Internet and the People with Mental Health Problems

The Internet informs and empowers those with mental health issues, along with their family, friends, care givers, service providers and the policy makers.

Introduction

The article centers on UK and the growth and development of a wide range of internet services being created for the benefit of those with mental health problems. This also focuses on the way people with mental problems use the internet and what difficulties they encounter with it. This article also attempts to predict certain trends and how those with mental problems want to use the internet one day. It offers suggestions for mental health websites on how they could improve their sites for the patients.

Background

The Mental Health Foundation is a leading charity in the UK for mental health and learning disability issues. The foundation runs a lot of internet services, together with four leading websites, three forums and Connect, one of the biggest portals for mental health and learning disability in the world. Connect has been designed to give information about websites, organizations, news and events in the world. It has information on 2,400 and more websites and boosts of 8,500 registered affiliates. To have internet services, forums and research websites in the world gives organizations an overview of the quality and range of online services for people with mental problems.

Internet services

Beginning and the early days

In the early 1990s, only a few websites and forums were available for people with mental problems. These few sites contained only annual reports and academic research studies which was also limited to researchers and academics. Mental Help Net was set-up in 1995 while Internet Mental Health in 1994. Mental Help Net was launched in North America and became the first true website for mental health. Websites like schizophrenia.com focused on specific conditions and disorders. After some years, schizophrenia.com also included a discussion forum for those with schizophrenia to give advice, information and support. Australasians and Europeans followed in on the trend just a couple of years later just when more people realized how the Internet could have so much potential.

Growth

The internet is now one of the best ways to disseminate information for people and agencies around the world. More and more people are now getting into emails and internet services like MSN and Yahoo. These sites have made it easier for patients with mental problems to get in touch with other people. Online forums for people with mental problems have also grown so fast these few years. In November 2002, the internet service, Google, had seven forums listed for depression. Google has also given 2 million links to answer the subject of depression.

Mental health websites have also grown considerably these past few years. Open Directory (DMOZ) has more than 6,000 mental health websites. Google has also listed close to 12 million mental health websites. In UK, a lot of government owned institutions like the Department of Health, the Royal College of Psychiatry, the National Institute for Mental Health, Mind or the National Association for Mental Health, Scottish Association of Mental Health, and The Sainsbury Centre for Mental Health now run their very own websites. Along with these institutions, commercial and voluntary sectors also have their own websites. Similarly, even small organizations and private individuals have created their own. The NHS Direct Online and the Net Doctor give information on a wide range of medical cases and conditions, along with common mental problems.

Due to the fast growth of these websites, this shows that the internet is an important medium for information. Agencies and organizations have recognized the importance of the Internet as it offers to give help to a large number of people which was not possible before.

Diversity and focus

A large variety of forums and website have now been created to target specific groups of people. The most common topics rest on depression and anxiety. Less common conditions like personality disorders also have dedicated websites. These websites also carry more than just information for the conditions but as well as therapy and treatment like Alternative Mental Health. Mental health legislation also has a website – Hyperguide to the Mental Health Act.

Aside from these, forums and websites for hearing voices – Hearing Voices Network – and for those who self-harm – National Self-harm Network – are also available. For those who have survived from mental problems, their site is UK Survivors Network. More websites and forums center on the needs of the caregivers and the patient’s family. Some sites also focus on raising money for research to help discover new treatment and to support the patients through self-help groups.

Design and functionality

Websites and forums use different technology and vary greatly from the way they look. Some websites may look plain, consisting of just texts, while some use graphic packages which makes the websites look interactive. A lot of these sites use standard internet technology, like having guestbooks, search engines and a lot more. The website for young people who are anxious and worried all the time - @ease – look professional and sophisticated. Another one, Rethink, uses cartoons to become interactive with their users. By using technology, these sites make these issues more interesting and become more relevant to young people whom they want to get to.

