Social Media and Young People ’ s Mental Health

Evidence suggests that social media can impact detrimentally on children and young people ’ s mental health. At the same time, social media use can be beneficial and have positive effects. This chapter outlines the detrimental and positive effects of social media use for young people. Schools play a critical role in educating young people about how to use social media safely and responsibly. However, schools cannot address all the issues and parents, social media and advertising companies also have a responsibility to protect children and young people from harm. This chapter outlines some of the potential solutions to the issues that are identified. but our research demonstrates that some as little as 2 hours These students attend school in a state of exhaustion. They too tired to concentrate and it affects their learning and their behaviour. Disengagement in lessons results in them falling behind in their schoolwork and they then develop other problems such as low confidence and low self-worth . Real-time social connections are vital for positive wellbeing. Schools play a key role in teaching young people about how to stay healthy and in particular, the need for sleep. However, parents also play a critical role in supporting young people to develop positive habits through setting boundaries. Examples of boundaries might include restricting access to technology in bedrooms and at mealtimes. Also, parents need to be good role models by ensuring that they do not allow technology to interrupt conversations and other daily experiences.


Introduction
In England Anne Longfield, England's Children's Commissioner, has written to the biggest social media companies, urging them to commit to tackling issues of disturbing content. Her letter follows the suicide of 14-year-old Molly Russell, who tragically killed herself after viewing distressing self-harm images on Instagram. The letter urges social media companies to back the introduction of a statutory duty of care where they would have to prioritise the safety and wellbeing of children using their platforms. Ms. Longfield's letter ends with the following message to the digital industry: With great power comes great responsibility and it is your responsibility to support measures that give children the information and tools they need growing up in this digital world-or to admit that you cannot control what anyone sees on your platforms.
According to literature use of the internet has risen rapidly in the last decade [1]. The way in which young people interact has changed significantly over the last decade. Social media enables them to develop online connections with people within their immediate friendship group but also to form connects with people who are more geographically dispersed. As a result of the digital revolution in recent years, young people are now able to communicate with others more efficiently and gain access to knowledge and advice more rapidly. For those living in rural communities, social media can facilitate social communications which otherwise would not be possible.
My own discussions with young people in schools indicates that social media is an extremely important part of their daily lives. It brings many benefits but is also exposes them to risks. Young people are often very aware of these risks and understand how to keep themselves safe. However, sadly this does not prevent all of them from harm, as is evident through recent cases of teenage suicides as a result of social media, which have been highlighted in the media in the United Kingdom (UK) and more widely.
This chapter highlights some of the detrimental and positive effects of social media use on children and young people's mental health. The implications for schools, parents, social media and advertising companies and the government are addressed. This chapter highlights that schools cannot solve all of the problems and that other stakeholders also have a responsibility to keep young people safe when they are online.

How do young people use social media?
Research suggests that social media use is far more prevalent among young people than older generations [1]. Young people aged 16-24 are the most active social media users with 91% using the internet for social media [1]. Young people use social media for a variety of purposes, including for entertainment, to share information and network with others and to gain support and health information [1].

