Web‐based support services to help prevent suicide in young people and students: A mixed‐methods, user‐informed review of characteristics and effective elements

Abstract

The online world may provide an alternative means to engage young people and students with suicidal feelings, who are typically reluctant to seek help. We aimed to map, characterise and obtain user evaluation of current online suicide support for this group in order to assess the usefulness of current provision and how it may be improved. We conducted a mixed-methods study, comprised of an internet search, content analysis of site features and qualitative interviews with site users: 9 young people and 4 general practitioners. Data collection took place in 2019 and 2020 in the UK.Young people participants were recruited through the well-being networks of a large University in South-West England and via a national young person's mental health app. General practitioners were recruited locally through professional networks. We identified a wide range of easily accessible online support, including examples of interactive services, such as live chat and text messaging, but a lack of support that is both suicide-specific and young adult-specific, and an absence of online suicide or mental health crisis support services tailored specifically for students. Qualitative data showed that clarity, brevity and immediacy are the most important facets of engaging crisis help for young people, and that young people may prefer to use textbased rather than verbal forms of communication when seeking help. Few services provided access to active peer support, outside of lived-experience stories, which were evaluated as both valuable and potentially harmful. There is a need to further develop tailored suicide specific online crisis support for young people and students, which is able to 'speak to' their age-specific needs and preferences. While lived experience may provide a valuable means of supporting young audiences, caution is required since this may have unintended negative consequences and further research is needed to understand the safe framing of such material.

Investigating How People Who Self-harm Evaluate Web-Based Lived Experience Stories: Focus Group Study

“…Increasingly, young people are likely to initially self-disclose self-harm behavior via the web owing to affordances of anonymity and perceptions of being judged less [ 7 , 8 ]. Young people experiencing suicidal feelings are also particularly likely to search for advice or peer support on the web [ 4 , 9 , 10 ]. However, web-based help seeking is also associated with risks, such as unintentional exposure to graphic or prosuicide and self-harm content and engagement with discussion forums in which self-harm is sometimes normalized and negative feelings are reinforced [ 3 , 8 , 9 , 11 ].…”

“…Young people experiencing suicidal feelings are also particularly likely to search for advice or peer support on the web [ 4 , 9 , 10 ]. However, web-based help seeking is also associated with risks, such as unintentional exposure to graphic or prosuicide and self-harm content and engagement with discussion forums in which self-harm is sometimes normalized and negative feelings are reinforced [ 3 , 8 , 9 , 11 ]. Therefore, it is vital that the web-based support content provided is safe, effective, and evidence-based.…”

“…Lived experience stories are a frequently used source of information and support on the websites of third-sector or health care organizations and can include user-generated content on social media [ 5 , 9 ]. Stories published by more formal help sites, such as Mind or Samaritans, typically involve a personal narrative of help seeking and recovery.…”

“…Stories published by more formal help sites, such as Mind or Samaritans, typically involve a personal narrative of help seeking and recovery. Although limited research has focused on self-harm lived experience stories so far, there is emerging evidence suggesting that these narratives can inspire hope and help seeking in the reader [ 9 ]. A recent qualitative study compared recovery narratives presented live and recorded (in audio, video, or text-based formats) with adults using statutory mental health services in England [ 12 ].…”

“…Findings suggested that recorded narratives are valued for their availability on demand , for access to narrators without geographical constraint, and for the ability to access support without a need for social interaction [ 12 ]. In a mixed methods study including interviews with young people and general practitioners (GPs), Cohen et al [ 9 ] highlighted suicide-specific lived experience stories as a potentially useful and engaging source of web-based support. Simultaneously, concerns were raised by a GP that reading about someone else’s recovery could lead to negative comparisons and feelings of failure.…”