Introduction
In recent years, Ireland has seen an increase in self-harm among young adults with a decreasing age of onset (Griffin et al. Reference Griffin, McMahon, McNicholas, Corcoran, Perry and Arensman2018). The media may have both a positive and negative influence in the development of self-harm and suicidal behaviour. While the copycat and imitation effects of media reporting are well established (Gould, Reference Gould2001; Pirkis et al. Reference Pirkis, Francis, Blood, Burgess, Morley, Stewart and Putnis2002; Shoval et al. Reference Shoval, Zalsman, Polakecitch, Shtein, Sommerfeld, Berger and Apter2005; Stack, Reference Stack2005; Cheng et al. Reference Cheng, Hawton, Chen, Yen, Chen, Chen and Teng2007; Fu & Yip, Reference Fu and Yip2009; Niederkrotenthaler et al. Reference Niederkrotenthaler, Voracek, Herberth, Till, Strauss, Etzersdorfer, Eisenwort and Sonneck2010, Reference Niederkrotenthaler, Fu, Yip, Fong, Stack, Cheng and Pirkis2012; Sisask & Varnik, Reference Sisask and Värnik2012; Pirkis et al. Reference Pirkis, Blood, Sutherland and Currier2018), recently there has been emerging evidence in relation to using the media as a tool to highlight that there is an alternative to suicide and there are ways of coping with a suicidal crisis (Till et al. Reference Till, Arendt, Scherr and Niederkrotenthaler2019; Niederkrotenthaler & Till, Reference Niederkrotenthaler and Till2019) – the so-called ‘Papageno’ or preventative effect. This concept propagates the potential protective effects of positive media messaging, to encourage help-seeking, reduce stigma and raise awareness (Niederkrotenthaler et al. Reference Niederkrotenthaler, Voracek, Herberth, Till, Strauss, Etzersdorfer, Eisenwort and Sonneck2010).
Media have been found to promote help-seeking and positive coping skills (Niederkrotenthaler et al. Reference Niederkrotenthaler, Voracek, Herberth, Till, Strauss, Etzersdorfer, Eisenwort and Sonneck2010; Till et al. Reference Till, Voracek, Herberth, Strauss, Etzersdorfer, Eisenwort, Sonneck and Niederkrotenthaler2013, Reference Till, Arendt, Scherr and Niederkrotenthaler2019; Daine et al. Reference Daine, Hawton, Singaravelu, Stewart, Simkin and Montgomery2013; Arendt et al. Reference Arendt, Scherr, Niederkrotenthaler, Krallmann and Till2018) and advance knowledge via educative websites, stories of lived experience and interviews with experts (Till et al. Reference Till, Voracek, Herberth, Strauss, Etzersdorfer, Eisenwort, Sonneck and Niederkrotenthaler2013, Reference Till, Arendt, Scherr and Niederkrotenthaler2019). Media coverage can also raise public awareness, alleviate stigma and correct misinformation and stereotypes (Niederkrotenthaler et al. Reference Niederkrotenthaler, Reidenberg, Till and Gould2014; Arendt et al. Reference Arendt, Scherr, Niederkrotenthaler, Krallmann and Till2018). In addition, there is increasing evidence showing that suicide prevention media campaigns can have positive outcomes in terms of certain suicide-related outcomes, such as improved attitude and knowledge among the general public (Hegerl et al. Reference Hegerl, Rummel-Kluge, Värnik, Arensman and Koburger2013; Kohls et al. Reference Kohls, Coppens, Hug, Wittevrongel, Van Audenhove, Koburger, Arensman, Szekely, Gusmao and Hegerl2017; Pirkis et al. Reference Pirkis, Rossetto, Nicholas, Ftanou, Robinson and Reavley2017) and have been recommended by the World Health Organisation (WHO, 2014).
It must be noted, however, that no study has clearly concluded that public information campaigns contribute to increased help-seeking or reduced suicidal behaviour (Dumesnil & Verger, Reference Dumesnil and Verger2009; Mishara & Dargis, Reference Mishara and Dargis2019). Moreover, a systematic review by Torok et al. (Reference Torok, Calear, Shand and Christensen2017) concluded that mass media campaigns have limited efficacy in generating behavioural change and decreasing obstacles to change.
