Should social care staff ever friend people they support on Facebook? According to this great paper by Peter Bates, Sam Smith and Robert Nisbet, the default view of social care staff and organisations is a resounding no. This stance is echoed in the proliferation of social media guidelines for health care practitioners that you can find curated here.

The authors make a case for a more nuanced response to this question as explored through the lens of support for learning disabled people. They argue that the multi-faceted nature of people’s lives resists the reductive notion of linear personal/professional boundaries implicit within social media guidelines. I have previously blogged about the positive affordances of boundary violation between the personal and professional on online social networking sites.  The authors point to the value of digital inclusion and potential of social media for accessing information and peer support. These ideas are beautifully captured in the context of mental health in a guest post by @positivitysmile.

I concur with the authors’ stance that a thoughtful approach to social media is required for health as well as social care practitioners. Use and ethics of social media are not routinely incorporated within practitioner training and in my view this should be integrated throughout the curriculum rather than either ignored or sidelined as a stand-alone session or module. As our online and offline lives become ever more intertwined, health and social care staff will benefit from a sharpened understanding of online social networking both for themselves and people they support.

Facebook is not a neutral space

I would like to add a few additional thoughts to those put forward by the authors. Firstly I’m not convinced that Facebook is a neutral space – it is a commercial platform that makes its money through our data and this has implications for the relationships described by the authors. It is in Facebook’s interests to share our data and our posts as widely as possible. So for example, if I click ‘like’ on a post in my timeline then this post may automatically show up on the timeline of my friends. Facebook will use my data to market products to me based on the demographic data I provide. By posting on Facebook I share my location with my friends unless I opt out. Facebook suggests new friends to me based on my existing connections and those of my friends. Not all of these things are straightforwardly in my control. Privacy settings can be tricky to navigate and if other people tag a photo of me in a post it can show up on the timelines of people I am not even friends with.

So what are the implications? Context collapse is a term coined by Danah Boyd to describe how the contexts that we manage in our offline lives can easily collapse in our online lives. Managing these various contexts can be tricky to manage all at the same time. So for example, when I updated my Facebook status with a picture of a fresh tattoo intended for my friends, I wasn’t expecting an indignant comment from my dad – my friendship and familial contexts collapsed. Our lives become much more permeable on social media in ways we don’t always understand or anticipate.  The authors suggest that rules about social media should be tailored to the medium as with letter writing, sign language and interpreting. Their comparisons are for very boundaried communications and it is easy to underestimate the complexity and lack of control we have over those afforded by online social networking. The opportunity for searchability, shareability and persistence are exciting but also challenging, and have both risks and opportunities associated with them.

Saying no to a friendship request – an issue of power

These complexities are not just for health or social care practitioners to manage but also for people accessing services. The paper perhaps assumes that people accessing services will want to be a Facebook friend with a member of staff. However, it is just as likely that a person accessing a service may not want to see updates from a member of staff and they may not want their updates showing up on the timeline of the friends of that member of staff because they ‘liked’ it. This may even inadvertently compromise their privacy and confidentiality. I recently received a message from a young person exasperated that yet another professional had asked to be their friend on Facebook – didn’t they understand she wanted boundaries!?! How easy is it to tell a member of staff that you don’t want to be their friend given the power imbalances we know exist and which the authors reference?

The authors undertook a survey of social care staff  in which they asked the if they ‘would be a Facebook friend with a person who used health or social care services’. Only 5% answered ‘yes, definitely’ or ‘probably’ and 81% selected the ‘no, never’ option. This question appears ambiguous – being a Facebook friend with a person who uses health or social care services is different to being a Facebook with someone accessing a service you provide. Anecdotally, it is my experience that many people use platforms such as Twitter, which don’t require synchronous connections, for professional networking, and Facebook with its synchronous connections for personal non-work related relationships. This may account for the survey responses – who you chose to ‘friend’ depends on the purpose of your Facebook account.

The case for a more nuanced approach to social media policies

The authors make an excellent point that a more creative approach could be taken by staff to support digital inclusion and I agree that we need a more nuanced policy context that is supportive of these possibilities:

Of course, there is nothing to stop people maintaining two Facebook accounts, one of which is used for work-based relationships. Similarly, there is nothing to stop a worker who does not own or wish to share their own Facebook account from supporting a learning disabled person in registering with Facebook and building a network of Facebook friends.

 

In conclusion I support the authors’ argument for a proportionate stance to use of social media and, in particular, Facebook, that in the author’s words:

recognises that all relationships, including professional ones, are negotiated arrangements that should be based on mutual trust and respect. So both individual staff and the people they work for should be able to choose whether to seek contact Facebook, and to navigate disclosures and safeguards as appropriate in response to the circumstances, rather than be restricted by rigid and unsupportable regulations.

 

However, I question whether staff are routinely equipped to understand the choppy and changeable terrain of online social networking to make these informed judgements to protect themselves and the people they support. We must also avoid assuming that people accessing services will want to ‘friend’, follow or communicate on public social media with health and care staff involved in their care – in my experience it is often the reverse.