PAX East 2021: Gaming streamers are frontline workers, not mental health experts

Look at me accomplishing very little.

Since PAX East 2021 is virtual again due to that little virus that’s been going around for over a year now, it should come to no surprise that it’s been prompting topics in gaming spheres. In fact, Take This’ Dr. Kelli Dunlap, mental health streamer Mxiety, and Games and Interactive Media MFA candidate Jocelyn Wagner worked on peer-reviewed research about mental health of streamers during COVID-19, and that was the subject of a panel this week at the convention.

While there’s a lot of research on stream users, streamers themselves seem to be much more under-researched. Dunlap noted that at academic conferences, mental health peers often don’t even know what Twitch or streamers are. While it should come as no surprise as moral panic plagues games to this day, the fact that many people were turning to streamers during COVID rather than mental health professionals says something not only about the stigma of mental health but about the accessibility of it. Despite the fact that two out of three of the presenters are in the mental health field, streamers in general are not mental health professionals and should not be treated as such, but they were thrust into the role of first-line responders by their communities.

Reference list

Before we get into the meat of things, I’d like to start out with some references recommended by the speakers that people can use if they’re going through a mental health crisis.

  • Mxiety’s Webpage is a good starting point, especially if you’re just starting to reach a point where you need help.
  • Safe in Our World is another good starting point, especially for gamers and game industry people, and they have international resources as well.
  • Take This, which Dunlap is a part of, is a good resource for US-based gamers and industry folks, as they have staff and recommended clinicians who are familiar with our hobby in particular.
  • Crisis Text Line works as a quick catch-all for any US citizen in a major crisis who needs mental/emotional help on the spot.
  • Games and Online Harassment Hotline is fairly self-explanatory and quite relevant for our US community members, though please note they’re only available in the evenings daily.
  • National Suicide Prevention Hotline stresses that you don’t need to be suicidal to call; you can get support for friends or dealing with revelations that someone close to you is suicidal.
  • Twitch Cares could be a very simple catch-all for streamers to link should they find themselves in a situation where they’re asked to be a therapist but are worried about filling that role.

Remember, even if streamers are licensed therapists, they are not your therapist. It’s best for you that you start with some of the above resources and then find personal help through a professional. Through personal experience, I know that some people may qualify for free help through their work or healthcare provider, even if it’s through service provided by the US Affordable Healthcare Act. The streamer-as-therapist-but-not-really issue was, in fact, the crux of the research issue.

“I’m not a doctor, but I play one on Twitch”

One thing that continually came up during the team’s research was the streamers’ experiences being thrust into the position of therapist. Starting from 62 candidates whittled down to 19 participants, the streamers (all with at least one year of experience prior to COVID) all had experience with community members, publicly or privately, revealing mental health crises to them.

This is neither new nor COVID-specific. The team found evidence of people using internet personalities as replacements for mental health workers as early as the internet broadcasting of the 1990s. But COVID seems to have made it occur more often. As one streamer told the researchers, there were always community members who would need some extra attention, but suddenly it was everyone, including the streamers.

While Dunlap is a trained professional, she is not the norm. Most streamers are obviously entertainers. One big “no-no” that a professional clinician abides by is not trying to treat patients with issues they themselves are getting help with, but streamers suffering from their own anxiety and depression were offering at least an ear if not actual advice to their communities. Dunlap noted that she felt perfectly comfortable describing many streamers as front-line mental health responders, despite streamers’ lack of training and potential to give out bad advice, as their actions in a time of crisis and the emotional impact of said crises matched those of trained professionals in similar situations.

To note, the streamers didn’t do this as a kind of self-promotion. Indeed, streamers often indicated that even when they noticed they were suffering from mental health issues themselves, they’d feel guilty about wanting to take a break or not wanting to get involved in someone else’s problems. They also felt as if they owed it to their communities to become educated and offer some kind of advice. The problem was that many didn’t know where to look beyond Google or occasionally contacting one of the researchers themselves due to their reputations as fellow streamers.

While the Twitch Cares page we noted above is available, most streamers didn’t know about it, and one even laughed about its existence. No one seemed to trust Twitch to be able to help anyone handle mental health issues. The researchers noted that Twitch is above average in taking mental health seriously, but it’s also disheartening that accessing the Twitch Cares page from the homepage – hidden behind six sub-menus – is about as difficult as finding the refund page on Amazon. If Twitch cares that much, the link should be directly found on the homepage.

