Modern media and mental health: help or hindrance?

Christmas is coming and with it will be a rush for the latest digital offerings, such as colourful mobile phones and reusable books that sent handwritten notes to cloud storage. The virtual world also offers other popular gifts like virtual wine tasting, cooking classes and even online gym membership so you don’t even have to leave your bedroom for a workout. But has our engagement in the virtual world influenced the world of mental health? We think it has as this journal has received many submissions both on the benefits and on the harms, of using the internet. They seem to fall into two main categories: research methods and service provision, with telehealth and the development and use of apps being a top priority.

O’Reilly (2020) looked at the role of social media in mental health in terms of “The good, the bad, and the ugly.” A great deal of attention has been paid to the “bad” and the “ugly” – which can be very ugly indeed: the recent coroner’s inquest on the suicide of one adolescent girl found unequivocal evidence that the algorithms used by social media platforms were largely instrumental in driving her to her death (Walker, 2022). There is, perhaps, a need to pay some attention to both the successes and the limitations of the “good.”

Surveys

Online surveys have always been popular via various outlets – email, Facebook, Twitter etc. A previous editorial of online surveys covered some of the pitfalls, particular representativeness, so we will not deal with it here (Wykes et al., 2019). The internet has also provided options for investigating trends in mental health awareness – both positive and negative. Mental health researchers have investigated internet search patterns to study and monitor public interest in mental health. For instance, Alibudbud (2022) used Google Trends to investigate Filipinos’ interest in mental health before the introduction of a new Mental Health Act, following that act, and during the Covid pandemic. The study demonstrated an increased interest in mental health topics when the legislation was enacted. The interest subsequently doubled during the pandemic. The hope is that this increased interest allows a better understanding of mental health, though that is yet to be explored.

There is a flip side with some social media providing not only fake information, but also increasing the stigma associated with mental health conditions. Jansli et al. (2022) collected tweets mentioning mental health conditions and, importantly, had mental health service users rate them as stigmatising or not. Their data suggests that about two fifths were stigmatising with those mentioning severe mental illness having the highest level of associated stigma. Stigma was associated with the perceived intention and context for the tweet, but some words, like “psycho” were judged as stigmatising irrespective of context. Knowing this, can we reduce the number of stigmatising tweets in the timeline? One study involved service users in the machine learning modelling to make this happen. Service user supervision not only set the priorities for the machine models, but also influenced the model validation process, which had effects on the model chosen. Of course this was not perfect in identifying stigma, but the project has highlighted how service users can influence artificial intelligence research in a meaningful way (Jilka et al., 2022). We have also received papers investigating online forums and discovered that they are a potentially useful method for peer support as well as experimentation with recovery narratives. However, current forum supervision lacks the ability to orient participants to posts or threads that match their narrative needs. One solution is to develop algorithms so matching can be more automatic (Sik et al., 2021).

Cooperation

One, still underestimated, benefit of online services is that they make cooperation between organisations so much easier. Cross-organisational efforts such as those described by Davidson (Davidson et al., 2021) would be extremely difficult without them. A large proportion of the papers received by this journal clearly depend on the ability to share draft documents and data over a distance.

Remote therapies

On the “good” side, the internet can provide a popular, or at least a popularised, method for providing health care, with enthusiasm from providers about the potential to scale up and be cost efficient for both the service user and therapist. We have already indicated issues which need to be addressed including privacy and client preference with remote therapies before they became so fashionable (Wykes, 2019; Wykes & Brown, 2016). In the last two years, when face-to-face interactions became impossible, our attention to the internet increased and we switched rapidly to remote therapy, and are now seeing evaluations of this type of care (e.g. Watson et al., 2021). We already know some disadvantages such as lack of technology expertise in both service users and in their service providers, and that the lack of resources is likely to continue with the cost-of-living crisis. So this will be a limitation for large scale implementation.

Computers and data were provided during the pandemic for clients to use at home, but this still left difficulties such as finding a private space at home for therapy sessions. One UK solution in the Increased Access to Psychological Treatment (IAPT) service was to set up computer hubs where service users had access to their therapist from a private space close to their home with only one button to press to connect. This solution was welcomed by clients who were mainly contacting for anxiety and depression. Implementation of such a service needs a framework to guide not only specific implementation, but also its sustainability and such a framework might also allow the service to spread out to other types of mental health problems (Camacho & Torous, 2021).

The service and cultural context as well as the clinical target might have been crucial to the success of the IAPT solution. Investigations into the cultural sensitivity of e-mental health services have not given them a glowing recommendation. They have been shown to be limited in their language diversity, cultural representation, and cultural competency. Recommendations are to include culturally tailored content, graphics, and phrases (Narayan et al., 2022).

Tele-mental health

Tele-mental health services though can be successful in low- and middle-income countries like India. We, in the west, have a lot to learn from them. The Indian services have not only allowed more access, but they have also led to changes such as normalizing conversations about mental health, creating awareness, and reducing the stigma about psychological health. There is also optimism that their new national 24 × 7 tele-mental health program will also curb the misinformation and stigma surrounding mental illness and encourage more people to seek help without feeling guilty (Majumdar, 2022).

Apps

Some therapeutic apps are effective although engagement is still a problem and the benefits only emerge if engagement is sustained (e.g. Phillips et al., 2020). Many studies recruit large numbers and then discover that few are left after an initial 10-day period. Part of this may be due to the general design of the app, as few include the actual end user in the design (Myklebost et al., 2022; see, as a good exception Goodwin et al., 2016), and when service users are involved it often throws up a cognitive load theme, given that many mental health difficulties interfere with information processing (Myklebost et al., 2022; Simblett et al., 2019). Apps come in several forms, staged in terms of the level of human interaction and although this interaction is appreciated by service users there is also evidence that human interaction boosts the effects of app-based interventions, although recent meta-analyses have not found a statistically significant difference (Linardon et al., 2019; Pauley et al., 2021). Factors in app design that can potentially improve engagement and end user involvement in the design have been described many times, but they are still not universally implemented (see Wykes & Schueller, 2019).

There are further ways of using the internet to provide high quality and engaging information to increase mental health awareness and access to high quality evidence. Digital video interventions are becoming more popular, but we have little evidence on whether they do influence mental health literacy or who accesses them. Currently information is also scant on who is involved in producing and developing them which is especially important to young people. The Journal of Mental Health has published a scoping review on these online videos (Ito-Jaeger et al., 2021), but we expect that they will need rapid updating, particularly for young people whose language and platform use varies so much.

We do wonder what 2023 will deliver and we hope any contributions will benefit from this year’s crop. What we want to see are the best research methods including co-design, so the next generation of internet offers attract and engage those with mental health difficulties as well as the general population.

Disclosure statement

No potential conflict of interest was reported by the author(s).