International Review of Psychiatry (2002), 14, 26–33

ISSN 0954–0261 print/ISSN 1369–1627 online/02/010026–08 Institute of PsychiatryDOI: 10.1080/0954026012011403 2

Media influences on mental health policy: long-term effects of the Clunis and Silcock cases1

ANGELA HALLAM

Centre for the Economics of Mental Health, Institute of Psychiatry, London, UK

SummaryThe policy of community care for people with mental illness came under intense scrutiny during the 1990s, following a series of homicidesand incidents of violence, suicide and neglect. The media appeared to be particularly successful in highlighting such cases, influencingpublic opinion and inspiring policy responses. This paper reports a small research project that set out to explore ways in which materialpublished in national newspapers has impacted on the development of mental health policy. Two cases involving people with a diagnosisof schizophrenia were selected as the focus of the study: Christopher Clunis, who killed a stranger at a London tube station and BenSilcock, who climbed into the lions’ den at London Zoo. The press coverage these incidents received, at the time they happened and overthe next 8 years, was analysed and, as far as possible, the published material’s effects on policy decisions were traced. The majority ofrelevant articles appeared in the broadsheet papers, with surprisingly little interest shown by the ‘popular’ tabloid press. Emotive, head-line-catching language was used to describe the predicament of Ben Silcock and Christopher Clunis, but not solely by journalists whoseknowledge of mental health issues might be limited. Both cases were associated with well-informed campaigners who wished to ensurethat people suffering from mental illness received better care and attention. By highlighting the risks individuals with schizophrenia maypose to themselves and (in particular) to others, however, such publicity has contributed to an unbalanced policy debate. Policymeasures introduced in response to public concerns about risk and dangerousness have served to impose additional constraints on peoplewith mental health problems. In addition, responsibility (and blame when systems fail) has increasingly been devolved to individualservice professionals, a development which is likely to have long-term implications for recruitment and morale in health and social careprofessions.

Introduction

Background to the research

Mental health service users have been at the centre ofpassionate public and policy debate during the last10 years in the UK. Massive redistribution ofpatients from Victorian psychiatric hospitals hasmeant that people with mental health problems areincreasingly visible in public places, as are the symp-toms of their disorders and the effects of medicationused to treat them. A series of high profile homicidecases during the 1990s led to widely expressedconcern about public safety, and evidence of theneglect of vulnerable individuals triggered publicindignation. Headlines in the national newspaperssuch as ‘Freed mental patients kill two a month’(Daily Mail, 13 October 1997), ‘Caring daughterkilled by human timebomb’ (Daily Mail, 28 May1993) and ‘Abandoned to wreak havoc’ (DailyMirror, 24 February 1994) increased the atmosphereof unease.

A small piece of independent research was carriedout early in 2001 to explore the impact of the mediaon the design of mental health policy. The hypothesiswas that the media influence not only public atti-tudes towards mental illness, as demonstrated by

previous research (for example: Philo & Secker,1994; Philo, 1997a, 1997b; MIND, 2000) but alsopolicy development. The research focused on themedium of the national press and, because of thecase-specific nature of media interest, it was decidedto explore the newspaper coverage of those incidentslikely to have had the greatest, and most long-termeffects on the policy-making process.

Newspapers are major sources of topical informa-tion: the 10 national daily papers sell a total of over13 million copies a day and 60% of the adult popu-lation read at least one national Sunday paper(research.expressnewspapers.co.uk/intronn.html).While television news and current affairs provide aservice for the whole nation, newspapers have agreater journalistic and editorial freedom, as theytarget sub-groups (Barnes & Earnshaw, 1993).