Interactivity

A lot of websites entice their users by using interactive tactics like the following:

Sainsbury Centre for Mental Health gives out a monthly email newsletter to their subscribers to notify them of new developments, news and events on their site.
Mental Health Foundation sends a tea cup that is animated to their subscribers to raise their awareness of work-related stress. The recipients are encouraged to have a break for five minutes.
STAND, a depression site, gives their visitors questionnaires to get them involved.
The Community Care Journal Online has just hosted a forum about the Mental Health Bill along with Louis Appleby who is a czar on mental health in Wales and England.
The website Net Doctor encourages their visitors to be members in at least one of their virtual communities. Their members have the same interest and can connect with each other through their forums. The site has 10,000 members in their Depression community.

By using interactive methods to attract loyal customers and members, these websites encourage other people to become more interested in the issues and therefore are able to create virtual communities.

Numbers of internet users

Estimating the number of people who use the internet for mental problems is hard since not everyone will admit to it. Being anonymous when these patients use the internet is big thing for them because they could discreetly seek help when they do not want to reveal who they are to other people. Though the exact number of users is not known, the following numbers will help us get an idea:

One out of four people will have mental problems in one year – meaning at least one internet users suffers from a mental problem. Some people may find it harder to access the internet so this figure may even be less in reality.
As the population grows, the people using the internet also grows – Which?, a consumer watchdog site suggests that around 19 million people use the internet annually in UK. People use the internet for at least seven hours every week. One out of ten people will spend 20 hours every week using the internet.
The internet is used for finding health-related info – Data Monitor, a company based in the UK, asked 4,351 adults in Germany, France, Spain, Italy, US and the UK about what they think about the internet when searching for health information. They found that 57% of them searched for health information in the internet for the past 12 months.
Traffic analysis in forums and websites – a lot of these services are able to count the number of visitors or people the using their site. It is safe to think that of these people; one out of four may have mental problems especially if the site is for mental health.
A research by Paul Baker says that some agencies like Mind have hundreds of thousands of visitors annually. But these figures are still small compared to BBC.

It can be safe to conclude that there are millions of people who use the internet for searching information or treatment for health-related issues.

Using the internet

People who suffer from mental problems use the internet in many ways:

Looking for information. The Guardian Newspaper and the Health on the Net Foundation have recently been used a lot by people who want health-related information. Aside from information, these people may also look for treatment, symptoms, their rights and the agencies and services that could help them. Searching these topics on the internet is very easy, accessible and fast. More information could also be provided by the internet as compared to books, magazines, leaflets or by a person. But by being able to check out these information, especially the treatments, patients may become reluctant in trying them because they will have an idea on what might happen to them.
To publish their own data. Even those with mental problems want to publish their own accounts:
Their personal stories about their own mental problems – an example is the 1st Person website where the people can create a narrative, artwork or diary about their lives.
The Tidal Model website tells about plans and strategies with could help in coping up with their problems by using alternative and complementary therapies.
The Mad Nation website encourages their users to share their own perspectives on policies and practices in mental health.
The Critical Psychiatry Network website encourages their users to assess and critique service providers and policy makers.
The Mental Health Alliance calls upon their users to campaign for political change.

Publishing their works on the internet is also a form of therapy for some because it gives the chance to let their feelings and thoughts out. This also gives them validation from being acknowledged by other people. For some, publishing on the internet is their way of helping other people. More people take the opportunity to campaign for political change or to refute some information which has been published elsewhere. Campaigning for a lot of things immobilizes people to step up for their rights and for the rights of other people. People nowadays do not rely entirely on what their doctors or clinicians have to say because the internet could fill this role as well.

Problems using the internet

Digital divide. The internet empowers people with mental problems to possibly take the stigma away of mental illness. But this tool is not without problems. The digital divide comes from the inability of some people to access the internet. There is a debate on digital divide on the More than Just Access and Community Programmes site: Fitting Literacy and Content into the Digital by Andy Carvin.

