is one such courageous individual.

Carol Smith, then a reporter at the Seattle Post-Intelligencer newspaper, told Stephanie's recovery story. It appeared on the front page with the headline, "This Story of Mental Illness and Recovery is Still Being Told."

Stephanie's story being published demonstrates that the silence around mental illness can be broken and the positive story of recovery is newsworthy.

The coalition's work is ongoing and sustainable because once you have a positive brush with news media, future engagement is more likely.

The philosophy of Washington's program is strongly weighted towards the strategies of praise and personal contact. We are saving protests for when there are flagrant instances of sensational or inaccurate reporting.

Journalists have told us that the key to influencing them is to catch them when they are doing things right. We are taking this advice seriously.

This spring the coalition will be awarding Washington State's first annual Mental Health Reporting Award in partnership with our State's Department of Social and Health Services and the Washington Community Mental Health Council, an organization that represents the majority of community mental health organizations in our state. The contest is open to all journalists in Washington State.

The award will be given during Washington State's largest mental health conference. It is a day we are looking forward to as there has been some excellent journalism on mental health in our state in the past year.

In summary, if you want more information on Washington's program or a copy of our media guide, check out our Web site again, at www.mentalhealthreporting.org.

While Washington's program has had some early success, we must remember that changing reporting practices around mental health and illnesses is a marathon and not a sprint. Thank you.

Jane Tobler: Thanks Jennifer and you're absolutely right, it is a marathon and it's something that everyone can do.

We appreciate you sharing your projects stories and the strategies again, that anyone can utilize in improving mental health reporting in the media.

We put together a list of resources that I encourage you to take a look at in the next three slides, and I'd like to note that the Rosalynn Carter Fellowship for Mental Health Journalism is currently accepting applications which must be postmarked by April 19, 2010.

Slide 45, or 47 if you aren't currently online, includes additional resources. And the last bullet includes the URL for the Voice Awards, which Bob mentioned earlier in his presentation.

The Voice Awards honors writers and producers for giving a voice to people with mental health problems. The Voice Awards also recognize the accomplishments of consumer leaders and advocates.

Anyone may nominate a television show, movie, or an individual to receive a Voice Award. I encourage you to go to the URL and nominate people or a television show or a movie if you've seen something that deserves an award.

Slide 46, or 48 if you aren't online, lists radio shows produced by people with a lived experience of mental health recovery.

And finally on Slide 47, or 49 if you aren't online, we've shared the presenters contact information.

We will now take questions from callers. Please dial star 1 on your telephone keypad to be placed in the queue and give the operator your name. If you do not wish for the operator to say your full name publicly, then please only state your first name.

Upon hearing the conference operator announce your name, please ask your question. After you've done so your line will be muted so the presenters can respond.

If you have additional questions or would like to follow-up, please feel free to email the SAMHSA ADS Center at promoteacceptance@samhsa.hhs.gov. The address and contact information is listed on Slide 52, or if you aren't online, Slide 49.

Thanks so much and we will now begin our questions which you may either email or you may call.

Our first question comes from (Suzanne). Go ahead.

(Suzanne): Yes, this question is for Bob Carolla. I enjoyed your presentation very much. I noticed on your slide about protests, that under picking battles you have a note about private versus public strategies. And I was wondering if you could say more about that?

Bob Carolla: Well private versus public basically means whether or not the, you know, the contacts are occurring in a, either privately. For example, I mentioned that I had written a letter but it wasn't a letter to the editor, it was to the publisher with a copy to the editor.

In other words, I didn't really want to go public in voicing my complaint but I wanted it a little bit more direct and that worked in my case. That was with the Newsweek example.

There, sometimes there are, you can actually do both, it's a question of how high you want to raise the profile of a protest.

And I know that even prior to this teleconference there have been, there's been interest in the Burger King commercials that have been running which are a source of great controversy.

Without releasing it to the press we did write a fairly strong and lengthy letter to the president and CEO of the company with copies that also went to some key members of the Burger King Board.

At the same time, in our last StigmaBuster Alert which was the first week in March, we did give contact information for people, encouraging people to contact the company directly to share their individual concerns.

There has been no response from the company so far. So in other words private diplomacy or a low-key profile has not worked in terms of even getting an acknowledgement of, you know, of concerns over the, those, you know, the commercials that are running.

But we, you know, there's other ways that we can try, some still more private than public but also we could notch it up a bit.

