Case Studies & Literature Review * Real Time Crisis Centre Hub #RTCH

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Case Studies & Literature Review * Real Time Crisis Centre Hub #RTCH

  1. 1. Running Head: SOCIAL MEDIA AND MENTAL HEALTH INTERVENTION 1Social Media and Mental Health Intervention: A Collection of Case StudiesEmma Batten, B.A. (Hons)In consultation with Constable Scott Mills and Anne Marie Batten RNSuccess and Safety Relationships and Technology Centers (SSRTC)April 19, 2013
  2. 2. SOCIAL MEDIA AND MENTAL HEALTH INTERVENTION 2Literature ReviewBarriers to TreatmentIn recent years, the Canadian mental health system’s effectiveness has been called into question.Numerous studies have identified treatment barriers. Such barriers unintentionally deny a patient fromaccessing treatment. The Mental Health Commission of Canada has stated that, “Only one in three peoplewho experience a mental health problem or illness- and as few as one in four children or youth- reportthat they have sought and received services and treatment” (Mental Health Commission of Canada, 2012,p. 12). This is atypical of other health conditions and suggests an inadequacy in current mental healthservices.A Canadian study conducted in 2006 by Wang provides some useful statistics. Of the 4094participants in this study, 21.6% reported that they required assistance for mental health or substanceabuse issues and did not receive it (Wang, 2006). These participants were also asked to provide reasonsfor their lack of treatment. Of this 21.6%, 794 participants reported various treatment barriers (Wang,2006). However, the treatment barriers commonly reported were related to acceptability rather thanaccessibility (Wang, 2006). In other words, individuals chose to avoid treatment because of perceivedsocial stigma.With regards to treatment barriers, there are two distinct categories. These categories are referredto as acceptability barriers and accessibility barriers. Acceptability barriers refer to issues of stigmaand social acceptance. On the other hand, accessibility barriers refer to the availability and accessiblenature of services. In the case of Wang’s study, participants reported issues of social acceptance as theirperceived treatment barriers. Thus, availability of mental health services was not perceived as an issue.The Mental Health Commission of Canada has supported this idea. According to their report,stigma and the fear of being labeled prevent many individuals from seeking mental health services(Mental Health Commission of Canada, 2012). In addition, some people are unaware that they have amental health problem, which can result from either a lack of knowledge or the symptoms of the mental
  3. 3. SOCIAL MEDIA AND MENTAL HEALTH INTERVENTION 3disorder itself (Mental Health Commission of Canada, 2012). Interestingly, other Canadian studies haveidentified lack of knowledge as a barrier to treatment.A Canadian study in 2007 found that low-income individuals who had not completed high schoolwere the most likely group to report acceptability barriers to mental health care (Steele, Dewa, & Lee,2007). With regards to treatment barriers, low education levels are strongly correlated with perceptions ofstigma. This is consistent with the idea that a lack of knowledge, or education, can serve as a treatmentbarrier. An individual may be unaware that they require treatment.In a study based on Ontario’s health care system, patients reported financial barriers to treatment(Sareen, et al., 2007). This is consistent with another Canadian study conducted in 2006 (Steele, Glazier,& Lin, 2006). High-income respondents are more likely to receive mental health services (Steele, Glazier,& Lin, 2006). Since Canada’s health care system is universally funded, it is possible that individuals oflower socioeconomic status are not receiving treatment due to a lack of education. This supports thenotion that education and mental health treatment are linked. Within Canada, there is a need for increasedoutreach to low-income individuals (Sareen, et al., 2007).This presents an interesting challenge for Canada’s mental health system. The prevailing issue isnot availability of resources. Rather, there appears to be a fundamental disconnect between patients andavailable services. To date, there are a significant percentage of mentally afflicted patients who are notreceiving treatment. This has serious implications, since an untreated mental illness affects an individual’squality of life. Also, on a macro level, untreated mental illness can have a negative effect on the healthand productivity of a community (Sareen, et al., 2007).Social Media UseBefore discussing the relationship between social media and mental health services, it isimportant to note the growing use of social media in general. In the last decade, social media has becomeincreasingly popular. According to Ipsos’ most recent report, more than one-half (62%) of all Canadianshave visited or browsed a social networking site (Ipsos Reid, 2012). This is higher than ever before. This
  4. 4. SOCIAL MEDIA AND MENTAL HEALTH INTERVENTION 4increase in social networking may be due to an increase in mobile internet access.Currently, 86% of Canadians have access to the Internet (Ipsos Reid, 2012). There has not beenan increase in Internet access over the past few years (Ipsos Reid, 2012). However, 37% of Canadiansnow have mobile Internet access (Ipsos Reid, 2012). This is a dramatic increase from Ipsos’ 2001statistics, where only 5% of participants possessed mobile Internet access (Ipsos Reid, 2012). Overall,the increase in availability of mobile internet access may be responsible for the increase in social networkuse.Of the Canadians who have visited a social networking site, approximately half report visiting asite on a daily basis (Ipsos Reid, 2012). This is an increase compared to recent years, and suggests thatparticipant’s reliance on social networking has increased. In