Games For Good: How ‘Hellblade’ Helped The World Talk About Mental Health

Tom Regan
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It’s hard to get away from the word ‘game’, isn’t it? While cinema, literature and television are all blessed with respectable-sounding monikers, poor old interactive entertainment seems to be stuck with the woefully reductive ‘video game’. It’s why — even in 2019 — many adults still think this billion dollar art form is no different, to say, Operation. While gamers may protest, to the uninformed, even something as majestic as Journey looks like an interactive toy. A video game.

Yet, in spite of all the ignorance that surrounds it, gaming is now a billion-dollar industry. In just five short years, Grand Theft Auto V has made more money than the original Star Wars managed in four decades. And now sports stars, politicians, and chat show hosts alike are desperately playing catch-up – making references they don’t quite understand and awkwardly smiling their way through Fortnite dance-offs.

But, while it’s great to see gaming become more widely accepted, there’s actually something far more important happening in the world of video games. Almost 50 years after Pong, developers are harnessing the unique interactive quality of video games in order to teach us all a little more empathy — and there’s no better example of this than five-time BAFTA-winner, Hellblade: Senua’s Sacrifice.

Changing the Game

Don't be fooled, there's more here than meets the eye.

At a glance, you’d be forgiven for thinking Ninja Theory’s latest looks like any other over-the-top action game. Yet, look beyond Hellblade’s sword-wielding protagonist and gritty aesthetic and you’ll actually discover one of the most authentic — and terrifying — depictions of psychological trauma in entertainment.

Here, players are put into the shoes of a PTSD-stricken Nordic warrior named Senua, caught in the throes of a crippling psychosis. Seamlessly blurring the lines between fantasy and reality, it’s an experience that soon has players questioning everything they see on screen. Once invitingly-lit paths suddenly become engulfed in darkness. Friendly faces inexplicably flicker between teacher and tormentor.

'Hellblade' is a dark and at times dizzying assault on the senses.

Yet, it’s not until you play Hellblade with headphones that you really get sucked into this grim Nordic fantasy. Pop in a pair of earbuds, and you’ll soon find yourself overwhelmed by a cacophony of conflicting whispers, as all of Senua’s doubts and insecurities cackle around your cranium in terrifying surround sound.

It all adds up to create an experience that’s simultaneously moving, thought-provoking and utterly harrowing — the last thing you’d expect from the team that brought you the swords and sass of 2013’s DMC. Then again, this was a game created by a very different Ninja Theory.

Indie-pendence Day

With the studio’s once lucrative Disney Infinity gig drying up and no publishers willing to bite on its eyebrow-raising game concepts, this once in-demand Cambridge-based studio suddenly found itself making Hellblade alone:

“We developed the whole thing saying, well now we’ve got this freedom, what can we do with it? We’ve always made fantasy games, and the idea [for Hellblade] was that this was a fantasy as well, but one created in Senua’s mind,” explains Ninja Theory’s Dominic Matthews (Dom). “I remember having meetings talking about [the concept] and thinking, ‘Alright, if we can pull this off, then maybe we can actually do some good as well.”

As it turns out, it fulfilled both sides of that equation. Thanks to the game’s disorienting hallucination effects and jaw-droppingly convincing binaural audio system, Hellblade strikes such an authentic portrayal of mental illness that it’s now being used as an academic case study in lectures across the UK.

Dominic Matthews, Commercial director at Ninja Theory.

“Our representation of voice-hearing and visions [in Hellblade] is being used in lectures across the country,” says Dom with a disbelieving smile. “We’ve had conversations with the [UK] government, we’ve been down to the Houses Of Parliament…. I hoped we’d make something that was successful and that reviewed well but to make something that’s had an impact on people’s lives as well… it’s just phenomenal.”

Research and Development

So how did a small, independent studio manage to create a game that caught the eye of the UK government? For Ninja Theory, it largely came down to utilising one of the most powerful (but often overlooked) tools in a creator’s arsenal: research. Where triple-A games require multi-million dollar budgets and leave little room for creative risks, Ninja Theory’s newfound independence gave them the time to really delve deeper into a trickier topic.

“I emailed the University of Cambridge and told this Professor – Paul Fletcher — what we wanted to do,” explains Dom. “Initially, Paul was nervous about what we were going to do and if you look historically at what games have done with mental health… it’s not great. I think a lot of developers perhaps take the attitude of ‘we’re going to make this thing and then afterwards, let’s show it to a bunch of people and check that they’re not offended.’ For us it was important that we didn’t do that.”

For the team at Ninja Theory, it was crucial that they get Fletcher on board. Serving as a renowned Psychiatry professor at Cambridge University, Fletcher went on to give a Ted Talk on the many misconceptions surrounding psychosis. In other words — he was perfect. But, with Fletcher wary about mental illness simply being turned into an ‘edgy’ gaming gimmick, Ninja Theory knew it’d have to make a convincing prototype in order to win him over. The challenge was, how do you make the player really connect with the horrors in Senua’s mind?

