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Barriers to the Facebook Generation Getting Help and Support Online

As one of the team of people involved in organising the first Internet Safety Day, it was a day that made me reflect on the continued absence of concerted action by mental health organisations and in particular, their governing bodies, in internet safety initiatives.

This week saw the 10th annual Internet Safety Day and events to highlight this year's theme of 'Connect with Respect' took place in more than 90 countries on 6 continents. As one of the team of people involved in organising the first Internet Safety Day, it was a day that made me reflect on the continued absence of concerted action by mental health organisations and in particular, their governing bodies, in internet safety initiatives.

Internet safety relates to the risks to children and young peoples' well being that include for example, online bullying, content that promotes self-harm behaviours and inappropriate contact. Research findings provide insights into the nature of the experiences young people have online, for example, in 2012, 10% of European children aged between 11-16 year olds reported that they had seen pro-anorexia sites, and this increased to one in five teenage girls in the age group 14-16 years old. 7% of young people have seen sites that advocate self-harm and 5% have seen suicide sites.

The internet industry has a duty to provide easily accessible means by which Internet users can report instances of abuse. Abuse management teams are trained to make decisions about how to handle reports of abuse in strict accordance with a website's Terms of Service. Typically, abuse management teams on child focused and general audience platforms are not comprised of mental health professionals and it is not their role to direct people, whom they think might be negatively affected by the content or activities they reported, to appropriate sources of support, advice and guidance.

Whilst child protection organisations have been active in the field of internet safety for more than 10 years, there has been a degree of reticence on the part of mental health organisations and in particular, their governing bodies to get involved in these discussions. For example, in September 2009, the Royal College of Psychiatrists issued a statement, in response to the establishment of the UK Council for Child Internet Safety (UKCCIS), calling for urgent action to protect vulnerable young people from the harmful influence of pro-eating disorder websites, however, this did not translate into concrete actions in support of their own statement. Neither the Royal College of Psychiatrists or any other mental health governing body has engaged with the UK Council for Child Internet Safety Executive Board by, for example, offering to work with key stakeholders to inform the development of e.g. training manuals for moderators and e-safety educators about how best to address mental-health related issues online.

This week, at a meeting entitled Innovating to Protect Children Online, hosted by Google, NSPCC and Tim Laughton MP, to mark Internet Safety Day, Florian Rathgerber, a computational scientist, presented the rationale underpinning a technology based solution called 2nd.Friend.

Florian described 2nd.Friend as a 'multi-channel tool that can act as an umbrella and single access point for a variety of help and support organisations. Young people can access 2nd.Friend via several entry points: a browser plugin, a mobile-friendly website, an SMS gateway and in the future an app'.

The need that 2nd.Friend seeks to meet is recognised by Government in a recent strategy document entitled 'No Health Without Mental Health', which outlines its strategy to improve outcomes for people with mental health problems through high quality services. The related NHS programme 'Improving Access to Psychological Therapies' (IAPT) is rolling out services across England, offering interventions approved by the National Institute of Health and Clinical Excellence (NICE) for treating people with depression and anxiety disorders. Critically, for the IAPT programme to succeed it will need to extend its reach and relevance to densely populated online communities, and that will require an internet industry facing collaborative approach.

There are a small number of innovative mental health organisations operating online services which do provide valuable services and illustrate that issues such as data protection, privacy, client confidentiality and consent can be managed successfully. However, to create a thriving eco-system online of help, support, advice and guidance there are a range of issues that need to be tackled and this will require a large number mental health organisations and their governing bodies to engage collaboratively with companies such as Google, Facebook and others, innovators like Florian Rathgerber and policy bodies. To create a viable, scalable eco-system, there are a myriad of practical questions, e.g. about what types of mechanisms can be used to effectively triage online requests for help such that they are directed to the correct organisations. These can only be addressed fully if there is a concerted effort to remove the barriers to constructive and meaningful dialogue between key stakeholders.

Ultimately, facilitating early help seeking online by affording easy access to appropriate sources of help and support will have a myriad of positive outcomes, not least amongst these is a reduced risk of harm to internet users.

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