tag:theconversation.com,2011:/uk/topics/13-reasons-why-38225/articles13 Reasons Why – The Conversation2021-03-14T18:53:25Ztag:theconversation.com,2011:article/1543732021-03-14T18:53:25Z2021-03-14T18:53:25ZA very special episode: how TV shows can be powerful tools for public health<figure><img src="https://images.theconversation.com/files/384364/original/file-20210216-21-1onvgyo.jpg?ixlib=rb-1.1.0&rect=12%2C0%2C4200%2C2835&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>We all know what we should do. We should eat well and exercise. But then there’s ice cream and alcohol and the couch …</p>
<p>But what if watching TV could actually <a href="https://www.youtube.com/watch?v=JLzXfghGfTg">be good for you</a> — if your favourite TV show could inspire and support you to be healthier? </p>
<p>In 2012, on <a href="https://www.imdb.com/title/tt1225901/">90210</a> (a reboot of the 90s’ <a href="https://www.imdb.com/title/tt0098749/">Beverly Hills, 90210</a>), 18-year-old Erin Silver (Jessica Stroup) was confronted with the choice to test for BRCA gene mutations. Her mother died from breast cancer, and if Erin had a mutation she was at elevated risk of cancer herself.</p>
<p>The show’s creators worked with <a href="https://hollywoodhealthandsociety.org/">Hollywood, Health & Society</a>, an organisation established to provide the entertainment industry with expert information on health, safety and security. </p>
<p>In getting the health information right, 90210 was able to tell a compelling and dramatic story while engaging viewers with their own health.</p>
<p>After the show aired, a study found 12% of female viewers <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6084479/">reported</a> scheduling a doctor’s appointment to discuss their breast cancer risk, 13% talked about the BRCA gene with a woman they knew and 17% searched for more information about breast cancer online.</p>
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<a href="https://images.theconversation.com/files/384362/original/file-20210216-16-yej3rk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Teen sits next to her mother's hospital bed." src="https://images.theconversation.com/files/384362/original/file-20210216-16-yej3rk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/384362/original/file-20210216-16-yej3rk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=250&fit=crop&dpr=1 600w, https://images.theconversation.com/files/384362/original/file-20210216-16-yej3rk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=250&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/384362/original/file-20210216-16-yej3rk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=250&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/384362/original/file-20210216-16-yej3rk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=314&fit=crop&dpr=1 754w, https://images.theconversation.com/files/384362/original/file-20210216-16-yej3rk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=314&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/384362/original/file-20210216-16-yej3rk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=314&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">After the death of her mother, Silver was forced to confront if she should get tested for the BRCA gene.</span>
<span class="attribution"><span class="source">CW</span></span>
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<p>Many non-communicable diseases, such as diabetes, cardiovascular disease and certain cancers can be can be <a href="https://www.aihw.gov.au/reports/burden-of-disease/abds-impact-and-causes-of-illness-death-2011/contents/highlights">prevented by modifying behaviour</a> such as tobacco use, dietary habits and physical activity. But the rise of such diseases shows current methods of health communication are <a href="https://ourworldindata.org/burden-of-disease">inadequate</a>.</p>
<p>Television can not only provide you health information, but can also motivate you to do what’s good for you.</p>
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Read more:
<a href="https://theconversation.com/we-tested-women-and-men-for-breast-cancer-genes-only-18-percent-knew-they-had-it-103717">We tested women and men for breast cancer genes – only 18 percent knew they had it</a>
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<h2>Entertainment can harm</h2>
<p>Entertainment that canvases health issues can lead to misinformation. This can be really harmful.</p>
<p>Mental illness is commonly <a href="https://scholarworks.gvsu.edu/cgi/viewcontent.cgi?article=1036&context=honorsprojects">misrepresented</a> in films and on television, contributing to <a href="https://www.tandfonline.com/doi/full/10.1080/10410236.2011.560787">stigma</a> which can have a profoundly negative impact of the <a href="https://pubmed.ncbi.nlm.nih.gov/23032675/">well-being of people living with mental illness</a>. </p>
<p>A particularly sobering example was seen after the release of <a href="https://www.imdb.com/title/tt1837492/">13 Reasons Why</a>, a Netflix series about the aftermath of a suicide. In the month following the first season release in 2017, the suicide rates in Americans between the ages of 10 and 17 <a href="https://www.jaacap.org/article/S0890-8567(19)30288-6/fulltext?rss=yes">increased 28.9%</a> and remained elevated for a further two months.</p>
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<a href="https://images.theconversation.com/files/384363/original/file-20210216-21-1547iy9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A teen talks into a tape recorder." src="https://images.theconversation.com/files/384363/original/file-20210216-21-1547iy9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/384363/original/file-20210216-21-1547iy9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/384363/original/file-20210216-21-1547iy9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/384363/original/file-20210216-21-1547iy9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/384363/original/file-20210216-21-1547iy9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/384363/original/file-20210216-21-1547iy9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/384363/original/file-20210216-21-1547iy9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">13 Reasons Why was criticised for not following media guidelines.</span>
<span class="attribution"><span class="source">Beth Dubber/Netflix</span></span>
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<p>13 Reasons Why was <a href="https://www.smh.com.au/opinion/netflix-needs-to-conform-to-australian-standards-for-streaming-of-13-reasons-why-20170828-gy5kmi.html">criticised</a> for overlooking media guidelines against stories promoting simplistic explanations of suicidal behaviour or depicting suicide as a means of <a href="https://www.jaacap.org/article/S0890-8567(19)30288-6/fulltext?rss=yes">accomplishing a goal</a>. </p>
<p>If the series had followed best practice guidelines in telling this story, the outcomes may not have been so devastating.</p>
<h2>The positive power of narrative</h2>
<p>But entertainment can also have a powerful positive impact on health. </p>
<p>In 2001, Hollywood, Health & Society worked with <a href="https://www.imdb.com/title/tt0092325/?ref_=fn_al_tt_1">The Bold and the Beautiful</a> on a story where Antonio Dominguez (Paulo Benedeti) learned he was HIV positive. An HIV/AIDS hotline was presented at the conclusion of the episode, and <a href="https://learcenter.org/pdf/BBHotline.pdf">calls increased dramatically</a>.</p>
<p>In 2006, the organisation worked with <a href="https://www.imdb.com/title/tt0433309/?ref_=fn_al_tt_1">Numbers</a> on an episode where Charlie Eppes (David Krumholtz) changes his position on organ donation, telling his family he would like to be a donor.</p>
<p>After the episode aired, audiences were found to be more likely to <a href="https://hollywoodhealthandsociety.org/sites/default/files/for-public-health-professionals/research-and-evaluation/cases_1_08.pdf">register as organ donors</a> and <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1460-2466.2008.01408.x">encourage others</a>.</p>
<h2>Confidence in the truth</h2>
<p>In decision making, we naturally give greater weight to narrative evidence than statistical evidence. This is increased in situations of high emotional engagement such as <a href="https://econpapers.repec.org/article/eeejobhdp/v_3a160_3ay_3a2020_3ai_3ac_3ap_3a51-67.htm">related to health</a>. </p>
<p>By embedding health storylines in popular narratives we can reach audiences where they are. But the spread of contested health information has led to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5494502/">growing public scepticism</a>.</p>
<p>It is important to present accurate information in a way that is responsible and adheres to best practice to build audience confidence.</p>
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Read more:
<a href="https://theconversation.com/why-telling-stories-could-be-a-more-powerful-way-of-convincing-some-people-to-take-a-covid-vaccine-than-just-the-facts-155050">Why telling stories could be a more powerful way of convincing some people to take a COVID vaccine than just the facts</a>
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<p>While Hollywood, Health & Society does important work in providing information to the entertainment industry, viewers don’t know if this content is trustworthy, and there is no method to ensure stories are told in the most impactful way. </p>
<p>If we had a widely used methodology to guide the development of entertainment produced in partnership between the entertainment industry, health and science experts and consumers to promote health, we could make a big difference.</p>
<p>Scripted television and movies could be the next big thing in health promotion. But we need artists, health experts and audiences working together. </p>
<h2>Creating a road map</h2>
<p>We lack a pathway for health experts, health bodies and people with lived experience to create stories to promote health. </p>
<p>My research team is working on identifying the characteristics of entertainment which can successfully influence health behaviours. This could be having characters key audiences can identify with, and having those characters engage in healthy behaviours related to their well-being. </p>
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<a href="https://images.theconversation.com/files/384359/original/file-20210216-16-33gh7o.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6016%2C4016&q=45&auto=format&w=1000&fit=clip"><img alt="Happy young two black women lying down in the couch watching tv" src="https://images.theconversation.com/files/384359/original/file-20210216-16-33gh7o.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6016%2C4016&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/384359/original/file-20210216-16-33gh7o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/384359/original/file-20210216-16-33gh7o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/384359/original/file-20210216-16-33gh7o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/384359/original/file-20210216-16-33gh7o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/384359/original/file-20210216-16-33gh7o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/384359/original/file-20210216-16-33gh7o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">With a little bit of work, television could be good for you.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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<p>We are establishing a consortium of policy makers, health experts, entertainment industry professionals and audiences to guide the production of entertainment-driven content to promote health. </p>
<p>Television episodes and films produced following this method will be certified as scientifically accurate. When you watch it, you will know the information delivered is trustworthy.</p>
<p>It will be produced using the best knowledge about how to support people to take charge of their health. It will impact attitudes and behaviours that can improve health.</p>
<p>And in this, television will improve lives. </p>
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<p><em>If this article has raised issues for you or you’re concerned about someone you know, call Lifeline on 13 11 14.</em></p><img src="https://counter.theconversation.com/content/154373/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michaela Pascoe does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>We know we should exercise more and sit on the couch less … but what if television was actually healthy for you?Michaela Pascoe, Senior Research Fellow in Mental Health, Victoria UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1227732019-09-17T12:48:43Z2019-09-17T12:48:43ZIs it even possible to connect ‘13 Reasons Why’ to teen suicide?<figure><img src="https://images.theconversation.com/files/292469/original/file-20190913-8697-1c4uzhz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">It's impossible to conduct truly causal research on media consumption and suicide.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/2598976?src=cKK5Z35G8PrXCzuYzfOutA-1-4&size=huge_jpg">Stephen Mcsweeny/Shutterstock.com </a></span></figcaption></figure><p>Netflix recently released the third season of “13 Reasons Why,” and the Salt Lake City school district has already <a href="https://fox13now.com/2019/08/29/salt-lake-city-school-district-sends-letter-to-parents-regarding-the-netflix-series-13-reasons-why/">sent home a letter to parents</a> imploring them to discourage their children from watching the show. </p>
