Is the NHS rubbish with social media? Part II of a three part interview with

What do you think about how the NHS is responding to social media? Read part II of my three part interview with One in Four editor and Social Spider development director, Mark Brown, to get his take on where we’re at with social media and what the future holds.

Where do you think we are at with social media in mental health services?It amazes me how little the thinking has moved on in the area of social media and mental health.  It’s like a country, hidden away from progress, on a secret plateau.  There’s so much focus on how does mental health do social media or ‘how do we do social media at people with mental health difficulties?’. It’s unconnected to the experience of people actually doing and using social media.

The problem isn’t about access (there are computers in libraries, school, workplaces and an increasing number of homes) the problem is meaning.  Why would people want to go online?  Without a particular reason to do so and support to improve your competency, the tendency is to get there, turn the thing on, prod it a bit and then wonder why it isn’t bringing all of these amazing and life changing things into your life.

What are your views about how NHS Trusts are currently using social media? To an NHS press office doing social media, timely means putting out a scheduled tweet about it being a bank holiday, on a bank holiday.  This isn’t to say that there isn’t room for machines (or press offices) to pump content into social media space.  Indeed, if you’re going to see your role as an information provider then you should do it consistently, but that isn’t the same as having a social media presence.  It’s injecting information into a social media space, and I think there’s a big difference.

Twitter is news, and the ideas of people about news, all as one unified space.  Rather than public opinion being what happens outside the newsroom door, it’s now in the news room and is often difficult to separate from the news itself.

What would you say to mental health professionals who are concerned about the potential negative impact of social media for the mental health of people they support? I think it’s going down the wrong track to discuss social media as if it is something that is either good or bad for your mental wellbeing.  It all depends on both how you’re using it and what you’re using it for.  For some people social media is a kitten photograph or an inspirational aphorism collecting device.  For others it’s their place of work.  I think the issue is how you use it and what you’re hoping to get out of it.  I think the best way to look at it is a huge cloud of opinion, ideas, news, experiences and just stuff made by people.

There are huge advantages to living an online life ‘in the spotlight’ and also drawbacks.  It’s fantastic that when I go to Twitter there are people talking to me.  It’s also awful when I don’t feel like engaging in weighty discussions about the future of mental health.

I think it’s a pointless quest to try to make social media space ‘safe’.  We would be far better off concentrating on looking at ways that people can elect to keep themselves safe.

Social media used properly accelerates your thinking.  Follow the right people and you suddenly have access to the latest research, the most up to date news stories, the fastest opinion.  Whereas catching up with the world used to be a paper on the train and then a few monthly or weekly magazines for longer reads, now I read huge amounts of stuff across a wide range of topics.

 How do you think mental health professionals should be engaging with apps and social media in their day-to-day clinical work? I think it’s useful to detach ideas for apps from thoughts about social media. Apps might interact with social media, they may even be based within social media platforms, but they aren’t social media.  Thinking of the two in the same breath makes people think of ‘doing a Facebook for mental health’ or ‘let’s set up a closed discussion forum’.

I’ve been to a few innovation events recently and it’s confirmed to me that apps work only when they do specific things, in a specific context for specific people and they don’t work if those people don’t want to use them.  Check out this blog post that I wrote about a #mindtech event I attended recently.

What social media can be incredibly effective at is liberating knowledge assets from institutional silos.  The NHS building blocks for this exist but we’re in a transitional phase. Lots of NHS stuff exists online but not so many NHS folk exist in the social media sphere.

At the minute there are a number of people doing smash and grab raids on these info piles using search engines rather than crowbars; finding relevant information or data and launching it out to a lay audience on Twitter.  This has pre-empted policy to do so. These diggers are actually doing what big orgs should be doing, moving their assets into public spaces where their value may be realised in ways that no-one planned.  has been tweeting the NICE guidelines for minimum standards in mental health care and suggesting people keep a copy with them for reference when accessing services. This does the potentially transformative job of making people who access services aware of the actual standards to which those services should subscribe.  This turns an asset created for one purpose into an asset with value to a completely different audience to that for which it was intended.

I think the NHS is massively behind the game in understanding this.

The role of peer support workers are becoming more common in many mental health services. Do you think there’s room for a similar social media version? There’s a proper term for the practice of making sense of information and guiding people towards the most useful and relevant apomediation. I see one of my roles as an apomediary – being a trusted voice to guide people to the good and relevant knowledge assets and away from the bad or awful ones.  This is an active process based on having a good idea of what my followers might find useful and being able to translate a raw asset into something with a realisable value to people.  Signposting has an established professional role, but is often seen as something that happens within a particular pathway and forgets that people exist for 24 hours a day and not just at points of contact with services.

I think the NHS as a whole hasn’t been great at seeing the potential of apomediaries as partners in making mental health systems work better.  The NHS tends to see information from their side of the desk and to forget that what they want to tell people isn’t necessarily what they want or need to know.  I think there’s incredible scope for the NHS to work more closely with apomediaries as partners and peers.  The NHS is a system.  It’s great at providing for people.  It’s often awful at knowing people as people rather than patients.