Social media and its links to mental health
Evidence suggests that social media use can result in young people developing conditions including anxiety, stress and depression [1]. There are various reasons for this, and this section will explore the contributing factors. Research has found that four of the five most used social media platforms make young people's feelings of anxiety worse [1]. Research suggests that young people who use social media heavily, i.e., those who spend more than 2 hours per day on social networking sites are more likely to report poor mental health, including psychological distress [2].
Cyber-bullying is a significant problem which affects young people. Evidence suggests that seven in 10 young people experience cyberbullying [1]. Cyberbullying exists in a variety of forms. It can include the posting of hurtful comments online, threats and intimidation towards others in the online space and posting photographs or videos that are intended to cause distress. This is not an exhaustive list. Cyberbullying is fundamentally different to bullying which takes place in person. The victim of the bullying may find it difficult to escape from because it exists within the victim's personal and private spaces such as their homes and bedrooms. Additionally, the number of people witnessing the bullying can be extremely large because of the potential of social media for online posts to be shared across hundreds, thousands and millions of people. For the victim this can be significantly humiliating and result in a loss of confidence and self-worth. Humiliating messages, photographs and videos can be stored permanently online, resulting in the victim repeatedly experiencing the bullying every time they go online. Victims of cyberbullying can experience depression, anxiety, loss of sleep, self-harm and feelings of loneliness [3].
Social media has also been associated with body image concerns. Research indicates that when young girls and women in their teens and early twenties view Facebook for only a short period of time, body image concerns are higher compared to non-users [4]. Young people view images of "ideal" bodies and start to make comparisons with their own bodies. This can result in low body-esteem, particularly if young people feel that their own bodies do not compare favourably to the "perfect" bodies they see online. Young people are heavily influenced by celebrities and may desire to look like them. If they feel that this is unattainable it can result in depression, body-surveillance and low body-confidence. Young people can then start to develop conditions such as eating disorders. The issue of body image is not just a female issue. Young males are also vulnerable and influenced by the muscular, well-toned bodies that they see online. We now live in an age when males are taking increasing interest in their appearance and viewing images of muscular, toned bodies can result in them putting their bodies through extensive fitness regimes and males are also vulnerable to developing eating disorders.
The opportunity for people to use digital editing software to edit their appearance on photographs can also result in young people developing a false sense of beauty. It is worrying that there is a rise in the number of young people seeking to obtain cosmetic surgery [1] and the popularity of "selfies" in recent years has resulted in an increase in images which portray beauty and perfection. These images can have a negative impact on body-esteem and body-confidence.
Research demonstrates that increased social media use has a significant association with poor sleep quality in young people [5]. It seems that young people enjoy being constantly connected to the online world. They develop a "Fear of Missing Out" (FoMO) which is associated with lower mood and lower life satisfaction [6]. This can result in young people constantly checking their devices for messages, even during the night, resulting in broken sleep. Sleep is particularly important during adolescence and broken sleep can result in exhaustion and lack of opportunity for the brain to become refreshed. Lack of sleep quality can have a range of detrimental effects, but it can also impact on school performance and their behaviour. My own conversations with school leaders suggest that many adolescents demonstrate signs of tiredness during the school day. This can result in disengagement in lessons, thus having a detrimental effect on academic attainment.
The link between social media use, self-harm and even suicide is particularly worrying [1]. The fact that young people can access distressing content online that promotes self-harm and suicide is a significant cause for concern. This content attempts to "normalise" self-harm and suicide and can result in young people replicating the actions that they are exposed to.

The benefits of social media
Research suggests that young people are increasingly using social media to gain emotional support to prevent and address mental health issues [7]. This is particularly pertinent for young people who represent minority groups, including those who identify as lesbian, gay, bisexual or transgender (LGBT), those with disabilities and those representing black and minority ethnic groups. The use of social media to form online digital communities with others who share similar characteristics can be extremely powerful. Young people from minority groups are able to become "global citizens," thus reducing isolation. Participating in online networks presents them with an opportunity to meet with others who share their identities, to gain mutual support and advice and to gain solidarity. These networks can reduce feelings of loneliness and support the development of a positive, personal identity. They can also support young people to become more resilient to adverse situations which can help them to stay mentally healthy.
While online communities can be beneficial, they also bring associated risks. For example, members of the LGBT networks can become easy targets for abuse, discrimination, harassment and prejudice. It is therefore critical that young people understand how to keep themselves safe online and develop appropriate digital resilience to enable them to address these challenges.
Social media use can allow young people to express themselves positively, letting young people put forward a positive image of themselves [8]. The problem with this is that people tend to use social media to present the best version of themselves and of their lives. This can result in others making unhealthy comparisons between their own lives and the idealised lives that are depicted on the internet, resulting in low self-esteem.
Social media platforms enable young people to share creative content and express their interests and passions with others [1]. This can help to strengthen the development of a positive identity among young people and provide them with numerous opportunities to experiment with a range of interests. This is particularly important for young people who live in rural communities who may find it more challenging to develop social connections in the offline world.
Students living in boarding schools benefit from using social media platforms because it enables them to maintain contact with family members and friends at home. This is particularly important because students living away from home may experience isolation and homesickness and social media platforms facilitate these connections.
Social media platforms offer young people a useful tool to make, maintain or build social connections with others [1]. Additionally, research suggests that strong adolescent friendships can be enhanced by social media interactions [9]. Thus, young people can use social media to cement the friendships that they have formed in the offline world and to develop new friendships that would not have been possible in the offline word due to geographical restrictions.

