“I don’t have to be alone anymore”: The new face of youth mental health intervention: an analysis of a proactive online intervention and risk assessment practices on Instagram

Abstract

Background: Mental health intervention, both online and in-person, operates within a traditional model whereby support is provided if a young person (or their family) actively seeks support. Proactive outreach is an innovative approach to intervention and has been shown to be effective in other areas of healthcare. Live for Tomorrow chat (LFT) was delivered on Instagram and comprised of counsellors who reached out to provide brief person-centred intervention to young people who posted content indicating distress or suicidality.

Aim: This thesis focused on two aims presented across two articles. The first aim was to explore young people’s experiences of distress and LFT’s proactive online intervention. The second aim was to explore how counsellors engaged young people and how risk assessment was conducted in this proactive online intervention.

Methods: Thirty-five transcripts of conversations with young people aged thirteen to twenty-five were analysed using the six-step approach of Braun and Clarke’s reflexive thematic analysis. These transcripts included a counselling intervention and a follow-up chat that collected feedback about the counselling intervention.

Results: A total of thirteen themes across two articles were identified. These findings highlighted that in moments of psychological distress and suicidality, young people who engaged in this intervention experienced a multitude of difficulties and felt alone in this distress. Suicidality was experienced in this context. Young people expressed and managed their distress through using social media and created an identity around these experiences. Social media also allowed them to support each other. Young people experienced the proactive approach of LFT as someone showing they cared and would listen, which are key therapeutic elements. Counsellors were able to use counselling micro-skills to facilitate conversations. Counsellors would approach conversations about suicidality by seeking permission from the young person to talk about suicidality, assuring confidentiality, validating the young person’s experience of suicidality, and focused on identifying interventions.

Conclusion: Proactive online chat-based interventions represent a novel approach to engaging with young people experiencing psychological distress and suicidality. The findings have demonstrated the feasibility and benefits of moving mental health intervention to a medium where young people are currently disclosing distress and intervening proactively.