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National Strategy for Suicide Prevention:
Goals and Objectives for Action

GOAL 9:
Improve Reporting and Portrayals of Suicidal Behavior,
Mental Illness, and Substance Abuse in the Entertainment
and News Media

The media–movies, television, radio, newspapers and magazines–have a powerful impact on perceptions of reality and on behavior. The American Academy of Pediatrics has estimated that American children and adolescents spend 22-28 hours per week viewing television, more than any other activity except sleeping (APA, 1990). The Internet, while not historically considered to be a part of the media, has become quite important in terms of provision of information, and many persons–including youth–spend many hours weekly viewing Web-based presentations on a variety of subjects; however, there is no knowledge currently available that addresses whether the depiction of suicide through the Internet affects those at risk differently than through other media.

Research over many years has found that media representations of suicide may increase suicide rates, especially among youth (Schmidtke & Schaller, 2000; Velting & Gould, 1997). "Cluster suicides" and "suicide contagion" have been documented (CDC, 1988; Gould et al., 1990) and studies have shown that both news reports and fictional accounts of suicide in movies and television can lead to increases in suicide (Davidson & Gould, 1989). It appears that imitation plays a role in certain individuals engaging in suicidal behavior. In particular, suicides increase primarily in the geographic area where a front-page suicide story was published with the effect proportionate to the amount of publicity the suicide receives (Phillips, 1985; Schmidtke & Schaller, 1998). Highly publicized suicides of entertainment celebrities appear to produce imitation suicides most powerfully (Wasserman, 1984).

It is widely acknowledged that the media can play a positive role in suicide prevention, even as they report on suicide or depict suicide and related issues in movies and on television (Gould, 2001). The way suicide is presented is particularly important. Changing media representation of suicidal behaviors is one of several strategies needed to reduce the suicide rate.

Media portrayals of mental illness and substance abuse may also indirectly affect the suicide rate (Hawton et al., 1999). Negative views of these problems or inaccurate depiction of treatment may lead individuals to deny they have a problem or be reluctant to seek treatment, and untreated mental illness and substance abuse are strongly correlated with suicide.

There have been several attempts over the last two decades to address the portrayal of suicide in the media. For example, the National Institute of Mental Health and the Association for Media Psychology held a workshop on violence prevention in 1984 in which action steps were developed to address identified problems, but lack of funding precluded follow-through (Berman, 1989). The Health Resources and Services Administration supported a workshop in 1989, convened by the Association of State and Territorial Health Officials and the New Jersey Department of Health, that focused specifically on suicide contagion. This workshop produced a set of recommendations for health professionals in dealing with the media and outlined aspects of news coverage that can promote suicide contagion (O'Carroll & Potter, 1994). These recommendations were published and disseminated. Anecdotal reports suggest that the recommendations have proved to be workable in some communities (Jobes et al., 1996). However, there is no evidence that they have been widely adopted or that they have had a measurable effect on the depiction of suicide or suicidal behaviors. Other organizations have published guidelines on media coverage, including the National Institute of Mental Health, the American Association of Suicidology, the American Psychological Association, and the American Psychiatric Association. The Entertainment Industries Council, founded in 1983 by leaders in the entertainment industry to provide information, awareness and understanding of major public health and social issues among the entertainment industry and to audiences at large, published and disseminated depiction suggestions on mental illness in collaboration with the Carter Center in 1993, updated in 2001 (http://eiconline.org/creative/spotlighton/mentill/depict1.html). Such recommendations and guidelines have been promoted and made available to the media and the public, but again there is no clear evidence that they have changed the portrayal of suicide or suicidal behavior.

The objectives established for this goal are designed to foster consideration among media leaders of the impact of different styles of describing or otherwise depicting suicide and suicidal behavior, to eliminate inflammatory coverage, and to encourage the presentation of content in the media that can help prevent rather than increase suicide. Thus, these objectives incorporate elements of awareness, as well as intervention.

In light of First Amendment issues, there is generally a resistance on the part of the media to "guidelines" or other external attempts to influence artistic expression in entertainment. However, once individuals in the media have a clear understanding of the implications of the ways in which suicide and other issues, including accurate depiction of mental illness and of treatment, are depicted, many see value in modifying their approaches (Knickmeyer, 1996). This understanding is best achieved through collaborative action between the public health sector and media representatives. Such public/private partnerships have been developed to address other issues, such as interpersonal violence prevention. Monitoring the effects of changes, providing feedback on these effects, conducting research, and ensuring constant communication between media representatives and public health leaders can help sustain progress. An association of media leaders, together with public health professionals, with an organizational mission of responsibly addressing the depiction of suicide, mental illness and substance use disorders could be a key to solidifying an ethic within the television and movie industries that would improve public health without unduly restraining artistic expression.

Currently, no consensus recommendations have been formulated for entertainment media that specifically address the depiction of suicide and suicidal behaviors. As noted earlier, depiction recommendations do exist for mental illness and substance use disorders (see http://www.eiconline.org). Once such recommendations are developed, it will be important to work towards their implementation, especially because depictions of suicide are common in the entertainment media. For example, a study conducted in the late 1980s found that by the time adolescents were high school seniors, they had witnessed approximately 800 suicides on television, not all of them realistically portrayed (Radeck, undated). Widespread adherence to depiction recommendations should promote a better public understanding of suicidal behavior and mental illness. Since news reporters are also a part of that public, it is likely they too will have their attitudes changed, which could affect their reporting of suicide.

Public health officials believe that it is not so much the reporting of suicide that may lead to "copy-cat" suicides as it is the manner in which suicide is reported. To minimize the likelihood of suicide contagion, news reports can incorporate recommendations developed at the 1989 New Jersey workshop discussed above. Participants agreed that reporting should be concise and factual. Other suggestions include minimizing repetitive, ongoing or excessive reporting of suicide; limiting morbid details and sensationalism; and avoiding "how-to" descriptions of suicide (O'Carroll & Potter, 1994). Information that can help to reduce suicide can also be inserted in news stories, such as reporting about the complex nature of suicide, listing help resources, explaining how to identify high-risk individuals, and describing available treatment for depression (O'Carroll, 1996).

One way to foster responsible depiction of suicide and mental illness– that is, depictions that do not encourage suicide or stigmatize mental illness–is to encourage discussions of the implications of how news is presented among journalism students. Little is now known about the way suicide, suicidal behaviors, or mental illness and substance use disorders is addressed, if at all, in schools of journalism across the country. It is important to integrate such discussions fully into all journalism schools

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