The role of schools
Schools play a critical role in keeping children safe online. A well-planned digital curriculum should cover themes such as digital resilience and digital citizenship so that young people know how to respond to distressing content and how to behave responsibly online. The curriculum should also provide digital literacy skills so that children and young people have the skills to keep their own accounts safe through privacy settings, blocking perpetrators of abuse, reporting abuse and setting passwords. Schools should also support children and young people to critically engage with content they see online. They should be taught to question and interrogate content for accuracy, exploitation, abuse and discrimination.
Schools also play a critical role in developing young people's mental health literacy. This should cover common mental health conditions, including stress, anxiety, depression, self-harm and cyberbullying. Educating young people about mental health is essential and reduces the stigma that has traditionally been associated with mental health conditions. Young people also need to have strategies for managing their own mental health. If their mental health is adversely affected by their experiences online, they need to be taught strategies to self-regulate their emotions and strategies to aid digital resilience. Some young people who have negative experiences online respond by closing down their social media accounts. This situates the control with the perpetrators of abuse and removes control from the victim because they are disadvantaged. Developing practical approaches to aid digital resilience in the face of adversity must be a key component of the digital curriculum that schools provide. Young people need to know how to respond to abuse, who to report it to and how to block the accounts of perpetrators. In addition, they need to be taught about the importance of maintaining secure social media accounts and how to keep themselves safe by not sharing personal information.
Schools need to provide a social need to provide a social media curriculum which is progressive and age appropriate. Given the prevalence of fake content online and content which has been digitally edited, young people need to be taught to critically evaluate content that appears online so that they understand the harmful effects of some content. Themes including exploitation, body-esteem and gender stereotyping can be addressed through critically evaluating online content.
Children and young people often have a good understanding of the issues associated with social media because they are the users of it. Therefore, they experience the issues, sometimes frequently. Working in partnership with young people through empowering them to lead on aspects of social media education is a powerful way of developing student partnership and empowers them to be leaders. Often, young people understand the online applications better than teachers and they are acutely aware of the issues that occur online. Student-led events such as student-led workshops and conferences, which highlight the issues that relate to social media and mental health, are powerful ways of providing ownership to students. Developing digital ambassadors who act as peer mentors to younger students is also a powerful strategy for developing students' confidence and leadership skills. Young people who need someone to talk to about the issues that they are experiencing online can be paired with a digital ambassador who can provide them with confidential advice. Processes for recruiting digital ambassadors would need to be carefully considered by schools and the scheme would need to be properly led and managed by a member of staff to monitor its effectiveness. Student-led peer mentoring schemes are valuable because some students prefer to talk to peers about the issues that they are experiencing rather than teachers or parents.
Schools also play a critical role in educating parents about the relationship between social media and mental health. It is important that parents understand the online applications that their children are using, and schools can play a critical role in developing their understanding. Schools can also provide guidance to parents on the signs and symptoms of mental ill health so that they are better able to identify mental health problems in their child. Schools can provide guidance to parents on how to support their child's mental health at home and guidelines about responsible use of social media in the home. It is critical that parents understand the association between poor sleep quality, mental health and academic attainment and schools can play an important role in this. Schools also play a crucial role in developing parents' knowledge about how to be a good social media role model for their child.

