13 Reasons Why: Is it 'exposing the truth' or a 'primer' on teen suicide?

It's a death scene unlike most others on television. A 17-year-old girl kills herself in a bathtub and the audience, which includes a significant young adult following, sees every moment.

The Netflix series 13 Reasons Why, based on the best-selling YA novel by Jay Asher, has scored fans around the world for its raw portrayal of high school life and teen suicide. But it's also getting widespread criticism from mental health experts who argue the show could trigger those on the brink and who need help.

What's the series about?

13 Reasons Why traces the buildup to the suicide of Hannah Baker, a teenager who sends a series of tapes to the classmates she says played a role in her decision to take her own life. All 13 episodes were released for streaming March 31.

The show has a TV-MA rating (may not be suitable for those under 17) and provides a warning to viewers before the episodes with particularly graphic content.

• 'Let your kid watch it,' Quebec teen says of controversial show 13 Reasons Why

"I think it's showing, like, what's really going on out there in the high school world and it wants to show us we shouldn't treat others like that," 15-year-old student Ashley Rosales told CBC News, sitting with six other friends at a Los Angeles mall, all of whom watch the show.

"If anything, it's exposing the truth about it, like what really happens," said Alex Funes, 14.

Why the concern?

How truth is perceived might be part of the problem, experts warn. The main character is able to make her voice heard after she's dead, "experiencing the success of revenge or making people realize the things that they had done," according to Katherine Cowan from the American National Association of School Psychologists.

That unrealistic sense of reward could also be a trigger factor for others potentially at risk, she said.

A growing memorial on Baker's locker at school, a location the series re-visits several times, is not advised in the aftermath of a suicide for the same reason.

"All of those are things that go against suicide prevention best practices 101," said Cowan. "The series is very intense and romanticizes the story of Hannah and her suicide."

The character blames other people for her decision, and the underlying causes of depression and mental illness aren't clearly addressed, she adds. It's what prompted NASP to issue a serious warning to educators, parents and "vulnerable youth" about the series when it was released.

Many schools in Canada —including in Ottawa and around B.C.— have since sent out their own advisements to parents. One Edmonton elementary school has prohibited students from talking about 13 Reasons Why on school grounds.

• 13 Reasons Why criticized for messaging on teen suicide

Cowan said another cause for concern is that there are no effective adult characters on the show. When Baker's character tries to confide in her school counsellor following a sexual assault, he dismisses the event and lays blame on her instead.

"Adults are portrayed almost across the board as being disengaged, uninformed and almost uncaring and, therefore, not a source of help or support around any of these issues," she said. "It sends a message 'you're in this on your own.' The adults can't help you."

What's Netflix saying?

Netflix issued a statement following the growing controversy, saying mental health experts were consulted during the production, "to show how these issues impact teens in real and dramatic ways."

The series, co-produced by pop star Selena Gomez, cites bullying, sexual assault and tumultuous teenage relationships as catalysts for the suicide.

"Many people are accusing the show of glamorizing suicide and I feel strongly — and I think everyone who made the show feel very strongly — that we did the exact opposite," writer Brian Yorkey, whose Pulitzer Prize-winning musical Next to Normal grappled with mental illness, told the Associated Press. "What we did was portray suicide and we portrayed it as very ugly and very damaging."

Helen Hsu, a clinical psychologist in Fremont, Calif., whose work involves suicide prevention in schools, helped shape some of the 13 Reasons Why scripts. She said not showing Hannah's suicide would be almost "coy and avoidant" and that medical studies aren't definitive about the risks of suicide contagion.

The JED Foundation, an American organization dedicated to teen suicide prevention, disagrees.

Is the risk of copycat suicides real?

Victor Schwartz, a psychiatrist and JED's chief medical officer, says there's "good evidence" that the more details young adults at risk are given, the higher the risk for copycat suicides.

"The more I think I have a picture of that person, the greater the chance that there's going to be this connection and imitative behaviour," he said, citing research from world-renowned suicide contagion expert Madelyn Gould. "We know that this contagion effect exists."

"The show explicitly shows the suicide and, in a sense, is a kind of primer for showing a young person how they could kill themselves."

Schwartz says JED was approached by the producers behind 13 Reasons Why shortly before the series was released and expressed deep concerns at that time over the way the topic was handled.

They then worked alongside the show to create informational talking points on a companion website. There's also a 30-minute special following the season finale called Beyond the Reasons. 

How have other shows handled it?

One of the most acclaimed portrayals of teen suicide and its impact was on the popular Canadian television show Degrassi High. Many Canadian teachers have used the series in the past as an instructional tool for students.

"I have to say that of all the storylines that we have done, the issue of suicide scares me the most because it's fraught with danger," Degrassi co-creator Linda Schuyler told CBC News over the phone. "We had more specialists helping on that episode than any other."

In the episode, which aired in 1991, the character of Claude Tanner brings a gun to school and kills himself in the boys' bathroom. Snake, played by Stefan Brogren, discovers the body. The Degrassi franchise has dealt with the issue of suicide in two other storylines over the years.

Schuyler, a former grade eight teacher, said after social workers and psychiatrists were consulted for the multiple episodes exploring the issue, the suicide itself was never shown.

"The last thing you want to do is present a storyline that somebody uses as a copycat vehicle," she said. "You just couldn't live with yourself as a producer if you felt that had happened."

Aislinn Paul, a Canadian actress who starred on Degrassi: The Next Generation, recently tweeted that she believes 13 Reasons Why "discusses teen suicide & depression in an unhelpful & unhealthy way."

The series is out, kids are watching, so what now?

Now that the series has clearly taken off among young viewers, there is an important opportunity for parents to connect with their children about it. Cowan credits the series for spurring discussion around issues often difficult to approach.

If your son or daughter hasn't seen the series yet, talk to them about it, says Cowan. Better yet, watch it together if you think they're ready to see it. And if they have already binge-watched it, the conversation might have to shift, but can still take place.

"Even though we would prefer it [the series] was done in a different way, we want to take the opportunity to take advantage of those discussions and respect what the issues are and why it's important to the kids, as opposed to just dismissing it or criticizing it."

The JED Foundation's talking points, which could help guide a parent's discussion about 13 Reasons Why, can be found here.