Now, it could be easy to simply let the streamers off the hook. Afterall, most “real” celebrities aren’t half as accessible as a streamer. They can stay off social media and still earn the big bucks, while even a major personality may lose about a fifth of their subscribers if absent from their stream for 48 hours, directly affecting their revenue. The whole reason the streamers are paid is that they’re accessible, so time away from their communities can be seen as lost content for users.

Worse, though, is that the accessibility to one’s favorite streamer is wholly unique compared to most other celebrities, feeling more akin to traditional Japanese Geisha, who were essentially celebrities for personal entertainment, rather than to modern movie or music stars. This distinction is pretty important as someone saying, “This musician saved my life,” can rarely be as literal when applied to a streamer, whom fans can actually directly communicate with.

Although this can be highly rewarding for the fan, the lack of boundaries can be oppressive not just for streamer but for the entire community. One interviewed streamer noted that streaming was a way to destress as well. The streamer didn’t want to be in charge of making everyone else happy, and a single community member emotionally dumping in chat could bring everyone down regardless of the streamer’s hard work to create an upbeat atmosphere.

At the end of the day, the pressure to be both community performer and personal therapist is mentally and emotionally draining for streamers. While about 3 million of the about 7 million streamers prior to COVID quit during the first month of the pandemic, Mxiety noted that many streamers often talked about burnout and guesses it’s quite high in the field. The lack of training and support while simply trying to be an entertaining personality certainly has worn down many a streamer during the past year.


Wishes for the future

When the streamers were asked what they wanted to address their issues, the first thing was resources. In particular, they wanted it to be easier to connect people with mental health resources and professionals. However, as previously noted, the majority of mental health experts are ignorant of what streaming even is, to say nothing of the issues that streamers go through themselves when acting essentially as non-volunteer hotline workers.

What’s worse is that streamers also want something beyond links and hotlines. People often seeking mental health often don’t want to be referred elsewhere, and I’ve had people in crisis tell me as much. That’s a hard pill to swallow when you’re a non-professional suddenly being asked to listen to a stranger’s very personal suffering when somebody’s on the edge of doing something with mortal consequences.

I’m not sure exactly what these people or the streamers expect, given that mental health is more than simply vomiting up feelings and walking away. It’s about looking at one’s own habits and changing them. That being said, the researchers suggested something like psychological first-aid training. While most streamers may not want to act as frontline para-therapists, those who truly care could potentially go through a course so that in emergency situations they can rely on some kind of training to get fans in crisis, as well as themselves, through some hard situations until a trained professional can step in.

The streamers and their communities are resilient. They do find ways to cope, from emotional dumping to in-game memorials we’ve all read about or participated in. However, many fans need to remember that their favorite streamers are not actually their friends and are certainly not their therapists even if that’s their profession. We previously talked about how MMOs may not be the big communities we often think of but rather “socially saturated environments” where other people are more of an audience instead of partners. I’d argue that people who emotionally dump, in that moment, are thinking more of themselves than their communities, which is natural for someone in crisis.

I say this not to shame people but to remind readers that using the above-mentioned resources should be the first path to restoring one’s mental health to workable levels. It’s good to talk about things, but our friends and family aren’t always equipped to deal with crisis. They may love and care about us, but even our fellow adults aren’t always mentally mature, especially during a time when people around the world are having their mental health tested. Be pro-active about your mental health, and as much as you may love a streamer, their job isn’t to save your life. That’s on you and the people who actually train to help you with that. Use them and then return to your favorite streamers so you can enjoy them while they do the work they actually want to do, because you know what? That is actually how you can help save their lives.


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Some people just need a place to ‘vent’, where they can feel like someone’s listening/caring (Even if they aren’t.). Many of the streamer’s community members just throw out bits about their lives because they want ‘to be heard’. Often, most of the people actually ‘conversing’ don’t actually give a crap whether someone’s responding to them, they are just ‘getting it off my chest’. I’ve watched a few streamers off and on over the past few years, and seen many people in their chats just unload their ‘issues’.

As someone who spent a goodly portion of their life in ‘therapy’/locked up in ‘facilities’ and learned many ‘coping mechanisms’, and lots of psycho-babble and explanations (Who could probably actually help others if I weren’t in such a shit situation myself…) I can honestly say it’s just about as helpful as any other means. Yeah, maybe they aren’t ‘trained’ for it, and they ‘shouldn’t have that kind of power’ over others, because some people use it for ill will, but some really do care, and want to help others.