People working in and using services are beginning to get their heads around personal and professional identities and boundaries. What are your views about this? I think that social media represents in practice the equivalent of 18^th Century coffee houses, a far more widespread and democratic version of the ‘public sphere’.  There are less barriers to entry, anyone can dive in.  We’re seeing the establishment of a notional place of discussion where public opinion is formed, fought over, modified and manipulated.

Whereas the real coffee houses were where the newly arrived middle class formed coherent ideas about how they would struggle against autocratic decision makers and rulers, this social media coffee house is a repository and trigger of far more forms of ideas, expressions and actions, as the people entering it are far more diverse.

In mental health, I think social media is actually serving exactly the same function: creating a discursive space where a ‘new’ mental health is being hashed out collectively as the kind of sum of millions of tweets, blogs, videos, discussions and podcasts.

The NHS is the place of the fading autocratic rulers and in the mental health public sphere you have a huge number of different voices all, whether they realise it or not, asking the same question: ‘How can we make life better for people with mental health difficulties, or in many cases, ourselves?’

What’s interesting to me is the extent to which mental health professionals are keeping out of this discussion.  They have huge knowledge assets which they currently aren’t contributing to this grand conversation (apart from notable exceptions).  It seems, tied up in rules and guidance that the NHS collectively has moved to try to keep the barbarians from the gates.

Social media is a boundary fucker.  We talk so much about confidentiality and protecting patients then you look and find people tweeting from inside inpatient wards while ill.  We find people who a trust will see as patients writing blogs that many more readers than the chief executive of the trust that provides them services.  Social media, by its nature, puts together people who would never have met.  It creates strong public voices which didn’t get there through traditional routes.  It creates stories that appear from odd angles and at unexpected times.  It makes public issues of things that might once have remained behind closed doors.  It doesn’t let things stay where policy makers have traditionally put them.

It also creates a situation for mental health where it is less ‘them and us’ and more ‘just us’.    There is something hugely satisfying in seeing someone who offline would be seen as a ‘patient’ discussing online with someone who would be seen as an ‘expert’ and both learning from that experience.

This does create huge boundary issues which are being played out across all professional sectors at the moment.  There are similar debates going on across local government, the media industries, the NHS as a whole about professional boundaries.

The challenge is moving from being a closed organisation to an open one, from a series of monolithic structures to a series of groups of individuals working together with the communities that they serve.  That is not well governed by heavy handed rules usually written by people who see social media only as a challenge or a danger – social media as scandal waiting to happen.  They need a clear and developing debate for guidance that is based on flexibility not regimentation.

Can it be a choice for mental health professionals or do they need to understand social media? I think mental health professionals have to keep up with the aspirations, ideas, hopes and ideals of the people they work on behalf of anyway.

It’s absurd that spending time in front of a computer is seen as de facto more harmful than reading a book – it depends what book you’re reading versus what you were doing online.

I’ve heard awful things like people being told to stop blogging ‘for their own good’ or being forbidden from tweeting while in hospital.  I’ve also heard of professionals using information from people’s blogs in their professional practice of treating that person (now there’s a two way boundary shifter!)

One of the things that I did find out very early online in social media was that there is not a uniform level of digital competency across people and that is often in no way related to their academic or social status.  Some people don’t realise that information that they put online can be seen by people other than those they intend.  Some don’t understand the difference between debate and bullying.  Others still can’t understand that a blog post by someone is not the same as an article published in a major newspaper.  This creates a wide disparity of expectation and also a wide differing of understanding as to what actions in that social media space mean.

If my local NHS mental health trust follows me I think: “Cool! the person running their account must be vaguely interested in what I say”.  Someone else might think:  “Shit!  They’re checking up on me and want to read all my personal business!”

I think that’s why mental health practitioners need to develop or co-produce not rules for social media use but an ethics of social media use as, at heart, you’re dealing with people through a technology not just a technology itself.

Should we be worried about anti-social networking? I think in social media you have to roll with the nature of the space that you’re in.  People contact you at odd hours and discuss things that you weren’t expecting to discuss.  I think a personal or professional based ethics approach is the way to go.  It’s almost the same as being mindful: know what you’re doing and why you’re doing it, be authentic, behave with kindness and compassion for others but also for yourself.

I think we all grow our social media tool kit.  I keep to hand lots of different links that are useful when people bring certain questions to me on Twitter.  I think it’s always worth remembering that most of the time, people have come to directly address you on social media for one of four reasons: (1) they really want to talk with you (2) they really want you to tell other people something they’ve told you (RT/share) (3) they’re talking to you because they can’t get to talk to the people they really want to talk to (4) they really want you to listen.

The first rule of any social media space is always to put in more than you take out.  I think if you stick with that you’re usually fine.

 A final note from me

So do you think the NHS is rubbish with social media? and if so, what should we be doing to change things for the better? My view (as someone who works for an NHS Trust) is that we’re learning fast but still have a long way to go. We’d both be very interested to hear your reaction to what Mark has to say and we’ll both respond to any comments you make. We’ve really enjoyed our conversation and would like to expand it further with you too.