When MTV introduced its long-running documentary series “True Life” in 1998, the first installment offered a grim look at heroin addiction. Reporting from the affluent Dallas suburb of Plano, Tex. — where a spate of teen overdose deaths had caused nationwide alarm — Serena Altschul interviewed young adult subjects as they used intravenous drugs. Director Wilson Van Law told the Houston Chronicle he was so unsettled by what he’d documented in “True Life: Fatal Dose” that he temporarily quit smoking and drinking. “It certainly depressed me,” he told the newspaper. “It was the most difficult story I’ve worked on, and I’ve done some pretty dark stuff.”

Though groundbreaking in its own way — the broadcast was followed by a number for Narcotics Anonymous and a roundtable on addiction — “True Life: Fatal Dose” stands in stark contrast to a new MTV series about teens struggling with addiction. “16 and Recovering,” which premiered Sept. 1, follows students at Northshore Recovery High School in Beverly, Mass., a Boston suburb hit hard by the opioid epidemic.

As principal and founder Michelle Lipinski says in the first episode, relapses are a reality at Northshore. But viewers never see the students using substances. While there are serious moments — one episode revolves around the overdose death of a beloved student — the overarching theme of “16 and Recovering” is one of hope, as Lipinski doles out hugs (and surprise drug tests) in the school’s hallway. “The world needs to be a kinder, gentler place with people who are struggling with addiction,” she says. That sentiment extends to the world outside the show: A companion website for the series lists resources for those who may be struggling with substance use.

“16 and Recovering” offers a glimpse into a shift executives at MTV and its parent company, ViacomCBS, hope will lead the entertainment industry when it comes to tackling mental health on-screen. The forward-looking approach is outlined in a comprehensive mental health media guide the network compiled in partnership with the University of Southern California’s Annenberg Inclusion Initiative and a group of mental health organizations, including the American Foundation for Suicide Prevention and the youth-focused Jed Foundation.

Mental health experts have for years emphasized that sensitivity is needed when it comes to exploring topics such as mental illness, addiction, suicide and sexual assault in media. The efforts at ViacomCBS arrive as TV creators are increasingly grappling with how to responsibly address those issues in on-screen narratives and how to support viewers who may be vulnerable. MTV and its expert advisers describe the media guide as a blueprint for doing just that. Seen as a “living document” that will continue to evolve, it calls on TV and film creators across the industry to take a proactive and holistic approach to incorporating mental health and related issues into scripted and unscripted story lines.

MTV is uniquely suited to spearhead such an effort. The network was among the first to promote mental health awareness when it teamed with Jed in 2006 to launch Half of Us, a Peabody Award-winning campaign geared toward decreasing stigma around mental illness. Over the years, several notable celebrities have opened up about their own mental health struggles and related issues such as addiction on MTV’s airwaves.

But the network has faced some criticism, too.

An imperfect legacy

As anyone who has ever sat through a “Teen Mom” marathon can attest, MTV — along with its sister network VH1 — has a flawed legacy when it comes to unscripted television. Over the years, a slew of questionable incidents have unfolded on “Teen Mom” and its spinoffs: In 2017, the network was slammed for airing footage of an impaired driver after Ryan Edwards, who shares a son with “Teen Mom OG” cast member Maci Bookout, was shown driving erratically. The following year, MTV aired footage of Jenelle Evans, then a cast member on “Teen Mom 2,” reaching for a handgun during a confrontation with an aggressive driver as her 8-year-old son sat beside her.

VH1’s “Celebrity Rehab,” which premiered in 2008, was heavily criticized for making TV drama at the expense of individuals suffering from life-threatening addictions. The backlash ramped up following the deaths of several former participants, including former Alice in Chains bassist Mike Starr, actor Jeff Conaway, Rodney King, and country singer Mindy McCready, who died by apparent suicide in 2013. Later that same year, host Drew Pinsky announced there would be no more seasons of the show.

Pinsky recently told The Washington Post’s Emily Yahr that he still thinks the show made a difference. “I do believe we helped increase an understanding and awareness of the struggles of addiction and the challenges of treatment,” he said. “And as the opiate epidemic has unfolded in the public consciousness, I think people understand now even more vividly how serious this condition is.”

Chris McCarthy, president of entertainment and youth brands for ViacomCBS — which, in addition to MTV and VH1, includes networks such as Comedy Central, Logo, Paramount Network and Pop TV — said part of the Annenberg partnership involved taking a critical look at the company’s own programming.

One of the biggest takeaways was that the network could use a different approach with unscripted shows and the real lives they chronicle, he said: “It’s not something you can just write into a script.”

That self-reflection could lead to changes in the way ViacomCBS networks screen for potential reality show participants, he added. In fact, the media guide suggests that creators get mental health experts involved during the casting process so producers can make informed decisions about whether individuals who may be struggling with mental health issues or addiction are ready to share their story with the world.

Scandals notwithstanding, both VH1 and MTV have already made mental health a focus in documenting the lives of reality show personalities.

