The popular Netflix series, “13 Reasons Why” raises serious issues such as rape, suicide and bullying, but many are warning about the dangers of how the show uses entertainment as a platform to explore suicide. If you’ve not seen the show, the main character, 16 year old Hannah experiences bullying by her peers, becomes a witness to and a victim of trauma, then ultimately ends her life. Mental health professionals are speaking up about what some consider dangerous implications. Some psychologists voice concerns that this show either glorifies suicide or appears as a solution to problems. Another message from the show some are concerned about is that suicide appears to be a strategy to punish people for hurting you. You can read more about these issues here or here.
I had another issue when I watched the show which regards the producers’ decision to create the School Counselor’s character as an unreliable adult figure who was likely the most important person that could have saved Hannah. He made several ethical mistakes, especially on Hannah’s fatal last day. These mistakes were so obviously wrong and would never happen in reality. Counselors in real life spend years in training, practice thousands of hours under supervision, and must pass national exams in order to even become licensed to practice Counseling. They must also follow a code of ethics and laws to protect clients and patients.
The attempt at “counseling” in this show would never happen in real life. By depicting a character who was so off demonstrates that in Hannah’s case, even a therapist- someone professionally trained and committed to helping, supporting and guiding others safely – couldn’t be of any help. This is the last thing a show about suicide awareness should be demonstrating.
I did watch the discussion after the final episode between the producers and they explained their decision to have the therapist “miss” some key points. I’m glad they recognized these mistakes, and made a point to write the script this way. Sure, sometimes therapists miss. Sometimes we get it wrong or aren’t the right fit for every client. The thing is, no practicing therapist would miss Hannah’s obvious suicidal clues or dodge her suggestions of being raped.
To set the story straight, here’s what would have happened in real life:
1. When Hannah began saying things like nothing matters anymore and she’s stopped caring, the therapist would ask her what she meant by that and would ask if she’s had thoughts of hurting or killing herself or someone else.
2. Assessing what types of suicidal thoughts, how recently/often, if she has a suicide plan, and if she’d had any previous attempts would come next. Even if she was unclear with her answers, being vague can still give big clues about level of risk. There’s also a good chance that if someone is there to listen and not judge, she’d be willing to honestly share and start opening up more about how she was doing.
3. The therapist would discuss a safety plan and since Hannah is a minor, the therapist would be required to break confidentiality and let her parent/legal guardian know. He would talk about this with Hannah and why this is important (safety), even if it breaks some of her trust. In this case, keeping Hannah alive is more important and it’s legally required so there’s no getting around it. When there’s a suicide plan, confidentiality is always broken and safety measures start taken place.
4. Since Hannah was suicidal, had a plan and was going to attempt that day, the therapist would keep Hannah in the office until a parent came in who would need to agree to immediately take her to a hospital; or would call police to escort her to the hospital if a parent couldn’t or if Hannah was at risk of fleeing (other safety measures can be discussed if suicide risk is lower, such as a referral to a psychiatrist. In this case she was high risk so hospitalization would be necessary).
5. Hannah mentioned she didn’t consent to sex and she was confused about what happened, suggesting she was possibly raped. Even if she wasn’t sure, it would have been taken extremely seriously. She’d need to consider pressing charges, seeing a doctor and seeing a trauma specialist to work through the emotional pain she experienced. It can sometimes depend on age in certain states but it’s likely the therapist would also need to break confidentiality with Hannah in this case as well. It could be that he notifies her parents, or he can call the police to report the incident.
After that, Hannah would be escorted to a hospital and would go through an intake assessment to be considered for in-patient treatment. Again, her high level of suicide risk would be reason to admit her to the hospital where she would get intensive care. Once she stabilized (this can usually last about a week but depends on how the patient responds to treatment), she’d move to a less intensive treatment, then transition to ongoing, regular outpatient care with a psychiatrist, family therapist and individual therapist. She would need consistent treatment considering the traumas and her high risk of suicide.
The takeaway is that there are people who care, can help and will always step in, especially trained professionals and therapists. Counselors take their job seriously. Safety is a top priority and they’re always there to listen. If we’re going to reduce the stigma of mental health, it’s time to show how useful and effective professional care can be, not the opposite.