<p>In season one, which was released in 2017, the protagonist died by suicide. Since then, studies have emerged about the effects of the show, and media has tended to cover the findings with alarmist headlines. In response to public anxiety, <a href="https://www.nytimes.com/2019/07/16/arts/television/netflix-deleted-13-reasons-why-suicide-scene.html">Netflix edited out the original suicide scene</a> this past July.</p>
<p>Many parents across the country fear that, in watching the show, kids might be inspired, consciously or subconsciously, to mimic the characters – what’s called a “<a href="https://www.thedailybeast.com/teen-copycat-suicides-are-a-real-phenomenon">copycat effect</a>.” </p>
<p>Is their concern founded?</p>
<p>We know more teens have been dying by suicide <a href="https://suicidology.org/wp-content/uploads/2019/04/2017datapgsv1-FINAL.pdf">over the past decade</a>. But as <a href="https://scholar.google.com/citations?user=mKKjryQAAAAJ&hl=en&oi=ao%20and">suicide researchers</a>, <a href="https://scholar.google.com/citations?user=dIcnUcoAAAAJ&hl=en&oi=ao">we</a> also know how difficult it is to investigate the causes.</p>
<p>Determining whether a fictional TV show has any effect on suicide is that much more challenging, and many of the studies that have come out on “13 Reasons Why” leave room for interpretation.</p>
<h2>Practical and ethical constraints</h2>
<p>In 2017, approximately <a href="https://www.nimh.nih.gov/health/statistics/suicide.shtml">47,000 Americans</a> died by suicide, making it the 10th leading cause of death in the U.S.</p>
<p>But to study trends in suicide deaths, researchers must rely on large-scale, population-based data, such as Centers for Disease Control and Prevention’s <a href="https://www.cdc.gov/violenceprevention/datasources/nvdrs/index.html">National Violent Death Reporting System</a>. There’s no additional information on media consumption – and certainly no opportunity to ask questions like, “Did you watch ‘13 Reasons Why?’” </p>
<p>In reality, it’s impossible to conduct truly causal research on media consumption and suicide. For practical and ethical reasons, you couldn’t show one group of depressed teens “13 Reasons Why,” forbid another group from watching it and then see how many teens from each group died by suicide over an ensuing period of time.</p>
<p>In lieu of these limitations, some researchers have studied indicators of suicidal thoughts or behavior.</p>
<p>A 2018 study of suicide-related admissions in a Canadian pediatric hospital <a href="https://doi.org/10.1016/j.jadohealth.2018.08.028">found</a> a higher-than-expected admission rate following the release of “13 Reasons Why.” But this increase cannot be definitely linked to the show; we don’t know if these children watched it. Also, not all suicide attempts result in hospitalization, so these results might not capture the full scope of the show’s connection to self-harming behavior.</p>
<p><a href="https://doi.org/10.1016/j.pmedr.2019.100825">Another study</a> examined Crisis Text Line usage after the show’s premiere and found that usage briefly spiked for the two days after the show’s premiere – but declined to a below-average call volume for the next month and a half.</p>
<h2>Talking to viewers</h2>
<p>Then there are researchers who have interviewed people who had already watched the show. </p>
<p><a href="https://doi.org/10.1176/appi.ps.201800384">In one study</a>, researchers spoke with 87 youth with psychiatric conditions; 49% of them reported that they’d seen “13 Reasons Why.” About half of those who watched the show felt that it made them more suicidal.</p>
<p><a href="https://doi.org/10.1016/j.jaac.2018.02.019">A larger study</a> of 21,062 Brazilian adolescents explored the relationship between watching “13 Reasons Why” and suicidal thoughts. However, most participants with histories of suicidal thoughts – particularly those who weren’t currently in a depressive episode – actually reported decreases in suicidal thoughts after viewing the show.</p>
<p><a href="https://doi.org/10.1080/07448481.2019.1586713">And a 2019 study of 818 college students</a> found that those who watched the show understood suicide better but scored no higher on measures of suicide risk than those who did not watch it. However, the study took place several months after participants viewed the show, so the results weren’t able to identify any short-term risk increase.</p>
<h2>A spike in deaths?</h2>
<p>Another approach involves tracking the number of teen suicide deaths before and after an event. </p>
<p>That’s what epidemiologist Jeff Bridge and some of his colleagues did. In a study released earlier this year in the Journal of the American Academy of Child & Adolescent Psychiatry, <a href="https://doi.org/10.1016/j.jaac.2019.04.020">they found</a> that there was a statistically significant spike in suicide deaths among boys ages 10 to 17 in the month following the show’s first season, which was released in March 2017. There was also a slight increase in suicide deaths among girls ages 10 to 17 as well, but it wasn’t large enough to be statistically significant.</p>
<p>The significant spike among boys – but not girls – was surprising. The character who dies by suicide in the show is a teenage girl, and <a href="https://doi.org/10.1016/j.socscimed.2009.07.041">studies have shown</a> that the more similarities someone shares with a person who has committed suicide, the stronger the copycat effect.</p>
<p>But there could be an explanation for this. Across all age groups, men are <a href="https://afsp.org/about-suicide/suicide-statistics/">more than three times</a> as likely as women to die by suicide. Bridge’s study only looked at deaths, not attempts. So it’s possible the spike could be attributed to the fact that males are much more likely to die from a suicide attempt. </p>
<p>Nonetheless, as with the hospital admission study, the spike can’t be linked to the show with certainty. We don’t know whether these people watched the show. </p>
<p>Despite these unknowns, the spike in suicide deaths that Bridge was able to identify was alarming. This, combined with the fact that the show did not follow well-established <a href="https://afsp.org/wp-content/uploads/2016/01/recommendations.pdf">media guidelines for addressing suicide</a>, <a href="https://mashable.com/article/13-reasons-why-suicide-study/">led to considerable public backlash</a>.</p>
<h2>Where the real danger lies</h2>
<p>Yet all of the attention being paid to a fictional television show could be misplaced.</p>
<p>Sociologist Stephen Stack <a href="https://www.jstor.org/stable/42864031?seq=1#page_scan_tab_contents">has sifted through decades of research</a> on the relationship between the media and suicide. He was able to show that stories about real people had a greater effect than those about fictional characters. And articles about suicide in the newspaper had an 82% greater effect on suicide rates than television news coverage of suicides.</p>
<p>So the fact that “13 Reasons Why” is a fictional television drama could mean that the concern is overblown. It’s getting all of the attention; meanwhile, real suicides <a href="https://www.salon.com/2018/06/26/clicks-over-ethics-mainstream-medias-coverage-of-suicide-is-careless-even-dangerous/">are still being irresponsibly covered by the media</a>. </p>
<p>Nonetheless, suicide is such a serious issue that Netflix is correct to proceed with caution.</p>
<p>[ <em><a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=expertise">Expertise in your inbox. Sign up for The Conversation’s newsletter and get a digest of academic takes on today’s news, every day.</a></em> ]</p><img src="https://counter.theconversation.com/content/122773/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael R. Nadorff receives funding from the Substance Abuse and Mental Health Services Association and the National Institute of Mental Health. </span></em></p><p class="fine-print"><em><span>Emily Lund does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Over the past decade, more teens have attempted suicide. The trend has vexed researchers, but it’s that much more difficult to determine whether a fictional TV show has had any role.Emily Lund, Assistant Professor of Counselor Education and Rehabilitation Counseling, University of AlabamaMichael R. Nadorff, Associate Professor of Psychology, Mississippi State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1164342019-05-07T20:10:08Z2019-05-07T20:10:08ZSuicide rates are rising with or without 13 Reasons Why. Let’s use it as a chance to talk<figure><img src="https://images.theconversation.com/files/272960/original/file-20190507-103082-zfxlll.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Hannah Baker, played by Katherine Langford, eventually takes her own life in the show 13 Reasons Why.</span> <span class="attribution"><span class="source">Beth Dubber/Netflix/IMDB</span></span></figcaption></figure><p><a href="https://www.netflix.com/au/title/80117470">13 Reasons Why</a>, the controversial Netflix programme that broaches the topic of adolescent suicide, has drawn further criticism after <a href="https://www.sciencedirect.com/science/article/abs/pii/S0890856719302886">new research</a> showed a potential link to a rise in suicide rates coinciding with the show’s release. </p>
<p>This leaves parents confused about whether they should allow their children to watch the show, discourage it, or even ban viewing. </p>
<p>While some parents might feel uncomfortable discussing the issues raised by the show, it should be seen as an impetus to talk to young people. It also provides a framework in which to have these difficult conversations.</p>
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Read more:
<a href="https://theconversation.com/why-we-shouldnt-ignore-what-13-reasons-why-is-trying-to-tell-us-76800">Why we shouldn't ignore what 13 Reasons Why is trying to tell us</a>
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<p>The study in question, published in the <a href="https://www.jaacap.org/article/S0890-8567(19)30288-6/fulltext">Journal of the American Academy of Child and Adolescent Psychiatry</a>, assessed the association between suicide rates over a five year period (a total of 108,655 suicides) and the Netflix show 13 Reasons Why. </p>
<p>It showed a significant increase in suicides among those aged 10-17 years in the three months following the programme’s Netflix launch. April 2017 – the first month the show was available to stream online – saw a suicide rate of 0.57 per 100,000. This was the highest rate across the five years of the study and <a href="https://www.jaacap.org/article/S0890-8567(19)30288-6/fulltext">a step increase of 28.9%</a> on the average monthly rate. </p>
<p>This adds to <a href="https://www.ncbi.nlm.nih.gov/pubmed/30454731">prior research</a> that showed increased rates of suicide attempts in the period after the show became available.</p>
<p>While these findings should not be discounted, it’s important to note suicide rates are on the rise regardless of the show. The rates of <a href="https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/3303.0%7E2017%7EMain%20Features%7EIntentional%20self-harm,%20key%20characteristics%7E3">suicide in Australia</a> have increased over the last decade from 10.9 suicide deaths per 100,000 persons in 2008, to 12.6 deaths per 100,000 persons in 2017 – an increase of 13%.</p>
<p>And for every death that does occur, around <a href="https://www.who.int/mental_health/prevention/suicide/suicideprevent/en/">20 people</a> attempt suicide.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/13-reasons-why-season-2-could-still-be-problematic-but-content-warnings-might-help-96994">13 Reasons Why season 2 could still be problematic, but content warnings might help</a>
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</em>
</p>
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<h2>Suicide contagion</h2>
<p>The popular Netflix series sees high school student Clay Jensen given a collection of 13 audio tapes in which his close friend Hannah Baker explains why she ended her life.</p>
<p>In each episode, we get an insight into the difficulties Hannah faced leading up to her suicide. These include social conflicts, problematic romantic relationships, seeking independence, and the added complexities of social media, bullying and mental health issues that affect young people today.</p>
<p>There is a phenomena called “<a href="https://www.ncbi.nlm.nih.gov/pubmed/29920166">suicide contagion</a>”, where it is believed exposure to suicide in the media and popular culture may lead to copycat behaviour. These concerns have been present for several decades, but are amplified by the volume of content available in today’s digital age.</p>
<p>Suicide contagion is well documented in the literature and it is a real threat. But a greater risk is that young people who are thinking of suicide don’t talk about their thoughts with trusted family and friends. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/272962/original/file-20190507-103068-q7edxb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/272962/original/file-20190507-103068-q7edxb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/272962/original/file-20190507-103068-q7edxb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/272962/original/file-20190507-103068-q7edxb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/272962/original/file-20190507-103068-q7edxb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/272962/original/file-20190507-103068-q7edxb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/272962/original/file-20190507-103068-q7edxb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">If your children have watched 13 Reasons Why, it’s worth talking to them about it.</span>
<span class="attribution"><span class="source">From shutterstock.com</span></span>
