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Can social media play a role in youth suicide prevention?

Benefits outweigh potential risk factors in using new media to address suicide, researcher says

An internationally known suicide prevention researcher visited the Stanford University School of Medicine on Monday to share her work on how social media can be used to prevent suicide, offering insight into alternative avenues for addressing teen mental health concerns.

Jo Robinson, head of suicide prevention research at Orygen Youth Health in Melbourne, Australia, spearheaded two recent studies on transforming social media – a world often "demonized" as a potential contributor to suicide contagion – into a therapeutic tool to provide services and connect and empower teens. Both studies were launched in response to teen suicide clusters in Melbourne, she said.

"Social media gets demonized quite a lot when it comes to suicide," Robinson said Monday, speaking to a small audience in a classroom at Stanford's Li Ka Shing Center for Learning and Knowledge. In the wake of suicides, online memorial pages, photos and comments often spring up and can glorify the incident in a way that is thought to contribute to a contagion.

"One of the things that's kind of informed the work that we're doing is that we thought, 'Well, yes, that's all potentially true and we have to be concerned about that but actually, social media is not going anywhere and young people actually prefer using social media than seeing professionals like me,'" Robinson said. "So how can we actually engage in a positive and constructive way with social media to work with young people and provide a service to them?"

Robinson described how Internet-based treatment has become an increasingly popular way to deliver health programs across the board, including cognitive behavioral therapy (CBT), a method considered one of the most effective ways to treat adolescents with depression, anxiety or suicidal ideation.

Robinson stressed that any online program shouldn't replace face-to-face treatment, but can be a beneficial "adjunct" treatment for teenagers in particular.

Other signs of this shift toward using new media as a suicide-prevention strategy include text-only suicide hotlines, robust social media prevention and anti-stigma campaigns at both the local and national level and a new feature on Facebook that allows users to report suicidal posts or content, which automatically sends a message to the poster indicating a friend is concerned about them and provides access to resources to get help.

Robinson also gave an example of a group of Melbourne teens who, disappointed in local professionals' response to several teen deaths by suicide on a rail line, created a youth suicide prevention group on Facebook that had more than 20,000 members within days of its launch, she said. The group became so large so quickly that mental health professionals were enlisted to monitor the page, with about 1,000 referrals to outside services made in just three months, according to The Australian.

Similarly, though on a smaller scale, a Palo Alto High School graduate created this year a support group on Facebook hoping to connect more alumni with current Paly and Gunn High students "with the intention of elevating dialogue about mental health during this epidemic of teen suicides," the group's description reads. With currently more than 2,700 members, the page has becoming an online gathering place of sorts, with users regularly posting resources, news articles, invitations to local events or related projects and more.

Robinson's first study, conducted in 2011 and 2012 with a group of 21 high school students, investigated the impact of Internet intervention on suicidal ideation. The result was "Reframe-IT," an eight-week online intervention program for students experiencing suicidal thoughts, meant to be completed with the help of a school counselor on campus.

Participants would log on to the website each week, watch and analyze videos of other young people dealing with difficult situations (ranging from an abusive parent to failing a driver's license test), complete several activities and then record their own video testimonial on their smartphones. (Robinson described the smartphone as a "therapeutic tool" that allowed the students to track their feelings wherever they were.)

The website is monitored by a therapist who can provide personalized feedback on the activities, help the participants through each modules of therapy (one per week) and provide crisis intervention if needed.

Though the results of the pilot program were encouraging – there was a significant reduction in suicide ideation, depression and hopelessness in the participants – "no one wants to sit in front of a static website anymore," Robinson said.

The pace of this kind of research can also fail to keep up with the ever-changing world of technology, she said, often rendering the very platform that one is studying null by the time research is complete.

So Robinson moved to studying social media, finding it a more flexible, organic – and effective – way of supporting at-risk teens and reaching them where they are. She and other researchers recently launched a 12-week pilot project, dubbed "Safe Conversations," with a small group of students affected by a recent student death by suicide.

The 11 students – who also came from a vocational school for students who have been kicked out of or "disengaged" with their traditional high school, Robinson said – worked with Robinson and other Orygen researchers to design intervention strategies to roll out on Facebook for the rest of the school. The group collected data, learned about suicide and mental health and worked with a local social media company with a background in health to develop their ideas.

One intervention was the creation of messages to be distributed online and in person with positive messages like "You are perfect exactly as you are with all your flaws; there's no need to change a thing except for the way you see them." Another was a video showing a young man, standing sad and alone at a beach, writing a negative message in the sand before a wave washes it away and a friend joins him to write a more positive message.

Robinson called the results "encouraging" but noted that this was, again, a small uncontrolled study and with a very specific population of students. All six participants who responded to an evaluation agreed or strongly agreed that participating in the project helped them to develop new skills, in particular technical skills; five of six reported it was motivating, enjoyable and worthwhile; and four of the six said it helped them feel better able to talk about suicide safely online. All six are also returning next semester to serve as peer leaders with a new cohort of students who will create their own social-media based intervention strategies.

"It was all about capitalizing on the idea that young people want to hear from other young people," Robinson said.

Shashank Joshi, a Stanford Medicine child and adolescent psychologist who serves as a mental health consultant for the Palo Alto Unified School District, was in the audience at the Monday morning talk. He told Robinson that he has seen local schools similarly struggle with reaching kids where they are and breaking down the perception that adults won't be able to help them, so they don't seek help.

He offered the example of Palo Alto's Sources of Strength, a peer leadership/mentoring program which he said depends on first finding teachers who students view as trusted adults to serve as advisors and then the administration buying in enough to provide these teachers with the release time necessary to sustain the program. The schools that offer teachers an hour of release time once a week to work on the program have been the most successful, Joshi said.

The school district's "Comprehensive Suicide Prevention Toolkit for Schools," a 150-plus page document developed in response to the teen suicide cluster in Palo Alto in 2009 and 2010, does suggest social media be used proactively to not only communicate with students and families but also to provide support and intervention if necessary.

"Although schools may initially consider social media to be outside of its traditional jurisdiction, they can in fact collaborate with students and utilize these tools to disseminate important and accurate information to the school community, identify students who may be in need of additional support or further intervention, share resources for grief support and mental health care, and promote safe messages that emphasize suicide prevention and minimize the risk of suicide contagion," the toolkit reads.

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