by Dr Victoria Betton
How can health and care practitioners better support teens with mental health difficulties to develop resilience in their connected lives? This is a question I’ve been exploring for a piece of work commissioned by the NHS Digital Widening Digital Participation Programme.
The project report comprises a review of evidence, themes from interviews and focus groups, together with insights from our participatory work with young people at mHabitat. The purpose of the report is to help shape health and care practitioners’ understanding of the digital landscape so that they, in turn, can help young people shape theirs. As smartphones and digital media become increasingly ubiquitous, our project found that it is crucial that practitioners are equipped to help teens traverse the associated ups and downs.
mHabitat is an NHS hosted team whose purpose is to help health and care services make use of digital technologies to improve services. Sometimes, digital technologies have a useful role to play and sometimes they are a distraction. Too often, they are perceived as a silver bullet without an appreciation for how they will fit (or not) within complex workflows and cross-organisational care pathways. There is a danger that they end up shelved or only half-deployed, only to be forgotten about. When it comes to young people, digital health tools and services are competing with Instagram and Snapchat for attention. There are many challenges as well as opportunities in the digital sphere.
We have found that the best way to navigate this complex terrain is by running co-designed, participatory events with young people and practitioners, which combine interviews, ethnography, and workshops. Through these combined approaches, we can begin to understand teen online norms and behaviours that are otherwise hidden from adult gaze. This understanding is the first step towards enabling practitioners to understand how they can offer more effective help and support to young people, and for technologists to design tools and services that are both acceptable and desirable to them.
Below are three themes that have emerged through our recent participatory work with young people accessing mental health services. These themes are described in more depth within the report:
The power of distraction
“[The internet is] a way of forgetting that we actually have this problem by doing something that we’re not only good at, but we enjoy. And then, they [parents] have a go at us […] it’s just our way of coping with something …”
Many young people we spoke with described how they purposefully use digital media to distract themselves from troubling emotions. They indicated how playing games, scrolling through Instagram, or browsing YouTube can each provide coping mechanisms to manage distress. Teens told us that, sometimes, they felt resentful that adults not only didn’t understand, but actively tried to remove this coping mechanism. Others recognised that sometimes a helpful distraction can tip over into wasting time, which can result in them feeling worse.
Young people told us they want adults to see beyond the smartphone interface and to understand the context, purpose and meanings associated with their use of digital media - moving beyond banning and blame to help young people harness some aspects of digital media as useful tools for managing distress.
Relatable and aspirational
“Having access to people that aren’t necessarily an authoritative figure … [makes it feel like] it’s not someone official telling you what to do. It gives you the access to … hear other people’s stories that are real people. Whether it’s someone that has been suicidal and they talk about how they coped … or whether it’s someone who has an eating disorder… [or] a hang-up about their body and there are people out there to help and advocate the fact that there are things out there that can help…”
While it was unsurprising that Snapchat and Instagram are hugely popular platforms, we were fascinated by how often young people talked about YouTubers in relation to their mental health. For them, video bloggers were easily relatable and aspirational in ways that many of the teens we spoke with found irresistible. Having an insight into a vlogger’s life and their ups and downs is powerful and the notion of relatability came up repeatedly.
It is important for practitioners to be aware that teens are at least as likely to access health information on YouTube as they are from professionally generated information on sites such as NHS Choices. For this reason, services should think about reaching out to young people in the online spaces that they occupy, rather than expect them to visit their website - digital outreach is a worthwhile challenge and opportunity.
Digital naivety rather than digital natives
“Resources aren’t readily available for mental health … You go on the internet and it’s all just social media …”
While many of the teens we spoke with were savvy online, we were struck by the extent to which some were naive when it comes to accessing information about mental health. For a few young people, the idea of searching for mental health information online was a novel idea. Others told us that they would only search for information online when directed to do so by a practitioner. This reinforces the idea that the notion of digital natives has been largely discredited and it is equally important that practitioners do not fall into the trap of regarding themselves as digital immigrants - they have valuable life experience to share.
As with any other aspect of continuing professional development, practitioners need to be up to speed with digital media. Teens live a life where digital media is an intrinsic component of their everyday experience and ignoring this reality means leaving out a massive component of teens’ existence.
In our work with teens, we are constantly surprised when our assumptions about teens and digital are blown out of the water. When we assumed young people would want a game as reward for completing an app-based outcome questionnaire they berated us for undermining the gravitas of the task. When we suggested young people might want tele-consultations to avoid long journeys, they told us that it was the lack of bus fare that prevented them from getting to appointments. So, the problems we perceive as practitioners and the solutions we might proposed based on an idea of young people being digitally oriented, are often mistaken. If we are to develop health and care services that meet the needs of connected teens, then we first need to truly understand their digital lives and especially where care in the physical world remains of critical value.
Victoria is founder and director of mHabitat - an NHS hosted organisation which supports people-centred digital innovation in health and care. She is a qualified social worker and coach with over twenty year’s experience in local government, third sector and the NHS. She has Masters degrees in Women’s Studies, Social Work and a Diploma in Public Sector Relations. Her doctoral research was on the theme of mental health and online social networks. She is an Improvement Fellow at the Y&H Improvement Academy, an RSA fellow and a visiting research fellow at the University of Cumbria. She is a trustee for Solace, a refugee and asylum seeker charity. You can find her blog at www.codesigndigitalhealth.co.uk You can find her on Twitter @VictoriaBetton and her Pets as Therapy dog Bibi on Instagram at bibithepatdog.
Chair in Science Communication & Future Media, University of Salford, Manchester.