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<p>Some researchers who have studied responses to 13 Reasons Why suggest there can be both <a href="https://www.sciencedirect.com/science/article/abs/pii/S0277953619302072?via%3Dihub">harmful and helpful effects</a> of watching the show.</p>
<p>While some children watching 13 Reasons Why can be “triggered” by material suggestive of acts of self-harm, others have shown an increased compassion and willingness to help others who may be going through difficult times.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/young-adult-fiction-can-be-a-safe-space-to-discuss-youth-suicide-30562">Young adult fiction can be a safe space to discuss youth suicide</a>
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</p>
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<h2>Talking about it can reduce the stigma</h2>
<p>There are <a href="http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/3303.0%7E2017%7EMain%20Features%7EAustralia's%20leading%20causes%20of%20death,%202017%7E2">around 3,000 suicides</a> in Australia every year, and this number is growing.</p>
<p>Around the world that figure is about <a href="https://www.who.int/en/news-room/fact-sheets/detail/suicide">800,000 suicides</a> annually, equating to one person every 40 seconds. Suicide is the second leading cause of death among 15- to 29-year-olds.</p>
<p>People experiencing thoughts of suicide will often be <a href="https://www.ncbi.nlm.nih.gov/pubmed/30409079">frightened to talk</a> about it because they are concerned about the reactions of others and potential consequences in terms of their job security or social standing.</p>
<p>Being afraid to talk about suicidal thoughts is not only a problem with teenagers. It’s also often seen in <a href="https://www.beyondblue.org.au/docs/default-source/research-project-files/bl1132-report---nmhdmss-full-report_web">high pressure jobs</a> such as the medical profession, the police and armed forces.</p>
<p>There are consistent calls across mental health networks to reduce the stigma associated with thoughts of suicide and self-harm, with an emphasis on encouraging openness and discussion.</p>
<p>As <a href="https://www.beyondblue.org.au/the-facts/suicide-prevention/worried-about-suicide/having-a-conversation-with-someone-you're-worried-about/language-when-talking-about-suicide">Beyond Blue</a> notes, it’s time to bring the issue of suicide out into the open and stop hiding it as if it is a crime. Using pejorative language like “committed suicide” implies it’s an offence.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-ask-someone-youre-worried-about-if-theyre-thinking-of-suicide-100237">How to ask someone you're worried about if they're thinking of suicide</a>
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</em>
</p>
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<p>The series 13 Reasons Why bravely tackles this social taboo head-on. Importantly, the creators have provided <a href="https://d1msa02p2vx1bf.cloudfront.net/wp-content/uploads/2018/05/US-13-Reasons-Why-Discussion-Guide.pdf">helpful guides</a> on how to watch the show, as well as <a href="https://13reasonswhy.info/">plenty of resources</a> on how to seek help.</p>
<p>It’s imperative we provide opportunities for discussion with young people about these powerful feelings of depression and self harm. There are many <a href="https://headspace.org.au/assets/Uploads/PARENTS-13RY-Headspace2.pdf">resources available</a> to parents to help them start the conversation.</p>
<p><em>If this article has raised issues for you or you’re concerned about someone you know, call Lifeline on 13 11 14.</em></p><img src="https://counter.theconversation.com/content/116434/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael Musker does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Although a US study found a spike in teen suicides after 13 Reasons Why first aired on Netflix, rates of suicide are generally on the rise. The last thing we should do is shy away from the show.Michael Musker, Senior Research Fellow, South Australian Health & Medical Research InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/979562018-06-08T08:28:08Z2018-06-08T08:28:08Z13 Reasons Why is a real opportunity to help troubled teens<figure><img src="https://images.theconversation.com/files/222196/original/file-20180607-137301-3lu8ho.png?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption"></span> </figcaption></figure><p>When one of my 16-year-old students suggested I watch <a href="https://www.theguardian.com/tv-and-radio/2017/mar/31/13-reasons-why-review-sex-drugs-and-mixtapes-in-netflix-high-school-horror-show">13 Reasons Why</a> – the harrowing US teen drama that centres around the suicide of a 16-year-old girl – I agreed because he said it “showed what being a teenager was actually like”.</p>
<p>I was curious. Like most parents I thought I understood what being a teenager was actually like, having been one myself. But in the ever-accelerating internet age, where social media simultaneously means a greater level of connectedness and isolation, being a teenager now is not the same experience that I had.</p>
<p>The current generation of adolescents has a completely different set of hurdles to negotiate as they make their way through school and enter the world of adulthood. Understandably, all parents want their children to pass through this stage as unscathed as possible. Could a TV programme really help them support their offspring as they find their way?</p>
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<p>The <a href="https://www.theguardian.com/media/2018/may/11/netflix-criticised-over-return-of-suicide-drama-13-reasons-why">controversial</a> Netflix series is based upon the suicide of a girl called Hannah Baker who leaves 13 tapes, each for a specific person, explaining how each one contributed to her ending her life. The second series, which started streaming at the end of May, documents Hannah’s life as the court battle between her parents and the school, over who was responsible for her death, escalates to draw more of her contemporaries into the tale. A third season has just been <a href="https://www.engadget.com/2018/06/06/13-reasons-why-season-3-netflix/">announced</a>.</p>
<p>Focusing on the day-to-day lives of young people, it is a deeply dispiriting drama. While the problems explored may seem alien to older viewers, they are serious and <a href="https://www.teenvogue.com/story/survey-shows-what-young-people-thought-of-13-reasons-why">very real issues</a> for teenagers. Having watched the first series, I believe it is imperative that adults seek to genuinely understand what youngsters face, and use the publicity surrounding 13 Reasons Why to start a bigger conversation with teens about the kinds of things that affect their mental health and general well-being.</p>
<p>The issues highlighted will horrify parents – bullying, isolation, mental illness, depression, self-harm, substance abuse, sex, rape and suicide — but these are issues that many young people are experiencing. And some parents may simply not be aware of it.</p>
<p>Views on the programme are mixed, with some finding the scenes of suicide and rape <a href="https://www.huffingtonpost.co.uk/entry/13-reasons-why-rape-scene-mop_uk_5b03e639e4b0463cdba5ac82">gratuitous and overly graphic</a>. But young people I have spoken to largely agree that this drama is representative of life as a teenager in 2018. The pain felt by characters who are self-harming, grieving over lost friends and struggling with their identity and every decision they make is clear to see. In the course of my work, one teen who lost a 14-year-old friend to suicide told me that, six years on, 13 Reasons Why helped explain all the things they had felt – something which they struggled to articulate at the time. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/222205/original/file-20180607-137309-1wl9lry.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/222205/original/file-20180607-137309-1wl9lry.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/222205/original/file-20180607-137309-1wl9lry.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/222205/original/file-20180607-137309-1wl9lry.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/222205/original/file-20180607-137309-1wl9lry.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/222205/original/file-20180607-137309-1wl9lry.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/222205/original/file-20180607-137309-1wl9lry.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Often teenagers feel they cannot talk about their problems for fear of being judged.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-homeless-boy-sleeping-on-bridge-403125922">Shutterstock</a></span>
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<p>Being aware of what matters to a young person is crucial if we are to ensure that struggling children are supported through these difficult teenage years; if it matters to them, it should matter to the rest of society. Only teenagers are experts in how to be teenagers in 2018, so they need adults to listen to them and take their problems seriously. There needs to be dialogue.</p>
<p>I frequently come across adults who believe that children have too many rights, that rights should only be granted to youngsters showing responsibility. Instead of focusing upon <a href="https://pure.qub.ac.uk/portal/files/15482673/Behind_the_Headlines_Printed_Summary_Report.pdf">negative stereotypes</a> of young people, we need to realise that we cannot expect model citizens at 18 <a href="https://childhub.org/en/child-protection-online-library/lundy-model-child-participation">without support and involvement</a>. Effective listening means working with young people to share their problems, not telling them how to feel or act – a major deficit in our education system and across society. </p>
<h2>Mental health awareness</h2>
<p>Some have argued that 13 Reasons Why provides <a href="https://www.teenvogue.com/story/what-netflix-thirteen-reasons-missing-mental-health">triggers for suicidal tendencies</a>, but it does highlight the growing issue of suicidal teens and the pressures they face. <a href="http://research.bmh.manchester.ac.uk/cmhs/research/centreforsuicideprevention/nci/reports/cyp_2017_report.pdf">Research</a> shows that teen suicides in the UK are increasing and the causes are often the same issues explored in the drama.</p>
<p>When you consider that over <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/414024/Childrens_Mental_Health.pdf">half of mental health problems in adult life</a> start by the age of 14, and 75% by the age of 18, society needs to understand the difficulties that children and young people are facing. It is clear that the NHS is struggling to cope with the number of young people <a href="https://www.independent.co.uk/news/health/children-mental-health-treatment-specialist-nhs-services-nspcc-a8349816.html">needing mental health support</a> so it is an issue that needs to be urgently addressed if a mental health epidemic amongst teens is to be avoided.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1004683113052758016"}"></div></p>
<p>In 13 Reasons Why, students have a school counsellor (in the UK pupils have guidance teachers) but it is not standard practice for those who work in schools to be trained to speak and listen properly to young people in terms of mental health. Mental health promotion cannot just be left to outside agencies. The likes of the <a href="https://www.nspcc.org.uk/what-we-do/">NSPCC</a>, <a href="https://www.samaritans.org/how-we-can-help-you/contact-us">The Samaritans</a> and <a href="https://www.mind.org.uk/about-us/what-we-do/">Mind</a> are all experienced at helping youngsters who need to talk and provide advice to those looking to help others with mental illness. But children need proper access to this at school.</p>
<h2>Listen without prejudice</h2>
<p>We’ve all been adolescents, but as we age we tend to forget the pain of being a teenager – and the problems we faced back then recede as life brings new concerns. It’s easy to diminish the growing pains of our teenage years – we grow, we change and hopefully we mature. But those of us who work with and promote the rights of children and adolescents have respect for the young people who face myriad daily battles, pressures and emotional hurdles. </p>
<p>Whether you love, hate or are yet to see 13 Reasons Why, it’s clear the Netlix drama has had an impact, underscoring the importance of dialogue, empathy and ensuring youngsters know that there are people and services they can turn to for help. It all starts with listening, without judgement. As one of the characters says: “The minute you start talking about it, it gets easier.” Children need to know it’s okay not to be okay.</p><img src="https://counter.theconversation.com/content/97956/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tracy Kirk does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Despite the controversy over the graphic content, this Netlix drama could be a lifeline for young people.Tracy Kirk, Interdisciplinary Researcher: Child and Adolescent Rights, Northumbria University, NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/969942018-05-31T02:20:11Z2018-05-31T02:20:11Z13 Reasons Why season 2 could still be problematic, but content warnings might help<figure><img src="https://images.theconversation.com/files/220896/original/file-20180530-80626-1y4mdmx.png?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Parents should watch 13 Reasons Why with their kids, and talk about it afterwards.</span> <span class="attribution"><span class="source">Netflix</span></span></figcaption></figure><p><em>This article details the content of season two of 13 Reasons Why.</em></p>
