Many fans of the Netflix series “13 Reasons Why” are eager for the coming launch of the show’s second season. I’m waiting for it too, but for a different reason: I want to see if the show can move beyond the trappings of its flawed name. I want to see if the series’ creators and writers can tap the show’s potential to reveal the biggest factor in people taking their own lives and the real ways to save them.
What’s wrong with the show’s name? “Reason,” as defined by dictionaries, is an “explanation,” “justification” or “rational motive.” In using the phrase “Reasons Why,” the title of the show (and the book it is based on) suggests that suicide is a rational choice. This is the opposite of what we know: People who die by suicide aren’t thinking rationally.
In fact, science tells us that the biggest factor leading to suicide is depression, a treatable medical illness that often runs in families. Sadly, our society does not think of depression or mental illness as we do cancer or other illnesses. Would we ever hear the word “choice” used when it comes to cancer?
As a suicide prevention advocate and the creator of a questionnaire used worldwide to identify people at risk for suicide, I talk to communities across the globe and have seen this dangerous misunderstanding prevent people from getting the help they need. Here’s a fact the first season of “13 Reasons Why” never addressed directly: An estimated 90 percent of people who die by suicide are dealing with depression or another diagnosable mental disorder. These are accurately described as illnesses, treatable with medication and/or therapy.
Research shows that the use of modern antidepressants has dramatically lowered the suicide rate in dozens of countries across all age groups, reversing a trend prior to their introduction. Suicides are most often associated with no treatment or noncompliance, highlighting that not treating mental illness is what kills people. While the vast majority of people with mental disorders do not take their own lives, any serious discussion of suicide prevention must acknowledge the outsized impact when these conditions are left undiagnosed, untreated or undertreated.
Yet in its first season, “13 Reasons Why” focused almost solely on external factors as the causes of Hannah’s tragic and unnecessary death, such as rape, bullying, and other horrific or neglectful acts. Beyond a handful of passing references, the show did not shed any light on any underlying mental health condition that she may have experienced.
If “13 Reasons Why” really is going to make a difference in saving lives, it needs to confront this mental health issue head-on in its second season. It also should cover more ground in how to identify people who are at risk and how to help them. Consider, for example, how the first season ends, with Clay reaching out to Skye, another troubled teen. In the real world, what should happen next?
Clay should ask Skye some direct questions, like those used in the Columbia-Suicide Severity Rating Scale that I helped develop through exhaustive research into the best questions to ask for identifying risk. Has she had any thoughts about killing herself? If so, has she thought about how she might do this? Has she ever done anything, started to do anything or prepared to do anything to end her life?
If Skye answers “yes” to any of these questions, Clay should seek help from family members and friends as soon as possible. If she’s thought about a plan or started to make any preparations, he should immediately tell a family member or trusted adult to make sure she isn’t left alone and gets immediate attention.
These adults, family members and friends should encourage and guide Skye to get the counseling, therapy and treatment she needs to cope with the mental illness that is the underlying cause of her suicidal thoughts or behaviors. The show, in its first-season conclusion, suggests that Clay’s kindness alone — and by implication, the kindness of others — is enough. But in the real world, that’s not going to work.
Also, in the real world, Hannah’s school and school district should be taking her suicide as a wake-up call. Almost 16 percent of high school students in the U.S. have seriously considered suicide, and 8 percent attempt it each year, according to the Centers for Disease Control and Prevention. CDC figures also show that suicide is the second-leading cause of death among U.S. youths and young adults ages 10–24. Around the world, suicide is the No. 1 cause of death of adolescent girls, according to the World Health Organization.
The good news is that research and real-world experience show that people who are thinking about suicide need to be asked and want to be saved. (The research also shows, definitively, that asking the questions doesn’t put the idea of suicide into anyone’s head.)
That’s why many schools in the U.S. and other countries are starting to screen students for suicide risk. They’re also training nurses, teachers and students on how to ask the right questions — not just when someone is obviously troubled, but also as a matter of course, just as they check vision and hearing. That’s why every schoolteacher in Israel has the questions as part of a toolkit. That’s why school guidance counselors now are asking the questions routinely, unlike the counselor in Hannah’s school, and why many parents have begun asking their children the questions too.
In the real world, the stigma around mental illness and suicide needs to be eliminated. Openness and frank discussion are part of the solution. Everyone needs to know that suicidal thoughts are nothing to be ashamed of and that those thoughts are often the result of a medical illness called depression. They need to know there is hope and there is help for this treatable condition.
In that respect, a second season of “13 Reasons Why” could be valuable. There are some encouraging signs. A one-minute pre-show video featuring the show’s stars will encourage viewers to talk to someone or call a crisis line if they need help with issues such as suicidal thoughts, sexual assault, or substance abuse. Netflix also is beefing up its list of suicide prevention resources on a show-affiliated website, 13reasonswhy.info.
The true test, however, will come from the second season’s content. Will the show’s developers make people aware of the biggest contributing factor to suicide? Will they present real ways to address this crisis and save countless lives?
If so, they will give the show’s existence a critical “reason why.”
Kelly Posner Gerstenhaber is director of The Columbia Lighthouse Project, which works with systems, states, countries and communities to empower everyone to identify people who are suicidal and to help them get the support they need.