Nearly four in 10 news stories about mental illness analyzed by Johns Hopkins Bloomberg School of Public Health researchers connect mental illness with violent behavior toward others, even though less than five percent of violence in the United States is directly related to mental illness.

The findings, published in the June issue of Health Affairs, suggest that this routine linkage of mental illness with violence toward others paints an unfair portrait of those with mental illness, suggesting that most are prone to violence when numerous studies have concluded that only a small percentage actually commit violence. The researchers, who examined a sample of stories published in top-tier media outlets over a 20-year period, say they were surprised that there was little change in how the media portrayed people with mental illness. If anything, they say, the portrayals may have increased the stigma toward people with mental illness. Just one percent of newspaper stories linking violence with mental illness appearing on the front page in the first decade of the study period (1994 to 2005) compared with 18 percent in the second decade (2005 to 2014).

"Most people with mental illness are not violent toward others and most violence is not caused by mental illness, but you would never know that by looking at media coverage of incidents," says study leader Emma E. "Beth" McGinty, PhD, MS, an assistant professor in the departments of Health Policy and Management and Mental Health at the Bloomberg School. "Despite all of the work that has been done to reduce stigma associated with mental health issues, this portrayal of mental illness as closely linked with violence exacerbates a false perception about people with these illnesses, many of whom live healthy, productive lives.

"In an ideal world, reporting would make clear the low percentage of people with mental illness who commit violence."

In any given year, 20 percent of the U.S. population suffers from mental illness and, over a lifetime, roughly 50 percent receive a diagnosis.

For their study, the researchers analyzed a random sample of 400 news stories about mental illness over a 20-year period that appeared in 11 high-circulation, high-viewership media outlets in the United States. The most frequently mentioned topic across the study period was violence (55 percent), with 38 percent mentioning violence against others and 29 percent linking mental illness with suicide. Treatment is mentioned in 47 percent of stories but just 14 percent described successful treatment for or recovery from mental illness.

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"Stories about successful treatment have the potential to decrease stigma and provide a counter image to depictions of violence, but there are not that many of these types of narratives depicted in the news media," McGinty says.

A deeper dive into the media coverage found that depictions of mass shootings by individuals with mental illness increased over the course of the study period, from nine percent of all news stories in the first decade to 22 percent in the second decade. The number of mass shootings, according to FBI statistics, has remained steady over the time period. Among the stories that mentioned violence toward others, 38 percent mentioned that mental illness can increase the risk of such violence while eight percent mentioned that most people with mental illness are never or rarely violent toward others.

Schizophrenia was the specific diagnosis most frequently mentioned as related to violence (17 percent) and the two most frequently mentioned risk factors for violence other than mental illness were drug use (five percent) and stressful life events (five percent).

One limitation of the study is that it did not include stories from local television news, where large segments of Americans get their news.

McGinty says the negative stories add to the perception that people with mental illness are dangerous, a stigmatizing portrayal that prior studies have shown leads to a desire for social distance from people with mental illness: people who say they wouldn't want to work with someone with mental illness or wouldn't want someone with mental illness to marry into their families. Such stigma can lead to a reluctance among people with symptoms to seek treatment, problems staying in treatment and discrimination regarding housing and employment.

She concedes, however, that it may be difficult for members of the news media not to assume mental illness is in play because of the idea among many that anyone who would commit violence, especially mass shootings, must have mental illness.

"Anyone who kills people is not mentally healthy. We can all agree on that," McGinty says. "But it's not necessarily true that they have a diagnosable illness. They may have anger or emotional issues, which can be clinically separate from a diagnosis of mental illness. Violence may stem from alcohol or drug use, issues related to poverty or childhood abuse. But these elements are rarely discussed. And as a result, coverage is skewed toward assuming mental illness first."