‘What’ to ask – the content of conversations

What should be covered within conversations about online activity to enable practitioners to identify risk and support a young person’s mental health

Good Practice Indicators

1. There is a set of key topics that it is important for clinicians to always ask about when exploring online activities (see below)

2. There is a set of key topics that clinicians should ask young people with disordered eating when exploring online activities (see below)

3. There is a set of key topics that clinicians should ask young people presenting with self-harm or suicidal thoughts when exploring online activities (see below)

4. Discussions about worrying online activity should usually include asking for the names of sites visited, descriptions of content created by the young person and details of participation in online groups

5. Asking about online activities should take the form of a deeper conversation in which clinicians encourage the young person to reflect on their behaviour patterns and the impacts of these (see below)

6. Adapted approaches may be necessary if asking younger age groups or young people with neurodevelopmental disorders

Topics to always ask about

Activities and content viewed

Gaming online
Social Media use (generating or browsing content)
Use of crisis services
Chatting to others with shared experience of mental health (e.g. via chat-rooms/ forums)
Use of apps
Viewing self-harm/ suicide-related content (e.g. methods and images)
Viewing graphic violence (eg. images/ videos of death or serious injury)
One-to-one online friendships

Online experiences

Cyberbullying
Being groomed
Radicalisation
‘Doxing’—having personal information shared without consent (eg. intimate images)

Patterns of use/ activity

Frequency
Time spent online (eg. browsing)
Times of the day spent online
Changing use (e.g. peaks, dips, increases)
Impact on sleep

Topics to ask young people

with disordered eating

Visiting ‘pro-ana’ websites
Use of exercise apps
Use of dieting apps
Online purchase of weight loss medicine Obsessively viewing food-related sites
Use of physical activity/ smart devices

Topics to ask young people with with self-harm or suicidal thoughts

Looking up methods of harm/ suicide
Viewing images of self-harm
Joining forums to discuss self-harm
Posting images of own self-harm
Visiting pro self-harm/ suicide sites
Individuals/ influencers followed
Consuming media with themes of depression

Topics to explore to encourage reflection and self-awareness

Strategies for reducing exposure to harmful content
Strategies for recognising where patterns of online activity indicate worsening mental health
Strategies for dealing with harmful or upsetting content
Identification of offline alternatives to online activities
Signposting to useful sites or apps

Clinician quote

"I don’t think we should make assumptions about what we expect a young person’s online activity to look like. It is better to remain curious and ask everyone the same questions even if we think they may not be relevant"

Young person quote

"Younger people may not yet be exposed to some topics and become curious after being questioned. Filter questions"