NEWSMEDIA,MENTALILLNESSANDHOMELESSNESSINCANADA:HASDEPICTIONOFMENTALILLNESSANDHOMELESSNESSCHANGEDINCANADIANNATIONALNEWSPAPERSSINCETHERELEASEOF‘OUTOFTHE
SHADOWSATLAST’?by
ArezuMoshrefzadehBachelorofArts,UniversityofBritishColumbia,2006
THESISSUBMITTEDINPARTIALFULFILLMENTOFTHEREQUIREMENTSFORTHEDEGREEOF
MASTEROFPUBLICHEALTH
IntheFacultyofHealthSciences
©ArezuMoshrefzadeh2010SIMONFRASERUNIVERSITY
Fall2010
Allrightsreserved.However,inaccordancewiththeCopyrightActofCanada,thisworkmaybereproduced,withoutauthorization,undertheconditionsforFairDealing.Therefore,limitedreproductionofthisworkforthepurposesofprivatestudy,research,criticism,reviewandnewsreportingislikelytobeinaccordance
withthelaw,particularlyifcitedappropriately.
ii
APPROVAL
Name: ArezuMoshrefzadeh
Degree: MasterofPublicHealth
TitleofThesis: NewsMedia,MentalIllnessandHomelessnessinCanada:HastheDepictionofMentalIllnessandHomelessnessChangedinCanadianNationalNewspaperssincethereleaseof‘OutoftheShadowsatLast’?
ExaminingCommittee:
Dr.GratienPrefontaineChairofDefenseAssistantProfessor,FacultyofHealthSciences
Dr.JulianSomersSeniorSupervisorAssociateProfessor,FacultyofHealthSciences
Dr.MichaelHayesSupervisorAdjunctProfessor,FacultyofHealthSciences
Dr.JimFrankishExternalExaminerAdjunctProfessor,FacultyofHealthSciences
DateDefended/Approved: September15,2010
Last revision: Spring 09
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iii
ABSTRACT
OnMay9,2006,aSenateCommitteereportentitled"OutoftheShadowsat
Last"waspublished,highlightingthecrisisinthementalhealthsysteminCanada.It
stressedthecriticalneedtodevelopthementalhealthsystemandtochangepublic
attitudestowardsmentalillness.Usingagendasettingandframingtheories,the
currentstudyexploreswhetherthedepictionofmentalillnessandhomelessness
changedinCanadianNationalnewspapercoveragesincethereleaseofthisreport.
Relevantarticlesfroma2003‐2009werecodedusingacategoricalcodesheet.The
resultsshowasignificantandlastingincreaseintheagendasettingpotentialof
CanadianNationalnewspapercoverageregardingmentalillnessandhomelessness
sincethereleaseofthereport.Theevidencesuggeststhatthereportappearsto
haveplayedacatalyticroleinincreasingtheoverallfrequencyofreportingona
numberofprominentthemesconcerningmentalillnessandhomelessness.
Keywords:newsmedia;agendasetting;framing;mentalillness;homelessness;SenateReport
iv
DEDICATION
tomyparents,
whoneverletmeforgettheimportanceofeducation
andalwaysencouragedmeinitspursuit
v
ACKNOWLEDGEMENTS
Thankyoutomythesissupervisors,JulianSomersandMichaelHayes,for
theirinsightandguidancethroughouttheresearchprocess.Thankyoutomy
externalexaminer,JimFrankish,forhiscontributions;andtothechairofmy
defense,GratienPrefontaine,forhiskindnessandparticipation.ThankyoutoJen
VanRasselforallherhelp,thecountlessquestionsshehashadtoendureandthe
positivitywithwhichshedoesso.AndthankyoutoMichelJoffres,withoutwhom
thiswouldnothavebeenpossible.
Aspecialthankyoutomyfriends,wholistened,understoodandpushedme
toovercomethechallengesandfinallycompletethisthesis.Thankyoutomyfamily
fortheirconstantsupportandencouragement.Tomyhusband,whosewellof
patienceprovedtobetrulybottomless,thankyouforsharinginallthemini
victoriesalongtheway.Thisprocesswouldhavebeeninfinitelymoredifficult
withoutyou.
vi
TABLEOFCONTENTS
Approval............................................................................................................................. iiAbstract ............................................................................................................................. iiiDedication ......................................................................................................................... ivAcknowledgements.............................................................................................................vTableofContents ...............................................................................................................viListofFigures .................................................................................................................. viiiListofTables...................................................................................................................... ix
1:Introduction ................................................................................................................. 11.1 ResearchContext ....................................................................................................... 11.2 StudyPurpose ........................................................................................................... 2
2:Background .................................................................................................................. 42.1 UnderstandingthePopulation ................................................................................... 4
2.1.1 PrevalenceofMentalIllnessAmongtheHomeless .......................................... 42.1.2 ChallengesinEstablishingPrevalence............................................................. 52.1.3 InteractionBetweenMentalIllnessandHomelessness.................................... 72.1.4 HealthChallenges ........................................................................................... 92.1.5 TheRoleofHousing ..................................................................................... 11
2.2 ‘OutoftheShadowsAtLast’ ..................................................................................... 122.2.1 MentalIllnessandHomelessnessintheSenateReport.................................. 132.2.2 PrimaryPrinciplesandGoals ........................................................................ 152.2.3 TheMentalHealthCommissionofCanada .................................................... 17
2.3 NewsMedia ............................................................................................................. 172.3.1 NewsMediaCoverageofMentalIllness ........................................................ 172.3.2 NewsMediaCoverageofHomelessness ........................................................ 192.3.3 MentalIllness,HomelessnessandNewsMedia ............................................. 202.3.4 NewsMediaandAttitudesofthePublic ........................................................ 20
2.4 AgendaSettingandFraming .................................................................................... 22
3:Methods...................................................................................................................... 253.1 NewspaperSelectionandDateRange....................................................................... 253.2 EstablishingSearchTerms ....................................................................................... 253.3 ArticleSelection....................................................................................................... 263.4 CodingProtocol ....................................................................................................... 27
3.4.1 TheoreticalOrientation ................................................................................ 283.4.2 ArticleCharacteristics .................................................................................. 283.4.3 ArticleThemes ............................................................................................. 293.4.4 ArticleFraming ............................................................................................ 30
vii
3.5 CodingMethods ....................................................................................................... 313.6 StatisticalAnalysis ................................................................................................... 32
4:Results ........................................................................................................................ 334.1 Inter‐coderReliability. ............................................................................................. 334.2 GeneralOverview .................................................................................................... 334.3 ArticleCharacteristics.............................................................................................. 34
4.3.1 QuantityofCoverage .................................................................................... 344.3.2 ProminenceofCoverage ............................................................................... 36
4.4 ArticleThemes(AgendaSetting) .............................................................................. 394.5 Framing................................................................................................................... 45
5:Discussion .................................................................................................................. 595.1 KeyFindings ............................................................................................................ 59
5.1.1 AgendaSettingEffects .................................................................................. 595.1.2 PotentialFramingEffects.............................................................................. 62
5.2 Limitations .............................................................................................................. 675.3 FutureDirections..................................................................................................... 70
6:Conclusions ................................................................................................................ 74
Appendices..................................................................................................................... 77AppendixA ...................................................................................................................... 78AppendixB ...................................................................................................................... 80AppendixC ...................................................................................................................... 87AppendixD ...................................................................................................................... 90AppendixE ...................................................................................................................... 91
References...................................................................................................................... 92
viii
LISTOFFIGURES
Figure1: QuantityofCoverageBeforeandAfterthereleaseofTheSenateReport........... 35Figure2: QuantityofCoveragebyyear ........................................................................... 36Figure3: AverageWordCountbyyear ........................................................................... 37Figure4: ArticlePlacementPre‐SenateReport(No.ofarticles) ....................................... 38Figure5: ArticlePlacementPost‐SenateReport(No.ofarticles) ..................................... 38Figure6: Frequencyofarticlesmentioning‘Recovery’ .................................................... 40Figure7: Frequencyofarticlesmentioning‘PublicSafety’............................................... 40Figure8: Frequencyofarticlesmentioning‘Inequity’ ..................................................... 41Figure9: Frequencyofarticlesmentioning‘AffordableHousing’..................................... 42Figure10:Frequencyofarticlesmentioning‘IntegrationofServices’................................ 43Figure11:FrequencyofarticlesmentioningStigma ......................................................... 44Figure12:FrequencyofArticlesmentioningthemes ........................................................ 45Figure13:EpisodicandThematicArticles(No.ofArticles) ............................................... 45Figure14:ArticleApproachPre‐SenateReport(No.ofArticles) ....................................... 46Figure15:ArticleApproachPost‐SenateReport(No.ofArticles) ...................................... 46Figure16:QuantityofEpisodicandThematicArticlesbyYear.......................................... 47Figure17:ArticlesPrimaryEvent/Story(No/Otherremoved).......................................... 49Figure18:PrimaryEvent/Story:OtherandNo/Unclear ................................................... 51Figure19:PrimaryEvent/Story:PersonalStory ............................................................... 52Figure20:PrimaryEvent/Story:ViolenceAgainstaHomelessand/orMentallyIll
Individual........................................................................................................ 53Figure21:PrimaryEvent/Story:ViolenceByaHomelessand/orMentallyIll
Individual........................................................................................................ 53Figure22:AttributionsofResponsibility .......................................................................... 55Figure23:AttributionsofResponsibility(EpisodicandThematic).................................... 55Figure24:BenefitsoftheSolution.................................................................................... 56Figure25:BenefitsoftheSolution(EpisodicandThematic) ............................................. 57
ix
LISTOFTABLES
Table1: Summaryofarticleexclusion(notmutuallyexclusive) ..................................... 27Table2: Variablesusedtoassesspotentialmediaeffects ............................................... 28Table3: ArticlesPrimaryEvent/Story ........................................................................... 48Table4: ArticlesPrimaryEvent/StoryoverTime .......................................................... 50Table5: SummaryofVoiceinallarticles ....................................................................... 58
1
1: INTRODUCTION
1.1 ResearchContext
Massmediaservesasanimportantsourceofhealthinformationforthe
generalpublic(Martinson&Hindman,2005)andmorespecifically,isthemost
commonsourceofinformationregardingmentalillness(Wahl,Wood&Richards,
2002).Assuch,researchershaveraisedconcernsoverthecontentandaccuracyof
informationpresentedinthemedia,andnewsmediainparticular.Newscoverage
ofmentalillnesshasbeenfoundtoreinforcenegativeandstigmatizingviews(Wahl
etal.,2002).Thesenegativedepictionscanhavesignificanteffectsonthepublic’s
perceptionandtreatmentofthosewithmentalillness(Francis,Pirkis,Dunt&Blood,
2001;Wahl,1992).This,inturn,holdswiderimplicationsforpolicydecisions
regardingindividualslivingwithmentalillnessascommunitiespressfordecisions
tobecenteredonpublicsafetyconcerns(Paterson,2006;Takahashi&Dear,1997).
TheStandingSenateCommitteeonSocialAffairs,ScienceandTechnology
chairedbytheHonourableMichaelJ.L.Kirbyconductedatwo‐yearstudyacross
Canadaintothestateofmentalhealth,mentalillnessandaddictionsservicesin
Canada.TheyreleasedtheirfinalreportonMay9,2006,whichhighlightedthe
crisisinthementalhealthsystem,andtheneedtoaddressit(TheSenate,2006).
Thereportwasaptlynamed‘OutoftheShadowsatLast’,asitwasthefirstnational
documenttobereleasedconcerningmentalhealthandmentalillnessinCanada.
2
Amongothergoals,thereportaimedtoinitiateandadvancechangesindeep‐rooted
publicattitudestowardspeoplelivingwithmentalillness.Itputahumanfaceon
mentalillnessthroughrecountingstoriesanditexpressedahopethatthereport
wouldaffectitsreaders.Thereportstressedpriorityareasintransformingthe
landscapeofmentalillness,includingtheneedtoaddressthecrisisofhomelessness,
stating,“Itwouldbehardtooverestimatetheimportanceofadequatehousingfor
peoplelivingwithmentalillness”(TheSenate,2006;p118).Whilethisreportheld
obviousimplicationsforpolicydevelopmentintheareaofmentalhealth,little
researchhasbeendoneonitseffectontheperceptionofthegeneralpublicandthe
channelsthatinformthem,includingthemedia.
1.2 StudyPurpose
Thisthesiswillexplorethevariationinmediacoverageofmentalillnessand
homelessnessinCanadainrelationtotheSenatereport‘OutoftheShadowsatLast’.
Theprimaryresearchquestionis‘Hasthedepictionofmentalillnessand
homelessnesschangedinCanadianNationalnewspapercoveragesincetherelease
of‘OutoftheShadowsatLast’?Thisthesisaimstodeterminewhetherthegoalof
theSenateReporttocreateachangeinpublicattitudestowardsmentalillnessand
toincreaseawarenessoftheprimaryprinciplesoutlinedwithinithavebeen
advancedinrelationtohomelessnessinnationalnewsmedia.Thenullhypothesis
isthatthereisnochangeinthepotentialfortheseeffectsinthenationalnews
coverageofmentalillnessandhomelessness.Inaddressingtheresearchquestion
andtestingthishypothesis,thisthesiswillspecificallyexamine1)thequantityof
3
articlespresentedaboutmentalillnessandhomelessnessand2)thevariationin
howthesearticleshavebeenpresented.Thiswillapproachthearticlesconsidering
bothagendasettingandframingtheories,andaimtoexplorethefollowingcentral
questions:
1) Howfrequentiscoverageregardingthehomelessmentallyillovertime?
2) Hastheprominenceofreportingonthisissuechangedovertime?
3) Arethemesidentifiedasprioritiesin‘OutoftheShadowsatLast’
representedinthenews,anddoestheircoveragechangeovertime?
4) Whatapproachdothearticlestake(i.e.episodicorthematic)?
5) Aresolutionsclearlyidentifiedinthearticles,andhowaretheyframed?
6) Whosevoicesarequoted?
Researchfindingsmaysuggestwhetherornottheimportanceofaddressing
thehomelesslivingwithmentalillness,asstressedin‘OutoftheShadowsatLast’,is
reflectedinnewspapercoveragesurroundingthispopulation.Findingsmayalso
indicatewhethertherewerechangesinthewayinwhichhomelessnessandmental
illnesswereframedinnationalnewspapercoverageandtheimplicationsthese
changesmayhold.
4
2: BACKGROUND
2.1 UnderstandingthePopulation
2.1.1 PrevalenceofMentalIllnessAmongtheHomeless
Thetransientnatureofthispopulationmakesdatacollectionachallenge,
andestimatesoftheprevalenceofmetalillnessamongthehomelessvaryby
locationandstudy.InCanada,theexactnumberofindividualsconsidered
homelessisunknown(Echenberg&Jensen,2008)andresearchtoassessthe
prevalenceofmentalillnessandaddictionamongthehomelessisnotconductedon
anongoingbasis(TheSenate,2006).Canada’sNationalSecretariaton
HomelessnesshasestimatedthenumberofhomelessinCanadatobearound
150,000people(Echenberg&Jensen,2008)butotherreportsvaryfrom10,000
homelessindividualsonanygivennight(CIHI,2007)to300,000(Laird,2007).It’s
estimatedthatapproximately60%ofindividualswhoarehomelesshavealifetime
diagnosisofmentalillness,whichistwotothreetimestheratefoundinthegeneral
population(Riordan,2004).FurtherresearchinCanadaestimatesthatbetween
30%and40%ofhomelessindividualsarelivingwithamentalillness(TheSenate,
2006).Otherestimatessuggestthatthisiscloserto80%(Howlett,2008).