fact, 41% of Canadians felt that theycommunicated with people online more than offline (Ipsos Reid, 2012). Thus, it would appear that socialmedia has become a tool for individuals to communicate and relationship-build.According to Ipsos, the most popular social networking sites appear to be Facebook, Twitter,Linked-In (Ipsos Reid, 2012). With regards to Twitter, research has shown that individuals are using thesite to share information and meet people (Johnson & Yang, 2009). A study conducted by Chen in 2011seems to expand on this notion. Chen found that, through Twitter, individuals can gratify the basic humanneed to connect with other people (Chen, 2011). Twitter appears to be a medium that people actively seekout in order to connect with others (Chen, 2011). By facilitating interpersonal communication, socialnetworking sites can improve an individual’s psychological well-being.There is evidence to support the idea that social networking can have psychological benefits.Using social media, individuals can express their feelings and share ideas. Social networking can also beused to relationship-build and connect with other individuals or groups. Communication plays a vital rolein integrating people into their communities (Kontos, Emmons, Puleo, & Viswanath, 2010). Suchintegration can be achieved by helping to build support, maintain ties, and promote trust (Ackerson &
  5. 5. SOCIAL MEDIA AND MENTAL HEALTH INTERVENTION 5Viswanath, 2009). Through social networking sites, individuals can reach out and establish meaningfulsocial connections.Medical Uses for Social MediaBecause social media is used for relationship-building and information-sharing, many healthprograms have begun to connect with individuals through social networking sites. Social networkingoffers the potential for mass collaboration, which is useful from a health standpoint. Studies have shownthat there is an absence of inequalities with regards to social network use.With regards to Internet access, there are significant disparities among racial, ethnic and socialgroups. Generally speaking, there are sociodemographic inequalities when it comes to Internet access.However, it has been shown that, once Internet access is gained, there is consistent use of socialnetworking sites regardless of any sociodemographic characteristics (Kontos, Emmons, Puleo, &Viswanath, 2010). Thus, there is an absence of inequalities with regards to social networking. Thissuggests that social networking sites might be an effective tool for sharing health information. Forexample, there has been success with sharing public health interventions on social media sites (Kontos,Emmons, Puleo, & Viswanath, 2010). Through social media, health care services can communicate withmany different groups of people.However, many workplaces do not allow their employees to engage in social media. There hasbeen research to demonstrate that social media can enhance a workplace’s performance, specificallywithin the health care field. A good example of this is the Mayo Clinic in the United States. The Mayoclinic has embraced social media and has become very popular online. The Mayo Clinic has the mostpopular medical provider YouTube channel and nearly 200 000 Twitter followers (Cleary, 2011). TheMayo Clinic has been able to use social networking to share health information and spread awareness.In the past decade, there has been an increase in online health information. Recently, this digitalhealth information has become more mobile (Della, Eroglu, Bernhardt, Edgerton, & Nall, 2008). A goodexample of this is the Apple Store, also referred to as iTunes, which sells digital media online. iTunes
  6. 6. SOCIAL MEDIA AND MENTAL HEALTH INTERVENTION 6provides free podcast sessions from numerous health information sources (Della, Eroglu, Bernhardt,Edgerton, & Nall, 2008). This allows individuals to download health information right to their mobiledevices. Many large health institutions are also offering podcasts and RSS feeds directly from theirrespective websites (Della, Eroglu, Bernhardt, Edgerton, & Nall, 2008). There has been a dramaticchange in the way that individuals receive and share health information. As a society, reliance on digitalinformation is rapidly increasing. Many medical institutions have responded by offering online healthcare information.Social Media and Mental HealthWithin the mental health field, it is believed that social media use can make a significantdifference. As discussed previously, there are significant treatment barriers within the mental healthsystem. Many individuals do not receive treatment for their symptoms due to acceptability barriers.However, social media allows for individuals to interact with mental health supports in a comfortableenvironment. As previously stated, 41% of Canadians currently communicate with individuals onlinemore frequently than offline (Ipsos Reid, 2012). For individuals who prefer online communication, socialmedia could serve as an effective tool to provide mental health counseling. Also, the portability of socialmedia allows for rapid, unencumbered communication.To date, there is not a lot of literature examining the effectiveness of mental health casemanagement through social media. However, a Canadian study in 2012 has demonstrated that there is adesire for online mental health counseling services (Bender, et al., 2012). This study involved testicularcancer survivors, who were recruited through the Princess Margaret Hospital. Of the participants whoused social media, more than half (60%) expressed a desire to engage in online supports (Bender, et al.,2012). Furthermore, 26% of the social media using participants admitted to using online communities forsupport related to testicular cancer (Bender, et al., 2012). Thus, individuals were using the Internet tosupplement their treatment process. By reaching out through social networking, testicular cancersurvivors were able to satisfy psychosocial needs.
