Perspective
The world is entering a new direction. The development and advances in information technology allow us to access anything that occurs in any part of the world. In other words, we can easily get information from any source because information exchange happens quickly (Prasetyo, 2022). Unfortunately, the changes that are currently occurring may sometimes violate someone’s privacy rights, especially the information obtained on social media. Whereas the available information on social media is not necessarily true, it is difficult to hold it accountable. However, many people still use the information from social media as a reference because it is convenient and accessible (Oducado et al., 2019).
In this case, many people may seem ignorant and do not care whether the information they get from social media is accurate or a hoax. As long as the obtained data is relevant and under their desires and expectations, they can easily share it on their social media platforms. Like in the market, the goods will be available if there is a demand. Social media as a market provides tremendously needed information that drives many people to provide them.
Moreover, many reports show that social media users worldwide have increased drastically. Current reports indicated that the number of people using social media was growing by over 4.26 billion in 2021, and it was projected to reach almost six billion in 2027 (Dixon, 2022). This number may be projected based on the addition of the population in the world. But it is possible that everyone with access to a cell phone, regardless of age, tends to access social media. Interestingly, another report revealed that social media users in Indonesia reached 191.4 million in January (68.9%), an increase of 21 million compared to last year (Kemp, 2022). This number can also be biased as Indonesia is one of the world's most populous countries, so the number of social media users surpasses other countries. But, taking Indonesia as an example may be interesting because it is included as one of the developing countries with a high population growth in Southeast Asia (ONeill, 2022). So, it is undeniable the number of social media users will be increased over the years, as well as social media platforms.
Indeed, there are so many social media platforms where people spend most of their time. But, the reports mentioned that Facebook, YouTube, Instagram, and TikTok are the most popular social media sites for showing explicit content that viewers may find intriguing (Dixon, 2022; Kemp, 2022). Based on the types of platforms, people will usually be provided with photos and videos, which triggers many content creators to compete with each other to produce more attractive images and videos. Some content creators develop ideas to generate a specific theme, but others do not follow some particular pattern. Often, other content creators steal others' opinions or just copy and repost them on their platforms.
Literally, various types of social media content could increase the number of viewers across all platforms (Koshy, 2022). First of all is educational content. Most of this type of content provides information about education, for example, how to succeed at school, get a scholarship, experience studying abroad, or even make and publish a paper. The next type of social media content is inspirational content which relates to how to inspire others by showing good experiences, attention, caring, and helpful actions. This content is one of the most popular and searchable content because people tend to look nicer to another person, especially deprived people. Another type of content is interactive content, which provides interaction with the viewers by giving them chances to ask questions and answer quizzes. Celebrities, public figures, and influencers offer most of this content. Then, connecting content targets specific audiences with particular interests by posting something related to popular hobbies, such as sports, movies, or music.
Furthermore, the other type of social media content is promotional content. The mostly content creator will provide much information to increase the added value of something by giving facts, benefits, etc. Subsequently, newsworthy content provides factual information by offering links to famous news websites to ensure its validity and truthfulness. People tend to refer to this type of content to ensure that the data is valid and trustworthy. Finally, the last type of content that gets attention from the viewers is entertaining content. This type of social media content provides something for fun and to be amused by posting funny videos, jokes, memes, puzzles, etc. No less important, content creators will find ways to make watchable content by following the desires and trends of the community. In other words, they will make videos based on their last-highest number of viewers. This includes mental health problems-related content. Therefore, this paper aims to provide the perspectives of psychiatric nurses regarding mental health-related issues in social media, including how to put content about mental health problems on social media appropriately.
Admittedly, content about mental health problems looks like two sides of a coin. On one side, it can increase negative perspectives regarding people with mental health problems, as they are frequently portrayed as insane that look shabby and unkempt. As a result, they are easy to be discriminated against and stigmatized in their community. On the other side, if they are portrayed better, the public perception may be changed. For example, those who take medication regularly will lead to fewer symptoms, and those with a successful life with controllable symptoms and supportive families. Interestingly, Betton et al. (2015) mentioned that putting personal experiences in the public eye could minimize discrimination and stigmatization towards people with severe mental health problems. Therefore, it will depend on how people with mental health problems are portrayed on social media platforms. But the content is not only about delivering the messages to the public. In fact, content creators may have their own intentions.
