What the Media Gets Wrong (and Right!) About Suicide

Tips for writing about suicide responsibly

September is Suicide Prevention and Awareness month and today, September 17th is National Physician Suicide Awareness Day. As psychiatrists, we are acutely aware of the pressures facing our fellow physician colleagues and have been disappointed when media coverage of physicians who have died by suicide has been handled poorly. Similarly, when high profile celebrities like Kate Spade, Robin Williams and Anthony Bourdain die by suicide, media coverage has often not been in line with established journalistic guidelines designed to responsibly report on this topic. 

On our Clubhouse Creator First show, New Frontiers, we recently curated a conversation around reporting on or talking to the public about suicide. Our panel included Chris Maxwell, the head of PR and Media for the American Association of Suicidology, suicidologist Fredric Matteson, Raghu Appasani, MD,  founder of the Minds Foundation, and Cory Feist, who is the brother in law of Dr. Lorna Breen, an emergency room MD who died by suicide during the pandemic, and president of the Dr.Lorna Breen Heroes foundation started in her honor to help physicians who are struggling emotionally. We also spoke with journalist and researcher, Klaudia Jaźwińska, who is the co-author on a recent study of how the media reports on suicide. 

Here are the key takeaways from our conversation: 

There are 16 commonly cited best practice recommendations to follow when writing about suicide in the media: 

  1. Share a hopeful message that Suicide is Preventable 

  2. Convey that Suicidal behaviors can be reduced with mental health support and treatment

  3. Provide helpful information such as warning signs or risk factors of suicide

  4. Do not provide details about the location of death

  5. Provide National Suicide Prevention Lifeline phone number or similar crisis number (see end of article for a list of some)

  6. Do not include details or images of the lethal means or methods used

  7. Do not display the article prominently in the newspaper

  8. Do not describe the suicide as inexplicable or without warning

  9. Do not provide specific details regarding notes left behind

  10. Use preferred language (e.g. Died by Suicide, not committed suicide)

  11. Use a photo that focuses on an individual’s life vs death

  12. Use a non-sensational headline

  13. Avoid single cause explanation for suicide death

  14. Avoid referring to suicide as a growing problem, epidemic or skyrocketing

  15. Avoid prominent photo placement at the top of the article

  16. Do not glamorize or romanticize suicide using language of heroism

Help and Hope Exists!

In the study by Jaźwińska and colleagues which looked at the media coverage of the death of Dr.Lorna Breen during the height of the Covid-19 pandemic, every media outlet violated at least 5 of the guidelines and some only followed 2 of them. Seven of the guidelines were followed by fewer than 1/3rd of the outlets. What we found most striking as psychiatrists was that none of the news outlets shared a hopeful message that suicide is preventable even though we have effective treatments available for mental illness. Very few indicated that suicidal behaviors can be reduced with mental health support and treatment. 

We know as mental health professionals that help is available for suicide. We have several medications with an evidence base for reducing suicidal behavior. For example, esketamine recently was FDA approved for suicidal patients with depression, clozaril is approved by the FDA for suicide risk reduction in patients with schizophrenia and there are meta-analyses suggesting lithium reducees suicide in individuals with bipolar disorder. We also have evidence-based therapies. Cognitive Behavior Therapy for suicide attempters, Dialectical Behavior Therapy and Mentalization Based Treatment all are designed to help reduce thinking and behaviors. Other interventional treatments including Transcranial Magnetic Stimulation and ECT can be game changers for individuals with severe depression. The bottom line is there are treatments that can help and it is dismaying as psychiatrist that work with individuals who experience suicidal ideation that this messaging is not being included as regularly as it could be in reporting on suicide. 

There is concern about a possible contagion effect following reporting of suicide deaths, although this is quite difficult to study and Chris Maxwell noted the data on this is quite messy. Following Robin Williams death, one study reported an increase in the U.S. suicide rate by 9.58% in the 6 months thereafter compared to the previous year. There could be other factors for this of course, but following his death, the media did take more of an interest in following best practices. While there has been an improvement over time in coverage that could be harmful, coverage that could be beneficial is limited.  The results of a similar study around the deaths of Kate Spade and Anthony Bourdain indicated that the more hopeful messages about treatment and prevention were limited to non-existent in most media coverage. Anthony Bourdain died by suicide several days after Kate Spade and due to backlash and education around suicide reporting immediately following Spade’s death, coverage of Bourdain’s was slightly more adherent, as this graph from the article shows: 

What can you do to help?

In seeking panelists for the conversation, I reached out to several journalists who write about mental health. They noted that they received little to no training in journalism school or by the editors when reporting on suicide. I certainly hope that is changing and that coverage will continue to improve when suicides do occur. It is important if you do see a piece that is problematic, to contact the news outlet right away so they can make the appropriate adjustments. We know that can make a difference, as it did in the case of Anthony Bourdain and Kate Spade.

Of course, journalists want their articles to gain a lot of views and shares and so there is in some ways an inevitable tension between reporting in a sensationalized fashion and in reporting in a responsible manner around suicide. However, a 2020 study suggests that articles that better adhered to suicide prevention guidelines were associated with an increased likelihood of being shared on Facebook and receiving positive engagement.

We hope that you will share this article too to spread the word and keep these principles in mind should you be contributing to the many conversations around suicide happening this month and beyond! 

Crisis Hotlines

A really easy way to incorporate one of the guidelines is to include information about crisis Lines in articles, posts and places like profiles on Clubhouse, Discord Servers and personal websites. Here are some Crisis Hotlines/Warmlines Throughout the World:

U.S. National Suicide Prevention Lifeline: 800-273-8255

U.K. 0800 689 5652

India: 8888817666  

Canada: 1 (833) 456 4566 

CRISIS TEXT LINE: Text HOME to 741741

To find a crisis line throughout the world:

http://findahelpline.com/

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Please follow the Sphere Mental Health Club on Clubhouse for more great content and sign up for reminds of upcoming happenings at AskSphere.Club. While our New Frontiers season is over, we have ongoing conversations on Clubhouse, including an AMA with the Frontier Psychiatrists and other mental health experts every Sunday night at 7pm EDT.