  7. 7. SOCIAL MEDIA AND MENTAL HEALTH INTERVENTION 7Social media can also serve as an effective tool to communicate public mental health information.For example, in post-911 New York, mental health services were provided to deal with disaster-relateddistress. There was an aggressive media campaign promoting the availability of free counseling, publiceducation, and referral services (Frank, et al., 2006). By advertising through electronic media, mentalhealth services were able to overcome the barriers of stigma and lack of information (Frank, et al., 2006). It was found that electronic media may be effective in encouraging help-seeking behaviour (Frank, et al.,2006). When incorporating electronic media into public mental health campaigns, individuals were moreapt to seek treatment.Success has also been documented among suicide prevention centers in the United States(Estrine, Hettenbach, Arthur, & Messina, 2011). Within the United States, a few suicide preventioncenters are providing crisis services online (Estrine, Hettenbach, Arthur, & Messina, 2011). Onlineservices have been provided through the use of chat room communication. There has been a great deal ofcriticism regarding effectiveness, but these centers have been very successful. These online crisis centershave reported that individuals who reach out are able to openly express themselves in online venues(Estrine, Hettenbach, Arthur, & Messina, 2011). This is likely a result of the online dis-inhibition effect,which refers to the tendency of people to open up more and say more about themselves online than intelephone or face to face interactions (Estrine, Hettenbach, Arthur, & Messina, 2011). The success ofonline crisis intervention demonstrates the importance of online mental health services. If mental healthservices were able to interact with individuals through social media, this would increase the availabilityand mobility of mental health support.ConclusionIn conclusion, our current mental health system presents clear treatment barriers. This literaturereview discussed the growing use of social media, especially within the healthcare field. Overall, socialmedia can be used to help overcome treatment barriers. Diminishing treatment barriers can positivelyaffect an individual and how they relate to their community. Within the mental health field, social media
  8. 8. SOCIAL MEDIA AND MENTAL HEALTH INTERVENTION 8use can make a significant difference for patients. The following case studies demonstrate effectivemental health case management and intervention through social media. The names of the studiedindividuals have been changed to maintain confidentiality.Case Study 1: JoeHistoryJoe is a homeless male, approximately 50 years old. He is schizophrenic and exhibits symptomsof severe paranoia. He also presents with persecutory delusions. Consequently, Joe exhibits very reclusivebehaviour and is mistrustful of others. This makes it very difficult to establish a clinical relationship. Joedoes not take any prescribed medication. Rather, he attempts to self-medicate with the use of marijuana.However, the use of marijuana seems to intensify his delusions. In rare circumstances, he exhibits apotential for violence.InterventionsHe presented himself to Toronto Police Headquarters on June 26, 2010. Upon his arrival, Joeexhibited aggressive behaviour. More specifically, he was yelling loudly and threatening police officers.Due to the G-20 summit taking place in Toronto at this time, Joe’s outburst was occurring in the midst ofa heavy police presence. In order to prevent further conflict, Cst. Scott Mills calmly approached Joe andoffered him something to eat. Through this, Mills was able to quietly remove him from the situation.After this event, Mills continued to meet regularly with Joe and a trusting relationship wasformed. From this point, Mills contacted his colleague Anne Marie Batten. Batten was a crisis outreachnurse who was able to provide Joe with additional support. In order to establish a clinical relationship, itwas important for Batten to meet with Joe independently. However, Mills and Batten case managed Joecollaboratively.
