By Dr. Elena Mikalsen
Chief of Pediatric Psychology
The Children’s Hospital of San Antonio
Mental health professionals have become increasingly concerned about the new hit Netflix show and its portrayal of the suicide of the main character, Hannah. While I am glad that the show can start conversations about bullying, sexual assaults in high schools, and teen suicides, I am also very concerned about how the show incorrectly portrays some facts about teen mental health and suicide in general.
Hannah’s suicide is portrayed as being caused by the actions of other people (bullies, friends, school counselor, etc.). In reality, decades of research on teen suicide have shown that 90 percent of teen suicides are the result of mental illness. Teens first develop mental illness, such as depression, social anxiety, panic disorder, ADHD and then slowly, over time (one to two years), become unable to cope with stressors in their lives. When a teen with mental illness encounters bullying, divorce, family violence, academic stressors, and other stresses present in teen lives, he or she develops thoughts of suicide and begins to contemplate ending their life. This means family, school counselors, pediatricians, mental health professionals are able to intervene and help the teen if symptoms of mental illness are caught early on.
Hannah goes to her school counselor for help and, while he recognizes her thoughts of suicide, he tells her to forget about her sexual assault and tells her she should get over her distress about the sexual assault. This is not a realistic portrayal of what happens when a teen reaches out for help in this situation. It is illegal and unethical for a counselor to behave this way. Mental health help is absolutely available for teens who have experienced sexual assault and are contemplating thoughts of suicide. The show uses this scenario for dramatization purposes and it is not helpful for teens or parents to see this.
What I would really like for parents to know is that it is really important to watch out for any signs that your teen may be struggling with mental health difficulties. Some of these signs are:
- Any change in personality, behavior, appearance
- Withdrawing from family activities the child previously enjoyed
- Not wanting to spend time with close friends
- Not wanting to go to school
- Dropping grades
- Sleeping all the time or being in his/her room all the time alone
- Social media postings about wanting life to be over (or everything to be over)
- Statements about the future being hopeless or not wanting to talk about future
- Preoccupation with death or giving away possessions
- Statements about not wanting to have pain or wanting to fall asleep and never wake up
If you notice any of these signs, please talk to your teen and take your teen to a pediatrician for a depression and mental health screening. If you are concerned about your teen, please insist on a referral to a mental health professional. Your teen may want to hide their symptoms from you to make sure you don’t worry. However, a pediatrician or a mental health professional has techniques to get them to open up. Suicidal thoughts are preventable if caught early on.
I strongly recommend that children under the age of 17 only watch the show with their parents present. The show should not be binge-watched, but watched one episode at a time due to highly emotional dramatic content. If your teen has watched it already without you, have a discussion about what they think of the show, of the main character, and what the main point of the show was in their opinion. It’s very important to discuss with your teen that Hannah’s story is fictional. In real life, teens do not get to make everyone feel sorry about their suicide and do not get memorials on their lockers.
The show depicts a violent death, as well as a violent sexual assault. Children are very likely to be strongly influenced by vivid depictions of suicide in the media. In fact, from numerous studies, we know that reading descriptions or watching depictions of suicide in the media increases the likelihood of “copycat” suicides. If your teen struggles with mental health, please mention this to your pediatrician or the teen’s mental health provider that she has watched the show, so your teen can be screened for suicidal thoughts.
If your teen has been struggling with mental health difficulties, please seek help from your pediatrician or a school counselor. If your teen is struggling with thoughts of suicide today, please call 9-1-1 or proceed to your nearest emergency room.
You can also call the National Suicide Prevention Hotline at 1.800.273.TALK or text START to 741741 for immediate help.
About Dr. Elena Mikalsen
Dr. Elena Mikalsen is the Chief of Pediatric Psychology at The Children’s Hospital of San Antonio and has been providing psychological services to children, adolescents, and families for more than 10 years. She specializes in anxiety disorders, teen stress, chronic medical illness, and prevention of mental health difficulties. Her advice on how to help teens cope with stress has recently appeared in Teen Vogue.