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How 13 Reasons Why sparked years of suicide-contagion research


13 Reasons Why sparked controversy about suicide contagion. Four years later, a new UCLA study offers guidance for Hollywood on how to best handle such topics going forward.”>
Enlarge / Back in 2017, the first season of the Netflix series 13 Reasons Why sparked controversy about suicide contagion. Four years later, a new UCLA study offers guidance for Hollywood on how to best handle such topics going forward.
Netflix

When 13 Reasons Why debuted on Netflix on March 31, 2017, it was initially met with mostly rave reviews from critics and viewers alike. Viewers appreciated the show’s frank and sensitive handling of such complex topics as suicide, bullying, rape, and depression. Within weeks, however, mental health professionals began voicing strong objections to the YA-targeted show’s treatment of suicide in particular—these professionals believed the depiction could trigger suicidal thoughts or actions in vulnerable teens. It’s well known that high-profile suicides can sometimes influence copycats, but the issue is less clear when it comes to fictional stories. Throughout the last four years, multiple, often contradictory studies on that very topic have since appeared. Some of the studies show negative impacts, while others show beneficial effects in young people who watched 13 Reasons Why.

The series aired its fourth and final season last year, but 13 Reasons Why continues to inspire research on the potential impact (positive or negative) of fictional stories on teen mental health. A new study available today from researchers affiliated with UCLA’s Center for Scholars and Storytellers focuses specifically on the show’s third season, and it shows that series like 13 Reasons Why can have a positive impact on teen mental health as long as the issues are depicted accurately and with empathy.

The report also recommends that appropriate supplementary resources be provided to viewers—which is a major challenge, since most viewers don’t engage with such resources even when they are available. But whether it’s a streaming series or accompanying readings, the researchers at UCLA’s Center for Scholars and Storytellers strongly believe that the media tweens and teens consume plays a crucial role in their development, as it does with any other young demographic.

“I went into the film business because I believe content can change the world,” said Yalda Uhls, a former film executive who went on to earn a PhD in child development and now leads this three-year-old research center. “We’re working to harness the power of entertainment media for tweens, teens, and young adults, and to support social and emotional learning. There’s a long history of doing this for preschool audiences, like Sesame Street and PBS Kids. I felt there was a gap there. The tween and teen years are just as important a developmental period as early childhood.”

(Spoilers for 13 Reasons Why below.)

The Netflix series at the center of all this is based on the 2007 YA novel Thirteen Reasons Why by Jay Asher, in which a high school student named Clay struggles in the aftermath of his friend Hannah’s suicide. (Asher was moved to write the book after a close relative attempted suicide.) Hannah has left behind seven double-sided cassettes, identifying 13 people she blames for driving her to such a desperate act. It’s her way of confronting her tormenters from beyond the grave.

There is the boy who humiliates her after their first date; the girl who spreads rumors about Hannah to hide her own same-sex inclinations; a student who betrays her trust; the bullying jock, Bryce, who rapes Hannah; and the high school guidance counselor who turns a blind eye to Bryce’s chronic bullying and rape-y behavior, just to name a few. (Hannah was not Bryce’s only victim.) The tapes are mailed out to each person on the list in succession. Hannah’s story is told in flashbacks, with present-day events narrated from Clay’s point of view.

Asher’s novel remained on The New York Times bestseller list for more than three years despite mixed critical reviews, and it ultimately garnered a number of awards. But the story also generated a fair amount of controversy because of its frank depictions of bullying, sexual assault, and suicide. From 2010 through 2019, it was the third most-banned book in the US. The release of the Netflix series only brought renewed attention.

