Self-injury, Suicide, and Overdose

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The hardest stories to tell are those where mental health challenges are left unaddressed or not addressed properly, and lead down a dangerous pathway toward long-term health impacts, injury, or death.

The most concerning negative outcomes are self-injury, suicide and overdose, and when telling stories involving these outcomes, it’s important to be aware of contagion risk. See below for more information on contagion.

The use of the word “outcome” doesn’t necessarily equate to a life lost. The negative outcome means reaching a point where substances are misused, harm is inflicted, and suicide is considered. All of these negative outcomes, however, are treatable and preventable. There are many more people who have survived substance misuse, self-injury, and suicidal thoughts than those who haven’t. Telling these stories of survival can help illustrate and amplify the reasons people lived.

Understanding Contagion

Each of these three negative outcomes requires an additional level of sensitivity when represented in entertainment media, particularly with regard to audience members who may be at risk for these outcomes or considering actions related to them. For these individuals, contagion — or copying the self-injuring behaviors they witnessed, heard about, or watched in media content — is a key concern.

The areas where the mental health community has the most data-driven evidence of contagion are: 

  • Additional suicide attempts or deaths after news of a suicide is communicated to a community or campus.
  • An increase of suicide by a certain means or at a certain location after details of an initial suicide are communicated publicly through channels, like the press.
  • “Copycat” attempts or deaths after a high-profile artist or admired celebrity dies by suicide.

The causes and specific triggers of contagion are complex and not fully understood. Here are some key principles and factors discovered through research, experience, and expert consensus that can drive safe storytelling practices: 

  • Instruction: Details in entertainment storylines can inadvertently provide people who are struggling with ideas of how to obtain, use or hide substances, harm themselves or hide the physical signs of those injuries, or find and use means or methods of ending their own lives. 
  • Impulse: Seeing a character or cast member use drugs or harm themselves can trigger impulses to emulate those behaviors, especially for people who are in recovery and may be actively trying to suppress or not focus on those urges. Similarly, some people who have a history of dealing with mental health challenges might think about suicide as a way to escape their pain. Watching or hearing the specifics of how a character attempts suicide could, in some cases, contribute to an impulse to more seriously consider their own suicide narrative. 
  • Causation: Some storylines simplify causation to move a narrative forward, heighten the stakes, or create a mystery for the plot to unravel about why someone harmed themselves. For example, a storyline might position a character as attempting suicide to get revenge on someone, to escape an abusive relationship, or to protest injustices they haven’t been able to stop. These narratives can send the message that ending your life is a powerful way to make your pain felt by others and punish people who have hurt you, or present suicide as a reasonable exit strategy for situations that feel inescapable. For some distressed viewers, this presentation of suicide as a solution might align with real, heightened, or imagined problems they are facing.
  • Romanticizing/Memorializing: Sometimes, when real people or beloved characters die by suicide or overdose, they and/or their work are lifted up as more important, timeless or memorable because of their untimely and tragic death. For at-risk individuals — especially teens and young adults — who may feel unseen, forgotten, or hopeless about their own future, this could inadvertently send a message that suicide is a way to be seen, remembered, appreciated, or leave a legacy. Romanticizing drug use or self-injury in a way that makes a character seem adventurous, mysterious, dangerous, or complicated can also reinforce perceptions that these behaviors are desirable and without consequence. 

Tips for avoiding contagion are in the sections for self-injury, suicide, and overdose.

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more in part 6