  9. 9. SOCIAL MEDIA AND MENTAL HEALTH INTERVENTION 9Collaborative case management was achieved through the use of social media. For the most part,communication regarding Joe occurred through the use of Twitter. In order to communicate moreeffectively, the hashtag #Homeless Joe was created. This alias was selected by Joe himself.From following the hastag #HomelessJoe, Joe was provided with a lot of unanticipatedcommunity support. Many individuals on twitter began following #HomelessJoe. #HomelessJoe wasfollowed by journalists, police officers, and many other caring community members. As a result,#HomelessJoe could be used for both communication and intervention purposes.For instance, in spring 2012, both Mills and Batten were unable to locate Joe. In responseto Batten’s concerns, she tweeted that she was unable to locate #HomelessJoe. As a result, severalmembers of the public began to search for Joe. Through social networking, Joe was eventually locatedby a concerned community member. Once Joe was located, it was clear that he required hospitalization.Thus, he was admitted to a Toronto treatment facility. For this admission, he was both accompanied andsupported by Batten.ResultsDue to Joe’s paranoid and persecutory symptoms, he would be labeled “difficult to serve” withinthe traditional health care system. However, Batten and Mills were able to establish a clinical relationshipwith Joe. This relationship was achieved by establishing a level of trust. Such a level of trust is difficult toestablish with a client of this nature. Through the use of Twitter, Joe received a level of support that isunattainable within our traditional healthcare system.As a result of his relationship with Mills and Batten, Joe became more receptive and trustingwithin the community. Joe was able to engage with various community supports. For example, Joe wasable to secure both housing and disability insurance. Prior to the use of #HomelessJoe, this outcomewould not have been established.Benefit of Social Media Engagement
  10. 10. SOCIAL MEDIA AND MENTAL HEALTH INTERVENTION 10Social media was used to increase awareness, maintain community safety, and to enhance Joe’squality of life. With regards to awareness, #HomelessJoe was the subject of news articles highlightinggaps in the current mental health system. #HomelessJoe encouraged discussion regarding unconventionalapproaches to mental health management. Through Twitter, Batten and Mills continue to advocate forchanges in the mental health system.Also, in Joe’s case, the use of social media had a direct impact upon community safety. Throughthe use of #HomelessJoe, Batten and Mills were able to maintain direct contact with Joe. This allowedfor a level of monitoring and intervention that cannot be provided by our conventional health system.Through social media contact, Joe’s potential for violence was reduced. Through #HomelessJoe, Joe’sbehaviour was monitored. If needed, hostility diffusion and crisis support was administered. Batten andMills were able to use a proactive and preventative approach, which counteracted Joe’s violent outbursts.Through the use of Twitter, Batten and Mills were able to engage with Joe and earn his trust.Ultimately, this led to an increase in Joe’s quality of life. Through frequent contact and support, Joe wasconnected to appropriate resources and housing was obtained. Overall, there is a direct link betweenhousing and health. Once Joe’s housing was secured, his health showed overall improvement. Hedemonstrated improvement in the following areas: nutrition, personal hygiene, and sleeping patterns.However, it is important to note that Joe remained un-medicated. Since Joe refused medication, he stillrequired monitoring and support. Currently, Batten and Mills continue to monitor Joe.Case Study 2: AaronHistoryAaron is male, approximately 20 years old. He has been diagnosed with bipolar disorder,depression, and social anxiety. Aaron is prone to suicidal ideation. He lives independently in his ownapartment. An Assertive Community Treatment Team (ACTT) meets with Aaron and provides support.On occasion, Aaron has required support from the Mobile Crisis Intervention Team (MCIT). MCIT is a
  11. 11. SOCIAL MEDIA AND MENTAL HEALTH INTERVENTION 11team comprised of both a police officer and a nurse.InterventionsIn February 2013, Cst. Scott Mills was contacted by a person who has required online support inthe past. This individual was concerned for Aaron’s safety. Aaron had been posting suicidal thoughts onhis Facebook account. This prompted the concerned third party to seek assistance on Aaron’s behalf. Inorder to provide Aaron with support, Mills contacted his colleague Anne Marie Batten.Anne Marie Batten reached out to Aaron on Facebook. She sent him a friend request and hepromptly accepted. She then initiated communication via private messaging. Batten was able to engageAaron in conversation, establish trust, and complete a risk assessment. After lengthy communication, itwas determined that Aaron was not an immediate safety risk. Overall, Batten was able to diffuse and de-escalate Aaron through Facebook messaging.ResultsAaron was