Whenever you do raise something to the point of a very high profile public protest though, again keep in mind that you pick your targets carefully. You don't necessarily go in with an expectation that you're going to win, but that it at least is trying to create a teaching moment.

And you also have to weigh that relative to, you know, especially for grassroots organizations, what the other priorities may be that you're facing.

Certainly if you're in a direct service mode, you don't want to get pinned down fighting a stigma battle that takes too much of your time.

(Suzanne): Thank you.

Jennifer Stuber: I'd like to add the additional point that if you're working, if your goal is to try to improve news reporting, when you use protests you have to really be careful.

Because remember one of the things that's really key to working with news media is building a relationship in terms of getting the better, more positive recovery stories out there in the future.

So when you use protest you do have to be, you know, careful about how you do it. And so I think, you know, catching, the comment about catching journalists when they're doing it right is also really important to keep in mind.

Jane Tobler: Okay great, next question.

Coordinator: Our next question comes from (Arian). Go ahead.

(Arian): Hi, you may have already answered this but, I just wondered why you didn't also contact President Clinton, this is for Bob.

Bob Carolla: Back with the Newsweek example?

(Arian): Yes.

Bob Carolla: Well, you know, President Clinton had enough other things to worry about and it was - and keep in mind, he was the source - I mean he was the target of the criticism where they were basically, you know, making fun of people from Arkansas. I mean that oversimplifies it.

You know, it just wasn't something that was—it just didn't—it just wasn't really feasible. I mean trying to send a letter to the president to tell him that you were upset about the way the president was being compared.

Whereas my reaction was that it really impacted me in a very personal way because I had the, you know, because I clearly had the same diagnosis as the person that the article that they had written was referring to.

Otto Wahl: I wonder if I could add also, I think that it is important when you take the actions, to think about where your action will have the greatest impact.

Sending something to a busy president's office who gets mail probably in the bags full may not have as much impact as writing to your local editor or publisher.

Jane Tobler: Thank you. The next question will be from an e-mail that we received earlier.

"I'm appalled every time I see the Burger King commercial on TV in which two supposed psychiatric hospital attendants in white coats chase the Burger King yelling, "Stop him, he's crazy," crazy because he is selling a sandwich for a ridiculously low price.

The imagery is archaic, offensive, and stigmatizing. How do we get a popular nationally recognized fast-food chain to modify an ad campaign like this one?"

Bob Carolla I'm going to ask you to respond.

Bob Carolla: Well as I said, we've already started a response, both with a formal letter as well as encouraging email letters.

One thing I would suggest is that, you know, everyone on this call who also, you know, uses the Internet, use your Facebook accounts; go to some of the Facebook pages of some of the key mental health organizations and encourage people to also contact Burger King.

There, if you go to the NAMI Web site which is http://www.nami.org/stigma, you'll find an archive for StigmaBuster Alerts.

The March 5, alert has the information about the Burger King protest. It includes the postal address for the Chairman, John Chidsey, in Miami. It includes a link for email comments to be sent, and there's also the phone number for the Customer Relations line for the company.

And if nothing else, the number you can call to weigh in is 305-378-3535. That's Burger King's Customer Relations and call them up and tell them, you know, we want it our way and that's without any stigma.

Jane Tobler: Excellent Bob thanks so much.

The following question also comes from an e-mail. "As both a mental health consumer and a mental health professional, I submit that some of the most insidious prejudice against consumers can be found among mental health professionals.

Although I generally make it a point to disclose my client's status at my workplace, there have been at least two settings in which I provided art therapy and/or counseling and did not disclose, because I feared repercussions in an atmosphere that seems to denigrate the clients it served, or at the very least, did not take client's wishes and rights seriously."

"How can we, working with the media, begin to change this?"

Otto, would you respond please?

Otto Wahl: Certainly. Mental health professionals are a product of their culture just as our journalists and others and sometimes also a product of training that too often emphasizes pathology and does not talk enough about stigma and inclusion and those kinds of things.

So absolutely, there are mental health professionals and mental health settings where people are going to encounter stigma; they're going to encounter behaviors and attitudes that are damaging and detrimental. That is, that does happen.

My own opinion is that most of the time, that's not intentional. That is, the people who are involved are not out there to create obstacles for people with whom they work, with whom they've chosen to work, but rather are doing so because they are themselves not aware of the impact of their behaviors.

And so one of the things that's important is that we increase awareness; we increase their consciousness about issues related to respect and inclusion and stigma including being able to accept that they themselves may, however inadvertently, contribute to those things.