<hr>
<p>Series two of the controversial series 13 Reasons Why was certain to incite debate. Series one provided considerable discussion about the graphic depiction of suicide, in addition to a range of associated issues including social exclusion, <a href="https://eric.ed.gov/?id=EJ988674">bullying</a>, regrettable behaviours, <a href="https://doi.org/10.1186/s12889-016-3314-4">alcohol and other drug use</a>, <a href="https://www.ncbi.nlm.nih.gov/pubmed/23246711">drink driving</a> and <a href="http://dx.doi.org/10.1071/SH14215">sexual assault</a>. </p>
<p>Series two has built on these issues. While the show’s creators appear to have heeded some warnings from concerned mental health and suicide groups, and have attempted to ensure the show becomes an opportunity for discussion and help-seeking, the series continues to include graphic scenes and confronting issues that are likely to be challenging for some viewers.</p>
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<strong>
Read more:
<a href="https://theconversation.com/why-the-creators-of-13-reasons-why-should-pay-attention-to-the-spike-in-suicide-related-google-searches-79162">Why the creators of '13 Reasons Why' should pay attention to the spike in suicide-related Google searches</a>
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<h2>Can we blame schools?</h2>
<p>The series revolves around the trial between Hannah’s parents and the high school, examining if the school was responsible for Hannah’s suicide. While dramatic, blaming the school is concerning. </p>
<p>There are a range of influences that impact mental health problems. During adolescence, <a href="https://www.ncbi.nlm.nih.gov/pubmed/28506925">social relationships</a>, which <a href="https://www.researchgate.net/publication/323178673_The_relationships_between_school_climate_and_adolescent_mental_health_and_wellbeing_A_systematic_literature_review">may be influenced by</a> the school environment, are significant. </p>
<p>But placing the blame on the school ignores the <a href="https://books.google.com.au/books/about/The_Ecology_of_Human_Development.html?id=OCmbzWka6xUC">broader range of factors</a> that influence mental health problems. The complex influences relate to the individual, friends and family, community, and <a href="https://books.google.com.au/books/about/The_Ecology_of_Human_Development.html?id=OCmbzWka6xUC">broader societal factors</a>.</p>
<p>The program does raise the question of what, realistically, schools can do. When kids feel connected to their school, they’re <a href="http://dx.doi.org/10.1016/j.childyouth.2017.08.011">less likely to have</a> poor mental health. And the school curriculum provides opportunities to enhance awareness, skills and attitudes. </p>
<p>Series two shows where school staff ignored inappropriate behaviours, and where they could have been more discerning and supportive. Australian mental health organisation Headspace has worked with Netflix to provide support for schools prior to the screening of series two, with many schools sending discussion tips and links to support to parents.</p>
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<p>
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<strong>
Read more:
<a href="https://theconversation.com/popular-netflix-drama-13-reasons-why-sends-out-worrying-messages-about-suicide-78008">Popular Netflix drama 13 Reasons Why sends out worrying messages about suicide</a>
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<h2>Sexual assault</h2>
<p>Series two continues to focus on reasons for Hannah’s suicide, including flashbacks. It also builds on current issues and behaviours, including a greater focus on consent and sexual assault. The importance of seeking consent is important learning for adolescents. </p>
<p>However, difficult issues such as consent are not always discussed in schools. <a href="https://www.tandfonline.com/doi/abs/10.1080/14681811.2016.1225259?journalCode=csed20">Studies have found</a> some teachers feel uncomfortable and the lack skills needed to address controversial topics.</p>
<p>The sexual abuse scenes in series one (the rape in the hot tub) and series two (the male rape scene in the final episode) graphically depict sexual assault. These scenes have received strong criticism and raise concerns regarding the need for such a graphic portrayal. But the issues are important to raise, given <a href="https://www.aihw.gov.au/reports/domestic-violence/family-domestic-sexual-violence-in-australia-2018/contents/table-of-contents">one in five Australian women</a> and one in 20 men report they’ve been sexually assaulted or threatened.</p>
<p>While both male and female rape lead to <a href="http://dx.doi.org/10.1016/j.cpr.2017.06.002">long-term psychological impacts</a>, male rape is talked about less frequently. The series depicts rape culture in which sexual assaults are condoned by the “jocks”, perpetrators are excused and victims are blamed. The victims are consequently <a href="https://www.sciencedirect.com/science/article/pii/S1359178917301799">hesitant to report assaults</a>.</p>
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<figcaption><span class="caption">Debate is rife about whether the graphic scenes should have been included.</span></figcaption>
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<h2>Gun violence</h2>
<p>A focus on gun violence has also been included in the second series. While not executed, the planned school shooting is not unrealistic in the US. </p>
<p>The underlying issues associated with this planned act, including social exclusion and ongoing bullying and discrimination, provide opportunities for discussion. As does the importance of gun violence, responding to gun violence and legislation.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-we-shouldnt-ignore-what-13-reasons-why-is-trying-to-tell-us-76800">Why we shouldn't ignore what 13 Reasons Why is trying to tell us</a>
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<h2>Content warnings</h2>
<p>After criticism of the first series, warnings are included at the beginning of the first episode, with content warnings in each episode. Warnings come from the cast themselves, which provide a personalised approach and are presented in a realistic way. They warn some content may be difficult for some people to watch, especially those with existing mental health problems. At the end of each episode, viewers are directed to the 13 Reasons Why site for information about support services.</p>
<p>While these content warnings and links to support may not meet the needs of all young people, every opportunity should be taken to encourage teens to seek help. <a href="http://www.mindframe-media.info/home/resource-downloads/?a=10217">Media guidelines</a> encourage use of helplines, which are <a href="https://www.lifeline.org.au/get-help/topics/lifeline-services">widely accessed</a>.</p>
<p>Seeking help is complex, and in the words of the maligned principal in the program Mr Porter, who for a range of reasons did not act on Hannah’s call for help in series one:</p>
<blockquote>
<p>not every kid seeks help, not everyone is able to ask for the help they need.</p>
</blockquote>
<p>Better resources for mental health professionals and ongoing training for school staff <a href="https://doi.org/10.1186/1471-244x-10-51">may alleviate</a> some of these issues. Providing young people with better skills to seek help, and <a href="https://doi.org/10.1016/j.adolescence.2018.05.003">reducing the stigma</a> associated with mental health problems is important. For some, <a href="https://www.tandfonline.com/doi/abs/10.1080/15398285.2010.502020">online support is also useful</a>. </p>
<p>Studies from the <a href="https://www.ncbi.nlm.nih.gov/pubmed/26976489">UK</a> and <a href="https://www.ncbi.nlm.nih.gov/pubmed/26546772">US</a> have found internet searches for suicide-related terms and methods are common for young people experiencing suicidal thoughts. </p>
<p>A <a href="https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2646773">study conducted after season one</a> of the series found increased use of internet searches in the 19 days after airing, indicating suicidal ideation, prevention and helplines. While these trends are very concerning, it also gives suicide prevention websites the <a href="https://www.ncbi.nlm.nih.gov/pubmed/29245021">opportunity to engage</a> with at-risk young people.</p>
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<figcaption><span class="caption">The warning at the beginning of each episode.</span></figcaption>
</figure>
<h2>How parents can help</h2>
<p>A key focus of series two has been the efforts of the parents of key characters to engage in discussion with their adolescents. Not all parents in the series depict positive conversations, with some demonstrating difficulty in discussing the issues raised, and others attempting to make the problem go away for their child. </p>
<p>Although peers are increasingly important for social support and advice during adolescence, <a href="http://dx.doi.org/10.1016/j.dr.2017.10.001">parents also continue to play</a> an important role. Especially since feeling connected to family is <a href="http://dx.doi.org/10.1016/j.childyouth.2017.08.011">important for good mental health</a>. </p>
<p>To support parents, Headspace has provided tips to help foster discussion around the key issues raised including suicide, grief, bullying, sexual assault, drug use and gun violence. Increasing mental health literacy and mental health first aid skills for teachers, students and the general public <a href="https://doi.org/10.1186/1471-244x-10-51">will help others</a> recognise those in need and support them in getting help.</p>
<p>While some scenes in series two of 13 Reasons Why are confronting and difficult to watch, the attention this series has received has ensured there are significant content warnings along with links to support services and help for young people, parents and teachers. Not all media available online offers the same level of scrutiny, and consequently associated support. </p>
<p>13 Reasons Why is rated Ma15+. Parents should watch the show with their kids, and talk to them about it afterwards.</p>
<hr>
<p><em>If you are feeling concerned about a friend, family member or work colleague, call <a href="https://www.lifeline.org/">Lifeline</a> 13 11 14; <a href="https://www.suicidecallbackservice.org.au/">Suicide Call Back Service</a> 1300 659 467 or <a href="https://kidshelpline.com.au/">Kids Helpline</a> 1800 55 1800.</em></p><img src="https://counter.theconversation.com/content/96994/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sharyn Burns does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Season two of the controversial show tackles similar issues, and while Netflix appear to have taken heed of some concerns of mental health advocates some issues remain confronting and challengingSharyn Burns, Associate Professor, Curtin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/823532017-08-11T00:59:26Z2017-08-11T00:59:26ZBullying and suicide: What’s the connection?<figure><img src="https://images.theconversation.com/files/181718/original/file-20170810-20984-pl77tp.jpg?ixlib=rb-1.1.0&rect=49%2C337%2C3394%2C1954&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Child suicide, such as the 2013 death of 12-year-old Rebecca Sedwick, has often been blamed on bullying.</span> <span class="attribution"><span class="source">AP Photo/Brian Blanco</span></span></figcaption></figure><p>Bullying, as many people know, can be a tremendously painful experience for a young person. The point has been driven home over the last decade by stories about teens like <a href="http://www.bostonmagazine.com/2010/05/phoebe-prince/">Phoebe Prince</a> or <a href="http://www.bbc.com/news/world-europe-27076991">Amanda Todd</a>, who killed themselves after experiencing bullying.</p>
<p>Recently, the parents of eight-year-old Gabriel Taye <a href="http://www.cbsnews.com/news/gabriel-taye-death-lawsuit-blames-schools-for-bullying-child-suicide/">filed a federal lawsuit</a> against the Cincinnati public schools, alleging that their son committed suicide because the school covered up and failed to prevent a culture of bullying.</p>
<p>All 50 states have some kind of <a href="http://www.huffingtonpost.com/deborah-temkin/all-50-states-now-have-a_b_7153114.html">anti-bullying law</a>, and schools are increasingly being called upon to implement bullying prevention programs. </p>
<p>Bullying and suicide are both significant public health concerns for children and adolescents. As a scholar with expertise in youth violence and bullying, I’ve done considerable research to understand the link between bullying and suicide. Although there certainly is a connection between the two, research highlights the complexity of the relationship.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/yVaUq98qWGE?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">In the Academy Award-winning ‘Moonlight,’ Chiron snaps after being bullied at school.</span></figcaption>
</figure>
<h2>Bullies and their victims</h2>
<p>Many studies have examined the relationship between bullying and suicidality, or the tendency to have suicidal thoughts and behaviors. We wanted to see what these studies could tell us about the strength of this association: Is being bullied or bullying others associated with suicidality?</p>