The role of other stakeholders
Schools cannot solve the problems associated with social media in isolation. This section outlines the responsibilities of parents, social media companies and advertising companies. The responsibilities of the government are also outlined.
Parents are in a unique position to influence their child's social media use. They should establish clear expectations about the amount of time their child spends online. However, imposing rules on children can lead to conflict and the breakdown of relationships between parents and children. It is far more effective for parents and children to negotiate the rules jointly so that young people have ownership of determining the boundaries of acceptable and unacceptable behaviour. If rules are imposed rather than negotiated it is likely that young people will find ways to break the rules and therefore adopting a top-down approach may not be the most effective way of encouraging young people to develop healthy social media use. Some parents may try to restrict their child's use of social media by installing filters or by disconnecting the internet supply at specific times of the day or week. However, young people will find ways to subvert this and policing their use of the internet in this way is unlikely to foster digital responsibility. It might be more effective for parents to talk to their child about what it means to be a digitally responsible citizen and to explain why it is important to restrict screen time, particularly during the night. Families might want to consider allocating specific time each day or week when no-one accesses technology.
In addition, parents also need to be role models. They cannot expect their child to demonstrate the skills of digital citizenship and digital responsibility if they are not prepared to demonstrate these skills. It is therefore important for parents to model healthy online behaviours so that their children can then replicate these. It is also important for parents to develop their own digital literacy, so they are aware of the platforms and software that their child is interacting with. Parents also need to develop knowledge of the risks that their children are exposed to, given that these are constantly changing. If parents do not keep abreast of developments, they will not be able to support their child effectively.
Parents should negotiate rules with their children about what constitutes appropriate use of the internet. Imposing rules on children is unlikely to be effective because young people will find ways to resist or subvert these. It is also important that parents provide their children with a degree of autonomy about their internet use. It is unlikely to be helpful if parents continually monitor what their children are doing online. However, it is reasonable for parents to set some rules for appropriate use to protect their child from harm. Examples include: • not using technology during the night; • restricting technology use during mealtimes or other social occasions; • limiting the amount of screen time which children are exposed to.
It will be more effective if young people are involved in discussions with their parents about what might constitute appropriate use of the internet.
Social media companies have a responsibility to protect young people from harm. They can do this in a variety of ways by: • establishing strict and robust policies on the age at which users can access platforms; • blocking accounts of perpetrators of abuse; • reporting abuse to the police; • removing inappropriate content immediately; • filtering specific content before it goes live; • producing information to service users about responsible and safe use of social media; • generating warning messages when users have exceeded reasonable levels of screen time; • responding rapidly to reports of abuse. This is not an exhaustive list. However, it illustrates the sorts of actions that can be adopted by social media companies to protect children and young people from harm. Companies have not responded quickly enough to reports of abuse or inappropriate content as cases of suicide in the UK suggest that social media companies have failed to protect young people from harm. The government also has a clear responsibility to hold companies to account which fail to protect children and young people from harm. Simply fining companies is not enough and will not necessarily address the problem. The government needs to take firmer action against social media companies which breach their safeguarding responsibilities.
In addition, advertising companies have a responsibility to ensure that young people do not develop low body confidence. They can achieve this in a variety of ways. These include: • providing warning messages that images may have been digitally edited; • ensuring that images of bodies on products represent a range of body types, including a range of body sizes, disabled bodies and people of colour; • avoiding gender-stereotypes when advertising products; • producing warning messages about the dangers associated with product-use so that young people are aware of the risks; • portraying natural bodies without make-up on some products.

Young people's perspectives
Our own research in Cambridge [10] with students in secondary schools demonstrates that they had a good understanding of the benefits and risks associated with social media. Focus groups demonstrated that the students had developed an excellent understanding of the benefits of social media and the relationship between social media use and mental ill health, including sleep deprivation, cyberbullying and low body-esteem. They had also developed a better understanding of how to keep themselves safe online. The quotes and Figure 1 below are taken from our research report [10]. We can become stressed through social media because celebrities show images of being slim. This mainly affects women but now men are becoming bothered about how they look. This is stress that becomes a mental health problem. The students summarised the advantages and disadvantages of social media below:

