Mass Media Explore Behavioral Health Issues — to Great Effect

Stories that caught our attention

Sesame Street character, Karli, and family sit on bench.
A new Sesame Street initiative to help kids coping with parental addiction stars a new green Muppet, Karli, whose mom has an addiction, and 10-year-old Salia (second from right), whose parents were successfully treated for addiction. Photo: Flynn Larsen / Sesame Workshop

For the 50 years that Sesame Street has entertained and educated young children, the show has distinguished itself with content and production values that reflect early childhood education research and changing social norms. Recently, Sesame Street introduced a new cast member, a Muppet named Karli, who lived in foster care while her mother was in treatment for a substance use disorder. Sesame Street’s new story line is a powerful example of how popular media are adapting messages to address current social issues like behavioral health.

Essential CoverageSherrie Westin, president of social impact and philanthropy for Sesame Workshop, the nonprofit educational organization behind the show, told the New York Times’s Derrick Bryson Taylor that the producers want to help children cope with the stress and big feelings that come with parental addiction. “What we’ve learned over the last year was how much need there was and how little resources there are for some of the traumatic events that children are facing,” Westin said.

The initiative “includes seven new videos, a storybook, a coloring activity, and articles that parents, educators, and health care providers can use to talk to children about addiction and help answer common questions that kids tend to have, including what addiction is and how adults get treated,” Shraddha Chakradhar reported in STAT News. The resources are free and available in English and Spanish.

Sesame Street character Elmo sits with his father on a park bench.
As part of a new Sesame Street initiative on parental addiction, Elmo’s father explains that addiction is a disease. Photo: Zach Hyman / Sesame Workshop

In one video, the Muppet Elmo asks, “How come Karli’s mommy had to go away?” Elmo’s father explains, “Karli’s mommy has a disease called addiction. Addiction makes people feel like they need a grown-up drink called alcohol or another kind of drug to feel okay.”

In the US, 5.7 million children under age 11 live with a parent who has a substance use disorder, according to Jeanette Betancourt, EdD, MS, MA, the senior vice president for US social impact at Sesame Workshop. “For children, we particularly want them to know what parental addiction is but also provide a sense of hope and help them feel they’re not alone,” Betancourt told Chakradhar.

That’s why the project includes live-action films starring Salia, a 10-year-old girl whose mother and father had addiction when she was younger. Today, the whole family is thriving because Salia’s parents were able to get treatment. “I’m proud of mom and dad for asking for help and not using drugs or alcohol,” she says in one video. “Going through tough times is harder for families, but when they get to the end of it, they end up stronger.”

Educating Mature Audiences

Older viewers are also learning more about mental health issues through shows aimed at mature audiences. Last month HBO announced a new campaign, “It’s OK,” which promotes increased awareness about the mental health challenges faced by characters in a show, Elizabeth Harris reported in the New York Times. Episodes of shows portraying a mental health issue will start with an advisory describing the issue and an alert that the program highlights characters’ struggles with such conditions as depression, obsessive-compulsive disorder, or substance use. The advisories encourage people who need help to contact the National Alliance on Mental Illness. Older shows, like The Sopranos, will be updated to include advisories at the beginning of relevant episodes.

“We are not saying, ‘Viewer discretion is advised,’” Jason Mulderig, HBO’s vice president of brand and product marketing, told Harris. “We are saying, ‘Viewer conversation is encouraged.’”

The campaign includes a video series called “HBO Doctor Commentaries” featuring clinical psychologist Ali Mattu, PhD, discussing scenes focused on mental health issues of the characters. One discussion centers on the portrayal of obsessive-compulsive disorder (OCD) in the show Girls. In season two, Hannah, the main character played by Lena Dunham, has a relapse of OCD symptoms.

“The impairment here, the isolation, the difficulty to just get out of her bed and to go about her day — very realistic example of what OCD can look like,” Mattu says. He cautions against the inaccurate and inappropriate use of the term OCD to describe one’s pickiness or preference for organization. “Going back to check if you turned off your coffee machine — it’s not OCD,” Mattu says. “If you’re not diagnosed with OCD, try not to joke about it.”

Hollywood, Health & Society (HH&S), a program of the USC Annenberg Norman Lear Center, works with television writers and producers to ensure that they accurately depict health issues, including behavioral health issues. (CHCF is a cofunder of the group). HH&S consulted with the ABC show Black-ish in its fourth season to tackle a story line about the show’s matriarch, an anesthesiologist named Rainbow (Tracee Ellis Ross), experiencing postpartum depression. After the birth of their fifth child, Rainbow’s husband begins to suspect that she might have postpartum depression. Although Rainbow insists she is fine, he encourages her to seek help from her ob/gyn, who diagnoses postpartum depression and prescribes an antidepressant.

“The episode was a good way to introduce a topic that is not talked about,” Ross told Maureen Ryan of Variety. “Postpartum depression is something that is extremely undiagnosed and way more common than any of us are aware.”

Superheroes Answer the Call

In addition to television, other popular media help to generate conversations about mental health among therapists and their patients. Janina Scarlet, PhD, a licensed clinical psychologist at the Center for Stress and Anxiety Management in San Diego, “is part of a growing number of psychologists who incorporate pop-culture figures into their therapy practices in order to inspire patients,” Olga Khazan wrote in The Atlantic.

Scarlet uses “superhero therapy,” sometimes known as “geek therapy,” to help her patients talk about past trauma. She told Khazan about a 15-year-old patient who had difficulty opening up during their sessions. The only thing the girl would talk about was Veronica Mars, an early-2000s television show starring Kristen Bell as the eponymous teenage private investigator (a new season of the show was released in 2019, starring Bell as an adult Mars). In hopes of connecting with her patient, Scarlet binge-watched a full season of Veronica Mars one night, and when she met with her patient again, they talked about her depression in the context of the main character. How would Veronica Mars handle the situation?

The patient responded that Mars would make a speech, so “after two weeks of preparation, her patient gave a short talk in her class, speaking about depression, self-harm, and the importance of seeking help,” Khazan reported. Her classmates responded positively, and the speech kindled classroom conversations about mental health. The girl started a support group to help other teens.

Superhero therapy can be effective for some patients because “fictional characters might help us see alternative paths and endings to our story,” Khazan wrote. “Superhero therapy, while not perfect for everyone, is a valid way of coming up with better stories for your life.”

In Case You Missed It

CHCF has published a statewide survey to better understand the type of medical care and services Californians would prefer to receive if they had a serious illness or if they were approaching the end of life. Among other insights, the survey revealed that when palliative care is described, 9 in 10 Californians without a serious illness say they would want this type of care if they had a serious illness.

Get the results of the survey and see why palliative care physician Sunita Puri wants all medical students to learn about the transformative power of palliative care.

Have you seen excellent popular media portrayals of behavioral health issues recently? Tweet at me with #EssentialCoverage or email me.