<p>To find out, we conducted an analysis of <a href="https://doi.org/10.1542/peds.2014-1864">47 studies on bullying and suicide</a> among students in K-12 settings. The studies were from the United States and several other countries (including China, Australia, the U.K. and Finland).</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/181715/original/file-20170810-20110-1sms1ep.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/181715/original/file-20170810-20110-1sms1ep.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/181715/original/file-20170810-20110-1sms1ep.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=889&fit=crop&dpr=1 600w, https://images.theconversation.com/files/181715/original/file-20170810-20110-1sms1ep.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=889&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/181715/original/file-20170810-20110-1sms1ep.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=889&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/181715/original/file-20170810-20110-1sms1ep.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1117&fit=crop&dpr=1 754w, https://images.theconversation.com/files/181715/original/file-20170810-20110-1sms1ep.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1117&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/181715/original/file-20170810-20110-1sms1ep.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1117&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">In the Netflix series ‘13 Reasons Why,’ bully Bryce Walker is reason number 12 that Hannah commits suicide.</span>
<span class="attribution"><span class="source">Netflix</span></span>
</figcaption>
</figure>
<p>Overall, we found that youth involved in bullying in any capacity – both bullies and victims of bullying – were more likely to think about and attempt suicide than youth who were not involved in bullying. In short, bullying is bad for everyone involved.</p>
<p>We also found that bullying and suicidality are most strongly related for bully-victims: youth who have experienced both sides of bullying, as victim and perpetrator. This is consistent with past research suggesting that bully-victims are at <a href="https://doi.org/10.1007/s10964-006-9153-3">particularly high risk</a> for experiencing mental health issues such as anxiety and depression.</p>
<h2>Who is most at risk?</h2>
<p>In addition to questions about bullies versus victims, we examined three factors in the association between bullying and suicidality: gender, country and how bullying is measured.</p>
<p>While associations between bullying involvement and the tendency to have suicidal thoughts or behaviors were similar for boys and girls, we did find a difference when it came to the country of origin for these studies. In general, there were stronger associations between bullying and suicidality in the U.S. studies compared to their international counterparts.</p>
<p>As a whole, studies also showed a stronger connection between being a bully victim and suicidal thoughts when the study asked a single question to identify victims such as “Have you been bullied?” Studies that asked about specific behaviors (without mentioned the word bullying) showed a weaker connection. </p>
<p>This finding might reflect that suicidality is more common in youth who self-identify as being bullied, when compared to those who admit only to experiencing specific behaviors (e.g., they’ve been teased). The latter may not self-identify as someone who has been bullied and may be less at risk of suicidal thoughts and behaviors.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/181720/original/file-20170810-27667-11qips5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/181720/original/file-20170810-27667-11qips5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/181720/original/file-20170810-27667-11qips5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/181720/original/file-20170810-27667-11qips5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/181720/original/file-20170810-27667-11qips5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/181720/original/file-20170810-27667-11qips5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/181720/original/file-20170810-27667-11qips5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/181720/original/file-20170810-27667-11qips5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">For youth who identify as being bullied, the tendency to suicidality can be quite high.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/depression-teen-pain-suffering-tunnel-113875279">hikrcn/Shutterstock.com</a></span>
</figcaption>
</figure>
<h2>What else do we need to consider?</h2>
<p>Research clearly indicates there is an association between bullying involvement – on both sides – and suicidal thoughts and behaviors. However, it also suggests that there are factors beyond bullying that are relevant to suicidal thoughts and behaviors. </p>
<p>For instance, in one study of fifth through eighth graders, researchers found that <a href="https://doi.org/10.1016/j.jadohealth.2012.09.017">once depression and delinquency were considered</a>, there were only small differences between youth who were not involved in bullying and those who were. </p>
<p>A recent study of adolescents highlighted the role of <a href="https://doi.org/10.1007%2Fs11121-014-0510-2">low self-esteem and depression</a> as factors contributing to suicidal thoughts and behaviors for sexual minority and heterosexual youth who had been bullied.</p>
<p>In short, a host of psychological and other factors may contribute to suicidality.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/181719/original/file-20170810-20110-1h55zy9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/181719/original/file-20170810-20110-1h55zy9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/181719/original/file-20170810-20110-1h55zy9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=422&fit=crop&dpr=1 600w, https://images.theconversation.com/files/181719/original/file-20170810-20110-1h55zy9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=422&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/181719/original/file-20170810-20110-1h55zy9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=422&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/181719/original/file-20170810-20110-1h55zy9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=530&fit=crop&dpr=1 754w, https://images.theconversation.com/files/181719/original/file-20170810-20110-1h55zy9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=530&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/181719/original/file-20170810-20110-1h55zy9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=530&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Emily-Anne Rigal, right, founder of WeStopHate.org, and Jeanne Demers, left, founder of Realize, Inc., champion anti-bullying at the launch of their first book, ‘FLAWD,’ Aug. 18, 2015.</span>
<span class="attribution"><span class="source">Diane Bondareff/Invision for Monster High/AP Images</span></span>
</figcaption>
</figure>
<h2>What does this mean for intervention and prevention?</h2>
<p>Our <a href="http://www.thirteenreasonswhy.com/">cultural narrative</a> about bullying presumes that youth who are bullied are at great risk for suicidal thoughts and behaviors. But research shows that bullies themselves are at risk as well.</p>
<p>The analysis provides additional evidence that youth who experience bullying as both perpetrator and victim are at particularly high risk for psychological distress.</p>
<p>In short, bullying involvement of any stripe is harmful.</p>
<p>Our research (and more that can be done in the future) should prompt the creation of more effective prevention and intervention programs to better address the mental health needs of youth involved in bullying. In particular, it’s essential that we bolster mental health supports for kids who bully – not just their victims.</p>
<p><em>This is an updated version of <a href="https://theconversation.com/understanding-the-link-between-bullying-and-suicide-39037">an article</a> originally published on May 14, 2014.</em></p><img src="https://counter.theconversation.com/content/82353/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Melissa Holt does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>From ‘13 Reasons Why’ to real-life events, there’s been increased scrutiny on the link between bullying and suicide. However, research shows that we may not be getting the full picture.Melissa Holt, Assistant Professor, Counseling Psychology, Boston UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/791622017-08-03T01:00:12Z2017-08-03T01:00:12ZWhy the creators of ‘13 Reasons Why’ should pay attention to the spike in suicide-related Google searches<figure><img src="https://images.theconversation.com/files/180760/original/file-20170802-7625-bewz2t.png?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">As the show's popularity surged, interest in suicide also grew.</span> <span class="attribution"><span class="source">Nick Lehr/The Conversation via www.shutterstock.com</span>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span></figcaption></figure><p>Does it matter that people seem to have become more interested in suicide – expressing more suicidal thoughts, while becoming more likely to research ways to commit or prevent suicide – in the wake of the popular Netflix series “13 Reasons Why”?</p>
<p>According to <a href="http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/jamainternmed.2017.3333">new research</a> my colleagues and I conducted, suicide-related Google searches increased in the weeks following the spring release of the popular Netflix series “13 Reasons Why.” </p>
<p>The show – which became the streaming service’s <a href="http://www.teenvogue.com/story/13-reasons-why-netflix-most-popular-show-social-media">most discussed series on social media</a> – chronicles a high school girl’s suicide over the course of 13 episodes. In the season finale, the suicide is depicted in a three-minute scene.</p>
<p>Singer Selena Gomez, the executive producer of the show, <a href="http://www.rollingstone.com/culture/news/selena-gomez-defends-13-reasons-why-as-honest-w486466">said</a> she hoped the series would raise suicide awareness. Yet some – including <a href="https://www.schoolcounselor.org/school-counselors-members/professional-development/learn-more/13-reasons-why-resources">educators and school psychologists</a> – fear the series glamorizes the victim and her suicide in a way that could promote copycat behavior. </p>
<p>In recent months, stories about the possible effects of the series have circulated in the media. In May, The Washington Post <a href="https://www.washingtonpost.com/local/education/educators-and-school-psychologists-raise-alarms-about-13-reasons-why/2017/05/01/bb534ec6-2c2b-11e7-a616-d7c8a68c1a66_story.html?utm_term=.d44ed16c1294">reported</a> that school administrators in Florida were witnessing more risky behaviors among their students, from self-mutilation to suicide threats. In June, People magazine <a href="http://people.com/chica/peruvian-man-imitates-13-reasons-why-commits-suicide/">told the story</a> of a young man in Peru who took his own life, leaving behind recordings in a way that mimicked the main character in the series. </p>
<p>Our study adds to this discussion by considering a novel source: search data. Because the internet is a place where people can anonymously search for information free of judgment, researchers can see what’s on the mind of the public by monitoring what they’re searching. </p>
<p>For this reason, my colleagues and I will often turn to the internet to track real-time trends in <a href="https://well.blogs.nytimes.com/2013/04/11/a-seasonal-pattern-to-mental-health/">mental heath</a> and <a href="https://well.blogs.nytimes.com/2014/01/08/hard-times-and-headaches/">other health concerns</a> in order to better understand how the public is thinking, feeling and behaving. (For example, earlier this year we demonstrated that Charlie Sheen’s HIV disclosure in 2015 corresponded with record levels of <a href="https://tonic.vice.com/en_us/article/wnwkab/the-charlie-sheen-effect-on-hiv-testing-was-equivalent-to-7-world-aids-days">interest in HIV testing</a>, which showed search trends could signal concrete prevention outcomes.)</p>
<p>With “13 Reasons Why,” we wanted to see how the content and volume of internet searches about suicide changed after the series’ release. We analyzed suicide-related searches from March 31, the day the series was released, to April 18, the day before former NFL star Aaron Hernandez <a href="https://www.bostonglobe.com/metro/2017/04/19/aaron-hernandez-kills-himself-prison/Hkp9wdGcZImoMBomJLMNVJ/story.html">committed suicide in prison</a> (a national news event that likely caused suicide-related searches to spike on its own). Then we compared these results to the expected search volumes had the series never been released, figures we arrived at by analyzing daily search trends between January 15 and March 30. </p>
<p>Compared to the searches between January and March, searches that signaled suicide awareness (terms such as “suicide prevention”) and suicidal ideation (terms such as “how to commit suicide”) increased following the release of “13 Reasons Why.” People were also more likely to use search terms like “teen suicide,” “suicidal thoughts” and “how to kill yourself.” </p>
<p>Together, suicide searches were 19 percent higher for the 19 days following the series’ release compared to the period before the release. That figure reflects over one million more searches than what would have normally been expected. </p>
<p>While heightened suicide awareness can be a good thing, the spike in searches that indicate suicidal ideation, from ways to commit suicide to suicidal thoughts, could signal a more disturbing trend. <a href="http://www.jad-journal.com/article/S0165-0327(11)00052-8/fulltext">Prior research</a> has shown that suicide search trends are correlated with actual suicides, and <a href="http://jech.bmj.com/content/57/4/238">media coverage</a> of suicides concur with increased suicide attempts.</p>
