Our study aimed to provide insight into how the South African print media framed issues relating to schizophrenia spectrum and other psychotic disorders in the years following the enactment of two major health policies. A common thread in the news stories was the misperceptions about schizophrenia and other psychotic disorders. Most of the news stories reported that people living with schizophrenia and other psychotic disorders were perceived by society as violent and dangerous and that this was a justification for institutionalising them. Some news stories reported how people living with schizophrenia are abused and sometimes put in handcuffs. An online study by Owen [22] analysing 41 movies for depictions of schizophrenia found that the majority of characters in the movies displayed violent behaviour toward themselves or others. The framing of schizophrenia in the media may trigger and sustain the false stereotype that people with schizophrenia are prone to violence and unpredictable behaviour. Nonetheless, it was reassuring that some of the news stories in our sample had frames debunking this myth by indicating that people with schizophrenia were frequently victims of violence [23]. However, none of these news stories referenced the provisions of the Mental Health Policies of 2002 and 2003 that requires that every individual or organization providing mental health care to protect people living with a mental illness from exploitation, abuse and degrading treatment [18, 19].

Some of the frames reflected the societal perceptions of the illness as a spiritual problem which required treatment by spiritual people. A study among Xhosa people in South Africa found that schizophrenia may be attributed to the influence of ancestors or to bewitchment. This suggests the need for a better understanding of cultural frameworks in treating the illness [24]. Our study further showed how the print media framed the cultural interpretations of schizophrenia and other psychotic disorders. These portrayals tended to be derogatory and therefore stigmatising. Rhydderch and colleagues [25] conducted a media analysis of mental illness in England and found that people had negative attitudes towards people with schizophrenia and other psychotic disorders. In addition, our media analysis showed that the media painted a picture that psychotic disorders and other mental conditions were not being taken seriously by the policymakers.

Another common frame in the news stories was on the incidence and prevalence of psychotic disorders. According to the DSM-5, the prevalence of schizophrenia spectrum disorders is 0.3–0.7% of the population with variations across regions and countries [3]. Many of the new stories cited medical experts while others cited Wikipedia. One news story citing Wikipedia indicated a prevalence of 0.6–1% while another news story referencing a physician cited the prevalence as 1% of the population. Yet another news story cited a rate of 2%. Although the rates cited by the news stories seemed to be slightly higher than that by the DSM-5, it is consistent with the documented evidence. In this case, the framing of the prevalence of schizophrenia did not appear to have exaggerated the true prevalence of the condition. Therefore, one could argue that the framing of the prevalence of schizophrenia in the news stories was close to accurate.

One of the problem frames in the news stories was the shortage of mental health professionals notably psychiatrists and psychologists. These stories focused on the low clinician to patient ratios across the country. The problem of shortage of health professionals was framed as pervasive and a symptom of larger problems within the health system. These problems included few mental health professionals being trained every year, few mental health care facilities and the problem of trained health care professionals preferring to work in the private health sector. This framing seemed to be consistent with the literature that suggested that there is an artificial shortage of mental health professionals as many qualified and registered mental professionals choose to work in private practice, leaving the majority of the South African population, who depend on the public health facilities, without access to basic mental healthcare services [26].

The dominant frame of the cause of schizophrenia and other psychotic disorders in the news stories was that it is mainly caused by the use of psychoactive drugs/substances, particularly Cannabis. Several news stories reported on new and on-going research that found a link between Cannabis and psychosis. Some news stories reported that people who have a family history of psychosis were more likely to develop psychosis if they smoked Cannabis. This framing is consistent with literature which suggests that the tetrahydrocannabinol component of cannabis could be a factor that triggers psychosis in at-risk populations [27, 28].

Still, it is interesting that most news stories noted that the exact causes of schizophrenia and psychosis were not well understood even in the science field, a position that is consistent with the literature [29]. Indeed, research has not identified one single cause of schizophrenia [1]. Studies have shown that the causes of schizophrenia are complex and multifactorial, with contributions from physical, genetic and environmental factors [30, 31]. Psychosocial factors may also affect the onset and course of schizophrenia [1].

It is notable that only few news stories discussed therapies for schizophrenia. This may limit health literacy and tend to mislead the public into having a limited understanding of the potential therapies available for the treatment of schizophrenia. Enhanced health literacy may likely encourage health seeking behaviour among people living with schizophrenia and their significant others.

With regards to moral judgements, many news stories called for an increase in the number of mental health professionals and the provision of more psychosocial and mental health services, specifically an increase in the capacity of mental health institutions and community mental health services. This framing seemed to be consistent with the literature that suggested that community mental health services were cost-effective in terms of improved population coverage [32]. Many of the news stories also called for the provision of services that would ensure early detection of mental health problems. With regards to suggested remedies, de-institutionalisation was a dominant frame in the news stories. However, some news stories opposed this policy by framing it as being primarily aimed at saving cost. Some news stories also framed de-institutionalization as not properly implemented because people living with schizophrenia spectrum and other psychotic disorders ended up being re-institutionalised.

A number of limitations of the study must be noted. First, we limited our study to the print media whereas other types of media such as radio, television and social media reporting issues relating to schizophrenia and other psychotic disorders were excluded. Second, we included only print media available on the SA media database on SABINET whereas there might be print media not available on this database. Third, we included new stories published in English but did not include those published in local South African languages. Print media published in local South African languages may be important sources of information for a wide variety of people in South Africa. Fourth, we focused on news stories published over an 11-year period immediately following the enactment of two major mental health policies. We note that more current media reporting may differ from media reports from the period that we analysed.