Online mental health support forums are becoming increasingly popular and there is evidence that they are useful: particularly for providing anonymous support and filling information gaps. However, there are also very real concerns about negative outcomes for users. One online mental health service, Big White Wall, manages these risks and supports its members through the provision of 24 hour professional moderation. Comparison of Big White Wall’s member population with the population of one London borough shows a diverse user group, but members are more likely to be female, and aged 25 to 34, or unemployed.

Online peer support communities play an important part in many people's experience of healthcare. They can be particularly significant in behavioral health/mental health due to the difficulties that people may experience in accessing face to face care for these conditions. There is considerable diversity of practice in service management, target group, and moderation practices of online peer support communities. People using the communities also appear to have diverse aims and experiences. This heterogeneity contributes to a relative lack of data about the value and effectiveness of online peer support in behavioral health, although there is significant research into some aspects of these communities. The digital behavioral health service Big White Wall was launched in the UK in 2007, and in the US in 2015, and is focused on delivering moderated peer support. There are considerable differences in health systems between the two countries, and this has been reflected in different experiences of implementation. The value of online peer support could be maximized if systemic challenges to implementation and adoption were addressed more effectively.

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We describe a case of a delayed presentation of a traumatic soft tissue mallet injury to the distal phalanx of the hallux in a teenager. Reports of this rare injury are sparse and there is no consensus in their treatment. This injury was treated with open repair of the tendon using a Mitek suture anchor, and stabilization with a 1.2-mm K-wire and extension splinting for 8 weeks. Following this treatment, she regained full power and a range of movement compared with the contralateral side, and achieved full function. We advocate surgical reconstruction of these injuries with suture anchors and stabilization of the interphalangeal joint.