Access to the internet in an acute child and adolescent mental health inpatient unit

To the Editor

Internet and social media are increasingly important in adolescents’ worlds and are becoming part of our clinical practice (King and Delfabbro, 2014). Managing access to the internet in inpatient settings is relatively new. Rees et al. (2013) surveyed providers of general paediatric inpatient care in the UK and found a range of levels of internet access with few unfavourable consequences. We would like to report our experience of increasing internet access for young people in an acute child and adolescent mental health unit. A desktop computer with Wi-Fi access was placed in a central corridor early in 2014 as part of an implementation study of SPARX, an e-therapy programme for treating mild depression in adolescents (Merry et al., 2012). Staff and some young people were interviewed, and browsing history from the computer was recorded over 1 month.

Approximately 45% of the searches identified were Facebook and 35% were YouTube. The other 20% were over 138 search terms. For two of these access was denied (via internet security programme). None of the others was identified as inappropriate. The browsing history may have been wiped, but our records are consistent with staff observation.

Young people were very positive about internet access. Some endorsed the need for time limits. Concerns described included slow connection, outages and the availability of only one computer. Some described pressure, occasionally described as bullying, from other young people who wanted to use it. One young person described experiencing distress from something they read on Facebook.

Staff reported fewer problems than expected and found them straightforward to manage with supervision. They described (i) some pressuring of young people by each other for access to the computer, (ii) some inappropriate posts on Facebook and (iii) concern about the amount of time young people spent on the computer. Staff also described therapeutic opportunities. The public position of the Wi-Fi computer enabled sharing of online activity with clinicians. They could support young people in looking up important information, gain more understanding of their lives and engage with them in reflecting on their internet use.

Key important questions remain with respect to the value of young people having time out from online contact during an inpatient admission and the opportunity for clinicians to engage with young people in their use of the internet.