Cyberbullying
Cyberbullying is bullying which takes place in the online world, including bullying which takes place on social media. It takes multiple forms. These include: • posting hurtful comments; • posting videos which are targeted directly at a person to cause distress; • posting photographs which are designed to cause distress; • inciting others to make hurtful comments aimed at a person; • sending hurtful text messages using a mobile phone; • sending hurtful private messages to a person [11].
According to Glazzard and Mitchell [11]: Cyberbullying is fundamentally different to face-to-face bullying in several ways. Firstly, victims cannot escape from it when they are at home because it takes place on mobile phones, tablets and computers. Secondly the abuse is witnessed by a larger audience; messages are in the public domain and can be repeatedly forwarded. This can result in victims experiencing the abuse on multiple occasions, which results in further psychological distress. Thirdly, the evidence of the abuse is usually permanently stored online which means that the abuse is not erased. These messages serve as a permanent reminder of the abuse and this can result in abuse being continually experienced by the victim.
Forms of cyberbullying are outlined below and taken from Glazzard and Mitchell [11]: Harassment: Harassment is the act of sending offensive, rude, and insulting messages and being abusive. It includes nasty or degrading comments on posts, photos and in chat rooms and making offensive comments on gaming sites. Posting false and malicious things about people on the internet can be classed as harassment [11].
Denigration: This is when someone may send information about another person that is fake, damaging and untrue. It includes sharing photographs of someone for the purpose to ridicule and spreading fake rumours and gossip. This can be on any site online or on apps. It includes purposely altering photographs of others to ridicule and cause distress [11].
Flaming: Flaming is when someone purposely uses extreme and offensive language and deliberately gets into online arguments and fights. They do this to deliberately cause distress in others [11].
Impersonation: Impersonation is when someone hacks into someone's email or social networking account and uses the person's online identity to send or post vicious or embarrassing material to or about others. It also includes making up fake profiles of others [11].
Outing and trickery: This is when someone shares personal information about someone else or tricks someone into revealing secrets and subsequently forwards it to others. They may also do this with private images and videos too [11].
Cyberstalking: Cyberstalking is the act of repeatedly sending messages that include threats of harm, harassment, intimidating messages, or engaging in other online activities that make a person afraid for their safety. The actions may be illegal depending on what they are doing. Cyberstalking can take place on the internet or via mobile 'phones. Examples include: • silent calls; • insulting and threatening texts; • abusive verbal messages; • cases of stolen identities [11] Exclusion: This is when others intentionally leave someone out of a group such as group messages, online apps, gaming sites and other online engagement. This is also a form of social bullying and is very common [11].
Bullying by spreading rumours and gossip: Online abuse, rumours and gossip can go viral very quickly and be shared by many people within several minutes. It is not uncommon for former close friends or partners to share personal secrets about victims [11].
Threatening behaviour: Threatening behaviour which is directed at a victim to cause alarm and distress is a criminal offence. Taking screenshots of the evidence and reporting it is one way of challenging this [11].
Happy slapping: This is an incident where a person is assaulted while other people take photographs or videos on their mobile phones. The pictures or videos are then circulated by mobile phone or uploaded on the internet [11].
Grooming: Grooming is when someone builds an emotional connection with a child to gain their trust for the purposes of abuse and exploitation. It is conducted by strangers (or new "friends") and may include: • pressurising someone to do something they do not wish to do; • making someone take their clothes off; • pressurising someone to engage in sexual conversations; • pressurising someone to take naked photographs of themselves; • making someone engage in sexual activity via the internet [11].
Groomers may spend a long time establishing a "relationship" with the victim by using the following strategies: • pretending to be someone they are not, for example, saying they are the same age online; • offering advice or understanding; • buying gifts; • giving the child attention; • using their professional position or reputation; • giving compliments; • taking them on trips, outings or holidays [11].
Inappropriate images: It is very easy to save any pictures of anyone on any site and upload them to the internet. Uploading pictures of someone to cause distress is a form of cyberbullying. This also includes digitally altering pictures to embarrass someone [11].
Bystander effect: Witnessing cyberbullying and doing nothing about it is not acceptable. Some people are worried about getting involved but victims of bullying need brave witnesses to make a stand. Perpetrators of bullying thrive when they have an audience. Making a stand against what they are doing is an important way to reduce their power. Most sites now operate a reporting facility so that online abuse can be reported and addressed. Bystanders are not innocent. They have a responsibility to report abuse that they witness [11].

