SPECIAL REPORT: CHILD AND ADOLESCENT PSYCHIATRY
“Have you considered rocket fuel? It’s the perfect stimulant to replace Adderall! You swipe. PTSD? Try touch therapy! It’s better than any drug on the market! You swipe and moan.
Anyone who spends time on social media has seen these ads. Influencers, vloggers, celebrities, and everyone in between are selling a new, unproven treatment for a mental health disorder. What was once only found on television and in magazines now appears on our patients’ smartphones, especially via social media applications like TikTok.
Origins of mental health misinformation
The origin of the teen mental health misinformation debacle plaguing social media platforms involved multiple factors striking at once. Adolescents value peer acceptance and identity formation, for which social interaction, group affiliation, and peer affirmation are necessary.1 However, the quarantine due to the COVID-19 pandemic has deprived young people of these experiences, replacing them with social isolation. At the same time, the mental health of young people has deteriorated. At the start of 2021, emergency room visits in the United States for suspected suicide attempts were 51% higher for adolescent girls and 4% higher for adolescent boys than at the beginning of 2019.2 Access to mental health professionals, already limited, has become even more so.
Understandably, teenagers have turned to digital means of connection, mainly through social gaming platforms and social networks such as TikTok, where they have shared mental health challenges. Users posted videos on TikTok describing their struggles (for example, racing thoughts, depressive feelings, and inattentiveness), to which peers responded by commenting, liking, or sharing the video with others.
The snowball effect
As the audience for such videos grew, a market was formed. Opportunistic startups have hired influencers to advertise untested supplements, remedies, and other forms of treatment. Even telehealth companies like Cerebral have seen the potential, spending millions of dollars on predatory advertising, espousing nonspecific symptoms as proof of an attention-deficit/hyperactivity disorder diagnosis to lure clients into treatment.3 Peak Health Global, a self-proclaimed general wellness start-up, advertised a remote ketamine treatment for depression. Peak has been criticized for a lack of psychiatric oversight of patient care and a lenient screening process.4
Mental health misinformation has become rampant on TikTok. A recent study looked at 500 TikTok mental health videos totaling about 25 million views. Medical professionals found that 84% offered advice that was inaccurate or potentially harmful, many of which featured unqualified content creators or encouraged self-diagnosis.5
Is this the problem with psychiatrists?
A conflict often arises when medical professionals consider speaking publicly about physical and mental health. We are often trained to maintain confidentiality, prioritize neutrality and nuance, and represent our profession whenever we speak to the community. Our hesitation to speak up can lead us to believe that we are protecting our image, career, and alliance with our patients. However, we live in an age where access to inaccurate mental health information is almost ubiquitous, while access to adequate mental health care is rare. Over 28% of the 1.5 billion users on TikTok are under the age of 18, and only 3% of the most popular mental health videos on TikTok are created by accredited mental health doctors.6.7
Thus, the educational vacuum is largely filled by those who lack psychiatric skills. The question then becomes: If we psychiatrists don’t use social media to educate adolescents and parents living in an adolescent mental health crisis, who will?
Ethical practices on social media
Diving into the world of social media content creation can be challenging for the psychiatrist. Regarding ethical considerations, psychiatrists interested in creating educational content should consider 2 areas of action: within the application and outside the application.
Inside the app
Psychiatrists entering the public forum by posting TikTok videos should follow these basic guidelines.
1. Refrain from offering medical advice. The disclaimers that each video is intended for general education and not tailored to individual viewers underscore how the general information may not apply to everyone.
2. Avoid polarizing language. Much of social media thrives on hooks, emphatic responses, and black-and-white thoughts. Most viewers under the age of 18 are unfamiliar with the intricacies of mental health that our experience conveys. Becoming a popular content creator with a balanced approach to psychoeducation gives viewers mental flexibility and teaches them not to jump to conclusions about diagnosis or treatment.
3. Offer evidence-based information in simplified language. Psychiatrists have been trained to effectively interpret data and resolve biases. Using this craft, we must interpret the scientific literature and summarize the findings in terms that teens and parents can understand in 60-second segments.
4. Announce disclosures. Psychiatrists who engage in social media advertising must also announce their financial information. Highlighting personal biases and revealing financial relationships that could influence a video’s message are important even in cases where the video does not advertise anything.