<p>While we don’t know whether any specific search preceded an actual suicide attempt, the trends we found in search data suggest that the show’s creators probably have an obligation to mitigate suicidal ideation in the future. </p>
<p>Netflix did give “13 Reasons Why” a TV-MA rating, and a few episodes did have specific warnings for explicit material.</p>
<p>But if they want to go further, they could follow the <a href="http://www.who.int/mental_health/prevention/suicide/resource_media.pdf">World Health Organization’s media guidelines</a> for preventing suicide by removing the scenes that depict the actual suicide. They could also display suicide hotline numbers at the start of each episode. These suggestions could be retrofitted to season one and considered prior to the release of the <a href="http://www.eonline.com/news/860730/13-reasons-why-season-2-officially-underway-get-your-first-look">second season</a>. </p>
<p>Either way, the findings underscore the value of big data from online social systems. Whether it’s searches about suicide, HIV testing or other health concerns, the rapid and reliable information from search engines can make public health agencies more responsive to the populations they serve.</p><img src="https://counter.theconversation.com/content/79162/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jon-Patrick Allem does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Researchers found that suicide-related searches soared in the weeks after the show’s release. What are the broader public health implications?Jon-Patrick Allem, Research Scientist, University of Southern CaliforniaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/798062017-07-06T14:06:57Z2017-07-06T14:06:57ZWhy psychologists have got it wrong on 13 Reasons Why<figure><img src="https://images.theconversation.com/files/176584/original/file-20170703-32631-1sko45c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Netflix</span></span></figcaption></figure><p>Since its debut the Netflix drama series, 13 Reasons Why, has been at the centre of a media firestorm. Psychologists and mental health groups have spoken out publicly against the show, especially its frank depiction of suicide, claiming that it sends out the wrong <a href="https://theconversation.com/popular-netflix-drama-13-reasons-why-sends-out-worrying-messages-about-suicide-78008">message to viewers</a>. </p>
<p>Vulnerable teens, so their argument goes, may strongly identify with the protagonist, Hannah Baker, and view the series as an instruction manual for suicide. The overarching fear is that 13 Reasons Why might not only encourage someone to take their own life, but may also <a href="https://theconversation.com/to-talk-or-not-to-talk-the-dilemma-of-suicide-contagion-46434">become contagious</a>. As if suicide works the same way as, say, the common cold or other airborne infections. </p>
<p>We have heard many exaggerated claims about research that supposedly proves that there is a link between fictional drama and suicide rates. Speaking to the Washington Post, Dan Reidenberg, executive director of Suicide Awareness Voices of Education, <a href="https://www.washingtonpost.com/news/arts-and-entertainment/wp/2017/04/14/the-problem-with-how-13-reasons-why-treats-suicide/?utm_term=.d88a5d40f1fd">argued</a> that young people are “not that great at separating fiction from reality” and “we see them actually replaying what they’ve seen”. In fact, <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1467-8624.2006.00973.x/full">research shows</a> that young people are adept at differentiating between reality and fantasy from infancy. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/176585/original/file-20170703-7743-rurcyu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/176585/original/file-20170703-7743-rurcyu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/176585/original/file-20170703-7743-rurcyu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/176585/original/file-20170703-7743-rurcyu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/176585/original/file-20170703-7743-rurcyu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/176585/original/file-20170703-7743-rurcyu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/176585/original/file-20170703-7743-rurcyu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Palpable nonsense.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/589801625?src=JqbGsoRXktXhumTyDQ8yww-1-1&size=medium_jpg">Kunst Bilder/Shutterstock</a></span>
</figcaption>
</figure>
<p>The idea of suicide contagion stems from <a href="https://www.jstor.org/stable/2094294?seq=1#page_scan_tab_contents">an academic article</a> written in 1974 by an American sociologist, David Phillips. Phillips named it “the Werther effect” after the protagonist in an 18th-century novel by Johann Wolfgang von Goethe, The Sorrows of Young Werther. The eponymous hero of the book shoots himself following an episode of unrequited love. Shortly after the publication of the book, it is said that followers of Goethe, especially those who identified strongly with Werther, began taking their own lives using the same method as the protagonist. Phillips study, however, did not look at the historical evidence of people committing suicide in the 18th century as a result of Goethe’s novel. He looked at the link between the modern reporting of suicide in the press and suicide rates. </p>
<p>Briefly, Phillips counted the number of front-page suicide news stories in the New York Times, between 1947 to 1968, and mapped them against national suicide rates in the month following the announcement of the suicide. Readers may well be asking: what does one have to do with the other? Quite. This is what psychologist Christopher Ferguson describes as <a href="https://www.netgalley.com/catalog/book/105159">“an illusory correlation”</a>, that is, believing there is a relationship between variables even when no such relationship exists. </p>
<p>Phillips’ methodology has been widely criticised and the research effectively debunked from <a href="http://www.tandfonline.com/doi/abs/10.1080/13576270500178112?journalCode=cmrt20">within the field itself</a>. After analysing the methodology and findings, James Hittner, associate professor of psychology at the College of Charleston, found that “the Phillips data were not supportive of the Werther effect”. </p>
<h2>Fiction v journalism</h2>
<p>13 Reasons Why is not journalism, it is fictional drama, so even if the statistical absurdity of Phillips’ study had any merit, he did not make these claims about fictional media. In fact, Australian academics, Jane Pirkis and Warwick Blood, <a href="https://www.researchgate.net/publication/11512033_Suicide_and_the_Media_Part_II_Portrayal_in_Fictional_Media">found</a> that the supposed link between suicide rates and fictional entertainment is not born out by research. The evidence is not only inconsistent, say the researchers, but “relatively weak”.</p>
<p>Novels, films, TV dramas and their ilk do not contain messages that can be transmitted into the minds of children and young adults. Audiences are not passive recipients like Pavlov’s poor hounds. They interpret, evaluate and use media in a wide variety of ways. Claiming that 13 Reasons Why can lead to real-life suicide is not only sensationalist but runs the risk of creating a <a href="https://www1.bournemouth.ac.uk/news/2017-05-25/open-letter-journalists-mental-health-campaigners-psychologists">moral panic</a>. Sending <a href="http://www.refinery29.com/2017/04/151731/13-reasons-why-school-sent-letters-warning-parents">cautionary letters</a> to parents, <a href="http://www.avclub.com/article/canadian-school-bans-discussions-13-reasons-why-254504">banning</a> the series from schools or <a href="http://nypost.com/2017/05/16/school-district-pulls-13-reasons-why-book-from-libraries/">the book from libraries</a>, or warning people about the dangers of watching the series, will not stop young people watching the show. </p>
<p>As we now surely know, from countless moral campaigns of this kind, scapegoating media as forbidden only challenges people to seek it out to learn what all the fuss is about. It is not the media, in whatever form, that should be causing anxiety, but substantial <a href="http://www.independent.co.uk/news/health/mental-health-nhs-funding-cut-millions-five-england-regions-1-billion-spent-2021-scarborough-walsall-a7700476.html">cuts in mental health funding</a> as well as the continuing <a href="https://www.time-to-change.org.uk/category/blog/stigma-and-discrimination">discrimination and stigma</a> attached to such conditions. As clinical psychologist David Swanson <a href="http://www.cbsnews.com/news/netflix-13-reasons-families-claim-show-triggered-suicide/">argues</a>, 13 Reasons Why will not cause people to take their own lives. It is anxiety, depression and major stress that are the triggers.</p>
<p>Perhaps our time would be best served by thinking of ways to help those most in need by protesting against the damage being done to suicide prevention services <a href="http://www.independent.co.uk/news/uk/politics/suicide-prevention-services-funding-cuts-samaritans-health-committee-a7391536.html">by policies such as austerity</a>, rather than awarding a TV series – or indeed a book – more power than it actually has. </p>
<hr>
<p><em>The Samaritans can be contacted in the UK on 116 123. Papyrus is contactable on 0800 068 41 41 or by texting 07786 209 697 or emailing pat@papyrus-uk.org. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found <a href="http://www.suicide.org/international-suicide-hotlines.html">here</a>.</em></p><img src="https://counter.theconversation.com/content/79806/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>William Proctor does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Many psychologists claim that 13 Reasons Why could incite young people to take their own lives. But their claims aren’t supported by evidence.William Proctor, Lecturer in Media, Culture and Communication, Bournemouth UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/778362017-06-19T11:45:33Z2017-06-19T11:45:33Z13 Reasons Why follows a long literary (and misogynistic) tradition of rape and suicide<figure><img src="https://images.theconversation.com/files/170594/original/file-20170523-5763-161mnda.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Netflix</span></span></figcaption></figure><p>13 Reasons Why is a misnomer. There is only one reason in this “whydunnit” from Netflix. The miseries borne by its protagonist, Hannah Baker, and chronicled over the course of the narrative – bullying, <a href="https://theconversation.com/13-reasons-why-when-a-tv-series-sheds-light-on-gender-violence-and-harassment-at-school-77061">slut-shaming</a>, stalking, loneliness and gossip – are nothing when compared to the rape that “breaks her soul”. It is the reason for her suicide. </p>
<p>Or at least, it is the reason as presented by a show that seems more interested in how it tells its story, than in its psychological realism. As has already been <a href="theguardian.com/tv-and-radio/2017/apr/26/netflix-13-reasons-why-suicide">pointed out</a>, one of the show’s most problematic features is that it presents suicide as a rational, if extreme, response to <a href="https://theconversation.com/popular-netflix-drama-13-reasons-why-sends-out-worrying-messages-about-suicide-78008">external forces</a>, rather than as a product of acute mental distress. </p>
<p>Each episode is structured around a side of a cassette tape recorded by Hannah before her death. Each tape is addressed to a different person, with the now heavily <a href="http://nymag.com/selectall/2017/04/what-is-the-welcome-to-your-tape-meme-from-13-reasons-why.html">parodied</a>: “Welcome to your tape”, launching an explanation of the harm the addressee caused Hannah. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/170589/original/file-20170523-5790-ips5t6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/170589/original/file-20170523-5790-ips5t6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=360&fit=crop&dpr=1 600w, https://images.theconversation.com/files/170589/original/file-20170523-5790-ips5t6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=360&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/170589/original/file-20170523-5790-ips5t6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=360&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/170589/original/file-20170523-5790-ips5t6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=452&fit=crop&dpr=1 754w, https://images.theconversation.com/files/170589/original/file-20170523-5790-ips5t6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=452&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/170589/original/file-20170523-5790-ips5t6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=452&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Katherine Langford as Hannah Baker in a scene from the Netflix series, 13 Reasons Why.</span>
<span class="attribution"><span class="source">Beth Dubber/AP</span></span>
</figcaption>
</figure>
<p>But the cumulative force of these injuries – and the implication that her suicide was a result of “one thing on top of another” – is belied by the rape in episode 12 (or “Tape 6, Side B”). “In that moment”, as Hannah said on the tape, she “had felt like” she “was already” dead. Indeed, it is previously suggested that her other hardships are all things that she might have lived with.</p>
<p>We have heard this story before. The twinning of rape and suicide – and further, of rape with a death that anticipates bodily destruction – is a classic scenario. </p>
