Crisis calls for help on Twitter – how should health and social care practitioners respond?

Crisis calls for help on Twitter – how should health and social care practitioners respond?

I recently shared a number of important questions put to me by health and social care practitioners during a workshop on social media in mental health practice. I was struck by the extent to which participants needed to address their worries and concerns before they could grasp its positive potential.

Over fifty health and social care practitioners from across the world kindly shared their answers to those questions, thanks to Anne Marie Cunningham who set up an online survey and shared it with her networks. A big thank you also to everyone who took the time to respond, you can find the results here.

Below are my reflections to responses to the question: ‘what do I do if someone I support clinically @mentions to me on Twitter that they are suicidal?’

No consensus – I was struck by the diversity of responses which ranged from a sense of strong 24/7 professional commitment at one end of the spectrum: ‘I think we’re a profession that is 24/7. Pillars of the community, generations of medics have created that image. We have a duty of care to respond to help when we can. It (should be) is in our DNA’ through to concerns about personal and professional boundaries: ‘It is vital to keep boundaries and if you get drawn into these things out with working hours it’s difficult to know where work and home life begins and ends.’

Respecting privacy – the vast majority  were in favour of responding – some either via @mention or direct message, but the majority indicated that it should be done through direct means rather than on a public social media platform. ‘Context is everything and no one case will ever be like another. But I would try to take the conversation into a safe space but give clear advice about where they can seek help.’ Only three respondents suggested contacting emergency services and two indicated that they would block the individual: ‘I would consider blocking them but wait until the situation has been made safe before doing so.’

Ethical and practical issues – some fascinating ethical issues were articulated and the following stood out for me: the importance of setting expectations with people you support from the outset, not following or ‘friending’ people you are working with clinically, applying the same rules from offline contexts to an online setting, knowing your organisation and/or professional body’s social media guidelines.

The importance of context – three important factors were articulated: (1) the importance of context (2) knowing your organisational and/or professional policies and guidelines (3) using your judgement. There isn’t a straight forward answer to the question but it is important to have anticipated that this could happen and think ahead. A great example is Dr Keely Holmes, who has developed a social media policy which she incorporates into treatment agreements from the outset.

So whilst there is no simple answer, I hope you will find the results useful if you work as a health or social care practitioner. I think the most useful advice is to use your common sense and apply your knowledge from other contexts – Twitter is just another communication tool after all.

If you use mental health services then I’d also love to hear your thoughts about both the question and the responses. In my next post I will be reflecting on responses to the another question: ‘Can a personal Facebook account be completely private? What if I post a picture of me a bit the worse for wear on a night out – isn’t that ok? Don’t I have a right to a private life?’


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  1. As a service user who’s on Twitter and seen many suicidal people looking for help, I know people will seek any avenue of support available on their platform of choice. If they know the username of their therapist, it is logical from their perspective to use it to contact their care provider. However, I understand from the provider’s point of view how problematic it can be with privacy and liability issues. I think it’s important to set out a social media policy with clients from the start, as Keely Kolmes outlines, and not to give out usernames if you don’t want to be contacted. Otherwise, the unexpected can be expected.

    • Thank you for your comment – very much appreciated. I agree that a social media policy makes most sense so that everyone knows where they stand 🙂

  2. Also a service user but also a wife of a husband who could never let go of his job I think it is important that m h professionals can escape their ‘day job’ and not get suicidal tweets from their patients. My own CPN admitted to checking online over the weekend to see what was happening with patients but finally has now been strong enough to keep laptop switched off. There are other avenues such as crisis helplines there to be used.

    • Thank you for your comments – great to have a response from a perspective of someone using services. I agree it is important that mental health practitioners are able to switch off from work and it is also fascinating to see how personal and professional boundaries are shifting with social media.


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