5. Engage the audience, not the patient. Access to mental health care is severely limited. Individual users often reach out to content creators, asking for personalized medical advice. Psychiatrists must avoid establishing doctor-patient relationships on social media. A practical approach to such requests includes ignoring messages or replying that such a recommendation is impossible.
Outside of the app
When TikTok goes down, ethical and legal dilemmas remain for the posted psychiatrist. Using certain approaches may offer some security.
1. Have institution approval. Many psychiatrists work within an institution with strict social media policies that hold employees accountable as brand representatives. Talking to your HR department, department chair, and communications department before you start posting content minimizes the risk of reprimand or dismissal for violating employee contracts.
2. Consider charity and loyalty. Doctors can earn a fee by advertising the brand’s stuff on TikTok. Therapy and therapeutic services often seek to employ psychiatrists as spokespersons. In cases of services being advertised for the benefit of members of the public who otherwise would not have access to treatment, their promotion would fit the beneficence rule (i.e., acting for the benefit of the patient). However, a psychiatrist who does not disclose his or her financial relationship regarding said service violates fidelity (that is, the act of being loyal or truthful in one’s dealings with others). Both ethical terms must be weighed by psychiatrists engaged in such work.
3. Follow the guidelines. Social media existed before TikTok. Government bodies like the American Medical Association and the Substance Abuse and Mental Health Services Administration have guidelines that psychiatrists should follow when creating an online presence.8.9
Closing thoughts
Social isolation, the need to connect and the search for identity have pushed teenagers to TikTok during the pandemic. A shared interest in mental health has compelled many to use TikTok to understand psychiatric illness. As experts in our field, psychiatrists have the opportunity and obligation to educate the public in a safe and ethical manner, providing both nuanced and engaging informational content. Ignoring the potential of social media as a vehicle for psychoeducation would risk failing our calling as adolescent mental health advocates.
Dr. Sood is a child and adolescent psychiatrist working with SSM Health Treffert Studios in Fond du Lac, Wisconsin. He specializes in treating neurodivergent youth through a strengths-based approach and educating parents and patients on the pros and cons of digital media.
References
1. Brown BB, Lohr MJ. Peer group affiliation and adolescent self-esteem: An integration of ego identity theories and symbolic interaction.J Pers Soc Psychol. 1987;52(1):47-55.
2. Office of the Surgeon General. Protecting the mental health of young people. United States Department of Health and Human Services. 2021. Accessed February 27, 2023. https://www.hhs.gov/sites/default/files/surgeon-general-youth-mental-health-advisory.pdf
3. Little O. TikTok has raked in over $14 million from a company under investigation for allegedly overprescribing stimulants. Media Matters for America. May 26, 2022. Accessed February 27, 2023. https://www.mediamatters.org/tiktok/tiktok-raked-over-14-million-company-under-investigation-allegedly-overprescribing
4. Dickson EJ They’re pushing cut-rate ketamine therapy on TikTok. Rolling stone. Aug 27, 2022. Accessed Feb 27, 2023. https://www.rollingstone.com/culture/culture-features/peak-ketamine-therapy-tiktok-startup-1392775/
5. How accurate is the mental health advice on TikTok. Plush Care. November 28, 2022. Accessed February 27, 2023. https://plushcare.com/blog/tiktok-mental-health/
6. Iqbal M. TikTok Revenue and Usage Statistics (2023). The app business. Updated January 9, 2023. Accessed February 27, 2023. https://www.businessofapps.com/data/tik-tok-statistics/
7. Miodus S, Jimenez A. TikTok Therapy: An Exploratory Study of TikTok’s Popular Mental Health Content. Paper presented at: Technology, Mind & Society 2021 Conference Proceedings. 2021. Accessed February 27, 2023. https://assets.pubpub.org/2tv2iqfv/41634765009549.pdf
8. AMA Medical Code of Ethics: professionalism in the use of social media. American Medical Association. Accessed February 27, 2023. https://code-medical-ethics.ama-assn.org/ethics-opinions/professionalism-use-social-media
9. Sample Social Media Guidelines. Substance abuse and the administration of mental health services. Updated April 14, 2022. Accessed February 27, 2023. https://www.samhsa.gov/childrens-awareness-day/resources/sample-social-media-policy
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