Estimatesfromotherpartsoftheworldpresentasimilarpicture,butaswith
muchoftheCanadiandata,varyfromstudytostudy.Scott(1993)reportsthatin
GreatBritainbetween30%and50%ofhomelessindividualshaveamentalillness.
5
StudiesintheUnitedStatesofAmericaestimateprevalenceratesformentalillness
amongthehomelesspopulationtobebetween10%and45%dependingonthe
methodologyused(Susseretal.,1993).Examplesofthisshowarangefromaone‐
quarter(Smithetal.,1992),toone‐third(Bachrach,1992;Minkoff&Drake,1992),
toone‐half(Adams,Pantelis,Duke&Barnes,1996).Whilethereisalackofprecise
dataregardingproportionofindividualswithmentalillnessamongthehomeless,
evidencesupportsthatthisproportionisasignificantone(Levine&Rog,1990).
2.1.2 ChallengesinEstablishingPrevalence
Underlyingtheuncertaintysurroundingthequestionoftheprevalenceof
mentalillnessamongthehomelessareanumberofmethodologicalchallenges.One
isthelackofastandarddefinitionofhomelessness(Bachrach,1992;Patterson,
Somers,McIntosh,Sheill&Frankish,2008;Echenberg&Jensen,2008).Studies
rangeinscopefromincludingonlythehomelesslivingonthestreets,todefining
homelessnessasanyformofresidentialdislocation(Susseretal.,1993).InCanada,
notonlydodefinitionsofhomelessnessvaryacrossprovinces,butbetween
jurisdictionsaswell(OAGBC,2009).
Accuratediagnosisofmentalillnessinhomelesspopulationsalsoposesa
challenge(Bachrach,1992;Mojtabai,2005;Susser,Conover&Struening,1989).
Individualsoftendonotwanttobeapproachedorquestioned(Bachrach,1992).As
aresult,somestudiesresorttoself‐reportsorrelyonstaff,oftenunqualified,to
makeassessmentsbasedonsurveysconductedinshelters(Susseretal.,1989).Itis
furtherassertedthatitisnearimpossibletoestablishmentalillnessinanindividual
6
sufferingphysicaldeprivationasthedeprivationconfoundsanyresultingdiagnosis
(Bachrach,1992).
Homelessindividualsandgroupsareofteninvisibletoresearchersfora
numberofreasons(Mosher‐Ashley,Henrikson&French,2000;Ropers,1988).
Beingaverymobilegroup(Bachrach,1992),thereisasignificantchallengeto
locatingthispopulation.Researchisoftenconductedinshelters,butmanyhomeless
peopledonotusethesheltersystemoritsassociatedservices(Ropers,1988).
Sheltersthemselvesoftenhaveadmissioncriteriathatexcludeparticulargroups,
suchasmenorthosewithaddictions(Jacobs,Little&Almeida,1993).Further
complicatingthis,thementallyillhomelesspopulationoverlapswithother
subgroupsofmentallyillpeople,makingitdifficulttodistinguishthemasaseparate
group(Bachrach,1992).Thisisparticularlytrueofinvolvementwiththecriminal
justicesystem,asbothhomelessnessandmentalillnessarestrongpredictorsof
interactionwiththissystem(Riordan,2004).
Goingbeyondthechallengesoflocatingthispopulationarethe
methodologicalissuessurroundinghomelesscounts.Mostinformationregarding
theextentofhomelessnessinCanadacomesfromhomelesscountsconductedby
municipalitiesand/orvolunteerorganizations(OAGBC,2009).Asnotall
municipalitiesparticipatemanygounrepresented,especiallyruralcommunities
(OAGBC,2009).Thedatathatiscollectedisgenerallynotacquiredwiththesame
methodologyacrossthecountrymakingitdifficulttoformcomparisons(OAGBC,
2009).Additionally,thereislittleconsistencyinthesamplingmethodsandthe
timingofthecounts(CIHI,2007).
7
2.1.3 InteractionBetweenMentalIllnessandHomelessness
Thedebateoverwhetherhomelessnessinfluencesthedevelopmentof
mentalillness,orifmentalillnessisapathwaytohomelessnessisacomplexone
(Riordan,2004).Thereisresearchtosupportthathomelessnessisaplausible
causeofmentalillness(Susseratal.,1993).Itissuggestedthatthepotential
emotionaltraumaofbecominghomeless,thephysicaldeprivationandhardshipof
livingonthestreets,andentryintoasubculturewherevictimizationandaddictions
arecommon,havethepotentialtotriggermentalillnessorworsenpre‐existing
disorders(Susseretal.,1993;Pattersonetal.,2008).Conversely,numerousstudies
supportthatmentalillnessisapotentialcauseofhomelessness(Folsom&Jests,
2002;OAGBC,2009,Susseretal.,1993).Twowavesofresearchonpsychiatricand
substanceusedisordersamongthehomelessinthe1980’sidentifiedschizophrenia,
bipolardisorder,depression,alcoholanddrugabuseasriskfactorsfor
homelessness(Susseretal.,1993).Symptomsofmentalillness,suchasanxiety,
paranoiaanddepression,mayleadtohomelessnessbyimpedingindividuals’ability
tomaintainemployment,paydebtsandsustainsocialrelationships(CMHS,2003).
Areviewofresearchmethodologyacknowledgesthedifficultyindeterminingan
exacttimefortheonsetofmentalillnessandestablishingitsrelationtotheonsetof
homelessness(Susseretal.,1993).Whilenodefinitiveconclusionscanbemade
aboutthedirectionalityinwhichmentalillnessandhomelessnessrelatetoone
another,itisapparentthattherelationshipisacomplexonethatlikelyhas
reciprocaleffects(Pattersonetal.,2008).
8
Theadditionaleffectsofmentalillnessandhomelessnessoneachother
increasethevulnerabilityofthispopulationcomparedtohomelesspeoplewithout
mentalillness.Individualswithmentalillnessremainhomelessforlongerperiods
oftime(CIHI,2007;Sullivan,Burnam,Koegal&Hollenburg,2000)andshow
decreasedabilitytocopewithadversecircumstances(Pattersonetal.,2008).There
aresignificantlyhigherratesofmentalillnessamongthechronicallyhomeless
comparedtotherestoftheshelteredhomelesspopulation(Metraux,Marcus&
Culhane,2003).Thehomelesslivingwithmentalillnessaremorelikelytohave
repeatedepisodesofhomelessnesscomparedtootherhomelessindividuals
(Sullivanetal.,2000),andhavegreaterdifficultyexitinghomelessnesscompletely
(CMHS,2003).
Thisincreaseinvulnerabilitypairedwithareductioninsocialassistanceand
socialhousingprograms,hasmadeitmoredifficultforhomelesspeopletoacquire
housingandaccessmentalhealthservices(Riordan,2004).Thisisaparticular
challengeforthosewithseverementalillnessandaddictions(Pattersonetal.,
2008).Thosewithconcurrentdisordersarealsodisadvantagedduetothelimited
availabilityofhousingwithintegratedmentalhealthandsubstanceusetreatment
(CMHS,2003).Thecomplexityoftheapplicationprocessforsocialassistanceanda
reducedcapacitytonavigateitmeanthatmanyhomelesspeoplewithmentalillness
donotreceivebenefitstheymaybeeligiblefor(CMHS,2003).Inaddition,service
providershavegreaterdifficultyengagingmentallyillpeoplewholiveonthestreets
(Tsemberis&Eisenberg,2000).Withfewersocialsupports,decreasedaccessto
benefitsandlowinvolvementwithsupportiveservices,itisunsurprisingthat
9
homelessindividualslivingwithmentalillnessareatanincreasedriskofbeing
arrested,incarceratedorotherwiseinvolvedwiththecriminaljusticesystem
(CMHS,2003;Riordan,2004).
2.1.4 HealthChallenges
Homelessnessandhousinginstabilityhavelongbeenacknowledgedas
publichealthconcerns(Krieger&Higgins,2002;Wolitski,Kidder&Fenton,2007).
Thisislargelyduetotheincreasedriskofmajorhealthproblemsassociatedwith
unstablehousingandhomelessness(Krieger&Higgins,2002).Morbidityand
mortalityratesamongthehomelessarehighlyelevatedcomparedtothegeneral
population,withthehomelesspopulationbeingatmuchgreaterriskofpremature
death(Hwang,2001;Golden,Currie,Greaves&Latimer,1999).Dependingonthe
typeofstudyandgroupcharacteristics(suchasgenderandtypeofhomelessness),
mortalityrateswerefoundtobethreeto31timeshigherthanaverage(Hwang,
2001).Thisisrelatedtothehighrateofunintentionalinjuriesamongstthis
population,primarilyaresultoffallsandpedestrianinjuriesfromcaraccidents
(Hwang,2001).However,deathsresultingfromdrugand/oralcoholoverdoseare
alsocommon(Hwang,2001).
Substanceabuseratesareparticularlyhighamongstthehomelesspopulation
andcoexistenceofmentalillnessandaddictionsseemtobethenorm(Homan,Flick,
Heaton&Mayer,1993;North,Smith,Pollio&Spitznagel,1996;Pattersonetal.,
2008;Riordan,2004;Smith,North&Spitznagel,1992).Prevalenceratesofsevere
mentalillnessarealsoreportedlyhigheramongthehomeless(CIHI,2007)with
10
schizophreniaandbipolardisorderbeingassociatedwithahighriskfor
homelessness(Susser,Moore&Link,1993).Studiesamongshelterusersindicate
higherratesofdepression,anti‐socialpersonalitydisorderandsubstanceabuse
comparedtothegeneralpopulation(CIHI,2007).
Highratesofinfectiousdiseaseshavealsobeenacauseforconcern(Hwang,
2001;Goldenetal.,1999;Wolitzkietal.,2007).Additionally,researchindicatesthat
homelesspopulationshavehigherratesofchronicpulmonarydiseases,respiratory
tractinfections,musculoskeletalconditions,skinandfootproblems,seizuresand
unintentionalinjury(Hwang,2001;CIHI,2007;Krieger&Higgins,2002).While
thesehealthconcernsarenotspecifictohomelessindividualslivingwithmental
illness,thesocialdeterminantsthatleadtoincreasedexposureandrisk(Krieger&
Higgins,2002)encompasstheentirehomelesspopulation.
Healthchallengesfacedbythehomelesspopulationareofevengreater
concerninrelationtothosewithmentalillnessastheinteractionofmentalillness
andhomelessnessleadstopoorerhealthpracticesandoutcomes(Mosher‐Ashleyet
al.,2000;Pattersonetal.,2008;Sullivanetal.,2000).Whileresearchinthisareais
sparse,itindicatesthathomelessindividualslivingwithmentalillnesshavehigher
prevalenceofbothacuteandchronicconditionscomparedtothegeneralhomeless
population(Sullivanetal.,2000).Thisisfurtherexacerbatedbyagreaterdegreeof
stigmatization(Mosher‐Ashleyetal.,2000)andanincreaseddifficultyinaccessing
healthcare(Sullivanetal.,2000).Theyareatanincreasedriskofvictimization,
exposuretocommunicablediseases,suicide,andloweroverallsubjectivequalityof
life(Drake,Bebout&Becker,1999;Sullivanetal.,2000).Theyhavelowerlevelsof
11
subsistenceneedsmet(Drakeetal.,1999)andassucharemorelikelytoengagein
negativehealthbehaviours.Forexample,homelessindividualslivingwithmental
illnesshavebeenfoundtobemorelikelytogettheirfoodfromadumpster(Gelberg
&Linn,1988).Ithasalsobeenreportedthatwhensubsistenceneedsarenotmet,
thosewithmentalillnessrequiredevotingtheirfullattentiontomeetingthematthe
expenseofaddressingotherneedssuchasmentalhealthservices(Sullivanetal.,
2000).
2.1.5 TheRoleofHousing
Adequatehousingplaysacriticalroleintherecoveryofmentalillnessandin
preventinghomelessness.Researchindicatesthatthoseinsupportivehousing
showsignificantreductionsinshelteruse,hospitalizations,lengthofhospitalstays
andtimeincarcerated(Culhane,Metraux&Hadley,2002;Metrauxetal.,2003).
Supportivehousingforthoselivingwithmentalillnessamongthehomelessshow
highretentionrates(Culhaneetal.,2002)andisfoundtoincreasethenumberof
dayshousedsubstantiallycomparedtointensivecasemanagementalone
(Rosenheck,Kasprow,Frisman&Liu‐Mares,2003).Emphasizingtheprovisionand
maintenanceofsupportivehousinghasbeencitedasthemostsuccessfulstrategyin
improvingthequalityoflifeandgeneralwellbeingofthispopulation(Sullivanetal.,
2000;Davis&O’Neill,2005).
Despitetheimportanceofsupportivehousing,servicedeliveryplansoften
facestrongcommunityoppositionthatleadstochangesinzoningby‐lawsthat
discriminateagainstsupportivehousing(Dear&Gleeson,1991;Takahashi&Dear,
12
1997).ThiscommunityoppositioniscommonlyreferredtoastheNIMBY(Notin
MyBackYard)syndromeandiscitedasoneofsociety’sdefiningissues(Takahashi
&Dear,1997).ResearchoftheNIMBYprocessidentifiedspecificgroupsthat
communitiesconsidermostobjectionable,andthementallydisabledandhomeless
wereoftentheleastacceptablegroup(Takahashi&Dear,1997).Studiesidentify
thatgroupsperceivedtobetheleastproductiveandmostpotentiallydangerousare
leastlikelytobeconsideredacceptable(Takahashi&Dear,1997),suggestingthat
theportrayalofindividualswhoarehomelessandlivingwithmentalillnesscan
stronglyinfluencecommunityacceptance,andconsequently,communityopposition
tosupportivehousing.
2.2 ‘OutoftheShadowsAtLast’
InFebruary2003,TheStandingSenateCommitteeonSocialAffairs,Science
andTechnology(hereafterreferredtoastheCommittee)beganastudyofmental
health,mentalillnessandaddictioninCanada,undertheleadershipofSenator
MichaelKirby(MHCC,n.d.).Researchwasconductedoveratwoandahalfyear
periodinwhichtheCommitteereceivedstoriesthroughtheirwebsiteandtravelled
toeveryprovinceandterritoryinCanadatoconductpublichearings(MHCC,n.d.,
TheSenate,2006).TheresultsofthisstudywereformallypublishedonMay9,
2006inthefinalreportoftheCommitteeentitled“OutoftheShadowsatLast–
TransformingMentalHealth,MentalIllnessandAddictionServicesinCanada”
(hereafterreferredtoastheSenateReport).Thisstudyisparticularlysignificantas
itwasthefirststudy(andto‐date,onlypublishedstudy)concerningmentalhealth
13
tobeconductedonanationallevel(MHCC,n.d.).Assuch,althoughtherehavebeen
over300nationalreportsonthephysicalhealthsystem,theSenateReportwasthe
firstnationalreportonmentalhealth(Kirby,2008).
2.2.1 MentalIllnessandHomelessnessintheSenateReport
TheSenateReportaddressesnumerousconcernsrelatedtopolicies,
programs,andthelivedexperienceofthoselivingwithmentalillnessinCanada,and
contains118recommendationsforaddressingtheseissues(TheSenate,2006).