Examination of the literature revealed that specificpolicy initiatives have been claimed by journalists tobe responses to many individual cases, but the namesof Christopher Clunis (who killed Jonathan Zito, astranger, in an unprovoked attack on the platform ofa tube station) and Ben Silcock (mauled when heclimbed into the lions’ enclosure at London Zoo) areprobably the most well known (Bean, 2001; Rumgay& Munro, 2001; Johnson et al., 1997). Both

Correspondence to: Angela Hallam, Centre for the Economics of Mental Health, Health Services Research Department,Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK. E-mail: cemh@iop.kcl.ac.uk

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Media influences on mental health policy 27

incidents happened in London, in December 1992;each involved a young man suffering from schizo-phrenia and a breakdown in service provision. Thecases were highlighted in the press when the power ofsupervised discharge was announced in 1993 andwhen the new Mental Health Act White Paper waspublished, more than 7 years later. The report intothe care and treatment of Christopher Clunis, pub-lished in 1994, became ‘iconic’ as an informationsource of how mental healthcare was (and was not)working (Turner et al., 1999).

Methodology

The Lexis-Nexis software system was used toretrieve the headlines, dates and sources of all refer-ences to Christopher Clunis, Jonathan Zito and BenSilcock in national newspapers between December1992 and December 2000. Six hundred and seventy-five relevant articles were identified. The original aimwas to download all the data produced in response tothe key words, and to conduct a systematic analysisof press coverage over time. Resources and access tothe software were limited, however, so the objectivehad to be modified. After examination of presscoverage of the incidents at the time they occurred, abroad overview was conducted, with attention paidto detail in a sample of articles.

Headlines were sorted by date; every month inwhich the number of headlines reached 10 or morewas selected for further investigation. The full text ofa selection of broadsheet and tabloid articles for eachof these months was then retrieved, using the samesoftware. After examination of these data, anotherstage in the selection process eliminated data thatappeared to contribute nothing new to the policydebate (Mr Clunis’s unsuccessful attempt to sue thehealth authority responsible for his care, for example,and use of Mr Clunis’s or Mr Silcock’s name eachtime a failure in community care provision wasreported). Although these data were not analysedany further, it should be acknowledged that theyensured the names were not forgotten by journalists,policy-makers or by the general public.

Press coverage analysed in detail included theimmediate aftermath of the incidents; the trial ofChristopher Clunis; publication of the report into hiscare and treatment; publication of the report intohomicides and suicides by people with mental illness;and publication (in 1998) of the strategy documentModernizing Mental Health Services.

Historical and cultural representations of people with mental illness

The tendency of society to reject those who do notconform has ensured that, throughout history, themad person has been assimilated with the criminal,the vagabond and the indigent (Foucault, 1961).

Legislation making special provision for the mentallydisordered has been in place since 1324 (Zigmond,1998). As a source of fear and fascination, madnesshas found itself locked into a shifting landscape ofcultural images and preoccupations down thecenturies: an object of curiosity and mockery in theceremonies of Bedlam; the final downfall of excessivehabits in Hogarth’s Rake’s Progress; and the‘madwoman in the attic’ who haunts the margins ofnineteenth century novelists’ texts (Pearson, 2000,p. 166).

The ‘lunatic on the loose’ was a popular imagewith audiences in the early years of cinema. In thisformula, order is restored and the situation resolvedwith the protagonist’s safe return to custody. Fromthe 1950s onwards, insanity came to be associatedwith the disintegration of personality, loss of controland consequent violence. Beginning with ‘Psycho’,the formula spawned a dynasty of evil ‘psycho-killers’which are still thrilling audiences today (Byrne,1998).

The poet, novelist, artist and film-maker gaveexpression to popular imaginings of madness andhelped to shape them: the mass media have takenover that role. Now that the psychiatric institution nolonger serves as a convenient bulwark, the image is ofunchecked madness stalking the streets, the lethalpotential of ‘rampant and racially tinged violentmasculinity’ (Pearson, 2000, p. 166).