13 Reasons Why.”>
Enlarge / Katherine Langford starred as Hannah Baker, a teen who commits suicide, in the first two seasons of 13 Reasons Why.
Netflix

Apart from a few small deviations, the streaming series hews pretty closely to Asher’s novel. There is one key difference, however. In the novel, Hannah kills herself by swallowing a handful of pills. By contrast, the TV series originally included an intense, graphic scene where Hannah slits her wrists in the bathtub. Full disclosure: I was a fan of the first season, and I found that scene to be beautifully rendered and emotionally powerful, albeit extremely difficult to watch. (The two are not mutually exclusive.) So I was frankly surprised when the backlash began. In retrospect, I shouldn’t have been.

The backlash begins

By standard Hollywood metrics, 13 Reasons Why was a success. The response, and viewership, was sufficiently strong to spawn three subsequent seasons (which were far less well received). Katherine Langford, who played Hannah, was nominated for a Golden Globe. The series even won a Mental Health America Media Award in 2018 “for elevating the dialogue across the country between parents, students, and mental health advocates on the epidemic of teen suicide, depression, and bullying.”

Among those who were not fans was Washington Post television critic Hank Stuever, who compared the show to one of ABC’s old afterschool specials. He also objected to the basic storyline. “[It] strikes me as remarkably, even dangerously naive in its understanding of suicide,” he wrote. As the weeks wore on, voices like Stuever’s began to dominate the conversation.

The backlash centered on the risk of suicide contagion (or copycat suicides) among teens. Suicide contagion is a phenomenon in which exposure to suicide within a family, among friends, or through the media may be associated with an increase in suicidal behavior. Many expressed concerns that the show glamorized suicide, and these critics thought the bathtub scene in particular violated current journalistic guidelines for responsible reporting on suicide.

In April 2017, the National Association of School Psychologists released a statement warning about the potential adverse effects of the series, and the organization also sent a letter to school mental health professionals—the first time it has undertaken such an action. The Society of Clinical Child and Adolescent Psychology (SCCAP) released a similar statement and also criticized the depiction of ineffectual mental health professionals—notably, high school guidance counselor Kevin Porter (Derek Porter), who fails Hannah when she seeks his help after her rape by Bryce.

“From a public health perspective, the producers of 13 Reasons Why (S1) disregarded established science and the evidence that the approach they were set on taking—depicting suicide in a raw and graphic way—would set a blueprint for a vulnerable subgroup, especially those who identified with the main character,” said John Ackerman, a psychologist specializing in suicide prevention at Nationwide Children’s Hospital in Columbus, Ohio.

Ackerman is quick to emphasize that he is not anti-Netflix. “I am not someone who overstates media effects,” he told Ars. “Media, gaming, and social media can be part of the solution if done well. However, the science was strong enough at the time to know there was strong potential for harm. There was virtually unanimous condemnation of this series by the suicide prevention and mental health community. Why? Because they knew what the producers did not—all attention to a problem is not created equal, and modeling suicide as a solution to distress and bullying is dangerous.”

Enlarge / Dylan Minnette starred as Clay Jensen, who had a crush on Hannah and became obsessed with the tapes she left behind.
Netflix

The best intentions

This is not a trivial concern, and nobody is claiming otherwise. According to the CDC, suicide is the third-leading cause of death among young people between the ages of 10 and 24. It was certainly not the intent of anyone involved in the creation of the series to glamorize suicide—quite the opposite, according to producer Joy Gorman (Home Before Dark). She and showrunner Brian Yorkey did their homework even before Netflix greenlit the series, and the team made sure they hired two psychiatrists as consultants to read scripts and advise on how best to approach the many sensitive issues portrayed on the show, including suicide.

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“Both our consultants agreed vehemently with us that, had we not shown the terrible, ugly, painful bridge from life to death for Hannah, then we’d have been glorifying suicide,” Gorman told Ars. “It was never meant to be gratuitous, and it wasn’t done just because of some artistic decision. We didn’t want kids to feel like dying was some light choice.”

Yorkey was no stranger to writing about mental health issues. He won a Pulitzer in 2009 for penning the Broadway musical Next to Normal, which featured a bipolar protagonist and involved issues of drug abuse, grief, depression, and suicide. The diverse writers’ room spanned several generations and included people who had struggled with many of the same issues, including suicidal ideation. One woman on the writing staff credited the 1999 film Girl, Interrupted, with persuading her not to kill herself.

