In the wake of criticism, the reality TV show Love Island introduced stricter mental health checks for its contestants. But even in clinical settings, risk prediction is an uncertain business, finds Ian Hamilton

After a break of 18 months, the hit reality TV show Love Island is set to return for a seventh series next week. The show’s successful six year run has been blighted by the suicides of two previous contestants, Mike Thalassitis and Sophie Gradon, and accusations that the welfare of those participating has been neglected. Responding to this, ITV announced an enhanced support package for contestants in 2019, which it confirmed again earlier this month.                                                    

The welfare of reality TV contestants has come under the spotlight in recent years. In the wake of greater public and parliamentary scrutiny, Ofcom issued new rules on producers’ obligations to protect reality TV participants, which came into effect in April 2021. ITV’s protocol takes up Ofcom’s charge that broadcasters follow a clear standard of care: their announcement recognises the negative as well as positive fallout associated with appearing on the show, including critical social media and the psychological impact this can have. What’s changed with this support package is the idea that these conversations should take place with potential contestants in advance of the show, rather than waiting for things to go wrong during or after the series has aired. The show has also placed a greater emphasis on aftercare, with the offer of at least eight therapy sessions after filming and a promise to provide “proactive contact” for 14 months after the series has finished.

Potential contestants will receive “thorough pre-filming psychological and medical assessments,” presumably with the aim of highlighting any psychological vulnerability.  ITV doesn’t, however, say how they will act on the information these assessments might reveal and who ultimately decides a potential contestant’s fitness to be on the show. In the past, mental health professionals working on other reality TV shows have aired their concerns that their advice was overruled when it came into conflict with the pursuit of providing entertainment.

Any attempt to predict the potential risk for suicide in an individual is also known to be difficult, as any mental health professional will attest to. Even though previous suicide attempts are a useful indicator, this relies on an individual sharing this or confirmation from a collateral source such as their GP. Given the motivation of those applying for a place, it is also questionable as to how likely and willing they would be to give an accurate picture of their mental health, knowing that any negative assessment findings could jeopardise their chance of selection. Some candidates will simply give the answers they think the assessors want to hear and that maximise their chance of securing a much coveted place.

For decades, mental health services, just like TV broadcasters now, have sought to control risks to those they’re looking after, including the risk of self-harm and suicide. But risk is messy and riddled with uncertainty; there’s a danger that completing a checklist or assessment gives producers false confidence they have mitigated this risk when the reality is that they can’t completely. 

What is predictable is the hostile media, including social media, attention that will be directed towards some of these contestants. Even if a person starts the process with optimum levels of confidence and wellbeing, this can evaporate quickly when they are on the receiving end of relentless and all consuming negative attacks. The impact this will have will be variable: while some people may be able to handle this attention, it’s more likely to play into existing negative thoughts and problems with self-esteem. Candidates’ motivation to apply is most likely fame, money, and possibly meeting a new partner. But even with the strongest of motivation, nothing can truly prepare these young people for the hostile personal attacks that can be directed towards them.

Of course, it’s not just prospective contestants who have a potential conflict with how they handle information about risk. The producers of reality TV rely on characters that engage viewers: having a group of well balanced participants who all get along will not always bring in record numbers of viewers. The formula relies on in-fighting, back biting, and challenge—for some, these ingredients have the potential to trigger a rapid deterioration in mental health. Will producers with an eye on ratings and the pressure to bring in revenue always be able to resist stoking this type of drama at the expense of the individual contestant?     

It’s welcome progress to see television producers not just recognise the risks to participants’ mental health, but to try and mitigate them. This is a goal we also strive for in clinical practice when assessing people who are struggling with their mental health, but the lesson we can share is that risk is individual and guidelines, by their nature, are general. If understanding this helps us all move beyond a checklist mentality and appreciate the individual, that’s the kind of love I’d like to see.

Ian Hamilton is an academic at the University of York with an interest in addiction and mental health. He previously worked as a mental health nurse with people who had combined mental health and substance use problems. Twitter: @ian_hamilton_

Competing interests: None declared.