The Importance of a Social Media Assessment

By Isobel Rosenthal, MD, and the College Student Committee at the Group for the Advancement of Psychiatry

When I was a resident psychiatrist, I saw a referral in our emergency room for a patient who had “committed suicide” on a social media platform. I was confused and distressed. What did suicide, in this context, mean?

I was told the patient hadn’t actually killed himself; rather, he’d faked his own death within the large online community in which he spent much of his time. Now, the members of his online social circle were grieving a close friend whose home, contact information, and even real name they may have never known.

Mental Health Assessment in a Digital Age

When children and young adults are receiving a mental health assessment for the first time, their clinicians have a unique opportunity to make the encounter as meaningful and comprehensive as possible, especially in a time of crisis.

However, the conditions for these assessments can be less than ideal. They may take place in crowded hallways of general emergency rooms or busy inpatient units. Clinicians must balance the complexity and intimacy of these conversations with the pressure to move things along.

The spread of social media in recent decades has added a factor that needs to be included in this assessment. Consequently, mental health professionals increasingly need to incorporate an understanding of a patient’s virtual digital life, and the patient’s subjective experience of self and others as presented online, into their evaluations.

Mental Health Assessment Across the Generations

Clinicians should be aware of the potential intergenerational transference (feelings from past lived experiences directed towards the mental health clinician) and countertransference (feelings from the mental health clinician directed towards the patient) reactions that such a line of inquiry could engender.

For example, young people can easily perceive this clinical exploration as a form of intrusive interrogation. They might feel threatened, defensive, and protective of their online identities, especially if those identities diverge from their real-life presentation of who they are to friends and family. On the other hand, some might be appreciative that an adult has, for the first time, taken an interest in learning about their virtual and imagined life.

Taking a History

Mental health professionals are taught to take careful and complete social histories. Clinicians are often asked to think about the fabric of a patient’s social life. They are trained to ask their patients: Where are you from? Where do you live? With whom do you live? Are you in school or employed? Who are your social supports?

Given the integration of technology into people’s lives, the social history is now more complex. A best friend or romantic interest could be someone that a patient has never met in person before and only communicated with via social media.

Understanding these complicated components of someone’s life has always been difficult. But now mental health professionals must expand their understanding of the person they are evaluating to include the fabric of his life both in person and online.

Consequently, it is important to appreciate the significance these virtual online communities play in the lives of young adults, adolescents, and children today, without passing judgment on the significance of this medium in their lives and identities.

It is also critical that clinicians share important safety information with young people—advising, for example, that they not share their real-life address with those they meet online.

Social Media Essential Reads

Social Media Scams Continue to Dominate Losses

We Know Social Media Use Stirs Up Anxiety and Depression for Many

Taking a Good Internet-Social Media History

Here are a few possible questions that might serve as points of entry when taking an internet-social media history:

• Do you use social media platforms?
• What do you like about the platforms you use?
• Do you have friends that you have met on the internet?
• How are your friends different online versus in school?
• Are there ways you use the internet and or social media that make you feel happy?
• Are there ways you use the internet and or social media that make you feel sad?

Answers to these, and other questions, will better inform the clinicians’ understanding of the person they are evaluating, and this enriched understanding will lead to a more informed clinical formulation and treatment plan.

As to the patient mentioned in the opening, much of the evaluation was spent attempting to understand his online life versus his in-person life. We also saw how his online life often offered a harbor from the hardships of his real life. Ultimately, he did not need acute hospitalization, as he was decided not to be at acute harm to himself or others.