Two concepts of moderation : how online communities can protect young people at risk of self-harm

Abstract

Introduction The idea of receiving social support through online chat rooms, bulletin boards and social media, is nothing new, but the emergence of digital healthcare has presented an opportunity to re-examine how the internet and online communities can help support those at risk of mental ill-health. Progress in this area has also seen the emergence of moderated communities specifically aimed at vulnerable groups, such as young people at risk of self-harm.

Key questions that remain include what the relationship ought to be between online communities and professional services, and how the architects and moderators of online communities can best design standards and protocols to protect young people, whilst also maintaining the open space that makes them accessible and unique.

This paper reviews the literature relating to online support communities, and presents standards and protocols related to the management of online communities. It also explores some of the challenges of providing online support, and discusses how clinicians and moderators can approach the tensions between internet censorship and openness, with reference to Isaiah Berlin’s seminal lecture, ‘Two Concepts of Liberty’.

Methods Papers investigating and reviewing online support communities were identified using a systematic search in PubMed, and manual searches. These papers were examined and conclusions, limitations and standards and protocols for online communities were organized.

Findings A total of 22 papers were identified containing appropriate evaluations and standards and protocols relating to online support communities. These included evaluations of online peer support in a general sense, as well as several summaries of specific communities and their moderation techniques. Overall, there was a lack of good evaluations to prove the value of online peer support, but also no evidence was found for online support communities being harmful. Potential benefits, as well as standards and protocols, were reviewed.

Conclusion In spite of limited evaluations for online support communities, there are various standards that communities can adhere to. These include methods of moderation that minimize risk to users, but also methods that may maximize the benefits of online peer support. It is suggested that the emphasis on minimizing risks has had greater attention, perhaps due to negative media portrayals of the influence of the internet on mental health, and that online communities also need to utilize more ‘positive’ forms of moderation in order to maximize the benefits of online support communities.