'13 Reasons Why' a failed attempt at reducing stigma surrounding mental illness

TV-13 Reasons Why
This image released by Netflix shows Katherine Langford in a scene from the series, “13 Reasons Why,” about a teenager who commits suicide.

Suicide is the third leading cause of death amongst youth ages 10-14, and the second leading cause of death among young adults ages 15-34 years. In 2013, 17 percent of students in grades 9-12 in the U.S. seriously considered attempting suicide. Additionally, researchers have found that suicide contagion is real; 24 percent of 22,000 respondents aged 12 to 17 who had considered or attempted suicide in the last year said they knew, or knew of, someone who had committed suicide.

There has been a lot of controversy over the last few months surrounding Netflix’s original show “13 Reasons Why.” Many have argued that it has increased suicide risk among adolescents, and in fact there is some recent evidence that it has. It has also brought to light a critical issue: mental illness recognition and treatment access for young adults.

Unfortunately, in the Netflix hit show, there is little mention of seeking professional help until the last episode, when the protagonist truns to her school counselor for help. The counselor’s unsuccessful, if not blatantly neglectful, attempt draws the protagonist even deeper into despair. While this counselor is certainly not representative of the vast number of mental health professionals, this harmful misrepresentation of counseling and the minimization of the importance of seeking help perpetuates the already deep-seated stigma associated with mental health treatment.

Rates of mental illness among young adults are staggering and on the rise. Between 2005 and 2014 rates of major depression alone jumped 37 percent in the U.S. Yet mental health treatment for young adults is severely lacking. One study found that of 1,000 youths diagnosed with depression, 36 percent received no treatment at all within three months after their initial diagnosis.

The sad reality is that there is limited access to mental health professionals, many of whom are not covered by insurance, or minimally covered. This problem will only continue to worsen if the Republican health reform agenda passes, allowing states and insurers to offer plans that do not cover all ten essential health benefits, including mental health treatment.

A systematic review highlighted many reasons why young people do not seek mental health treatment, among them were stigma and embarrassment, problems recognizing symptoms, and a preference for self-reliance.

In a survey of eighth grade students, 59.1 percent said that a major barrier to seeking mental health treatment was their embarrassment about what other kids would say.

Reducing the stigma surrounding mental health treatment is crucial. In recent years, many celebrities have come forward about their mental illnesses and have even shared anecdotes about their treatment. Kristen Bell, for example, recently shared how her therapist has helped with her depression. The more we are able to freely talk about struggling with mental illness, the more mental illness can be normalized.

“13 Reasons Why” was a failed attempt at addressing this issue. Had the show discussed seeking mental health treatment it could have been a platform for change. Instead, it depicted suicide as a result of other people’s actions, as an act of revenge, and as the only way out for someone so clearly suffering. It missed an incredible opportunity to show teenagers how to effectively deal with their depression, rather than sensationalizing a serious illness. We need to model for young people the reasons not to commit suicide, not the reasons why. In the end, the show has undermined the slow but steady progress that has been made to increase young adults’ utilization of mental health services.

Andrea Segal is research coordinator at the Scattergood Program for Applied Ethics of Behavioral Health Care and an MPH candidate at the University of Pennsylvania Perelman School of Medicine.