Technoference
The following text is taken from our blog [12].
Research from Queensland University of Technology has identified that half of young people aged 18-24 are less productive and more tired because of their mobile phones. Scientists have adopted the term "technoference" to describe the way that mobile phones intrude on and interrupt everyday conversations and the way they interrupt other aspects of people's daily lives.
It is worrying that family life is being interrupted by technology. While technology has significant benefits, continual use of technology can impact detrimentally on the quality of people's interactions and conversations. We live in a society where people are constantly attached to their technology. People interact with technology on public transport, in meetings and during leisure time rather than engaging in productive, meaningful conversations. It seems that people would rather interact with a phone rather than having a conversation and while this is not necessarily a problem in some contexts, it can have a negative impact in other contexts. For example, young children require social interaction with adults. This allows them to develop secure attachments with significant others, it enables them to learn about the world and through conversation children are exposed to language. Exposure to language underpins reading and writing development. Children who have rich exposure to language become better readers, better writers and understand far better what they are reading. Lack of exposure to language can impact detrimentally on the structure of the brain. This can create reading difficulties and even lead to difficulties which are consistent with dyslexia, even though the difficulties may not have a genetic origin. The brain is malleable. It is responsive to environmental influences and lack of exposure to language can impact on phonological and phonemic awareness. Both of these skills play a critical role in reading development. Interacting with technology can restrict opportunities for communication between babies, children and their parents and can interrupt the flow of normal conversation.
It would appear that adolescents seem to be attached to their phones during the night. They are desperate to network and keep up-to-date with their online peers. This results in broken sleep and tiredness during the school day. Adolescents need approximately 8-10 hours sleep but our research demonstrates that some get as little as 2 hours sleep. These students attend school in a state of exhaustion. They are too tired to concentrate and it affects their learning and their behaviour. Disengagement in lessons results in them falling behind in their schoolwork and they then develop other problems such as low confidence and low self-worth.
Real-time social connections are vital for positive wellbeing. Schools play a key role in teaching young people about how to stay healthy and in particular, the need for sleep. However, parents also play a critical role in supporting young people to develop positive habits through setting boundaries. Examples of boundaries might include restricting access to technology in bedrooms and at mealtimes. Also, parents need to be good role models by ensuring that they do not allow technology to interrupt conversations and other daily experiences.

Statistics
Statistics demonstrate the risks of internet use on young people's lives. Key statistics are summarised below [13]: • year on year increases in the numbers and rates of police-recorded online child sexual offences in England and Wales and Northern Ireland • increases in police-recorded offences of obscene publications or indecent photos in all four UK nations over the last 5 years • increases in the number of URLs confirmed by the Internet Watch Foundation (IWF) as containing child sexual abuse imagery since 2015 • less than half of children aged 12-15 say they know how to change their settings to control who can view their social media • the majority of parents, carers and members of the public agree that social networks should have a legal responsibility to keep children safe on their platforms. Additionally: • a total of 5161 crimes of sexual communication with a child have been recorded in 18 months [14]; • in 2019 there has been almost a 50% increase in offence in offences recorded in latest 6 months compared to same period in previous year [14]; • in 2010 there has been a 200% rise in recorded instances in the use of Instagram to target and abuse children over the same time period [14]; • there have been over 5000 online grooming offences recorded in 18 months [14].

Conclusions
Social media use can have a detrimental impact on children and young people's mental health. It can result in anxiety, depression, body image concerns, self-harm, substance abuse and even death. However, for young people social media is a tool for networking, keeping in touch with friends, exchanging information, a source of support and advice and a rich source of knowledge. Preventing children and young people from using social media is not an appropriate solution, given all the benefits that come with it. Schools, parents and the digital industry need to do all they can to keep children safe from harm through adopting a proactive approach rather than a reactive approach when crises occur.