Beyond Content Notices: Mental Health Accessibility in Gaming
by Blog Writers
Editor’s Note: This blog contains mentions of suicide, self-harm, and panic attacks.
By Coty Craven
Imagine this scenario:
You’re enduring a depressive episode. You’re isolated, you’re no good at asking for help, or maybe mental health care is inaccessible to you. The current state of the world is not helping things and suicidal ideation remains stuck at the back of your mind because nothing is showing any signs of getting better. You’re longing for a break from what you’re feeling and video games have always provided you with that, so you fire up the latest game you’ve just downloaded.
Instead of that desperately needed break, the first thing you’re met with is a cutscene in which a young woman is willing herself to commit suicide. Now the one place you can often find an escape is mirroring your reality and you had no idea that would happen when you bought the game. What goes through your mind?
Games are a powerful medium. Some of the most important relationships in my life began because of a shared love of them. I’ve used games as a tool to navigate grief, loneliness, and depression. I’ve cried during the death of a character I’ve spent dozens of hours with in a fictional world and agonized over who to pursue romantic relationships with in games that feature them. Games are a unique medium in that they put us in control of the characters and events in the way books, TV, and movies cannot. In games, we walk into the burning buildings, carry out acts of war, and face the deaths of loved ones. Given games’ unique nature, we can be impacted by them in unique ways.
The necessity – and the dire state – of mental health accessibility in games was recently brought into sharp focus for me a few months ago during what I’d intended to be a relaxing gaming session after my weekly therapy appointment. Undergoing EMDR (eye movement desensitization and reprocessing) therapy for a fire-related trauma, my session had been difficult with time spent recalling and focusing on the memory of the trauma I was processing. My therapist prescribed self-care and being gentle with myself as my homework that day and asked me to avoid triggers related to the work we were doing. My method of choice for self-care? Time spent continuing my fifth play through of one of my favorite games, The Witcher 3.
Screenshot from The Witcher 3.
Still on edge from EMDR, I launched the game and snuggled up on the couch with my dogs. Continuing the main quest line, I led Geralt to Crow’s Perch, the Bloody Baron’s hold in Velen. Geralt ran toward the castle where alarm bells were ringing and as he approached, the unmistakable roar of fire filled the air. I’ve played this game five times and knew precisely what to do. Run to the burning barn, climb the ladder, free the horses, unblock the barn door, and save the trapped man. But this time it was different. This time, the roar of flames was fresh in my mind, the urgency of escape and safety my only focus. My chest became tight and my vision narrowed. I could feel my heartbeat in my teeth and the metallic taste of adrenaline filled my mouth. Before I knew it, I, too, was surrounded by flames and choking on smoke.
From the safety of my home, this quest in a game I’ve played countless times brought on a panic attack. This usually mundane quest didn’t even cross my mind as being potentially triggering when I sat down to enjoy the game. I later asked my therapist why this time, what had changed since the first five playthroughs? She explained that my brain was essentially more primed for panic from things related to the trauma we were processing together because the event and all the emotions related to it were fresh and top of mind because we were revisiting them through EMDR. She also explained that it wouldn’t always be like that, which was a relief because I just wanted to enjoy time with Geralt.
According to the National Alliance on Mental Illness (NAMI) one in five adults and one in six youth in the US experience mental illness every year. Among them are PTSD, depression, and anxiety. With 65% of the US population playing video games (ESA, 2023) it’s safe to say that far more than just me stands to have their mental health impacted by video game content.
The games industry has made massive strides in accessibility in recent years with the launches of games like Forza Motorsport and Stories of Blossom and updates to games like Marvel’s Spider-Man 2 which brought audio description and full closed captions among many other improvements. Though we still have a ways to go, games can be enjoyed by more people than ever before. There’s one area in which we’re still regularly failing in accessibility though – mental health. While we are seeing many games addressing things like thalassophobia (the fear of deep water) and arachnophobia, there’s still little being done to aid gamers with things like PTSD, anxiety, and depression beyond the general “this game contains depictions of…” warning many games display upon launching them. If your mental health could be impacted or even harmed by content such as structure fires, racist violence, or the death of a child, there’s not really a standard in place to support you in making your gaming choices. So what’s a person to do if like me, they’ve been given instructions to avoid triggering topics and have no way to tell what they may experience in a game?
Chicory: A Colorful Tale allows gamers to skip certain content.
In the Xbox Accessibility Guidelines, Microsoft offers guidance on how to support players wanting to protect their mental health. They advise providing players with information on game and story content and tools to skip or avoid potentially triggering content. Recently, we’ve seen more games trying to address mental health. Horizon Forbidden West patched in a thalassophobia mode which lessens the deep water effect for underwater areas. Lethal Company has an arachnophobia mode which turns all in-game spiders into the word “Spider.” The Dead Space Remake has a robust content warning system that allows players to both be warned when triggering content is coming up and skip it entirely, similar to that of Chicory: A Colorful Tale.
So many of us play games both to connect and escape and nothing can wrench someone out of that joyful place quite like being unknowingly confronted with something traumatic or triggering. As conversations on mental health become more and more commonplace and accepted, I hope that games can catch up to meet the needs of those of us who love the medium and want to protect our peace by building better and more thoughtful content warning systems, so we can enjoy our hobby while also caring for ourselves.
Coty Craven is a game accessibility and inclusion expert and the founder of game accessibility sites Can I Play That and the Game Content Triggers Database. He lives in Michigan with his dogs and works as a project manager at Descriptive Video Works. He loves exploring fictional worlds in games and exploring the outside world on hikes.
