Managing the Media
(Is That an Oxymoron?)
by Katherine L. Wisner, M.D., M.S.
Gottfried and Gisela Kolb Professor of Outpatient Psychiatry, Obstetrics and Gynecology and Pediatrics Director, Women's Mental HealthCARE
and Belinda F. Hartley, M.D., Research Psychiatrist

We will describe our clinical research program, and then our management of the
multiple phone calls we have received recently about a very specific issue in women's mental health:Andrea Yates, the mother in Texas who drowned her five children.

We enjoy women's mental health research, specifically the study of pregnancy and postpartum disorders. Our population is women (across the reproductive lifespan) who suffer from mood disorders, with a particular focus on women of childbearing age. The interface of psychiatry with obstetrics and gynecology, pediatrics, endocrinology, nutrition and neurology is a fascinating place to be working! Several NIMH-funded clinical trials are ongoing: a comparative drug study (nortriptyline vs sertraline for postpartum depression), a preventive intervention for women at high risk for postpartum depression, and a study of light therapy during pregnancy with Mike Terman (Columbia) and Dan Oren (Yale). The pilot data will be published in the April issue of the American Journal of Psychiatry.

We have been impressed with the following quote: "Health care organizations tend to view the need for gender-based medical approaches as merely a customer service issue rather than a reorientation in medical practice." Genie James: Winning in the Women's Health Care Marketplace). This statement is a powerful one that captures the challenge to shed current approaches to women's health care and create new models.

Our vision for a Women's Mental Health Center is structured by several basic concepts. A primary issue is the definition of the term women's health. We favor a broad view that includes services for illnesses that occur only in women, occur more frequently in women, or are treated differently in women than in men.

This concept dictates that a Women's Health Center include not only obstetrics and gynecology but also an extensive array of services from other medical disciplines. For example, women who breastfeed and take antidepressant medication have access to systematic psychiatric monitoring, maternal and infant serum drug level assessment (the blood is drawn by pediatric nurses), lactation consultation from the obstetrical service, and state-of-the-art pharmacologic assays perfected on small samples of serum.

The multiple services needed to provide comprehensive treatment have been organized by our team so that the patient sees a seamless care program for herself and her infant. She does not see the traditional separation of the multiple disciplines involved (pediatrics, obstetrics, psychiatry, nursing, pharmacology).

The philosophy must reflect how women's health fits into the overall mission and vision of the parent organization. Therefore, the tripartite academic mission of research, education, and clinical care must be embraced by the Women's Mental Health Center model. The very term health care must mean a commitment to "health" rather than "sick" care. Quality standards for the care of women can be implemented not only in the Women's Mental Health Center, but also across the institutional system. The Women's Health Center and parent institution can then become recognized within the community for addressing the needs of women.

So what if you have a commitment to women's mental health, and you get calls about Mrs. Yates? Immediate cognitions: Media horror stories! "Our doctors are not available for comment- those journalists can't even quote you right, they twist what you say. I filmed for an hour and a half and they used three minutes of the least important material! All they want is a sensational story!"

The reality is that the media plays a central and critical role in education of the American public. If we take the position of not working with the media, we ensure that OUR message will not be heard. Rachel Jones, reporter for National Public Radio, provided guidelines for work with the media at the Center for Disease Control-sponsored conference Safe Motherhood: Investing in the Health of Women, on September 7, 2001. Her ten points of wisdom follow.

1. Answer the question: Why should the public know about the issue about which you are concerned? State the reason concisely, and support it with evidence.
2. Determine your target audience. Do you want to address policy makers or the general public?
3. Identify the key messages. In mediaspeak, this is the "lead"- the most important aspect of the information, and highlight it carefully.
4. Trim any extraneous points from your written materials, and focus your written word on translation of absolutely critical points and supporting information to the reporters.
5. Realize that the reporters will want to speak with other experts to capture the inevitable controversy around any issue. Have a list of your colleagues and suggest those whom you feel are the most appropriate. Although you have no control over whom the reporter will call, your suggestions save precious time for the reporter and make your suggested calls more likely.
6. Personalize the story! How can you make the story real? Do you have patient who is willing to speak about the experience? Is there an agency that represents the concern you have? Put a face on the story to emphasize that real people are affected by the issue.
7. Have background research ready in bullet-point summary form. A 500-page tome of the latest critical review will not be read. Time is as precious to reporters as to us in these times of managed care. What are the top 3 studies and why in a page or less?
8. Create a one-page briefing sheet with information you think is critical for the reporter to keep in hand.
9. Create relationships with the media representatives. They are really people too! They actually have the same agenda as you- to create a story that has a meaningful impact for the public.
10. Health care professionals "in the trenches" often complain that their views are not heard. Make them heard! The collective community needs these views and information. Write it- and don't give up - isn't all your hard life's work worth it?

Our motto: Managing Yourself and How You Interface with People in the Media
(Is NOT an Oxymoron!) And Andrea Yates is one of millions of women who suffer from postpartum illnesses every year, most of whom are not harming their children. Let us use this as a means for education along the above lines. And NPR did a nice piece on state-of-the art information on postpartum disorders, with contact information for viewers.

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