<h2>Lucretia</h2>
<p>It is a pattern followed by one of the most famous rape victims of antiquity: Lucretia. Her story, recounted in Livy’s compendious Roman History (c.25BC), tells of how Sextus Tarquin, son of the Roman king, tries to seduce Lucretia. Finding her unwilling, Tarquin threatens to kill her and a male slave, swearing to place their bodies together so that it will look like Lucretia had committed adultery. Livy writes that rather than endure this “dreadful prospect”, Lucretia’s “resolute modesty was overcome” by Tarquin’s forceful and “victorious lust”. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/170516/original/file-20170523-8905-zqjazu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/170516/original/file-20170523-8905-zqjazu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=715&fit=crop&dpr=1 600w, https://images.theconversation.com/files/170516/original/file-20170523-8905-zqjazu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=715&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/170516/original/file-20170523-8905-zqjazu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=715&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/170516/original/file-20170523-8905-zqjazu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=898&fit=crop&dpr=1 754w, https://images.theconversation.com/files/170516/original/file-20170523-8905-zqjazu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=898&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/170516/original/file-20170523-8905-zqjazu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=898&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Lucretia, 1664, Rembrandt van Rijn.</span>
<span class="attribution"><span class="source">Minneapolis Institute of Arts</span></span>
</figcaption>
</figure>
<p>The next day Lucretia explains to her father and husband what had befallen her and, after imploring the men to avenge her, stabs herself to death. In the tale, her family carries Lucretia’s body through the streets until the citizens, enraged by the sight of her, rebel against the Tarquins and banish the king, founding the Roman republic. </p>
<p>Another early account, Ovid’s Fasti (c.8AD), describes how Lucretia’s male relatives returned to find her preparing her funeral. This detail, memorably recalled in Chaucer’s The Legend of Good Women (c.1386) when Lucretia is asked by her attendants for whom she is in mourning, serves to reinforce the idea that Lucretia is, in effect, already dead – her suicide is a formality. </p>
<p>This impression is made explicit in Shakespeare’s narrative poem, The Rape of Lucrece (1594), when the matron declares her soul to be polluted and chained with “wretchedness” after Tarquin’s attack – her suicide is presented as a means of preventing the spread of this contamination. Shakespeare was to return to this theme in Titus Andronicus and Measure for Measure.</p>
<p>In the mid-18th century Samuel Richardson’s <a href="http://www.independent.co.uk/arts-entertainment/books/reviews/book-of-a-lifetime-clarissa-by-samuel-richardson-6288595.html">Clarissa</a> (1748) used the Lucretia story to analogise its heroine and her evocatively named rapist, Lovelace. After the rape that forms the novel’s central action, Clarissa, too, declares her soul to be divided and warring within her before making a welcome, even willing, embrace of death.</p>
<h2>Victim shaming</h2>
<p>The overwhelming impression in each of these narratives is of rape as a violence that attacks the mind or spirit as well as the body, and of suicide as an inevitable – even logical – response to this violation. </p>
<p>But part of what is so insidious – and so disturbing – about this pattern is the culture of the victims’ shame, rather than the attacker’s guilt that seems to drive these actions. It is they, and not their rapists, who are dishonoured by the violence.</p>
<p>We see this misogyny firmly on display in the 21st-century in 13 Reasons Why. It is the reason why the counsellor Hannah consults hours before her suicide tells the teenager to “move on”. It is the reason her rapist declares that “every girl in the school wants to be raped”. It is the reason that reports of the sexual assault of a young woman at Stanford University in 2016 regularly referred to her attacker’s swim times as some kind of mitigating evidence, repeatedly <a href="http://www.independent.co.uk/voices/to-the-swimmer-who-raped-a-girl-at-stanford-im-sorry-we-have-failed-you-by-giving-you-an-inadequate-a7069111.html">calling him a swimmer</a> rather than a rapist. </p>
<p>For Hannah, if this culture is not going to change, she’d “better get on with it”. Determining that “no one would ever hurt” her again, she hurts herself. Her suicide is, on the face of it, an act of revenge, a call to arms that highlights the leniency of a malignant culture that is detrimental to the physical and emotional well-being of any person who might in any way inhibit it. </p>
<p>But, in marking her rape as the turning point on her road to suicide, in presenting her death as the actualisation of a murder that has already taken place, the show does more to uphold the misogyny it purports to revile than repudiate it. Hannah neither outlives nor survives rape. Like Lucretia, her rape becomes a story presided over and disseminated by men. There should be no reason for any of this.</p>
<hr>
<p><em>The Samaritans can be contacted in the UK on 116 123. Papyrus is contactable on 0800 068 41 41 or by texting 07786 209 697 or emailing <a href="pat@papyrus-uk.org">pat@papyrus-uk.org</a>. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found <a href="http://www.suicide.org/international-suicide-hotlines.html">here</a>.</em></p><img src="https://counter.theconversation.com/content/77836/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Georgie Lucas does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond the academic appointment above.</span></em></p>The series has divided critics: many have praised its sensitive depiction of rape and suicide, others have said it romantises taking one’s own life.Georgina Lucas, Associate Lecturer, Bath Spa UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/780082017-05-31T09:23:29Z2017-05-31T09:23:29ZPopular Netflix drama 13 Reasons Why sends out worrying messages about suicide<figure><img src="https://images.theconversation.com/files/171473/original/file-20170530-30121-7v88y5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/281190623?src=9qnRRzG2klZjI0rMM5KkpQ-1-34&size=medium_jpg">ami mataraj/Shutterstock</a></span></figcaption></figure><p>Netflix drama 13 Reasons Why deals with fictional teenager Hannah Baker’s death by suicide. Before her death, she recorded a series of 13 cassette tapes, each addressing a person whose actions she felt were instrumental in leading her to the point where she had no option but to take her own life. As a suicide researcher and someone personally affected by suicide, I was very concerned about the messages that come through the programme as well as the way suicide was depicted. Here’s why: </p>
<p><strong>It normalises and legitimises suicide.</strong> By providing clear reasons why a person would want to take their own life, the series suggests that suicide is reasonable, given a particular set of circumstances. This is an unhelpful message to send. People who have experienced similar problems may begin to view suicide as a viable option for them. </p>
<p><strong>The message about suicide is wrong.</strong> By suggesting there are clear and linear reasons why a person would contemplate taking their own life, the series conveys an inaccurate message about suicide. The situation for many people is much more complex, and for some people there are no clear or obvious reasons why they feel how they do. For people unable to identify their reasons for feeling suicidal, there is little to legitimise their experience. Distress is valid and people are deserving of help, whether there is one reason, 13 reasons, or no obvious reason at all. The series also suggests that, with so many reasons, suicide was the protagonist’s only option. It wasn’t. </p>
<p><strong>The series does nothing to encourage young people to seek help.</strong> None of the characters in the series speak to an adult about what’s going on. This is true of Hannah before her death – when dealing with issues such as bullying, stalking and rape – and the recipients of the tapes following her death. In fact, the characters are shown going to great lengths to keep information away from sources of potential support. The one time Hannah did seek help, the experience is shown to be negative. This provides an inaccurate representation of support services, suggesting others are incapable or unwilling to help someone in distress. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/171474/original/file-20170530-30172-15hgnje.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/171474/original/file-20170530-30172-15hgnje.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=457&fit=crop&dpr=1 600w, https://images.theconversation.com/files/171474/original/file-20170530-30172-15hgnje.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=457&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/171474/original/file-20170530-30172-15hgnje.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=457&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/171474/original/file-20170530-30172-15hgnje.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=574&fit=crop&dpr=1 754w, https://images.theconversation.com/files/171474/original/file-20170530-30172-15hgnje.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=574&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/171474/original/file-20170530-30172-15hgnje.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=574&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">There are lots of support services, such as the Samaritans, that people can contact in times of distress.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/421972540?src=9j6KMMJGlb9ZiMC0OQBpvg-1-6&size=medium_jpg">Emerald Raindrops/Shutterstock</a></span>
</figcaption>
</figure>
<p><strong>The suicide scene is extremely graphic.</strong> The suicide scene in the final episode of the series is very graphic and makes for difficult viewing. The detail provided and the length of the scene fails to comply with any <a href="http://www.samaritans.org/media-centre/media-guidelines-reporting-suicide">international recommendations</a> about the fictional portrayal of suicide. <a href="http://www.mindframe-media.info/__data/assets/pdf_file/0005/6494/Suicide-and-the-entertainment-media.pdf">Research</a> indicates that exposure to detailed descriptions or images of suicide, including methods and means of suicide, is associated with increased distress and can increase the risk of imitation by vulnerable people, particularly those who have been affected by suicide. This is known as copycat behaviour or social contagion. </p>
<p>I disagree with the <a href="http://www.vanityfair.com/hollywood/2017/04/13-reasons-why-suicide-controversy-nic-sheff-writer?mbid=social_twitter&mbid=social_twitter">producer’s claim</a> that it was important to show suicide in unflinching and painful detail. You don’t need to see a dead body to understand the realities of suicide. </p>
<p><strong>Others are not to blame for suicide.</strong> For anyone affected by suicide, the series is likely to add to the guilt they may already be feeling as a result of the loss of a loved one. By presenting people’s actions as reasons for her suicide, Hannah makes others responsible for her death. The final message of the series is that if just one person had done something differently, Hannah might still be alive. Suggesting that there is always someone to blame when a person takes their own life is wrong and does nothing to alleviate the “what if…?” questions that torment people who have lost someone to suicide. Presenting suicide as a way to “teach people a lesson”, also triggers debate about whether suicide is a heroic or selfish act. These judgements are inaccurate and unsafe (possibly leading to imitation) representations of suicide.</p>
<p><strong>People do not live on through anything left behind.</strong> Death is final. The series, however, gives the impression that Hannah is able to live on, after death, witnessing people’s reactions to her tapes, and achieves her desired outcome of teaching people a lesson. This fails to demonstrate the permanence of suicide.</p>
<p>It’s important that we talk about suicide – silence doesn’t help anyone – but broadcasters have a responsibility to know what they are showing and the impact that certain content can have on an audience, especially a young audience. Broadcasters should do everything possible to make it less likely that someone will act on suicidal thoughts when distressed, and part of that is the responsible portrayal of suicide; 13 Reasons Why fails in this respect.</p><img src="https://counter.theconversation.com/content/78008/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Katie Dhingra does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Broadcasters have a responsibility to understand the impact that certain content can have on an audience.Katie Dhingra, Senior Lecturer in Criminological Psychology, Leeds Beckett UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/768002017-04-28T05:50:06Z2017-04-28T05:50:06ZWhy we shouldn’t ignore what 13 Reasons Why is trying to tell us<figure><img src="https://images.theconversation.com/files/167111/original/file-20170428-15097-dnlkny.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">13 Reasons Why is the story of high-school student Hannah, who took her own life and left 13 tapes explaining why.</span> <span class="attribution"><a class="source" href="http://www.imdb.com/title/tt1837492/mediaviewer/rm3241424384">IMDb/Kicked to the Curb Productions, Anonymous Content, July Moon Productions, Paramount Television</a></span></figcaption></figure><p>The Netflix show 13 Reasons Why has stirred debate recently, with growing numbers of <a href="http://www.abc.net.au/news/2017-04-18/netflix-series-13-reasons-why-prompts-mental-health-concerns/8450176">calls to counselling services</a> from those alarmed the show’s graphic depiction of suicide could be harmful to vulnerable teenagers. </p>
