Channel 4's Handcuffed: Last Pair Standing is the latest format to test where entertainment ends and welfare begins. Strangers with opposing worldviews, physically chained together 24 hours a day, navigating forced intimacy, sleep deprivation, and escalating emotional friction, all on camera. It makes for compelling viewing. It also raises a question the industry has been circling for years: what duty of care do these shows actually owe to the people they put on screen?
It's not a new question. The public exchange between Katie Waissel and Dermot O'Leary brought it back into the open recently, but I've been having this conversation privately for a long time. As Co-Founder and Chair of Music Support, and someone who has spent thirty years working across the entertainment industry, I've sat with a significant number of people whose lives were profoundly shaped by their time on reality TV. Some of those experiences launched careers. Others left damage that took years to surface and longer to address. In several cases, the person never fully recovered.
That's not dramatic effect. It's what the evidence, clinical and anecdotal, consistently shows. The gap between what we know about protecting people in these environments and what actually gets implemented remains unacceptably wide.
What Actually Happens to People
A contestant enters an environment of extreme emotional intensity. They are assessed, ranked, praised, and rejected in front of millions of people, often within weeks. Their vulnerabilities, their backstory, their reactions under pressure, all become content. The production environment is designed to heighten emotion because heightened emotion makes good television. That's not a conspiracy. It's the format.
The human nervous system doesn't distinguish between manufactured pressure and real danger. A contestant standing under stage lights waiting for a verdict is experiencing a genuine stress response: elevated cortisol, activated fight-or-flight, impaired rational processing. The fact that it's "just a TV show" is irrelevant to their biology.
Layer on top of that: weeks of isolation from normal support networks, disrupted sleep, intense competition with strangers, and the knowledge that your performance is being broadcast to millions. Then, win or lose, you're released back into the world with a fundamentally altered public profile and, in most cases, minimal structured support for what comes next.
This is not a safe process by default. It can be made safer. Ofcom's strengthened protections show that regulators recognise the scale of the risk. But regulation only works if implementation is consistent and independently governed.
What Genuine Duty of Care Requires
The phrase "duty of care" is used so often in entertainment that it risks meaning nothing. So let me be specific.
Before production: Every contestant should undergo a thorough psychological assessment conducted by a qualified professional with no reporting relationship to the production team. Not a checkbox screening. A proper evaluation that identifies pre-existing vulnerabilities and establishes a baseline for ongoing monitoring.
During production: Welfare support should be available around the clock, provided by experienced mental health professionals who understand the specific pressures of this environment. And here is where the conversation becomes uncomfortable: these professionals must be structurally independent from the production.
This is the point that matters most. When the organisation creating the psychological pressure is also the one providing welfare support, there is an inherent conflict of interest. A production company has a commercial interest in keeping contestants on screen, in emotional intensity, in dramatic storylines. An in-house welfare provider exists inside that framework, funded by it and accountable to it. Asking that person to always prioritise the contestant over the production is asking them to bite the hand that feeds them. It doesn't work in clinical governance. It doesn't work here.
Independent welfare provision, appointed and funded through a structure separate from production, is not a radical proposal. It's standard practice in clinical governance. You don't ask the organisation that creates the risk to be the sole judge of whether that risk is being managed.
After production: This is where the system fails most consistently. The transition from sudden fame (or sudden public rejection) back to ordinary life is one of the most psychologically destabilising experiences a person can go through. It involves identity disruption, grief for a version of life that was briefly promised and then withdrawn, and a level of public scrutiny the person was never equipped to manage.
Most productions offer a follow-up call. Some offer a handful of counselling sessions. Very few offer anything approaching the sustained, specialist support that the experience actually warrants. A follow-up call is not aftercare. It's a gesture.
What We Already Know
Through my work, including the Empathy for the Devil podcast where we examined the lives of artists who left us too soon, one theme has emerged with painful consistency: the people around someone in crisis often knew something was wrong. They could see it. They just didn't have the structures, the authority, or the backing to act on what they could see.
That pattern repeats in the talent show context. Former contestants have spoken publicly about isolation, psychological strain, inadequate support, and a transition back to normal life that nobody prepared them for. I would never question anyone's personal experience. These are first-person accounts from people who were there, and they deserve to be taken seriously.
What they describe, collectively, is not a series of individual misfortunes. It's a systemic pattern. Some productions, ITV's published welfare measures around Love Island among them, have made real progress. But the need to keep restating those commitments tells us something: recognition is not the same as resolution.
Every preventable tragedy from this point forward represents a failure to implement existing solutions. The knowledge is there. The clinical frameworks exist. The expertise is available. What's been missing is the will to prioritise welfare with the same seriousness applied to production values, ratings, and revenue.
The Viewer's Role
It would be dishonest to ignore the audience's part in this.
A contestant who is publicly rejected on a Saturday night broadcast will, by Sunday morning, have been dissected by thousands of strangers online. Some of those comments will be supportive. Many will not. That is not a peripheral part of the experience. It is part of the environment.
Recognising contestants as real people with real vulnerabilities, not characters created for entertainment, is not sentimentality. These are often young people with limited media experience who signed up for an opportunity without fully understanding the exposure involved. They didn't know what they were getting into. I've witnessed that time and time again.
What Needs to Change
Voluntary improvements, applied unevenly, are not enough. What's needed is enforceable regulation: standards for psychological welfare provision in any production that places members of the public in high-pressure, high-exposure environments, covering pre-screening, ongoing support, post-production aftercare, and the structural independence of welfare provision.
The industry already has the tools and knowledge to protect the people inside it. The issue has never been a lack of solutions. It's been a lack of consistency in implementing them.
I remain optimistic that this can change. When proper support systems are in place, I've seen first-hand how people come through these experiences stronger. The creativity and courage that draw audiences to these shows deserve to be protected, not exploited.
But duty of care cannot remain a compliance phrase. It has to mean something to the person standing under those lights, not just the person signing off the insurance policy.
If you work in entertainment and are looking for specialist support, for yourself, someone on your team, or a talent you represent, the guide to crisis support for music industry professionals covers what specialist support in these industries involves and who it is for. You can also read more on what specialist music industry mental health support looks like, or how duty of care on the road applies to the people running these productions. Or book a confidential consultation to discuss what support might look like in your situation.
This is an updated version of an article by Matt Thomas originally published on the Attune website.