I've been asked by several people over the last few weeks about my views about the popular Netflix show - 13 Reasons Why. If you haven't come across it yet, this show is a Netflix series about a girl (Hannah) who suicides by cutting her wrists in a bath-tub. The show follows the audio tapes she has made prior to her death which explain her reasons for doing so (primarily related to bullying, conflict and rejection by her peers). I read the book version of this show a year ago, and found it sad and confronting. I haven't watched the full series, but have seen snippets of it, and read through the plot of each episode (which varies a little from the book).
There has been much written about these series.
Some people (including, not surprisingly, the producers and psychologist consultant for the show itself) say that it is a valuable mental health awareness raising exercise. Others are highly critical of the series and say it may increase suicidality in teens (clearly it's intended audience). As with so many issues, I find myself in the middle of the road about it. Here are my thoughts!
There are some potentially positive aspects for teens in watching the show.
1. It's going to appeal to many teens. It has excellent production values, an interesting story line and is about characters which many teens will relate to.
2. It clearly shows the extent to which suicide can cause terrible grief and distress for survivors. For some teens with suicidal thoughts, this may dissuade them from acting on their thoughts.
3. It shows the graphic and painful nature of the suicide method used by Hannah. There is little "glamorisation" of the suicide scene itself, it is filmed realistically and graphically.
4. The show provides an opportunity for ourselves as professionals/families/schools to talk with teens about the potentially devastating impact of sexual assault, bullying and conflict on individuals.
5. The show provides an opportunity for ourselves as professionals/families/schools to talk with teens about suicidal thoughts.
In addition, I find that "banning" teens from watching something, tends to make it far more interesting than if we hadn't banned it in the first place..something about teens wanting to assert their individuality and sense of being control!
However, I also believe there are a number of potentially significant risks for some vulnerable teens if they watch this show. These are as follows:
1. The show is undeniably distressing in and of itself. We get to know Hannah and care about her. We also care about other characters. Seeing her parents try to revive Hannah for example is heart-breaking. There can be real grief for young people seeing a "friend" die, even if that friend is a character on a TV show.
2. Suicide is portrayed as a "reasonable" response to bullying. Viewers feel as through it "makes sense" that Hannah suicides, rather than seeing it as an irrational, short term decision.
3. The show has Hannah "memoralised" - her thoughts/points of view are remembered and understood by many after her death. There is a shrine created of her after she has died. Being memoralised in this way may be an attractive thought for some teens and may increase suicidal thinking.
4. The method of suicide is clearly shown - this may increase the knowledge and understanding of suicide for some teens and increase the likelihood of suicidal thinking and behaviour.
5. The show suggests that there is no reliable hope, treatment or support for people who are feeling suicidal - (Hannah reached out for support and did not get it) - again, this may decrease the chance of help seeking behaviour and also increase the likelihood of suicidal thinking and behaviour in some teens.
For all of these reasons, and knowing the 50 plus studies which show that the way suicide is publicly portrayed increases the risk of suicide for vulnerable individuals - I believe some teens are likely to be at increased risk of suicidal thinking and behaviour if they watch this series.
Essentially, I believe mental health education and promotion can be done in more positive ways.
Here are the messages we need to spread amongst teenagers:
Feeling depressed and suicidal is very common. You are not "abnormal" or "a freak" if you feel this way.
Feeling depressed and suicidal is not your fault.
Suicide is not a logical nor reasonable option.
You can get help and support when you are feeling depressed and suicidal.
I'm not sure that 13 Reasons Why effectively communicates any of these messages.
If teens talk with us about wanting to watch 13 Reasons Why, I'd suggest we do this:
1 Ask them what appeals to them about watching it. Is there something in particular about it they are curious about? Do they feel people are being unnecessarily negative about it?
2. Share your concerns about them watching it (use the list above if you like).
3. If they intend to watch it, and you have contact with parents/carers - suggest that parents/carers watch it with them. If you do not have contact with parents/carers - and you feel it's appropriate - give them KidsHelp Line number and Lifeline number to call after watching if you think they might be distressed. Suggest they follow up with yourself or someone else they know after watching it.
4. Avoid general class discussions about the topic if possible, discussions in a group setting or class assignments on the topic. As discussed, this series may be distressing for some young people and it's impossible to monitor well being accurately in a group.
5. If you get an opportunity to talk with teenagers one on one after they tell you they have watched it, ask the following questions.
What did you think of the show?
How did it make you feel?
What could Hannah have done differently at this point/this point/what about here?
If I was Hannah's counsellor/school teacher - how could I have helped her?
What is Hannah thinking and feeling which is not true, helpful or logical?
What could Hannah have reminded herself of when she was feeling hopeless?
If you were in Hannah's position and experiencing those events - what would you do?
Have you felt this way in the past?
What could others have done for you to help?
5. And of course, if you get any information from a teen which suggests they have suicidal thoughts - we need to take further steps to monitor their safety. This means - depending on the relationship we have with them - doing a more detailed risk assessment (click here if you'd like more info on this Keeping Teens Safe). It may also mean breaking confidentiality and taking steps to have the teenager more closely monitored and supported, and getting further help.
6. For professionals working with young people and who feel anxious about this topic, it's important to remember that suicide in Australian teens is still statistically rare (11 per 100,000 in 14-17 year olds). However of course, it does occur and we need to be on the lookout for teens at risk.
6. Finally, if you have watched 13 Reasons Why yourself - take care of yourself too. Without diminishing our need to take care of our needs, it's important to note that statistically adults are more likely to experience suicidal thinking than teenagers are. If you feel depressed, or suicidal, see your own GP or call Lifeline 131114.