The Stanford Department of Psychiatry and Behavioral Sciences, along with many other mental health professionals and national organizations dedicated to adolescent suicide prevention, have serious concerns about "13 Reasons Why," a Netflix television series focusing on teen suicide, sexual assault and bullying, that is currently available for viewing. When we initially became aware of its pending release from our community connections in late March, Stanford Psychiatry faculty mounted an anticipatory response to also notify school and other community partners who were not aware of it, and provided some early guidance on the disturbing content of the show. In addition to the graphic images related to suicide, the show's depictions of sexual assault and bullying may trigger strong emotional reactions that may also increase the risk of self-harm, particularly among those teens who have had similar experiences.

We now share the recommendation of multiple organizations that youth with a history of suicidal thoughts, non-suicidal self-injury, or suicide attempts should not watch "13 Reasons Why."  However, due to the popularity of the show, it is likely that most teens have already seen or heard about it. Many parents have become very concerned to learn their children have been watching this show with friends, and having active discussions of the graphic content without their knowledge. We encourage parents to learn about the series, ask your teens what they know about the show, and then discuss the show together in order to help young people safely process the difficult topics and images presented. The American Foundation for Suicide Prevention has created tips (AFSP tips for parents;  joint webinar about initiating conversation) to assist parents with these conversations, and many other organizations have created resources to aid in dealing with the impact of this series, including the Jed Foundation, National Association of School Psychologists, and other organizations.

The American Foundation for Suicide Prevention has also published a list of guidelines for safe media reporting of content related to suicide (AFSP media guidelines).

Unfortunately, many of these guidelines were not followed in “13 Reasons Why.” Some of the violations of greatest concern are:

1. including a graphic scene in which a teen dies by suicide
2. the portrayal of this death by suicide as an effective means of gaining a desired outcome (revenge on peers who Hannah feels have mistreated her), which can increase risk for "contagion" or "copycat" suicidal behavior by other teens
3. not providing information about how to easily access help if a viewer is feeling suicidal or struggling with mental health concerns (i.e., suicide hotline numbers)
4. suggesting that Hannah's friends and family are at fault for her suicide and failing to show that the causes of suicide are complex, with the primary cause of suicide usually being mental health related
5. the depiction of adults and counselors as being unreliable, unavailable and unhelpful.  

 In addition to these errors, the show misses opportunities to highlight the importance of seeking help from trusted adults and mental health professionals and the critical role of hope and support in recovery.  Furthermore, this series misses the opportunity to recognize that mental health treatment is very effective in helping youth cope with very painful emotions and experiences in safe and positive ways, and that even difficult problems can be solved.  Our Department looks forward to working with all interested community partners in improving the safety and quality of the media, especially shows directly marketed to our youth.