13 Reasons Why: Warning Label

The new Netflix series 13 Reasons Why is generating alarm among many mental health professionals and suicide prevention experts, who are concerned about the risks of glamorizing suicide and the possibility of contagion.

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Netflix kicked up a controversy with the series released on March 31 about a high school junior named Hannah who takes her own life. The series received a 91 percent critics approval rating and an 88 percent audience rating on Rotten Tomatoes. Critics praised the cast’s performances and the “authentic,” “sensitive,” and “hard hitting” portrayal of teenager angst.

However, 13 Reasons Why needs a warning label. The National Association of School Psychologists cautions that the series should not be viewed by vulnerable young people who experience any degree of suicidal ideation. NASP warns:

“Its powerful storytelling may lead impressionable viewers to romanticize the choices made by the characters and/or develop revenge fantasies. They may easily identify with the experiences portrayed and recognize both the intentional and unintentional effects on the central character. Unfortunately, adult characters in the show, including the second school counselor who inadequately addresses Hannah’s pleas for help, do not inspire a sense of trust or ability to help.”

NASP has problems with the accuracy of how mental illness and suicide are portrayed in the series. For example, it is concerned that the series does not emphasize that common among most suicide deaths is the presence of treatable mental illnesses. And that suicide is not the simple consequence of stressors or coping challenges, but rather, it is most typically a combined result of treatable mental illnesses and overwhelming or intolerable stressors.

Despite the strong misgivings, some see the widespread publicity around 13 Reason Why as an opportunity at least to spread greater awareness about suicide and suicide prevention. NASP says that the controversy is an “opportunity to better understand young people’s experiences, thoughts, and feelings,” educate parents, teachers, and students alike about suicide risk warning signs, and reinforce the message that suicide is not a solution to problems.

NASP advises that school psychologists and other school-employed mental health professionals can assist stakeholders such as school administrators, parents, and teachers to engage in supportive conversations with students as well as provide resources and offer expertise in preventing harmful behaviors. NASP published “Considerations for Educators,” guidance on 13 Reasons Why. Download it here.

Experts say if you’re thinking about the safest and best way to lead a discussion with teens about 13 Reasons Why and suicide, read the tip sheet co-authored by Suicide Awareness Voices of Education (SAVE) and the JED Foundation. Click here to download the tip sheet.

Some recommended reading from experts on the subject of suicide contagion:

Preventing Suicide With A “Contagion Of Strength” (National Public Radio February 25, 2015)

The Science Behind Suicide Contagion (New York Times, August 14, 2014)

Teen suicide: Prevention is Contagious, Too (Christian Science Monitor, December 8, 2013)

[If you or someone you know feels the need to speak with a mental health professional, you can contact the National Suicide Prevention Lifeline at 1-800-273-8255 or contact the Crisis Text Line by texting HOME to 741-741.]

Removing the Stigma for LGBTQ Teens

An important new study says that suicide attempts by American high school students decreased by 7 percent in states that passed laws to legalize same-sex marriage. The rate decreased by 14 percent among students identifying as lesbian, gay, or bisexual.

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“State same-sex marriage policies were associated with a reduction in the proportion of high school students reporting suicide attempts, providing empirical evidence for an association between same-sex marriage policies and mental health outcomes,” said the study, published by JAMA Pediatrics, a journal of the American Medical Association, on February 20. “We estimated that, each year, same-sex marriage policies would be associated with more than 134 000 fewer adolescents attempting suicide. These results reflect an important reduction in adolescent emotional distress and risk of mortality from suicide.”

The study concluded:

“We provide evidence that implementation of same-sex marriage policies reduced adolescent suicide attempts. As countries around the world consider enabling or restricting same-sex marriage, we provide evidence that implementing same-sex marriage policies was associated with improved population health. Policymakers should consider the mental health consequences of same-sex marriage policies.”

Study leader Julia Raifman of the Johns Hopkins Bloomberg School of Public Health speculated that the same-sex marriage laws diminished a social stigma by making LGBTQ people feel equal and supported by the wider social community.

Victor Schwartz, a chief medical officer of the JED Foundation, told the PBS NewsHour that the feelings of being accepted and connected to society have “a protective effect in relation to suicide risk, suicidal ideation, and suicidal behaviors. It’s a real risk factor, a feeling that you’re at odds with your family or community. It’s very painful, and can be very frightening. You feel like you’re going to be left out on your own.”

Suicide is the second leading cause of death among adolescents between the ages of 15 and 24 years. The prevalence of suicide attempts is four times greater among LGBTQ youth.

The Johns Hopkins study looked at 32 of the 35 states that legalized same-sex marriage between 2004 and 2015, comparing suicide rates in those states to suicide rates in states that did not legalize same-sex marriage. In 2015 the U.S. Supreme Court legalized same-sex marriage for all Americans.

Download a PDF of the study here.