Writer Nic Sheff defended the series’ unflinching portrayal in an op-ed in Vanity Fair, speaking frankly about his own past history that included drug use and an aborted suicide attempt. “It seemed to me the perfect opportunity to show what an actual suicide really looks like—to dispel the myth of the quiet drifting off, and to make viewers face the reality of what happens when you jump from a burning building into something much, much worse,” he wrote. “It overwhelmingly seems to me that the most irresponsible thing we could’ve done would have been not to show the death at all. I stand behind what we did 100 percent. I know it was right, because my own life was saved when the truth of suicide was finally held up for me to see in all its horror—and reality.”

Enlarge / Justin Prentice played high school jock Bryce Walker, a bully and serial rapist. Hannah was among his victims.
Netflix

Gorman cites the many viewer emails they received claiming that the show had triggered helpful conversations between teens and parents. Rebecca Hendrick, a psychiatrist at Cedars-Sinai Medical Center in Los Angeles, consulted on all four seasons of the series and heard reports of positive experiences from almost all her own patients who had watched the series. UCLA’s Uhls watched the show with her teenage daughter, who confided that one of her friends had been raped. “I am 99.9 percent sure she never would have told me that without us watching the show together,” she told Ars. “So my own lived experience as a mother was that the show was a positive thing.”

Ackerman’s lived experience as a psychologist was markedly different. Shortly after S1 debuted, “I was receiving calls from therapists and parents in the community indicating that many of their patients (including many middle and high schoolers) were struggling after watching the series and many had increased suicidal thoughts,” he told Ars. “Our emergency department had reported several patients admitted for suicide attempts just after viewing the program. Is this evidence for a causal effect? No. Is it unique to any television series that has been released in the past decade? Yes.”

As for Sheff’s contention that the graphic scene was meant to act as a deterrent, “We have decades of data across many fields of behavioral science that such outcomes associated with ‘scared straight’ [approaches] do not lead to their intended consequences,” said Ackerman. “Suicide contagion has been studied for years, and we know that highlighting the suicide method in detail is problematic. We know that showing suicide as the inevitable outcome of overwhelming distress, or that it serves a function (e.g., revenge), is harmful.”

There have indeed been many studies over the years on suicide contagion. However, the extent to which fictional portrayals of suicide may contribute to suicide contagion remains a matter of genuine academic debate. There is also a degree of self-selection at play when it comes to finding expert consultants for films and TV shows, and that seems to have occurred in the case of 13 Reasons Why. Both writers’ room consultants held similar views on the issue, and those views were reflected in their feedback to the showrunners. So the series unwittingly became a lightning rod for that ongoing debate. “What we learned [after the fact] is that the field of suicide is really polarized,” said Gorman.

“There are some researchers that think there’s no harm in these fictional portrayals,” said Dan Romer, a psychologist at the University of Pennsylvania’s Annenberg Public Policy Center, where he studies media and social influences on adolescent health. “There’s a concern [among those experts who disagree] that if they get the upper hand in terms of influence in Hollywood, then Hollywood will go crazy with this kind of content. I feel like one has to steer a middle course here.”

Enlarge / The depiction of ineffectual high school guidance counselor Kevin Porter (Derek Luke) sparked criticism from child psychologists.
Netflix

Goethe and the Werther effect

Suicide contagion is sometimes called the “Werther effect,” after the young protagonist of Johann Wolfgang von Goethe’s 1774 novel, The Sorrows of Young Werther. In the novel, Werther falls in love with a beautiful young girl named Charlotte, who is already engaged to another man. Convinced that the only way to resolve the romantic triangle is for one of the three to die, Werther shoots himself in the head. Shortly after the novel was published, young men reportedly began committing suicide in the same manner, causing Goethe’s book to be banned in several countries.