<p>Some have complained about the simplistic, <a href="http://www.mamamia.com.au/13-reasons-why-mental-health/">cause-and-effect</a> portrayal of suicide. Others have chosen to see it as an <a href="http://www.smh.com.au/comment/what-i-learnt-from-watching-13-reasons-why-with-my-teenage-son-20170424-gvr3na.html">educational tool and conversation starter</a>.</p>
<p>Certainly, there are concerns, including the graphic suicide scene in the last episode. But, overall, the story of high school student Hannah who took her own life and left 13 tapes explaining why, raises many realistic and relevant topics for adolescents.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/167128/original/file-20170428-15091-boflyl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/167128/original/file-20170428-15091-boflyl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/167128/original/file-20170428-15091-boflyl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=890&fit=crop&dpr=1 600w, https://images.theconversation.com/files/167128/original/file-20170428-15091-boflyl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=890&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/167128/original/file-20170428-15091-boflyl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=890&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/167128/original/file-20170428-15091-boflyl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1119&fit=crop&dpr=1 754w, https://images.theconversation.com/files/167128/original/file-20170428-15091-boflyl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1119&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/167128/original/file-20170428-15091-boflyl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1119&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Talking about mental health issues is important.</span>
<span class="attribution"><a class="source" href="http://www.imdb.com/title/tt1837492/mediaviewer/rm805384704">IMDb/Kicked to the Curb Productions, Anonymous Content, July Moon Productions, Paramount Television</a></span>
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<p>It shows compounding associations between mental health issues and a range of behaviours documented to impact a young person’s mental health. These include social exclusion, rumour and innuendo, <a href="http://ro.ecu.edu.au/ecuworks2012/378/">bullying</a>, <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-016-3314-4">regrettable sexual behaviours</a>, alcohol and other drug use, <a href="https://minerva-access.unimelb.edu.au/handle/11343/58760">drink driving</a> and <a href="http://www.publish.csiro.au/sh/SH14215">sexual assault</a>. </p>
<p>The storyline plays out a tangled web of everyday life: peer relationships, friendships, sexual identity, family dynamics, social media and, importantly, the school environment. </p>
<p>Friends’ reactions to Hannah’s suicide and their response to her depiction of their behaviour also provide the opportunity to discuss how different people relate with and react to each other. </p>
<h2>Issues with the show</h2>
<p>Certainly the media should be careful when portraying suicide. Research shows depicting the means of suicide and/or glorifying the act can in some instances result in suicide spikes. However, <a href="http://econpapers.repec.org/article/eeesocmed/v_3a180_3ay_3a2017_3ai_3ac_3ap_3a152-159.htm">researchers also suggest</a> there are usually complex underlying issues associated with copycat suicides (when one person from a community suicides after someone else has).</p>
<p>The association between media exposure and subsequent suicide is not a simple one, while <a href="https://www.ncbi.nlm.nih.gov/pubmed/15843330">evidence for the impact of fictionalised depictions</a> of suicide isn’t as robust as when it comes to real-life portrayals.</p>
<p>In Australia, the media follow guidelines such as <a href="http://www.mindframe-media.info/home/resource-downloads/?a=10217">those produced by Mindframe</a>. These recognise the importance of raising awareness of suicide and suicidal behaviours, but caution against depicting the method. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/167123/original/file-20170428-15117-9uih5v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/167123/original/file-20170428-15117-9uih5v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/167123/original/file-20170428-15117-9uih5v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/167123/original/file-20170428-15117-9uih5v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/167123/original/file-20170428-15117-9uih5v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/167123/original/file-20170428-15117-9uih5v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/167123/original/file-20170428-15117-9uih5v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/167123/original/file-20170428-15117-9uih5v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">The show provides an opportunity to discuss how different people relate with and react to each other.</span>
<span class="attribution"><a class="source" href="http://www.imdb.com/title/tt1837492/mediaviewer/rm148518656">IMDb/Kicked to the Curb Productions, Anonymous Content, July Moon Productions, Paramount Television</a></span>
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<p>Australian fictional television programs and movies that portray suicide and other mental health issues provide information for where to go for help at the end of each program. </p>
<p>Although Netflix provided such information <a href="http://www.13reasonswhy.info/#aus">on its website</a> and a supplementary episode describing the issues raised and options for help, helpline details were not given after each episode.</p>
<h2>Raising awareness is important</h2>
<p>Raising awareness and talking about mental health issues is important and young people are certainly talking about 13 Reasons Why. But talking isn’t everything. Health and education professionals, as well as parents, need the skills to respond appropriately to these conversations. </p>
<p>Given the show’s focus on the school, it is important school staff – especially health service staff and teachers – feel confident discussing mental health problems and influences. This does not mean teachers should become counsellors; rather, teachers need resources and support to enable meaningful discussions about issues with older teenagers as appropriate. </p>
<p>While some may feel confident discussing such issues, studies have found there are a <a href="http://www.tandfonline.com/doi/full/10.1080/14681811.2015.1019665">range of topics</a>, such as a relationships, gender identity, bullying and mental health, that can be challenging and for which many teachers have <a href="http://apo.org.au/files/Resource/sexeducationinaustsecondaryschools2010-1-5-2011.pdf">little or no professional development</a>.</p>
<p>The national secondary curriculum already includes options to discuss literature reflecting many of these issues. The <a href="http://v7-5.australiancurriculum.edu.au/">Australian</a> and Western Australian <a href="http://k10outline.scsa.wa.edu.au/home/p-10-curriculum/curriculum-browser/health-and-physical-education">Health and Physical Education Curriculum</a> provides a specific focus on mental health and relationships issues.</p>
<h2>Seeking help</h2>
<p>School staff also need accessible services to refer students to if necessary. Access to school nurses, psychologists and pastoral care professionals <a href="https://espace.curtin.edu.au/handle/20.500.11937/998">varies considerably</a> across schools. Access to community mental health services also varies. In some areas there may specific services that meet the needs of LGBTI or culturally or linguistically diverse young people. </p>
<p>While accessing help for mental health problems is recognised as a <a href="https://www.mja.com.au/journal/2007/187/7/when-and-how-do-young-people-seek-professional-help-mental-health-problems">protective factor</a>, it is not always easy to do so. Stigmatising attitudes towards mental health problems are improving in Australia, but <a href="https://www.ncbi.nlm.nih.gov/pubmed/22417929">they are still evident</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/167126/original/file-20170428-15097-1v5y6u9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/167126/original/file-20170428-15097-1v5y6u9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/167126/original/file-20170428-15097-1v5y6u9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=346&fit=crop&dpr=1 600w, https://images.theconversation.com/files/167126/original/file-20170428-15097-1v5y6u9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=346&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/167126/original/file-20170428-15097-1v5y6u9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=346&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/167126/original/file-20170428-15097-1v5y6u9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=435&fit=crop&dpr=1 754w, https://images.theconversation.com/files/167126/original/file-20170428-15097-1v5y6u9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=435&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/167126/original/file-20170428-15097-1v5y6u9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=435&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Given the show’s focus on the school setting, it is important school staff feel confident discussing mental health problems and influences.</span>
<span class="attribution"><a class="source" href="http://www.imdb.com/title/tt1837492/mediaviewer/rm2741974528">IMDb/Kicked to the Curb Productions, Anonymous Content, July Moon Productions, Paramount Television</a></span>
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<p>We also know young people are less likely to seek help if they feel negatively about it, which may be influenced by previous experiences. In 13 Reasons Why, Hannah sought help from the school counsellor but her efforts were ignored. Mr Porter could have referred her to a more qualified health professional or taken more time to listen. </p>
<p>Young people may also be <a href="https://www.mja.com.au/journal/2007/187/7/when-and-how-do-young-people-seek-professional-help-mental-health-problems">hesitant to seek help</a> if they feel they should resolve the issue themselves. And those with suicidal thoughts are <a href="https://www.mja.com.au/journal/2007/187/7/when-and-how-do-young-people-seek-professional-help-mental-health-problems">less likely to seek help</a>, so there is concern they may feel that programs such as 13 Reasons Why validate their thoughts.</p>
<p>It is important to <a href="https://www.ncbi.nlm.nih.gov/pubmed/11059991">enhance health literacy</a> so young people are better able to <a href="https://www.ncbi.nlm.nih.gov/pubmed/16403031">recognise signs of problems</a> and feel confident seeking help. It is also important friends, family and other significant people look out for warning signs and encourage young people who are feeling distressed to seek help. </p>
<p>Such signs <a href="https://www.headspace.org.au">may include</a> withdrawal from activities people usually enjoy, changes in sleep or appetite, being unusually moody, angry, stressed or anxious, participation in risky behaviours they would usually avoid, and expressing negative thoughts. </p>
<p>If, as in Hannah’s case with the counsellor, the help isn’t great, then seek another source. Acting on issues early and preventing problems from developing should be a focus. Similar to 13 Reasons Why, too often interventions are implemented only after a crisis. Prevention programs that consider the complexity of mental health and include strategies that focus on the broader environment and ethos are important. </p>
<h2>Should you watch it?</h2>
<p>Netflix suggests viewing 13 Reasons Why for young people <a href="https://www.netflix.com/au/title/80117470">aged 15 years and over</a> (MA15+) and the <a href="http://www.classificationoffice.govt.nz/find-ratings/new-zealands-classification-labels.html">New Zealand Classification Office</a> recently rated the program as RP18. Concerned parents can help by watching the program with their teenager and discussing salient issues.</p>
<hr>
<p><em>If you are feeling distressed or are concerned about a friend, family member or work colleague, call Lifeline 13 11 14 <a href="https://www.lifeline.org.au/">www.lifeline.org.au</a>, Suicide Call Back Service 1300 659 467 <a href="https://www.suicidecallbackservice.org.au/">www.suicidecallbackservice.org.au</a> or Kids Helpline 1800 55 1800, <a href="https://kidshelpline.com.au/">www.kidshelp.com.au</a></em></p><img src="https://counter.theconversation.com/content/76800/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sharyn Burns does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>While there are some some safety concerns about watching the show, 13 Reasons Why raises many issues relevant to adolescents – and we should learn from them.Sharyn Burns, Associate Professor, Curtin UniversityLicensed as Creative Commons – attribution, no derivatives.