Within this context, the documentary ‘My Other Life: Ireland’s Young and Their Mental Health’ was developed by an independent film maker and broadcast by Raidió Teilifís Éireann (RTE), Ireland’s national broadcaster, on World Mental Health Week, October 2018. Via interviews, the programme vividly communicates the personal mental health stories of young adults from across Ireland and began as an online video before becoming the first crowd-funded project to air on national television. As well as the airing on national television, the documentary was shown in special viewings in colleges and universities countrywide. Recent research has established that students in Ireland are experiencing very high levels of anxiety, depression and stress (Price & Smith, Reference Price and Smith2019; Dooley et al. Reference Dooley, O’Connor, Fitzgerald and O’Reilly2019).
The documentary provided an opportunity to disseminate information and to promote conversations about mental health. To measure this, we conducted a national survey, through which we sought to obtain people’s perceptions on the impact of a television documentary on awareness of mental health, well-being, mental health difficulties and help-seeking behaviour.
Similar studies in Australia have found that television documentaries have the potential to positively impact men’s health outcomes (King et al. Reference King, Schlichthorst, Reifels, Keogh, Spittal, Phelps and Pirkis2018a, Reference King, Schlichthorst, Spittal, Phelps and Pirkis2018b) and effectively address factors that place males at heightened risk of suicide (Schlichthorst et al. Reference Schlichthorst, King, Spittal, Reifels, Phelps and Pirkis2018). Viewers reported being more aware of others, more prepared to help someone in distress, more open about their emotional health, and more inclined to help others and express their own emotions (King et al. Reference King, Schlichthorst, Spittal, Phelps and Pirkis2018b). In a related study in South Korea, researchers found that a television public service announcement had a positive impact in terms of call volume to a crisis hotline (Song et al. Reference Song, You, Kim, Kim, Kwon and Park2017).
However, the ‘Man Up’ documentary in Australia is one of the few social change documentaries that have been evaluated (King et al. Reference King, Schlichthorst, Reifels, Keogh, Spittal, Phelps and Pirkis2018a, Reference King, Schlichthorst, Spittal, Phelps and Pirkis2018b) and knowledge of the concepts which underpin change is limited (Karlin & Johnson, Reference Karlin and Johnson2011). It remains unclear what the immediate impact of a documentary is in terms of people’s perceptions on help-seeking behaviour.
Key objectives of the survey include obtaining young people and adults’ insights on their own mental health, general well-being and help-seeking behaviour, after viewing ‘My Other Life: Ireland’s Young and Their Mental Health’. Correspondingly, strategic priorities of Ireland’s National Strategy to Reduce Suicide, 2015–2020, Connecting for Life (Department of Health, 2015) and the World Health Organisation’s Global report on preventing suicide (WHO, 2014) are focused on reducing stigma and improving the nation’s understanding of mental health and suicidal behaviour. Specific approaches to reduce suicidal behaviour and improve mental health among priority groups, such as young people, are also addressed.
Methods
Our mental health survey
In the weeks following the airing of a documentary on national television, we asked the general public and college students aged 18 years and over to complete an anonymous 14-item mixed methods online survey (see Appendix A). The survey included the General Help-Seeking Questionnaire (GHSQ; Wilson et al. Reference Wilson, Deane, Ciarrochi and Rickwood2005) in addition to open-ended questions. The online survey website chosen to circulate the questionnaires was Survey Monkey (Cresswell, Reference Cresswell2009, p. 149). The survey was open and accessible from October 10th until October 31st, 2018.
Participants were recruited via the Union of Students in Ireland who circulated the link to student union presidents in universities and third-level institutions countrywide for dissemination among the student population in their respective areas (estimated 30 000 students overall). Additionally, social media platforms such as Facebook, Twitter and YouTube were utilised as they have a large reach and a high usage among young people.
