She irritates your parents. She baffles your grandparents. The preoccupied young mum feeding, with one hand, organic sweet potato puree to her eager eight-month-old, and checking her Facebook notifications with her smartphone in the other. A stereotype which would pass for a member of the Modern Tribe and one I’m sure you already recognise. Perhaps she is closer to yourself than you would like to admit.
To say that parents will have to adjust to a new way of life when they have a baby is perhaps the most cliched of all understatements. Social contact becomes less face-to-face due to the physical and logistical challenges a new baby brings. Leaving the house for a simple errand becomes a near military operation incorporating sleep schedules, changing supplies, feeding equipment. A spontaneous evening out to the cinema with friends? An impossibility. Text messages become almost nostalgic, phone calls time consuming and social media quickly fills the social void for the new parent, who is likely to be surviving on caffeine, chocolate and very little sleep.
Connecting with people via social media is immediate, with responses often instant. Positive replies can become an addictive gratification, bringing confirmation of the image people want to project of themselves, be it intelligence, charisma or wit. Social media offers an uninhibited space in which people can express themselves freely, bringing with it the bounty of validation of who they are, where they fit within a social circle and their place within a community. Arguably, this is the essence of good mental health and is particularly pertinent when talking about women – and men – when they have a baby.
The elephant in the nursery
Although social media presents an opportunity to make a connection with other new parents who, reassuringly, may be going through the same uncharted newborn territory, it may reveal the elephant in the nursery. The pressure to appear as the perfect parent is omnipresent online, and these platforms are particularly unhelpful when they present the Hollywood edit of parenthood. Carefully crafted sepia-toned Instagram glimpses of yoga mum or zen dad may actually disguise a multitude of imperfect truths. Research has found there are many barriers to disclosure of perinatal mental health problems including embarrassment, stigma and “failure at being perceived as not coping”. What role does social media play in facilitating this unhelpful undermining of confidence and capability of a new parents? Is social media a witness to the development of perinatal mental health problems or a sly accomplice?
My interest in the relationship between social media and maternal mental health has developed during the five years I have been working as a GP, as well the last 18 months working as a clinical fellow for the Royal College of General Practitioners (RCGP). Despite mental health problems during the perinatal time affecting one in five women and one in 10 men, only 50% of these cases are identified, meaning many people are struggling on without receiving appropriate treatment they need. The RCGP is working to raise awareness on these issues, and social media has helped in many of these projects such as #MumTalk in conjunction with Sport Relief , open access e-learning modules in conjunction with Health Education England and most recently the Perinatal Mental Health Toolkit which was launched in July 2016 on the RCGP website.
The toolkit offers more than 300 free resources to help professionals care for those directly affected, as well as information for women who are affected. Social media has helped recruit women with lived experience to contribute in this important work, as well as sharing links across the healthcare online global community.
Through this role, I have met many inspiring women who show courage and conviction in telling their stories on blogs, such as Laura Clark @butterflymum83 and Eve @littlemissevec. In sharing their recovery narrative so eloquently, they encourage others to come forward and seek help. There are also Twitter discussion groups, the most established of which is the brilliant #PNDHour (weekly, Wednesdays 8-9pm), which is run by Rosey @PNDandMe and recently hosted by Laura @cooksferryqueen, both of whom have had postnatal depression. This platform in particular is unusual in that health professionals are welcome to contribute – the voice of a woman with expertise through her experience is considered equal to that of a professional expert by training, and both groups can learn much from each others’ contributions. Misconceptions such as “I thought it meant I was a bad mother” and “I didn’t think I could take antidepressants if I was breastfeeding” are commonly challenged, and damaging myths debunked.
However, there is a risk that professional boundaries of the doctor/patient relationship become blurred and less visible to both parties, with unintentional consequences possible. This should not discourage GPs from contributing to these forums but the principles guiding their practice in the consultation room should be maintained on line, as discussed in the RCGP Social Media Highway Code,including respecting privacy, treating others with consideration and maintaining confidentiality. This is in addition to a general consensus within the profession that social media is inappropriate for giving personalised medical advice on an individual basis.
Peer support or trigger trouble?
Another innovative development of digital technology in mental health is online peer support groups. These are often quoted by women with lived experience as an important part of their recovery. One of the most established of these is the one run by the charity Action of Postpartum Psychosis . Importantly, these groups need moderators who have access to training and clinical supervision so they can redirect someone to seek medical help when appropriate and moderate any unhelpful or unkind behaviour from those participating. This kind of forum may carry “trigger warnings”. Triggering is a fairly new phrase for a familiar concept of bringing up negative emotions or memories from other people’s words and is also something to be considered when discussing mental health online. Trolling or cyberbullying, misinformation and misdiagnosis are all potential risks from using social media to discuss maternal mental health. But the prospect of reaching so many women who are socially isolated, facing self-stigma or just living with undetected illness and encouraging them to come forward is a persuasive argument for exploring this area further.
Social media has been a great driver for recognition of Perinatal mental health,raising professional and public awareness and influencing policymakers and commissioners – most recently future investment from NHS England has been promised. The full benefit of the public and healthcare professionals using social media in the ways described here are only just becoming apparent and are yet to be fully understood, with a quality evidence base slowly developing. So whilst social media is far from a panacea in terms of helping women facing perinatal mental health problems, there is great scope for health professionals to further exploit its full potential.
Source: The Guardian
Khan L. Falling through the gaps: perinatal mental health and general practice. 2015; London: Royal College of General Practitioners and Centre for MentalHealth.
National Institute for Health and Care Excellence. Clinical Guideline 192. Antenatal and postnatal mental health: clinical management and service guidance. 2014; London: NICE.