Care in the community: policy context

The history of the psychiatric hospital closure pro-gramme in the UK has been underpinned bytension between the quality of life that can be pro-vided for vulnerable people with high support needsand the financial implications of providing services.By the 1960s, normalization theories were begin-ning to emphasize the right to be valued in societyand to participate in the mainstream of life (Ramon,1991). The introduction of neuroleptic drugs, andtheir effectiveness in reducing positive psychoticsymptoms, had made it easier to care for peoplewith severe psychiatric problems outside a hospitalsetting (Leff, 1997; Johnson et al., 1997). The hos-pital stock itself was predominantly more than acentury old, recruitment of staff was difficult andfinancial incentives had failed to raise standards. Anumber of well-publicized scandals relating to thetreatment of patients in long-stay hospitals awak-ened public interest and concern (Carrier &Kendall, 1997). Progress with reprovision was slow,however, until the policy emphasis on communitycare gained support with the dawn of the Conserva-tive Government’s ‘value-for-money’ imperative ofthe 1980s. It was believed that hospitals providinglong-term care were more expensive than commu-nity services of comparable quality. Furthermore,many hospitals were sitting on prime building land:

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28 Angela Hallam

sale of these sites might be expected to release quickinjections of money into State coffers (Knapp et al.,1997).

In 1990, the Junior Health Minister (StephenDorrell) was reported as saying that the Governmentwould be carrying forward ‘with a renewed vigour’the shift from hospital-based psychiatric care tocommunity-based treatment. However, his com-ments came against a ‘backdrop of mounting uneaseover the rundown and closure of long-stay psychiat-ric hospitals, leaving some former patients living onthe streets’ (Guardian, 13 November 1990). Anxietywas expressed in the press: under the headline ‘Fearon the streets’ a journalist reported on ‘the potentialdanger in releasing psychiatric patients from hospitalwithout the backup of proper community care’(Guardian, 5 February 1992). ‘Homeless formerhospital patients an affront to society’ warned theIndependent in January 1992.

Concerns in the community: 1992

There had been tragedies in community settingsbefore Christopher Clunis killed Jonathan Zito: theDepartment of Health had already set up an inquiry(directed by Dr William Boyd) into suicides andhomicides by people with mental illness. The timingof the Clunis and Silcock incidents was particularlyunfortunate for the Government, however, happen-ing just 3 months later the final phase of the 1990NHS and Community Care Act was due to be imple-mented. There was an atmosphere of dislocation andsuspicion among service professionals as April 1993approached, especially as the core of the Govern-ment’s policy, which involved the restructuring ofsocial services departments and changed roles forsocial work staff, was known to be an attempt to cur-tail excessive spending on residential care (Lewis &Glennerster, 1996).

Findings

Eight years’ press coverage of the Clunis and Silcock incidents

The incidents of December 1992 generated a gooddeal of press interest: in the 8 years ending December2000, 420 articles in major world newspapers madereference to Christopher Clunis or Jonathan Zito;and Ben Silcock’s experience was used in 255separate articles. What is, perhaps, surprising, can beseen when the press coverage is considered month bymonth (Figure 1).

The homicide evoked little press interest at thetime it happened, whereas there was a massive mediaresponse to Ben Silcock’s experience in the lions’enclosure. Six months later, the trial of ChristopherClunis drew a large amount of media attention, inwhich the Silcock incident was remembered asanother failing of community care policy, butsubsequently their media presence followed differenttrajectories.

The incidents as news

The death of Jonathan Zito was reported in twonational papers. The Times devoted 53 words tonews of the ‘tube murder charge’, while the DailyMail focused on the reversal of fate for the Zitofamily (‘son who planned a Christmas get-together istube stab victim’). One sentence noted that a manhad been charged with murder (Daily Mail, 19December 1992). Next day, the Mail on Sundaynoted that Mr Clunis said nothing during a briefcourt appearance. It was 6 months before the inci-dent received any further coverage in the nationalpress.

Research by media groups has shown that no eventis naturally newsworthy. What appears as ‘news’ is anend product: a journalistic creation that is the result

Figure 1. Number of newspaper articles mentioning Clunis or Silcock incidents (month by month).

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Media influences on mental health policy 29

of the operation of a complex set of criteria of news-worthiness (Philo, 1983). The origins of news valuesare complex, including values about society, journal-istic conventions and the nature of sources, but themore criteria an event satisfies, the more likely it is toreported (Fowler, 1991). The less serious incident inDecember 1992 apparently met a greater number ofsuch criteria.

