Television Viewing Habits and Their Relationship to Tolerance Toward People with Mental Illness.

The electronic media has been criticized by mental health advocates as contributing to the stigma of mental illness. In this study, college-aged individuals who received their information about mental illness primarily from television were investigated to uncover the relationship of their television viewing habits and their tolerance toward mental illness. Results of trend analyses revealed that the number of hours of television watched per week was significantly and positively related to intolerance and that the type of television show watched accounted for significant variance in measures of tolerance toward people with mental illness. Implications are drawn for mental health counselors.

Mental health counselors have long been aware of the negative effects of social stigma on persons with mental illness. Corrigan (1998) traced the impact of stigma on mental illness and noted that while people with mental illness suffer from the harmful effects of the disease itself, "society's reaction to the disease seems to have an equally harmful impact on the person's abilities to successfully achieve life goals" (p. 202). He noted that negative stereotypes of people with mental illness lead to discrimination in housing, employment, and social interactions. In 1986, the National Institute of Mental Health (NIMH) reported that stigma was the most debilitating handicap faced by former mental patients. More recent reports confirm the ongoing negative effects of stigma on the quality of life for individuals with mental illnesses (BBC Online Network, 1999).

Beginning more than 2 decades ago, television was implicated in perpetuating the stigma attached with mental illness (U.S. President's Commission on Mental Health, 1978). Since that time, mental health advocates have asserted that the electronic media depicts mental illness in both an unfavorable and inaccurate manner that contributes to perpetuating harmful misconceptions about people with mental illness (Corrigan, 1998; Rose, 1998; Thornton & Wahl, 1996). These inaccurate depictions of mental illness are often the only opportunity that viewers have to form opinions about mental illness. A 1990 national survey on mental health attitudes found that the mass media was identified by an overwhelming majority of Americans as the primary source for information about mental illness (Daniel Yanklovich Group, 1990).

Empirical and anecdotal reports have indicated that television images of mental illness have been far from tolerant. Both the frequency of the depictions of people with mental illness and the inaccuracy of those portrayals have contributed to the stigma attached to mental illness (Wahl, 1992).

Several studies have investigated the frequency of the images of mental illness in the media. Fruth and Padderud (1985) found that of all the available programming time during a 2-week period of daytime television, 11.4% was devoted to portrayals or discussions of mental illness. Wahl and Roth (1982) found that 29% of prime time television shows over an entire month had some relevance to mental illness. In the 20 years between 1969 and 1989, mental illness was depicted in about one fifth (20.5%) of prime-time dramatic programs (Signorielli, 1989). Television depictions of individuals with mental illness remains a popular theme.

The assertion that the images portrayed are inaccurate also has been supported through research. Rose (1998) found that in a 3-month period in 1992, 65% of people with mental illness shown on the news were portrayed as having committed acts of violence against others. In daytime television, Fruth and Padderud (1985) found that characters with a mental illness differed from normal characters in appearance and behaviors, and one third of all the depictions of mental illness indicated that mental illness is a serious disease. In her 20-year study of television, Signorielli (1989) found that 72.1% of prime-time characters with a mental illness hurt or kill others. In a study in which participants were asked to describe characters with a mental illness in prime time, the most frequently adjectives were "active," "confused," "aggressive," "dangerous," and "unpredictable" (Wahl & Roth, 1982, p. 603-604). These violent images of mental illness persist, in spite of research to support that only between 6.4% (Teplin, 1990) and 15% (Jemelka, Trupin, & Chiles, 1989) of the prison population has a major mental health disorder diagnosis, and estimates that 92% of people with mental health problems show no indication of ever being violent (Swanson, Holzer, Ganju, & Jono, 1990). The magnitude of the media's misrepresentation of people with mental illness as violent was reported by Diefenbach (1997). He found that during a 2-week period in 1996, television characters with a mental illness were 10 to 20 times more violent than were people with mental illness in the U.S. population over the course of an entire year.