Data analysis
The quantitative data were analysed including descriptive statistics and running Pearson Chi-Squared Independence Tests, in addition to an Independent Samples t-test. The two open-ended questions were qualitatively analysed independently by three researchers (NMcT, LMcC, and EG) using thematic coding and qualitative content analysis (Graneheim & Lundman, Reference Graneheim and Lundman2004; Braun & Clarke, Reference Braun and Clarke2006). This involved interpreting the communications and descriptions provided to identify 30 subthemes which were merged into 11 key categories, framed in line with key objectives of the study.
Table 1. Demographic characteristics, mental health and well-being rating and GHSQ score
*Eighteen participants identified as ‘other’.
Table 2. Help-seeking behaviour findings
Table 3. Primary areas of impact findings
Quantitative results
Documentary reach
Data from RTE indicate that 55 000 people viewed ‘My Other Life: Ireland’s Young and Their Mental Health’ when it was broadcast, and in the days and weeks subsequent to this when it was available on RTE player (RTE, 2018). Social media activity was extensive with 415 487 impressions recorded on Facebook, Instagram, YouTube and e-mail.
Demographic characteristics
In total, 2311 people completed the survey, of which the majority were females (84%). Over half of respondents (55%) were aged 18–25 with a mean age of 29 years (s.d. 10.98). Most of the participants (61%) reported living in an urban area.
Mental health and well-being, and help-seeking behaviour
There was a significant association between watching the documentary and positive emotional well-being and general mood (p ≤ 0.001). In addition, viewers had a 5% higher level of intention to seek help than non-viewers of the documentary (p≤0.001, 1.61, 95% CI 0.94–2.29) (see Table 1).
Using the help-seeking questionnaire which asked participants how likely they were to seek help from a number of sources, the researchers recoded responses into two categories (1) extremely likely or likely and (2) extremely unlikely or unlikely and analysed this for those who watched and those who did not watch the documentary.
The most likely sources of help for those who watched and those who did not watch the documentary were intimate partner, friend, mental health professional, parent, doctor/GP and online resource or mobile app.
The results indicate that participants were more likely to seek help from all of the listed sources after watching the documentary; however, this was only statistically significant for seeking help from parents (<0.01), other relatives and family members (<0.05) and helplines (<0.05). Moreover, respondents who did not watch the documentary were more likely not to seek help from any source (<0.01) (see Table 2).
Based on a list of possible stressors, the top five causes of stress reported by those who did watch the documentary were body image (47.9% of sample), family (44.7%), relationships (43.6%), school (40.8%) and money (36.6%). Those who did not watch the documentary reported that family (55.3% of sample), body image (54.8%), relationships (51.5%), money (48.5%) school (45.4%), friends (43.1%) and loss (41.6%) were the principal causes of stress. The top five stressors were selected by a higher proportion of non-viewers than viewers, suggesting they are a more stressed group.
Awareness of mental health and well-being
In response to the closed questions, (n = 854), 94% believed that the documentary will have a positive impact on young people’s mental health and well-being, 91% perceived the documentary as encouraging for young people to open up and talk to someone if they are experiencing problems and 87% of those surveyed perceived the documentary as helpful in reducing stigma. Nearly all respondents (98%) would recommend watching the documentary to friends or family.
Qualitative results
Elements of the documentary which contribute to a potential impact on perceived awareness of mental health and well-being
Seven hundred and fifty-two participants (88%) responded to the open-ended question asking what part of the documentary had the biggest impact on their perceived awareness of mental health and well-being. One hundred and two participants (12%) declined the invitation to participate in this part of the survey. The responses to the open question were resoundingly positive (see Table 3).
Participants indicated that the identifiable personal stories and individual experiences shared by those interviewed had the most profound effect on them:
The true-life stories that are nearly identical to what I’m going through at the moment.
Survey respondents referred to the openness and honesty of those interviewed and the real, raw unscripted accounts of the individuals:
All of it. The honesty and openness was so refreshing. Those people are so brave, and I believe it will make it easier for others to open up about their own mental health.
Reference was made on participant’s ability to accurately articulate their feelings in a way that resonated with viewers:
How these young people found the words to express their feelings.
The understanding, passion, and positive attitudes of the contributors, moreover, were alluded to:
Just listening to others’ stories, especially the creators themselves, it showed that they have a real understanding and passion for this issue.