co-operative and appreciative of Batten’s support. He did not require hospitaladmission or police intervention. Currently, he maintains Facebook contact with Anne Marie Batten. Inaddition, his community team provides ongoing support.Benefit of Social Media EngagementThrough the use of social media, Aaron was able to receive support in a timely manner. OnceAaron began posting suicidal thoughts on Facebook, he received assistance quickly. By responding to hisFacebook posts, Aaron’s safety was ensured. Batten and Mills were able to prevent Aaron’s symptomsfrom worsening. Due to social media interventions, a police response was not required. In addition,transfer to hospital was not required. Aaron was able to receive the necessary support before his conditionworsened, which prevented a negative outcome.Case Study 3: NancyHistory
  12. 12. SOCIAL MEDIA AND MENTAL HEALTH INTERVENTION 12Nancy is a female in her late-twenties. She has a history of anxiety, depression, and self-harm.Nancy experiences frequent episodes of anxiety and difficulty coping. She lives in supportive housing.However, her housing support is not sufficient. Since her needs are not met, she often seeks supportthrough social media. Nancy frequently tweets police officers. Using twitter, she often threatens self-harm, which results in a police response.InterventionsDue to the nature of her tweets, Cst. Scott Mills became involved with Nancy. Mills engagedwith Nancy through social media. Through the use of Twitter, Mills was able to earn Nancy’s trust.Through online support, Mills encouraged Nancy to volunteer at community policing events.Volunteering at events became a source of empowerment for Nancy.ResultsOnce Mills established trust with Nancy, she was able to positively engage with other policeofficers. She was also able to positively engage with Anne Marie Batten. Overall, Nancy’s quality of lifehas significantly improved. She is less depressed and more trusting of others. Nancy is more confidentand shows an increased sense of self. When interacting with others, Nancy is much more comfortable insocial situations. As a result, she is engaging in less self-harm. To date, Nancy continues to be monitoredthrough social media.Benefit of Social Media EngagementNancy has expressed that social media has enhanced her quality of life. When Nancy isstruggling, she is able to reach out through social media. Through Twitter, she receives assistance in atimely manner. Overall, the use of social media provides Nancy with support and comfort. As mentionedpreviously, Nancy is engaging in less self-harm. Since Batten and Mills have provided social mediasupport, Nancy has not required any hospital visits.Case Study 4: Julie
  13. 13. SOCIAL MEDIA AND MENTAL HEALTH INTERVENTION 13HistoryJulie is a female in her mid-twenties. She has been diagnosed with autism. In addition, shedisplays symptoms of borderline personality disorder. Julie is very demanding and attention-seeking. Shehas court-ordered case management support. In May 2011, Julie was communicating ideas about suicidethrough Twitter. It was believed that Julie was a risk to herself.InterventionsIn response to her suicide ideation, Mills initially established communication through Twitter.Once contact was established, communication extended to Facebook and Twitter. He was able to create atrusting relationship. Although Mills maintained contact with Julie through social media, her behaviourcontinued to escalate. Julie began sending hostile messages to various police officers. Her behaviour wasvery disruptive.In March 2012, Julie’s tweets required further intervention. Julie was tweeting slanderousinformation about various police officers. It is believed that this was a ploy for attention. In response toher behaviour, Mills consulted Anne Marie Batten. Anne Marie began to engage with Julie via socialmedia, providing online support. Julie has a heightened aggression response and frequently lashes out.Because of this, Batten had to apply various diffusion techniques. Overall, Julie’s behaviour involvedfrequent monitoring and diffusion.It is relevant to note that while Julie was communicating with Batten and Mills, she continued toreach out to other community members through Twitter. Julie continued to communicate her suicideideation and occasionally threatened self-harm. Through this, Julie had effectively created an extensivecommunity of online support. As a result, Julie’s online behaviour was difficult to manage.Through communication with Julie, Batten and Mills were able to obtain consent to speak withJulie’s case manager. Julie’s case manager informed Batten that Julie had not been attendingappointments or programs. Julie had told her case manager that she was receiving mental health supportin another city. However, it was discovered that this was false. In reality, Julie had been relying on her