The pervasiveness of inaccurate depictions of mental illness on television is of particular concern, given the significant role of television in Americans' lives. The percentage of homes with television has increased 63% from 1970 to 1998, to more than 98% (Nielsen Media Research, 1998). In 1997, in the average household, the television set was on 7 hours and 12 minutes per day. Young adults (ages 18 to 24), the focus of the current study, watch on average between 20 hours and 40 minutes (men) and 24 hours and 42 minutes (women) per week (Nielsen Media Research, 1998).

A recent study by Granello, Pauley, and Carmichael (1999) found that the relationship of the media to attitudes toward people with mental illness is a significant one. The authors found that college-aged individuals who received their information about mental illness from the electronic media were significantly more authoritarian, more in favor of social restrictiveness, and less willing to support the integration of mental health facilities into the community than were individuals who had received their information from other sources. The individuals who received their information from the electronic media were less tolerant than those who had received their information primarily from classes they had taken, from the print media, and from experience working with or having a family member work with people with mental illness. Tolerance was measured by a self-report instrument, the Community Attitudes Toward the Mentally Ill (CAMI) (Dear & Taylor, 1979). It is important to note that of all the demographic variables included in this study (e.g., race, gender, hometown population, year in school, and source of information), source of information was the only variable that had a significant impact on individual's attitudes. This finding is consistent with the belief that the media is a powerful source in influencing the public's perceptions.

The current study was intended to build on the Granello et al. (1999) research and to further investigate the relationship of television watching to attitudes toward people with mental illness. Specifically, the current research was designed to discover more about the individuals who cite television as their primary source of information about mental illness. It was hypothesized that among this group of individuals, the more television one watched, the less tolerant one would be toward people with mental illness. The type of television one watched also was investigated to determine if the amount of a particular type of television (e.g., daytime talk shows, news programming, prime-time dramas, etc.) was related to intolerance toward people with mental illness. No hypotheses were made regarding types of television that might lead to tolerance or intolerance.

METHOD

Participants

Participants were 183 undergraduate students at a large, Midwestern university. The survey included an item requesting information about the participant's primary source of information about mental illness. A total of 154 individuals (84%) correctly completed this item by marking only one primary source, as indicated in the directions. Of the 154, only the 53 students who reported that television was their primary source for information on mental illness were included in the analysis. Individuals excluded from the analysis indicated that they received their information about mental illness primarily from sources other than television. These included: experience with a family member or close friend with a diagnosable mental illness (16%, n = 24), experience with an extended family member or acquaintance with a diagnosable mental illness (15%, n = 23), work with or having a parent work with people with mental illness (14%, n = 22), coursework (16%, n = 24), or the print media (5%, n = 8).

The group of 53 individuals included in the analysis (the television group) was primarily female (70%, n =37), and Caucasian (81%, n = 42), with seven individuals self-identifying as African American, two as Asian American, and two identifying as members of other races. The average age was 20.54 (SD = 2.30), with a range of 18 to 31. These demographics were comparable to the overall sample, in which the participants were primarily female (69%), Caucasian (77%) and had an average age of 20.81. In the television group, participants were divided between undergraduate classes, with 9% identifying as freshmen, 44% as sophomores, 27% as juniors, and 19% as seniors.

Individuals were asked to indicate the approximate number of hours they spent each week watching television. From these answers, the respondents were divided into five categories: 0-5 hours (n = 14), 6-10 hours (n = 14), 11-20 hours (n = 11), 21-30 hours (n = 9), and 31 and over hours per week (n = 5). These categories were imposed on the data to create groups with approximately equivalent numbers of participants.

Instrument

The Community Attitudes toward the Mentally Ill (Dear & Taylor, 1979) was designed to measure the public's attitudes on several subscales. It is a 40-item, self-report instrument scored on a 5-point Likert scale. Respondents are asked to indicate the degree to which they agree with a particular item, with responses ranging from SA (strongly agree) to SD (strongly disagree). Half of the items are reverse-scored to minimize the possibilities of response set bias.

Alpha coefficients on the subscales of the CAMI range from .68 to .88 (Taylor & Dear, 1981). In the current study, alpha coefficients were: Authoritarian r = .62, Benevolence r = .79, Community Mental Health Ideology r = .87, and Social Restrictiveness r = .68. Factor analysis was used by the test authors to assess construct validity. There is evidence of some overlap between the subscales, with interscale correlations ranging from .63 to .77 in previous studies (Taylor & Dear, 1981), indicating that the distinctions between the subscales may be more of an academic distinction than a practical one. In the current study, interscale correlations ranged from .55 to .69.