Ben Silcock’s experience was announced on 1January 1993. Under the headline ‘savaged in thelions’ den’, the Daily Mail account of the incidentwas colourful: the victim was ‘tossed around like arag doll’ while ‘dozens of visitors watched in horror’.The Zoo’s Chief Executive was quoted on safetyrecords and emergency responses, and animal loverswere assured that the lion would not be put down(Daily Mail, 1 January 1993). No mention was madeof Mr Silcock’s mental illness.

Next day, the Daily Mail featured a very differentarticle, under the headline ‘Can no one help tragicyoung men like Ben?’ The style was emotive. Whyhad the young man climbed a high fence to face‘certain injury and possible death?’ The answer, ‘inone shuddering word, is schizophrenia’. The writerwas Marjorie Wallace, a friend of the Silcock familywho, as a journalist, had worked with Ben’s father.She was also Chief Executive of the voluntary organ-ization Schizophrenia A National Emergency(SANE) and an experienced mental health cam-paigner. The incident provided a major opportunityto use her skills and influence and, 2 days later, theDaily Mail ran the headline ‘Ben’s tragedy bringshope: Minister acts after the Mail’s disturbing reporton lion man’. Virginia Bottomley had contactedMarjorie Wallace after reading her article and was‘planning a shake-up of mental health laws’ inresponse to Mr Silcock’s ‘schizophrenia torment’. Inthe light of subsequent policy developments andincreasing surveillance of the lives of people withmental illness, it is interesting to note the phrase that

had particularly impressed the Health Secretary: ‘thecruel catch of the illness is that to get treatmentsomeone has to be too ill to know they need it’ (DailyMail, 4 January 1993).

Seventy-six articles about the incident appeared inthe national press in January 1993 alone. Figure 2shows how they were distributed between newspa-pers. Clearly the Mail (which was running acampaign in the aftermath of Ms Wallace’s article)included the highest number of comments on thesubject, but the Times was close behind and the threeother broadsheet papers were all well represented.What is, perhaps, surprising, is the absence of articlesin the ‘popular’ tabloids (Sun, Mirror, Daily Star).

It was beyond the scope of the research to test thetrue weight of public opinion in January 1993 infavour of placing greater restrictions on people withmental illness. However, the message from mentalhealth experts (as professionals and carers, andincluding Ben Silcock’s father) was that investmentwas needed in acute provision for people while theywere in crisis and in services they would actuallywant to use. Mrs Bottomley’s plans, however, out-lined in the Ten Point Plan which was published7 months later, focused on a scheme for superviseddischarge for psychiatric patients considered at risk,and registers of mentally ill people discharged to livein their own home (Department of Health, 1993).

It was more difficult to trace a specific policyresponse to press coverage of the Christopher Cluniscase, because the publicity followed that associatedwith Ben Silcock. It has already been noted that theincident itself aroused little press interest. It is sur-prising that there was no mention of the incident inconnection with the debate over Ben Silcock whicherupted a few days later, so it seems that Mr Clunis’sdiagnosis of schizophrenia had not been revealed tothe press at that time. This is interesting in relationto the earlier discussion of news values. It may bethat the random killing of a young, newly married,

Figure 2. Number of newspaper articles relating to Ben Silcock incident during January 1993.

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30 Angela Hallam

talented man in a public place is not enough toattract press interest: it is the mental illness of theperpetrator that tips the scales.

The trial of Christopher Clunis

Figure 3 shows the distribution between newspapersduring the 8 years following the homicide. TheMirror was the only ‘popular tabloid’ to be repre-sented, and the Mail the only ‘middle markettabloid’.

There was no month in which press coveragerivalled the exposure given to the Silcock incident inJanuary 1993, although 45 newspaper articlesappeared during the month following the trial ofChristopher Clunis. The first account of the trial, inthe Evening Standard on 28 June 1993, wasrestrained. Noting that Mr Clunis had pleaded guiltyto manslaughter on the grounds of diminishedresponsibility and would be held in a secure hospitalindefinitely, it mentioned only in passing that he hadfailed to keep outpatient appointments.