WhilethescopeoftopicsaddressedintheSenateReportrelatingtomentalillnessis
vast,sixthemesthataddressissuesrelatedtohomelessnessandweremostrelevant
tothepopulationbeingdiscussedinthisthesis(thosewhoarehomelessandliving
withmentalillness)wereidentifiedandaresummarizedbelow.
HousingasRecovery
TheCommitteeemphasizesthroughouttheirreportthat“Itwouldbehardto
overestimatetheimportanceofadequatehousingforpeoplelivingwithmental
illness”(p118).Theneedforhousingasaformofrecoverytothoselivingwith
mentalillnessisidentifiedasanessentialneed,andissuggestedtobeaformof
protectionfrommentalillness.TheSenateReportspecificallystressesthestrength
ofsupportivehousingasasuccessfulaspectofrecoveryinitspromotionof
independence,safety,andcommunityintegration.
14
Inequity
Whilehousingisidentifiedasafundamentalaspectofwellbeing,theSenate
Reportdrawsattentiontoincreaseddisadvantagethatthoselivingwithmental
illnesshaveinfindingsafeandadequatehousing.Inadditionofthedifficulties
facedbythosewhoarehomeless,thoselivingwithmentalillnessmayfaceunique
challenges.AsconveyedbyanindividualquotedintheSenateReport:
“We must remember that people also have to face the task ofrecovering from the effects of external and internalized stigma,learnedhelplessness, institutionalization,poverty,homelessnessandthewoundsofabrokenspirit”(p43).
Individualswithmentalillnessmayrequireadditionalsupportiveservicestoenable
themtoliveinthecommunity,increasingthedifficultyoffindingappropriate
housing.Inadditiontothis,theadministrativesysteminplacetoapplyforbenefits,
assistanceandservicesischallengingtonavigatewiththeaddeddifficultiesofliving
withamentalillnessoraddiction,creatingconfusionaboutthesupportservices
availableandhowtoaccessthem.
AffordabilityofHousing
TheSenateReportshedslightonthelargenumberofpeopleoftenlivingin
verysmallhomesinneighbourhoodswithhighcrimeanddrugrates,particularly
thoseonsocialassistance,andstronglystressestheneedforanincreasein
affordablehousing.TheCommitteecitesfindingsoftheCanadianMentalHealth
Organizationthatshowthatthenumberofaffordablehousingunitscreatedbythe
GovernmentofCanadadroppedfrom24,000to940between1980and2000(The
Senate,2006;p119).TheSenateReportassertsthatnotonlyaremorehousing
15
unitsrequired,butthereisaneedformoreGovernmentalassistancesothatpeople
canaffordtorentexistingapartmentsatmarketrates.
IntegrationofServices
TheSenateReporthighlightstheimportanceofaddressingthesocial
determinantsofhealthinpreventingandtreatingmentalillness.TheCommittee
emphasizesthenecessityofbetterintegratingmentalhealthserviceswithabroader
rangeofservicesandsupportsthatarerequiredbythosewithmentalillness,
includinghousingservices.Inparticular,theSenateReportencourages
collaborativecareinitiativestofostercommunity‐basedcare.
StigmaandPublicSafety
AlargeportionoftheSenateReportisdedicatedtoacknowledgingthe
painfulanddamagingeffectsofstigmaonthoselivingwithmentalillness.The
Committeeemphasizesthepressingneedtoaddressstigmarelatedtomentalillness
incommunitiesacrossthecountry.Additionally,theSenateReportpointsto
negativemediadepictionsofmentalillnessthatincreasestigmaagainstthosewith
mentalillness,particularlyportrayalsthatincreasethefearofviolence.
2.2.2 PrimaryPrinciplesandGoals
ThesixthemesidentifiedabovereflectmanyofthePrimaryPrinciplesofthe
SenateReportasstatedbytheCommittee.ThesePrimaryPrinciplesinclude:
• tocreatethebestpossibleconditionsforrecovery;
• toaddresssocialdeterminantsofhealthasarequirementtopromoting
mentalhealthandrecovery;
16
• tointegratementalhealthservicesandsupports;
• toaddressmentalillnessandthementalhealthsystemwithmorerespect
andseriousness
Asmentionedpreviously,inadditiontohighlightingtheneedtoaddress
mentalhealth,mentalillnessandaddictioninCanada,theSenateReportcontains
over100recommendations.TheSenateReportemphasizesthatallits
recommendationsareultimatelytohelpthoselivingwithmentalillness“livethe
bestpossiblelifetheycan”(p479).Themajorityoftheserecommendationsaddress
theorganizationanddeliveryofmentalhealthservices,aimedatimprovingthe
structuralframeworkofthementalhealthsystem.Thereis,however,asocietalgoal
expressedintheSenateReportaswell.Thiscomesfromtherecognitionthat
“profoundchangeisessentialifpersonslivingwithmentalillnessaretoreceivethe
helptheyneedandtowhichtheyareentitled”(TheSenate,2006,p2).The
Committeeexpressesitshopethatreadersofthereportwillbeaffectedbyits
content,andthatthiswillchangedeep‐rootedpublicattitudestowardsmental
illness,subsequentlyreducingthestigmaanddiscriminationfacedbythoseliving
withmentalillness.Theanalysisinthisthesisaimstoaddressthisgoalofthe
SenateReportinrelationtothehomelesspopulationbydeterminingwhetherthe
reportincreasedthepotentialforachangeinpublicattitudesregardingmental
illnessandhomelessness.Inrelationtothis,thepotentialforincreasedpublic
awarenessofthePrimaryPrinciplesoutlinedabovewillalsobeexplored.
17
2.2.3 TheMentalHealthCommissionofCanada
TheSenateReportincludedarecommendationforthecreationofthe
CanadianMentalHealthCommissionwhowould,amongotherresponsibilities,
worktoeliminatediscriminationintheprovisionofaffordablehousingto
individualswithmentalillness(TheSenate,2006).In2007,theMentalHealth
CommissionofCanadaformallylauncheditsactivities,andcontinuedtodraw
attentionthetopicsofhomelessnessandmentalillness.Oneofthefourmajor
initiativesthattheCommissionlaunchedinitsfirstyearwastoaddress
homelessnessrelatedtothoselivingwithmentalillnessthrougharesearchproject
fundedbytheFederalGovernment(Howlett,2008).Thisongoingprojectaimsto
studytheservicesandsystemsforthosewhoarehomelessandlivingwithmental
illnessinfivecitiesacrossCanadawithparticipationfrom2285homelesspeople
livingwithamentalillness(MHCC,n.d.).Itsscopeasthelargeststudyofitskind
currentlyintheworld(MHCC,n.d.)isanindicationoftheimportancetheMental
HealthCommissionhasplacedoninvestigatingandaddressinghomelessness
amongthoselivingwithmentalillness.
2.3 NewsMedia
2.3.1 NewsMediaCoverageofMentalIllness
Themediaisthepublic’smostcommonsourceofinformationregarding
mentalillness(Wahl,Wood&Richards,2002).However,newscoverageofmental
illnesshasshownalong‐standingpatternofnegativeportrayal(Wahl,Wood&
Richards,2002).Studieshavefoundthatnewsarticlespredominantlyportray
18
mentalillnessinanegativetoneandconveyastrongassociationbetweenmental
illnessandviolence(Philo,McLaughlin,&Henderson,1996;Ward,1997;Allen&
Nairn,1997;Nairn,1999;Hazelton,1997).Individualswithmentalillnessareoften
depictedasathreattothecommunity(Allen&Nairn,1997).Storiesassociating
mentalillnesswithviolenceandcrimearegivengreaterprominencewhen
comparedtopositivearticles(Francisetal.,2001,Philoetal.,1996,Day&Page,
1986).Positivestatementsregardingmentalillnessaremostlikelytobefoundin
editorialarticles(Philoetal.,1996).Fewerreferencestoviolencearefoundin
articlesthatcentertheirdiscussionaroundthestatementsofmentalhealth
professionals(Allen&Nairn,1997).Whiletheuseofhealthprofessionalsas
sourcesofinformationmayimprovetheportrayalofthosewithmentalillness,this
issubjecttothejournalistsframingoftheissue(Nairn,1999).
Newscoverageofmentalillnesswasfoundtoreinforcestereotypicaland
stigmatizingviewsofmentalillness(Wahletal.,2002;Philoetal.,1996).Itis
suggestedthatthemediaperpetuateastereotypicalimageofasingleunemployed
malewithschizophrenia,whileothergroupsareunrepresented,suchaswomen,the
elderlyandthosewithmentalillnessesotherthanschizophrenia(Philoetal.,1996).
However,otherstudiessuggestthatcoverageofschizophreniaisuncommon(Wahl,
1996;Wahl,Borostovik&Rieppi,1995).
InCanadaspecifically,thereweretwomajorstudiesregardingmedia
coverageofmentalillness.Matas,el‐Guebaly,Harper,Green,&Peterkin(1986)
studiedthechangeincoverageofmentalillnessinCanadabetween1961and1981
intwonewspapers.Theirresultsshowfewsignificantdifferencesoverthetime
19
periodstudied.Incontrasttootherstudies,theysuggestthatarticleswritten
regardingcriminalincidentsweregenerallypositive.However,theyalsofoundthat
articlesgivenmostprominence(i.e.frontpageofthenewspaper)weremorelikely
toportraymentalillnessasdangerous.DayandPage(1986)didacontentanalysis
ofnewspapersfrom1977‐1984andsimilarlyfoundthatnegativeitemsweregiven
greaterprominencethanpositiveones.Additionally,theirresultsshowthatthe
overalltoneofthearticlesanalyzedwasnegative,withfew(18%)positive
statements.
2.3.2 NewsMediaCoverageofHomelessness
Therehasbeenlittleresearchconductedregardingthedepictionof
homelessnessinnewsmediaandtheextenttowhichthismayimpactpublicopinion
(Min,1999;Lee,Link&Toro,1991).Thefewexistingstudiesfocusprimarilyonthe
UnitedStatesandconsidermostlytelevisionnews(Min,1999).Thisresearchfound
thatnewsstoriesregardinghomelessnessshowanincreasingtrendintheUnited
States(Min,1999)andthatthepublicregardhomelessnessasaseriousissue(Lee
etal.,1991).Whilesomestudiesreportthatthenewscoveragefocusonstoriesof
homelessindividuals,blamingthemfortheircondition(Min,1999),othersreport
thathomelessnessisperceivedtobeaproblemwithstructuralroots(Leeetal.,
1991).Whilethereisnodefinitivepictureonhowhomelessnessisportrayedin
newsmedia,Leeetal.(1991)suggestthatthereisaplausiblelinkbetweenthe
volumeandcontentofmediacoverage(bothprintandbroadcast)andthepublic’s
perceptionofhomelessness.
20
2.3.3 MentalIllness,HomelessnessandNewsMedia
Tomyknowledge,therehasonlybeenonepublishedjournalarticletodate
thatexaminesthemedia,mentalillnessandhomelessnesscollectively.Thisarticle
isentitled“TheMediaandHomelessMentallyIllPersons”andwrittenbyLeonaL.
Bachrachin1990.Thisarticleemphasizesthatwhileprofessionalarticlesfocus
theirattentiononthehomelessandmentallyillindividualswhoareeasiestto
accessandstudy(suchasshelterusers),themediafrequentlyreportsonmore
unusualsituations,givinginsightintolessaccessiblemembersofthispopulation.
Assuch,Bachrach(1990)summarizesthatnewsmediadocumentationofthe
homelessmentallyillshouldbeconsideredanimportantsupplementtoscientific
literatureregardingthispopulation.
2.3.4 NewsMediaandAttitudesofthePublic
Themediahasbeenwidelycitedasthemostimportantsourceofinformation
regardingmentalillness(Granello,Pauley&Carmichael,1999;Lopez,1991;
Benkert,Graf‐Morgenstern,Hillert,Sandmann,Ehmig,Weissbecker,Kleppinger&
Sobota,1997,Philo,1996).InCanada,theSenateCommitteeidentifiesmediaasthe
mosteffectivemeansofspreadinginformationaboutmentalillness(TheSenate,
2006).Howeverresearchfocusedspecificallyontheimpactofportrayalsofmental
illnessisrare(Wahl,1992)andassuch,empiricalevidenceofthisimpactonpublic
attitudesislimited(Dietrich,Heider,Matschinger&Angermeyer,2006).As
mentionedpreviously,thisisevenmorescantwithregardstohomelessness.
21
Whiletheamountofresearchislimited,thelittlethathasbeendonehas
beenconfidentinstatingthatnegativedepictionscanhavesignificanteffectson
people’sattitudesandtreatmentofthosewithmentalillness(Francisetal.,2001;
Wahl,1992).Negativeportrayalsofmentalillnesshavebeenassociatedwith
negativeattitudes(Francisetal.,2001).Dietrichetal.,(2006)showthat
adolescentswhoreadanarticlethatlinkedmentalillnesswithviolentcrimeare
morelikelytodescribeanindividualwithmentalillnessasviolentanddangerous.
Furtherstudieshavefoundthatnegativeattitudesassociatedwithmediadepictions
ofmentalillnessaredifficulttoalteroncepresent.Thepresentationofpositive
imagesofmentalillnessdoesnotappeartochangenegativeattitudes(Francisetal.,
2001).Positivepersonalexperiencescanalsobeoverwhelmedbynegativemedia
images(Philo,1996).
Asnewsmediafocusesontheassociationbetweenmentalillnessand
violence,andthepublicbecomeincreasinglyconcerned,thismayleadtopolicy
decisionsregardingindividualswithmentalillnessthatgiveprioritytopublicsafety
(Paterson,2006).Aspreviouslydiscussed,thisisofparticularimportancein
relationtohousingasproposalsforsupportivehousinggenerallyencounter
neighbourhoodresistance,themajorityofwhichisbasedonfearsregarding
increasedcrimeandreducedpropertyvaluesasaconsequence(Takahashi&Dear,
1997).
22
2.4 AgendaSettingandFraming
AgendaSettingandFramingaretheoriesconcernedwithwhatthemedia
choosetofocusonandhownewsispresented.Agendasettingreferstotheprocess
bywhichproblemsbecomerecognizedasissuesthatmeritpublicattention(Cook,
Tyler,Goetz,Gordon,Protess,Leff&Molotch,1983),andisoneofthemost
commonlycitedinfluencesofnewsmedia(Collins,Abelson,Pyman&Lavis,2006).
ThecentralclaimofAgenda‐SettingTheorywasfirstsummarizedbyCohen(1963):
“Thepressmaynotbesuccessfulmuchofthetimeintellingpeoplewhattothink,
butitisstunninglysuccessfulintellingitsreaderswhattothinkabout.”(ascitedin
Weaver,1996,p37).AgendaSettingtheoryassertsthatwhilemediamaynot
necessarilytellthepublichowtothinkaboutissues,theyshapepublic
consciousnessthroughtellingthepublicwhatissuesareimportant(Brosuis&
Kepplinger,1990).Thisresultsinastrongcorrelationbetweentheimportance
mediaplacesonparticularissuesandtheimportancethepublicattributetothose
issues(Mitchell,2007;McCombs&Shaw,1972).Studieshavesuggestedthistobea
dose‐responserelationshipwiththelevelofimportancegiventoanissuebythe
publicproportionaltotheamountofcoverageitreceivesinthemedia(Collinsetal.,
2006;Funkhouser,1973;Glynn,Herbst,O’Keefe&Shapiro,1999).