The CAMI instrument contains an operational definition of mental illness. Participants are asked to respond to questions regarding their beliefs about mental illness and people who are mentally ill based on a statement in the instructions to the instrument that reads, "the mentally ill refers to people needing treatment for mental disorders but who are capable of independent living outside a hospital" (Dear & Taylor, 1979). There are four separate subscales on the CAMI: Authoritarianism, Benevolence, Community Mental Health Ideology, and Social Restrictiveness.

* Authoritarianism reflects the view of the people with mental illness as "an inferior class requiring coercive handling" (Taylor & Dear, 1981, p. 226). It includes topics such as the need to hospitalize those with mental illnesses and the importance of custodial care. Sample questions on this scale include: "As soon as a person shows signs of mental disturbance, he should be hospitalized" and "Mental illness is an illness like any other" (reverse scored).

* Benevolence was described as "a paternalistic, sympathetic view, based on humanistic and religious principles" (Taylor & Dear, 1981, p. 226). It addresses the beliefs that society should assume responsibility for those with mental illnesses, that people should be sympathetic and kind, and be willing to be personally involved (Thornton & Wahl, 1996). Sample questions include: "The mentally ill have for too long been the subject of ridicule" and "The mentally ill are a burden on society" (reverse scored).

* Community Mental Health Ideology has been conceptualized as traditional (mental hospital) versus nontraditional (community-based) mental health care. It addresses the belief in the therapeutic value of community and the acceptance of deinstitutionalized care (Thornton & Wahl, 1996). Sample questions include: "The best therapy for many mental patients is to be part of a normal community" and "Mental health facilities should be kept out of residential neighborhoods" (reverse scored).

* Social Restrictiveness was intended to measure "viewing the mentally ill as a threat to society" (Taylor & Dear, 1981, p. 226). It reflects sentiments involving the dangerousness of people with mental illness and the need to maintain social distance (Thornton & Wahl, 1996). Sample questions are: "The mentally ill should be isolated from the rest of the community" and "No one has the right to exclude the mentally ill from their neighborhood" (reverse scored).

The responses are scored in such a way that higher scores indicate greater agreement with the factor concept for each subscale. Therefore, a tolerant person would be expected to have higher scores on the subscales of Benevolence and Community Mental Health Ideology and lower scores on Authoritarianism and Social Restrictiveness. Responses to individual items are added together to form a subscale score, with a possible range from 10 to 50 on each subscale.

Procedure

All participants were given the CAMI questionnaire along with demographic questions during one of their regularly scheduled undergraduate courses in the College of Education. Selected courses were electives and included teacher preparation (primarily education students), study skills (university-wide enrollment), and career development (university-wide enrollment). Although participation was voluntary and students were given the option of declining participation in the study, all students in all classes surveyed completed the questionnaires for a 100% participation rate. The second author administered and collected the instruments. The demographic questions were included after the CAMI questions so as not to bias the opinions of study participants. Completion of the instrument took approximately 15 minutes.

Data Analysis

Several procedures were used to analyze this data. First, descriptive statistics were calculated for each of the demographic variables. Then, to answer the question of the relationship between the number of hours spent per week watching television and tolerance toward people with mental illness, monotonic trend analyses were conducted by the SPSS[R] MANOVA program (1996). Unlike regular ANOVAs that simply detect differences between groups, a specialized type of ANOVA, the trend analysis, is used to uncover whether there are trends in the data. Whereas an ANOVA would uncover whether individuals who watch between 0-5 hours of television per week are different in their attitudes than those who watch 6-10, 11-20, 21-30, and 31 and over, a trend analysis determines not only if there are differences, but if these differences follow a distinguishable pattern or trend. In this study, the trend analysis used was monotonic and not linear because the intervals for time spent watching television per week were not equal. The means score compared in each analysis were unweighted, because each of the four subscales on the CAMI had the same number of items and therefore had equal weight in the analysis. Eta was used as a measure of effect size (Rosenthal, 1994). Finally, a regression analysis was conducted on each subscale to determine if the number of hours spent watching a certain type of television program could predict intolerance toward people with mental illness.

