With the third season of the popular Netflix series "13 Reasons Why" now in production, mental health professionals want parents to be prepared for how the show — which includes subject matter such as sexual assault, school violence, substance abuse, bullying and suicide — might affect their children.
"'13 Reasons Why' had a pretty significant impact on young people," Dr. Brian P. Kurtz, a child and adolescent psychiatrist at Cincinnati Children's Hospital Medical Center, told TODAY Parents. "For those of us who see many young people in crisis — coming to the emergency department with suicidal ideation, for example — the fact that the show was on the mind of these patients and their families really jumped out at us. And this was across the country."
Kurtz noted last May that in a survey of 14 pediatric emergency services published by the Journal of the American Medical Association, 13 saw a jump in patient volume compared with the same month the previous year after "13 Reasons Why" debuted, and 40 percent reported seeing patients with suicidal behavior that imitated the show. Another study showed 900,000 to 1.5 million more suicide-related Google searches than expected in the 19 days after the show's release, including a 26 percent increase in queries on “how to commit suicide.”
Kurtz and Sansea L. Jacobson, M.D., an assistant professor of psychiatry at the University of Pittsburgh, were two of an international coalition of mental health experts who helped develop an online toolkit of resources for parents specifically regarding the themes and subject matter of "13 Reasons Why."
"We know from research that teens more likely than not will choose to watch shows like '13 Reasons Why' alone," Jacobson said. "This is problematic, especially in a series which depicts adults as incapable of really listening to or understanding teen issues.
"Our coalition felt that a toolkit for parents could help counteract this effect," she said. "We figured that by providing pertinent information and resources, we would empower parents to know what questions to ask and to feel more confident to listen attentively and non-judgmentally. These opens lines of communication send the message loud and clear that there are trusted adults who do care, are interested, and can be helpful!"
Jacobson cited a recent survey by Northwestern University that showed that one-third of teen and young adult viewers who watched the first season of "13 Reasons Why" felt it was "too graphic" for them. "Younger viewers and those with higher social anxiety appear to be especially sensitive to graphic content," she said.
For that reason, Jacobson advised parents to consider watching the show with their children if possible, and warned that at-risk youth, such as those struggling with depression or trauma-related disorders, should not watch the series at all.
"If a teen is planning to watch the show, we strongly recommend they do so with a parent or a trusted adult," Jacobson said. "Not only does this provide an opportunity to discuss and reflect on content from one episode to the next, but it also provides an opportunity for the parent to check-in and evaluate whether any of the themes might be too overwhelming for that child."
The American Foundation for Suicide Prevention (AFSP) partnered with Netflix to create their own resources for parents regarding the show, including a discussion guide and tips on how to talk to their kids about the series and suicide.
Dr. Christine Moutier, Chief Medical Officer for the AFSP, said parents should look beyond the surface for less obvious signs of distress in their teens as they process the show's content. "Be a learner and an observer of your child's behavior patterns," she told TODAY Parents, "and if you see a shift in any direction, that's a time to pay extra attention and to engage them in dialogue."
Some signs a teen is struggling might include withdrawing from the family or at school and from friends. Moutier said changes could also be biological, such as a loss of appetite, a change in sleep patterns, fatigue and moodiness.
Though moodiness can be normal for teenagers, Moutier said, "knowing your kid and what their mood patterns normally look like might help you know if there is any indication they might be having feelings of hopelessness or worthlessness, or if they are feeling trapped or overwhelmed."
Moutier stressed that any or all of these signs could simply be indications that children are going through life challenges and are not necessarily indications of suicidal thoughts or behavior. She encouraged parents trying to create a supportive and non-judgmental relationship with their teens to ask questions about their lives and friendships without trying to "fix" them.
"Center yourself," she said. "Don't react, don't judge, keep it open-ended. Watch your tone of voice," she advised. "Even simple questions like, 'Tell me more about that. What was that like for you?' can help them begin to show you a little bit of their world."
One subject of the second season that particularly worries psychiatrists: school shootings.
"While school shootings can and do happen, it's important to remind youth that they are extremely rare and schools are safe places," Jacobson said. "We can hope that the writers of the show will surprise us this season with interweaved narratives of hope, healing, and promotion of mental health-seeking behavior."