Ethical Considerations and Social Media: A Case of Suicidal Postings on Facebook

Abstract

Social media sites such as Facebook are increasingly accessed and used by mental health professionals and clients alike, creating fertile ground for ethical challenges and complex decision making. We review a case report in which a clinician discovers suicidal ideation on Facebook (in the form of both photos and explicit statements) by a client with serious mental illness. Ethical issues relevant to this case and others involving social media are discussed, including the principles of beneficence and maleficence, issues of privacy and confidentiality, multiple relationships, clinical judgment, and informed consent. In using social media to obtain information about clients, we highlight potential benefits and harm, including harm to the therapeutic alliance, the difference and consequent impact of actual versus perceived privacy violations, and the necessity of obtaining the client's informed consent.

Keywords:

• social media
• Facebook
• serious mental illness
• suicide
• ethics

ACKNOWLEDGMENTS

This material is the result of work supported by resources from the Department of Veterans Affairs Office of Academic Affiliations, Advanced Fellowship Program in Mental Illness Research and Treatment, VA Puget Sound Health Care System, Seattle, Washington, The Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, and Thresholds Psychiatric Rehabilitation Centers in Chicago, Illinois. The views expressed in this article are those of the authors and do not necessarily reflect the views of the Department of Veterans Affairs, Dartmouth College, or Thresholds.