Game For Thought - Mental Health in the Digital Entertainment Industry

For the panel, Keisha Howard, Jean-Gobert De Coster and Rachel Kowert were invited to share their insights, while Allie Weis moderated.

Check out the full video here:

How to insert mental health themes in games without compromising the entertainment value?

Keisha Howard: It’s going to be difficult for game developers without a medical background to be responsible for tackling such themes correctly. “Mental Health” is a broad concept that can mean so many different things to different players.

Rachel Kowert: Indeed, if you’re going to create a game with mental health themes, you should be consulting with mental health professionals. You don’t have to become the expert yourself. But it also depends on what you’re making. Is it Depression Quest, a game made to provide insight into what depression is like, or are we talking about Stardew Valley or Psychonauts 2, which are entertainment games first, that happen to have some mental health topics interwoven into them. It depends heavily on what you’re trying to create.

Jean-Gobert De Coster: I’ve discussed this with a researcher who works on educative games and the conclusion was that when a game tries to be educative and tries to add a layer of fun on top of it, it doesn’t work. If the game is not fun, there is no stimulation. It doesn’t necessarily have to bring joy, but it does need to create emotions.  Even a game that scares you is going to trigger some things in your brain, making you learn from the experience. If you want to develop a game that is articulated around a theme, you’re better off making the game first and then injecting the theme into the game. Build the fun mechanics first and then add the other layers on top of it. Fun comes from the experience, it’s not something you can slap onto a product afterwards.

Which games represent mental health in an inspiring way?

Rachel Kowert: I have to say Hellblade: Senua’s Sacrifice. Ninja Theory consulted with a group of psychiatrists in order to present a nuance and accurate portrayal of schizophrenia. The main character, Senua, has auditory and visual hallucinations. It wasn’t developed to be a game about schizophrenia, but it added an extra layer. They wanted it to be a good representation of what it feels like to suffer from the effects and for this, they extensively consulted with people who understand the mental condition. They then built it into the mechanisms and the narrative. It can be very powerful, as it can even help family members experience what it’s like and understand the people who have schizophrenia better.

Hellblade really set the gold standard, but many others do it great as well: GRIS, Celeste, Psychonauts 2… It’s becoming ever more prevalent in both the indie and the AAA space.  

‍

Jean-Gobert De Coster: The first game I thought about was GRIS, like has been said, mental health is a very broad topic.  GRIS is about grief and depression. But I’m also thinking about games like The Stanley Parable. I’m not sure if there was an intention behind that one to have themes of schizophrenia, but there is also that little voice in your head and you decide whether to follow it.

If you’re telling a good story, at some point you’re going to tackle “a problem”.  You create rich characters, and such characters have rich issues. That’s why we make story games: they carry those messages naturally. For Asfalia: Anger , we’re making a game where a child has anger that is so strong, that it wakes up in world constructed from their own anger and then meets various characters that embody different inner conflicts. When you look closely at those characters, you’ll find themes like toxicity, escapism, obsession, the frustration of not being heard.

There are thousands of games being made, on just as many different topics, so there will be something out there eventually for everyone. It’ll come naturally. As creators, if we put our heart and soul into telling a story, it’s going to be significant for some people.

Keisha Howard: Exactly. It’s super important that we are cognizant of the impact the characters and stories we create can have on other people.

How to foster a safe and supportive community for players’ mental well-being

Keisha Howard: We first need to collectively define what safety is. When we want to create a safe space, who are we giving the reins to secure that safe space? “Gamers” are one of the most diverse consumer demographics, so everyone is represented in some way. If you want to be inclusive, you’ll need to deal with people who have a personality that is different from yours, which doesn’t always feel safe. But it’s empowering, building such a space yourself or holding other companies accountable for doing what is needed for their own communities.

Communities form naturally around a game. If you play DOOM or Call of Duty, you’re going to have different type of interactions with people than if you’d be playing Animal Crossing, but that doesn’t need to mean that one game is better at making the people inside the community feel positive in a certain way. We are all responsible as members of such a community for making it happen.

Rachel Kowert: I agree with Keisha. What’s considered toxic or acceptable in one community is going to differ from one game to the next. I think the best advice I can give is for the players, to help curate the kind of space you want to be in. If you see something you don’t like, say something. That’s how the culture gets shaped from the bottom up.

Jean-Gobert De Coster: I’ve been an exchange student in Canada for a year and you’d be surprised how two cultures that seem the same from the outside actually have different ways of thinking about topics. People will often speak as if they are bringing up a general truth that is experienced the same by everyone, but they fail to realize when that is not the case. This can create frustration and even violence in the interactions.

If a game developer can help address such things, often depends on the culture of the company. An example of a good community is the one behind Hades, as the game is inclusive to many types of romance and characters, and the developers understand that there are people like this in their community as well. It’s a difficult game, and it’s dangerous in such games to have a “git gud” kind of mentality, where players just blame each other’s lack of skill in not being able to progress, but Supergiant Games has managed to foster a community where this type of thinking isn’t supported.

Asfalia: Anger is played by kids and a single-player narrative, so it will not build online communities around it, but the kids will talk to their friends and family, and as a game developer, we can still add the values into the story that we want the players to share with others.

Does the process of focusing on mental health differ in indie studios, versus larger AAA studios?