A pair of studies published in 1985 and 1989, respectively, by University of California, San Diego, sociologist David Phillips (who coined the term “Werther effect” in the 1970s) concluded that copycat suicides tended to spike after a well-publicized suicide, and those affected are typically the same age and gender as the original suicide. Those most susceptible are usually either young or old; ages in between don’t seem to be affected as much. The strongest evidence for suicide contagion in fiction, according to Romer, is a 1999 study concluding that an episode of the British medical drama Casualty—within which a young man poisons himself with paracetamol—led to an increase in hospital admissions of self-poisonings among young men and women two weeks after airing.

That said, “Just because you see a story about someone having died by suicide, that doesn’t mean you’re going to go out and do it,” Romer told Ars. “The contagion phenomenon is very restricted to people who are susceptible to that kind of information.”

“Just because you see a story about someone having died by suicide, that doesn’t mean you’re going to go out and do it.”

There is also a corresponding “Papageno effect,” named after the lovelorn character in Mozart’s opera, The Magic Flute, who contemplates suicide but then chooses otherwise after other characters show him there are more beneficial ways to solve his problems. Per Romer, this is a form of empathy called “perspective taking,” in which a fictional story can actually produce a decrease in suicide among those exposed to it, simply by depicting how one’s suicide would impact one’s community.

As for 13 Reasons Why specifically, there have been several studies claiming to demonstrate a harmful effect and several others claiming beneficial effects. But it’s a notoriously difficult thing to research, and these studies have been all over the place in terms of methodologies, metrics, sample sizes, and so forth. For instance, one 2017 study found a sharp spike in Google search terms corresponding to the show’s release. There was a 26 percent increase in searches for “how to commit suicide,” an 18 percent increase for “commit suicide,” and a nine percent increase for “how to kill yourself.” But the frequency of search terms, while suggestive, can’t really tell us anything about why people were Googling for that information.

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Enlarge / Michele Selene Ang played Courtney Crimsen, a closeted student who spread rumors about Hannah to protect the secret of her own sexual orientation.
Netflix

A 2018 study by a team at the University of Oklahoma’s Health Sciences Center found increases in admissions to a children’s hospital of patients between the ages of 4 and 18 relating to self-harm after the debut of the show. Another 2018 study examined the show’s perceived impact on a sample of 87 teens (and their parents) admitted to a psychiatric emergency department with suicide-related concerns. That study found that 51 percent thought the show increased their suicide risk, strongly correlated with how much they identified with the female lead. Those teens with the strongest depressive symptoms, who thought about suicide more frequently, were much more likely to identify with the lead characters and experience negative effects while watching the show.

A study published the following year involved just three teenage female outpatients in Vienna, Austria, who participated in an hour-long focus group after watching S1. All three suffered from depressive and post-traumatic stress disorders. And all three reported an increase in thoughts about suicide and the intent to harm themselves after watching the show. They said that it gave them “specific ideas on how to end their lives”—findings consistent with the Werther effect, albeit gleaned from a tiny sample size.

By contrast, a 2018 Northwestern study (commissioned by Netflix) surveyed the responses to the show of 5,400 adolescents, young adults, and parents of adolescents in Australia/New Zealand, Brazil, the United Kingdom, and the US. The Northwestern team found that a healthy majority of teens in all regions felt the show resonated with their concerns, that it authentically depicted their high school experiences, and that it had been beneficial for them to watch. Substantial numbers of teen respondents also reported seeking out information to educate themselves on the issues raised after watching the show, and these respondents said it had fostered communication with parents and peers. Between 63-79 percent (depending on the region) agreed that the graphic suicide scene “was necessary to show how painful suicide is.”

According to Uhls, several other studies published between 2018 and 2020 also reported positive effects associated with watching 13 Reasons Why. These included less severe symptoms of depression, fewer incidences of suicidal ideation and self-harm, a decrease in the social stigma often associated with mental illness and suicide, and better awareness of suicide risk factors.

