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Distorted depictions: Popular movies misrepresent the reality of mental health conditions

Mental health is on the minds of medical professionals, policymakers, parents, and advocates these days. Yet a new study reveals that one area where little has changed for mental health is popular movies.

The new report from Associate Professor of Communication Stacy L. Smith and the USC Annenberg Inclusion Initiative is the third in a series examining mental health representation in popular films. The study, “Mental Health Conditions Across 300 Popular Films,” was also supported by Dr. Christine Yu Moutier, chief medical officer of the American Foundation for Suicide Prevention. The new research examines the prevalence and portrayals of mental health conditions across the 100 top-grossing films from 2022, comparing the new findings to the Initiative’s previous studies covering 2016 and 2019.

Only 2.1% of the 3,815 speaking characters examined in 2022 were shown with a mental health condition. This is consistent with the findings from 2016 (1.7%) and 2019 (1.5%) and reveals that there has been no change over time. The percentage also falls below the 21% of U.S. adults who reported experiencing a mental illness in the U.S. National Comorbidity Survey.

“Our work has demonstrated that change has occurred in entertainment across a variety of indicators,” Smith said. “Yet when it comes to mental health conditions– which are reported by a significant portion of the population– there has been no improvement over time. Entertainment can play a role in shaping perceptions of mental health conditions, but the absence of these portrayals communicates that mental health conditions are invisible as are those who live with them. This must change.”

Nearly half of the films examined (48%) did not feature even one character with a mental health condition. Another 34% of the movies in the sample showcased only a single character with a mental health condition. This means that more than three-quarters of 2022’s top movies had little to no depictions of mental health.

“Media representation matters,” Moutier said. “We are seeing a greater degree of readiness among the public to engage with the topics of mental health and suicide prevention. When mental health experiences are depicted in nuanced and hopeful ways in storytelling, it promotes help-seeking, decreases social shame, and provides comfort to those who are struggling. Entertainment content creators can be reassured that it’s a win for all when stories provide sophisticated, helpful, safe content.”

The most commonly depicted mental health conditions were addiction, mood disorders, and anxiety/PTSD. There was some variability from year to year in the types of conditions shown in films, but top-grossing movies consistently depicted few portrayals over time. 

There was little difference in the percentage of men (50.6%) and women (49.4%) depicted with mental health conditions. However, the majority of characters with a mental health condition were White (76.3%) and few characters were from underrepresented racial/ethnic groups (23.8%). Only 7 LGBT-identified characters were shown with a mental health condition. Finally, 15 characters with a mental health condition were also depicted with a disability.

The study also examined how characters with mental health conditions were portrayed in the unfolding plot. Nearly 80% of characters with mental health conditions experienced some form of disparagement on screen. While this could include general insults that were not related to a character’s mental health condition, almost half of characters (47%) were disparaged specifically with respect to their mental health.

In addition to experiencing derision in the storyline, nearly 20% of characters were also the object of humor or jokes regarding their mental health condition, which is similar to the report’s findings on films from 2016 and 2019. The negative context surrounding mental health portrayals paints a problematic picture for audiences.

“Often when characters with mental health conditions are shown, we see how poorly they are treated,” says the study’s co-author, Al-Baab Khan. “It’s clear from the findings that little has changed in the ways the storytellers portray characters experiencing a mental illness. There is a huge opportunity, especially given our current climate, to be better and to be relatable.”

The report also revealed that characters with mental health conditions were linked to violence. Since 2016 (46%), the percentage of characters shown as perpetrators of violence rose significantly, reaching 63.4% in 2019 and 72.3% in 2022. A similar finding was observed for characters with mental health conditions who were targets of violence– this percentage increased from 60.9% in 2016 to 77.1% in 2022. Films continue to perpetuate and convey to viewers a portrait of mental health as enmeshed with violence.

Violence was also a hallmark of how characters with mental health conditions died in popular films. Almost 40% of the characters died by the end of the film, including those who took their own lives and those who were killed by another. Of those characters that perished, 54.5% died by violent means. On-screen, suicide was the cause of death for 21.2% of characters with mental health conditions.

“Film appears to have little value for the lives of characters with mental health conditions,” Smith said. “From violence to death, popular films draw on outdated stereotypes in ways that may have a negative impact on the attitudes, perceptions, and beliefs of audience members when it comes to mental health.”

In addition, the study explored how often help-seeking behaviors occurred in connection to mental health portrayals. Roughly one-quarter (25.3%) of characters with mental health conditions were shown in therapy, including individualized support, group therapy, and substance abuse care. There has been no significant improvement in the depiction of therapy since 2016. In films from 2022, only 15.7% of characters used medications or other forms of treatment for their condition. Though low, this figure has not changed since 2019.

One solution to increase the portrayal of mental health is for creatives to use the Mental Health Media Guide. The Guide is a comprehensive blueprint for content creators that outlines best practices at every stage of the production process. Developed by the Annenberg Inclusion Initiative alongside MTV Entertainment Group, and expert practitioners, the Guide offers insights to increase the number and authenticity of mental health portrayals across both scripted and unscripted entertainment. The Guide is also one of the signature efforts of the Mental Health Storytelling Initiative, which also includes the Mental Health Storytelling Coalition, a collection of leading industry groups and mental health non-profits. Through the Mental Health Media Guide and the Mental Health Storytelling Coalition, storytellers can learn and be connected to experts who can help shape safe, authentic, and nuanced portrayals of mental health.

The report is the latest from the Annenberg Inclusion Initiative and is available here.