Is mental health still misconstrued on screen? Psychology goes to Hollywood to dispel stigma

Helen Hsu, PsyD, was about 350 miles from Hollywood—and a million more miles mentally—when producers called.

It was 2016, and Hsu, an expert in adolescent and multicultural mental health, was providing clinical care for low-income children and families and overseeing a public school–based counseling program. She rarely, if ever, watched TV.

But the folks on the line invited Hsu to join their world and consult on the Netflix drama 13 Reasons Why, which ran from 2017 to 2020 and depicts the impact of a teen’s suicide on her classmates as they uncover why she took her life.

Hsu, who frequently talked to journalists about teen mental health but had never been involved in a project of that scale, was in. “I thought, here’s another opportunity to get information to an audience that’s far larger than what I could ever do academically,” she said.

While the show received criticism from some mental health professionals—­particularly for a graphic suicide scene Netflix later removed—it also was linked to an uptick in calls to crisis lines, raised awareness of sexual assaults among men, and prompted crucial parent-child conversations, Hsu said, noting that the popularity of the book the show was based on indicated a hunger among youth to talk about these hard issues.

“I’m a firm believer in meeting young people where they are at,” she said. The show’s second season premiere reached 6 million viewersopens in new window in just 3 days.

Hsu is one of many psychologists working to infuse the entertainment industry—from film and TV to theater and music to gaming and science fiction—with psychological science and accurate information about mental health, mental illness, and mental health treatment. The partnership, though not without its pain points, can be win-win, both psychologists and creatives say: Mental health professionals get a chance to improve the stories coming out of Hollywood and other entertainment hubs, and storytellers get to tell more authentic stories and create more realistic characters. As a result, in the best-case scenario, well-made shows attract more viewers, and our collective mental health elevates.

[Related: A different type of storytelling: Reality TV consulting]

“Storytelling has always been a way for us to find healing, to better understand our own identities and one another, to understand differences, to be able to safely and more confidently talk about the things that, under other circumstances, might feel too vulnerable, unsafe, personal,” said Drea Letamendi, PhDopens in new window, a clinical psychologist in Los Angeles who advises the gaming, visual effects, and entertainment media industries. “So we can use the media to talk about very impactful, real psychological topics and increase their awareness. And in many ways, this increases people’s interest and buy-in in psychological science, which is really important right now for our field.”

The partnership is savvy from a business perspective, too, Noopur Agarwal, MTV Entertainment Studios’ vice president of social impact, added. “It’s absolutely vital the entertainment industry is really speaking to the mental health aspect of people’s lives because it’s so front and center now,” she said. “There is a lot our audience can and does learn from the content they watch, and it shapes norms and it changes the conversation.”

While pop culture representations of mental illness, marginalized communities, and human behavior have improved over the past few decades, more work is needed to destigmatize psychological conditions in all populations and showcase healthy ways to seek help.

For example, of the 3,815 characters in 100 top films from 2023, just over 2% experienced a mental health condition, according to research by the University of Southern California’s Annenberg Inclusion Initiative (AII),opens in new window the world’s leading think tank that studies diversity and inclusion in entertainment. With funding from MTV Entertainment Studios, AII now houses the Mental Health Storytelling Initiative—a coalition of more than 60 entertainment media companies and mental health expert organizations, including APA, aiming to raise awareness and change the narrative on mental health.

AII’s research has also found that when mental illness is portrayed, it is not reflective of the culture at large, where people from all backgrounds and with all identities are affected.

“I’d really love to see more full-bodied stories of the clients we see—they’re very diverse,” Hsu said. “Mental health challenges happen in every community. People do recover, but what does that look like? And they’re not dangerous. In fact, unfortunately, most of my clients are taken advantage of by so-called ‘normal’ people.”

And yet, AII has found that 72% of 2022 film characters with a mental health condition were perpetrators of violence, even though psychological research has long shown that few people with mental illness are violent. What’s more, many films continue to normalize dehumanizing language like “freak” and “crazy,” and do not often feature characters who need mental health treatment actually seeking it.

“Most film and TV makers aren’t trying to cause harm to an audience, but the way the system is set up, it’s not always a clear-cut path to figure out, ‘Am I telling the story in a way that’s harmful—or authentic?’” said Ashley Kolaya, head of the Mental Health Storytelling Initiative, who led a training in November 2023 at APA headquarters aimed at introducing psychologists to the types of opportunities available in entertainment, and how to work with creatives effectively.