In 2019, a particularly damning study appeared in the Journal of the American Academy of Child and Adolescent Psychology co-authored by Ackerman and Jeffrey A. Bridge of Ohio State University, along with several colleagues. Bridge et al. analyzed the CDC’s data on deaths due to suicide for people between 10 and 64 during the period from January 1, 2013, to December 31, 2017. They used a time-series forecasting method in order to project future trends in suicide and compared those forecasts to the rate of suicide deaths in the three months following the show’s release.

As a control, the team also analyzed homicide deaths over the same period, since those can be influenced by some of the same social and environmental factors as suicide. Their results showed a 28.9 percent increase in suicide rates among young people between the ages of 10 and 17 in the months following the first season’s release, while there was no change in homicide rates over the same period. However, when the researchers broke the data down by gender, there was a statistically significant increase in suicide rates for boys, but the increase for girls was not statistically significant—counter to the authors’ original hypothesis that the show’s release would have a larger impact on girls than boys. That aspect contradicted what we know thus far about suicide contagion.

This was nonetheless solid, quantitative data, compared to the more qualitative approach of some of the earlier studies. The authors concluded that caution was warranted with regard to exposing children and adolescents to the show. Still, Bridge et al. couldn’t definitively make a direct causal link between the release of 13 Reasons Why and the increase in suicide rates, and thus they could not rule out other factors influencing those rates over the critical period. Ultimately, they noted in an op-ed for USA Today that “this pattern of an abrupt, significant rise in suicide has all the hallmarks of a media contagion event.”

Enlarge / Brian d’Arcy James and Kate Walsh played Hannah’s parents, Andy and Olivia.
Netflix

In the wake of that study and continued concerns, Netflix did something unexpected. Ultimately, the streaming service caved and edited out the original graphic three-minute scene in 2019—roughly two years after it originally aired. New viewers instead see a distraught Hannah looking at herself in the mirror, and then the scene cuts to her parents reacting to her death. “No one scene is more important than the life of the show and its message that we must take better care of each other,” Yorkey told the Hollywood Reporter. “We believe this edit will help the show do the most good for the most people while mitigating the risk for especially vulnerable young viewers.”

One could argue that, essentially, the show’s writers and producers found themselves faced with a classic trolley problem, where something that is beneficial to one large group could be harmful to another smaller group, creating a difficult choice. If 13 Reasons Why‘s frank depiction of a suicide helped 15 teens but served as the trigger for another to commit suicide, is that an acceptable tradeoff? Netflix clearly decided it wasn’t willing to bear responsibility for that risk. “If anybody believed that a child could be harmed, it wasn’t worth allowing that to sit out there in the world, even though we knew it wasn’t true,” Gorman told Ars. “It was a decision that was really painful and hard to make, but we felt it was our only choice at the time.”

A re-analysis raises questions

As Netflix prepared to air the second season of 13 Reasons Why, Romer and several colleagues saw an opportunity to conduct an analysis on possible suicide contagion in real time, rather than sifting through aggregate data after the fact. For their 2019 study, Romer et al. recruited a panel of 729 young people between the ages of 18 to 29 years and interviewed them before the second season premiered. The students then watched the season, and Romer et al. conducted interviews with them afterward. That second season dealt with the aftermath of S1’s events, focusing on the trial resulting from Hannah’s parents’ decision to sue the school district after Hannah’s tapes were released online.

The results showed some evidence for a Papageno effect, even among some of the more vulnerable viewers. Those viewers who reported beneficial effects also demonstrated more sympathy about helping someone in a suicidal crisis than people who stopped watching or didn’t watch the show at all. “To be honest, I was expecting only negative effects, so I was surprised to find that the show has had beneficial effects,” said Romer. “There was some negative effect, but the people who became upset stopped watching.”