Framinggoeshandinhandwithagendasettingtheory.Whileagendasetting
analyzeswhichissuesaregivenimportancethroughbeingselectedasnews,framing
focusesonthewayinwhichissuesarepresentedorinterpretedinthenews
(Entman,1993).Amediaframeisaparticularperspectiveonanewsstory,which
23
canshapetheinterpretationandperspectiveofthepublic,usuallywithouttheir
awareness(Dorfman,2003).
Asframinghaswideapplications,moredetaileddefinitionsofvariousmedia
frameshavebeenwidelydiscussed(Scheufele,1999;Scheufele,2006;Weaver,
2006;McCombs,Shaw&Weaver,1997;Iyengar&Simon,1993).Fortheanalysisin
thisthesis,theframingcomponentwillbediscussedasthenewspaperarticles
approachtothestory.Iyengar(1990a,1991,1996,1997)differentiatesbetween
twotypesofapproach:EpisodicandThematicnewsframing.Episodicframing
“depictspublicissuesintermsofconcreteinstancesorspecificevents”(Iyengar,
1990b,p.7),whilethematicframing“placesthepublicissuesinsomegeneralor
abstractcontext”(Iyengar,1990b,p.7).Episodicframescentertheircoverageon
personalexperiencesandevents(Iyengar,1990b).Theyfocusonthedetails
surroundingtheeventitself,payinglittleattentiontocauses,trendsorbroader
implicationsofevents(Dorfman,Woodruff,Chavez&Wallack,1997).Thistendsto
generatelargenumbersofarticlesoverashortperiodoftime(Collinsetal.,2006).
Incontrast,theobjectofcoverageinthematicframesisgenerallyimpersonal
(Iyengar,1990b)andcoverageofaspecifiedissueismorecontinual(Collinsetal.,
2006).Thematicarticlesfocusonrootcausesandtrends(Dorfmanetal.,1997),
placingissuesinanappropriatecontext(Iyengar,1990b).Whilemuchofframing
researchisconductedwithtelevisionnews,studieshavefoundsimilarframing
effectsandpatternsareexhibitedinnewspapers(Collinsetal.,2006;Dorfman,
2003;McManus&Dorfman,2002).Whilenotallarticlesarepurelyepisodicor
24
thematic,oneframecangenerallybeidentifiedasthepredominantone(Iyengar,
1996;Scheufele,1999).
Thedifferenceintheseframingstylesbecomesparticularlymeaningfulwhen
consideringtheimpliedattributionofresponsibilitytheyconvey.Evidenceshows
thatwhatpeopleidentifyascausesandsolutionstoanissuedependsignificantlyon
thewayinwhichtheissueisframed(Iyengar,1990a).Resultssuggestthatepisodic
framingengendersindividualisticattributionsofresponsibility,(Iyengar,1990a).
Thepersonalizationfoundinepisodicstoriesdrawsattentionawayfromstructural
causes(Dorfman,2003),focusingthepubliconparticularindividualsorgroups
insteadofpolitical,historicalorstructuralissues(Iyengar,1996).Asaresult,
characterdeficiencies(suchaslaziness,apathy,etc.)areblamedforcreating
adversecircumstances(Iyengar,1990b),whichinturnshieldssocietyand
governmentfromresponsibility(Iyengar,1996).Incontrast,thematicframing
assignscausationtosocietalfactors(suchaseconomicconditions,inadequate
governmentalefforts,etc.)andassuch,engendersstrongsocietalandstructural
attributionsofresponsibility(Iyengar,1996).
25
3: METHODS
3.1 NewspaperSelectionandDateRange
NewspaperswerechosenonthecriteriaofbeingaCanadiannational
newspaper,ofwhichtherearetwo:‘TheGlobeandMail’and‘NationalPost’.Both
arebroadsheetEnglishlanguagenewspaperswithadailypublicationschedulefrom
MondaytoSaturday.‘TheGlobeandMail’isconsideredcentristinideology,while
theNationalPostisconsideredconservative/right(Mitchell,2007),however
neithernewspaperisexplicitlyassociatedwithaspecificpoliticalparty(Collinset
al.,2006).Theirweeklyreadership,asreportedIn2007,was2768100(Globeand
Mail)and1570200(NationalPost)(NADBANK,2007).
TheCanadianNewsstandDatabasewasusedtoselectarticlesfromMay9,
2003toMay9,2009(inclusive).Thisrangecoveredthreeyearspriorto,andthree
yearsfollowingthereleaseoftheSenatereport.
3.2 EstablishingSearchTerms
Initialsearchtermswereselectedtotargetarticlesrelevanttotheresearch
question:
‐mentalillness,mentaldisorder,ormentallyill;and
‐homeless,homelessnessorhousing.
Thesearchterm‘mentalhealth’wasconsidered,butasithadmuchwider
implicationsandlessdirectassociationwithmentalillnesswhencomparedtothe
26
otherinitialsearchterms,itresultedinmanyirrelevantarticles.Asampleof
articlesusing‘mentalhealth’asasearchterm(andexcludingtheotherinitialsearch
termsrelatedtomentalillness)werestudiedforanyfurtherphrasesthatmaybe
usedtopointmoredirectlytomentalillness.Itwasfoundthatmanyoftherelevant
articlesusedtheterms‘mentalhealthissue/s’and‘mentalhealthproblem/s’to
refertomentalillness,andthesephraseswereincorporatedintotheinitialsearch.
‘Mentalhealthsystems’wasalsoaddedtothesearchterms.Oftheremaining120
articlesassociatedwiththe‘mentalhealth’searchterm,arandomsampleof40%of
thearticleswasselectedforaninitialanalysis,whichshowedthat90%ofthese
articleswerenotrelevanttohomelessnessormentalillness.Thesearticleswould
ultimatelybeexcludedfromthedataanalysisatalaterpointforbeingirrelevant.
Giventhelowproportionofrelevantarticlesgeneratedfromthe‘mentalhealth’
searchterm,itwasnotusedasasearchtermforthisanalysis.
Thefinalsearchtermsweretherefore:
• mentalillness,mentaldisorder,mentallyill,mentalhealthsystem,mental
healthissue/sormentalhealthproblem/s;and
• homelessorhomelessnessorhousing.
3.3 ArticleSelection
Oncethesearchtermswereestablished,allarticleswithinthespecifiedtime
periodcontainingthesearchtermswereselected,resultingin414articles.
Obituaries,letterstotheeditor,articlesunder150words,andentertainment/art
reviewswerethenexcluded.Articlesthatappearedmorethanoncewerealso
excluded.Thesearticleswereonesthatappearedinvariousregionaleditionsofthe
27
newspaperandwereidenticalincontent.Atotalof81articleswereexcludedas
summarizedinTable1,leaving333articlesforanalysis.
Table1: Summaryofarticleexclusion(notmutuallyexclusive)
Reasonforexclusion Numberofarticles
Entertainment/ArtReview 23
LettertotheEditor 22
Articlerepetition 22
Wordcountunder150 14
Obituary 8
IndexArticle 2
3.4 CodingProtocol
Acodesheetwasdevelopedtogatherdataregardingpublicationdetailsand
potentialagendasettingandframingeffects.Althoughmediacontentanalysesoften
usequalitativecodingmethods(Collinsetal.,2006),thecodesheetwasdesignedto
consistprimarilyofcategoricalvariables.Thiswastoreducethepossibilityofcoder
subjectivityandtolaterallowforbothadescriptiveandquantitativeapproachto
thedataanalysis.Pilottestingwascarriedoutamongundergraduatevolunteers
andtheresultsofthisidentifiedvariablesthatneededtobeaddedorclarifiedto
improvereliabilityacrosscoders.Thefinalcodesheet(AppendixA)contained23
items.
28
3.4.1 TheoreticalOrientation
Thecodesheetwasdesignedtoallowanalysisofpotentialagendasettingand
framingeffectsassummarizedinTable2.Potentialagendasettingeffectswere
examinedbycodingforthequantityofcoverageofmentalillnessandhomelessness
inthenewspapers,theprominenceofthearticles,andthequantityofcoverageof
selectedthemesidentifiedintheSenateReport.Thepotentialforframingeffects
wasexploredinthecomparisonoftheamountofepisodicandthematiccoverage
(articleapproach),theassociationofthearticleapproachtothesolutionsidentified
inthearticles,andthevoicethatwaspresentedthroughthearticles.
Table2: Variablesusedtoassesspotentialmediaeffects
PotentialEffectsExplored Variable
AgendaSetting QuantityofCoverage
ArticleProminence
Articlethemes
Framing ArticleApproach
Voice
Responsibilityandbenefitsattributed
tosolutions
3.4.2 ArticleCharacteristics
Eacharticlewasassignedanidentificationnumber(ID#)andcodedforbasic
articlecharacteristics–newspapername,articledate,typeofarticle(newsor
29
editorial/column),authorandarticleheadline.Thesewereprimarilyfor
identificationofthearticlesandtheirplacingalongatimeline.Thearticle’sword
count,whetheraphotographaccompaniedit,anditsplacementwithinthe
newspaperwascodedtoassessarticleprominencetoseewhetherthischangedover
time.Acodeforarticlerelevancewasaddedafterthepilottestsshowedthat
althoughsearchtermswerepresentwithinthearticle,theyweresometimes
misidentified(e.g.thedatabaseidentified‘elementalproblem’asthesearchterm
‘mentalproblem’)ormentionedonlyinpassing(e.g.inthejobtitleofaquoted
individual),makingfurthercodingnotpossible.Thesearticleswerecodedas
keywordonlyandlaterremovedfromtheanalysis.Remainingarticleswerealso
codedforrelevanceusingaroughapproximationofhowmuchofthearticlewas
relatedtomentalillnessand/orhomelessness.Astheoverlapofthehomelessand
thosewithmentalillnesswasoftennotclearlydefinedduetothenatureofthis
population,articleswerecodedforbeingaboutmentalillnessorhomelessnessin
general,notnecessarilythehomelessmentallyillspecificallybecauseofthislackof
clarity.
3.4.3 ArticleThemes
TheAgendaSettingcomponentofthecodingwasprimarilyinthedetection
ofarticlethemes.Sixmajorthemesrelatedtomentalillnessandhomelessnesswere
identifiedin‘OutoftheShadowsatLast’,aspreviouslydiscussedintheBackground
sectionofthisthesis:
• Recovery:Identificationofhousingasaformofrecoveryforthoseliving
withmentalillness;
30
• PublicSafety:Concernsrelatingtothesafetyofthepublicatlarge;
• Inequity:Issuesrelatedtotheuniquechallengesfacedbythispopulation
ortheirincreasedriskofbeinghomeless/mentallyill;
• AffordableHousing:Problemsrelatingtothecostofhousing(e.g.lackof
affordablehousing,needforallocationoffundingtowardscheaper
housing,etc);
• IntegrationofServices:Indicationoftheneedforservicesoragencies
(e.g.health,housing,police,healthauthorities,etc)toworktogether,or
shareinformation;
• Stigma:Specificmentionofstigma,discriminationorNIMBYism.
AsAgendaSettingtheoryfocusesonthepresenceofparticularcontent,the
themeswerecodedasbeingeither‘mentioned’or‘notmentioned’inanarticle,
regardlessofthecontextorlengthofdiscussionaroundit.
3.4.4 ArticleFraming
Theframingcomponentofthecodingwasinarticleapproachandvoice.
Articleswerecodedforwhethertheywereepisodicorthematicintheirapproach
andwhatevent/storytheywerewritteninresponseto.Episodicarticleswere
thoseinwhichtheprimaryfocusofthearticlewasaspecificeventorstory,with
littleattentiontothebroadercontextoftheissue.Thematicarticleswereidentified
asthoseinwhichthemajorityofthestoryfocusedonthecontext,trendsorcauses
ofaparticularissueinsteadofaspecificeventitself.Althoughmanyarticles
containedelementsofbothapproaches,thedominantapproachwasidentifiedand
coded.Articleswerealsocodedforwhethertheystatedasolutiontoanyissues
raisedinrelationtohousingandmentalillness.Pilotstestsofthecodesheetshowed
thatcodingforsolutionsthatwereimpliedinthearticleledtoverylowcorrelation
31
betweencoders,signallinganeedforamoreobjectivecode.Assuch,thecodesheet
wasalteredtocodeonlyforclearlystatedsolutionsmadebythearticle.The
solutionswerethencodedforwheretheresponsibilitylayintheir
creation/implementationandwhowouldbenefitasaresult.Thefinalaspectthat
wascodedwasvoice,whichwasdefinedasanyonedirectlyquotedinthearticle,to
seewhatperspectivesandgroupswererepresentedwithadirectvoice,and
whetherthischangedovertime.Somearticleshadquotationswithnopersona
attachedtothem(innameorposition),andthesecouldnotbecoded.
3.5 CodingMethods
Codingofthearticleswasdoneinthreestages.Theinitialstageinvolved
usingaPerlscriptthatwasdesignedforthisspecificsetofarticles(SeeAppendixB
forthefullscript).Thisscriptscannedalltheselectedarticlesandidentifiedthe
newspapername,identificationnumber,articledate,articletype,headline,author,
wordcount,pagenumberanddirectlinktoeacharticle.Itthenenteredthisdata
intoaspreadsheetwherearandomsamplewascheckedforaccuracybyacoder.As
thesedetailswerenotsubjecttointerpretation,anautomatedformofcodingwas
thoughttodecreasehumanerrorandprovidegreateraccuracyofresults.Inthe
secondstage,allofthearticleswerecodedfortheremainingitemsonthecodesheet
byonecoder.ThecoderwasblindtoallidentifyinginformationexceptforID#,such
asarticledate,headlineandauthornametodecreaseanybiasincoding.Toreduce
errorsinrecordingandimproveinternalvalidity,thiscodingwasconducted
throughtheuseofaformthatidentifiedvariablesforselectionandautomatically
32
transferredthedataintoaspreadsheet(SeeAppendixCfortheform).Inthefinal
stage,asampleof20%ofthearticles(n=68)wasrandomlyselectedandcodedby
anotherindividualtoassessintercoderreliability.
3.6 StatisticalAnalysis
CodedarticleswereenteredintoanExcelSpreadsheet(Excel2008,Mac
version)formanagement.Basicdescriptivestatisticssuchasfrequency
distributionswereconductedusingthissoftware.Datawasalsoimportedintoan
SPSSDatabase,version17.0,forcross‐tabulationtests.Thesetestscalculatedthe
Pearsonexactchi‐squaretest(usingthe95%confidencelevel)fortestsof
significantdifferencesintheappearanceofarticlethemesanddifferencesin
episodicandthematiccoverage.Forsmallsamples,Fischersexacttestwasused.
33
4: RESULTS
Asstatedpreviously,articleswereselectedfromMay9,2003–May,9,2009
(inclusive)forcodingananalysis.Assuch,whenresultsarereferredtobyyearin
theproceedinganalysis,theyearisconsideredtobeginonMay9(i.e.2003‐2004
referstoMay9,2003–May8,2004inclusive).Theresultsalsoreferencethethree
yearspriortoandthethreeyearsfollowingthereleaseoftheSenateReport,which
willbereferredtoaspre‐SenateReportandpost‐Senatereportrespectively.
