EDITOR'S NOTE: This is the fifth in a series of articles about mental health, managing disorders, treatment and local resources available for anyone with mental illness.
A popular series on Netflix is the latest example in pop culture that critics claim romanticizes suicide or, at the very least, sends conflicting messages about mental illness.
Netflix released all 13 episodes of "13 Reasons Why," which depicts the act of suicide of its female teenage lead, on March 31. April is Mental Health Awareness Month.
"It is directly in conflict with safe reporting on suicide," said Susie Reece, violence prevention specialist for CHI St. Vincent Hot Springs and executive director of Suicide Prevention Allies. "The content is very graphic. It depicts the actual act and the means. From what I have seen, it really puts suicide itself into very petty issues being the root causes of why the girl dies from suicide and she directs a lot of blame at others.
"It does not encourage help-seeking. We do not see enough evidence of that. It would be better if, at the end of each episode, there would be some sort of way to connect the viewers with information on suicide and resources available to them."
The show was coproduced by actress and singer Selena Gomez and is based on the 2007 best-seller by Jay Asher about a high school student who leaves 13 audiotapes about events that led to her suicide. Creators and consultants have defended the show's depiction of suicide despite it being in direct contrast with safe reporting guidelines developed by a coalition of health, mental health and prevention organizations.
"Many people are accusing the show of glamorizing suicide and I feel strongly -- and I think everyone who made the show -- feel very strongly that we did the exact opposite," writer Brian Yorkey told The Associated Press. "What we did was portray suicide and we portrayed it as very ugly and very damaging."
The Centers for Disease Control and Prevention, American Association of Suicidology, American Foundation for Suicide Prevention, National Alliance on Mental Illness, National Institute of Mental Health and more than a dozen other organizations developed a list of recommendations for safe reporting on suicide. The recommendations say covering suicide carefully, even briefly, can change public misperceptions and correct myths, which can encourage those who are vulnerable or at risk to seek help.
"More than 50 research studies worldwide have found that certain types of news coverage can increase the likelihood of suicide in vulnerable individuals," the recommendations say. "The magnitude of the increase is related to the amount, duration and prominence of coverage.
"Risk of additional suicides increases when the story explicitly describes the suicide method, uses dramatic/graphic headlines or images, and repeated/extensive coverage sensationalizes or glamorizes a death."
Reece said the pattern repeats when new art, such as music or film, addresses or depicts suicide. Many schools have sent warning letters to parents and guardians to combat the possible effects of the show.
"We have seen increases," Reece said. "I have had school-based counselors and school-based professionals who have reached out and said they are seeing rises in self-harm, suicide attempts and suicide ideations. It is definitely something there should be awareness about."
Dr. Helen Hsu, a clinical psychologist in Fremont, Calif., further defended the show by telling The Associated Press to not show the character's death "would be almost 'coy and avoidant' and that medical studies aren't definitive about the risks of suicide contagion." Hsu worked on scripts for some of the episodes.
New Zealand's Office of Film and Literature Classification created a new rating just for the show. The RP18 is meant to ensure parents or guardians are always present to accompany viewing by anyone younger than 18.
"Viewer discretion advised" warnings were placed at the beginning of three episodes with explicit material and the series is rated TV-MA for mature audiences only. Criticism prompted Netflix to add an additional warning before the first episode.
"I think we have very short attention spans and I do not see anyone going back to that first episode and looking for that viewer discretion," Reece said. "They may not even understand why it is there, especially if you are talking about youth. They understand that suicide is a problem, but we do not need to just present the problem. We need to start presenting solutions."
Depression and mental illness are minor factors on the show as it points to external factors as what drove the character to suicide. Elements of the story allowing the character to tell her story after she died and portraying the school guidance counselor as blaming the victim have also drawn criticism.
"We have barely scratched the surface in regards to the public acknowledging that people deal with mental health issues," said Lenora Erickson, clinical director for Therapeutic Family Services. "No one wants to acknowledge or talk about these things."
Erickson is also the chairwoman of the SPA youth committee and the Arkansas Board of Examiners in Counseling. She said steps for maintaining mental health include scheduling regular personal time, asking for help, setting realistic goals, taking care of physical health and creating positive sleeping patterns.
Karla Gentry, a licensed professional counselor, also recommended getting enough sleep. She said being honest with oneself is an important step.
"I think the biggest issues are that we tell ourselves that we are supposed to be perfect and that if we fail at something that we aren't good enough, and that's just not true," Gentry said. "We need to tell others, 'I really can't do that,' or, 'It's not OK for you to talk or treat me that way.'"
Gentry said surrounding yourself with positive people can aid in maintaining mental health, as well as taking part in a new activity at least once per month, regularly sitting or walking outside for at least 10-15 minutes and eating less fast food.
Suicide prevention specialists said teenagers may binge watch the series before they are able to absorb the issues and ask questions. They also claim the show should regularly provide prevention information, such as the number for the National Suicide Prevention Lifeline.
The free, confidential Lifeline is available 24 hours every day at 800-273-8255. In immediate crisis, dial 911.
An alternate line for anyone who is deaf or hard of hearing can be reached at 800-799-4889. A chat option is also available online at https://suicidepreventionlifeline.org/.
Text HOME to 741741 to reach the Crisis Text Line. Trained crisis counselors are available 24 hours every day.
The NAMI HelpLine handles requests for information on mental health conditions, treatment options, local programs, recovery strategies, resource referral and support. Call 800-950-6264 to reach the HelpLine Monday through Friday from 9 a.m. to 5 p.m. Central Time. It is also available through email at [email protected]Local on 05/04/2017