The involvement of young people and the structure of the programme were highlighted among a small proportion, with respondents insinuating that the interviewees were relatable as they were of a similar age demographic to them:
I really can’t express enough how useful I think this documentary is. Listening to people who are my age and are expressing details of how their own mental health and how it can come to light and affect our social and work lives anytime made me feel so much more comfortable in this consistent stream of thoughts that I have felt over the last 7 years……. Thank you so much for making such an important piece. You’re all incredibly brave to share such intimate pieces of your lives.
Similarly, the involvement of young males was identified as beneficial:
Seeing men telling their story. And seeing how similar my own story was to one of the men.
Several of those who responded to the open-ended question in this study conveyed that the documentary had a positive impact with regards to help-seeking behaviour. Subthemes which emerged include an appreciation that change is possible, struggles can be overcome, help is available (albeit with a delay in some cases) and the benefit of talking and being open about your thoughts and feelings with friend’s/family members/significant others:
Everyone telling their own personal stories and describing exactly how they have felt at times. Explaining how each person felt after they sought help was eye opening and would really encourage me to seek help if I felt I needed it.
A prominent theme emerging from the qualitative data was a reluctance to talk and the stigma and shame experienced by interviewees in the past, and their willingness to share this:
It was probably the first mental health documentary I watched that I believe made an impact in ‘generalising’ mental health.
Survey respondents indicated that the discussion reverberated with them and made them realise that they were ‘not the only one’ and lots of different people have similar problems:
The fact that it was almost like listening to my own history being spoken back to me. The prevalence of the issues spoken of really hit home and the fact that you’re not the only one…
Increased understanding and awareness following the viewing and a general lack of knowledge of the issues raised beforehand was apparent:
The fact that people are suicidal because they don’t know how to cope with their feelings. As a primary teacher this documentary has strongly encouraged me to teach my children (ALL AGES) about their mental health and how to care for it, despite the fact that it’s not on the curriculum!.
Respondents spoke of a lack of knowledge on how to cope and deal with their thoughts, and a lack of understanding of the issues highlighted, with several pointing to the lack of education in schools and colleges as a causal factor:
I could relate to not knowing what was going on in my head, not knowing what anxiety or panic attacks were, and being ashamed to tell anyone.
Many of those who responded referred to the statistics highlighting how prevalent suicide, depression and mental health issues are in Ireland, particularly among young people:
Seeing the statistics on how many people suffer.
Interviewees’ dialogue around their attempts to take their own life was alluded to by multiple respondents. For the majority of replies, it was unclear if this had a positive or negative impact with many simply stating ‘attempted suicide’ in their answer. Nevertheless, many referred to the interviewee’s thoughts of family members and how an impulse initiated thoughts of suicide and a single, instant thought changed the decision. A small number indicated that the recollection had brought back painful memories:
The part where the man said he was one second from being dead.
Additional themes which respondents related to was participant’s experiences of alcohol and adverse mental health, lack of supports for vulnerable people, time spent on waiting lists while awaiting specialist help and the necessity to speak with people while on waiting lists:
The blonde guy who spoke about going to October fest being the worst thing ever etc. His whole story was like looking in the mirror. Exactly me. His story resonated with me and really hit me.
Forty-nine participants stated that the entire documentary had an impact on them, without providing additional details on specific aspects. A very small number of participants included negative comments. One respondent stated that the documentary had no impact on them, one participant alluded to a lack of content relating to the mental health of older generations and one was critical of the lack of professionals and academics working in mental health.
Discussion
The present study indicates that television programmes in the format of a documentary involving young adults with lived experience recounting stories of resilience and recovery after experiencing mental health difficulties can have positive impacts on the emotional well-being and general mood of young adults. Listening to personal experiences and engaging with young people when developing effective interventions has been advocated (Connor et al. Reference Connor2017); however, there is a paucity of research on what young people and adults identify with when it comes to their mental health and well-being, and they are regarded as a hard to engage cohort (Silenzio et al. Reference Silenzio, Duberstein, Tang, Lu, Tu and Homan2009). The findings of this study provide an insight into the specific aspects which resonate with young people and adults and underline the outcomes of research in Australia which found that young people can safely participate in the development of suicide prevention messages, and their involvement in this process may improve the traction of mental health promotion campaigns with other young people (Robinson et al. Reference Robinson, Bailey, Hetrick, Paix, O’Donnell, Cox, Ftanou and Skehan2017).