4.1 IntercoderReliability.
Aspreviouslymentioned,arandomsampleof20%ofthearticles(n=68)
werecodedbyasecondcoder.Inter‐coderagreementwasassessedseparatelyfor
specificvariables,namelydepthofdiscussion,eacharticletheme,episodic/thematic
framingandpresenceofasolution.Kappascoresforthesevariablesrangedfrom
0.731–1.00(p=<0.001forallscores)showingsubstantialtoalmostperfect
agreement(Viera&Garrett,2005),indicatingahighlevelofinter‐coderreliability.
TheKappascoreforeachassessedvariablecanbefoundinAppendixD.
4.2 GeneralOverview
Atotalof333newspaperarticleswerecoded.Articlesinwhichthedepthof
discussionregardingthehomelessandmentallyillwereconfinedto‘keywordonly’
wereremoved(n=102),leaving231articlesforanalysis.Thedepthofdiscussionof
theremainingarticleswasprimarily‘majority/entirearticle’(n=179).Withinthe
34
sampleddatarange,articleswerefoundfrom13‐August‐2003to7‐May‐2009.Of
these,55articleswerefromtheNationalPostnewspaper,and176werefromThe
GlobeandMailnewspaper.Thenumberofauthors(bothjournalistsandpublic
figures)representedintheanalyzedsamplewas127,withthemaximumnumberof
articleswrittenbyasinglejournalistbeing12.
4.3 ArticleCharacteristics
4.3.1 QuantityofCoverage
QuantityofCoveragewasusedtoinvestigateagendasettingeffectsandwas
countedasthetotalnumberofarticlesinagivenperiodoftime.Therewasa
greaternumberofarticlesinthethreeyearsfollowingthereleaseoftheSenate
Report(n=169)thanthethreeyearsprior(n=62),ascanbeseeninFigure1.
35
Figure1: QuantityofCoverageBeforeandAfterthereleaseofTheSenateReport
Toseehowthisrelatesproportionallytohowmanyarticleswerepublished
ingeneralinthoseyearsandtoestablishwhetherthisincreasewasduetoageneral
increaseinnewspaperarticlepublication,asearchwasconductedtoestablishthe
totalnumberofarticlespublishedbyTheGlobeandMailandNationalPost
newspapersinthesixyearsbeingstudied.Theresultsfound434,880articlesinthe
threeyearspre‐SenateReport,and374,270articlespost‐SenateReport.These
figuresrepresenttotalnumberofarticles,includingtypesofarticlesthatwere
excludedfromthestudysamplesuchasletterstotheeditorandarticlesfewerthan
150words.Assuch,thesefiguresarenotmeanttoconveyanaccurate
representationofnewsarticlesprintedinthattime.Theyarehowever,importantin
36
exploringwhethertheincreaseinthenumberofarticlesrelatedtomentalillness
andhomelessnessismeaningful.Consideringthis,therewasasignificantincrease
inthenumberofarticlespost‐SenateReport(p<0.0001at99%confidenceinterval).
ThetrendsinthequantityofcoveragebyyearareshowninFigure2.The
numberofarticlesincreasedeveryyear,with15articlesin2003‐2004,17articlesin
2004‐2005,29articlesin2005‐2006,46articlesin2006‐2007,61articlesin2007‐
2008and63articlesin2008‐2009.
Figure2: QuantityofCoveragebyyear
4.3.2 ProminenceofCoverage
Articleprominencewasexploredbyanalyzingthechangeintheaverage
articlewordcount,theplacementofthearticlewithinthenewspaperandthe
presenceofartworkorphotographsaccompanyingthearticle.Themeanword
countofthearticlesoverthesixyearsstudiedwas973words/article,withasmall
increasebetweenthemeanwordcountpre‐SenateReport(909words/article)and
37
post‐SenateReport(996words/article).Therewaslittlevariationinthemean
wordcountbyyearasshowninFigure3,withthegreatestvariationbeingseen
between2007‐2008and2008‐2009.
Figure3: AverageWordCountbyyear
ForArticlePlacement,inthethreeyearsprecedingthereleaseoftheSenate
Report,therewerethreearticlesthatappearedonthefrontpageofthenewspaper,
10thatappearedonthesectionfrontpage,and49articlesthatappearedinother
pagesofthenewspaper(seeFigure4).Comparatively,inthesubsequentthree
years,sevenarticlesappearedonthefrontpageofthenewspaper,33onthesection
frontpage,and129inotherpartsofthenewspaper(seeFigure5).When
comparingFigures4and5,itisimportanttonotethatinadditionanincreaseinthe
totalnumberofarticlesappearinginthepaperfrontpageandsectionfrontpagesof
38
thenewspapers,thereisanincreaseintheproportionofarticlesinprominent
positionsofthenewspaperpost‐SenateReport.
Figure4: ArticlePlacementPreSenateReport(No.ofarticles)
Figure5: ArticlePlacementPostSenateReport(No.ofarticles)
Therewerefewarticleswithanaccompanyingphotograph(n=33)inthe
analyzedsample.InthethreeyearspriortothereleaseoftheSenateReport,10%
39
ofthearticleshadaphotograph(n=6),whileinthethreeyearsfollowing,16%ofthe
articleshadaphotograph(n=27).
4.4 ArticleThemes(AgendaSetting)
Potentialagendasettingeffectswerefurtherexploredthroughthe
appearanceofthemesderivedfrom‘OutoftheShadowsatLast’.Nostatistically
significantdifferenceswereobservedpreandpost‐Senateinthementionsofanyof
thethemes(p‐valuesforeachthemecanbefoundinAppendixE).However,there
wasanincreaseinthenumberofarticlesmentioningeachtheme,asoutlinedbelow.
Recovery
Thenumberofarticlesthatmentionedthethemeof‘Recovery’showedan
increasefromthetimepre‐SenateReport(n=6)toPost‐SenateReport(n=34).
Figure6showsthenumberofarticlesmentioningthethemeofrecoverybyyear,
showingveryfewmentionsinbetween2003and2006,whichweremorethan
doubledin2006andfurtherincreasedin2008‐2009.
40
Figure6: Frequencyofarticlesmentioning‘Recovery’
PublicSafety
Thenumberofarticlesthatmentionedthethemeof‘PublicSafety’increased
inthethreeyearsfollowingthereleaseoftheSenateReport(fromn=10ton=27).
Whilethenumberofarticleswiththisthemewaslowbetween2003and2005(only
onearticleineachyear),itincreasedtoeightarticlesin2005‐2006,andremained
betweeneightandtenarticlesinthethreeyearsfollowing,andshowninFigure7.
Figure7: Frequencyofarticlesmentioning‘PublicSafety’
41
Inequity
Thefrequencyofarticlesmentioningthethemeof‘Inequity’showedan
increaseinthepost‐SenateReportyears.Thefrequencyofarticlesmentioningthis
themeshowedanincreasefromatotalof12articlesinthethreeyearspriortothe
releaseoftheSenateReporttoatotalof38articlesinthethreeyearsfollowing.The
trendintheincreaseofthenumberofarticlesisshownbyyearinFigure8.
Figure8: Frequencyofarticlesmentioning‘Inequity’
AffordableHousing
Thetheme‘AffordableHousing’wasthemostfrequentlymentionedtheme
amongallthearticles,beingmentionedinatotalof63articlesoverthesixyears
analyzed.Thenumberofarticlesthatmentionedthisthemeincreasedfromatotal
of16articlespre‐SenateReporttoatotalof47articlesinthethreeyearsfollowing
thereleasethereport.Therewasamarkedincreaseinthenumberofarticles
mentioningthisthemein2006‐2007.Thisdecreasedin2007‐2008,butthenumber
42
ofarticlesinthisyearstillremainedhigherthaninanyofthethreeyearspre‐Senate
Report.Thebreakdownofthenumberofarticlesmentioningthisthemebyyearis
showninFigure9.
Figure9: Frequencyofarticlesmentioning‘AffordableHousing’
IntegrationofServices
Thetheme‘IntegrationofServices’increasedfromafrequencyofthree
articlesintheyearspriortothereleaseoftheSenateReportto20articlesinthe
threeyearsfollowing.Thequantityofarticlesmentioningthisthemeshoweda
generalincreaseovertime,asseeninFigure10,exceptfor2004‐2005inwhichno
mentionsofthisthemewerefound.
43
Figure10: Frequencyofarticlesmentioning‘IntegrationofServices’
Stigma
Thenumberofarticlesmentioningstigmaincreasedpost‐SenateReport.The
frequencyofarticlesincreasedfromatotaloffivearticlesmentioningstigmainthe
threeyearsprecedingthereleaseoftheSenateReport,toatotalof30articlesinthe
followingthreeyears.Figure11showsthefrequencyofarticlesmentioningthis
themebyyear.Ascanbeseen,therewasamarkedincreaseinthenumberof
articlesthatmentionedthethemeofstigmain2006‐2007.Whilethefrequencyof
articlesmentioningthisthemedecreasedin2007‐2008,itagainshowedanincrease
in2008‐2009.
44
Figure11: FrequencyofarticlesmentioningStigma
Summaryofthemes
Asummaryofthefrequencyoftheappearanceofspecificthemes,bothpre
andpost‐SenateReport,isshowninFigure12.Asdemonstratedinthisfigure,all
themesshowedanincreaseinthefrequencyofarticlesinwhichtheywere
mentionedPost‐SenateReport.ThethemesofStigma,RecoveryandIntegrationof
Servicesshowedamoremarkedincreaseincomparisontootherthemes,increasing
byafactorof6,5.7and6.7respectively.Incomparison,thethemesofPublicSafety,
InequityandAffordabilityofHousingincreasedbyafactorof2.7,3.2and2.9
respectively.
45
Figure12: FrequencyofArticlesmentioningthemes
4.5 Framing
Potentialframingeffectswereexploredthroughtheanalysisofarticle
approach,namelyepisodicorthematic.Ofallthearticlesusedforanalysis(n=231),
themajoritywereepisodic(n=200).ThiscanbeseeninFigure13.
Figure13: EpisodicandThematicArticles(No.ofArticles)
46
Figures14and15showtheamountofepisodicandthematiccoveragepre‐
SenateReportandpost‐SenateReport.Whiletheamountofepisodiccoverageand
thematiccoveragebothincreasepost‐SenateReport,Figure15showsanincreasein
theproportionofthematicarticlesPost‐SenateReport.
Figure14: ArticleApproachPreSenateReport(No.ofArticles)
Figure15: ArticleApproachPostSenateReport(No.ofArticles)
47
Figure16showstheamountofepisodicandthematiccoverageineachother
analyzedyears.Bothepisodicandthematiccoverageshowanincreaseeachyear,
exceptfor2008‐2009inwhichthenumberofepisodicarticlesdropped.The
numberofthematicarticleswaslowinthefirstfewyearsofanalysisandincreased
intheyearsfollowingthereleaseoftheSenatereport(2006‐2009).Aswiththe
coverageofmanyofthethemes,thenumberofthematicarticlesshowedamore
pronouncedincreasetheyearthattheSenateReportwasreleased,followedbya
decreaseinthefollowingyear.Thiswasthenfollowedbyanotherpronounced
increasein2008‐2009.
Figure16: QuantityofEpisodicandThematicArticlesbyYear
PrimaryEvent/Story
Articleswerecodedfortheirprimaryevent/story,thesummaryofwhichis
presentedinTable3.
48
Table3: ArticlesPrimaryEvent/Story
MainStory/EventEpisodic(n)
Thematic(n)
Total(n)
Other 356 41
No/unclear 25 16 41
Personalstory 23 1 24
Newbuilding/zoningallocation/opening 21 1 22
Politicalevent/election 14 1 15
Releaseofreport 11 4 15Violence/crimeagainstanMI&Hindividual 15 0 15
Violence/crimebyanMI&Hindividual 13 0 13
Fundingallocation 10 1 11
Newpolicy/strategy 8 0 8
Deathofahomelessindividual 7 0 7
Healthpolicy/administrativechange 5 0 5
Homelesscount 5 0 5
Policeaction 4 1 5
2010WinterOlympicGames 4 0 4
ThemostfrequentlycodedcategorieswereNo/Unclear(n=41)orOther
(n=41)accountingfor35%ofthetotalsampleofarticles.Thesewerearticlesthat
eitherdidnothaveacleareventorstory,orthoseinwhichthestorycouldnotbe
categorizedinameaningfulwaywithothers.Examplesofthisincludereportsofthe
creationofahomelesschoir,thelossofahomelessman’sdogandacommentaryon
theuseofasafeinjectionsite.Forvisualclarity,thesetwovariableswereremoved
forFigure17,tomoreeasilyshowthefrequencyoftheremainingvariables.Stories
49
thatfocusedonpersonalstories(n=24)andNewbuilding/zoning/allocation/
opening(n=22)werethenextmostfrequentstories.ThiswasfollowedbyPolitical
events(suchaselections),thereleaseofareport,andviolence/crimeagainstan
individualidentifiedashomelessandmentallyill(n=15).
Figure17: ArticlesPrimaryEvent/Story(No/Otherremoved)
Astherewerefewthematicarticles,thestoriesrepresentedinepisodic
articlesshowedasimilartrendasthoseinthefullgroupofarticles(asseeninTable
3).Thethematicarticleshowever,showedadifferentpattern.WhileNo/unclear
!" #" $!" $#" %!" %#"
!"#"$%&'()*$+,-./&0$12.)3$
4)2,(5$/6,&0-728.&'&3(*2(&9)$052':)$
46.),)33$06;'($
<6,&0)$20(&6'$
=)2(5$6>$2$56.),)33$&'8&9&8;2,$
?)@$/6,&0-73(*2():-$
A;'8&':$2,,602(&6'$
B&6,)'0)70*&.)$C-$2$.)'(2,,-$&,,756.),)33$&'8&9&8;2,$
<6,&(&02,$)9)'(7),)0(&6'$
D),)23)$6>$*)/6*($
B&6,)'0)70*&.)$2:2&'3($2$.)'(2,,-$&,,756.),)33$&'8&9&8;2,$
?)@$C;,8&':7E6'&':$2,,602(&6'76/)'&':$
<)*36'2,$3(6*-$
!"#$"%$&'()*+,-$
.'()*+,-$/')0&'1$23,4(56("'1$7!"58(9,'$',0"3,:;$
50
andOtherwerestillthemostfrequentstory,thenextmostfrequentstorywasthe
releaseofareport.
ThePrimaryEvent/Storywasthenstratifiedbypublicationyear,theresults
ofwhicharesummarizedinTable4.
Table4: ArticlesPrimaryEvent/StoryoverTime
PrimaryEvent/Story20022003
20032004
20052006
20062007
20072008
20082009
Other 2 4 5 9 10 11
No/unclear 1 3 7 10 9 11
Personalstory 3 2 0 5 5 9
Newbuilding/zoningallocation/opening 1 0 2 4 10 5
Politicalevent/election 7 0 1 1 1 5
Fundingallocation 0 0 0 4 2 5
Violence/crimebyanindividualwhowashomelessand/ormentallyill 0 2 2 3 3 3
Releaseofreport 0 0 3 5 6 1
Healthpolicy/administrativechange 0 0 0 0 2 3
Policeaction 0 0 0 2 0 3
Deathofahomelessindividual 1 1 1 0 2 2
Violence/crimeagainstanindividualwhowashomelessand/ormentallyill 0 1 5 1 7 1
Newpolicy/strategy 0 2 0 1 4 1
Homelesscount 0 2 2 1 0 0
2010WinterOlympicGames 0 0 1 0 0 3
51
Oftheseresults,thereareafewnotabletrends.Articlescategorizedas
No/unclearandOthershowedasimilaryearlyincreasingtrendtothetotal
frequencyofallarticles,asdemonstratedinFigure18.
