What are young people up to online?

It seems like a straightforward question, if one which comes with an air of hand-wringing.

But in the age of social media it's no longer really valid for many of Scotland's youth, according to Chris O'Sullivan, policy and development manager for the Mental Health Foundation (MHF).

Loading article content

"Young people have an almost seamless on and offline life. It is completely blurred. They talk about what they do offline and online and you can't tell which is which," he explains.

That became relevant when Greater Glasgow and Clyde NHS began to look at how best to use digital products to communicate with young people about mental health under the title Project 99.

Working with partners including Young Scot, MHF and the Glasgow Association for Mental Health, the first big decision they took was to involve young people directly themselves, not to design a website or an app which might miss the mark by a mile and be shunned or ignored. "The world is full of half-designed half-empty portals", Mr O'Sullivan says.

A good example of the complexity of the relationship young people have with technology is the dilemma clinicians face when first admitting a young person who needs in-patient mental health care, he explains. A phone can be a part of a young person's illness, through use of pro-eating disorder or self-harm websites, or because of online bullying, for example. But for many it is also a source of support. For a significant number it is both.

"Maybe we need to be asking people on first admission, 'how do you use the internet? Are you better without the distraction? Better to keep connected?' It could help decide whether we take a phone off you."

The difficulty for workers in the NHS and other sectors is understanding that complex relationship, according to Dr Trevor Lakey, the health board's leader on Project 99.

The mental health improvement and inequalities manager for NHS Greater Glasgow and Clyde, Dr Lakey says the internet offers the opportunity to learn from other people's approaches from Birmingham to Australia - both of which have produced useful tools. But engaging with young people was vital. "At the outset we felt 'this is like alien territory to us'. But we could see its potential."

Recruiting a group of young people through national youth Agency Young Scot, GAMH and the East Renfrewshire youth mental health scheme Big ShoutER, the health board began to explore ways in which the internet and social media could promote good mental health among people aged 15-21.

The approach is not an alternative to existing services, nor about saving money, Dr Lakey insists. "This is not about diminishing real world services. It is not the whole landscape of what we offer, but it is about how you get more out of clinical treatment. It is another recovery tool."

It could also provide an early intervention tier to prevent conditions worsening and save money which might be spent later on higher level specialist services, Dr Lakey says.

The result of Project 99 is a series of reports published this week which will lay the foundations for ongoing work with the young people who will codesign new online services and portals to helpful material elsewhere on the internet.

Design agency Snook were also part of the collaboration. Co-founder Sarah Drummond says the reports are a 'massive design brief' for the next step. "What we've done so far is prevent the NHS wasting money on 50 apps that don't work," she says.

Young people told the team they needed less help than might have been expected to avoid dangers online and find their way to support.

"They described it like a city," says Mr O'Sullivan'. "You know where to go and not go at certain times. You know where to buy the equivalent of guns and drugs, but you don't do that if you are a responsible citizen."

Nevertheless there are risks, Dr Lakey adds. "The biggest positives are possible for the most vulnerable young people.

"But the most vulnerable people offline are also the most vulnerable online. We had people telling us very clearly they had come across things on the web that they don't like"

Young people also wanted things to be fun and attractive, Dr Lakey says, and wanted to be involved. "If you have a hand in developing something you have an interest in keeping it nice, in looking after it."

Emma Alford, 18, of the Big ShoutEr, who has helped a friend who was struggling, has worked on Support Squared, a potential product to support young people who were in her situation. "Mental health can be like a virus, you can be infected yourself," she says. "But you know everything you've experienced isn't in vain if it helps other people learn from what you have gone through," she says.

Young people expect public services to be online and to be good, but their expectations are not unreasonably high, Ms Drummond says. "They said to us 'if you are going to design anything it should be beautiful and not crap'."

Like anything else in life, young people will return to the products they like, she adds.

"If the NHS is delivering services like this, I want to deliver something as appealing as what Apple would do for you."

One contribution was to design 10 tips for keeping well, as animated gifs which are popular online. "Using humour and sending animated gifs could potentially stop people committing suicide. Who would have thought?" she says.