Psychologists can help clear that path. For Hsu’s work on 13 Reasons Why, for example, she urged writers to portray the long-lasting impacts a suicide has on a person’s family and peers—rather than dwell on the tragedy itself. She also encouraged creators to include conversations about safe sex given some of the characters’ risky behaviors. She met with the actor who played the school counselor to help him grasp the pressure his character might face, too.

“I said, ‘Listen, you might be one counselor who doesn’t even have a clinical degree, and you’ve got hundreds of students,’” said Hsu, now the outreach director at Stanford’s Counseling and Psychological Services department. “He really depicted the conundrum that many counselors are put in: a ton of responsibility without the right training or support. And I thought that came through well in the show.”

More than preventing harm, involving psychologists in show creation can equip viewers with mental health tools—whether the viewers are conscious of it or not. For example, three-quarters of viewers of the Paramount+ teen drama series Wolf Pack, which follows teenagers in a California town after a wildfire drives a supernatural creature to attack, said the show introduced them to new coping mechanisms. “Lion’s breath,” for one, is a mouth-wide, tongue-out breathing technique the central characters—and real-life yogis—use to manage stress and anxiety.

“What was really cool about Wolf Pack was that it delivered education and empowerment without people seeking it out or even realizing that’s what was happening,” Agarwal said.

It is no coincidence that mental health professionals—in this case, from the JED Foundationopens in new window focused on youth suicide prevention—were involved in that production from the beginning (like sitting in the writers’ room) to the end (like developing mental health resources to pair with the show’s release).

“I hope to see more of those collaborations that span the full scope of the production,” Agarwal added, “because that’s where the magic happens.”

Showtime’s The Chi, a coming-of-age drama set in Chicago’s South Side, also modeled healthy ways to seek support in communities where therapy is stigmatized or inaccessible, thanks to the input of Virginia-based psychologist Alfiee Breland-Noble, PhDopens in new window, who was tapped for her expertise in mental health in diverse communities.

When working through one scene featuring a group of Black men in a makeshift support group, Breland-Noble, creator of the Couched in Color podcast, told the creative team: “I think it’s important to highlight that you don’t need a degree to run a discussion group, but you do need help thinking through the kinds of questions you might ask.” She also supported the Black Emotional and Mental Healthopens in new window Collective to put out materials for viewers interested in replicating the scenario.

The portrayal was well received, with one fan writing on Xopens in new window, formerly Twitter, “that scene in the chi episode where the men had a group meeting just to be vulnerable and speak their truth was so refreshing to watch. all men (especially Black men) deserve the safe space to just release everything they’ve been holding in.”

The youngest viewers can pick up skills from psychologist-informed TV, too. Temple University developmental psychologist Kathy Hirsh-Pasek, PhDopens in new window, for one, has long worked with Sesame Street to conceptualize various seasons’ themes—be it critical thinking or curiosity—and bake the research right in.

When Sesame Workshop evaluated the show’s impact, Hirsh-Pasek said it found that the kids who watched more episodes not only solved related problems more effectively, but they also thought about problem-solving in a better way, and with grit: “They would give more tries—they wouldn’t just give one try and quit,” she said.

Even storylines that are not explicitly tied to psychology—or based in reality, for that matter—can heighten viewers’ mental health by helping them establish community or witness resilience, said Letamendi, who created and hosts The Arkham Sessions, a podcast about the psychology of superheroes and other pop culture narratives.

“We don’t just watch horror and science fiction or fantasy. We then go online and talk about it,” she said. “So I always say: Our relationship with media is bigger than the story itself. Yes, it can be a way of escapism, but media also buffers loneliness; it can trigger social responses like finding others who are just like you. There are really fascinating and uplifting ways in which heroic stories, in particular, can teach us about resilience and overcoming hardships.”

Psychologists are also wading into the entertainment business in ways other than reviewing scripts.

APA’s Science Directorate has an ongoing partnership with the Science and Entertainment Exchange program of the National Academy of Sciences to advance the way psychological science is portrayed in entertainment, and recently cohosted an event called “Storytelling and the Science of True and False Memories” featuring psychologists Jeffrey Zacks, PhD, and Elizabeth Loftus, PhD.