Figure18: PrimaryEvent/Story:OtherandNo/Unclear
Articleswithafocusonpersonalstories(seeFigure19)showedadecline
fromthreearticlestononeinthethreeyearspre‐SenateReport.Intheyear
followingthereleaseoftheSenateReporttherewasanincreaseinthenumberof
articles,andafurtherincreasecanbeseenin2008‐2009.
!"
#"
$"
%"
&"
'!"
'#"
#!!()#!!$" #!!$)#!!*" #!!*)#!!%" #!!%)#!!+" #!!+)#!!&" #!!&)#!!,"
!"#$"%$&'()*+,-$
.,/'$
0')1/'2$34,5(67("'28$9(:,'$/5;$!"6<5*+,/'$
!"#$%&
'()*+,-$.%&
52
Figure19: PrimaryEvent/Story:PersonalStory
Articleswrittenaboutapoliticalevent/electionshowedgenerallylow
coveragewithpeaksofhighercoverageinspecificyears.Thiscanbeexpectedas
mostofthesearticlesreferredtopoliticiansandtheirelectionplatformregarding
homelessness(andsometimesmentalillness).Assuch,itcouldbeexpectedthat
therewouldbeincreasedcoverageregardingthistopicinyearswithanelectionor
politicalcontraversy.Articlesregardingthereleaseofareportwereonlypresent
after2005,andwhiletheyshowedincreasingcoverageuntil2008,thenumberof
articlesonthistopicdeclinedin2008‐2009.Articlesregardingfundingallocations
wereonlypresentpost‐Senatereport.Articlesinwhichtheprimaryevent/story
wasviolenceagainstanindividualwhowashomelessand/orlivingwithmental
illnessshowedgenerallylowyearlycoveragewithpeaksofhighercoverageintwo
specificyears,asshowninFigure20.
!"
#"
$"
%"
&"
'"
("
)"
*"
+"
#!"
$!!%,$!!&" $!!&,$!!'" $!!',$!!(" $!!(,$!!)" $!!),$!!*" $!!*,$!!+"
!"#$"%$&'()*+,-$
.,/'$
0')1/'2$34,5(67("'28$0,'-"5/+$7("'2$
53
Figure20: PrimaryEvent/Story:ViolenceAgainstaHomelessand/orMentallyIllIndividual
Incomparison,articlesinwhichtheprimaryevent/storywasviolencebyan
individualwhowashomelessand/orlivingwithmentalillnessshowedmore
generallysteadyreportingwithalowoverallyearlyfrequencyofarticlesregarding
thistopic.ThiscanbeseeninFigure21.
Figure21: PrimaryEvent/Story:ViolenceByaHomelessand/orMentallyIllIndividual
!"
#"
$"
%"
&"
'"
("
)"
*"
$!!%+$!!&" $!!&+$!!'" $!!'+$!!(" $!!(+$!!)" $!!)+$!!*" $!!*+$!!,"
!"#$"%$&'()*+,-$
.,/'$
0')1/'2$34,5(67("'28$9)"+,5*,$&:/)5-($/$;"1,+,--$/5<6"'$
=,5(/++2$>++$>5<)4)<?/+$
!"
#"
$"
%"
&"
'"
("
)"
*"
$!!%+$!!&" $!!&+$!!'" $!!'+$!!(" $!!(+$!!)" $!!)+$!!*" $!!*+$!!,"
!"#$"%$&'()*+,-$
.,/'$
0')1/'2$34,5(67("'28$9)"+,5*,$:2$/$;"1,+,--$/5<6"'$
=,5(/++2$>++$>5<)4)<?/+$
54
Articleswrittenaboutthedeathofahomelessindividualwereinfrequent
anddidnotmarkedlychangeinthetimeperiodstudied.
Solutions–ResponsibilityandBenefits
Articleswereanalyzedforwhethertheyprovidedaclearsolutiontoany
problemsidentifiedregardingthehomelessorthosewithmentalillness.Ofallthe
articlesanalyzed,49articles(21%)offeredaclearsolution.Ofthese,33werecoded
asepisodicarticles,and16werethematic.Whilethereweremoreepisodicarticles
amongthosewithsolutions,itisimportanttonotethatthe33articlesaccountfor
onlyfor16.5%ofallepisodicarticles,whileincontrast,51.6%ofthethematic
articlesofferedclearsolutions.Thematicarticlesofferedasolutionsignificantly
morethanepisodicarticles(p=<0.0001).
Articlesthatcontainedaclearsolutionwerethenanalyzedtoseewhether
theresponsibilityforimplementingthesolutionlaywithgovernmentalagencies,or
withtheindividualsaffectedbymentalillnessand/orhomelessnessthemselves.
TheresultsaresummarizedinFigure22.
55
Figure22: AttributionsofResponsibility
Asshowninthisfigure,themajorityofthesolutionsattributedthe
responsibilityofthesolutiontoGovernmentalagencies(92%).Whenstratifiedby
articleapproach(Figure23),itcanbeseenthatwhilebothepisodicandthematic
articlesmostfrequentlyattributedresponsibilityforsolutionstoGovernmental
agencies,nothematicarticlessuggestedthattheindividualsaffectedshouldbe
responsible.
Figure23: AttributionsofResponsibility(EpisodicandThematic)
!"#
$#$#
%&&'()*&(+,-#+.#/0-1+,-()(2(&3#
!"#$%&'$&()*+
,&-.#.-/)*0+)11$2($-+
3&2*$)%4&"(+$56*.2.(+
56
Articlesthatpresentedsolutionswerethencodedtoseewhichgroupswere
identifiedasrecipientsofthesolution,meaningthosewhowouldbenefitfromthe
solutionifitweretobeimplemented.TheresultsareshowninFigure24,showing
thatthemajorityofthesolutionsofferedwereidentifiedasbeingofbenefittothose
whowerehomelessand/ormentallyill(n=22,45%).
Figure24: BenefitsoftheSolution
Whenstratifiedbyarticleapproach(Figure25),resultsshowedthatepisodic
articlesthatofferedsolutionsprimarilysuggestedthattheindividualsaffected
wouldbenefit,whilethematicarticlesweremainlyunclearornotexplicit.
!"
##"
$%"
&"
'()(*+,-"./",0("1.23,+.)"
!"##$%&'()*')+*,-.)
/%0&1&0$*+2)*33.4'.0)
5%4+.*,6%"').78+&4&')
9"':)
57
Figure25: BenefitsoftheSolution(EpisodicandThematic)
Authors
Authorsofthenewspaperarticlesweregroupedbythenumberofarticles
writtenbyeachindividualauthorinthesample.Thishelpedtodistinguishbetween
regularjournalistsandarticleswrittenbyone‐timeauthors(oftenpoliticalorother
publicfigures).Thematicarticleswerefoundtobesignificantlymorelikelytobe
writtenbyjournalistswhohadwritten4ormorearticlesrelatedtomentalillness
andhomelessness(p=0.0298).
Voice
ThevoiceofanyoneindirectquotationswasnotedandsummarizedinTable
5below.Inarticlesfrombothpreandpost‐SenateReport,individualsidentifiedas
homelessand/orlivingwithmentalillnessweremostfrequentlyquoted.
58
Table5: SummaryofVoiceinallarticles
Whoisquoted(Individualidentifiedas) PreSenate
Report(No.
ofarticles)
PostSenate
Report(No.
ofarticles)
Homeless/MentallyIll/HomelessandMentallyIll 20 42
Politician 16 32
HealthProfessional,Researcher/Expert 10 32
Organization/ProfessionalSociety 9 34
Shelter/Housingrepresentative 7 1
Policeofficer/representative 6 19
Ministry/HealthAuthority 6 15
FamilyMember 6 10
Judge 3 9
Advocate 3 18
Governmentrepresentative 2 16
Businessperson 0 6
Articlesisaninterview 1 6
None 10 30
Other 12 16
59
5: DISCUSSION
Overall,theresultsshowthattherehasbeenachangeinthedepictionof
mentalillnessandhomelessnessinCanadiannationalnewspapercoveragesincethe
releaseoftheSenateReport.TheresultssuggestthattheSenatereporthada
lastingandmeaningfuleffectonthepublicagendaadvancedbythenational
newspapercoverage.Theresultsfurthersupportthatnewspapercoverage
regardinghomelessnessandmentalillnessshowsanincreasingtrendinthe
presentationofthemesidentifiedasprioritiesintheSenateReport.Additionally,
whilethemajorityofcoverageisfocusedonepisodicreporting,thereisanincrease
inthenumberofarticlesprovidingcontextualinformationandsolutionsregarding
thispopulation.
Thischapterdiscussesthesekeyfindingsinthecontextofagendasettingand
framingtheories,followedbyadiscussionofthelimitationsofthisanalysisand
directionsforfutureresearch.
5.1 KeyFindings
5.1.1 AgendaSettingEffects
Therewasasignificantincreaseinthenumberofarticleswritteninthethree
yearsfollowingthereleaseof‘OutoftheShadowsAtLast’comparedtothethree
yearspriortoitsrelease.Thequantityofcoverageincreasedeachyearinthetime
periodstudied.Theaveragelengthofthenewspaperarticlesshowedlittlechange.
60
Howevertherewasanincreaseinthenumberofarticlesappearingonthefront
pageofthenewspaperandfrontpageofsectionsofthenewspapersaswellasan
increaseinthenumberofarticlesaccompaniedbyaphotograph.Thisindicatesan
increaseintheprominenceofarticlesrelatedtohomelessnessandmentalillness.
Theincreasedquantityofcoverageandthegreaterprominenceofrelevantarticles
implythatthepotentialforexposuretoarticlesregardingmentalillnessand
homelessnessincreasedpost‐SenateReport.Thisinturnsignifiesthatthepotential
foragendasettingeffectsincreasedfollowingthereleaseoftheSenateReport.
Theanalysisalsoindicatesthatinthethreeyearsprecedingthereleaseofthe
SenateReport,therewereanincreasingnumberofarticleswritteneachyear.A
likelyexplanationforthisisfoundintheSenateReportitself.Inthereport,the
Committeerecognizesthatduringthetwoandahalfyearsinwhichtheywere
conductingtheirresearch,themomentumtoaddressandchangethementalhealth
systemwasalreadybuilding.
Whiletheamountofcoverageregardingmentalillnessandhomelessness
increasedintheyeartheSenateReportwaspublished,thereisfurtherevidenceof
thisincreaseinthesecondandthirdyearfollowingthereleaseoftheSenateReport.
Aseffectsofreportsaretypicallyexpectedtobeshorter,thisislikelyfueledbyother
influences.Itispossiblethatpastnewspapercoverageitselfgeneratesadditional
coverageasreportersaremoreassuredofliteracyaroundthesetopics,andassuch
canensurereadershipandinterestoffurthercoverage.ThecreationoftheMental
HealthCommissionofCanadaisalsoalikelyinfluenceonthecontinuedincreaseof
coverage.TheCommitteeemphasizedthatwhiletheSenateReportwoulddraw
61
attentiontomentalhealthissues,nationalfocusontheseissuescouldonlybe
maintainedthroughthecreationoftheMentalHealthCommission.Assuch,it
possiblethatboththecreationoftheMentalHealthCommissionandtheir
subsequentactivitieshavecontinuedtokeepmentalillnessandhomelessness
salienttopics.Similarly,itislikelythatpublicfocusandattentionbroughttoissues
concerningmentalillnessandhomelessnessaffordedothergroupsanopportunity
tocommentonthesetopicsinapublicforum.Thecontinuedincreaseincoverageis
suggestivethattheSenateReportappearstohaveplayedacatalyticrolein
increasingtheoverallfrequencyofreportingonmentalillnessandhomelessness.
Themes
Whilenostatisticallysignificantchangeswereobservedintheappearanceof
theidentifiedthemes,therewasanincreaseinthefrequencyofallthethemespost‐
SenateReport.Thistrendismeaningfulasitimpliesthattheagendasetting
potentialofnationalnewscoveragewithregardstothesethemesincreasedpost‐
SenateReport.Thisismorepronouncedinthepresentationofthethemesof
Recovery,StigmaandIntegrationofServices,whichshowedamoremarked
increase.Whilethereisnoclearindicationofwhytheincreaseinthecoverageof
somethemeswasmorepronouncedthanothers,thedifferencesarelikelyfueledby
otherensuingevents,reportsandfindings.Aswithoverallcoverageofmental
illnessandhomelessness,itispossiblethattheSenateReportactedasacatalystin
enablingtheseissuestobefurtherpubliclydiscussed.
62
ThispotentialcatalyticroleoftheSenateReportisfurthersupportedin
notingthepatternsofthereportingofthemesovertime.Fiveofthesixselected
themes(allexceptIntegrationofServices)showedapatterninwhichthenumberof
articlesmentioningthethemeincreasedintheyeartheSenateReportwasreleased,
declinedsomewhatinvaryingdegreesinthefollowingyear,andincreasedagainin
2008‐2009,inmostcasesabovethepreviouspeaknumberofarticlesin2006‐2007.
Incomparison,thetotalnumberofarticlesinthesamplesteadilyincreasedinthis
periodoftime,signifyingthatthispatternwasnotduetoageneraltrendinthe
numberofarticleswritten.Hadthecoverageofthemesbeeninfluencedbythe
SenateReportalone,itwouldbeexpectedthatafterapeakofcoverageintheyearin
whichthereportwasreleased,adeclineinthecoverageofthesethemeswouldbe
observedinthefollowingyears.However,theobservedtrendreinforcesthatother
influenceslikelycausedcoverageofthesethemestonotonlycontinuetobe
presentedinnewspaperreportsatanelevatedlevelcomparedtoprioryears,butto
furtherincreasein2008‐2009.
5.1.2 PotentialFramingEffects
Theanalysisofpotentialframingeffectswascenteredondifferencesin
articleapproach.Overthesixyeartimeperiodanalyzed,alargeportionof
newspapercoverageusedepisodicframing.Therewasnostatisticallysignificant
differenceinarticleapproachwhencomparingpreandpostSenateReport,andboth
episodicandthematicarticlesincreasedpost‐SenateReport.However,the
proportionofcoverageusingathematicapproachincreasedpost‐SenateReport,
63
andthemajorityofthematicarticleswereinthethreeyearsafterthereleaseofthe
SenateReport.Althoughepisodiccoverageshowedamarkedincreaseoverthe
studyperiod,thenumberofepisodicarticlesdecreasedinthelastyearofanalysis
despiteitbeingtheyearwithmostcoverageregardingmentalillnessand
homelessness.Overall,thoughthemajorityofarticlesremainepisodicallyframed,
articleapproachshowedanincreaseintheamountofthematicreportingsincethe
releaseoftheSenatereport.