Here's an instance where people in the media, by talking about these issues, by writing about them, by presenting them, by raising them as an issue, can help to increase the awareness that these kinds of things, that language that is detrimental or respectful to people with mental illnesses can occur in all contexts, including mental health contexts.

And for mental health professionals I think it's also important to recognize that when that does occur—I'm not sure it occurs any more frequently than it does in other contexts—but when it occurs it may have even more damaging consequences because it is coming from people to whom people living with mental illnesses have turned for acceptance and understanding and support.

So it's particularly important that we recognize that it can occur there and try to help educate those mental health professionals as well.

Jane Tobler: Thanks Otto. Jennifer, do you have anything you want to add?

Jennifer Stuber: Not on that particular issue—no thanks.

Jane Tobler: Okay. I just wanted to let people know, a few participants have asked about getting copies of the slide presentation.

It will be available. The whole presentation is archived and when we go to the second last slide of the presentation, it will have the information where you can go to get that.

The next e-mail question is, "The entertainment industry certainly has the flexibility to make a story or portrayal go whatever way they want it to go, favorable or not.

How do we address the stigma that forms around people with mental illnesses when the news makes it sound like, in the criminal justice system, defense lawyers are so quick to raise the insanity plea to, as some might see it, excuse violent behavior or deflect personal responsibility for a crime.

Is this a result of the criminal justice system or is it a result of the news media's sensationalized reporting which can rile people up about such things?

The Amy Bishop Alabama shooting case is an example. Either way, how should we respond?"

Jennifer, can you respond to that, please?

Jennifer Stuber: Sure. Well I mean, I think it's a little bit of both. I think that, you know, sometimes journalists and frankly headline writers, so copy editors, are not aware of the fact that they are, you know, doing things that do further contribute to sensationalizing.

But I also think that there's a systemic problem in terms of the language, you know, coming out of the criminal justice system and frankly some of the language that we within the mental health system use.

So like the whole, you know, guilty by reason of insanity, that kind of language is something that a journalist, you know, thinks they're doing their job by, you know, repeating the language that is, you know, within our community.

So I think as a community we really do need to look, you know, more systemically. Because I think part of what journalists are doing is, you know, if you look at some of the stigmatizing language and portrayals in news media, that sometimes it actually comes from within the community itself.

So I think we have to look long and hard at that issue and then also raise awareness amongst journalists about the roles that they're playing in terms of this, and also to recognize that insanity defenses are very, very uncommonly used and that there's a reason for why they exist. So that answers the question I hope?

Jane Tobler: Thanks Jennifer.

Bob, is there anything you wanted to add on that one?

Bob Carolla: Not really. I mean the insanity defense is rarely used and it rarely succeeds. The problem is, is that again, what gets into the headlines are sensational cases and then if there is a trial that, in which it's being played out, you know, that's what's going to be reported.

And in some cases the language may not, it's, you know, the language itself may be what's written in the law.

Jennifer Stuber: Right.

Bob Carolla: Terms like guilty but not insane which are legal terms but they don't necessarily have much to do with medical terms and in many cases they have not even, you know, kept pace with the advance of science.

Otto Wahl: I'd like to add my two cents too. I think this is an instance where there is a vast public misunderstanding of what the insanity defense is; how often it's used, what the outcomes are, and its place in the legal and mental health system.

For example, insanity is not a mental health term, it is a legal term and people who have a mental illness are not necessarily by legal standards, insane.

Rather than go deeply into that I just want to say that I think it's necessary for people to have a better understanding of that, including reporters who are not necessarily versed in mental health or legal things and may need some help in understanding those distinctions.

By working with reporters, by creating guides such as Jennifer has talked about, I think we can help media professionals to do what they want to do which is to get the story right.

Jennifer Stuber: Right.

Jane Tobler: Thanks presenters. Operator, can you please go to the next caller?

Coordinator: Yes. Our next caller is Jamie. Go ahead.

Jamie Dakis: Hi, can you hear me?

Coordinator: Yes, ma'am.

Jamie Dakis: Oh, okay. My question is to, first of all, Bob Carolla. You mentioned the harrowing story of the woman that committed suicide. Because of the stigma that I've received from having a mental illness, I resulted in losing my daughter to suicide and my granddaughter to the State of Alaska.

I also in, well my name is Jamie Dakis and I did a play called, "There Is Never a Reference Point," and you can find that online and with it also the newspaper articles.