  14. 14. SOCIAL MEDIA AND MENTAL HEALTH INTERVENTION 14social media contacts to provide mental health support. This was problematic because Julie had beencourt-ordered to receive mental health treatment.Batten, Mills, and Julie’s case manager continued to communicate. In order to effectively treatJulie, Julie’s contact with her online community needed to be diminished. Through collaboration withJulie’s case manager, some of Julie’s Twitter and Facebook contacts were messaged. Whilst maintainingconfidentiality, they asked some of Julie’s contacts to lessen their communication with her. Julie wasinstructed to resume her court-mandated mental health treatment.ResultsTo date, Julie continues to see her case manager. In order to ensure that Julie receives propertreatment, her social media use is restricted.Benefit of Social Media EngagementJulie’s case has identified a specific gap in mental health case management. Use of social mediais often overlooked during treatment. To date, patient’s social media activities are not monitored by theirmental health workers. In Julie’s case, her mental health worker recognized the importance of onlinesupport. Currently, Julie’s mental health case manager is advocating for the use of social media withinsocial service agencies. Many agencies discourage social media use, often blocking popular sites. Thishinders relationship-building and communication. It is also a barrier to treatment.Case Study 5: SusanHistorySusan is a female in her thirties. She has been diagnosed with PTSD and depression. Shefrequently expresses suicide ideation. In addition, she struggles with substance abuse. More specifically,she struggles with her use of alcohol and marijuana. She has been prescribed anti-depressants. Susan uses
  15. 15. SOCIAL MEDIA AND MENTAL HEALTH INTERVENTION 15her medication sporadically, which makes her substance abuse very problematic. When mixing alcoholand anti-depressants, she often experiences adverse effects. Because of her suicidality, she has requiredpolice escorts into mental health facilities. As a result, she’s very hostile towards police officers and oftenlashes out towards them. Due to her heightened aggression response, she receives court-mandated mentalhealth support. Susan lives independently and works full-time.Susan often communicates her suicidal thoughts via Twitter. On several occasions, she hastweeted at the Toronto Police’s corporate Twitter account. These tweets expressed suicide ideation andSusan was considered a safety risk. On three occasions, the Toronto Police Communications Departmentcontacted Twitter and had Twitter trace her IP address. This is a very labour intensive process. However,such labour was necessary because Susan’s behaviour was considered hazardous. In all three cases, Susanwas found and effectively de-escalated. However, since Susan required substantial police resources, Cst.Scott Mills collaborated with the Communications Department to provide assistance.InterventionsCst. Scott Mills established contact with Susan using Twitter. Mills engaged with Susan andwas able to build a relationship with her through social media. Mills encouraged Susan to volunteerat community policing events. Often, community policing events have Twitter and Facebook pages.Through a community policing event’s Twitter page, Mills referred Susan to Anne Marie Batten. Battencommunicated with Susan via social media and established a trusting relationship. While communicating,Susan expressed anxiety regarding an upcoming court appearance. Because Susan was anxious, Battenprovided online court support through direct messaging.Batten has been able to intervene with Susan on a regular basis. Due to Susan’s heightenedaggression response, she has required frequent diffusion. Batten has employed various diffusiontechniques through Twitter. During one episode where there was an acute safety risk, Batten requiredpolice assistance. Police intervention was required to ensure Susan’s safety. In this case, Batten remained
  16. 16. SOCIAL MEDIA AND MENTAL HEALTH INTERVENTION 16online with Susan while police transported her back to her apartment. Since Susan had been effectivelyde-escalated, medical intervention was not required.To date, Batten maintains contact with Susan through social media. Batten and Susancommunicate on a daily basis. Through Twitter, Batten has been able to provide Susan with supportthrough her court ordered treatment.ResultsAs mentioned previously, Anne Marie Batten was able to provide court support through socialmedia. In order to receive support, Susan used a smartphone to communicate with Batten. While Susanwas attending her court hearing, she was able to communicate with Batten through social media. Battenwas able to diffuse Susan through Twitter, which prevented Susan from lashing out. Batten was able toeffectively manage Susan’s anxiety and hostility through online court support. This allowed Susan tobehave in a calm and controlled manner.Susan receives court-mandated mental health treatment. In order to ensure Susan’s mental healthtreatment is not compromised, Batten maintains superficial contact with Susan. Through Twitter, Battenhelps Susan to manage her emotional outbursts. Overall, Susan lacks social supports. By providing Susanwith online support, Batten and Mills have been able to enhance her quality of life.Susan has expressed that she feels more supported. She also demonstrates more control overher emotions. Since Batten and Mills have intervened, Susan has experienced less depressive episodesand rarely lashes out. It is also important to note that, after Batten and Mills intervened, Susan beganusing her medication regularly. She regularly uses medication because of her court ordered treatment.In addition, Susan now communicates with a nurse regularly. Although Susan consults with a nurse, shestill maintains regular contact with Batten and Mills. By providing online support, Batten and Mills havesupplemented Susan’s treatment.Benefit of Social Media Engagement