The conclusions outlined in this paper suggest that a personal, unedited approach, by people of similar age and gender, may be beneficial in meaningfully addressing young adult’s mental health and well-being. These findings are consistent with the ‘Man Up’ documentary in Australia which found that viewers favoured ‘the real world’ setting featuring ‘everyday men’ and the host articulating emotions ‘in an honest way’, facilitating ‘personal connection with the content’ (King et al. Reference King, Schlichthorst, Reifels, Keogh, Spittal, Phelps and Pirkis2018 a). In addition, the significant association between watching the documentary and positive emotional well-being and general mood, and the 94% of participants who believed that the documentary will have a positive impact on young people’s mental health and well-being resonates with the promising finding from the ‘Man Up’ study were 84% of respondents indicated that the documentary had triggered changes for the better in them (King et al. Reference King, Schlichthorst, Reifels, Keogh, Spittal, Phelps and Pirkis2018 a).
Recent studies in the U. S. have found that help-seeking intentions among university employees and college students with symptoms of depression were largely influenced by positive outcome expectations and social norms (Lueck, Reference Lueck2018, Reference Lueck2019). The author recommends that health promotion messages incorporate prompts that stimulate and reinforce, rather than change, the existing positive outcome expectations of those who seek help when targeting priority groups. Correspondingly, following a concept test of social media materials and a website developed as part of the ‘Man Up’ study, researchers in Australia concluded that participants favoured visual material that included active, empowering and direct language (Schlichthorst et al. Reference Schlichthorst, King, Turnure, Phelps and Pirkis2019).
The findings of the present study mirror these outcomes and indicate that television documentaries with cues that activate help-seeking intentions can potentially have a positive impact on increasing help-seeking behaviour. Based on the findings of this study, stimuli promoting the message that change is possible, struggles can be overcome, help is available and the benefit of talking and being open about your thoughts and feelings, has the potential for positive outcomes. The outcome signifying that viewers had a 5% higher level of intention to seek help than non-viewers of the documentary resonates with the ‘Man Up’ study (King et al. Reference King, Schlichthorst, Spittal, Phelps and Pirkis2018 b). Similarly, the 91% of respondents who indicated that the documentary will encourage young people to open up and talk to someone if they are experiencing problems corresponds with research which found that 70% of respondents were more confident about reaching out to someone who they knew was struggling and that 41% of those surveyed had opened up to someone about an issue that they had been keeping to themselves, after watching the programme. Seventeen percent of participants, moreover, recognised the importance of seeking help when needed after watching ‘Man Up’ (King et al. Reference King, Schlichthorst, Reifels, Keogh, Spittal, Phelps and Pirkis2018 a).
While societal improvements regarding stigma are evident, challenges remain and recent studies have found that stigma is still of concern to young people (Ali & Gibson, Reference Ali and Gibson2019) and those bereaved by suicide, in particular the negative attitudes of others and social awkwardness (Pitman et al. Reference Pitman, Stevenson, Osborn and King2018). Parallel to the findings of the OSPI-Europe depression awareness campaign in four European regions, which found that a public awareness campaign can contribute to improved attitudes and knowledge about depression in the general public (Kohls et al. Reference Kohls, Coppens, Hug, Wittevrongel, Van Audenhove, Koburger, Arensman, Szekely, Gusmao and Hegerl2017), the findings of the present study suggest that documentaries may be a credible method of educating the general public and alleviating stigma and shame. Those who responded to the ‘Our Mental Health’ survey indicated that interviewees speaking about their mental health will encourage and give others the confidence to do likewise and not suffer in silence. These elements should be considered for future public awareness campaigns.
Eighty-seven percent of those surveyed indicated that they believed that the documentary would help to reduce the stigma associated with mental health in Ireland. Again, this resonates with ‘Man Up’ which found that 63% of those surveyed changed behaviours or attitudes based on their new understanding of the ‘man code’ that they had gained from watching Man Up (King et al. Reference King, Schlichthorst, Reifels, Keogh, Spittal, Phelps and Pirkis2018 a).
