The internet, you have undoubtedly heard, is bad for your brain. It can be especially damaging for those struggling with mental illness. Trolls are everywhere. Searching for information about your struggles may lead you into dark places. Websites that promote self-harm, suicide, and eating disorders abound, and many have hard-to-spot social media presences that no platform has quite figured out how to moderate: They’re arguably some of the internet’s most toxic filter bubbles. Even if you don’t wander into someone else’s stability-compromising clutches, you may end up compromising yourself; after all, search results last forever.
But telling anybody to stay offline in 2018 is impractical and myopic advice. Besides, the internet solves many of the problems therapists and other researchers have been thumping against for decades. Seeking mental health care in person comes with stigma, but it’s easy to remain anonymous online. Getting to a therapist’s office can be too logistically challenging (think teens without driver’s licenses) or expensive for some. What’s more, the web makes suffering searchable—painful social media posts and searches related to mental health are now indexable data.
Into that amalgam, two approaches to using the internet to save our minds have emerged: using targeted ads make people aware of services that already exist, and starting new social platforms designed to encourage peer-to-peer support. Neither is without risk.
The first round of digital mental health interventions came out of telemedicine. Many of these early efforts focused on connecting veterans suffering from PTSD with therapists online, since many veterans are uncomfortable with the stigma of seeking mental help and also may have mobility issues. But as of this spring, services offered to the average citizen are on the rise too. But almost as soon as these average citizen services arrived, studies found that these apps’ usage numbers were low.
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A new round of products focuses on meeting prospective patients where they are—on social media—and drawing them to tools and services that already exist. “There have been excellent results in suicide prevention when researchers have been able to recruit patients right off the internet, just based on what they’re clicking,” says John Naslund, who studies digital mental health at Harvard Medical School. “There’s a lot of interest in learning from those clicks, getting people a targeted ad, and getting them the help they need that way.”
Last year, Facebook created an algorithm to monitor teenagers’ moods for signs of insecurity and worthlessness (both risk factors for suicidal thoughts) for the purpose of serving them ads for mental health services. Other offerings like Betterhelp, an online counseling service, have zeroed in on influencer marketing as a way to draw in patients. Health care companies have been refining this strategy for about a year—it’s not as natural for an Instagrammer to hawk a pharmaceutical firm as it is, say, sneakers—but Betterhelp managed to get endorsements from over 100 YouTubers, including superstars like Phillip DeFranco and Shane Dawson. (BetterHelp was even a sponsor for Dawson’s infamous Jake Paul series.)
This approach, though, has been beset by scandal. In an ongoing brouhaha, many of the influencers who promoted BetterHelp have now denounced the service after users accused the company of profiting off mental health problems while providing unprofessional, substandard service. (In a recent Medium post, BetterHelp’s CEO called these claims “false.”) Facebook’s ad targeting system has been widely criticized as invasive and profiteering, and in some cases, therapists have found that being bombarded with reminders that you’re depressed is, well, depressing.
Plus, no matter how successful influencers and ads are at raising awareness, there’s still that waning supply of qualified mental health professionals to sit at the other end of those services. Bolstered by research suggesting that social networks aren’t all bad, other companies are focused on building supportive peer-to-peer networks. East London & City Mental Health Trust psychologist Darren Baker found that some online communities can foster genuinely nurturing environments for those suffering from mental health problems, even when the problem was as serious as suicidal ideation. Naslund’s research found “naturally occurring peer support” in YouTube comments sections, of all places.
Boaz Goan, CEO and founder of Wisdo, built a whole social network around that idea. Wisdo connects users with others who already have been through whatever tough life experience they’re having, whether that’s breast cancer or gender transition. But Goan wanted to know if he was falling into the same isolating trap as, say, Instagram. Using the same methodology as researchers at the University of Pittsburgh who found that social media increases loneliness, Goan conducted a survey of Wisdo’s users, asking them to gauge their feeling of isolation. “Loneliness dropped by 15 percentage points compared with other social media sites,” Boaz says. “It means that what we put in place is helping people find the wisdom and support and human connection that they’re lacking.”
Now, there’s a difference between active mental health support and a less depressing Facebook. There’s anecdotal evidence that this peer-to-peer system is works, but so far it’s just anecdotes. “The challenge has been generalizing,” Naslund says. “No one knows why some of these groups are damaging and toxic and others have been helpful.” But proof of concept for technology for mental health is a slog, because good science about human beings (especially for techies and investors) is frustratingly slow. It’s only in the last few weeks that a study has shown that in-app therapy is beneficial not just in improving patient outcomes, while studies about its disuse and (promising) impact on health care costs were out months ago.
Standard social network problems like monetization and finding a user base will take time and iterative thinking to sort out. Still, these new mental health social sites show no sign of going away. They may help patients and give scientists access to unprecedented data sets. Despite the scandals and ambiguities, they’re too promising to be drowned out in the backlash against techno-optimism, and for once that might be a good thing.
Date: December 19, 2018