Suicide is the leading cause of death in the UK among 15-29 year olds. Among UK student populations, there are increasing levels of mental health or suicidal crises (where someone is seriously considering, or actually attempting suicide).

Crisis aversion

Many help resources exist, including those online, although young people are sometimes reluctant to seek assistance with their mental health. There is also evidence to suggest that many of these services don’t adequately help young people in crisis, and little is known about how - and to what extent – young people seeking help online can be encouraged to engage with ‘real world’ care pathways in a timely way. Indeed, the specific characteristics required to develop good, engaging online help for young people experiencing these crises are still largely unknown.

To address this, Dr Lucy Biddle, Dr Rachel Cohen and Professor Paul Moran from the Faculty of Health Sciences at the University of Bristol aimed to improve online help provision for young people and how it can connect service users to ‘real-world’, offline services. They used a Mental Health in Young People Award from the Elizabeth Blackwell Institute to fund the investigation, which they called the ‘REFER’ project.

Identifying the issues

First, the team identified online mental health and suicide crisis support services for young people – including those available to University of Bristol students - using a system of online searches and consultations with academic experts and medical practitioners. They went on to conduct one-to-one interviews with GPs and users of the services, which yielded a number of issues.

“We found that online services are useful,” said Dr Biddle, “but that they’re not a substitute for real-world help. They can offer a ‘holding space’ for young people in crisis, but there are concerns among some GPs that this may result in young people feeling falsely reassured about their level of risk and the kind of help that they need, which in turn may prevent or dissuade them from seeking real world help.”

Other findings included the importance of clear and concise psychoeducational material, age appropriate language, and the fact that too much information at once can be very off putting.

Text is best

“Perhaps unsurprisingly,” said Dr Biddle, “young people tend to prefer text or web chat formats rather than phone lines, and at the same time we found that there is a need for a more integrated approach to online and ‘real world’ services, and better, more ‘active’ signposting between services generally. Awareness of, and knowledge about, the online services needs to be improved, too - both amongst young people and the health care practitioners treating them.”

The team also has extensive plans to build on the work.