I was watching GTA RP when a few streamers lost another streamer to suicide. (I found it ironic that they acted like they cared about his loss, when they blatantly ignored him in-game most of the time…because he had one of those droning/monotonous voices and tended to be slurred/sluggish because he was constantly self-medicating with some ‘ahem’ substances…) This effected a few other streamers too, who came out with their own mental health/other struggles…and some ‘drama’ happened behind the scenes…(I read about some of it as an outside observer from videos they dropped on stuff like Twitter talking about it…) and this was around the time people started addressing some other issues that Twitch seemed unwilling to ‘care’ about…(LGBTQ/Mental Health/Sexism/racism/Etc/etc)…hence the laughter that statement caused among them.

One of the main characters I watched was actually a (Mostly?) Puerto Rican male (He often ran a face-cam…he actually looked like a regular white guy you’d see anywhere…) who played a Chinese man on the game, and Twitch after some people started calling them out on it, made him revert from using it and make a new character and they (The people running the server) started making him new skins and whatnot because he was a highly rated streamer with a huge following…but he’d casually make statements blowing it all off acting like it didn’t matter and saying he should be able to go back to what he was using before. (Which lead to him leaving Twitch and going to FB streaming service instead…so he became hard to find if you didn’t know how to navigate that service…) I kinda stopped watching him after all of that, and watched some of the other people he’d interacted with, but none of them had the same flair, or were all using their own unique ‘shock jock’ version of play to keep people entertained…while masking their own insecurities…I watched a Mormon woman who expressed her own issues with family (Her desire to rebel), and how the more I looked into her stuff, the more I realized it was all just a facade, and she was about as vain as they come…(Had gotten surgery to change/improve her looks…)…and was constantly showing off her car/computer rigs/etc and playing characters that she wished she COULD be. Another was a man who’d come close to becoming homeless before he found streaming and ‘gave thanks to his community every day’ for their support…who had a lot of random people that interacted with him with inside jokes that many people didn’t understand. I stopped watching him when he began using some ‘Pepe the Frog’ thing that mimiced when he talked, because he thought that was “OK” to use, and many others on Twitch do also, when Twitch has used many racist symbols for a long time now with people obliviously (Or not so much) going along with it.

That’s what our worlds are to some people. What they want life to be. Not what it is. Streamers and the people who watch, and the people who PLAY these games…the alternate realities. The alternate ‘facts’ for some of them.

I don’t claim to be much better. I’ve got many issues of my own. I keep them all close to the vest, because I learned a long time ago, nobody is trustworthy. I barely share my ills with others. Yes, there’s stigma, but there’s also, a point at which some of us are just ‘too broken’ to ‘fix’. I’m one of those.

I would never use a service like the ones you describe, because I learned the hard way how someone can lose their freedom if ‘you say the wrong thing’ to someone like that…(I had a therapist get me locked up for suicidal ideation when I specifically told them I had no plan, and was not planning to act, was just having thoughts…and described them because they asked…they went and told some legal person a blatant lie {That I wanted to jump off a bridge…I’m smarter than that, I know you’d either survive or hit hard enough to not kill you…but only make you hurt bad, and that’s not a way I’d choose if I did one.} and got me committed against my will…which cost me a job…and dinged my resume, along with making me look bad in the eyes of others along with having to prove to a doctor/judge that I wasn’t a ‘harm to myself or others’, and basically lead to a string of other issues that cost me many things. Only one in a whole host of issues in my life…).

So before you go telling people to ‘just ring up one of these’ stop and realize, there are people who’ve been on the ‘bad’ side of ‘help’, and that ‘a call for help’ isn’t answered like it is in games with someone rushing to help, sometimes, it can cause more harm than good. (Sometimes, if you call the cops on someone having a mental crises, it can lead to their death by cop.)

That’s one reason some of these people use these outlets…because anonymity is safety.

Vanquesse V

Thank you for writing this.

Hikari Kenzaki

This has been something that I always try to make clear to people I know in various forums, games, Discord, etc. It can come off as callous or uncaring, but it is exactly the opposite.

No one you kinda sorta know on the internet is a replacement for getting the help you need.

People rush to comfort their friends in these digital settings as a way to
A) Genuinely try to help
B) Ease the discomfort of the situation
C) Or even take advantage of the person in need

These may in fact offer temporary solutions, but do you really want to be the person who “cheered them up” only to have them do the unthinkable a week, month, or year later?