In addition, as one of the most searchable and watchable impressions on social media platforms, inspirational content about people with mental health problems caught most people's attention, for example, Indonesian YouTube viewers (Ariska & Syaefudin, 2021). They revealed that one popular YouTube channel, which focuses only on people with mental health problems, has almost five million subscribers, nearly 50 million views per month, and earns almost 200,000 USD per month. This specific content has become popular in Indonesia because people with mental health problems are still perceived as a weak and vulnerable group that needs to be fully supported in daily activities (Hanifah et al., 2021; Purnama et al., 2016). Therefore, most videos will depict people with mental health problems in deplorable conditions, useless, helpless, and powerless. It is part of the show to appeal to people, and sympathy can be conveyed as a form of concern without realizing that content creators may see it differently.
However, it is questionable whether the content creators genuinely care about people with mental health problems or just want to get compensated by YouTube, given that they reveal several details about their private lives with dramatic taglines, such as “bathing and dressing them to like models.” Unfortunately, the majority of the videos did not blur the faces of those who appeared uncomfortable participating in the assigned activities. Therefore, it becomes a question of whether they truly want to engage with the content or are not allowed to say “No.” One ethical question that needs to be answered and investigated is, “Do content creators inform them or their families before recording?” In addition, the hyper-exploitation of people with mental health problems on social media platforms has another significant impact, for example, stigma, discrimination, or even sadfishing.
The California Mental Health Services Authority (2014) mentioned apparent differences between stigma and discrimination among people with mental health problems. Stigma reflects their attitudes and beliefs that lead those to have feelings of rejection, avoidance, and fear as they think they are different from others. There are three kinds of stigma: public stigma, self-stigma, and institutional stigma (Borenstein, 2020; California Mental Health Services Authority, 2014). Firstly, self-stigma refers to negative attitudes and beliefs regarding their own condition. Secondly, public stigma refers to negative attitudes and beliefs of the community regarding people with mental health problems who perceive them as a dangerous group and have a higher risk for violence. Lastly, institutional stigma refers to negative attitudes and beliefs of organizations or governments by using stigmatized terms such as “schizophrenic persons” or other limitations in their policies, whether intentionally or unintentionally. Unfortunately, stigmatization among people with mental health problems becomes an unfinished task, especially when they have poor appearances (Saputra, 2016).
Currently, the over-exploitation of people with mental health problems on social media platforms may increase their risk of having the stigma (Robinson et al., 2019). Let’s take a look one by one. First, on self-stigma, they will perceive themselves like content creators portray them as people with lack the capacity and ability to take care of their own. This perception will be internalized and make them believe they are incompetent. If this situation continues, they will keep this perception, and their self-stigma will remain or even increase.
On public stigma, the public who watch content about incapacity and helplessness of people with mental health problems will perceive that they always need to be helped to take care of themselves, without knowing that sufficient support and empowerment are better than providing them with total help permanently. As a human, they need to be empowered and do many things in their lives on their own because it will increase their self-esteem. How about institutional stigma? Unluckily, the government and private organizations exposed to this particular content may perceive them the same as the public perception. Therefore, they may develop impartial policies unfavorable to people with mental health problems. They may also limit the opportunities for people with mental health problems to work in their company. That leads them to discrimination.
Discrimination reflects behavioral forms regarding the stigma, where people with mental health problems tend to receive unequal treatment, especially for their rights and opportunities (Borenstein, 2020; California Mental Health Services Authority, 2014). Therefore, it will be easier for them to get marginalized to access their civil rights, for example, higher educational level, higher paid salary employment, or even participation in elections. In addition, the content about people with mental health problems that spread on social media platforms may also increase discrimination towards them. For example, they may perceive that they do not need to go to schools or universities, work, or do other daily activities due to their conditions. Actually, it needs to be emphasized that the perception is wrong. They needed to be fairly given opportunities to access those civil rights like others.
Besides stigmatization and discrimination, the other impact of social media content about people with mental health problems is sadfishing. In a simpler way, sadfishing can be defined as posting someone’s emotional and dramatic personal content to get attention or sympathy from the viewers (Rutledge, 2021). As mentioned earlier, content creators tend to show that people with mental health problems are unable to take care of themselves. So, they like to deliver that message all over again and display it in their videos to make them look nice or care about that issue. Most of the time, the content creators will try to find people with mental health problems in terrible conditions, offer them bathing, dressing, and feeding, and turn them into “good-looking people.” They seem friendly and kind, but they reinforce the perspective that someone has to look terrible to experience mental health problems. In fact, many people with severe mental health problems have normal appearances like others. Moreover, people with mental health problems with minimal dependence and recovery look like ordinary people so they can study and work as usual (Safitri, 2011). Therefore, content creators should consider many important issues before making videos.