The unusual feature of the case, to which most ofthe article was devoted, was the behaviour of MrZito’s widow. Jayne Zito said the Government,rather than her husband’s killer, was to blame. Sheappeared to feel no hatred for Mr Clunis, who was‘not able to take responsibility’ and pointed out thather husband would still be alive ‘if someone hadtaken care of Mr Clunis’.

Subsequent press coverage was less measured.Next day, the Daily Mail’s headline put a direct ques-tion into the mouth of Mrs Zito: ‘Why was he set freeto kill my husband? Widow’s question as psychoticknifeman is locked away at last’ (Daily Mail, 29 June1993). A few days later, under the headline‘Compassion that has ended in a trail of horror’ the

Daily Mail agonized over the ‘deadly potential offreed schizophrenics’.

Jayne Zito’s role helped to ensure continuing pub-licity for the Clunis case. Initially operating alone ina campaign for a public inquiry into her husband’sdeath, she was outspoken in her criticism of policyand politicians. After meeting Virginia Bottomleyand Health Minister John Bowis, she was reported assaying they were ‘patronizing’ and had tried to turnthe incident into a personal tragedy ‘instead of tack-ling the questions that need to be answered aboutCare in the Community’ (Independent, 19 July 1993).Her remit broadened in 1994 when she aligned her-self with MIND. Later the same year she set up herown organization, and subsequent comments onpolicy came from the Zito Trust. In the press, how-ever, her name is usually linked specifically with thatof Mr Clunis.

Publication of the Ritchie report

The result of the inquiry into the care and treatmentof Christopher Clunis was published in February1994. Although it traced a ‘catalogue of failure andmissed opportunity’ (Ritchie et al., 1994, p. 105) thetone of the report was measured. The inquiry made12 recommendations, including investment in acutebeds and ‘haven-type’ accommodation, specialistteams to work with people deemed a potential risk tothemselves or others, and training in mental illnessfor the police (Ritchie et al., 1994). The reportspecifically avoided singling out a person, service oragency for particular blame, concluding that theproblem was ‘cumulative’.

Thirty-two articles appeared in national newspa-pers within a week and apportionment of blamefeatured prominently in 81% of these. When

Figure 3. Distribution of newspaper articles relating to Christopher Clunis/Jonathan Zito (1992–2000).

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Media influences on mental health policy 31

commenting on the findings of the Ritchie report(and despite the efforts of the inquiry team to retainobjectivity in the document) seven articles singledout social services departments for blame and sevenquoted Ritchie as blaming community care policy.The specific failings of the police service and healthservices were each noted six times and lack ofresources received six mentions. In addition, JayneZito held Virginia Bottomley personally accountablefor her husband’s death (Guardian, 25 February1994) and Virginia Bottomley blamed Labour-runcouncils for squandering funds on safari trips foryoung offenders (Observer, 27 February 1994).Marjorie Wallace commented that the reportacknowledged that ‘care in the community was fail-ing’ (Times, 25 February 1994). A single articleincluded a plea to avoid overreacting to the Clunisincident (‘one tragic death must not be transformedinto a multiple tragedy’, Guardian, 25 February1994).

Publication of the Boyd report

In the years that followed, the ‘tube murder case’ wasused by the media as a symbol of the failings of com-munity care policy. Although more difficult to link tospecific policy initiatives, reflection of the tense envi-ronment that ensured the potency of this image is asrelevant to the hypothesis of the evaluation as themoves of the media and politicians in the early daysafter the incidents.

