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illions of viewers will tune in Monday night to find out who will get the final rose on “The Bachelor.” What they won’t see: The emotional trauma that sends some contestants tumbling into mental health crises when the cameras stop rolling.

Three former contestants on the “Bachelor” and its spinoff, “The Bachlorette,” have committed suicide, with the most recent death last month. And it’s not just “The Bachelor.” The New York Post has tallied 21 suicides among reality TV participants in the last decade.

That’s no surprise to Jamie Huysman, a licensed clinical social worker in Orlando, Fla., who has worked as a consultant to talk shows, court shows, and reality TV since the 1990s. On many of these shows, “the common denominator is to get the person with the greatest psychopathology — the best trainwreck you can,” he said.

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“Television disposes of people,” Huysman said, and for contestants who may already be unstable, “when abandonment happens, that’s when all hell breaks loose.”

STAT talked to four reality TV contestants about the strains of the experience. They spoke of long days in front of the cameras, fueled at times by lots of alcohol — but very little food or sleep. They talked, too, of the isolation they felt during the filming, when they were barred from talking to anyone but fellow contestants. And of how uncomfortable it was to watch some of their fellow contestants being set up for very public humiliation.

They also spoke of how alone they felt when their part on the show ended, and the spotlight abruptly went dark.

Given how stressful participating can be, Sue Eastgard, a suicide prevention counselor in Seattle, urges reality show producers to give all contestants a crisis hotline number — and make sure they program it into their phones. She also urges primary care doctors to be especially vigilant about mental health screening for patients coming off high-stress situations, whether that’s military combat or a reality show.

Producers of the shows did not respond to requests for comment.

Here are the stories of four contestants:

Jesse Csincsak, winner of “The Bachelorette,” Season 4

Csincsak, 33, who owns a property management company, recalls a fairly long psychological screening for the show he joined in 2008, including 1,200 multiple choice questions. Later, he would come to believe that some questions were being asked not out of concern for his mental health, but to manipulate him more effectively.

“They ask you all your biggest fears, so when you tell them ‘I’m scared of heights’ they can put you 40 stories up on a building,” he said. “It’s used to make good TV. To create ratings. To make them money.”

The contracts signed by contestants on “The Bachelor” obligate them to take part in stressful and sometimes terrifying situations. They also give producers the freedom to edit footage and shape publicity to turn the contestants into characters for the public to embrace or despise, Csincsak said. He said he knows contestants who found the experience so traumatic that they’re still on anxiety medications, years after leaving the show.

“It’s all lies. It’s all for TV, and people’s lives are ruined every single day,” Csincsak said.

Contestants on “The Bachelor” and “The Bachelorette” often stay in touch and befriend participants from other seasons, forming a tight-knit community. No one from the ABC network or “The Bachelor” production team reached out to offer grief counseling or support after the suicides, Csincsak said. “They won’t even try to help the family in any way,” he said. “If it does not involve money, they are not interested.”

Csincsak urges public officials to step in and regulate reality TV shows, perhaps by mandating psychiatric care for contestants during and after the production.

Molly Swenson, contestant on “American Idol,” Season 10

Molly Swenson, a 28-year-old executive at a media company based in Los Angeles, made it into the top 50 contestants on “American Idol” in 2011.

She was disturbed during the auditions to see that the producers picked truly awful singers, as well as contestants with talent. “Those people are as convinced as everyone else that they are the next American Idol, and it’s really dark,” Swenson said. “You know which of the people are there to be made fun of, and it’s bad, because no one has told them.”

Swenson said she completed a 500-question psychological evaluation during the audition process; she remembers questions like, “Do you enjoy hurting small animals?” and, “Have you ever had suicidal thoughts?” She figured that it was meant to screen out people who could be a danger to themselves or others on the show. But that was as far as the show went: She said she never spoke with a counselor before, during, or after her time on camera.

Swenson said she tried to keep her hopes low so she wouldn’t be too disappointed if she was eliminated, but it still stung and left her reeling a bit. “Mostly, you are just sad that the fun is about to end,” she said.

The auditions and show tapings thrust contestants into “this super flashy life,” she said, where they are “surrounded by people who have been hand-picked and extreme personalities.”

Then you’re cut. Abruptly, it’s all over: “All of a sudden you are thrust back into the real world, and you have a little bit of reverse culture shock.”

Eliza Orlins, contestant on “Survivor: Vanuatu,” and “Survivor: Micronesia”

Eliza Orlins, a 33-year-old public defense attorney from New York, competed on two seasons of “Survivor,” in 2004 and 2008.

Both times, she took a psychological test and discussed the results with Liza Siegel, a psychologist who worked with the show. “She established a doctor-patient relationship in that you feel comfortable with her and she’s lovely, but it certainly is not a confidential therapy session by any stretch of the imagination,” Orlins said.

Siegel also met with contestants after they’re voted out — a mental health service that other, lower-budget reality TV shows don’t provide. “She tried to make sure everybody is in stable condition after they are voted out,” Orlins said.

Despite the psychological screenings, Orlins said the casting process is imperfect. Some vulnerable contestants slip through unnoticed — and she suspects in other cases, the psychologists or producers see red flags but cast the person anyway because emotional instability makes good television.

Even for the most stable of contestants, participating on “Survivor” can be taxing in the extreme: You don’t get enough food, sleep, or privacy for weeks on end. The bugs bite. The rain soaks. There are no clean clothes, no hot showers, no family members to lean on in a moment of crisis. “It’s miserable,” Orlins said.

And once you’re back home, watching the show from your comfortable living room can be brutal, too, as editing can turn you into a caricature you barely recognize.

“I think they they should do a better job screening people,” Orlins said. “Not everyone can handle the stresses of watching themselves be portrayed in a terrible way, or the negative comments that are written online about your personality or your physical appearance. People will just rip you to shreds in every aspect of your being. … And if [contestants] are susceptible, it could lead to real problems in their lives.”

Fans, Orlins said, “can be really cruel.”

Tyra Sanchez, winner, “RuPaul’s Drag Race,” Season 2

Tyra Sanchez, a 27-year-old from Florida, joined the show’s competition to find the next great drag queen in 2010.

He remembers taking a psychological test before getting cast for the reality show, but does not remember reviewing his results or talking to a counselor during the entire experience.

After the show, Sanchez struggled to cope with fame and critics who went after him online. “I couldn’t have my normal life back anymore,” he said.

Even though Sanchez considers himself to be resilient, the overwhelming volume of online bullying pushed him to the brink. In a moment of loneliness and inebriation, two years after the show, he attempted to end his life. “I was fed up,” he said.

Despite his struggles, Sanchez does not believe reality shows have any obligation to provide mental health resources for participants — who, he points out, participate of their own free will.

“A lot of people blame their TV persona, or their behavior, on TV, on editing,” Sanchez said. But, he said, “they can’t edit words into your mouth … they can only edit what you give them … You also have a right to say no.”

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