It was produced in 2006 at the University of Dallas, Texas and the proceeds went to the NAMI organization to help with non-profit mental health issues. And I did this in 2006.

My play is out there and I wanted to note, you had on your presentation, "The United States of Tara."

Bob Carolla: Right.

Jamie Dakis: And that's what my film was—that's what my—it's a video of a play emersion where everyone was invited and the donations and/or were to help NAMI—Dallas NAMI.

I never heard anything about it until last - November 5th. It was done at the Dallas Video Festival and I went to the screening and received no, nothing.

I was, I'm placed out there for the last four years of my life and I'm out there online and how do I, I mean I, this person did a beautiful job to try to help with the education of mental illness but at the same time, what I placed myself out there.

How do I undo this or how can I, you know, I'm trying to, if like The United States of Tara is a comedy now and it's on television it's my understanding, I don't watch television.

So all I've done for the last ten years of my life is to fight the stigma that caused the demise of my daughter and the loss of my granddaughter. And I'm still surviving and I'm still helping but I want to turn what I did, what I've worked in the last 10 years of my life around and I don't know how to do it so I'm asking you.

Bob Carolla: Well to clarify first is that you were glad that the video was shown in Dallas or did that create a problem for you?

Jamie Dakis: It created a problem because I was not part of the, in other words it was inaccurate information. It's being edited now.

Bob Carolla: Okay.

Jamie Dakis: But would, however, what I'm saying is it's all over the Internet...

Bob Carolla: Okay.

Jamie Dakis: ...and I actually, after I went and produced the play and then they put it on the Internet, I actually received hate mail from people saying, you know, people actually calling me some really awful names...

Bob Carolla: Yep.

Jamie Dakis: ...and, you know, just I want to be able to undo this. I want, you know, like the National Endowment of the Arts or someone to recognize that my life has been so affected. And I'd like to turn that around because it was turned into a play that was actually helping people, but the over-sensationalized videos of it...

Bob Carolla: Right.

Jamie Dakis: ...have been produced on You Tube and people are—like my life now is out there and it was—it's not that I wasn't happy, it's that I'm—I was appalled by the results of society.

Bob Carolla: Well Jamie...

Jane Tobler: Jamie?

Bob Carolla: ...first of all...

((Crosstalk))

...Jamie, at the end, my e-mail address is (unintelligible). Send me a quick note, not only reminding me of it but to make sure that I also have your name spelled correctly.

I can't promise results but I can look in to it and I'd have to start doing that with our, you know, with our NAMI Dallas affiliate. But I can at least look in to it, you know, to some degree.

And I guess the other thing I would say is that I mean, obviously we speak out with our stories and personal disclosure. But I think as, I think Otto had made the point and it's one that it's at time sobering, is that there is a vulnerability when we step forward and talk, and disclose our experiences.

And we have to at least be prepared for, if not surprised by, sometimes the reaction isn't the way we would, you know, would want it to be.

You know, I've been in a circle - in groups with circles of old friends where I've disclosed and in most cases, you know, I get, you know, supportive words of encouragement or other people actually saying, well gee my brother has the same diagnosis.

Or in one case there were actually two people that had the same diagnosis that were part of the conversation.

But then there's always one or two who one, they don't know how to deal with it and, or, they just ended up, you end up losing them out of your circle of friends because they distance themselves.

So whether it's at a personal level or from a media perspective, there are risks there.

But Jamie, do send me a note and I can at least look into seeing what, you know, what may be possible.

Jane Tobler: Bob thanks so much. And I want to remind everyone that the presenter's e-mails are on the slide.

Operator...

Jennifer Stuber: Can I just add something on that particular point because I was the one who made the point in my presentation about the—there is a risk, there is a vulnerability for people who step forward and disclose and tell their recovery story in a public way. So that risk ability does exist.

I want to just say that, you know, for the people in our state that we've worked with to do this, I have to say that it was - it did feel like a big risk and it was a nerve wracking experience.

But these people have now become extremely engaged with their local news media and see it now as their personal mission.

So I'd say the experience has been some positive and it's definitely a risk worth taking. And I think, you know, in most cases and I think that Bob, really Bob's examples in his presentation really also make that point.

Bob Carolla: It's liberating. There's risks but it's liberating.

Jane Tobler: Thank you. Next caller operator.

Coordinator: Yes, ma'am. (Marjorie), go ahead.

(Marjorie): Yeah, hi. I just wanted to thank all three of you for speaking out on the mental illness side.

