Designing games with high-mortality

[SandyAndy]

My DM liked to kill the PCs. We could bring people back, but it came at a cost. The first time it would just be an RP thing, like preferring the dark or having severe insomnia. The second time would be a mechanical thing, like having a hard time seeing in daylight the way Drow do. The third time would be serious, like wisdom or intelligence penalties or always having a point of exhaustion. You don't get to come back a fourth time.

He also gave us a wound at half health and a scar every time HP hit zero. Like losing a limb or an eye. It really made us think about what we were doing and made us spend a lot of time running away from crazy monsters instead of trying to blast our way through. That kind of thing really pushes the run and hide, prey-type instinct that you need for horror stories.

It was also really fun to RP a crew of hardened adventurers with missing limbs, severe deformities, and a smorgasbord of mental health issues trying to navigate a quiet village or a royal court. It also explained why every tavern owner was a badass former adventurer; the smart ones get out while they can. And it kept us from going murder-hobo because one travelling merchant with a knife might get lucky and take somebody's fingers. Overall, adding those permanent effects made the game more slow-paced and RP focused. Highly recommended.