Myley Cyrus’s ill-judged and thoughtless riposte to Sinéad O’Connor last week has at least highlighted the fact that old prejudices about mental health still abound.

Cyrus's attempts to shed her wholesome Hannah Montana image have been played out in public with her now-notorious appearance at the VMA awards followed by the phenomenally successful but explicit Wrecking Ball video.

Part of the video featured a close-up of Cyrus with a tear in her eye modelled on O'Connor's video for Nothing Compares to You in 1990.

It was this analogy which prompted O’Connor to respond in an open letter “in the spirit of motherliness and with love”.

She told Cyrus that’s she was in danger of being “pimped” out by thinking it was “cool to be naked and licking sledgehammers in your videos”.

“It is in fact the case that you will obscure your talent by allowing yourself to be pimped.”

Cyrus’s response was extremely unwise and illustrates the perils of young celebrities with immediate access to their fans through social media.

"First there was Amanda Bynes, now there's this," Cyrus wrote referring to the former teenage actress Bynes who has had serious mental health issues.

She posted a series of two-year-old tweets from O'Connor which amounted to a cry for help after a psychiatric episode.

Reinforcing the stigma
Cyrus's naive admonition of O'Connor has been nearly universally condemned not least by O'Connor herself who wrote another open letter stating: "I mean really really . . . who advises you? Have you any idea how stupid and dangerous it is to mock people for suffering illness?"

Niall Breslin, aka Bressie, who has had mental health issues of his own, summed up the revulsion of a lot of people towards Cyrus.

“Miley Cyrus’s reply to Sinéad O’Connor once again manages to reinforce the stigma on mental health. Miley indeed is a horrible human being,” he tweeted.

The response to Cyrus has shown how much perceptions of mental illness have changed, according to Sorcha Lowry of Headline, the organisation which monitors coverage of mental health issues in Ireland.

“I think we’ve turned a corner. People know right from wrong,” she said. “The media commentary and the public backlash shows what is not acceptable compared to what was acceptable years ago.

“I believe that social media is driving the quality of coverage of mental health, demanding sensitivity and giving a platform to authentic voices and highlighting for editors that the public appetite for formulaic and misleading coverage of mental health has moved on.”

The growth of social media forums, most notably Twitter and Facebook, have given ordinary people a voice in mental health issues which, in turn, influences media coverage of events, she believes.

“The public set the tone of what is acceptable and what is insensitive and unacceptable.”

Myley Cyrus has been a star for so long that people forget she is only 20 and has done all her growing up in public.

No such excuse could be offered by the executives in Tesco and Asda in the UK who showed incredibly crass misjudgment by bringing out a series of Halloween costumes featuring "mental patients" with axes and blood.

Well-known celebrities
Again it was public outrage which caused the media to highlight the issue and the costumes were eventually withdrawn.

Earlier this year Headline sought to address the issue of bipolar illness in its campaign called 99 and me. The title refers to the 1 per cent of people who have a bipolar disorder, which includes Sinéad O'Connor but also well-known celebrities such as Catherine Zeta-Jones and Stephen Fry.

Bipolar illness is distinguished by alternating periods of depression and elation, which makes it different to depression where the mood is always down.

It can be accompanied by periods of “mania” where people have manic episodes which can be manifested in many ways, from lack of sleep, distractibility to heightened irritability.

They can behave oddly, have ideas that lose touch with reality and do things that are out of character.

In more serious cases it can lead to psychosis. Some 70 per cent of people with bipolar disorder have an episode of psychosis which is loosely defined as losing touch with reality.

Projecting a positive image
Headline monitored media coverage of bipolar illness over four years between 2008 and 2012.

It found that celebrities such as O’Connor, Zeta-Jones and Stephen Fry had a “very positive effect” on the quality and quantity of coverage of the illness.

There was a particular spike in positive articles surrounding the illness when Catherine Zeta-Jones’s diagnosis was first made public in 2011.

However, Ms Lowry said it was often the experience of ordinary people that made the greatest impact projecting a positive image of mental health issues.

She cited The Irish Times chief reporter Carl O'Brien's recent series on people who had left mental health settings and returned to the community as an example.

“When someone in the public eye shares their own story it can be extremely powerful in giving a message of recovery and hope and in encouraging others to reach out and seek help,” she explained

“Coverage of Irish celebrities and mental health tends to be much more respectful and sensitive compared with the celebrity stories that originate in the UK and US press.

"The experience of the See Change campaign and stigma-reduction campaigns around the world is that the authenticity and relatability of real people's stories resonate much better with the public and are more likely to challenge stigma and promote discussion of mental health."