BasedonIyengar’s(1991)theoryofframingeffects,thiswouldsuggestthat
duetotheepisodicframingofthemajorityofnewscoverage,responsibilityfor
addressingconcernsrelatedtomentalillnessandhomelessnesswouldlikelybe
attributedtoaffectedindividualsthemselves.However,theanalysisofthesolutions
presentedinthearticlesindicatedthatthismightnotbethecaseforallepisodic
articlesinthisstudy.Theresponsibilityforimplementingsolutionsinbothepisodic
andthematicarticleswasalmostentirelyattributedtogovernmentalagencies.This
maysupportCollinsetal,’s(2006)suggestionsthatIyengar’s(1991)theoryof
framingeffectsmayapplytospecificissuessuchascrimeandunemploymentbut
notuniversallytoallpublicpolicyissues.Itisalsopossiblethatthedissimilarityis
duetodifferencesstudydesign,asIyengar’sresearchfocusedonreceptionstudies
andimpliedattributionsofresponsibility,whiletheresearchinthisthesisfocuses
onlyonclearlypresentedsolutions.Itisalsoimportanttonotethatwhilethe
episodicarticlesthatidentifiedsolutionsshowedstructuralattributionsof
responsibility,theyareasmallproportionofallepisodicnewspapercoverage.
64
Theincreaseinthematicreportingislikelytohaveapositiveeffectonthe
potentialforchangingpublicattitudes.Thematicarticlesplaceindividualsand
eventsinthecontextofbroadersocialandstructuralsystemsandassuch,allow
readerstomoreeasilyidentifythatifaproblemistobesolved;thecontextmustbe
addressed(Dorfman&Wallack,2008).Furthermore,thematicarticleswere
significantlymorelikelytoofferclearsolutions.Definingclearsolutionstosocial
issueshasbeenidentifiedasanimportantfactorinadvocatingforchangethrough
themedia(Dorfman&Wallack,2008).Theincreaseinthematicarticlespost‐Senate
Reportraisedthepotentialofthenewsmediatoraiseattitudesofchangeand
advancetheunderstandingofthepublicregardingthebroadercontextofmental
illnessandhomelessness.
Additionally,thematicarticlesweresignificantlymorelikelytobewrittenby
anauthorwithfourormorearticlesinthesamplestudied.Thisimpliesthat
journalists,asopposedtopoliticiansorotherpublicfigureswhowouldauthoronly
onearticleinthesamplestudied,wrotethematicarticles.Italsosuggeststhatmost
thematicarticlesarewrittenbyjournalistswhohaveaninterestinand/or
knowledgeofmentalillness,homelessnessorboth,andareprolificintheir
reportingoftheseissues.
ArticlesPrimaryEvent/Story
Theprimaryevent/storyatthecentreofeachnewspaperarticlewas
explored,andtheresultsofthisanalysisofferedadditionaldetailsregardingthe
depictionofmentalillnessandhomelessnessinnationalnewscoverage.More
65
specifically,theanalysisshowedthatwhiletherewasadiverserangeof
events/storieswritteninrelationtomentalillnessandhomelessness,coverage
centredonviolencewasnotamongthemostfrequentlyreportedevent/story.
Additionally,therewasanincreaseinthecoverageofpersonalstoriespost‐Senate
Report,suggestiveofahigherpotentialforpublicsympathytowardsthehomeless
andmentallyill.
Forbothepisodicandthematiccoverage,themostfrequentlycoded
categorieswere‘Other’and‘No/unclear’.Thisindicatesthatalargeportionof
articlesregardlessoftheirapproach,werewrittenaboutanisolated
event/occurrenceanddidnotfocusonanyparticularissueregardingthis
population.Overthesix‐yeartimeperiodstudied,thenumberofarticlesregarding
thesetopicsshowedasimilarpatterntotheoverallincreaseintheamountofnews
coverage.Thismaybeindicativeofthenatureofnewsreporting,whichrequires
findingnewandunusualoccurrencestoreport(Bachrach,1990),resultinginwide
diversityofstoriesbeingreportedregardingmentalillnessandhomelessness.
Coverageofpersonalstorieshowever,showedadifferentpattern.The
numberofarticlescentredonpersonalstoriesincreasedPost‐SenateReportand
showedfurtherincreaseintheyearsthatfollowed.TheSenateReportitself
containedmanypersonalanecdotesandputahumanfaceonmentalillness.It
appearsthatsincethereleaseoftheSenateReport,thisisincreasinglyoccurringin
nationalnewsmediaaswell.Thisfindingisparticularlynoteworthyasresearch
suggeststhatpersonalstoriescanbemoreemotionallyengagingforthepublicand
havehigherpotentialtochangepublicattitudesthroughelicitingsympathy(Gross,
66
2008).Whileithasbeensuggestedthatepisodicreportscanminimizeattitudesof
changebyfocusingontheindividualratherthanonstructuralforces(Iyengar,1991;
Iyengar,1990a,Dorfman&Wallack,2008),researchalsoindicatesthatcompelling
storiescanleadtostrongfeelingsofsympathytowardsthesubjectofthestoryand
inspireaneagernesstochangethestructurethatcreatedthatindividual’ssituation
(Gross,2008).
Theothernoteworthypatternsarethoserelatedtostoriesofviolenceand
crime.Asdiscussedinpreviouschapters,newscoverageofmentalillnesshasbeen
showntoperpetuateanassociationbetweenmentalillnessandviolence(Philo,
McLaughlin,&Henderson,1996;Ward,1997;Allen&Nairn,1997;Nairn,1999;
Hazelton,1997).Thisstudyfoundthatrelativelyfewarticleswerewritten
regardingmentalillnessandhomelessnessthatcentredonviolenceorcrimeand
thisshowednomarkedchangeovertimeshowinglowcoverageofspecific
incidents.Incontrast,newsreportsthatcentredonviolenceagainstanindividual
whowashomelessand/orlivingwithmentalillnessshowedpeaksofhigher
coverageinparticularyears,suggestingaproliferationofarticlessurrounding
particularincidencesofviolence/crime.Thisdifferenceincoverageislikelydueto
thenationalscaleofthenewspapersanalyzedandthedifferenceinthetypesof
crimereported.Whilestoriesofviolence/crimebyanindividualidentifiedas
homeless/mentallyillweregenerallyaboutaggressivepanhandlingincidents,
storiesofviolence/crimeagainstanindividualidentifiedashomeless/mentallyill
wereconcernedmoreviciousattacks.Assuch,nationalnewscoverageofmental
illnessandhomelessnessdoesnotappeartoperpetuatetheassociationofthe
67
homelessand/orthoselivingwithmentalillnesswithviolencethroughincreased
coverageofviolentincidents,exceptpossiblyasvictimsofit.
Voice
Ingeneral,thearticlesquotedawiderangeofpeople,bothbeforeandafter
thereleaseoftheSenateReportandshowednomeaningfulchangeovertime.
Therewerenomajordifferencesobservedinwhowasquotedinthearticleswhen
comparingpreandpostSenateReport.Thegroupthatwasmostfrequentlyquoted
inbothtimeperiodswasindividualsidentifiedashomeless,mentallyill,orboth
homelessandmentallyill,signifyingthatthepopulationbeingdiscussedwasgiven
thegreatestvoice.Thegroupsthatsawthegreatestincreasesinthenumberof
articlesquotedwerethoseidentifiedashomeless/mentallyill/homelessand
mentallyill,healthprofessionals/researcher/expert,andrepresentativesfroman
organizationorprofessionalsociety.Theonlygroupthatshowedadecreasewas
Shelter/Housingrepresentatives.Thisdifferencehowever,wassmall.
5.2 Limitations
Althoughthesearchtermsusedtoselectthenewspaperarticlesforanalysis
providedarelativelycompletesetofarticlesregardingmentalillnessand
homelessnessinthechosennewspapers,thesearchtermsdonotaccountforevery
possiblearticlerelatedtomentalillnessandhomelessnessanditislikelythatsome
articlesweremissed.AsmentionedintheMethodssection,thetermmentalhealth
wasnotused,whichmayhaveleftsomerelevantarticlesoutofthesample.Names
68
ofspecificmentaldisorderswerenotusedinthesearchterms,theadditionofthese
mayhavegeneratedmorearticlesforanalysisaswell.
Thesearchtermsusedalsomisstheinclusionofarticlesrelatedtochildren.
Childrenarenotlegallyconsideredhomelessbut‘wardsofstate’.Whileitisnot
anticipatedthattherewouldbemanyarticleswrittenaboutissuesrelatedtomental
illnessandhomelessnessandchildren,thesearticlescouldbeparticularlyimportant
asthepublicisgenerallydrawntoandsympathizeswithstoriesaboutchildren.Itis
alsomorelikelythatthepublicwouldattributechallengesrelatedtochildrenon
structural/societaldeficitsratherthanpersonalcharacteristics.
Incodingthearticles,sixthemesfrom‘OutoftheShadowsatLast’were
identifiedandcoded.Thesethemeswereidentifiedbymyselfalone,andwereones
Ithoughtaddressedmentalillnessandhomelessnessmostdirectlyinthereportand
highlightedtheprimaryprinciplesitcontained.Thereareotherthemesand
vulnerablegroupsstronglyemphasizedintheSenateReportthatwerenotincluded
inthecodesheetastheydidnotdirectlyaddresshomelessness.Thesetopics
howevercouldbeapplicableandtheidentifiedvulnerablegroupscouldoverlap
withthehomelessaswell.Examplesofthisincludementalillnessinseniors,
children/youthandwomen.Assuch,thesixthemesthatwereidentifiedand
analyzedarenotacompletereflectionoftheissuesraisedanddiscussedregarding
thispopulationintheSenateReport.
Aswithothercodingresearch,thecodingprocessissubjectiveinnature.To
monitorandminimizethesubjectivityofcoding,asecondcoderwasusedona
69
selectionofarticles,andhadtheintercoderreliabilityshownlowcorrelation,the
codesheetwouldhavebeenrevisedtoimprovereliability.Duringthedevelopment
ofthecodesheetandcodingprocess,categoriesweredevelopedforcodingto
increaseobjectivity,asthemajorityofthecodingwasconductedbyasinglecoder
(exceptforthesampleselectedforintercoderreliability).Whilethesecategories
aidedinidentifyingcodesobjectively,whatwaslostwastheabilitytocodecontent
thatwasimpliedandnotclearlystated.Thisisparticularlyrelevantinthecodingof
solutionsandtheresponsibilityforimplementingsolutions.Whilesomearticles
impliedwaysinwhichhomelessnesscouldbeovercome,theydidnotstatetheseas
aclearsolution,andassuchcouldnotbecoded.Forexample,inthedescriptionof
anissue,numerousarticleswouldassignblameonaparticularindividualorgroup
forthecreationoforlackofactionregardingthatparticularissue.Whilethis
pointingofblamestronglysuggestedwheretheresponsibilityforthesolutionlay,it
wasnotpossibletocodethis,astheauthordidnotpresentasolutiontotheissue
directly.
Withregardstotheanalysisofmediaeffects,whilethisanalysisexplores
agendasettingandframingeffects,findingscanonlyhaveimplicationsregarding
thepotentialeffectsofthenewspapercoverage;itisnotpossibletoknowtheactual
effectsonpublicperception.Itispossibletospeculatethattheremaybeeffects
basedonpreviousresearchconductedonpublicopinion.However,without
conductingreceptionstudiesexaminingpublicawarenessandopinioninthis
particularstudy,dataanalysiscanonlyraiseinferencesaboutpotentialeffects.
70
Whileitisnotpossibletosaythatanydifferencesobservedbetweenthe
threeyearspriortoandthethreeyearsfollowingthereleaseoftheSenateReport
werecauseddirectlybythereport,itislikelytobeaconsiderablefactorfora
numberofreasons.Asmentionedpreviously,thiswasthefirstnationalstudyinto
thementalhealthsystem,mentalillnessandaddictionsinCanada(MHCC,n.d.).As
such,theSenateReportwasthefirstnational‐levelreportaddressingmentalillness
tobepublishedinCanada.Thereportcontains118recommendationsandassuch,
isareportthatholdsimplicationsforactionthatmaybecarriedoutonvarious
levels.Asaresult,itislikelytohavebeenconsideredameaningfulandanticipated
documentbyindividualsandgroupsinthecommunityandhealthrelatedfields.It
wasalsotheonlynationalreporttoaddressissuesrelatedtomentalillnessor
homelessnesstobepublishedinthatparticularyear.
5.3 FutureDirections
Whiletheresultsofthisanalysisaddtopreviousresearchregarding
potentialmediaeffectsofnewsreportingonhealth‐relatedtopics,theyalsoraise
numerousquestionsthatcanbeexploredinfurtherresearch.Aswithmost
previousresearchconductedregardingmediaportrayalsofmentalillness,this
studywasconductedontheassumptionthatmediaportrayaldoesinfluencepublic
opinion.Whilethereisresearchtosupportthatthisisindeedthecase(Franciset
al.,2001;Wahl,1992;Dietrichetal.,2006),therehavebeencomparativelyfew
studiesthatexaminethisspecificallyandassesscommunityattitudestowards
mentalillness(Francisetal.,2001).Amorecomplexanalysisexaminingchangesin
71
publicawarenessandattitudestowardsmentalillnessandhomelessnesswouldbe
usefulinestablishingactualeffectsofnewspapercoverage.Thiswouldenablean
examinationoftheimpliedattributionsofresponsibilityraisedinthenews
coverage,providingamoreaccuratestudyofthelinkbetweenarticleapproachand
itsassociatedsolutions.Thiswouldalsoallowamoreaccuratecomparisonwith
Iyengar’s(1991)research,whichinturnwouldleadtostrongerconclusionson
whetherhistheoryofframingeffectswassupportedbythisresearch.
Anexpansionofanumberofmethodologicallimitationsinthisstudywould
giveamorecompletepictureofthepotentialchangesinmediaportrayalofmental
illnessandhomelessness.ThisstudyfocusedonCanada’stwonationalnewspapers.
Examiningothernewspaperswouldprovideinsightintohowreportingmaydiffer
inregional,localandelectronicnewspapers.Forexample,previousresearchhas
foundthattabloidnewspaperstendtoportraymentalillnessmorenegatively
(Francisetal.,2001),andindividualscitingelectronicresourcesholdlesstolerant
attitudestowardsmentalillness(Granelloetal.,1999).Itwouldalsobeusefulto
includeananalysisofcommentsandletterspublishedinthenewspapersasthis
mayprovideinsightintopublicinterestinthesetopics.
ThisstudyfocusesononlysixthemesfromtheSenateReport,butas
previouslydiscussed,otherthemesandrecommendationsarepresentwithinthe
report.Ananalysisincludingmoreofthesethemesandrecommendationswould
furtheraddinsightintowhethertheSenateReportinfluencedthecontentof
newspaperarticlessinceitsrelease.Additionally,researchoveranexpandedtime
periodwouldbeusefulinprovidingapictureofthedepictionofmentalillnessand
72
homelessnessintheyearsbeforeanyresearchorpublicannouncementrelatedto
theSenateReporthadbegun.
Itwouldbeinterestingtoseehowthereportingofotherissuesinfieldof
healthmayhavechangedinthesametimeperiod.Thiswouldhelpestablishhow
theincreaseinarticlesregardingmentalillnessandhomelessnesscomparedto
otherhealthissues,andwhethertheyshowsimilarorconflictingtrends.
Additionally,thiswouldfurthersupporttheunderstandingofhowmuchtheSenate
Reportinfluencedtheincreaseinreportingregardingmentalillnessand
homelessness.
Whilefurtherresearchonothernewsmediachannelswouldbeuseful,itis
alsoimportanttonotetheincreasinguseofsocialmedia,particularlybyyouth,and
thesubsequentneedtofurtherstudytheroleitplaysintheacquisitionofhealth
andsocialinformation.Researchhasbeenbeguntoexaminetherolethatsocial
mediamayplayinhealth,howeveramorecompleteanalysisofthepotentialagenda
settingeffectsofsocialmediawouldgreatlyaddtotheexistingresearchintothese
effectsinothermediaforms.
