Safeguarding the welfare of reality television participants is under the spotlight. Following the death of a guest on the Jeremy Kyle Show and the deaths of two former contestants in the reality dating show Love Island, the UK government has launched an urgent inquiry into the duty of care these programmes have to participants. Questions are being asked about the level of support provided to participants before, during, and after filming and how this is regulated. For doctors involved in this work, what guidance is available?

Reality television has come to dominate our television schedules over the past few decades. Yet its rapid expansion has highlighted international differences in broadcasting standards and led to growing concerns about some of these programmes’ formats and the welfare of those who are filmed.

In the UK, the Office of Communications Broadcasting Code contains protections for children and, to a lesser extent, vulnerable adults. Ofcom does not provide guidance for how vulnerabilities should be identified, but notes that they are broadly defined and can vary. Broadcasters are obligated to ensure children or vulnerable adults do not suffer “unnecessary distress or anxiety” when taking part in programmes, but this is not extended to adults who do not meet these criteria. This is concerning, especially when programmes include individuals in order to highlight difficulties or create drama. While some broadcasters publish their own protocols, such as the BBC’s Editorial Guidelines for working with vulnerable contributors, these are not enforced or standardised throughout the industry. Nor do they specify the duties expected of specialists who are called on to assist. Like Ofcom, the BBC provide definitions of vulnerability.  

Clinicians work on reality television at various stages. In pre-production, potential participants are screened for suitability. During filming, professionals assess and treat participants for any mental or physical difficulties that arise during the project and occasionally are filmed themselves, for example commenting on health-related issues. Post-transmission support is sometimes offered after programmes are broadcast, although to what extent and for how long varies greatly. Participants are usually expected to request this, but often those most in need are the least likely to seek help.

Many pre-production “psych tests” are done by psychologists for whom there is guidance from the British Psychological Society but some programmes require a medical opinion, for which no specific guidance exists. Yet working with the media carries significant risks. When in front of the camera, professional and personal conduct is scrutinised and doctors risk disciplinary action if they undermine public trust in the profession or fail to act with integrity. When working in pre-production and during filming, clinicians may have to navigate tensions between the demands of the programme’s format and their duty of care to participants. In my experience, and from what I’ve heard from other assessors,it is not uncommon for producers to put clinicians under pressure to ensure the more extreme (and more vulnerable) personalities “pass” the psych test, as they provide greater viewing entertainment.

A common ethical dilemma arises when vulnerable individuals are keen to participate in reality shows despite it being medically inadvisable. What duty or power does a doctor have in stopping them? In the absence of empirical evidence, how can you explain or evaluate the pros and cons of being on television, for which the potential outcomes range from experiential fulfilment and financial gain to public vilification and deteriorating mental health? And if the individual subsequently comes to harm, who is responsible? In March, the health secretary Matt Hancock said that reality TV shows have a duty of care to contestants who participate in their shows and the producers of Love Island have introduced new duty of care processes.

If, as a result of the government inquiry, stricter regulation and increased welfare provision are enforced for reality television participants then the duties of clinicians must also be clearly defined. In the meantime, work as a media expert should follow the same standards as other expert witness work. The Royal College of Psychiatrists’ guidance for expert witnesses provides a useful template, which considers relevant issues in detail, including restricting opinions to areas in which one has expertise and avoiding independent assessments on patients under one’s own care. Other existing principles and legal frameworks can be adapted for media work, such as the Mental Capacity Act 2005 when assessing capacity to consent to participate in television programmes.  Most importantly, doctors are advised to ensure that they are indemnified and never stray from the General Medical Council’s principles of Good Medical Practice.

Penelope Brown is a clinical research fellow and consultant in forensic psychiatry at the Institute of Psychiatry, Psychology and Neuroscience, King’s College London, and South London and Maudsley NHS Foundation Trust. She has worked as an expert witness and independent mental capacity assessor for television production companies and broadcasters since 2010.

Competing interests: PB is funded by the Wellcome Trust and NIHR Biomedical Research Centre to carry out research at the Institute of Psychiatry, Psychology and Neuroscience, King’s College London. She has worked as a self-employed mental capacity assessor for production companies and broadcasters including the BBC, The Garden Productions, Minnow Films, and Studio Lambert.

The opinions expressed in this article are the author’s own and do not necessarily reflect the view of the Wellcome Trust, the BRC, King’s College London and South London and Maudsley NHS Foundation Trust.