People with mental problems face the following difficulties:

Some do not have access or have limited internet access because they are in the hospital, low income households, with disabilities or in prison.
Some people may become confused and intimated by using the computer and the internet. They may worry that they cannot understand the language or the costs of using such facilities.
Some people become worried and hesitant to use the internet especially when they feel like they have been abused by the ‘system’. They are also reluctant to do so when their identities are recorded like logging on to forums or discussions.
The voluminous amount of information on the internet for mental problems can be the problem itself. For instance, Google has listed 8,680,000 page results for the word ‘stress’. Deciding where to begin is hard.
Some web designs are not that good so users find it hard to sift through the information they need. The W3C or the World Wide Web Consortium has set accessibility standards for web owners and designers to help make their websites friendlier to the users.
The information format may not be appealing to others. Some find it easier to look at pictures than reading lots of texts.
The information provided in the websites is of low quality. Some information may be outdated, inaccurate or unreadable.
Information posted on one website may be contradictory to some websites. For instance, the controversial topic electroconvulsive therapy (ECT) has detractors and supporters. For those who support ECT, The Association for Convulsive Therapy promotes the ethical and safe use of this therapy. On the other hand, detractors include Ban Shock which wants to ban any type of shock treatment. In the neutral ground is ECT on-line.
Some people simply do not want to use the internet.

Mental health problems caused by the internet

Using the internet also poses threats to our mental health:

Computer rage – users are frustrated with the computer and the internet.
Internet addiction – people becoming dependent on the internet.
Fragmentation of society – people losing communication skills due to using the internet all the time. They lose their friends and become withdrawn from society. But some people say that the internet brings people closer.

The future of the internet

To predict what happens in the future is hard but it is certain that the internet will become even more important in the future especially for those with mental problems. Changes which might affect how people with mental problems use the internet someday are the following:

Technological developments. This would include taking the broadband down and using more of WebTV, WAP, and a lot more. This leads to the internet being more sophisticated and more in tune with the user’s needs.
More people with mental problems using the internet. This can be done by lowering the costs and increasing the number of internet access points like Cyber Cafes. The Cybrarian project was created by the government for the general population of UK.
Using the internet by companies like pharmaceuticals to advertise their products.
More people with mental problems publishing their works online. This may mean having more blogs or web-based entries or diaries of personal accounts.
Increase in the number of forums and websites which would cater to a more diverse audience.
Becoming more interactive with the users especially those with mental problems. This would include using the following tools:

Questionnaires, puzzles, games
Self-help diagnostic like computerized Cognitive Behavioural Therapy
Sending out emails and newsletters
More forums and discussions which could enable more people to participate in these actions.
E-broadcasting of mental health problems and issues. This can be streamed or archived for ongoing access.
Online consultation as well as having online therapy sessions.
Increase in the e-communities about mental health problems.
More decisive approach in disseminating information by the policy makers and service providers.

Increase in websites like generic health websites such as NHS Direct and health specific websites such as Connects.
Forging more partnerships with health websites, forums and agencies. NHS Direct has partnerships with other websites to help them give more reliable and accurate information regarding mental health.

Website and forum administrators

The following issues are to be considered if you want to establish your own website or forum:

There are a lot of websites out there and adding one that is similar to most of them would create confusion. But if what you want to share is worthwhile, then create one.
Your site should have the minimum standard for design and content. Make sure that the information is up to date and accurate. Also, make your web design pleasing for the users.
Use the appropriate technology like making your site interactive to users. Avoid using spy technology like registration or cookies unless necessary. Make your forum or site secure so not just anyone could use the information.
Find ways to promote your site by:

Using reciprocal links to mental health forums and sites
Submit your site’s details and description to search engines such as Google or to Connects. You may also want to put your site’s details on printed materials.

Encourage the people with mental problems to join in the developing your site or advice them to start their own. Employment and having your website be more representative are the possible outcomes of this move.
If your business involves a hospital, home or drop in center, providing internet terminals for them can be lucrative. Providing training for those who have not used the internet before may also be provided. Providing internet access lessens the isolation faced by some people who have limited internet access. This could open up their lives more and forge more relationships online.

Conclusion

Using the internet has both benefits and problems for people who have mental problems, as well as for their family, friends, caregivers, policy makers and for the service providers. There are so may websites that cater to those who have mental problems. For these people, they use the internet for information about certain health-related topics, to be able to join discussions, share their feelings and thoughts and to campaign for change. The internet has become democratic and it bridges the gap for the marginalized people in society.

Using the internet also lessens the stigma of people with mental problems face every day because of their condition. It also opens up the society to more issues and awareness. Although the internet obviously connects people to one another, it should not be made a substitute for personal or face to face interaction with other people. You can have a part in developing the internet by promoting positive mental health to your users.