Millions of people struggle with depression, anxiety, and other mental health issues — just not on the big screen or on television.

Historically, films such as “Ordinary People” or “Good Will Hunting” and shows such as “In Treatment” have dramatized these types of issues, but they remain the exception to the rule. Less than 2% of all film characters and roughly 7% of TV characters experience mental health conditions on screen, according to a new report by the USC Annenberg Inclusion Initiative. That doesn’t reflect the experiences of a significant portion of the moviegoing and television-watching audiences. Close to 20% of the U.S. population reports some form of mental health condition or illness per year. And Hollywood often does more harm than good in its depictions. When mental health issues are portrayed on screen, the characters are often treated disparagingly or are shown being violent.

“It perpetuates negative attitudes and prejudices about mental health issues,” said Dr. Stacy L. Smith, the report’s author. “There is vast room for improvement.”

To get their results, Smith and her team looked at the 100 top-grossing movies of 2016, as well as the first episode of the highest rated TV series from the 2016 to 2017 season. They also used a broad definition of mental health conditions — one that encompassed mood disorders, anxiety, addiction, PTSD, suicide, and autism spectrum disorders.

The study found that 46% percent of film characters and 25% of TV characters with a mental health condition exhibited violent or aggressive behavior, something that experts say is divorced from reality. The report looked at how shows and movies depict suicidal characters, finding that there were 13 instances of suicide or suicidal attempts in the films they examined and six on television. These portraits of suicide often lacked sufficient depiction of the character’s larger mental health issues and did not deeply examine treatment options, the study claims. Many of the characters on screen were treated in a demeaning fashion. Nearly half of film (47%) and 38% of TV characters shown with a mental health condition were insulted and were called insults such as “crazy” or “freak,” or they suffered from other forms of rejection.

USC and Smith have devoted time and resources to looking at Hollywood’s lack of representation when it comes to depicting people of color, women, and members of the LGBTQ communities. This report is slightly different in its focus. The school conducted the latest study in partnership with the American Foundation for Suicide Prevention (AFSP) and received funding from the David and Lura Lovell Foundation, a fund that often supports initiatives dealing with mental health, integrative health and wellness.

In keeping with their earlier work, Smith and her team also looked at the populations that are depicted in movies and shows grappling with these health issues. They found that most characters with mental health conditions were straight, white, adult males, and few figures were from different racial or ethnic backgrounds. No film characters with mental health conditions were Latino or Hispanic, nor were any Middle Eastern, North African, Native American, or Pacific Islander. Four characters were Asian and 11 were African-American or black.

Moreover, no LGBT film characters had mental health condition across the 100 top films of 2016 and only 8 TV characters across 50 popular shows grappled with such issues. This omission occurred despite the fact that the National Association of Mental Illness reports that mental health conditions are three times more likely to occur among members of the LGBTQ community.

The study’s authors say they hope that movies and shows will be more sensitive in their depiction of mental health conditions, which could remove stigmas and encourage people to seek help. They also believe that Hollywood needs to do more to reflect a broader shift in the culture.

“When you look at prevailing attitudes towards mental health in our country, there’s been a tremendous turn for the positive in the past five to seven years,” said Dr. Christine Moutier,chief medical officer at AFSP. “Mental illness was once viewed as a moral or spiritual shortcoming — as a character flaw. But we’ve seen that change in recent years.”

“There’s a role for popular storytelling to play in deepening our understanding of these issues and removing negative attitudes,” she added.