Psychologists Ariana Hoet, PhD, of the children’s mental health organization On Our Sleevesopens in new window, and Eric Butter, PhD, of Nationwide Children’s Hospital in Ohio, joined leaders from the entertainment industry and children’s mental health at a White House roundtable in October 2023 focused on ways to decrease stigma and promote access to mental health resources through film and television. APA released a new resource for viewers called The Healing Guide: Inspired by the Color Purpleopens in new window to coincide with the 2023 film release.

“The possibilities are limitless. You can do on-camera work, you can do behind-the-scenes work, you can be a consultant,” said Breland-Noble, founder of the AAKOMA Project,opens in new window a nonprofit dedicated to the mental health of youth of color.

She has discussed suicide and women’s mental health on Red Table Talk with actor and host Jada Pinkett Smith; led a guided meditation for the cast of The Power of Kindness, a film she cohosted with Lady Gaga; and helped put together the first annual Mental Health Youth Action Forumopens in new window, a partnership between the White House and MTV.

There is also live theater; reality TV casting (see “A different type of storytelling: Reality TV consulting”); opportunities in other arts, be it museum curation or ballet; and expertise needed for projects like the Mental Health Media Guideopens in new window, which briefs creators on best mental health storytelling tactics.

Letamendi, meanwhile, most enjoys postproduction or marketing work. That could mean writing an article about a particular character, creating a documentary about the making of a film, or organizing panels at sci-fi conventions.

“It’s not necessarily changing a story that exists and that is curated and developed by the storytellers—it’s addressing the impact that that story has on our psychology,” Letamendi said. “And I get really excited about that as a psychologist.”

That excitement is contagious, she has found. “People will say, ‘Because of your podcast, or article you wrote about Spider-Man, or video you did with Warner Bros., I also want to go into mental health,’” she said. “So for me, one of the most rewarding outcomes is to welcome young people into our profession through this channel.”

Despite all the appeal, Hollywood is a notoriously tough place in which to “make it,” whether you are a writer, director, actor, producer, or—yes—psychologist.

“Some people would be surprised at how demanding making a television series is for the actors and the crew. Each scene is filmed over and over from every angle. The days are long and often exhausting,” said Barbara Van Dahlen, PhD, a clinical psychologist who, among many other projects in the entertainment industry, consulted on ABC’s drama A Million Little Things, which follows a group of friends in Boston learning to live again after the loss of their friend to suicide. “And yet, despite the complexity, the demands, and the stress, stories are created that move us, inspire us, astound us. It’s a privilege to be asked to contribute to the process.”

“If you’re hoping that this is going to give you validation or status or fame or some big bucks, it’s not,” added Ali Mattu, PhD,opens in new window a clinical psychologist in San Francisco who has been featured in shows on HBO, Netflix, PBS, and other channels for his expertise on anxiety and other mental health topics. “It can, but so can a lot of more reliable paths, like having a thriving practice.”

Mattu said he has worked on many projects that never made it to production, be it due to a tanking budget, studio leadership changes, or simply a script that did not get picked up. “I’ve learned a very important lesson: Until every contract is signed, until you’re actually filming, until it actually airs, I never believe that this project is going to happen,” Mattu said. “I just don’t get my hopes up.”

Even when a show gets made, psychologists do not always get paid well and sometimes not at all. On-camera work as an expert or commentator, even for a high-profile production like Today on NBC, for example, is largely unpaid, Breland-Noble said. “Psychologists have to be willing to make some sacrifices if we want to be engaged in this work,” she said.

For Letamendi, a key sacrifice is time. As a campus health and counseling leader at University of California, Los Angeles, she already works 40 to 60 hours a week in that full-time role. Her media consulting work, then, is typically relegated to nights, weekends, and sometimes holidays.

But she considers the work self-care. “I went into entertainment media because, since I was a kid, that’s what brought me joy, that’s what helped me feel included, that’s what helped me feel that I belonged,” she said.

If you decide the work is for you, here is what psychologists recommend:

Have an established niche or expertise. Producers found Hsu because she is an expert in teen mental health and had talked to the media on the topic. They tapped Hirsh-Pasek because she is an acclaimed and widely published developmental psychologist. And Van Dahlen, who founded the nonprofit Give an Hour, is a renowned expert in service members’ mental health and suicide prevention.