Thisstudyraisesawarenessontheimportanceofresearchinotheravenues
ofmediastudiesthatwouldaidinthediscussionoftheresults.Anexplorationof
thesourcesusedbyreportersandtheinfluencesthesesourceshaveonhow
newspaperarticlesarewrittenwouldassistinunderstandingwhythedifferences
betweenarticlesandtheirapproacharepresent.Understandingthemotivation
73
behindjournalisticwritingwillalsoaidtheunderstandingofhowpublichealth
professionalscanbestusenewsmediaasaneffectivetool.
Onabroaderlevel,themostimportantandusefulresearchthatthisstudy
hashighlightedaneedforisfurtherstudyintohowthemediaaffectspublicopinion
andpolicy.Understandingwhatthemostinfluentialmediastreamsareforvarious
issues,andwhichformsofmediahavegreaterabilitytoinform,topersuadeandto
settheagenda,willallowformediachannelstobeusedmoreeffectivelywithin
publichealth.
74
6: CONCLUSIONS
SincethereleaseoftheSenateReport‘OutoftheShadowsatLast’,therehas
beenasignificantandlastingincreaseintheagendasettingpotentialofCanadian
Nationalnewspapercoverageregardingmentalillnessandhomelessness.
Furthermore,publicawarenessofspecificconceptsidentifiedintheSenateReport
hasincreasedsinceitsrelease.Thedepictionofmentalillnessandhomelessness
hasshownachangeintheincreasedthematicframingofcoverage,raisingthe
potentialforincreasedpublicunderstandingofthecontextuallandscape
surroundingthispopulation.
Theanalysesshowthatthereweresignificantlymorearticlesregarding
mentalillnessandhomelessnessafterthereleaseoftheSenateReport.The
increaseincoveragecontinuedintheyearsfollowingthepublicationoftheSenate
Reportsuggestingthatthereportplayedanimportantcatalyticroleinincreasing
theoverallfrequencyofreportingregardingmentalillnessandhomelessnessin
nationalnewscoverage.Thishaslikelyallowedawiderdiversityofsourcesto
continuethediscourseregardingthistopiconapublicandnationallevel.
Furthermore,theagendasettingpotentialofnationalnewscoveragewithregardsto
therelevantthemeshasincreased.Thisshowsaheightenedpotentialforan
increaseinpublicawarenessoftheprimaryprinciplesandissuesraisedinthe
SenateReport.
75
Thenationalnewsreportsofmentalillnessandhomelessnesscovereda
widevarietyofeventsandstories.Amongthese,therewasanincreaseintheyears
followingtheSenateReport’spublicationinthenumberofarticlesdescribing
personalstories.Thisissuggestiveofanincreaseinthepotentialforheightened
sympatheticattitudesinthepublictowardsindividualswhoarehomelessand/or
livingwithmentalillness.Itwasalsoobservedthatstoriesthatofferedsolutions
regardingmentalillnessandhomelessnessplacedtheresponsibilityfor
implementingthesesolutionslargelyongovernmentalstructures.Thebenefitsof
thesesolutionsweregenerallyeitherunspecifiedorsuggestedtoonlyimpactthe
individualsaffected.Contrarytopreviousresearch,thisanalysisfurtherfoundthat
thenewspapercoveragedidnotfrequentlyportraymentalillnessasbeing
associatedwithviolence.
Withregardstotheapproachofthearticles,articleswereprimarilyepisodic
intheirframing,withthemajorityofthearticlespayinglittleattentiontothe
contextandrootcausesofmentalillnessandhomelessness.Thisshowedno
statisticallysignificantchangeoverthetimeperiodstudied.However,theevidence
supportsthattheamountofthematiccoverageofmentalillnessandhomelessness
showedanincreaseintheyearsfollowingthereleaseoftheSenateReport,andas
such,thepotentialtoinfluencepublicattitudesregardingthecausesandpossible
solutionsregardingthispopulationincreased.
Ultimately,theresultsofthisanalysisleadtoarejectionofthenull
hypothesisthatstatestherewouldbenochangeinthepotentialforalteringpublic
attitudestowardsmentalillnessandhomelessnessthroughnationalnewspaper
76
coveragesincethereleaseoftheSenateReport.Thisresearchsupportsthatthe
SenateReportverylikelyincreasedthepotentialforachangeinpublicattitudes
relatedtomentalillnessandhomelessaspresentedinnationalnewscoverage.
SincethereleaseoftheSenateReport,nationalnewscoverageregardingmental
illnessandhomelessnessincreasinglymadethepublicawareoftheimportanceof
boththinkingabouttheseissuesandthethemesandprinciplesthatrelatetothem.
Theincreaseinthematiccoveragecoupledwithanincreaseinreportingofpersonal
storiesamongtheepisodicarticleshaveraisedthepotentialforthepublictobe
sympatheticoftheimpactofmentalillnessandhomelessnessonindividuallives
andawareofthebroadercontextualframeworksthatsurroundthem.
ThisthesissuggeststhatreportsliketheSenateReporthavethepotentialto
influencethepublicagendaasadvancedbythemedia.Italsohighlightstheneedfor
increasedresearchontherelationbetweenpolicy,mediaandpublicopinion.More
specifically,itsuggeststhatpublichealthprofessionalsandpolicymakersneedto
furtherexaminetheeffectivenessofmediachannels,andthefactorsthatinfluence
thiseffectiveness.Examiningtheinteractionbetweenpolicydevelopmentand
mediacoverageisofparticularimportanceforpoliciesinwhichactionsandresults
areinfluencedbypublicopinion.Whilethereisstillmuchtolearnregardingmedia
effectsonpublicattitudes,especiallyinrelationtospecifichealthissues,thishas
becomeincreasinglyimportanttoexploreashealthpoliciesencouragecommunity‐
basedcareandrelyonpublicsupport.
78
AppendixA
Section Information Response
Coding details Date of coding dd/mm/yyyy
Coder name Text
Newspaper name Categorical National Post, Globe & Mail
Date dd/mm/yyyy
Type of article Categorical news, edit/column
ID number Numeric 000-414
Article Characteristics
Headline Text
Word count Numeric
Placement Categorical paper front pg, section front page, other Article prominence
Artwork/Photograph Categorical yes, no
Article Relevance Depth of discussion Categorical
keyword only, up to couple sentences, up to one paragraph, ¼ article, ½ article, ¾ article,
majority/entire article
Recovery Categorical mentioned, not mentioned
Public Safety Categorical mentioned, not mentioned
Inequity Categorical mentioned, not mentioned
Affordability Categorical mentioned, not mentioned
Integration of Services Categorical mentioned, not mentioned
Articles Themes
Stigma Categorical mentioned, not mentioned
79
Is the article primarily episodic or thematic?
Categorical episodic, thematic
Is it in response to a particular event or a story?
Categorical personal story, political event/election, new
building/zoning allocation/opening, violence/crime against someone with MI or H,
violence/crime by someone with MI or H, police action, release of a report, other (to be
sorted into categories post-coding)
Is there a clearly stated solution/s?
Categorical Yes, No
Who is responsible for the solution?
Categorical Collective/Governmental, Individuals affected,
Unclear/not explicit
Article Approach
Who does the solution/s benefit?
Categorical Community at large, Individuals affected, Both,
Unclear/not explicit
Voice (direct quotes) Who speaks?
Categorical Government representative, Politician,
Researcher/expert, Health professional, Advocate, Person with mental illness, Person
who is homeless, Person who is both homeless and has mental illness, Business
person, police rep/officer, judge, other (to be sorted into categories post-coding)
80
AppendixB
#!/usr/bin/perl‐w
#Input:Atextfile(CanadianNewsstandDatabasesearchresultemailedvia
# ProQuest)containingarticleswhichareidentifiedbyaheadingin
# theform"Documentxofxx".
#Output:Atabdelimitedfilecontainingasummaryofdataabouteacharticle,
# asoutlinedbelow.
#
#Readininputfile.Parsethefileintoarticlesusingthe"Documentxofxx"
#headingsasdelimiters,thenfurtherparseeacharticle,capturingthe
#following:NewspaperName,Date,Section,DocumentType,ProquestDocumentID,
#ISSN,Headline,Author,Wordcount,andPageNumber.Printtheresultsina
#tab‐delimitedfile.
#
#Author:JoubinMoshrefzadeh(joubin_at_gmail_dot_com)
#Copyright(C)2009JoubinMoshrefzadeh
#
useSwitch;
my$inpFile=shift;
my$outpFile=shift;
die"Usage:".__FILE__."<inputFile.txt><outputFile.txt>\n"
unless(defined($inpFile)&&defined($outpFile));
open(INFILE,"<$inpFile")ordie"can'topen$inpFile:$!";
open(OUTFILE,">$outpFile")ordie"can'topen$outpFile:$!";
#keepstrackofwhichstanza/articlewe'reon,andcorrespondinglytheelement
#inourhashwhichwillcontainthisarticle'sinfo
my$stanza=0;
81
my$firstParagraph=""; #tocontainfirstparagraphofeachstanza
my$line=0; #keeptrackoflinenumberwithinastanza
#aflagfordeterminingwhenwe'refinishedreadingthefirstparagraph
#ofaparticularstanza
my$done=0;
#Forstoringalltheimportantbitsfromeacharticle,
#oncethey'vebeenparsedout;mightaswellinitializeit
#forthefirststanza/article
my%searchResults=(
$stanza=>{
TEXT =>'', #thecompletetextofastanza/article
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SECTION =>'', #thearticle'ssection
PUBLICATION =>'', #thearticle'spublication
SOURCETYPE =>'', #thearticle'ssourcetype
ISSN =>'', #thearticle'sISSN
PROQUESTDOCID =>'', #thearticle'sProquestDocID
WORDCOUNT =>'', #thearticle'swordcount
URL =>'', #thearticle'sURL
PAPERNAME =>'', #thearticle'snewspapername
ARTICLEDATE =>'', #thearticle'sdate
PAGENUMBER =>'', #thearticle'spagenumber
HEADLINE =>'', #thearticle'sheadline
}
);
#beginprocessingfile
while(<INFILE>){
#Eachtime"Documentxofy"isseen,wehaveanewarticle/stanza.
82
#Doinitializationofvariablesforthisstanza.
if($_=~/Document[0‐9]{1,2}of[0‐9]{1,2}/){
$stanza++; #incrementthestanzacounter
$done=0; #resetthisflag
$firstParagraph="";#resetthisvariable
$line=0; #resetthelinecounter
#initializethehashforstoringthedetailsofthisstanza
$searchResults{$stanza}={
ARTICLETITLE =>'',
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DATELINE =>'',
SECTION =>'',
PUBLICATION =>'',
SOURCETYPE =>'',
ISSN =>'',
PROQUESTDOCID =>'',
WORDCOUNT =>'',
URL =>'',
}
}
#appendeachlinebeingreadtothishashelement(soitwillcontain
#alltextforthisstanza)
$searchResults{$stanza}{TEXT}.=$_;
#Extractfirstparagraph(terminatedbythelinecontaining
#"AbstractSummary")andparseoutthearticleheadline
if($_=~/Abstract\(Summary\)/){
#setthisflagsoweknowforremainderofthisstanza
#thatwe'repastthefirstparagraph
83
$done=1;
#Splitfirstparagraphusing"."asdelimiter
#andassigningresultstoanarray.
my@elements=split/\./,$firstParagraph;
#Dependingonthesizeoftheresultingarray,
#theHeadlinewillbeinelementnumber...
my$numElements+=@elements;
switch($numElements){
case7 {
$searchResults{$stanza}{HEADLINE}=$elements[0];
}
case8 {
$searchResults{$stanza}{HEADLINE}=$elements[2];
}
case9 {
$searchResults{$stanza}{HEADLINE}=$elements[3];
}
else {
#can'tdeterminetheheadline
$searchResults{$stanza}{HEADLINE}=
"COULDN'TGETHEADLINEINFO";
}
}
}
if($done==0){
#We'restillreadingthefirstparagraphso...
$line++;
#Weonlywantthelinesafterthe"Documentxofxx"line...
if(($_!~/Document[0‐9]{1,2}of[0‐9]{1,3}/)&&($line>2)){
84
#cleanupandappendlinestogethertoformonestring
$firstParagraph.=$_;
chomp$firstParagraph;
$firstParagraph.="";
}
}
#Nowwe'rebasicallyfocusingonthelastfewlinesofeachstanza
#whichcontainaheading,thenacolon,thensomevalue.Based
#ontheheading,setthevalueofthecorrespondinghashelementfor
#thisstanza.
chomp;
my($kee,$val)=split/:/,$_,2;
if($kee){
switch($kee){
case/Author/{
$searchResults{$stanza}{AUTHORS}=$val;
}
case/Documenttypes/{
$searchResults{$stanza}{DOCTYPE}=$val;
}
case/Dateline/{
$searchResults{$stanza}{DATELINE}=$val;
}
case/Section/{
$searchResults{$stanza}{SECTION}=$val;
}
case/Publicationtitle/{
$searchResults{$stanza}{PUBLICATION}=$val;
}
case/Sourcetype/{
$searchResults{$stanza}{SOURCETYPE}=$val;
85
}
case/ISSN/{
$searchResults{$stanza}{ISSN}=$val;
}
case/ProQuestdocumentID/{
$searchResults{$stanza}{PROQUESTDOCID}=$val;
}
case/DocumentURL/{
$searchResults{$stanza}{URL}=$val;
}
}
}
if($_=~/(TextWordCount)(\d+)/){
$searchResults{$stanza}{WORDCOUNT}=$2;
}
}
#Nowthatwe'refinishedprocessingtheinputfile...
#Printthecolumnheadingsfortheoutputfileintab‐delimitedformat
printOUTFILE"Inputfile:$inpFile\t\n";
printOUTFILE"NewspaperName\t";
printOUTFILE"Date\t";
printOUTFILE"Section\t";
printOUTFILE"DocumentType\t";
printOUTFILE"ProQuestDocumentID\t";
printOUTFILE"ISSN\t";
printOUTFILE"Headline\t";
printOUTFILE"Author\t";
printOUTFILE"WordCount\t";
printOUTFILE"PageNumber\t";
printOUTFILE"\t";
printOUTFILE"URL\t";
86
#Printthedetailsofeachstanza/articleintab‐delimitedformat
for($i=0;$i<=$stanza;$i++){
my@parts=split/\./,$searchResults{$i}{PUBLICATION};
my$size=scalar(@parts);
$parts[2]=~s/://;
printOUTFILE"$parts[0].$parts[1].\t";
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90
AppendixD
KappastatisticsSummaryItem Kappa
Score
DepthofDiscussion 0.731
Stigma 1.00
Recovery 0.747
PublicSafety 0.859
Inequity 0.790
AffordabilityofHousing 0.797
IntegrationofServices 0.863
Episodic/Thematicapproach 0.806
Solution(yes/no) 0.853
91
AppendixE
SummaryofP‐Valuesforeachtheme(comparingPreandPost‐SenateReport)Theme PValue
Recovery 0.0631
Stigma 0.0688
Inequity 0.6087
AffordabilityofHousing 0.7618
IntegrationofServices 0.1156
PublicSafety 0.9776
92
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