The potential of digital in youth mental health services

I’ve had a long standing interest in the role of the internet in mental health and for the last year, I've been leading Project 99 on behalf of the Mental Health Foundation, in partnership with youth information agency Young Scot and service design agency Snook.

The project assists NHS Greater Glasgow and Clyde by exploring ways in which its youth mental health activities can include digital and the whole team knew that there was an opportunity to deliver something that not only showed results now, but laid the foundation for a range of other potential work both in Glasgow and in a wider context.

The major aim of the project was to work with young people in the Greater Glasgow and Clyde area to enable them to use their knowledge and experiences in relation to mental health and digital to co-design and propose some ideas that NHS Greater Glasgow and Clyde might develop. As we always knew they would, the young people from GAMH Young Carers and BigShoutER did all this and more. Their ingenuity, enthusiasm and imagination achieved not only what was in the brief, but also additional case study material, and an outline agenda for action on young people’s mental health.

Alongside the work with young people, the brief laid out by GGC to the consortium also included a brief literature review and a mapping exercise. This work, though on the surface less innovative and exciting than the co-design work with the young people is very important, as we hope the findings, and the asset/service map produced will increase the power and validity of what the young people co-designed, as well as have a standalone value in themselves.

Rapid Review of Evidence

Much of the evidence base in this field has been developed in Australia by the Young and Well Cooperative Research Centre, whose publications in this field are comprehensive in field s such as risk, gaming and mental health, co-production, and on the mental health improvement aspects of social media are outstanding. Key aspects from the literature include:

  • There is an emerging evidence base for the role of digital technology as a protective factor in the promotion of mental health and the prevention of mental ill health.
  • Equally, the evidence base is growing as to the potential risks that new technologies can have, especially when their role and significance is not explored in the home and school environment.
  • The evidence suggests that the collaborative, creative and social capital aspects of digital technology can be important in young people’s mental wellbeing, and that some of the most excluded and potentially at risk young people can have some of the most to gain.
  • Equally, the evidence also points to those young people most at risk in an offline world being most at risk online.
  • The clear suggestion is that the management of risk, and the realisation of the many opportunities is best served by young people, and those in positions of power working together to develop evidence and solutions.

In this case, it was exciting to discover that the evidence base, largely developed across Europe and Australia was echoed in both case study discussions and the co-design sessions with young people.

Mapping the Territory of Digital Tools

To the best of our knowledge, nobody has produced a map of digital assets for young people’s mental health. For Project 99, we took around sixty active and developing digital mental health assets and mapped these both by audience and by the type of asset/activity offered. This included assets from across the UK and beyond, including the Innovation Labs projects.

In terms of audience, we wanted to ensure that the role digital can play in population mental health for young people was explored. We therefore present examples both of digital assets that are specifically targeted to young people using mental health services, young people in distress, vulnerable groups of young people who may be at risk of mental ill health, and a general population of young people using digital technology in their everyday lives. The evidence base shows that there are risks and opportunities in terms of digital for all of these groups.

In terms of activity, we define three main ’activity types’:

  • Technology for Information: Where young people seek information about mental health and distress using the internet or digital technology.
  • Technology for Service Delivery: Where young people access ehealth services, or use technology to engage with or prepare for engagement with services
  • Technology for Social Connection, Identity and Self-Realisation: Where young people use technology to curate their experience, offer and receive peer support, explore their identities, collaborate and share content.

This mapping framework is presented in prototype form, with the aim of connecting mental health professionals to some of the digital tools that exist, by associating them to familiar settings and populations.

Service Ideas and Learning Points

In addition to the research and scoping work with young people, the co-design team of young people developed a range of prototype ideas, and approaches for the health board to consider. Some of these, such as a trusted digital ‘springboard’ to enable access to services and existing digital mental health assets were quite conventional in a digital sense (though potentially still a challenge to operationalise in a public service environment.) Some ideas were very new and innovative, and these are presented in detail in the report. One idea for instance focused on the idea of creating a beautiful space for young people to curate content on their mental health, another an environment for peer support for those supporting friends or siblings experiencing distress.

We were also asked to produce a youth guide, with top tips from young people to guide peers in using the web for mental health. Rather than produce a leaflet or web page, the young people prioritised some key points to share, and then helped design shareable GIFs (animated graphics), which are easily shareable on social media platforms like Tumblr.

What might it all mean?

In Greater Glasgow and Clyde we found young people who were using digital technology on a daily basis and were seamlessly living online and offline, and expected that public services and the adults in their lives should better understand and engage that. Where there is reticence on the part of public services to engage, or a lack of awareness in the workforce of what and how people use technology, there is potential for opportunities to support to be missed, or for risk of harm to persist.

There is a substantial cohort of young people, and indeed of adults who experience distress, who use online communication as the primary method of discussing and seeking solutions to this distress.

A failure to recognise this and for public services to respond risks the development of a 'reverse inequality' where a reticence to act due to concerns about access for some leads to the exclusion of others. Digital isn't the answer for everyone. But for some it is the main port of call, and for many it is part of the picture. Understanding the challenges from the perspective of the audience has been crucial in this project, and is central to the concept of service design.

There has been a lot of discussion of risk online in the popular press. Work on this project so far has shown that whilst there are clearly risks that need to be addressed in relation to digital technology and young people’s mental health, the overwhelming narrative of risk in the popular press is not the only story, nor should it be the only component of a public service response.

In this project we found young people that were able to identify some of the challenges and risks they might find online, and suggest both strategies for managing these risks and tips to support others with doing so. Finally, we found young people who with very little prompting were able to use their skills to share and develop solutions, and communicate those on an equal basis with those in positions of power.

Hopefully this project, and others such as Innovation Labs will enable young people to continue to be part of the solution to developing tools for online management of distress and mental ill health, and part of the picture in meaningfully assessing, and proportionately addressing any risk. Equally, we hope to see the increasing use of co-design and digital innovation cross from work with young people, or digital natives, to work with excluded adults many of whom use the web to find solutions to their distress.

The Mental Health Foundation has an active programme of work developing co-design and digital innovation. As part of the Right Here Programme, in partnership with Paul Hamlyn Foundation, we have supported the development of Innovation Labs. Innovation Labs brought together the Mental Health Foundation, Comic Relief, Nominet Trust and Paul Hamlyn Foundation to scope, develop and support seven apps and websites for young people’s mental health.