Internet privacy

Psychiatry

Mental health

Philosophy

Sociology

Publishing

Political science

Scrutiny

Legislation

Harm

Government (linguistics)

Cruelty

Public relations

Computer science

Linguistics

Social media

Medicine

The Lancet

The death by suicide in 2017 of a 14-year-old British girl has in the past month led to a highly charged debate about social media's negative effects on children's and young people's mental health. The concern is the ease with which explicit images of self-harm can be accessed on Instagram and other platforms. Discussions have included the possibility of government-led regulations and legislation, such as privacy law. Facebook-owned Instagram reacted quickly to last week's scrutiny and has taken responsibility for users finding harmful images without restriction. Since meeting last week with UK Minister of Health, Matt Hancock, Instagram's head Adam Mosseri committed to newly monitoring and curtailing images that promote self-harm. This step is positive, although critics such as the National Society for the Prevention of Cruelty to Children say it's too little, far too late. Debate has also questioned with whom regulatory responsibility lies—should it be shared by the user community and individuals? Further consideration is being given to whether redefining Facebook and Twitter as publishing companies would force a duty of care towards their users, absent until now and with tragic consequences. At the end of this month, the UK Government is also expected to publish comprehensive guidelines for social media and tech companies, in what now appears an overdue move. Although there have been positive developments in the rapidly changing world of social media—including the 2017 launch of Facebook's algorithms designed to support mental health—those glimmers of hope and positivity as a force for good have not materialised. The association between social media and acts of self-harm remains a poorly understood one and it must be remembered that social media are just one influence on young people's mental health. Furthermore, alongside underfunded mental health services, problems are confounded through structural failure to act upon red flags of suicide ideation. Whatever the context, and whoever should take responsibility, social media platforms have been providing a route through which young people can find explicit images of self-harm. With fortuitous timing, on Feb 7, the UK Department of Health published a review map, 3 years in preparation, about screen-based activities and young people's mental health, with an accompanying commentary by the UK Chief Medical Officers (CMOs). Screen-based activities include use of all computer and electronic devices and smartphones for social media, gaming, internet, and cyberbullying by children and young people up to age 25 years. The review found that emerging research is largely focused on the relationship between screen-based activity and mental health issues, with fewer studies exploring risk factors and consequences of screen time using longitudinal or qualitative data. The CMO commentary provides advice for parents, teachers, carers, and children and young people themselves. Recommendations include frameworks for protection and safety, voluntary industry codes of conduct to prevent normalisation of harmful behaviour (such as self-harm and bullying), and advice for parents on how to lead by example with suggested limits on family screen time, such as not having access to devices during mealtimes. On Feb 4, the UK Department of Health also announced a trial of 370 UK schools whose pupils are participating in use of an app that supports teenage mindfulness and wellbeing. Described as the largest trial of its kind, multiple independent schools are already encouraging children to use smartphone apps to record their feelings. Until now, apps have not been based on evidence, instead informed by research extrapolated from and conflating findings unrelated to young people's development. Mindfulness interventions and support towards wellbeing could be helpful, but a smartphone app cannot replace face-to-face pastoral care or the benefits of communicating with an understanding adult at school, and ultimately it increases young people's screen time—at odds with wider and emerging issues. These multiple strands and initiatives point to the need for tailored and methodologically rigorous research into young people's mental health in relation to the digital world. Without leadership from the health community, we risk not protecting—or worse, harming—our greatest asset: the future generation's mental health. As per the speed with which young people adopt social media, the evidence is also moving very quickly, and by the time frameworks are imposed, they might be obsolete to young users who have already left those particular digital platforms behind. Our understanding of the benefits, harms, and risks of our rapidly changing digital landscape is sorely lacking.

Social media, screen time, and young people's mental health