Intended for healthcare professionals

Rapid response to:


Suicide on TV: minimising the risk to vulnerable viewers

BMJ 2017; 358 doi: (Published 22 August 2017) Cite this as: BMJ 2017;358:j3876

Rapid Response:

Re: Suicide on TV: minimising the risk to vulnerable viewers

Congratulations to the authors for their thoughtful and important editorial on the timely phenomenon of suicide and media portrayals of mental illness.

Criticisms of media portrayals such as 13 Reasons Why? focus on limited knowledge about mental illness, and poor insight, judgment, and moral decisions by creators. A logical solution, as the authors suggest, is to create policy, and better educate, monitor, and regulate media and creators to do the right thing, for better desired behaviors and outcomes when portraying suicide. But the entertainment industry and the media are driven by different motivations and incentives and owe little to public health. Furthermore, creators may genuinely believe they are doing more good than harm by portraying suicide to stimulate conversations and reduce avoidance and stigma of the topic, secondary to producing a smash hit entertainment series.

We believe the thinking and approach to the issue can be enhanced by reframing this as a human centered design challenge, in addition to a policy, monitoring regulatory problem. When conceptualized through the lens of human centered design, the media and audiences are given consideration as cultural and contextual variables or features that can be taken in to account and designed for or designed around for a desired outcome, rather than regulated. This may be even more useful in a rapidly changing social media landscape where patients, providers, and public are coming together in the same space. We have described human centered design as an overarching methodology and conceptual model for the design of anti-stigma interventions.

One of us (TU) applied this approach to the problem of suicide and media portrayals and produced a Reality TV style web-series Think You Can Shrink? The design strategically and purposely leveraged the popularity of entertainment and power of media to encourage viewers to seek help for mental health problems, or encourage others to do so, in hopes of improved health outcomes for men. Actors portray an episode of suicidal depression, and other mental health problems. Everyday people who think they are good at giving advice (bartenders, hairdressers etc.) are the contestants. Through modeling viewers learn about depression, suicidal ideation, and how to communicate with a person to encourage them to get help. We designed for the protective and beneficial effects of narratives and media, highlighting depression as an illness, and encouraging empathy, and help seeking. This is in contrast to shows like 13 Reasons Why? that seem to portray suicide as a dramatized and perhaps romanticized solution to social environmental causal factors.

Our proof of concept study demonstrated that the “edutainment” design works, with viewers finding the show entertaining, and more likely to seek help, or know what to say to someone who is suicidal after watching an episode.

In addition to policy efforts to regulate responsible portrayals, health promotion efforts may meet greater success using media as a powerful vehicle and tool to reduce and prevent suicide.

Thomas Ungar MD, MEd
Associate Professor, University of Toronto
Psychiatrist-in-Chief St. Michael’s Hospital Toronto, ON Canada

Stephanie Knaak, Ph.D
Mental Health Commission of Canada / Commission de la santé mentale du Canada
Ottawa, ON Canada

Cameron D. Norman Ph.D
Cense Research + Design, Toronto, Canada
Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

Competing interests: TU received a peer reviewed innovation grant funding from Movember Foundation Canada to produce Think You Can Shrink? and is the creator and owner of the intellectual property.

24 August 2017
Thomas E. Ungar
Psychiatrist, MD
Stephanie Knaak Phd, Cameron D Norman Phd
St.Michael's Hospital, University of Toronto