Most trigger warnings are inadequate TV and film need to do better

Warning: Mention of mental health conditions, alcoholism, self-harm and suicide.

As someone who used to self-harm, seeing Hannah submerge herself in the bath and pick up a razor during a graphic suicide scene in 13 Reasons Why left me feeling 'triggered'.

Aged 16, hearing all my mates argue and compete over who could be most like Effy from Skins – a 'cool', but undoubtedly mentally unstable and reckless teenager – while having depression and anxiety myself, also left me conflicted.

The Queen's Gambit, while an outstanding series with very talented actors, conveyed depression and alcoholism to be much more stylish, beautiful and glamorous than it is – a depiction that, once more, left me feeling confused.

So, why are there still so many problematic depictions of mental health on our screen, particularly when they could provoke uncomfortable feelings or stir unwelcome memories in those watching?

Portrayals of mental health on television and in films are still far from ideal, and the lengths that such entertainment companies go to properly safeguard their audiences remains widely considered as still fairly poor.

Mental health is a diverse and complex topic of discussion and subsequently, portrayals of mental health on-screen, in popular television and film, can be extremely difficult to navigate.

Portrayals can be risky due to the complexity of conveying such nuanced and sensitive states of mind and the precariousness of predicting the effect such portrayals could have on the audience's own mental wellbeing.

With some arguing that film and television have no responsibility to portray mental health correctly, or that the impact on a viewer's mental health is 'not the concern of the entertainment industry', according to The Journal of Health Communication, there is a need for both the film industry and metal health sector to collaborate to 'counter negative portrayals of mental illness'.

Severe mental health problems can result in violent or self-harming thoughts and even suicide, and to replicate this on-screen can be highly triggering to a viewer, maybe even resulting in these extremes taking place in real life.

Film and television rely on provoking a reaction in an audience. Previously, the industry has set out to provoke visceral reactions to gain a more extreme reception and hence higher exposure, which accounts to more views and revenue.

In focusing on provoking this extreme reaction, some film and television have neglected their responsibility to safeguard the mental health of the audience and to portray mental health accurately, in favour of shocking the audience.

Examples include films such as Todd Phillip's Joker (2019), which left mental health practitioners conflicted by its approach to portraying mental health, some accusing it of perpetuating the idea of 'us and them', which corresponds to the image of the 'mad, bad, and dangerous' mental patient which Simon Cross speaks of in his article, Visualizing Madness: Mental Illness and Public Representation.

Simon Gunning, CEO of the Campaign Against Living Miserably (CALM), which aims to take a stand against suicide, said he was personally 'appalled' by 13 Reasons Why.

"You have to be careful because it is real people's lives and you have to take the word of psychiatrists and doctors and follow their guidance and so 13 Reasons Why was irresponsible," he told UNILAD.

13 Reasons Why went against Ofcom regulations and Samaritan's media guidelines for being 'too graphic', according to The Guardian.

While the scene in question was later removed, it was discovered by the Journal of American Academy of Child and Adolescent Psychiatry that 'after accounting for seasonal effects and an underlying increasing trend in monthly suicide rates, the overall suicide rate among 10-17-year-olds increased significantly in the month immediately following the release of 13 Reasons Why'.

Jamie, a young actor, expressed he 'isn't sure that [he] has ever seen any film or television programme portraying mental health in a positive way'.

In conversation about 13 Reasons Why, he told UNILAD: "13 Reasons Why is a massive one where they really fantasise and eroticise suicide, when someone kills themselves it becomes an epic journey.

"In some ways it does good, but it all comes under the umbrella of suicide as an adventure so I'm not sure how much respect or credence I can give to the show."

Jamie warned against shows being made solely for 'monetary gain' and described how 13 Reasons Why appeared to be fuelled by such reasons on the basis that season two went straight into the topic of a school shooting.

"It's like they've said let's just get some trauma, and let's just make money out of it," he said.

Television and film have such power to support and even contribute to suicide prevention ‘as was proved by the Vienna experiment where changes in media reporting resulted in a >80 percent reduction in the number of subway-suicides and suicide attempts', according to the Industrial Psychiatry Journal.