Consistent with ‘Man Up’ (King et al. Reference King, Schlichthorst, Reifels, Keogh, Spittal, Phelps and Pirkis2018 a) and the OSPI-Europe depression awareness campaign (Kohls et al. Reference Kohls, Coppens, Hug, Wittevrongel, Van Audenhove, Koburger, Arensman, Szekely, Gusmao and Hegerl2017), the outcomes of this survey indicate that television documentaries may be an effective method of increasing perceived understanding of mental health and well-being. The findings outlined in the present study indicate that a television documentary may be advantageous in engaging and educating young people particularly in relation to emotions, everyday triggers, coping mechanisms, warning signs, how reaching out to an individual in distress can make a difference and how people can hide mental health issues. Increasing the likelihood of third-party intervention is a key priority of suicide prevention (Pirkis et al. Reference Pirkis, Too, Spittal, Krysinska, Robinson and Cheung2015). Forthcoming public awareness campaigns containing these concepts may be constructive in increasing awareness of perceived mental health and well-being.
Internationally, a recent systematic review found that school-based psycho-educational interventions together with screening have the potential to be effective; however, the authors note that the majority of studies were not planned specifically for young people, and only a small number included the involvement of young people (Robinson et al. Reference Robinson, Bailey, Hetrick, Paix, O’Donnell, Cox, Ftanou and Skehan2018). It may be beneficial to incorporate peer-reviewed documentaries in evidence-based school programmes. In this regard, these commendations correspond with the ‘Wrecking your head’ survey of teenage mental health in Ireland which highlighted a lack of public awareness and education as a key theme (Chambers et al. Reference Chambers, Ryan, Doolan, Kavanagh and Healy2017) and the Saving and Empowering Young Lives in Ireland study which found a need for enhanced universal programmes of mental health education (McMahon et al. Reference McMahon, O’Regan, Corcoran, Arensman, Cannon, Williamson and Keeley2017).
The outcomes concerning the dialogue around participants’ attempts to take their own life underline the importance of including supportive information at the end of documentaries, to facilitate help-seeking behaviour, in line with the media recommendations for reporting suicide (The Samaritans, 2013; WHO, 2017). The interviewee’s thoughts of family members at this time are comparable to the ‘Man Up’ study, whereby participants reported increased learning on the impact of suicide on family and friends, following the documentary (King et al. Reference King, Schlichthorst, Reifels, Keogh, Spittal, Phelps and Pirkis2018 a).
Overall, the findings of this study support previous research which has concluded that television documentaries have the potential to positively impact on health outcomes (King et al. Reference King, Schlichthorst, Reifels, Keogh, Spittal, Phelps and Pirkis2018 a, Reference King, Schlichthorst, Spittal, Phelps and Pirkis2018 b) and effectively address factors that place individuals at heightened risk of suicide (Schlichthorst et al. Reference Schlichthorst, King, Spittal, Reifels, Phelps and Pirkis2018). In addition, the outcomes of this study add weight to existing evidence that media coverage can increase public knowledge and understanding, alleviate stigma and alter stereotypes and misrepresentation (Niederkrotenthaler et al. Reference Niederkrotenthaler, Reidenberg, Till and Gould2014; Arendt et al. Reference Arendt, Scherr, Niederkrotenthaler, Krallmann and Till2018). The findings also support evidence that suggests that stories of recovery appear safe and beneficial to individuals at risk of suicide (Till et al. Reference Till, Arendt, Scherr and Niederkrotenthaler2019; WHO, 2019; Niederkrotenthaler & Till, Reference Niederkrotenthaler and Till2019). Research has shown that social media sites can reach large numbers of otherwise hard to engage individuals including young people (Silenzio et al. Reference Silenzio, Duberstein, Tang, Lu, Tu and Homan2009; Carew et al. Reference Carew, Kutcher, Wei and McLuckie2014; Robinson et al. Reference Robinson, Cox, Bailey, Hetrick, Rodrigues, Fisher and Herrman2016); the conclusions illustrated here indicate that documentaries could have a similar impact, especially when their messages can be further promoted through social media and mental health websites.