RESULTS

On average, the 53 participants in the television group watched between 11 and 20 hours of television per week. The most common type of program they watched was sitcom (M = 2.46, with a range from 0 to 15 hours per week), followed by music television (M = 2.33, range = 0-20), daytime soap operas (M = 1.78, range = 0-12), television movies (M = 1.52, range = 0-16), sports (M = 1.46, range = 0-11), and news (M = 1.40, range = 0-12). Other programming included daytime talk (M = 1.12, range = 0-12), late night programming (M = .81, range = 0-10), dramas (M = .25, range = 0-3), cartoons (M = .13, range = 0-3), science fiction (M = .05, range = 0-2), and other (M = .28, range = 0-5).

Prior to running the trend analyses, the assumptions of the ANOVA were tested using the statistics derived from the SPSS[R] EXPLORE procedures (SPSS, 1996), and neither the assumption of normality nor homogeneity of variance was violated. The means for each CAMI subscale by the number of hours spent watching television per week are displayed in Table 1.

Table 1. Means and Standard Deviations for the CAMI Subscales by Hours per Week Spent Watching Television

                               CAMI Subscales

  Number of Hours      Authoriarianism    Benevolence
      Per Week

    0-5 (n = 14)
        M                   24.71              38.50
        SD                 (4.61)             (4.42)

   6-10 (n = 14)
        M                   25.14              37.64
        SD                 (3.76)             (3.88)

  11-20 (n = 11)
        M                   25.91              35.82
        SD                 (3.36)             (2.64)

   21-30 (n = 9)
        M                   26.11              35.78
        SD                 (2.93)             (4.84)

31 and over (n = 5)
        M                   31.00              33.40
        SD                 (5.39)             (4.72)

                              CAMI Subscales

  Number of Hours        Community           Social
      Per Week         Mental Health    Restrictiveness
                          Ideology

    0-5 (n = 14)
        M                  36.07             26.50
        SD                (6.67)            (5.91)

   6-10 (n = 14)
        M                  34.50             27.21
        SD                (6.24)            (4.71)

  11-20 (n = 11)
        M                  31.82             27.82
        SD                (5.44)            (3.43)

   21-30 (n = 9)
        M                  30.50             27.78
        SD                (5.63)            (3.90)

31 and over (n = 5)
        M                  30.00             29.20
        SD                (4.80)            (3.90)

Time Spent Watching Television

Statistically significant monotonic trends were observed for the Authoritarianism, F = 9.15, df = 3,48; p = .004; Benevolence, F = 6.93, df = 3,48; p = .01; and Community Mental Health Ideology, F = 5.64, df = 3,48; p = .02 scales, but not for the Social Restrictiveness scale, F = 1.29, df = 3,48; p = .26. Thus, in the current study, a trend analysis was able to uncover the following pattern--the more hours an individual spent each week watching television, the higher his or her score on Authoritarianism, and the lower his or her score on Benevolence and Community Mental Health Ideology. Individuals in the lowest category of television hours watched per week (0-5), had the lowest scores on Authoritarianism. As the number of hours increased, each subsequent category of hours watched had correspondingly higher scores on Authoritarianism. With the scales of Benevolence and Community Mental Health, individuals with the lowest number of hours watched per week had the highest scores on these scales. With each subsequent category of hours watched per week, the scores on these scales had corresponding reductions.

In this study, eta was used as a measure of effect size. For the three significant subscales, eta was .41, .37, and .37, respectively. Effect sizes above .30 are in the moderate range, as defined by Cohen (1988). The Social Restrictiveness subscale eta was .17, which Cohen defines as small. SPSS[R] MANOVA program can generate approximate post-hoc power values for each test. At an alpha of .05, power was estimated at .66, .52, and .52, respectively for the three statistically significant tests, and at .13 for the test on the Social Restrictiveness subscale. Thus, given the effect sizes observed above, there was more than a 50% probability of detecting a trend, if it does exist in the population, on all the subscales except Social Restrictiveness, where the chances were only a little better than 1 in 10.