With the audio tech already in place, the team would need one more piece of the puzzle to bring Senua’s struggle to life. Having worked closely with Hollywood motion capture maestro Andy Serkis on Heavenly Sword and Enslaved: Odyssey to The West, cinematic performance capture tech had slowly become Ninja Theory’s calling card. With Hellblade being such a performance-led piece, once again, mo-cap seemed like the perfect tool to capture the raw emotion that would become such a vital part of the Hellblade experience.

From DIY to GOTY

Ninja Theory's jaw-droppingly realistic motion tech was a huge part of what made 'Hellblade' feel so immersive.

“When it came to performance capture in the game, it was never a question of can we do it, but how can we afford to do it.” Explains Dom. With no publisher to back Hellblade and funds from its last project quickly drying up, hiring the usual mo-cap studio wasn’t an option. This time, Ninja Theory would have to improvise.

“We had conversations saying, ‘can we do [performance capture] in our boardroom?’We had a lot of colleagues insisting that it wouldn’t work, that the sound wouldn’t be good enough etc.” But we had no choice — we needed to give it a go. So one of our guys drove over to IKEA and picked up a bunch of wardrobe poles, then we worked with a company called Vicon to get the cameras in and… it actually worked pretty well!”

With a makeshift mo-cap studio now up and running and the free-to-use Unreal Engine 4 providing the backbone for the game’s tech, Ninja Theory just needed one more thing – actors. Thankfully, the studio’s DIY luck hadn’t run out just yet.

Authenticity over accolades

Milena Juergens bringing Senua to life.

As the team began the search for its Senua, Ninja Theory decided to temporarily draft in its video editor — Melina Juergens — to star in some screen tests. Once she’d finished cutting together Hellblade’s dev diaries, she’d put her laptop down and head into their newly IKEA’d-out boardroom, spending hours howling and trembling as she channelled her inner demons into Senua. Little did the team know, despite her complete lack of acting experience, this was actually a role that truly resonated with Milena:

“I have no clue about acting, all I did was connect my real life emotions with the scenes in Hellblade…” admits Melina. “Removing stigma around mental health has always been in my heart. I was trying to find ways to [address mental health] through photography when I was younger because we have some mental health issues in my family… my father, he is quite sick….It’s one of the reasons I feel super proud to be a part of [Hellblade].”

It turned out, Ninja Theory already had the perfect woman for the job. Now, this once desk-dwelling video editor has not only managed to achieve her goal of helping to start a global conversation about mental health — she’s also become a BAFTA-winning actress in the process.

“I can’t quite believe that I’m holding a BAFTA, I never thought I’d win any kind of award – especially for acting — I’ve always avoided performing in front of people!” Gushes a shy Melina, “I think games are an amazing medium to tackle different issues, and having the game be so successful… It’s just amazing.”


As quickly as the team became enamoured with Milena’s screen tests — so too did Paul Fletcher. Intrigued by Hellblade’s compelling marriage of cutting-edge tech and Milena’s touchingly raw performance, Fletcher eagerly brought his expertise to the table. But if Fletcher and Ninja Theory were to really help people, they’d need to go one step further and hear from people who actually lived with psychosis.

Running regular playtests, the team would show snippets from the game to people who suffer from psychosis, PTSD, and other debilitating mental health conditions. Drawing from these lived experiences, the game quickly became a collaborative effort. It inspired not only Milena’s performance but increased the authenticity of the terrifying visual and auditory in-game effects, until they matched their advisors’ difficult reality. With all these elements coming together, Ninja Theory slowly managed to create what would go on to be one of the most convincing fictional portrayals of mental health in any medium.

Professor Paul Fletcher proudly posing with 'Hellblade's five BAFTAs.

“It has been a real privilege working with people who were willing to lend their own experiences [to the project],” says Paul Fletcher, “developing what we think is an honest, powerful and respectful representation of psychosis. One of the most horrible aspects of experiencing an unshared reality is that it isolates you from those around you, leading to loneliness and stigma. I have been very proud of what the game has achieved…[especially in] allowing people to get an understanding of what it might be like to suffer from voices, visions and other symptoms of severe mental illness.”

“We never had a point where the creative clashed with what we were hearing from the people with the lived experience” agrees Dom, “It really was a collaborative effort to make Senua’s journey real.”

Press ‘A’ to open up

Senua's struggles may be fictional, but they've helped many players deal with their own very real mental health difficulties.

When the game got into the hands of the press, something wonderful started to happen. As journalists began playing the game, Dom reveals that writers at various outlets used their Hellblade write-ups as a way to open up about their own struggles with mental health.

