Teen Suicide Experts Blast Netflix Series 13 Reasons Why

Megan Brooks

May 05, 2017

Adolescents are flocking to the new Netflix series 13 Reasons Why, which includes stark depictions of bullying, rape, and suicide – all of which have mental health professionals concerned.

"This show violates the number one principle of fictional depictions of suicide which has the potential to cause copycat suicides," Benjamin Shain, MD, PhD, child psychiatrist at NorthShore University HealthSystem in Illinois, noted in an interview with Medscape Medical News.

There is a substantial body of research on the contagion effect, he explained.

"There is an increase in adolescent suicides when there is a news report of an actual suicide or a fictional depiction of a suicide. Three percent of suicides are thought to be related to the contagion effect," Dr Shain said. "The news media has known about this for years, and it is now rare that you see a suicide report on the front page of the newspaper, and the coverage of suicide tends to be fairly muted."

Dr Shain also noted that the series "glorifies the suicide, and it explains the suicide as something to do with revenge. It makes it sound desirable, and there is no mention of psychopathology or depression. And the helpers or counselors are depicted as doofuses, so it doesn't encourage kids to ask for help from the professionals."

Amid a storm of controversy among parents, educators, and mental health advocates, this week, Netflix announced it would include additional "trigger warnings" cautioning the public about the series' graphic content.

Missed Opportunity

Mitch Prinstein, PhD, president of the Society of Clinical Child and Adolescent Psychology, also takes issue with the series for not providing an outlet for teens who may have suicidal ideation.

"As it often happens in conversations about mental health issues, there is good news and bad news," he told Medscape Medical News.

"The good news is that we are talking about mental health, and we are beginning to have dialogues around the kitchen table about really important and prevalent issues, like depression and suicide and sexual assault," said Dr Prinstein.

"The bad news is that it's very important that those conversations simultaneously talk about the importance of mental health treatment and talking with trained professionals and, unfortunately, I don't know that the series played that card as much as they could have," he said.

"Honestly, I don't think a lot of kids know that there are treatments that could help them, and sadly, that was a missed opportunity here to educate young viewers," Dr Prinstein added.

Social media outlets, on the other hand, are very proactive in directing teens to suicide prevention services, Dr Shain noted.

"Certainly a suicide in an adolescent is going to be big news on social media," Dr Shain said. "But social media like Facebook and search engines like Google are designed deliberately to send teens to places where they can get help. And it's been shown that teens learning of a suicide through Facebook do not have an increased risk, and the thinking there is that they had social support which mitigated the effects of learning of the suicide," he said.

Dr Prinstein encouraged all healthcare providers to ask kids about mental health.

"Mental health underlies many of the physical health issues that we see and changes kids' lives, their trajectory. It's important for primary care providers to collaborate and coordinate with mental health professionals and refer kids with mental health problems to specialists."

Suicide is now the second leading cause of death in the United States for persons aged 15 to 19 years, according to a 2016 clinical report on suicide and suicide attempts from the American Academy of Pediatrics.

Dr Shain and Dr Prinstein have disclosed no relevant financial relationships.

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