Romer was also skeptical of the Bridge et al. study’s findings, so he conducted his own reanalysis. He argued that the evidence for contagion should have been stronger for girls than boys, given that the show’s suicidal teen protagonist was female. Furthermore, that study didn’t take into account broader secular trends in suicide, particularly for boys. Suicide rates in teens ages 15 to 19 have been rising since 2008, and they rose by a whopping 20 percent between 2016-2017 alone. “This was a particularly large increase that was unlikely to be the result of a single television show,” Romer wrote. “Unless an analysis controlled for that trend, it would be difficult to separate the effects of the show from the secular trend.”

Romer used a standard auto-regression analysis rather than the time series analysis employed by Bridge et al. His results showed that the increase in suicides among teen boys reported by Bridge et al. was no greater than the increase in the month prior to the show’s release and that there were no effects in later months of that same year. However, he did find a small increase in suicide among girls in April. “There may well have been more Werther than Papageno effects of the first season, but identifying that effect in aggregate is difficult,” Romer concluded, adding that conducting a more fine-grained analysis at a week-by-week level might be more useful than aggregate rates of monthly suicides.

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Bridge et al. fired back, taking issue with Romer’s re-analysis in a formal comment. These researchers claimed Romer had failed to articulate how his auto-regression analysis was superior to their own approach. Among other points, they noted that one of the male characters did, in fact, contemplate suicide in the wake of Hannah’s death and that this could account for their finding an increase in male suicides. They also argued that Netflix’s marketing campaign in the month prior to the show’s release could account for the increased suicide rates observed in boys in that month.

Romer next published a counter to this counter argument, defending his re-analysis and gently mocking claims about the impact of Netflix’s marketing. “As far as I know, the cause has to precede the effect,” Romer told Ars. “I think the researchers were just eager to find that, even if it wasn’t clear that it was there, because the community was so much opposed to the show.” He closed his response with a call to resist drawing bold conclusions, given the current limited knowledge about the respective influences of the Werther and Papageno effects on vulnerable audiences. “As suicide and media researchers, we have the responsibility to report and interpret data that bear on the role of the media without allowing our hypotheses to over-ride the evidence,” he wrote.

Enlarge / Alison Boe played Jessica, another of Bryce’s rape victims, who opens a club for survivors of sexual assault in later seasons.
Netflix

UCLA enters the fray

Like Romer before her, Uhls saw the imminent debut of S3 as an opportunity to conduct a randomized, controlled experiment with teens as they were watching the show in order to better assess mental health impacts. The broad narrative arc of the third season involved the murder of Bryce and an investigation leading to the eventual unveiling of the killer. It further explored the themes of healing after sexual assault, toxic masculinity, and bullying—including delving into Bryce’s background to explore the making of a bully/serial rapist and the possibility of redemption.

Uhls’ past Hollywood experience and contacts came in handy. The show’s producers granted the UCLA team access to S3’s locked footage six weeks before it launched, giving them ample time to craft a survey suitably tailored to the season’s contents. Uhls and her cohorts then recruited 157 teens (82 female, 75 male) between the ages of 13 and 17, half of whom were asked to watch S3 (“viewers”) and half of whom were instructed not to watch the new season. The subjects completed surveys at the beginning of the experimental period and at its conclusion.

Of those who watched S3, a full 92 percent reported seeking more information about bullying and mental health, while 88 percent said they had discussed the show and related issues with others, typically friends (63 percent) or parents (47 percent). In fact, 60 percent of viewers actually watched the show with their parents at least once. Roughly one-third of viewers said they had explored the resources developed in conjunction with 13 Reasons Why, which the authors identified as evidence that investing in such resources is not merely performative and can have genuine positive benefits.

Uhls et al. were also able to identify several moderating factors for especially vulnerable teens. For instance, subjects who reported higher symptoms of depression, or who knew a victim of sexual assault, were more likely to engage in conversations around the issues raised in the show. More depressively inclined viewers talked about suicide more frequently after watching the show, Googled information on suicide more frequently, and were less likely to talk to their parents.