The committee headed by Dr William Boyd pub-lished its preliminary findings into homicides andsuicides committed by people with mental illness inAugust 1994 (Steering Committee, 1994, 1996). Asnoted earlier, the inquiry was set up before the eventsof December 1992, but there was a resurgence ofpress interest in the cases of Ben Silcock andChristopher Clunis, nonetheless, as can be seen fromthe graph in Figure 1.2

Tabloid papers do not have a monopoly on sensa-tionalist methods of reporting the news. The DailyTelegraph greeted the Boyd report’s publication withthe memorable banner headline: ‘One murder a fort-night by mentally ill’ (Daily Telegraph, 17 August1994). This article is a particularly interesting pieceof journalism. Statistics from the Boyd report appearin three places and each time the number of homi-cides is followed by some reference to patients’disengagement from treatment. The article beginswith the announcement of 34 murders in 18 months,followed by news that ‘more than half the killings’were carried out by people who had failed to takemedication or cooperate with treatment. Later, thefindings are set in context: 34 homicides over an18 month period were committed by people who hadreceived psychiatric treatment during the 12 monthsprior to the incident. In an examination of 22 of thecases, it is added, 13 people had stopped taking

medication and had disengaged with services. So‘more than half’ actually relates to a sub-sample ofthe 34. In column three, the focus turns to thehomicides in the context of the 600 or 700 totalkillings per annum. It is noted that murders bypsychiatrically ill people are ‘very rare indeed’ butthat homicides ‘often followed the patients’ failure tocooperate in their treatment’. Careful reading of thearticle allows an understanding of the report’sfindings, but they are easily missed ormisinterpreted.

Modernizing mental health services

Early in the second year of Tony Blair’s first term inoffice, Health Secretary Frank Dobson announcedthat ‘community care has failed’ (Department ofHealth, 1998a). The phrase also appears in his fore-word to the strategy document Modernizing MentalHealth Services (Department of Health, 1998b).The press anticipated the announcement: ‘£1bn toend care in the community’ was the headline in theGuardian on 25 July 1998. Over the next week, manyheadlines mentioning Christopher Clunis includedthe message that community care had been‘scrapped’, ‘thrown out’ or ‘shaken up’; and that itwas a ‘tragic’ or ‘failed’ policy. ‘At last someone haslistened to my prayer,’ Jayne Zito was reported assaying (Mirror, 30 July 1998). ‘Murders, suicides,broken families … thank God this obscene system isnow being changed,’ commented Marjorie Wallace(Daily Mail, 29 July 1998).

Discussion

Media-generated public anxiety, slow developmentof community-based services, inadequate fundingand the lack of effective liaison between provideragencies are stressful for service professionals, frus-trating for users and their carers and haveoccasionally ended in tragedy. Specific problemsinvolved in implementing community care policyhave been highlighted by the House of CommonsHealth Committee (2000) and the Boyd Committee,as well as the Ritchie Inquiry and other homicideinquiry teams (for example: Williams & Hennessey,1999; Richardson et al., 1997). The message comingfrom central Government that community care hasfailed is confusing, however, for professionals andservice users alike. The most notable change in hos-pital use has been the reduction in long-term carebeds. A full range of community services does not yetexist and, while ‘only half-implemented’, the successor failure of community care cannot be judged(Thornicroft & Goldberg, 1998).

Given the emphasis of most media coverage, thepublic could reasonably assume that all tragediescould be averted if people with a diagnosis of

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schizophrenia took their medication and compliedwith treatment. Such a belief contributes to anunbalanced debate and its associated risks: increas-ing public intolerance and mental health policydesigned to contain public fear (Sayce, 1995). Inattempts to counter stereotypical perceptions aboutmental illness, pressure groups are now addressingthe ways in which mental health issues are reportedin the media and encouraging people with mental ill-ness to express their own experiences through mediaoutlets (Byrne, 1999; Mental Health Foundation,1997; MIND, 1994).

Although media attention to such incidents hasescalated, there was actually little fluctuation innumbers of people with a mental illness committinghomicide in England and Wales between 1957 and1995, a time when the total number of homicidesincreased by 450% (Taylor & Gunn, 1999; Bennett,1996; Steering Committee, 1996). Furthermore,analysis of 40 homicide inquiry reports showed thatmore killings could be prevented by improving theresponse to patients who start to relapse, regardlessof their assessed potential for violence, than by tryingto identify high-risk patients and targeting resourceson them (Munro & Rumgay, 2000).

