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More BAFTA glory for Hellblade collaborator Prof Fletcher

Female figure standing in front of a burning tree

Photo Credit: Ninja Theory

09 April 2025 

There was more BAFTA glory for NIHR Cambridge BRC researcher Prof Paul Fletcher this week, when his collaborative work on virtual reality game Senua’s Saga: Hellblade II with gaming company Ninja Theory won best Technical Achievement at the 2025 BAFTA Games Awards.

The video game is the second collaborative project between gaming company Ninja Theory, Professor Fletcher and RCE Wellbeing Hub, which supports those with lived experience of psychosis.

Like its predecessor Hellblade, which won a BAFTA in 2018 for its accurate depiction of mental illness, Senua’s Saga: Hellblade II draws together expertise in video game design and clinical neuroscience with input from those with lived experience of psychosis to vividly show the altered perception of reality in a character experiencing psychosis.

Psychosis, which can be described as an altered state where a person loses contact with reality, is characterised by distorted perceptions (hallucinations) and beliefs (delusions). It can occur in a number of psychiatric and neurological conditions. The illness can be deeply harrowing and distressing, as well as carrying a deep stigma.

We spoke to Paul Fletcher, known for his research into psychosis in the context of how the brain comprehends reality using clinical studies, psychopharmacological experiments and neuroimaging, to find out more about the project.

Professor Paul Fletcher

Paul Fletcher – Bernard Wolfe Professor of Health Neuroscience, Cambridge University

How did the project start?

The initial project started about 10 years ago when I was approached by the creative director of the gaming company Ninja Theory. A friend of his had been affected by psychosis and he wanted to try to represent it as accurately and sympathetically as he could in a gaming context. They asked if I would be willing to talk to them and from there it turned into more talks and meetings and discussions and events and became an extended collaboration.

To gain greater insight into the reality of psychosis, we approached Recovery College East Wellbeing Hub, part of CPFT and spoke to a group of individuals who had had lived experience of psychosis and were either working towards recovery or had recovered. RCE Wellbeing Hub actively promote recovery and teach people new skills.

I described the project to the group and asked if any of them wanted to be involved and four to five people came forward as they were really interested.

Together with the artists and writers and myself they became part of the core group and were able to offer their experiences and participate in discussions and help direct the creative process. The topic of psychosis and mental health was dealt with in a very respectful and thoughtful way and everyone felt part of a team.

Why gaming?

Ninja Theory wanted to use the action-adventure game Hellblade in a completely different way. The game features an 8th Century Celtic female warrior venturing into Viking hell to redeem the soul of her lover. They thought this setting would be ideal as it is away from a tangible, modern, realistic context and allows gamers to immerse themselves in the storyline. Gaming, in essence, is a very participatory medium. By playing the game as a bewildered, frightened character that is hearing voices and venturing into dark places, a real empathy is generated by the player. Using gameplay, has allowed the message to reach millions of people and generated sensitive and thoughtful conversations about psychosis, as well as drawing on NIHR-supported research into the neurobiology of psychosis and active PPIE.

Impact

Following the release of the first Hellblade game with its vivid representation of psychosis, conversations around mental illness began to develop, not only in the gaming world but further afield. The game triggered people to share their experiences not only of psychosis but of other mental health conditions. Paul Fletcher feels this is because the main character in the game, Senua is a hero.

Despite being very vulnerable, she’s dignified and courageous. I think that people really responded to that. I certainly did. I think people felt empowered to talk about it in a way that they hadn’t previously before. It’s enormously powerful. It feels like it’s got a life of it’s own.

To extend the commitment to engagement, a 25 minute You Tube documentary was released alongside the game, which was shown at a collaborative event involving panel discussions and presentations.  The first game sold more than 1.2 million copies in over 20 different countries around the world.

‘I never know how to describe what happens in my mind. You have put words and pictures to how I feel’ – Game particpant

A You Tube video of accolades was put together following the project.

A TED Talk, by Paul Fletcher, describing the neuroscientific principles behind the game has received over 500,000 views.

The game has won 5 BAFTAs, including one in the new  ‘Games Beyond Entertainment’ category.  It has also received awards from the Royal College of Psychiatrists and, recently, the Research Impact and Engagement Award from the University of Cambridge.

The game has also been used as an educational tool, has changed national guidelines and led to national improvements.

Follow up project – Senua’s Saga Hellblade II

The follow up project to Hellblade: Senua’s Sacrifice,  Senua’s Saga: Hellblade II was started just after COVID and has been overall a larger collaboration.  The first game, which focused on the individual experiences of the illness or condition and was essentially a lone journey, did not contain any other characters. Time was spent fighting demons but there were no other ‘real’ agents. The second game became much more ambitious, as we wanted to represent not only the things you see and believe when experiencing psychosis, but the interactions with those around you and how difficult they can be. By having other characters in the second game, were were able to explore the complexity around this.

Again, we approached RCE Wellbeing Hub to seek participants to join the core group and we did have one member that stayed with us from the previous project. We also spent time capitalising on the more advanced technology to create a much more all-encompassing experience.  The working team was five times larger and used a new motion capture studio.

What have you learnt from the experience?

On a practical level, I have learnt from, and benefited from, the expertise of the artists in representing things that I had always read about in textbooks or talked to patients about. That gave a very different perspective. They have also really contributed to my research by creating experiences that I hope to use therapeutically.

The other thing I learnt was the sheer value of telling someone’s story. As clinicians and academics we can be fixated on intervening or changing things, but actually sometimes it’s really just a case of listening and sharing the story which in itself brings a huge therapeutic impact on people and can change how other people perceive and think about the condition. Not many people have a strong sense of what it could be like to have a completely unshared reality, by creating something that does this, on some level we can reduce stigma and create empathy.

I have also been able to reflect on the impact. I used to spend ages writing a scientific paper which perhaps three people would read and one  reference it. By helping to create something that has been shared and engaged with millions of people, it has had more impact than anything I had ever done before in any other setting. Working with people outside science and the clinic has made me realise what can be achieved and has bred a real sort of humility in me.

The primary purpose of the game was not some form of “edutainment”. It was about representing the experience of psychosis in a detailed and sensitive way and allowing players to invest themselves in the experience. In so doing, it might promote empathy and challenge stigma.

The future..?

Further collaboration with Ninja Theory is underway to explore the possibility that video gameplay and VR technology could provide therapeutic interventions for anxiety through the Insight Project. There are also plans to develop a cognitive testing game to measure and monitor cognitive processes underlying psychosis. Watch this space!

The NIHR Cambridge BRC is part of the NIHR and hosted by Cambridge University Hospitals NHS Foundation Trust in partnership with the University of Cambridge. We are at the heart of the Cambridge Biomedical Campus, Europe’s largest health research area.

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