But I just wanted to add a couple of people to the list that have been, made breakthroughs.

"Girl Interrupted" was a very powerful movie about this girl growing up with a mental illness, Patty Duke Astin with the bipolar, and Elyn Saks who's schizophrenic.

And people are coming out of the woodwork and I think it's very powerful to listen to the people that want to say something.

Jane Tobler: Absolutely, thanks for sharing that. And actually if you go to the Voice Awards it actually lists the winners of the Voice Awards from years past and you can find some really powerful material there; really powerful TV shows and powerful movies, so thanks very much.

(Marjorie): Thank you.

Jane Tobler: Operator, can we go to the next caller, please?

Coordinator: (Becky), you have an open line, go ahead.

(Becky): Hi. Based on the current media climate, would you say that they have kind of given an acceptability scale? For example, it's more acceptable to use alternative medicine to treat mental illness than the traditional Western psychiatrics? Or is it more acceptable to have one diagnosis as opposed to another?

Jane Tobler: When you say acceptable (Becky), what, can you explain what you mean?

(Becky): I guess the best way I could phrase it would be not as stigmatized.

Jane Tobler: Okay, okay. So your question is, is it less stigmatizing to have one versus multiple and whether using traditional versus kind of I guess alternative?

Otto, is that something that you could talk about?

Otto Wahl: Well yeah, I was going to say that the questions are excellent questions which we don't have complete answers to.

For a long time much of the research that went on about stigma focused on mental illness in general and so we don't know quite as much about which conditions of mental illness have greater stigma than others.

Also, as we've talked about stigma, stigma is a complex phenomenon and it has many different aspects so that for example, a diagnosis of schizophrenia may be more stigmatizing that a diagnosis of bipolar disorder in some ways but not in others.

So it's a difficult question to answer specifically, but there is a lot of work going on right now to try to articulate those things.

I do want to note though that with respect to the media, one of the things that has changed over the years because we have looked at that in some of our own studies is that the media are presenting a more differentiated picture of mental illness.

Ten years ago the stories you would find would talk again, mainly about mental illness as if it was all the same.

And these days we're finding stories that do talk more about specific conditions rather than mental illness in general which I think is a good thing and helps to educate the public better.

Jane Tobler: Excellent Otto, thanks so much.

We do have several more callers so I'm going to ask if people can be brief with their questions and brief with the answers, thanks. Next caller.

Coordinator: Yes, ma'am. (Carol), go ahead.

(Carol): Yes, I wanted to know if there's anything you can recommend folks do so they can review the stories that a particular journalist is going to produce.

I've had a bad experience with my first experience with the media and I just have always wondered what a person could request?

Jennifer Stuber: Well I'm sorry to hear that you had a bad experience with your first experience with the media, that's a shame and sad.

Now I think the one thing, one of the things is we have talked about kind of the inherent risks. And when you do step forward and fortunately you don't have the ability with the journalists to edit their story. Typically they won't actually show you the news story they write before they publish it.

That said, you do have the ability to kind of shape the terms of the meeting, you know, when you sit down, you know, even, you know, some people prefer in person, you can ask for that kind of meeting.

And you can also, you know, talk about, you know, I think you have to be really, really careful when you step into that interview that you figure out what it is that you want to say like what are the priority messages that you want to convey because, you know, there's really no speaking off the record here in terms in that.

So I think it's really, really important that, you know, that piece of it is addressed going in to it is that you have a clear sense of what you want to convey and what you don't want to convey and think that through.

Jane Tobler: Great points Jennifer, thank you. Operator next question, please.

Coordinator: Next is (John). Go ahead.

(John): Hi. A number of police shows are great for representing that those who, vile acts are committed by those with a mental illness.

And when you want to respond to that, to the show. Are e-mails more effective? Are letters more effective? Is there some way that can have a bigger impact or the best impact when you want to respond to some of the things that you see?

Jane Tobler: That's a great question, what gets the most impact? Bob, do you want to answer that and maybe Jennifer follow up?

Jennifer Stuber: Mm-hmm.

Bob Carolla: Well I want to say all of the above. But what I always tell people is that if you've got the time and ability to compose a one-page thoughtful letter and sending it to the producer or to the head screenwriter, I think that has an impact. You may never get a reply, but those are the kinds that at least get looked at.

Now on the other hand we do live in an e-mail age. And if you can find the right e-mail or even if you can just put something in on the comment line that most of the networks have for each show, someone somewhere takes a look at it and I have faith that it does get, you know, digested at some point.

