Gaming and Mental Health: Thoughts on EGX 2019

Guest author Sachin Shah from Gaming the Mind shares his insights on how EGX, the largest annual gaming event in the UK, promotes mental health awareness.

EGX is described as the UK’s biggest video game event, welcoming tens of thousands of gamers over four days at ExCeL London. There’s a variety of attractions for a gaming enthusiast to enjoy, from demos of upcoming games from big and small studios, to live e-sports competitions, stage shows, cosplay contests, a retro arcade, social events, board games, and plenty of vendor stalls for geeky merchandise.  That’s obviously a big part of why I went to EGX this October, but I was also there as part of Gaming the Mind, a group of mental health professionals who are interested in the mental health aspects of video games, especially how video games portray mental health issues and how video games affect the player’s mental health.

There were plenty of panels and talks that touched on wellness in some form. Game Workers Unite UK held a talk about forming the first UK trade union body made specifically for workers in the gaming industry. This is important because they need a union to defend themselves against stressful work conditions such as extreme overtime known as “crunch”, which can negatively impact mental health and lead to burnout. There was also a talk on how to gain confidence and tackle anxiety as an online game streamer, including dealing with toxic elements of the online community.

A group of students from Guildford College, led by their teacher Paul Kercal, were talking about their experiences with anxiety and how they used games therapeutically. Then Graham Johnson, an arts wellbeing producer, led a panel discussing self-care and gaming. The panelists spoke about how gaming was helpful to them and the relief achieved through, for example, causing mischief in the Untitled Goose Game. They also spoke about how they managed the times when gaming made things more difficult. One quote from the panel was “self-care is giving myself permission to stop”. They also warned about self-care becoming commodified and exclusive for those who can afford it.

One game developer, who goes by the handle @almostgames, held a talk about how he turned to game development in order to cope when his son was in hospital. To overcome his anxiety he had to find a way to have fun, which he explained on a neurochemical level, invoking endorphins. This came from what was available to him in the hospital: game development software on his laptop, which he could justify as “fun” because it was an open-ended problem-solving process; an “incredible experience” filled with moments of triumph. At a time when he had no control over wellbeing of his son, developing games gave him a sense of empowerment. He recommended the audience try a similar productive activity if they ever felt stressed.

It was also great to have panels about queer and ethnic minority representation in the games industry, as discrimination plays a part in the over-representation of mental health issues in minority groups. The former panel made clear that queer people don’t just need representation in the industry but they need power as well. The latter panel, led by Melanin Gamers, talked about how everyone has unconscious biases regarding ethnicity, and we need to keep combating this by assuring a diverse range of people are involved in game development.

Sachin (right) chairs panel with (left to right): Rachel Clancy, Vic Hood, Marina Díez, and Laura Kate Dale

I chaired a panel on mental health advocacy in video games, featuring mental health advocates Vic Hood (games writer at TechRadar), Marina Díez (game designer & developer of PTSD and Consent), Rachel Clancy (developer of The Hero’s Guide To Gardening; Sky Women in Tech Scholar), and Laura Kate Dale (author of Uncomfortable Labels; games writer at They began with discussing the portrayal of mental illness in games, and developing games that conveyed their own mental health experiences. One of the examples was Please Knock on My Door. We remarked that mental health representation in games is becoming more common because of the ease of access to game development and distribution, which has made the process more democratic. We also noted that bigger studios have begun to broach the subject, as it’s shown by Ninja Theory’s Hellblade. We had plenty of questions from the audience at the end of the panel, asking how to handle the external pressure to put your own experiences in a game, and what to do if the process of making a game about your own experiences is too uncomfortable. Ultimately, the message of the panel was that game creators shouldn’t include their own experiences unless they feel comfortable to do so, and they certainly shouldn’t be pressured into doing so, and that creators should always check in with themselves to make sure they are feeling confident with the process of making the game. You can find an audio recording of the panel on our website. I was delighted that we had a full audience, showing how important the topic is to people.


(Left to right): Members of Gaming the Mind Marcus and Fai Lam, along with colleague Tharun, volunteering for CheckPoint to run the quiet room at EGX

Myself and the rest of Gaming the Mind also volunteered for the Australian charity CheckPoint to run a quiet room at EGX. The room was open on all four days to provide some relaxation for people overwhelmed by the bright lights, loud noises and busy crowds on the show floor. After a day at EGX, I could understand why anyone would need a room to relax for a moment but we also had people with anxiety or autism who told us they found the room useful because an event like EGX can be specifically challenging for them. The room had comfy seating, a homey atmosphere, and though we couldn’t keep the noise out, we did have ear defenders for people who are sensitive to noise. We also had calming activities such as colouring sets, and wellness apps. The room was staffed by ourselves, our colleagues from mental healthcare, and medical students. We were all eager to discuss mental health with any visitor who wanted more information. It was a great opportunity for the medical students to promote mental wellbeing in a non-clinical setting. Running the quiet room was such a fulfilling experience, and visitors told us they greatly appreciated it and we’ve even heard from people on social media who said they are more likely to come to EGX because of it.

In terms of mental health-related games at EGX, two stand out. Just Breathe, developed by Engine House Studio, is a platform game in which the main character is at times overcome with anxiety, and the player needs to help them by using relaxation techniques such as breathing exercises. The player presses the screen and lets go in a steady rhythm, representing deep inhalation and exhalation that the player is encouraged to take part in at the same time. Once the player completes this activity, the character may progress in the game. Just Breathe seems like a great idea with a positive message about confronting and dealing with anxiety in a healthy way, rather than trying to escape it.

The other notable game was Disconnected, developed by Xu He. The protagonist is girl with autism, which is fantastic as autism is more likely to be overlooked in girls than in boys, so it’s so important to represent it in media. The idea is for people to play the game and experience the world as an autistic person, and thus be able to better relate to people with autism. The game uses various mechanics to convey the girl’s experience. For example, the character has difficulties with coordination of balance, which is shown through a platformer level where the player must control the character’s balance while moving them forwards. Issues with social communication are shown when the character tries to talk to other kids at school but must solve an on-screen puzzle first, simulating a layer of difficulty in social interaction. Throughout the game is narrated by people with autism, explaining these experiences, which helps the player further understand them. I feel like this game could be a powerful educational tool for young people and families.

Mental health is being addressed more in the gaming community than ever before as evidenced by all the attention the topic received at EGX this year. I hope the trend continues, and Gaming the Mind will remain involved in the conversation.

About the Author

Sachin Shah is a general adult psychiatrist working in London, and a member of Gaming the Mind.

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