Type of Television Program

Multiple regression procedures were used to investigate the relationship between the type of television shows watched and the scores on the four CAMI subscales. For each of the four regression equations, number of hours spent per week watching each type of television show was the predictor variable, and the CAMI subscale score was the criterion variable. Multiple regression procedures were used because variables were continuous, and there were multiple predictor variables with only one criterion variable (Schroeder, Sjoquist, & Stephan, 1986). For each equation, the predictor variables were selected through a stepwise procedure with entry criteria set at p [is less than] .05, and exit criteria set at p [is greater than] .10.

For the Authoritarianism scale, viewing of daytime soap operas accounted for the most variability ([R.sup.2] = .14). Viewing of sitcoms entered next and together with viewing of soap operas accounted for 23% of the variability in the Authoritarianism subscale. There was a positive correlation between viewing soap operas and sitcoms and scores on the Authoritarianism subscale. For the Benevolence scale, viewing of sitcoms entered first and accounted for 11% of the variability. Viewing of sports entered next and together with sitcoms accounted for 18% of the variability in the Benevolence subscale. There was a negative correlation between viewing of sitcoms and sports and scores on the Benevolence subscale. For the Community Mental Health Ideology scale, viewing of sports was the only predictor variable in the equation ([R.sup.2] = .14). There was a negative correlation between viewing sports and scores on the Community Mental Health Ideology. Finally, for the Social Restrictiveness scale, viewing of news programming was the only predictor variable in the equation ([R.sup.2] = .10). There was a negative correlation between viewing the news and scores on the Social Restrictiveness subscale. (See Table 2 for complete results of the multivariate regression equations).

Table 2. Results of Multiple Regression Using Type of Television to Predict CAMI Subscale Scores

Criterion Variable    Predictor Variables           Adjusted
(CAMI Subscale)       (Television Type)       R     [R.sup.2]

Authoritarianism      Step 1
                        Soap Operas          .38       .14

                      Step 2
                        Sitcoms              .48       .23

Benevolence           Step 1
                        Sitcoms              .33       .11
                      Step 2
                        Sports               .43       .18

Community             Step 1
Mental Health           Sports               .37       .14
Ideology

Social                Step 1
Restrictiveness         News                 .31       .10

Criterion Variable    Predictor Variables    Adjusted
(CAMI Subscale)       (Television Type)      [R.sup.2]

Authoritarianism      Step 1
                        Soap Operas             .12

                      Step 2
                        Sitcoms                 .20

Benevolence           Step 1
                        Sitcoms                 .09
                      Step 2
                        Sports                  .15

Community             Step 1
Mental Health           Sports                  .12
Ideology

Social                Step 1
Restrictiveness         News                    .08

Criterion Variable    Predictor Variables        Adjusted
(CAMI Subscale)       (Television Type)      [Delta][R.sup.2]

Authoritarianism      Step 1
                        Soap Operas

                      Step 2
                        Sitcoms                    .09

Benevolence           Step 1
                        Sitcoms
                      Step 2
                        Sports                     .07

Community             Step 1
Mental Health           Sports
Ideology

Social                Step 1
Restrictiveness         News

Criterion Variable    Predictor Variables         F for
(CAMI Subscale)       (Television Type)      [Delta][R.sup.2]

Authoritarianism      Step 1
                        Soap Operas

                      Step 2
                        Sitcoms                    5.79(*)

Benevolence           Step 1
                        Sitcoms
                      Step 2
                        Sports                     4.15(*)a

Community             Step 1
Mental Health           Sports
Ideology

Social                Step 1
Restrictiveness         News

Criterion Variable    Predictor Variables
(CAMI Subscale)       (Television Type)      [Beta]    t

Authoritarianism      Step 1
                        Soap Operas           .37      2.85

                      Step 2
                        Sitcoms               .31      2.41

Benevolence           Step 1
                        Sitcoms               -.33     -2.47
                      Step 2
                        Sports                -.27     -2.04

Community             Step 1
Mental Health           Sports                -.37     -2.75
Ideology