But those are the two things that I most recommend.

Jennifer Stuber: Yeah, and I think people have this assumption, you know, oh it takes so long to write a letter to the editor and it might not ever get published and that's a wasted effort.

Well I just want to say that that is absolutely not the case. I mean I have had one experience in particular where I wrote a letter to the editor about something that was, you know, was actually a cartoon on the editorial page that was extremely stigmatizing and offensive.

And, you know, I ended up getting back not, my letter to the editor was never published but it ended up getting into a long e-mail exchange with the editor of the newspaper who ultimately, you know, really understood what my position was.

So I really think, you know, taking the time to do online story comments, you know, you know, currently I don't know if some of you, you know, when you read the newspaper you see some of the comments after some of the news stories, they're appalling.

And I think it's really, really important to take the time to engage, you know, online, sending personal emails to editors, publishers, journalists. There is no waste of time here.

I mean, I think it's about, you know, speaking out and engaging and using the multiple vehicles available to do so.

Jane Tobler: Excellent, those are both great points and I think your suggestion around online story comments, remember that that does not take long. You've just read the story, to put again, the praise or the criticism. So thank you so much.

Operator, the next caller, please.

Coordinator: Thank you. (Martha), go ahead.

(Martha): Hi, this question is for Bob Carolla. I'm a consumer and I'm personally interested in this question.

Is mental illness ever funny?

Bob Carolla: That's a provocative and good question. You will get split opinion on it.

I think what, through StigmaBusters, we've tried occasionally and this is not a formal survey but it's, but we've tried to engage our subscribers to the, you know, which is a free newsletter but we've basically asked for their opinion on that question.

And what seems to come back is sort of an interesting, first of all an interesting division.

As a generalization, consumers tend to be, to roll with it a bit more than family members do and are inclined to find things, maybe have a higher tolerance in terms of some of the humor, so that's one very basic rule of thumb.

I think it goes to the question of first of all, who is the person making the joke; either as a character or as the source of the joke itself.

It's a lot easier when we're laughing at ourselves. So, you know, if I make a joke about someone with bipolar disorder which I don't normally do, but if I did I'd at least come at it from the perspective of someone who, you know, who lives the experience personally.

And then it depends on the, it would depend on the context. Is it, you know, what was the purpose of the joke? I mean is it to make fun of a person with a mental illness or is as much to show some irony or maybe humorous relief.

There's certainly a lot of dark humor that comes out of, you know, any time someone is living through tragic experiences, one means of coping with it sometimes is dark humor.

I think where it gets, I think where the line starts to get crossed is when it is someone who has never lived the experience, have had no experience, and is doing it simply to make, is, you know, raising a situation or raising a stereotype simply to get a laugh.

And that's where you start getting to the realm of offensiveness. But it's a tough call, that's one of the, I always include it in my presentations partly to be provocative and to get people thinking and I've also been in some situations where, I mean, where there have been really heated discussions about it.

And sometimes it's better to do it, you know, relative to a specific example or say for example a specific show.

Otto Wahl: Can I add just one quick thing?

Bob Carolla: Sure.

Otto Wahl: And that is that jokes, etc. about mental illness can be very funny. They can be knock-down, have you laughing. That doesn't mean that they're not damaging in the same way that very jokes about dumb blondes or racial ethnic jokes don't generate laughter, but they're damaging.

Jane Tobler: Okay. I want to thank our speakers. We've come to the end of our time today so if you do have questions that haven't been answered yet, I want to encourage you to contact the speakers whose information is on the slide show.

Or you also may contact the ADS Center, which the e-mail is also up there, its http://www.promoteacceptance@samhsa.hhs.gov.

I thought it was great, I thought the question and answers were great and it's been a real good experience today.

I want to thank all the listeners for caring about the topic enough to take time out of your afternoon to learn more and to thank the presenters for sharing their experiences and insights today and also Otto, Bob, Jennifer—thank you also for your work on this really important subject matter.

On Monday you'll receive an e-mail request to participate in an anonymous online survey about today's training. It will only take you about five minutes to complete so I ask you to please, please take five minutes and share your feedback with us.

This information will be used to help determine resources and topic areas for future training events.

As I mentioned earlier the conference has been recorded and the audio recording and transcription will be available in mid-April on the SAMHSA ADS Center Web site.

Finally, thanks everyone for joining us and thank you in advance for completing our survey. This ends our teleconference.

END