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.
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
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.
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.
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.
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.
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.
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 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 ‘Hjärnkoll’ has 65 bloggers who write about
mental health. When researching this editorial, Hjärnkoll’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.
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
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.