Social                Step 1
Restrictiveness         News                  -.31     -2.27

Criterion Variable    Predictor Variables
(CAMI Subscale)       (Television Type)        p

Authoritarianism      Step 1
                        Soap Operas          .006

                      Step 2
                        Sitcoms              .020

Benevolence           Step 1
                        Sitcoms              .017
                      Step 2
                        Sports               .047

Community             Step 1
Mental Health           Sports               .008
Ideology

Social                Step 1
Restrictiveness         News                 .028

N=51 (*)df 1,48

DISCUSSION

This study investigated the relationship between the amount of television watched and the level of tolerance toward people with mental illness. Previous research found that individuals who received their information about mental illness from the electronic media were less tolerant than those who received it from other sources (Granello et al., 1999). This study attempted to understand more fully this phenomenon by investigating in more detail the relationship of the media to intolerance toward people with mental illness. Only those individuals who stated that their primary source of information about mental illness was television were included in the analysis. Those individuals who stated their primary source of information on mental illness came from another source (e.g., having a family member with a mental illness) were not included, as it would appear that the amount or type of television they watched would have little influence on their attitudes.

The media was the primary source of information about mental illness for 34% of the respondents. Results of trend analyses indicated that for these individuals, the more television they watched per week, the more likely they were to indicate attitudes of authoritarianism toward people with mental illness. In addition, the more television they watched, the less likely they were to report attitudes of benevolence or community mental health ideology. The amount of television one watched was not, however, related to attitudes of social restrictiveness.

These findings are consistent with research that suggests that television portrays inaccurate and unfavorable images of mental illness. Concerns raised in the literature about the negative effects of the electronic media on public perceptions of mental illness are corroborated by this research. Wahl (1992) noted that there is much research to support the idea that repeated exposure to media stereotypes in general influences conceptions of social reality. For example, Gerbner, Gross, Morgan, and Signorielli (1980) found that heavy viewers of television (those who watch more than 4 hours per day) were more likely than light viewers (those who watch less than 2 hours per day) to give answers to questions about the nature of the world (e.g., how violent it is) that are congruent with television's distorted portrayals of reality. This current study is the first to empirically measure the role of the amount of television viewing toward intolerance toward people with mental illness. As the Gerber et al. study findings suggest, we found that heavier viewing is related to beliefs about mental illness that are congruent with negative images of mental illness portrayed on television. These findings were consistent, in spite of the fact that individuals in the current study watched, on average, less television (11-20 hours per week) than the national average for their age group (20-24 hours per week) (Nielsen Media Research, 1998). This suggests that even moderate viewing is related to intolerance toward mental illness. It is important to note, however, that the trend analyses do not imply causation. It is impossible to determine from this research whether the media causes those attitudes of intolerance or if intolerant individuals watch more television.

The type of television the participants watched accounted for a significant amount of the variance in their scores on the CAMI subscales, with between 10% to 23% of the variance explained by the amount of time they spent watching particular types of television shows. For three subscales, watching certain types of television was correlated with attitudes of intolerance. Viewing daytime soap opera and sitcoms was correlated with more authoritarian attitudes. Viewing sitcoms and sports was correlated with less benevolent attitudes. Viewing sports was correlated with lower community mental health ideology. However, watching the news was correlated with a lower score (e.g., higher tolerance) on the Social Restrictiveness subscale.

The current study was an explanatory analysis and thus few a priori hypotheses could be made. However, the emergence of daytime soap operas and primetime sitcoms as contributing to intolerance is not surprising, given research on the frequency and inaccuracy of portrayals of mental illness in these genre (Fruth & Padderud, 1985; Signorielli, 1989;Wahl & Roth, 1982). The failure of daytime talk shows to emerge as accounting for a significant amount of the variance is a rather surprising finding, given the recent emphasis on daytime talk as contributing to intolerance and incivility in general (e.g., Heaton & Wilson, 1995). The emergence of news programming as contributing to tolerance toward people with mental illness also is a rather surprising result. A 1998 study by Rose found that 65% of the people with mental illness shown on the news were portrayed as having committed acts of violence toward others. Viewers of news programming, therefore, have the majority of their exposure to people with mental illness occur in a violent context. Thus, it is surprising that the more news programming participants in this study watched, the less socially restrictive they reported themselves to be. It is very possible that an intervening variable accounted for this tolerance. Viewers of news programming may have certain characteristics of tolerance (e.g., education, social awareness), and it may be these characteristics, not the viewing of news programs, that accounted for the higher tolerance.

