Developing good practice indicators to help mental health professionals talk to young people about their life online

  • 21 July 2022

Good practice indicators guiding mental health professionals on how to engage young people in conversations about their online activities have been developed by researchers from the NIHR Applied Research Collaboration West (ARC West), the University of Bristol and NIHR Bristol Biomedical Research Centre (Bristol BRC). Researchers found that young people want to be approached in an open and non-judgmental way by professionals aiming to help them gain more control over their behaviours and safety online.

The team developed 27 good practice indicators based on the core issues identified during the study. These focused on the areas of:

  • ‘who’ – who should be asked about their online activity
  • ‘when’ – when should mental health practitioners initiate conversations about online activities and how often should these activities be discussed
  • ‘how’ – how should practitioners start conversations about online activities to maximise engagement and minimise blame or stigma
  • ‘what’ – what topics should be discussed so that practitioners can identify risk and support a young person’s mental health
  • ‘outcomes’ – how should the information obtained during these conversations be used, especially if risks are involved

Digital technology plays a big part in the everyday life of young people. It can have both a positive and a negative effect on them, with online activity being linked to poor mental health in children and adolescents. Despite that, there is very little guidance for mental health professionals on how to tackle this growing issue.

The study team wanted to address this knowledge gap. They did this with the help of two stakeholder groups made up of 21 mental health practitioners and 22 young people with lived experience of mental health problems and service use.

All the stakeholders were asked to complete questionnaires consisting of open-ended questions and requests to rate their agreement with specific statements. This process was repeated three times with subsequent questionnaires being adapted in line with findings from previous ones.

Beyond a focus on risks associated with the internet, researchers found that their results focused on empowerment and improved awareness of online harms. This was aimed at improving how young people managed their online activity rather than restricting it. Stakeholders agreed that all young people should be asked about their online activities.

They felt that this should happen at the start of any engagement and be repeated at regular intervals. They also identified a series of ‘red flags’ such as specific or changing patterns of device use, behaviour (for example bullying) or symptoms (for example disturbed sleep or suicidal thoughts) indicating that a conversation around online activity might be particularly helpful.

Lucy Biddle, lead author, said:

“There is a growing body of evidence to suggest that social media and internet use can lead to poor mental health in children and young people. We hope that the good practice indicators we developed provide some clarity on how this issue can be addressed during consultations

“Our study emphasised the need for a flexible approach from mental health practitioners. It showed that the positive aspects of online use should also be acknowledged to ensure that young people don’t feel misunderstood or that they are being judged for their activities.”

Myles-Jay Linton, a psychologist working on the project, added:

“It was really important for us to produce this guidance informed by the expertise of both young people with lived experiences of poor mental health and practitioners with their clinical expertise.

“More research is needed into how our preliminary good practice indicators are used and how they can be applied in different settings or particular population groups.”


Developing good practice indicators to assist mental health practitioners to converse with young people about their online activities and impact on mental health: a two-panel mixed-methods Delphi study

Lucy Biddle, Raphael Rifkin-Zybutz, Jane Derges, Nicholas Turner, Helen Bould, Felicity Sedgewick, Rachael Gooberman-Hill, Paul Moran and Myles-Jay Linton