There were some caveats with this new study. About one-third of the subjects didn’t follow the protocols for their assigned group, watching the show when they were supposed to abstain, or not watching the show even though they were instructed to do so. They were subsequently reassigned to the appropriate group before analysis. The authors also acknowledged that a larger sample size would have been desirable. For ethical reasons, the study was limited to teens who said they had never seriously considered suicide, and therefore it did not include those most vulnerable to the Werther effect. All the teens who participated in the study lived in the US, and the survey did not delve too deeply into the specific content of the viewers’ conversations after watching the show.

Looking forward

The question of whether 13 Reasons Why had a net positive or negative effect on its viewers will likely never be fully resolved to everyone’s satisfaction. But the series did spark important conversations, particularly regarding the moral responsibility of content creators and how best to ensure that teen-centric content dealing with controversial issues doesn’t put the most vulnerable members of that audience at risk. “We know that crafting accurate stories of mental health struggles, humanizing their struggle while depicting coping and treatment as accessible, is helpful,” said Ackerman.

Uhls concurs. “Accurate information with compelling storytelling works well,” she said. But how, specifically, can writers and producers of fictional films and TV shows aimed at YA audiences better protect against the Werther effect and foster the Papageno effect?

Enlarge / The show’s third season focused on the murder of Bryce.
Netflix

Gorman and her writers certainly aimed to produce a series that would be beneficial to viewers. Netflix added advisory warnings for rape and suicide before the ninth, twelfth, and thirteenth S1 episodes, and the company also produced a 29-minute documentary, Beyond the Reasons. The documentary featured commentary by the cast and crew alongside interviews with the mental health consultants for the show, although Gorman admitted that, due to the peculiarities of the Netflix algorithms, many viewers weren’t finding the documentary. (The second and third seasons also had accompanying documentaries.)

The SCCAP recommended post-episode cards informing viewers where to seek help and get answers to their questions, a practice followed by many TV shows. However, Gorman said that at the time, Netflix didn’t have the capability to do that, since the series premiered simultaneously in some 200 countries, only 60 of which even had hotline numbers.

In 2019, the National Action Alliance for Suicide Prevention issued its own recommendations for the depiction of suicide in fictional stories. First and foremost is to avoid showing or describing graphic details about the method of suicide. Other recommendations include conveying the many different factors that can lead to suicide, showing that help is available, connecting viewers with resources such as national hotlines, portraying characters who contemplate suicide but then opt not to do so, depicting the grieving process of friends and loved ones, consulting with experts in suicide prevention, and portraying characters who serve as a lifeline to someone in the midst of a suicidal crisis.

According to Uhls, all of this still isn’t sufficient, given how teens typically watch their favorite shows these days. “Young people watching a show will have their laptop or phone or tablet in hand,” she said. Her team is now exploring how such so-called second-screen content might amplify positive impacts of a narrative, encouraging more conversations and information-seeking about difficult topics.

Perhaps there could be a QR code viewers could scan during the end credits, so teens wouldn’t even need to type in a URL to access informational resources. Uhls also imagines something akin to Amazon’s X-ray vision, which reveals additional information right as a scene is playing (cast members, trivia, and so forth). Fostering memes or incorporating Easter eggs might be another way of boosting viewer engagement with those resources.

Ackerman, for his part, doesn’t see the tension surrounding controversial shows like 13 Reasons Why dissipating any time soon. “We absolutely need to share authentic stories of suicide, suicide loss, healing, and growth in the media,” he said. “But some of the traditional methods of engaging viewers are known to be harmful. We ask that, as in the medical profession, creatives seek first to ‘do no harm,’ or at a minimum make very clear the risks that their content poses. In a show geared towards youth that covers suicide, it is critical that those potential risks be shared with youth and parents to be able to make an informed choice to view or not.”

If you or someone you know is feeling suicidal or in distress, please call the Suicide Prevention Lifeline number, 1-800-273-TALK (8255), which will put you in touch with a local crisis center.