However, despite these encouraging signs, a pre-evaluation is required to determine the direct impact of a documentary or campaign. Evaluation on a documentary series over a longer period would also be beneficial. As alluded to in a recent systematic review of suicide prevention media campaigns, rigorous evaluation is required to assess valid outcomes, particularly to determine which messages are effective and which are not (Pirkis et al. Reference Pirkis, Rossetto, Nicholas, Ftanou, Robinson and Reavley2017). Consideration of the reach of programmes, in order to determine whether it would be reasonable to expect that they might have their desired effect, moreover, is suggested (Pirkis et al. Reference Pirkis, Rossetto, Nicholas, Ftanou, Robinson and Reavley2017).
It is recommended that future documentaries consider the approach used in this study as the documentary not only communicated the personal stories of young people but also it was led, directed and managed by young adults, in line with international research, which suggests the involvement of young people may improve the overall reach of mental health promotion campaigns (Robinson et al. Reference Robinson, Bailey, Witt, Stefanac, Milner, Currier, Pirkis, Condron and Hetrick2017).
The researchers were involved in an advisory capacity throughout and provided input prior to final editing, which ensured that the language used was appropriate for the target group and the content was in compliance with the media recommendations for reporting suicide (The Samaritans, 2013; WHO, 2017), while minimising the risk to vulnerable viewers (Arendt et al. Reference Arendt, Scherr, Till, Prinzellner and Hines2017; Ftanou et al. Reference Ftanou, Skehan, Krysinska, Bryant, Spittal and Pirkis2018). In line with this approach and international best practice (WHO, 2019), the involvement of a suicide prevention expert at the various stages of construction is advocated for future productions.
Strengths and limitations
In Ireland, this is the first systematic study exploring a television documentary as a potential tool for increasing perceived awareness of mental health and well-being and one of few international studies in this area. Coding was based on three researchers’ (NMcT, EG, and LMcC) interpretation of themes, and an intercoder agreement was established prior to analysis, thus increasing the reliability of the study. The sample of 1042 responses is substantial and supplements the legitimacy. The study analysed real-time data from October 2018 ensuring that the research is relevant and timely.
The present study did not include a pre-evaluation. Pre- and post- evaluation using a controlled design with standardised questionnaires would be required to establish the direct impact of a documentary in terms of help-seeking behaviour over a longer period. The study examined gender differences and found effects to be very similar. However, females were overrepresented in the sample. Even though females are commonly overrepresented in population-based surveys addressing mental health, a more balanced gender selection would be advantageous for future studies.
Research has shown that exposure to suicidal behaviour of others can have a negative effect on adolescents (McMahon et al. Reference McMahon, Corcoran, Keeley, Perry and Arensman2013). Public service announcements and messages related to suicide may also have untoward effects for vulnerable audiences (Klimes-Dougan et al. Reference Klimes-Dougan, Yuan, Lee and Houri2009; Ftanou et al. Reference Ftanou, Skehan, Krysinska, Bryant, Spittal and Pirkis2018). It is possible that the recollections shared by the participants may have initiated thoughts of suicide and self-harm, two respondents alluded to this in the survey. While the documentary adhered to the media recommendations for reporting suicide, further in-depth analysis is required to establish effects. It is also possible that recollections shared by those interviewed may have triggered pre-existing suicidal/self-harm thoughts. It is imperative to consider the contributors and film crew’s mental health during and after filming.
Future research
It would be recommended to conduct further research on a documentary series, predominantly to establish the direct impact of a documentary in terms of help-seeking behaviour over a longer period of time. Auxiliary research examining age differences would also be beneficial.
Conclusion
The findings indicate that a documentary addressing mental health and suicidal behaviour, including real life stories of resilience and recovery, has the potential to positively impact on emotional well-being and general mood. There are also indications of potential impacts in terms of reducing stigma related to mental health and encouraging help-seeking behaviour. Promoting messages that change is possible, struggles can be overcome, help is available and the benefit of talking and being open about your thoughts and feelings, has the potential to induce positive effects on viewers. Documentaries containing these concepts, with a strong public mental health focus and a consistent message to maintain and promote conversations about mental health and help-seeking behaviour, incorporating pre- and post-evaluations, should be considered.
