In 2017, developer Ninja Theory released Hellblade: Senua’s Sacrifice, an action-adventure game that took ambitious steps in exploring mental health and psychosis. Senua, a warrior struggling with psychosis, must not only overcome physical challenges, but also those presented by her mind. The award-winning game was a hit. But it also proved to the team that there was a place, as well as a need, for more games that carefully represented mental health.

Ninja Theory is working on a new venture, called The Insight Project, to do just that. The team will use tech, game design, and clinical neuroscience to work on new methods of therapy for mental disorders. In an interview with The Verge, Ninja Theory co-founder Tameem Antoniades called the undertaking a continuation of the collaborative work the studio did with neuroscientists and mental health professionals on Hellblade. “With Microsoft acquiring us, it’s taken off a lot of pressure from us as a studio,” he says. “So we stopped developing games for other people, you know, work-for-hire games, which meant we have the opportunity to start entirely new projects.”

Ninja Theory’s representation of psychosis — in which someone loses touch with their external reality — translated to Hellblade’s heroine, Senua, hearing voices or seeing things that aren’t really there. Building off of its partnership with health research foundation Wellcome Trust, Antoniades says The Insight Project is “sort of like a hypothesis that video game technology could help make things that have previously been invisible, visible.” That, in turn, opens those conditions up to diagnosis, analysis, and treatment, he adds.

For something like anxiety, for example, there are often physical symptoms. An anxious person likely experiences symptoms such as a racing heart, sweaty palms, or a feeling of unease. Paul Fletcher, a professor of neuroscience at Cambridge University who worked closely with Ninja Theory on Hellblade, says that biometric data on these mental health disorders could then be represented on-screen in simple ways, like a stormy sea. “You’re on a boat and in order to successfully navigate towards a target, you need to keep the sea as calm as possible,” he says. “Then what that would actually entail is keeping a control over your physiological state — so learning how you could keep a lid on those physical aspects of the emotion.”

The key thing to remember is that if the game is immersive enough, people will want to do it for their own pleasure. “It’s not a chore or homework that they need to do,” says Fletcher. “It’s not an assignment from their therapist, but rather it’s something they actively want to participate in, then you’re going to get a lot more buy-in from people, and they’ll be much more willing to participate and therefore much more likely to be able to make substantial changes in themselves.”

Ultimately, Fletcher says the goal is to give people additional ways of controlling or mitigating things like anxiety. “The aim of this is not to throw out the old therapies or to supersede them,” he says. “There is a good tool box of psychological and psychiatric therapies that can be used. But we think that combining the science, the clinic, the clinical work, and the talents of the gaming technology could actually produce some synergy and allow some of those therapeutic approaches to be used in very innovative and possibly more effective ways.”

It’s Hellblade’s success that encouraged Ninja Theory to be more daring and tackle projects that could have real impacts on the world, Antoniades says. But it also reiterated the importance of careful research. “There’s a rigor it adds to the research — the interpretation, the representation,” he says. “In a subject like mental health, you have to tread water and be very, very careful about assumptions you have. And the only way to kind of get round the tropes or assumptions that exist in your head is to start with research and lived experience.” In other words, he says, facts over fun. “I think we’ll make better games for it.”

The project is still largely exploratory; Ninja Theory doesn’t have a finished project to show just yet. Antoniades considers the studio to be at the beginning of a journey that will likely take years. Right now, it’s more of a pilot for a bigger movement. “If we can prove that we can make inroads into this area by collaborating and conducting the development in a certain way that’s ethical, and open, and scientifically backed,” Antoniades says. “That could become a model for other people to do the same and tackle other areas. There isn’t any single problem to solve here. It’s like solving climate changes. It requires everyone working together on many different levels.”

Ninja Theory will still pursue work on its more traditional games, and it has several other projects the team is working on. Still, Antoniades says, there’s an approach here that could work — one that combines scientific results with technology to improve or introduce therapeutic techniques. Now, at least, Ninja Theory has the ability to test those ideas. 

“There’s quite a few independent games that are doing [work with mental health], but the model is built around releasing products that are known, that are safe and known,” Antoniades says of the industry at large. “It’s a big budget commercial problem in consoles and PCs. You get funding from a publisher who wants you to make a game according to a certain sense of requirements. There’s not that much room to explore. It’s as simple as that.”