Adolescence, digital technology and mental health care: exploring opportunity and harm.

Lead Research Organisation: University of Bristol
Department Name: Bristol Medical School


This work will pave the way for a substantial programme of research focused on the relevance of adolescents' digital technology use to consultations about mental health. We will explore both opportunities and harms posed by digital technology use and if addressing these in consultations can help clinicians to manage patient risk. Specifically, we will pose questions around whether young people's technology use can be drawn upon to enrich face-to-face consultations, used as a tool to make these work better and more efficiently; and whether clinicians have a role to play in safeguarding against harmful use. There will be three workstreams of activity:
1) we will work closely with young people, their carers, mental health practitioners, general practitioners, social care workers, and technology providers to involve them in shaping our plans. We will ask what they consider to be the most important questions and needs in this area and explore their ideas about possible solutions and the type of research that would be acceptable to carry out. To do this, we will run a series of discussion workshops with these groups, consult practitioners to find out how they currently address issues relating to digital technology, and run a programme of arts-based activities with young people to help them express themselves and think about the issues under discussion. We will generate an online hub to make us a working community. This will help us jointly create research plans for a programme of research.
2) we will work with other researchers, especially those in general practice and data science, taking time to consider the best ways to include these important areas in our programme of research.
3) we will conduct two pilot projects. The first will look at a newly emerging example of where technology use may provide an opportunity: in this instance, for the MeeTwo teenage mental health app to provide information to mental health clinicians about a distressed young person, to help with history-taking and triage. We will build cases studies of where this happens, interviewing the young person and clinician involved to find out whether this was helpful, acceptable, and if it may have improved their relationship and the young person's care. Our second project stems from recent advice issued by the Royal College of Psychiatrists that mental health clinicians should ask young people about their online activities when assessing risk. This is in recognition of the harmful effects of some content, for instance, in relation to body image and self-harm. We know from our previous research that clinicians agree this is important but have concerns about how to engage in such conversations safely. Our project will gather together a virtual panel of mental health clinicians and of young people with experience of mental health difficulties. Each panel will be asked to rate statements (a Delphi study) about how clinicians should ask young people about technology use, including what should be asked, when and by whom. We will look for agreement, keeping the statements that receive a high level of endorsement. We will use the results to design a set of guidelines agreed by clinicians and young people about the best ways for mental health clinicians to talk to young people about technology use. Our pilot projects will provide the foundations for full-scale research. Project 1 leads into feasibility work exploring opportunities for technology enriched history taking and triage to be used more widely. Project 2 leads into research on clinical benefits and interventions that could follow from adding questions about technology use to mental health assessment.
Our activities will allow us to design a comprehensive programme of research informed by the key needs, questions, and possible solutions of those to whom it matters most; and to develop relationships with partners (clinical, academic, digital technology providers, and young people) to bring this to fruition

Technical Summary

This work will provide the basis of a large programme of research focused on adolescents' use of digital technology in the context of consultations about mental health. We will explore both opportunities and harms posed by use and whether addressing these in consultations can help clinicians to manage risk. There will be three workstreams. 1) we will engage young people, their carers, technology providers, and mental health, social care and general practitioners through an expert consultation and workshop sessions. We will scope current practice, determine the key questions and needs in this area, and seek co-created solutions. Arts-based activities will be used to facilitate involvement of young people, especially those with lived-experience. We will establish an online 'stakeholder hub' to facilitate shared-working and dissemination. 2) we will collaborate with primary care, data science and specialist qualitative methodologists to consider how input from these areas could strengthen our future research. 3) we will conduct two pilot projects. The first examines whether digital technology can interface with mental health services to enrich consultations by providing early history-taking and triage information. In partnership with the MeeTwo teenage mental health app, we will build a small number of cases studies of such newly emerging practice, interviewing the young person and clinician involved to explore acceptability and impact. The second develops Royal College of Psychiatrists advice that mental health clinicians should ask young people about their online activities when assessing risk. We will use a multi-panel Delphi study (mental health clinicians, adolescents with mental distress) to develop guidelines concerning how clinicians can safely address digital technology use with young people during mental health consultations. These projects will lay foundations for future feasibility work and interventions for safeguarding against harmful technology use.

Planned Impact

Beneficiaries include young people, mental health, primary and social care practitioners, youth workers, digital technology providers, and academics.
In the short-term, our engagement work will create a new research community, integrating those who deliver, use and design services, paving the way for future impactful research. Our stakeholder hub will provide a unique platform for prioritising research, ensuring members of the public and users of services can contribute at all research stages, and clear pathways for implementation. This will be essential to ensuring our future research is robust, responsive and can deliver impact, and could become a resource for adolescent mental health research in the UK.
This award and the ensuing research will lead to health gains for young people by improving adolescent mental health care around risk detection, clinical history taking, safeguarding against online harm, and mutual doctor-patient relationships. In the short term, the award will creating clinician awareness of emerging opportunities for technology-enriched consultations and the importance of asking adolescents about their online behaviour (which could provide immediate safeguarding benefit). In the long term, the award offers foundations for research of impactful new interventions, (eg. brief intervention on online risk taking) and practices (eg. interfacing with app data; crisis planning incorporating online safety).
Of immediate value to practitioners, we will produce a set of guidelines addressing how to talk with young patients about their online behaviour and technology use during mental health consultations in a way that is safe and acceptable, and to explore where use may be harmful. These will be co-produced through a Delphi exercise with clinicians and young people and direct relevance to a recent statement issued by the Royal College of Psychiatrists advising online behaviour should be explored with all young people during mental health assessment. We know from our previous work that clinicians regard this as import but also an area of uncertainty: practitioners and clinical bodies taking part in round table discussions, expressed a need for evidence and guidance. Our work will directly respond to this need and contribute to practitioners' skill-base and confidence. In the long-term, effective methods for addressing harmful online behaviour within the clinical consultation could support clinical risk assessment. Our guidelines will transfer to practitioners working in adult mental health, primary care, and to others in the care pathway including social care workers and school counsellors.
Academics: Our research will contribute knowledge in the areas of digital health, child and adolescent mental health, and doctor-patient communications, and transfer to other age groups and conditions.
Our work will help digital providers shape their products according to stakeholder feedback. Pilot 1 explores how technology can interface with clinical consultations. We have an established relationship with the MeeTwo teenage mental health app, who are looking to expand their work in this area. They will benefit from the insight of our interdisciplinary academic team and our findings, supporting them in their attempts to strengthen clinical links and in the future to increase the scope and efficiency of their services using data science.
Economic impacts: Adolescent mental ill-health is associated with poorer social and educational outcomes, which have associated economic implications. Our work to improve information available to clinicians during mental health assessments has the potential to create future cost-savings to healthcare and other public sectors. In the long-term, project 1 may shed light on whether consultations and the associated paperwork could be made more efficient through technology assisted history-taking. Our pilot work could be used as a foundation towards designing a trial and economic evaluation.


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