In order to promote such conversations, there is an opportunity for future documentaries to feature practical examples of positively evaluated public health initiatives such as the Health Service Executive’s ‘Little Things’ campaign (HSE, 2018). Similarly, there is an opportunity for future documentaries to discuss evidence-informed psychotherapeutic interventions, such as cognitive behavioural therapy (CBT) and Mindfulness based Cognitive Therapy (Slee et al. Reference Slee, Garnefski, van der Leeden, Arensman and Spinhoven2008; Hawton et al. Reference Hawton, Witt, Salisbury, Arensman, Gunnell, Hazell, Townsend and van Heeringen2016; Kuyken et al. Reference Kuyken2019) in order to foster hope and encourage people to seek help sooner rather than later. The language and content of such documentaries should be adapted to the target group and be compliant with the media recommendations for reporting suicide and National Institute for Health and Care Excellence recommendations.
Acknowledgements
The authors would like to express their sincere gratitude to the Our Mental Health Team for their assistance and expertise. In particular, we would like to thank Edvinas Maciulevicius for his leadership and foresight in creating the documentary. We would also like to thank Emillie Good and Lauren McCourt for reviewing the coding of the qualitative data , and Caroline Daly and Dr Paul Corcoran, for assisting with the statistical analysis. The National Suicide Research Foundation is in receipt of funding from the National Office for Suicide Prevention and the Health Research Board.
Financial support
This research received no specific grant from any funding agency, commercial or not-for-profit sectors.
Conflict of interest
NMcT, FR, EW, DC, and EA declare no potential conflicts of interest with respect to the research, authorship and/or publication of this article.
Ethical standards
Ethical approval for this project was granted by the Social Research Ethics Committee of University College Cork (SREC) in October 2018. People aged 18 years and older were eligible to participate in the survey. The National Suicide Research Foundation is registered with the Data Protection Agency and complies with the Data Protection Act of 1988, Data Protection (Amendment) Act 2003 and the General Data Protection Regulation (GDPR) 2018.
Appendix A Survey Questionnaire
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1. What age are you?
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2. What is your gender?
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3. Where do you live?
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4. Did you watch the documentary: My Other Life?
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5. Which part(s) of the documentary had the biggest impact on you?*
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6. Do you think the documentary will have a positive impact on young people’s mental health and well-being?*
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7. Do you think the documentary will encourage young people to open up and talk to someone if they are experiencing mental health problems?*
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8. Do you think the documentary will help to reduce the stigma associated with mental health in Ireland?*
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9. Would you recommend watching the documentary to your friends or family?*
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10. Overall, how would you rate your own mental health at the moment? (By ‘mental health’ we mean your emotional well-being and general mood)
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11. Have any of the following ever caused you long lasting stress or difficulty? (Tick as many as you like)
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School
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Family
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Friends
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Social media
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Relationships e.g. boyfriend, girlfriend
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Money
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Bullying or cyberbullying
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Body image
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Sexuality
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College
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Local or world news
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Exams
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Loss of a family member or friend
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Other (please specify)
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12. Below are some statements about feelings and thoughts. Please tick the box that best describes your experience of each over the last two weeks
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I’ve been feeling optimistic about the future
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I’ve been feeling useful
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I’ve been feeling relaxed
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I’ve been thinking clearly
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I’ve been feeling close to other people
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I’ve been able to make up my own mind about things
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13. If you were having a personal or emotional problem, how likely is it that you would seek help from the following people?
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Intimate partner (e.g. girlfriend, boyfriend, husband, wife)
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Friend
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Parent
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Other relative/family member
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Mental health professional, (e.g. psychologist, social worker, counsellor)
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Phone helpline (e.g. Samaritans, Childline)
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Doctor/GP
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Online resource or mobile app
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I would not seek help from anyone
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I would seek help from another not listed above. Please list in the space provided (e.g. work colleague). If no, please leave blank.
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14. And finally, is there anything else you would like to say about mental health and young people in Ireland today?
