Mental health professionals have expressed concern about “13 Reasons Why,” the Web television series on Netflix that tells the story of Hannah, a teen who leaves behind tapes outlining 13 reasons why she committed suicide.
The National Association of School Psychologists issued guidance for educators and families about the series and said in a statement, “We do not recommend that vulnerable youth, especially those who have any degree of suicidal ideation, watch this series. Its powerful storytelling may lead impressionable viewers to romanticize the choices made by the characters and/or develop revenge fantasies.”
The Society of Clinical Child & Adolescent Psychology stated that while the show serves as a “conversation starter” for mental illness and suicide, it fails to demonstrate the availability of evidence-based mental healthcare.
Charmain F. Jackman, Ph.D., a licensed clinical/forensic psychologist who works with high school students in Boston and also in private practice in Watertown, Mass., said a number of students have shared with her that they’ve been triggered by the series’ content.
“It makes them reflect on their own times when they had suicidal thoughts,” Jackman said. “I’m grateful that the students I work with are pretty open and a lot of students come in and talk about the things they are experiencing. I would be worried about schools with less support and students not having a place to turn to.”
Jackman said young people are intrigued by the series, noting it is a somewhat accurate portrayal of high school life. However, the portrayal of school counselors and mental health fall short of being accurate, she said.
For example, the concept of a suicidal teen taking the time to record 13 tapes. “My experience with students is that often it’s a pretty impulsive decision or a reaction to something that happened in kind of real time. There’s not this long distance between the trigger and the act,” Jackman said.
Furthermore, “They’ve highlighted different situations that triggered her final act but it doesn’t really talk about her depression,” Jackman said. “There is usually some mental health issue; severe depression that kind of deteriorates. You don’t necessarily see that feature in her function at all.”
Jennifer A. Cecchetti, Psy.D., a child and adolescent psychologist in private practice in Bedford, Mass., said the series is inaccurate and “that’s the part that’s a bit dangerous.”
“They aren’t speaking about a whole very important piece,” Cecchetti said. “Nobody addresses underlying mental illness in the series. Nobody discusses that Hannah could be depressed or has a mood disorder. They link it to bullying or social stressors.”
Cecchetti fears that the general population will view the character as a drama queen. “Absolutely bullying is traumatic but not every child teen that is bullied goes and commits suicide,” Cecchetti said. “There was no talk of coping strategies, ways to manage – not just for depression, but how one can manage these situations and feel empowered.”
“(The series) kind of dramatizes and romanticizes teen suicide,” Cecchetti said.
Cecchetti was also concerned about the suicide scene itself. “The suicide was extremely graphic, extremely upsetting,” Cecchetti said. “I am concerned about teens binge watching this. Were they by themselves when they watched it? Were they with friends? Because it’s a lot to process.”
Cecchetti is also concerned about trauma survivors watching the series, which depicts two scenes of sexual assault.
Jackman was frustrated by the counselor’s portrayal. “The counselor at the school was kind of blaming her, in terms of the way he was questioning her,” Jackman said.
Cecchetti said the counselor’s portrayal may make teens less likely to ask for help. “The way the school counselor kind of minimizes her concerns when she goes to see him – that’s not how we would respond,” Cecchetti said. “We don’t say, ‘Oh come on, you’ve got to move on from that bullying. In my personal practice, I don’t even say ‘Move on.’ I say ‘We’ll move through it,’ or ‘We’ll move through it together.’ You don’t send a teen away in angst.”
Jackman said her school has a very clear protocol. “Anytime a student mentions they have thoughts of hurting themselves or killing themselves, they get 1-on-1 time with me or with clinicians,” Jackman said. “We get a background from them, talk about triggers and supports, and what are the things that have been stressful.” The child’s parents would be involved, Jackman said.
Schools also have protocols around educating students and faculty about how to notice changes in student behavior and what to do if they overhear someone talk about self-harm or suicide.
In Jackman’s school environment, counselors consult with one another. “We make a point of including another team member,” Jackman said. “We run the case by them – what did I miss? Is there anything else I should be thinking of? Often you can get tunnel vision, so that is really helpful.” For counselors who work alone, many hospitals offer clinicians on call for consultations.
Cecchetti said the way the series’ school talked about suicide prevention only “after” the fact is also inaccurate.
On a positive note, the series has created an opportunity for conversation, Jackman said. Jackman encourages parents to watch the show with their children or talk to their children about the show.
Cecchetti said it is a teachable opportunity. “It has really opened up the lines of communication, certainly in my sessions,” Cecchetti said. “When it first came out, teens were coming in talking about it – multiple teens, multiple times a day, multiple sessions.” Cecchetti has tried to give teens viewing parameters, suggesting they watch the series with her or with their parents – not alone.