The role of social media in reducing stigma and discrimination

Abstract

This editorial explores the implications of social media practices whereby people with mental health problems share their experiences in online public spaces and challenge mental health stigma. Social media enable individuals to bring personal experience into the public domain with the potential to affect public attitudes and mainstream media. We draw tentative conclusions regarding the use of social media by campaigning organisations. Copyright and usage (C) The Royal College of Psychiatrists 2015.

Full text

Social media use by individuals
to challenge stigma
Social media can be defined as internet-based applications that
allow the creation and exchange of user-generated content.
1
Recent Ofcom
2
figures indicate that 47% of the adult population
in the UK use social media. However, low income families and
disabled people are less likely to use the internet,
1
raising concerns
that people who are already marginalised are less likely to be heard.
Despite the barriers for some, social media are inexpensive
and easy to use. They signify a trend towards more interaction
whereby people create as well as consume content. It is possible
to share stories, produce other content and influence the media
environment.
3
We argue that it is individuals, rather than
institutions, who are leading the way in bringing conversations
about mental health into public online spaces. We believe this is
important to highlight, as the more negative affordances of social
media are often emphasised. Although social media encompass
many different channels, we have selected case studies that
illustrate how the micro-blogging platform Twitter has been used
to challenge stigma. Twitter is an internet application that allows
140-character messages to be publicly sent and quickly shared
across many users.
Methods for challenging mental health stigma include
education, contact and protest.
4
Education replaces stereotypes
with accurate facts and figures; personal contact between members
of a stigmatised group and others undermines prevailing
stereotypes; protest highlights injustice and rebukes stigmatising
attitudes. Interaction on Twitter about mental health features a
dynamic blend of these approaches, with personal narratives at
the core.
A striking illustration of how social media can be used by
people with mental health problems to challenge stigma is a
protest on Twitter that took place in September 2013. Thousands
of people, offended by the ‘mental patient’ Halloween costume
advertised on the website of the national supermarket Asda’s
George clothing collection, sent tweets to show their disapproval.
5
The topic ‘went viral’ with tweets passed rapidly and across
networks. The story was the lead item on national news the next
day with mainstream media sourcing their information from
Twitter.
5
Asda and other retailers removed the costumes from sale,
apologised, and made donations to England’s ‘Time to Change’
anti-stigma campaign.
During the protest, a #mentalpatient hashtag was created by
people with lived experience. They posted photographs of
themselves (‘selfies’) alongside text such as ‘this is what a real
mental patient looks like’, to satirise the costume. The hashtag,
which creates a searchable string, was used 6694 times in 24 h.
The sharing of tweets by thousands of people may create a sense
of solidarity, as well as minimising a recognised limitation of
‘direct contact’, namely discounting the experience of one or a
few people as an exception, rather than the norm.
6
When scores
of people use a common hashtag it may be harder to ignore or
minimise their experience.
The protest was initiated by individuals on Twitter and
later backed by campaigning organisations. They amplified the
conversation and exploited journalistic interest so that the story
was taken into traditional media channels. Participants included
individuals with lived experience of mental health problems,
activists, journalists, public figures, charities and institutions.
The event suggests a willingness by many people personally
affected by mental health issues to voice their protest and to share
their experiences publically. The extent to which such incidents
have a positive effect on wider public attitudes has yet to be
measured, but it certainly illustrates an effect on the actions of
several corporations.
A striking aspect of social media sites such as Twitter is that a
spontaneous burst of protest can be initiated by one individual in a
single post and widely shared. The #DearMentalHealthProfessionals
hashtag was started on Twitter in early August 2013 by Amanda
after receiving a discharge letter from her mental health team.
She used the hashtag to voice her distress and the feedback she
would like to give to the team. It was quickly shared and added
to by a diverse mix of people with experience of using mental
health services. Although modest in comparison with the Asda
443
The role of social media in reducing
stigma and discrimination
Victoria Betton, Rohan Borschmann, Mary Docherty, Stephen Coleman,
Mark Brown and Claire Henderson
Summary
This editorial explores the implications of social media
practices whereby people with mental health problems
share their experiences in online public spaces and
challenge mental health stigma. Social media enable
individuals to bring personal experience into the public
domain with the potential to affect public attitudes
and mainstream media. We draw tentative conclusions
regarding the use of social media by campaigning
organisations.
Declaration of interest
None.
Copyright and usage
BThe Royal College of Psychiatrists 2015.
The British Journal of Psychiatry (2015)
206, 443–444. doi: 10.1192/bjp.bp.114.152835
Editorial
Victoria Betton (pictured) is a PhD student at the Institute of Communications,
University of Leeds and is employed by Leeds and York Partnership NHS
Foundation Trust as an mHealth programme director. Rohan Borschmann is a
postdoctoral researcher at King’s College London, Institute of Psychiatry,
Psychology and Neurology. Mary Docherty is a NIHR academic clinical fellow
at King’s College London, Institute of Psychiatry, Psychology and Neurology.
Stephen Coleman is Professor of Political Communication at the Institute
of Communications, University of Leeds. Mark Brown is the development
director of Social Spider CIC and the editor of
One in Four
magazine.
Claire Henderson is a clinical senior lecturer in psychiatry in the Health
Service and Population Research Department at King’s College London,
Institute of Psychiatry, Psychology and Neurology.