“Get really good at something and have that depth of experience that makes you valuable to other people,” Mattu said. “That depth of experience can come from research. It can come from applied experiences of working with organizations and corporations. It can come from years of service, either as a health care professional or in all the different areas in which psychologists can serve and help others.”

Ditch the psychological jargon and learn how creatives work. “We’re trained really well to communicate with our colleagues in a way that does justice to the complexity of human behavior,” Mattu said. “But everything that makes us good at communicating psychology to other psychologists can make us very bad at communicating psychology to the public.”

That is precisely why the Mental Health Storytelling Initiative came about. The initiative connects creatives with psychological professionals and provides trainings and workshops, like the November 2023 event hosted at APA, to help both parties speak the same language and operate on the same timeline.

“We get studio executives who say, ‘We’d love to hire more psychologists to advise on stories, but we don’t know who to reach out to,’ or, ‘If we do reach out, they don’t understand how quickly we need notes, or they send long abstracts of information,’” Kolaya said. “We built the training to help decrease that friction.”

Be visible and reachable. Letamendi recommends getting your name and contact information in various databases, like APA’s Media Referral Service, as well as on your own website and social media channels.

“Do not be afraid to think of your work as a potential for being marketed, being advertised, being networked outside of the traditional psychological discipline,” she said. “That means being a bit more curious, open, and flexible about the way you develop your own repertoire as a psychologist. And it’s true: It’s a little extra hustle.”

That extra work can pay off in a bidirectional way: Not only can creatives find you, but your creative work can bring you clients and patients, depending on what type of psychologist you are.

“Ask yourself: What do you have to offer them?” said Mattu, whose YouTube channel has 277,000 subscribers. “Do you have courses they can buy? A consulting operation? Clinical services? Develop products and services that can scale with your media work.”

Network. Vanessa Cox, PhD, went to graduate school to become a therapist but came out with an interest in entertainment. She had studied how the Black community is portrayed and affected by the media and wanted her results to do more than sit in an academic journal.

So, she reached out to a friend at the Geena Davis Institute on Gender in Mediaopens in new window, who connected Cox with the folks who later offered her a job. The gig—and accompanying move from Michigan to Los Angeles—led to a role working in diversity, equity, and inclusion at Paramount and eventually Cox’s own entertainment consulting company, Uncommon Eye, which launched in 2022. She has worked to increase nuanced, multidimensional representations of Black women on screen.

“I would not have gotten into this had it not been for my colleague,” said Cox, who is also an adjunct associate professor in communications at Long Island University.

Be willing to work your way up. Van Dahlen recommends finding a mentor or getting involved in a community project that works with media so you can “hit the ground running” if and when you work in entertainment. “The creative team is not likely going to be interested in someone getting up to speed and practicing on them,” she said.

Indeed, Breland-Noble said, while everyone’s path “up” looks different—and often crooked—she does not know any mental health professionals who have started at the top. “You start at the bottom, build your reputation, and work your way up.”

Maintain your integrity… About 20 years ago, Hirsh-Pasek created a female superhero that Warner Bros. wanted to acquire. But when she flew to Los Angeles for the meeting, the creators said they intended to make the character male because that is what they believed would sell. Hirsh-Pasek pushed back, saying, “females deserve superheroes, too.”

“The project manager looked at me and said, ‘Are you not hearing me? Warner Bros. is going to take your character, but it has to be a man,’” Hirsh-Pasek recalls. “I said, ‘I thank you for inviting me out to LA, but I’m not changing my mind on this.’”

“I’m probably a lot poorer,” she continued, “but my point is: We’ll all come up against those kinds of things, and I don’t think it’s ever worth compromising integrity.”

…but know when to compromise. Cox organizes her feedback into three levels of importance: major, secondary, and minor. If creatives do not incorporate all her advice from the latter two categories, that is OK. “You want to keep this person as a client, and that’s something that you always need to think about,” she said.

In other words: Do not let the risk of not being entirely heard prevent you from speaking up at all, Hirsh-Pasek said.

“I find this to be the most exciting, riveting area of psychology right now: figuring out how we take what we know—I call it edible science—and make it accessible, digestible, and usable for a broader population,” she said. “Producers are always going to write adolescent films, they’re always going to write about relationships, they’re always going to write about anxiety and depression. And if they can get it half right instead of totally wrong, then we have done a really good job.”