This joint post with @chaosandcontrol came about through a Twitter conversation we had about her experience of mental health staff confiscating her smartphone whilst she was an inpatient, which she has blogged about here. There came a connecting together of minds – @chaosandcontrol’s desire to influence mental health service social media policies and my desire to improve ours so our staff have the resources they need to support people effectively. Here’s our conversation:
VB – what do you think staff were worried about in terms of your use of social media when you were a patient on the ward?
CaC – There was a concern that patients could write anything about themselves, other patients or staff, be it fact or fiction. To some folks, social media is an unknown quantity, and sadly, the unknown has a great capacity to scare. You don’t have to Google very hard to find stories of employees disciplined or sacked as a consequence of posting inappropriate things on social media sites. Indeed, I wonder whether information surrounding the dismissal and disciplining of NHS staff adds fuel to the fire? Not that long ago, a pocket watch was the must have latest gadget. Were patients allowed to keep them when they were admitted to the asylum? Or, did they have to refer to the clock in the main building several fields away? I am not well read enough on my history to know the answer to that question. The point that I am trying to make is that we’re in the 21st century; smart phones, the internet and social media are not going to disappear. As such, it is time to embrace what is here to stay. I would like to see social media embraced rather than ignored.
VB – what do you think about the role of advance agreements/decisions in helping people think about their use of social media when they are well, so they have a plan in place should they become unwell?
CaC – there are several strands that need to be unravelled. Are patients putting stuff on social media they later regret? If so, that’s where the advance directive can be really helpful. When a named nurse sits down with a patient to discuss their care plan (yes, I am being idealistic here!), I think an honest conversation about phones ought to happen. If a patient is in possession of a smart phone, staff should encourage the patient to think about what (if anything) they post on social media. Remind the patient that if they want to give up their phone for a time, staff can facilitate that. In addition, staff might want to explore whether it’s better for the patient to simply watch what’s happening on their preferred social media sites rather than being an active user during the acute phase of their illness.
VB – I’m aware that some inpatient and crisis services in the NHS and voluntary sector, have a ban on use of social media for people using their services. What do you think about that? Does it help or hinder recovery?
CaC - personally, I don’t think there should be an outright ban on the use of social media because it can play a beneficial role in recovery. Me? I was told to stop blogging because I might write a bunch of lies and then publish it on the web. This takes quite a dim view of the patient. If staff are notified of or discover a blog, they should review its content and make a decision with the patient accordingly. If it doesn’t breach staff/other patient’s confidentiality then where’s the problem? It’s a low risk situation. I firmly believe that staff should take action if the patient is naming the specific ward in which they are residing and writing extensively about other staff/patients to the point of them being identifiable. Back in my undergraduate days, a number of my friends were student nurses and did placements every term. They talked about patients in vagaries because if I could identify the patient to whom they were referring by nipping up to the ward, they had broken confidentiality. I see no reason why the same principle shouldn’t apply to the use of social media.
VB – how can staff make sure they build consideration of social media and mobile technology into their day to day practice?
CaC – I would really like to see stuff about mobile phones written into ward orientation leaflets and spelled out when given an initial tour of the ward. How about organising a designated mobile phone lounge? If space is an issue, why not allow patients to use a specific area of the ward? For example, an activities room or ward round room is unlikely to be in constant use. That way, if patients want to text/make a phone call etc, it’s done in private. If a patient has their phone out then staff can direct the patient to their bedroom or the phone lounge. This has the advantage of phones not being flashed around the ward where photos and videos can be taken.
VB – do you think there should be any sanctions for people who use social media in a way that breaks confidentiality or breaches the agreement then have made with people supporting them?
CaC - I am very keen on a one strike and you’re out rule. For example, at orientation, the rule is made clear… No breaching the confidentiality of other patients through social media. If patients do, phones will be confiscated. If not, patients get to keep their phones. I think this sets clear expectations surrounding acceptable behaviour.
I would like to see staff following some kind of decision tree about how they proceed in relation to patients using social media. I don’t think it’s fair to take a one-size fits all approach. As such, if staff could be provided with a list of questions to work through and provided with guidance accordingly, this would help subtleties to be appreciated. Instead, what is going to continue is the variance in the treatment of patients. For example, on some wards patients are allowed to keep their mobile phones but must give up cigarette lighters. On other wards, patients are allowed to keep cigarette lighters but must give up their phones. The guidance that has been produced is vague and open to interpretation from ward to ward.