“Of all the shows I’ve worked on with Viacom, ‘Teen Mom’ is probably the one where we’ve tackled the biggest range of mental health issues,” said Courtney Knowles, head of Jed’s media practice. He cites last year’s “Teen Mom 2” fall premiere, which dealt with one young mother’s anxiety ahead of a family weekend trip. “It did a really good job showing the realities of that in a way that was really informative and educational, but also didn’t take away from the entertainment story line.”

Even “Jersey Shore,” for all its eyebrow-raising debauchery, spurred important conversations about mental health. A 2012 episode revolved around cast member Vinny Guadagnino’s chronic anxiety, which prompted him to leave the shoreside party house temporarily to seek treatment. And Mike “The Situation” Sorrentino has talked publicly about his battle with addiction to prescription painkillers.

Last February, VH1’s “Black Ink Crew: Chicago” stunned viewers with an emotional episode in which cast member Phor Brumfield opened up about his struggles with depression and suicidal thoughts. The rapper and tattoo artist was surrounded by his castmates, who urged him to get help. McCarthy said VH1 had been unaware of his struggles, but “with permission,” producers incorporated them into the show’s fifth season. “We were able to tell what we felt was a really great and thoughtful story over the arc of the season,” he said.

“Black Ink Crew” has continued to show Phor’s recovery and followed another cast member as he began therapy. These on-air moments can have a tangible impact: The night after Phor’s story aired, nearly 20,000 viewers visited the Half of Us resource site, according to a rep for ViacomCBS. The episode also prompted an outpouring of support for Phor on social media, generating more than 5 million video views and 200,000 engagements.

ViacomCBS’s media guide includes recommendations for depicting mental health conditions in people of color and in the LGBTQ community. It notes factors, such as stigma and racism, that may negatively affect the mental health of marginalized groups.

Earlier this year, Phor told the Root he took months off filming and started going to therapy after opening up about his depression. “I was in the process of healing and I knew through my story that I could help someone else,” he said. “Because these are things that get swept under the rug, especially in the black community.”

Setting an industry standard

Over the past few decades, medical professionals and advocates have quietly worked alongside creators and networks to avoid glamorizing or simplifying issues. But that work has tended to happen on a case-by-case basis, often as TV or film projects are nearing completion.

“When a new issue would come up, we would kind of have to dig to gather all the information and the data … what misconceptions were and what we should be emphasizing — often times in real time,” Knowles said. “Through the process of working towards this guide, what we found out it is that there are other people at other organizations that are doing the same thing.”

After more than 20 years of addressing mental health in its programming with varying degrees of success, MTV wanted to “take a step back and say, ‘How do we think about this differently?,’ ” said McCarthy, “And how do we use our power as storytellers to help demystify [and] destigmatize it?”

A study published last year by the American Psychological Association found that mental health conditions from depression to suicidal thoughts or actions were increasing among teens and young adults. Now, during the coronavirus pandemic and ongoing protests against police violence, both cited by experts as contributing to mental health struggles for Americans of all ages, advocates say it’s even more urgent that media approach mental health portrayals with care.

ViacomCBS plans to introduce the media guide at an industry summit this year, for use by outside creators working on scripted and unscripted entertainment. Even just under ViacomCBS’s umbrella, the media guide’s reach is potentially vast: For example, Netflix’s “13 Reasons Why” was produced by Paramount Television Studios.

The National Action Alliance for Suicide Prevention, one of the project’s expert partners, led the development of recommendations for suicide depictions in entertainment last year, spurred in part by discourse around the Netflix show, which featured a controversial and graphic suicide scene that the streaming service later deleted over concerns it could harm at-risk viewers.

The media guide is unique in that “it’s focused on broadening what we think about when we think about mental health and suicide depictions, including how to promote healthy narratives around hope and resiliency and coping,” said Colleen Carr, director of the Action Alliance.

‘16 and Recovering’

The thoughtful approach seen in “16 and Recovering” was the result of collaboration between director Steve Liss — who spent a year chronicling students at Northshore Recovery and later partnered with MTV to tell their stories — and Lipinski, who was adamant that the filmmaker follow certain rules.

“I said from the beginning, ‘You will not show one of my students using anything,’ ” Lipinski said in an interview with The Washington Post. “You’re not going to show pictures of needles. That’s not what this is about … I want to show what adolescent recovery looks like.”

Vulnerable young people may not always seek out mental health resources, Knowles said. But representation could potentially change that. Entertainment media is “one of the best channels we have to reach them and to relay these mental health messages and make them not feel alone.”

“Decreasing stigmatization, normalizing help, seeking and really providing authentic and human representation of mental health is so important” for viewers who may otherwise lack knowledge about where to turn, said Katherine Pieper, a research scientist for Annenberg.

In “Recovering’s” first episode, Liss captures a group of Northshore students at their prom — a hard-fought milestone. A bubbly student named Alba talks about her depression, which she says goes with addiction like “cheese and crackers.”

“You could be the happiest person on the planet, but depression is a sickness,” she says in a voice-over. “It’s something in your brain.”

“Mine will never go away, but I can try and help somebody else’s go away,” she adds. “And I guess that kind of makes me feel better.”

If you or someone you know needs help, call the National Suicide Prevention Lifeline at 800-273-TALK (8255). Crisis Text Line also provides free, 24/7, confidential support via text message to people in crisis when they text to 741741.

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