  17. 17. SOCIAL MEDIA AND MENTAL HEALTH INTERVENTION 17Generally speaking, Susan requires rapid intervention because of chronic crisis. Because ofher chronic crisis, Susan’s PTSD symptoms rapidly surface. Mills and Batten have been able meetSusan’s needs through social media. Using Twitter, Mills and Batten can engage in short but rapidcommunication. In addition, Susan has a very busy schedule and attends multiple appointments. Becauseshe has access to mobile internet, she is able to communicate with Mills and Batten through social media.By using mobile internet, Susan can manage around her busy schedule.Case Study 6: LauraHistoryLaura is a female in her mid-20s. As a child, Laura was diagnosed with ADD and exhibitedbehavioural problems in school. She also suffers from panic attacks and depression. Behaviourally, Lauraexhibits impulse control issues and a lack of control over her emotions. Laura is very sensitive to powerdynamics and will shut down or lash out if she feels that she is not in control. She lives independently andis attending a post-secondary institution. Outside of this post-secondary institution, Laura has nocommunity supports. Laura also has a lack of familial support; she has no contact with her immediatefamily members.She has a heightened aggression response and frequently lashes out at police officers. In addition,she threatens self-harm. Laura has a history of having police involvement for her behavioural problems.On several occasions, Laura has made slanderous statements on the Toronto Police Service’s Facebookpage about specific police officers. More specifically, she has accused certain officers of encouraging hersuicide ideations. In response to Laura’s statements, the Issues Manager of the Toronto Police Departmentcontacted Batten. Batten was asked to engage with Laura and to provide assistance.InterventionsBatten sent Laura a friend request on Facebook. In addition, Batten sent Laura a private messageon Facebook and introduced herself. Initially, Laura was very irate and thought that Batten was a police
  18. 18. SOCIAL MEDIA AND MENTAL HEALTH INTERVENTION 18officer. Through private messaging, Batten explained that she is a third party that helps the police withindividuals who are struggling and need support. Once Batten explained that she was a civilian, and notan employee of the Toronto police, Laura became less hostile.Batten was able to engage with Laura through private Facebook chatting. When chatting withBatten, Laura openly discussed her past and her lack of social supports. Laura expressed a desire forfriendship and meaningful social connections. Overall, she expressed a need to be understood andsupported. Through Facebook chat, Batten was able to fulfill Laura’s need for social connection andestablish trust.ResultsBatten used Solution Focused Therapy techniques to connect with Laura. Rather than focusingon the problems that required an individual to seek help, Solution Focused Therapy helps an individualselect outcomes and goals that they want to achieve. When Laura focuses on her past, she lashes out. Byencouraging Laura to focus her energy in a positive and constructive way, Batten was able to help Lauraregain control of her emotions.Since Batten has intervened, Laura has been able to create a busy schedule for herself. Laura hascentered her efforts towards school work and other positive aspects of her life. Since Batten’sinvolvement, Laura has not made any slanderous posts on the Toronto Police Service’s Facebook page.Batten maintains contact with Laura, providing reassurance and empowerment. Batten also maintainscontact with the Toronto Police Issues Manager, informing them of Laura’s progress, status, andbehaviour.Benefit of Social Media EngagementSocial media engagement was able to satisfy Laura’s need for meaningful social contacts. Whencommunicating with social media, there is no formality and no clinical environment. As a result, Laurawas more comfortable engaging with Batten. Batten was able to provide a non-threatening environment,free of power dynamics and inequalities. As mentioned previously, Laura will lash out or shut down if