Jean-Gobert De Coster: It comes down to the values the company was built on. With an indie studio, it’s easier to uphold those because you don’t have to account for shareholders or other external factors. If you’re an indie studio, and you want to stay true to your values, it should be one of the first things you establish. Identify your core values first, and grow your company around them.

Keisha Howard: I love Jean-Gobert’s response. I look at videogames as art, and when you’re an artist, you can choose to make art for yourself. Videogames are a medium for different types of artists, from writers to designers, but when we’re thinking about studios we also have to insert profitability into the game and this can drastically change the conversation. We have an innocent attachment to games as we grow up, but then as we become adults and work in the industry, that “putting your values first” can change when you’ve got to pay your bills. This means that you’re not always going to have the chance to work in a setting that aligns with your own core values.

Rachel Kowert: For a big company that has shareholders, the bottom-line is going to be the most important. But there is research to support that burn-out and crunch diminish the bottom-line. Having to rehire new people and train them up, is far more expensive than taking care of the employees you already have. We see some AAA do this better than others, or some indies do it better than others, in terms of how they address mental health in their games and treat their employees. There is a balance that can be found, it just has to be a priority for the company, and the financial argument is there if you look for it.

Editors note: Be sure to check out Rachel’s YouTube channel Psychgeist, which tackles such topics as well.

How can companies support their employees in a positive way?

Rachel Kowert: Be a good human. Don’t overwork your employees, take care of your workforce. Take This is a place that fosters good mental health. We have the whole week off for thanksgiving, if someone is feeling burnt-out and overworked we find other people to come in and take their place or ease their workload.

If a company forces people to work longer hours and go beyond their limits, that just produces bad games. As much as we’d like to pull on the heartstrings of the ethical argument, you have to be your own best advocate. If you’re being asked to overwork and the studio is capitalizing on your desire to work on games, you have to place your own well-being first and start looking for a different studio.

Keisha Howard: I agree with Rachel. On the other hand we do have people in our company who are neuro-divergent, and for some of them, spending 20 hours on something that they really like and hyperfocusing in the task is just something that they do. As a studio we want to protect them, but everyone should be allowed to navigate their mental health in way that works for them.  

It’s the studio’s job to make sure that there is space for people to work in the way that is most comfortable for their employees. But it’s important to know when you’re being exploited and abused, so you can make the proper decisions for yourself. What’s best for you might not be the best for another person, so we have to be careful not to apply a blanket approach for everyone.

What is the best way to handle a pro-crunch company?

Keisha Howard: Part of the issue is that the games industry is one of the most competitive industries to work in. If you can, you should research if the studio you’re going to work for has a pro-crunch culture and if you see yourself working in such a setting. And if abuse or exploitation is going on, don’t be afraid to call it out for what it is. If the company is transparent about this upfront, maybe just take a pass on them to take care of your own mental health. But that isn’t always as easy and not everyone has the luxury of choice, because as an adult, you also have to take care of your finances. Finding that balance is where it can get hard.

Jean-Gobert De Coster: There are several sources of crunch culture. Sometimes it can come from the team itself because they are happy to work long hours on a project they are passionate about, but I think that some of the responsibility lies with the company to prevent that. Not just for those people, but for the others. Otherwise it can create a situation where one person is overperforming and their colleagues could feel pressured into keeping up. It’s a communal responsibility to prevent crunch culture from snowballing.

Should companies hire the right people to make sure mental health issues are represented correctly?

Rachel Kowert: Absolutely. Overwatch 2 even had a huge uproar when a recent character was announced, Sigma, and he had a short backstory of coming out a mental health institute and not having shoelaces because he could hang himself with them and it being approached in a humoristic way. The mental health community immediately attacked this for being an awful thing to put out and to reinforce the idea that psychiatric treatment is an unsafe place. And Blizzard did have to come back on those decisions and approach that characters background differently.

Companies carry the responsibility and they should be consulting people to prevent them from contributing to gross overgeneralisations and stereotypes that we have about mental illness, because these are harmful.

Jean-Gobert De Coster: For Asfalia: anger, I’m consulting with a coach in schools who helps children to identify and talk about their emotions. I didn’t work specifically with a mental health expert, but it is someone who is experienced in the field of the theme for the game I’m working on.

How can you reintegrate a colleague that was burnt-out?

Rachel Kowert: There was a wonderful talk on burnout at GDC 2023 that goes over this topic. There were even two stories about reintegrating someone with a burn-out and each one took a different path. It will require the involvement of a mental health professional and it will require a person going at their own pace.

What role can mentorship and peer-support play in this?

Keisha Howard: It’s imperative. All this new technology connects us to people across the world, and allows us to be part of different communities. Allow people to make friends and give guidance to each other. “Give people their flowers” is an expression I use often. Compliment others on their achievements and it’ll be a great way to build relationships. You don’t have to take on the formal role of a mentor, just to acknowledge the good other people do.

In this Game For Thought Panel, we looked at the importance of mental health in games and in the studios that make them. It’s an important aspect to keep in mind during the process of game development and will require the advice of mental health experts, so don’t be afraid to consult with them.

About Game For Thought

Game For Thought (GFT) is a livestream series launched by Howest – Digital Arts and Entertainment (DAE) in collaboration with local medialab Quindo and sponsored by Vlaams Audiovisueel Fonds (VAF), it tackles ethically-relevant topics in the games industry and explores the impact & implications of industry developments. Each broadcast, Allie Weis, ethics coordinator at Howest DAE, invites a selection of industry experts to discuss the topic at hand.

‍