Many of today’s young people have grown up in a world dominated by social media – I often wonder what my child will think when I tell him I can remember when there was no internet! Lives are increasingly lived out online, so it makes sense for research to follow.
Suicide and self-harm online
My academic interests centre on the mental health and well-being of young people, in particular those who self-harm or have suicidal thoughts. Such behaviours, despite being stigmatised, are relatively common – 1 in 12 young people self-harm, and as many as 45% report having suicidal thoughts.
Like many stigmatised behaviours, suicide and self-harm communities flourish on the Internet, which provides the space to express what is otherwise a hidden activity. Research has drawn attention to the huge rise in the number of online forums and support groups relating to suicidal behaviours, and a recent systematic review highlights both the positive and negative influences of these. Such communities, particularly those on social media sites like Tumblr and Pinterest, have also been put into the media spotlight recently because of the death of a young woman heavily involved in them. Here commentators have discussed the potential for sites to promote increasingly dangerous self-harm behaviours.
Despite such activity around suicide and self-harm online, and the importance of the Internet in the lives of so many who engage in this behaviour, the use of online suicide prevention strategies is strikingly absent from professional programs. Many reasons can be speculated, but it appears that the potential negative influence, particularly in exacerbating already destructive behaviour, has stifled professional support services into inaction. This is not to say that there are no programs out there. However, the potential for eHealth interventions (such as those involving the Internet or mobile apps), an approach realised in many other areas of mental health research, does not appear to have been explored with the same enthusiasm.
This left me with the question: where are we now – what professional preventative suicide and self-harm programs are currently in operation and what can they teach us? In order to understand what has already been done in this area, it was decided to carry out a systematic review. By focusing specifically on professional programs (rather than informal online support networks, for example), we hoped to move forward with a development of an online suicide and self-harm prevention strategy.Although the search strategy followed systematic review procedures it became clear that while the studies told us a lot about how the programs were set up and run, they did not evaluate how effective they had been. This meant we used the term ‘descriptive review’ for our research, as due to the diversity and descriptive nature of the studies identified, it was not possible to appraise quality against a methodological hierarchy, a key feature of systematic reviews.
Perhaps the most striking thing to come out of the review was that no professional programs with a sole focus on self-harm were found. This is despite a proliferation of user-led sites, many of which promote & encourage suicide and self-harm. The absence of any professional voice to counter this means that an individual considering or already engaging in self-harming behaviours is very likely to find themselves amongst wholly negative content opposed to his or her recovery.Given the lack of professional programs with a sole focus on self-harm, the review reports evidence about Internet based professional suicide prevention strategies. The most common of these were:
- screening of high-risk individuals via email;
- group counselling and moderated forums;
- individual online counselling;
- community-wide awareness raising strategies;
- support and information for mental health workers.
What is also clear from the review is that the development and evaluation of online suicide and self-harm interventions is crucial to counteracting the sites that are directly hindering the improvement ofyoung people’s mental health and wellbeing.
The dominance of the Internet in people’s lives, particularly for health concerns, means that as a research community we need to engage with and develop this means of communication. We need to understand how healthcare professionals might work with distressed individuals in an online environment.
About the author: Dr. Nina Jacob is a post-doctoral research fellow at DECIPHer. The aims of the fellowship are to gather information on the nature of self-harm focussed Internet use in order to explore the role that targeted Internet support could play within self-harm and suicide prevention strategies.
This piece discusses the following article:
Jacob N, Scourfield J, Evans R. ‘Suicide prevention via the Internet: a descriptive review’ Crisis: The Journal of Crisis Intervention and Suicide Prevention 2014. First published online: 4 July 2014. doi: 10.1027/0227-5910/a000254. Image source – Blaise Alleyne, via Flickr.