  19. 19. SOCIAL MEDIA AND MENTAL HEALTH INTERVENTION 19she is not in control. Because she is so sensitive to power dynamics, social media is an ideal form ofcommunication. Also, Laura was able to contact Batten on her own terms. If Laura wanted tocommunicate, she had the power to send a message and receive a response.Case Study 7: JohnHistoryJohn is male and approximately 35 years old. He exhibits symptoms of anxiety and depression.He lives independently and works full-time. Outside of work, John has no community supports. In2012, John was arrested by the Toronto Police and charged with a minor offense. He had a verynegative experience with a Toronto Police officer. John was subjected to verbal abuse, characterized byhomophobic and derogatory comments. John was very upset by these remarks and turned to social mediafor support. John began lashing out on Twitter. He was posting offensive and derogatory remarks aboutthe Toronto Police Service.InterventionsThrough the Toronto Police Twitter page, Cst. Scott Mills became aware of John’s comments.Mills contacted John on Twitter and began to engage with him. Once Mills established contact withJohn through the Toronto Police Service account, Mills decided to use his own account to relationship-build. Thus, Mills began to interact with John using his individual police Twitter account. Mills was ableto build a trusting-relationship with John. Mills encouraged John to attend community policing events,where John could interact with police officers in a comfortable environment. At a community policingevent, Mills introduced John to Anne Marie Batten. Batten began engaging with John on Twitter. Johnmaintained social media contact with Mills and Batten, as well as several police officers that attendcommunity events.Results
  20. 20. SOCIAL MEDIA AND MENTAL HEALTH INTERVENTION 20John was able to establish meaningful connections through social media. By formingrelationships with Toronto police officers, John was able to positively engage with the Toronto PoliceService. As a result, John became more trusting and stopped posting derogatory statements on Twitter.Through Mills’ encouragement, John participated in an anti-bullying presentation. This was a source ofempowerment, as John was able to speak openly about his negative experience.Benefit of Social Media EngagementMills was able to establish contact through social media. As a police officer, it would have beendifficult for Mills to interact with him face-to-face. John’s negative experience with the Toronto Policeresulted in significant trust issues. Twitter provided a non-threatening environment, where John couldspeak openly about his experience.ReferencesAckerson, L. K., & Viswanath, K. (2009). The Social Context of Interpersonal Communication and Health.Journal of Health Communication, 14, 5-17.Bender, J. L., Wiljer, D., To, M. J., Bedard, P. L.,Chung, P., Jewette, M. A., . . . Gospodarowicz, M. (2012). Testicular Cancer Survivors
  21. 21. SOCIAL MEDIA AND MENTAL HEALTH INTERVENTION 21Supportive Care Needs and Use of Online Support: A Cross-Sectional Survey . Supportive Carein Cancer, 20, 2737–2746.Chen, G. M. (2011). Tweet This: A Uses and GratificationsPerspective on How Active Twitter Use Gratifies a Need to Connect with Others. Computers inHuman Behaviour, 27, 755-762.Cleary, J. F. (2011). Jumping into the World of Social Mediawith Palliative Medicine. Palliative Medicine, 25 (6), 611-612.Della, L. J., Eroglu, D., Bernhardt,J. M., Edgerton, E., & Nall, J. (2008). Looking to the Future of New Media in Health Marketing:Deriving Propositions Based on Traditional Theories. Health Marketing Quarterly, 25 (1-2), 147-174.Estrine, S., Hettenbach, R., Arthur, H., & Messina, M. (2011). Service Delivery forVulnerable Populations: New Directions in Behavioral Health . New York : Springer PublishingCompany.Frank, R. G., Pindyck, T., Donahue, S. A., Pease, E. A., Foster, M. J., Felton, C. J., &Essock, S. M. (2006). Impact of a Media Campaign for Disaster Mental Health Counselling inPost-September 11 New York. Psychiatric Services, 57 (9), 1304-1309.Ipsos Reid. (2012). TheIpsos Canadian Interactive Reid Report. Ipsos Reid.Johnson, P. R., & Yang, S.-U. (2009). Usesand Gratifications of Twitter: An Examination of User Motives and Satisfaction of Twitter Use.New York: S. I. Newhouse School of Public Communications, Syracuse University.Kontos, E.Z., Emmons, K. M., Puleo, E., & Viswanath, K. (2010). Communication Inequalities and PublicHealth Implications of Adult Social Networking Use in the United States. Journal of HealthCommunication, 15, 216-235.Mental Health Commission of Canada. (2012). ChangingDirections, Changing Lives: The Mental Health Strategy for Canada. Calgary, Alberta.Sareen, J.,Jagdeo, A., Cox, B. J., Clara, I., ten Have, M., Belik, S.-L., . . . Stein, M. B. (2007). PercievedBarriers to Mental Health Service Utilization in the United States, Ontario, and the Netherlands.Psychiatric Services, 58 (3), 357-364.Steele, L. S., Glazier, R., & Lin, E. (2006). Inequity inMental Health Care Under Canadian Universal Health Coverage. Psychiatric Services, 57 (3),317-324.Steele, L., Dewa, C., & Lee, K. (2007). Socioeconomic Status and Self-ReportedBarriers to Mental Health Service Use. Canadian Journal of Psychiatry, 201-206.Wang, J. (2006).
  22. 22. SOCIAL MEDIA AND MENTAL HEALTH INTERVENTION 22Perceived Barriers to Mental Health Service Use among Individuals with Mental Disorders in theCanadian General Population. Medical Care, 44 (2), 192-195.

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