So often guidance is produced as a consequence of an incident and often it’s not particularly nuanced. I recall the psychiatrist who talked to me about my blog mentioned that he was on a steep learning curve about social media. Once I had made a complaint about my treatment, the ward manager could see why I was upset about having my phone confiscated. I have had a mobile phone since I passed my driving test at the age of 17 (I turned 30 a couple of months ago) and it’s more than a phone, it’s part of my lifestyle. For example, I have knitting, news and games apps on my phone too. On the other hand, someone from an older generation might not be so upset to have their phone confiscated.
VB – I am not aware of any inpatient wards or other mental health services which have wifi available for people to access. It strikes me that this would be a great way for people to keep contact with friends and family while they are inpatients. Have you? And would you find this helpful?
CaC – I am aware of patients being able to access the internet in hospitals in Croydon and Gloucester because their policies are available through the Star Wards website. In Oxford password protected wifi is installed but only those with a University of Oxford account (e.g. medical students) can access it. I would be really keen to see wifi available on all hospital wards. Depending on the location of the hospital, some patients might already be able to access the internet through a hotspot. I take the view that it is better to give access rather than driving patients to circumvent the system.
VB – I find social media an important way to keep contact with people, build relationships and networks, and to be sociable. I’d love to hear a bit about the importance of social media for you personally
CaC - To me, social media is about connection. It’s important to highlight that social media can act as a protective factor. For example, through social media gardeners can discuss gardening and exchange tips to their hearts content. Likewise, those who use social media to discuss mental health can do so too. During the complaint process, I highlighted The World of Mentalists blog as a positive example of social media being used in a mental health context. Support is given and received through social media and I think it’s important to emphasise that sometimes bloggers meet each other in real life too. At times the conversation can be superficial but it can also have depth to it too.
CaC – Do you think there is any mileage in providing training and guidance in relation to social media? Might dispelling myths help to improve staff and patient experience alike?
VB – yes I absolutely think training is very important. Firstly I’m keen that an awareness of social media is built into existing training, such as advance decisions and risk management. Secondly, I think it should be covered in corporate induction for all new staff. Thirdly, I’m a real fan of social media surgeries, in particular the idea of people who are more confident about social media, sharing their knowledge and skills with people who want to learn more. We experimented with one in 2012 where people using and providing services shared skills and learnt from each other. I hope we will have regular ones running early in the New Year. Lastly, we had some great sessions on digital identity from @gopaldass in 2012 which was very helpful in enabling us to think more deeply about how we craft our identities online. Guidance is very important but I feel it needs to be flexible rather than overly prescriptive and illustrate the opportunities as well as any risks.
CaC – If a patient or a member of their family is publicising a poor experience of being a patient or carer via social media, how do you respond?
VB – our communications team have google alerts set up so we can monitor what is being said about us on the web. We also get comments directly sent to us on Twitter and Facebook. We always aim to respond promptly to any concerns raised, take it offline, and offer to help people sort out their concerns – usually by putting them in contact with our Patient Advice and Liaison Service or the relevant member of staff. If people are talking about us on blogs, for example, we might add a comment to direct people to how they can have their say about a particular issue they are discussing. But we’re keen to avoid wading into things if we don’t feel it is appropriate. We have information about how we use social media on our website.
CaC – What is your view on sites like Patient Opinion? Have you observed any benefits to their use?
VB – we are massive fans of Patient Opinion. We have their widget on our website so anyone visiting our site can see what people are saying about us. Patient Opinion have a system where they send us an automated alert as soon as they post a comment about us. Our communications team then gets in touch with the relevant member of staff and we put together a response as quickly as possible. We always offer an opportunity to meet up if an individual posts a concern about any of our services. We also include every Patient Opinion post in our Board of Directors performance report, so they see each one. We are piloting intensive use of Patient Opinion in our Healthy Living Service between January and March this year so we can evaluate the impact that it has. I’m keen that we increase the number of posts we get and make sure we collect evidence of what has changed as a result. I think the most important benefit of Patient Opinion is that it is independent and visible to everyone – this in itself nudges our culture towards being increasingly transparent.
So the key points for mental health organisations to take away are:
- A blanket social media ban isn’t helpful
- Build use of social media into advance decision making
- Build use of social media into the care planning process
- Ask people about social media when they are first assessed on the ward
- Don’t confiscate chargers (have them PAT tested so they can be used on the ward)
- Be clear about patient confidentiality and consequences of breaking it
- Consider providing free wifi on wards
- Provide guidance and training for staff
Anything you would add?
You can find a response from Amy at Patient Opinion here
@WeNurses are having a Twitter chat on this topic, and inspired by this blog post, on Thursday 17 January 2013 at 8pm using the hashtag #WeNurses – please do join it – really hoping we get a good mix of contributers with experiencing of both using and working in mental health services.