The ‘blame culture’ engendered by the case-specific nature of homicide inquiries is currently amatter of particular concern (House of CommonsHealth Committee, 2000, paragraph 73; Szmuk-ler, 2000). When services fail, blame may bedevolved on individual professionals rather thanthe policies of central Government (Atkinson,1996; Harrison, 1996). No account is taken of theextra work and responsibility involved (Whitehead,1996). Ultimately, this is likely to affect recruit-ment to the caring professions: the Institute ofPsychiatry has already noticed such an effect and isplanning research on the health consequences ofmandatory homicide inquiries for psychiatrists(House of Commons Health Committee, 2000,paragraph 73).

The names of homicidal patients and their victimsare well known. The public are less familiar withother (equally tragic) victims of the mental health-care system: those who have died in Broadmoor, oras a result of neuroleptic drugs. Such deaths werereckoned to be running at about one a week at thetime of the Clunis and Silcock incidents (MIND,1994). Munir Majotti died in hospital in York afterbeing injected five times within 40 minutes, eachtime with the maximum recommended dose of apowerful neuroleptic (Rickford, 1995). There was nooutcry in the newspapers about deficiencies in thecare provided for him, or his untimely end.

Conclusions

The research set out to look for evidence of a directlink between press coverage of the Clunis and

Silcock incidents and the subsequent design ofmental health policy. At the outset, it was expectedthat much of the material relating to the two inci-dents would come from the tabloid press, and thatthe effects of stereotypical views about mental illnessand dangerousness would be the issues to be ana-lysed. With the exception of the Daily Mail, however,the tabloid press appears to have shown little interestin these cases, although the issues raised may havepermeated the ways in which mental health issues arediscussed in the popular press. In a more extensivepiece of research, it would be interesting to tracesuch an effect.

The link that appears to exist is, at least in part, theresult of the ways in which the media have been usedby individuals. Both these cases are associated withwell-informed campaigners aiming to ensure thatpeople suffering from mental illness receive bettercare and attention (for themselves or for the safety ofothers). It has been argued (Taylor & Gunn, 1999)that, by highlighting killings by people with mentalillness, the activities of the Zito Trust may haveserved most prominently to influence the drive tomore restrictive care. Service users have expressedfrustration that an ‘under-educated and prejudicedpublic’ are scared into fearing the worst about peoplewith mental health problems (Simmie, 1998). How-ever, as pointed out by its Director, the Trust was setup to support the victims of community care failures(Howlett, 2000). The emphasis is important: thewishes and feelings of service users are not the focusof this agenda.

A campaigner may use the media to affect policydesign: a review of mental health services wasannounced as a direct response to the reporting ofthe Ben Silcock case. However, timing is crucial: inJanuary 1993 there was already concern amongpolicy-makers about the actions of a small number ofpeople with mental illness who had been dischargedfrom hospital prematurely, and the inquiry directedby Dr Boyd had begun its work.

Community care policy has had a troubled historyand policy measures introduced in response to publicconcerns about risk and dangerousness have furtherstigmatized people with serious mental health prob-lems. The White Paper Reforming the MentalHealth Act states that in new legislation ‘concerns ofrisk will always take precedence’ (Department ofHealth, 2000). Following current trends, this is likelyto involve closer supervision and monitoring andmore decisions made by service professionals underpressure. The implications of devolving responsibil-ity (and blame, when systems fail) to individualservice professionals are likely to include long-termproblems with recruitment and morale and, conse-quently, difficulties maintaining service quality in thehealth and social care professions. Under such cir-cumstances, the vulnerable mental health serviceuser is unlikely to receive appropriate care.

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Media influences on mental health policy 33

Notes

[1] This paper is adapted from Media and Social Policy: AStudy of Media Influences on Mental Health Policy, adissertation submitted to the London School ofEconomics and Political Science in June 2001.

[2] A certain amount of publicity was due to a similarcase to that of Ben Silcock, reported at around thistime.

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