“Seeing that was really great. I get a lot of people now who talk to me about their mental health difficulties because they go “ah, this guy isn’t going to judge me”. Wouldn’t it be great if everyone felt like that, felt like they could talk about it? Then [mental health] wouldn’t be this taboo thing anymore — it wouldn’t be seen as a weakness. If I’d met you today and asked ‘Oh, how’s it going?’’ [and you replied] ‘Yeah I’m alright, just got a cold’ I’d love it if we could [also] say ‘Oh, actually my anxiety is not so great today.’ If [mental health] could be treated in the same way…”

Hellblade’s terrifying tech quickly went on to impress UK mental health charity The Wellcome Trust, as the academic world slowly began to see gaming’s potential as a teaching tool.

“I’ve been really encouraged by the [academic world’s] openness to games actually,” beams Dom. “I’ve been to a few Wellcome Trust events with a lot of academics and people who are working on scientific projects and they’re all very excited about games and things like VR. That was really nice, people gave us a chance to get this right – because they didn’t have to. I think [Hellblade has] helped – in a small way – to give games more credibility.”

Don’t Fear the Research

To borrow (and bastardise) an old phrase, it’s not just about what the academic world can do for games, but also what games can do for the wider world.

“It’s so rare for a character with mental illness to be “the hero” of a story,” says Paul, “In Hellblade, [Senua] is not just the hero, but the eyes and ears through which the player experiences a dark, frightening world. ” Yet, thanks to its use in lectures, Hellblade isn’t just helping via representation.

“Of course, the game works best as an unfolding experience in which the player takes on Senua’s trials and experiences her reality. Yet, even in isolation, clips from the game have proved enormously useful when I give lectures to students and the public,” says Paul, “Recently, I gave a public lecture on “Visions”  and using selected cuts from the game had far more of an impact on people than my very limited powers of description.”

Yet, despite Ninja Theory’s success, academic research is still something that most creators in the gaming world seem hesitant to engage in. With video games requiring huge teams and ever grander budgets, there’s little room for most studios to take creative risks on delicate subjects — let alone to indulge in an academic case study. That’s why for indie studios, Dom believes it’s a risk that’s well worth taking.

“I hope other developers can look at [Hellblade] and go “oh maybe we can do this with X subject or Y subject” and not be nervous about working with academics,” says Dom, “I think some people assume that academics are going to say “you can’t do this, you can’t do that” but you have to find the right people. A lot of it is rooted in this idea that you don’t have to make a game that appeals to everyone. I think a lot of people are too afraid to go against the grain.”

With well over one million copies of Hellblade sold to date, this is not only a success story for Ninja Theory, but also for showing the wider world that video games’ interactive nature can make for a powerful teaching tool.

Now It’s Our Turn

Senua has quickly gone on to become a cosplay favourite. Pictured: Anna "Ormeli" Moleva

So far, it looks like Hellblade has succeeded in getting under people’s skin. Paying a visit to a tattoo convention, you wouldn’t be surprised to see pundits gleefully getting a Legend of Zelda or Overwatch related design etched onto their limbs. Yet, according to Dom, thanks to its all-too-real subject matter, fans seem to be already connecting with last year’s Hellblade just as passionately as the age-old classics:

“We’ve got fans who are getting tattoos of Hellblade, others who are naming their children after characters from Hellblade, and to me, that kind of dedication from a comparatively small fanbase is just amazing.”

“We’ve also received hundreds of messages from players telling us how much they’ve been able to relate to Senua’s story and even use Hellblade as a platform to talk about their own mental health difficulties,” he continues, “We had an incredibly moving message from someone who told us that playing Hellblade made their son change his plan to take his own life and to seek medical help instead.”

While Paul Fletcher is used to making an impact on his students, he feels incredibly proud to have been given such a powerful new platform in which to help people. “Working with Ninja Theory has been a real privilege. I’ve  been very moved by the testimonies of people for whom [Hellblade] seems to have had a genuine impact on, be it themselves or [their] loved ones.”

It turns out, it wasn’t just the BAFTA judges that Ninja Theory had impressed. At E3 2018, Microsoft shocked the gaming world by announcing it the Cambridge-based studio.  Yet despite previously relishing its independence, the studio is keen to stress that it won’t be making any creative compromises. “In short, we asked for full creative independence,” reassures Hellblade game director Tameem. And much to his surprise, Microsoft agreed.

Now Dom and the team hope they can use this new found financial stability to continue using video games to make a difference. “Hellblade was created with a small team of just 20 people and very limited resources” says Dom, “Imagine what we can achieve with a team of 100 people that are backed by Microsoft and focused purely on Ninja Theory’s vision.”

It’s an important sentiment because, for Ninja Theory, it’s not just the players this studio hopes to inspire — but other game developers, too.

“I think Hellblade has gone a little way to help demonstrate that the subjects that are available to literature film and TV are available to games as well and that games can actually also do things that those mediums can’t,” says Dom, “If we can take on [mental health] and give it the respect that it deserves in games, then why can’t that be done with so many other subjects? My hope is that Hellblade can be seen as an example of how games can have a positive impact on the world.”

If you have been affected by any of this issues — you’re not alone. You can find help, here.

Tom Regan
Having written for everyone from Trusted Reviews to The Guardian, Tom is a London based writer who can't stop talking about games.