Limitations

There are some limitations to the study that must be addressed. First, as the study is self-report, it relies on the participants to determine the primary source of their information, and it is possible that individuals are unaware of which source of information had the primary influence on their current views about mental illness. A second limitation is the possible effect of social desirability on the scores. The questions are straightforward, and it is not difficult to determine the "socially correct" response. A third limitation involves the construct validity of the CAMI instrument. Interscale correlations are quite high for several subscales and raise the concern that the subscales do not measure discrete attitudes. Finally, the study participants were limited in age and restricted to undergraduates, which limits the generalizability of the findings.

Implications for Mental Health Counselors

Recently, there has been an increasing emphasis in the counseling literature on the social advocacy role for mental health counselors. Working toward the reduction of stigma toward people with mental illness is inherent in this role. While it is clear that the media is a powerful tool for perpetuating stereotypes, it is also clear that the media could play a constructive role in educating the public about mental illness (Linter, 1979). According to Mayer and Barry (1992), "although the media must report news as it happens, there is also an obligation to provide a balanced view. The balance needs to include positive news: the successful recovery, the new treatment intervention, and the importance of community living" (pp. 77-78). Research has demonstrated that positive programming can have an effect on the public's perceptions about mental health policy issues (Medvene & Bridge, 1990).

Mental health counselors have a role to play in improving media coverage of mental illness. Several examples of what could be done include:

* Appoint a liaison from a mental health association to work with the media to help provide accurate and realistic information on mental illness (Matas, el-Guebaly, Peterkin, Green, & Harper, 1985). Local chapters of the American Mental Health Association (AMHCA) or the American Counseling Association can create a position on their boards for a media advocate. This person can contact local media outlets and offer to serve as a source of information and forward pertinent and accurate information to these media outlets for possible distribution.

* Attempt to publicize more good news about mental illness. For example, former clients who have been successfully treated can be encouraged to speak up about their positive experiences with mental health treatment (Matas et al., 1985) or respected celebrities who have had a mental illness can be encouraged to publicly discuss their experiences (Hyler, Gabbard, & Schneider, 1991).

* Write letters to television stations that contribute to the stigmatization of people with mental illness or letters to the editor that correct inaccurate portrayals of mental illness (Paramount denies, 1990). At times when mental illness is particularly in the news, mental health counselors can write letters to local newspapers and contact local television stations, offering to share corrective information.

* Participate in public information campaigns, such as Mental Illness Awareness Week (Hyler et al., 1991).

* Write a regular column for a local newspaper. Local AMHCA chapters or interested counselors can support a regular column in a local newspaper with information about particular mental disorders. The column can choose to focus on a particular disorder with each publication and give accurate and useful information to the general public about that disorder.

* Encourage recognition of documentaries that present accurate depictions of actual persons with mental disorders (Hyler et al., 1991).

* Help clients and their families to understand and explore the pervasiveness of the stigma and its intrusion into the homes of people with mental illness via the television. Bring up the topic of stigma within the counseling session and help clients to understand how it contributes to many of their presenting problems, including isolation, withdrawal, family problems, occupational difficulties, etc.

* Serve as a constant reminder--to clients, families, and friends--that television is intended to make money, not to educate. Whenever and wherever possible, help people to understand that what they see on television is not necessarily an accurate portrayal of reality.

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Darcy Haag Granello, Ph.D., is an assistant professor of Counselor Education, and Pam Pauley is a doctoral student in Counselor Education at The Ohio State University in Columbus, OH.

The authors wish to thank Dr. S. Martin Taylor for his assistance in obtaining the CAMI questionnaire. Correspondence regarding this article should be sent to Dr. Granello, Counselor Education, PAES, 283 Arps Hall, 1945 North High St., Columbus, OH 43210. Email [e-mail].