episode, it reached more people than would be readily possible
through non-virtual means. One practitioner tweeted: ‘This is
the info my team needs to know. Am going to use it in my team
meeting’. This tweet indicates how online content can be spread to
an offline environment. The motivation behind hashtags is not
necessarily as simple as a desire to make services better; sharing
experiences and having one’s voice heard on social channels can
create a sense of empowerment – of feeling less alone with a
personal struggle, and more confidence in showing a part of the
self that might usually remain hidden.
Helen, a mental health nurse, shared her experience as a
psychiatric in-patient on Twitter out of both ‘boredom and
frustration’ and to elicit support she felt she was not receiving
from ward staff: ‘it was quite a surreal experience . . . all these people
who we’d [Helen and her partner] never met, reaching out and
supporting us – people who’d used services before, people who
were carers, people who were professionals and people who never
had anything to do with mental health ever, but just were for some
reason touched by what I was tweeting and were interested’. As
well as gaining support and validation, Helen was also motivated
by challenging mental health stigma. She reached people she
would never otherwise have had contact with, as illustrated by
the 800 new followers she gained on Twitter during the week,
the re-tweets and the supportive responses she received. This is
another example of how direct contact on social media enables
sharing beyond the boundaries of face-to-face interactions and
can connect with new audiences.
Anti-stigma programmes’ use of social media
Social media channels are increasingly used by anti-stigma
programmes to share their work and influence public attitudes.
New Zealand’s ‘Like Minds, Like Mine’ Facebook page entitled
‘Stigma Watch’ allows members to post and discuss media articles
of concern because of their stigmatising content, thereby providing a
space for conversation.
‘Beyondblue’, Australia’s national depression and anxiety
initiative, uses the hashtag #SmashTheStigma whenever stories
of hope and recovery are posted, and has led to others using the
hashtag to share anti-stigma efforts.
The Swedish anti-stigma campaign ‘Hja
¨rnkoll’ has 65 bloggers
who write about mental health. When researching this editorial,
Hja
¨rnkoll’s communications officer asked Facebook fans how
social media can challenge stigma; in 3 days it was viewed by more
than 5000 people, received 225 ‘likes’, 77 comments and was
shared 41 times. One respondent observed that, by providing
people with the ability to ‘peek through the window’ surrounding
mental distress, social media is ‘a great way for people to digest
mental illness in their immediate surroundings without having
to be overpowered by social discomfort’. The ‘Time to Change’
campaign was launched in England in 2008. At the time of
writing, the campaign has 57 467 followers on Twitter with 224
re-tweets of the most recent post; and 129 000 fans on Facebook
with 431 likes on the most recent status update. These figures
indicate a significant number of people with whom the campaign
can connect regularly, and high levels of interaction with posts
that can amplify their cause.
Along with advertisements on YouTube, Spain’s ‘Obertament’
campaign uses Facebook and Twitter to inform people about their
efforts to eradicate stigma. Denmark’s ‘En Af Os’ campaign’s
Facebook page has attracted 16 398 ‘likes’, making it the country’s
second highest ranking website about mental health. Figures show
that ‘feel good’ photos about mental health attract more shares
than anything else posted on the page.
More sophisticated use of social media monitoring will see
campaigns increasingly anticipating and responding quickly to
mental health topics being discussed by individuals on social
media channels, as well as benchmarking and measuring their
activity.
Conclusions
This article demonstrates the potential democratising and
catalysing effects of social media in relation to public discourse
about mental health. Personal stories and unheard voices can be
made public and shared without temporal and spatial barriers.
They have significant potential to facilitate a dynamic blend of
education, contact and protest. This rise in user-generated content
means that collective action by individuals has the potential to
influence mainstream media and policy without sole reliance on
campaigning organisations. It may be that we are more likely to
adjust our attitudes because of what our peers think than because
of what organisations encourage us to think. The examples
provided in this editorial show how citizens have asked and
answered questions that organisations would not necessarily have
raised.
Campaigns are increasingly incorporating social media into
their communication channels, but perhaps their most important
role is amplifying individual-led conversations and channelling
them to mainstream media. Social media channels provide spaces
for professionals to learn and share by connecting with people
accessing services and colleagues. Further work should examine
the relationship between social media activity and changing public
attitudes to mental ill health.
Victoria Betton, PhD candidate, Institute of Communications, University of Leeds,
Leeds; Rohan Borschmann, PhD, DClinPsy, Mary Docherty, MRCP, MRCPsych,
King’s College London, Institute of Psychiatry, Psychology and Neurology, London;
Stephen Coleman, PhD, Institute of Communications, University of Leeds,
Leeds; Mark Brown, Social Spider CIC and
One in Four
magazine, London;
Claire Henderson, MRCPsych, PhD, Health Service and Population Research
Department, King’s College London, Institute of Psychiatry, Psychology and Neurology,
London, UK
Correspondence: Claire Henderson, Health Service and Population Research
Department P029, David Goldberg Centre, King’s College London, Institute of
Psychiatry, Psychology and Neurology, De Crespigny Park, London SE5 8AF, UK.
Email: Claire.1.Henderson@kcl.ac.uk
First received 1 Sep 2014, accepted 6 Nov 2014
Funding
C.H. is supported by a grant to Time To Change from the Government Department of
Health in England and Comic Relief and is an advisor for the evaluation of the En Af Os
campaign.
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Betton et al

10.1192/bjp.bp.114.152835Access the most recent version at DOI:
2015, 206:443-444.BJP
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Victoria Betton, Rohan Borschmann, Mary Docherty, Stephen Coleman, Mark Brown and Claire
The role of social media in reducing stigma and discrimination
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