onlineSocial media is having an increasing influence on public life, and mental health trusts are now beginning to utilise tools like Twitter to engage with service users in new ways. Sarah Hall reports.

Mention social media in the mental health arena and invariably there is a mixed response. Using Twitter to engage with vulnerable service users has been described as anything from “liberating” to “destructive”.

Twitter was confined for some time to mainstream health services and it is only in the past 18 months it has appeared to really branch out into mental health.

It allows people to instantly connect with what is important to them but without having to elaborate, indulge anyone else or actually have a conversation about it. For the first time, people with mental health difficulties are finding ways to connect with other people with similar problems across the world.

Acute trusts have used social media for campaigns and awareness-raising for many years and some large organisations have obtained a following of 6,000+ people on Twitter. But in mental health it is a little more complex. Is there a chance vulnerable people could be exploited through these mediums? Is it appropriate to engage in such a public way with service users? Maybe it is just not “cool” to follow a mental health trust?

None of these questions has a correct – or easy – answer.

One mental health trust, South London and Maudsley NHS Foundation Trust (SLaM), has become very active in using Twitter over the past six months. The communications team regards it as a highly beneficial way of improving the trust’s relationship with service users, staff, media and other healthcare organisations.


For instance, SLaM’s communications team has conducted four live tweetchats since November 2012. Tweetchats are a planned “chat” on Twitter with an organised group of people with similar interests in a particular subject matter at a certain time. The tweetchats have followed regular patterns; they last about 45 minutes and involve peaks and dips of activities, usually on a question and answer basis, with service users, carers, clinical professionals, members of the public and various related health and charity groups.

It is also a less time-consuming way people can find out about getting care and help for a particular condition. For instance, a busy mother who thinks she may have a child with obsessive compulsive disorder can take just a few seconds to ask a consultant for advice over a tweetchat and receive an immediate response. This can make the difference for someone deciding whether to take the next step to obtain suitable medical help for a family member.

The feedback on the tweetchats has been positive and inspiring with many saying they feel like they are “really participating” in a group chat. It has been a successful way of opening up channels of communication that maybe wouldn’t otherwise exist, as well as introducing SLaM to new service users.

So, is it just that it is the “right time” for mental health to be on the agenda and Twitter is an inevitable medium for this? Or is it about being selective about how and when you communicate with people through Twitter?

“A bit of both I think,” says Dan Charlton, head of communications and media at SLaM. “People are definitely more open and vocal about mental health issues than they were a few years ago. More people are speaking out about their problems such as depression and anxiety and others are able to relate to them. We are seeing a real growth in the visible mental health community and Twitter has helped this to happen.

“With social media sites we can engage and interact with these people. It has been invaluable to get feedback from our followers. Twitter is about listening and interacting, not just about broadcasting our own news.

“We can get a clearer idea of how people respond to what we do and what they would like to see more of. We ask our followers what they would like to have a chat about or what improvements we can make.

“People are not as afraid to get involved through Twitter as they may be through other mediums and we are reaching a wider audience.

“We also use what is going on in national media to engage with people to ensure our timing is right. For example, we may target groups and individuals with eating disorders during an awareness week or when a new report has been released.

“It has been really effective so far and – as long as we get the encouragement and feedback – we plan to keep going in this direction.”
SLaM has more than 2,600 followers on Twitter, as of January 2013, and this is rapidly increasing. Recent research suggests this is the third highest for any mental health trust in the country.

With Twitter there are benefits that override traditional forms of media. Twitter is updated constantly so news is always as up-to-date as it can be, and tweets are only as interesting as you make them, therefore if one subject/tweet gets a poor response you can promptly move onto the next one.

Gone are the days when communications departments were required to just send a lengthy press release to get information out to other organisations or people. If you want something disseminated quickly, get it online and then attach to a tweet. Got a live event going on? Get a picture on Twitter within seconds and all your followers have a direct insight into your activities.


However, there are downsides to using Twitter as a primary form of communication. Constraints such as only allowing 140 characters per tweet mean it is not always possible to get the exact message across.

All NHS trusts appear to be on a learning curve in terms of using social media to raise awareness. In December, SLaM took part in a national initiative called #tweetwell, where trusts were invited to tweet about what it was like to work in certain sectors of health. It was primarily aimed at emergency-based units in acute trusts that could provide minute-by-minute accounts of activities. SLaM wanted to get involved to raise awareness of what goes on in a psychiatric unit so it used its Lambeth Triage Unit. The tweets were a chance to use a national hashtag, thereby raising SLaM’s profile to a wider audience, and to truly reflect some of the daily activities staff and patients face on the unit.

But SLaM was asked by a GP to justify why it had used a number of its tweets. She suggested they could be “alarmist” and “may lead to a service user being identified”. SLaM felt its tweets were accurate and reflective and advice was taken from clinical staff on the unit before taking part in the campaign. However, it did raise an issue about the ubiquitous use of Twitter and if there is time to stop and think how it affects everyone involved.

Re-engaging through Twitter

Nevertheless, Twitter can make a real difference to people. One of SLaM’s regular followers is a lady who suffered with depression for years but never sought help.

She said Twitter has helped her overcome her fears and finally talk about her problems: “When I was really down I didn’t leave the house for a long time so Twitter was my way of slowly re-engaging with people,” she says.

“I have re-connected with some old friends and made new ones, I have given support and received support from others, I have found out that there are thousands more people like me and I no longer feel isolated or alone.

“The people I met through Twitter gave me the courage to go out there and start campaigning for improvements in mental health. I didn’t ever seek help for my depression because I was too embarrassed but somehow the new social media world has given me that help I never got. It finally feels as though people understand me.”

Like it or not, Twitter is here to stay – at least for now. For communicators in mental health trusts it is important to keep on top of what is going on in the social media world and incorporate it into goals. But it also needs to be ensured that any pitfalls are considered and the best interests of patients are foremost in everyone’s minds.

Follow SlaM on Twitter: @MaudsleyNHS

Sarah Hall is communications and media manager at South London and Maudsley NHS Foundation Trust.

This article first appeared in the January/February 2013  issue of Mental Health Today. For information on how to subscribe, click here.