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Introduction

In the old days, patients may have turned up fully armed with a pen and some paper. Nowadays their bags can contain mobile phones, smart phones with full internet access, ipads, laptops, e-readers (which might also have internet access). Thus equipped, patients are able to continue to their daily social, work, leisure, financial and other activities. Now, for some patients, at some stages of their admission, this can be not only unproblematic but beneficial, including the chance to use mental health social networking sites. For others, it raises complex and sometimes fraught issues. To some it’s an unknown, confusing and daunting world.

But what’s certain is that people are highly reliant on their mobile and especially smart phones. This usually intensifies rather than reduces when they in hospital. Randi Zuckerberg, author of Dot Complicated (& older sister of Facebook founder Mark) did research and discovered: 30% of women would rather give up having sex for a year rather than be without their mobile phone for a weekend. 50% would prefer to spend a night in prison than deactivate their social media accounts. Other sacrifices would include shoes, wine and even running water.

The use of social media is complicated because there are undoubted risks for some individuals, whether to themselves (eg making dodgy social connections online) or to others (eg sending ‘unwise’ or hurtful emails which the person may subsequently regret when in a better frame of mind.) But this is just a new permutation of the continuous issue of risk management, which must be based on individual circumstances rather than crude generalisations. Ward staff are skilled at making these complex judgements continuously through every shift, and all the usual processes and structures help with this.

The internet, along with its various manifestations of social media is here to stay and our lives are becoming more and more dependent on using this technology. Because of the many benefits for patients, we’d love it if wards felt able to embrace this rapidly evolving way of life. We strongly advocate access to social media on the ward, including a reliable Wi-Fi connection made available to all inpatients.

Whether it’s sharing words, pictures, music, videos or conversations, it’s all happening online through:

  • blogs and microblogs (e.g. Twitter)
  • content communities (e.g.Youtube)
  • social networking sites (e.g. Facebook and Skype)
  • virtual game and social worlds (e.g. Second Life)
  • collaborative projects (e.g. Wikipedia)

Concerns

One significant concern is patients putting stuff on the net they’ll later regret when they are feeling better. Then there’s the issue of confidentially; the privacy of the patient using social media as well anybody they might be tweeting, blogging or Facebooking about. Here are a few ideas to safeguard these issues:

  • Invite the patient to utilise an Advance Directive (more info here).
  • Upon admission have a non-judgmental chat with the patient about the pros and cons of them using their phone, ipad or laptop.
  • Offer the opportunity for them to hand in the device if they have any concerns about using them while on the ward. This could be for short or longer periods of time. Some patients may want to lock their phone away in their locker if they feel they are using too much.
  • Include information on use of equipment and social media in your patient welcome booklet; including the rules.
  • The main thing here is considering what’s best for each individual. To have their phone taken off them for one patient could be detrimental to their mental health, especially if using it is part of their support network, comfort and way of coping. For another, it could be a big relief.
  • Consider delivering staff training on internet use including social media.

Social media is here to stay

Love them or hate them, Facebook and other Social Network Platforms (SNPs) are here to stay. There are both good and bad points about patients using SNPs but let’s consider the good ones here:

  • No matter where we are (geographically or emotionally) SNPs have become virtual communities where we can all easily get connect with friends and family.
  • All mental health recovery models stress the importance of connection and interaction and sites like Facebook provide enable us to do just that – connect and interact.
  • SNPs are where conversations are happening. Nowadays we’re spending more time chatting via social media than email.
  • This isn’t just about updating our status and reading others’, these platforms also get us involved with what we’re passionate about and interested in.
  • We can learn to augment—not replace—our “real-world” relationships through social media.
  • Communication, social exchange and information sharing are all already essential factors of healthcare. In this sense, adopting and embracing the social networking phenomenon shouldn’t be too much of a stretch.
  • Patients (especially younger ones) already use smart phone apps like Twitter and MSN Messenger while on the ward. Build on this: incorporate this activity into ward life.
  • We can find support in online communities

In what might turn out to be a watershed in the use of Twitter by inpatients, in October 2013 a mental health nurse, known on Twitter as @teaandtalking tweeted her experiences when she was herself an inpatient. The hospital wasn’t named and it was a very upfront account of her, mainly very difficult, time on the ward. @teaandtalking’s honesty and courage were warmly and extensively acknowledged by people on Twitter and it was very clear how helpful she found all the feedback and support she got. The comments at the end of the article, and responses to these, raise some of the issues covered above.

Skype

We love Skype, in fact we think it’s the best thing since sliced Spam became unpopular. We energetically encourage the use of it on wards. It’s a great (and free!) way for patients to keep in touch with friends and family. Some Scottish wards use Skype to help patients keep in touch with relatives far away or living in very isolated, transport-deprived areas. You can have several people taking part in a Skype conversation – a sort of group video conference, without the name badges.

 

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