One crucial initial issue that content creators should notice is to ensure that people with mental health problems should be put as the subject and not the object of the videos. It means that content creators should have to determine that they have already received permission from people with mental health problems and their families before taking a shot. The content creators should blur their faces if they want to participate in the videos but do not want to be fully exposed. Subsequently, the videos’ objectives must be clear first, so both know exactly how the videos will be made. It will also determine the involvement of certain persons to support the whole story of the videos. After that, it will be better if they discuss the concept of the videos and how the narration will be made to describe them. Any input from people with mental health problems and or their families should take into consideration by content creators.
Furthermore, after every shot is finished, the video should be watched together, and the content creators have to ensure that everyone agrees to put it for the result of the video. After the editing process, the video’s final version should be watched together once more to convince that the agreement is achieved and everyone is satisfied with the video. But, it is noted that the messages in the videos have to be efficiently delivered and digested by the targeted audiences or viewers with misinterpretation. The content creators should pay attention to those steps to confirm that people with mental health problems become subjects rather than objects of the videos. The ethical concern is also already achieved by following those mentioned steps.
The copyright issue is the other important issue that content creators should notice regarding the inspirational content of people with mental health problems. As content creators raise an issue about the lives of people with mental health problems, they need to have rewards for their agreement to participate in the videos. It will be better if the content creators talk about this issue before taking the videos, so they and their families know what they will get from their participation. That is how the content creators appreciate people with mental health problems and their families. It will also protect the content creators from being sued over the published videos. Even less, money is one sensitive issue that should be appropriately treated.
Another critical issue is sustainability concern, where content creators should ensure that their goodwill is sustainable for a long time by involving healthcare providers, especially psychiatric nurses and community nurses. They have standardized nursing care for people with mental health problems in the community, so their information will benefit the content creators. Usually, psychiatric nurses in the community will provide people with mental health problems with structured methods, starting from mental health screening, conducting a full nursing assessment, establishing a nursing diagnosis, developing nursing intervention, delivering nursing implementation, and undertaking nursing evaluation (Kudless & White, 2007). So, it will be better if the content creators follow the program already planned for people with mental health problems. By doing so, the benefits can be achieved not only by the content creators, by earning more money from popular videos, but also for people with mental health problems and their families, by receiving standardized care that will achieve therapeutic outcomes, as well as psychiatric nurses, by having content creators to be involved in the program and spreading the video via their social media platforms. So, conclusively, content creators may play their part in articulating care for people with mental health problems in the community. However, they still need to pay attention to ethical and sustainability issues.
In the end part of the discussion, as psychiatric nurses, we may say that content creators have an essential role in supporting successful medication regimens for people with mental health problems in the community. As the number of relapses among people with mental health problems is so prevalent because of taking medication irregularly, the content creators can be involved in the campaign about medication adherence among that population. We have to agree that successful medication initially comes from two aspects, the internal motivation of the patients and supportive family members. They should be supported to have a motivation for recovery because the strong belief in recovery that came from them will direct them to follow the nursing care and treatment advice. But, if they hesitate and believe they will not recover, it will become more difficult to ask them to take medication. Therefore, the empowerment of people with mental health problems by putting them as subjects of the content creators’ videos will help them appreciate themselves and be more powerful in controlling their lives.
The content creators also can help people with mental health problems by triggering them to become supportive families. As stated above, in the very first process of video making, the content creators will welcome the involvement of the families. This will also help their families empower themselves. They may want to contribute more to caring for their family members with mental health problems. They even can learn how to provide support during the process by learning from the involved psychiatric nurses in the community. Unconsciously, the content creators act as facilitators to mediate the participation of family members in patients’ treatments and nursing care. So, showing those two strong messages in the videos will change the public perspectives. In addition, the content creators should have a video that displays the differences between patients who take and do not take medication regularly that drive from their own motivation to be recovered, including how the differences if they have supportive family members that always remind them to take medication regularly until it becomes a habitual activity. In conclusion, content creators may change the public perspective regarding mental health issues in the community if they realize their essential roles and expose the messages appropriately on their social media platforms. That is how content creators properly put mental health problem-related issues in social media. Hence, their content not only provides them with benefits but also positively contributes to people with mental health problems and fights stigmatization and discrimination.