The Papageno effect states that a way out of suicide, a chance at a better life and showing people who care and love the individual, should be portrayed. However, 13 Reasons Why depicted Hannah as having no other option and saw the character leave a trail of notes blaming individuals for their role in her mental health decline.

This glamorization of Hannah’s death making her a local celebrity correlates to how ‘the glorification of suicide victims as martyrs may encourage vulnerable persons to imitate the behaviour to win public adulation’, The Industrial Psychiatry Journal reports.

In response to being asked whether television and film has the power to trigger a viewer, both Gunning and Jamie agreed that it '100 percent' does.

"It happens a lot, and it happens to me," Jamie said. "100 percent, absolutely, totally," Gunning echoed.

However, in discussion as to whether there need to be tighter rules, Gunning spoke of the dangers of such regulations being implemented in case they shut down such important conversations.

He explained how 'all things added up... Our responsibility is to do more good than harm', but stressed this depends on coming with the 'intention of doing no harm'.

Instead, Gunning believes that companies 'absolutely don't need to get stuff wrong' in the first place. "It's not that hard, taking advice and advice from the right places is the way to do it," he commented.

Not only do negative, inaccurate, or unfair portrayals of mental health in the media impact on education surrounding mental illnesses, but ‘evidence also exists that such inappropriate representations do much to increase stigma, ostracism, harassment and victimisation of individuals with mental health problems by the public’, The Journal of Psychiatric and Mental Health Nursing reports.

So, what more could be done to protect the mental health of audience members?

Well, in 2021, I spoke to more than 10 professionals in the film, television and mental health industry who all agreed not enough is being done to properly safeguard audiences.

Through these conversations suggestions arose of how to improve the safeguarding of mental health within film and TV.

While audience members do have a responsibility for their own mental wellbeing, there must be good intentions and significant time and effort put in by production companies too.

It was clarified through conversations I had with these professionals – from actors to scriptwriters, casting directors to mental health experts – that one-size-fits-all rules and regulations may not work as they could restrict the openness in conversation. However, it was agreed that there should be higher expectations and better requirements put in place to adequately safeguard audience members to the best of the production’s ability.

One suggestion was that mental health care and support should be made compulsory for all members of the production company.

Furthermore, it should be a legal requirement for any film or television production portraying mental health to seek advice from a mental health charity, professional or organisation, and to actually have to incorporate the guidance.

More mental health awareness would not only benefit the mental health of all individuals involved in the creative process, but also create a more open conversation with more varied inputs as to how certain portrayals on-screen should be dealt with.

Examples of support included: A psychiatrist on-site; helpline numbers given out; mental health organisations present throughout the process; and mental health check-ins and check-outs (noted by Jamie as being significant in a previous production for making him feel adequately supported).

It was also resolved there should be a clearer system or set of criteria to establish whether a trigger warning is necessary for a programme or film.

Moreover, an additional information button or section should be provided in episodes or films with any significant mental health portrayal featured that viewers could click to gain access to more in-depth information about the mental health portrayals or potential triggers. Possibly even at what exact time those occur alongside a link to specific mental health support.

This would mean those who know they're more vulnerable with their mental health have the option to be more informed and can decide – with all the facts – whether or not to watch. A button would also not spoil anything for other viewers who do not feel the need for further insight and warning.

Although television and film often have a primary purpose ‘to entertain’, it's clear many believe that a better balance needs to be struck when it comes to safeguarding viewers.

Television and film portrayals of mental health do not have to be negative or harmful for a viewer, and, when done properly, have the power to be extremely beneficial in aiding de-stigmatisation, providing insight, education, support and prompting open conversation.

"I occasionally have a moment of fear... Well, our mission in order to be an effective suicide prevention organisation, is having to normalise conversation about the subject. If you don't talk about it, you ghettoise it and make it a dirty secret and an option," Gunning said.

However, Gunning resolved that 'you can be driven by money and still be good'.

"You don't have to compromise on integrity to make money [...] or in order to get people to like what you're doing, whether selling something or making TV."

If you're experiencing distressing thoughts and feelings, the Campaign Against Living Miserably (CALM) is there to support you. They're open from 5pm–midnight, 365 days a year. Their national number is 0800 58 58 58 and they also have a webchat service if you're not comfortable talking on the phone