Talking about internet use around suicide and self-harm can help you better understand a person's risk and identify if they have any unmet support needs.
The internet has increased access to a host of new information and discussion around suicide and self-harm. While this has opened important new opportunities for connection and support, it has also exposed users to new risks, including increased access to detailed information on methods of harm and content that promotes suicide and self-harm. This can be distressing, triggering and may encourage, maintain or exacerbate self-harm and suicidal behaviours.
It’s crucial that practitioners understand how the internet is used to explore suicide and self-harm and the risks that it poses, so that they can support individuals to stay safe. See our information page on suicide and self-harm online to learn more.
This guidance was developed in collaboration with practitioners, and individuals with lived experience around suicide and self-harm. Through focus group discussions and surveys, we co-developed this advice on how to discuss online use in a safe and supportive way.
Who is this guidance for?
This guidance is relevant for anyone working with individuals who could be at risk of suicide and self-harm, including but not limited to:
- Mental Health Nurses
- Social Workers
- Accident and Emergency Doctors and Nurses
- Listen and be non-judgemental.
- Ask direct questions about someone’s online use, and follow up on this in their regular support sessions.
- Try to understand the nature of the online content they are engaging with.
- Discuss what motivates their online use in relation to self-harm and suicidal content.
- Encourage them to reflect on how their online use makes them feel.
- Encourage them to go to safe sites for support and to seek help offline too.
- Provide them with resources on how to stay safe online. See Samaritans’ online safety resources as an example.
- Discuss the potential risks of viewing or engaging with harmful content online.
- Assess their risk of suicide and consider developing a safety plan together.
Why do I need to ask direct questions about online use?
Internet use is a common part of peoples journey to understand more about how they are feeling and connect with others with similar experiences. By asking about it directly, you can establish and respond to any risks. You can also help the person to feel less embarrassed or secretive about their online use.
How should I approach conversations about online use?
When discussing a person’s online use, remember that everyone is different: what’s triggering for one person can be helpful for another. Each conversation should centre around that individual’s experiences and their responses to what they see online.
Your main goal should be to develop a shared understanding of how and why they use the internet to explore suicide and self-harm. This will help you to understand if there are any unmet support needs, as well as how their online use might affect their mental health, and suicide or self-harm risk.
Once you have a good understanding of their online use, you may want to suggest some ways to stay safer online or offer alternative ways of getting support. If you’re concerned for their safety, you can explore this with them or raise it with a colleague or their support and care teams.
If they didn’t ask me, I would never talk about my online use for fear they’d think it was weird or wouldn’t understand. By asking, it would stop me feeling so embarrassed.
Person with lived experience on why practitioners should ask about online activity
How can I develop a shared understanding of their online use?
Ask about the types of content or communities they engage with online
Knowing the platforms and content that they view will help you to understand why they are using the internet to explore these issues and whether what they're viewing is likely to be harmful or helpful. Remember that people have different triggers and what is harmful for one person may be different for another.
Help them to reflect on the emotional impact of their online use
Ask how their online use makes them feel: do they find it comforting or does it make them feel anxious or distressed? If people struggle to identify changes in their mood, consider asking them to keep a diary of their online use to help them notice how it makes them feel. If there are particular sites or types of content that they find distressing, talk about how they can avoid or block this content. For more information on how to do this see our online safety resources.
Explore what motivates their online use
The drivers and functions of a person’s online use may help you to identify unmet support needs, or ways to direct them away from more harmful activities. For example, if they’re trying to connect with people with similar experiences, they may benefit from a peer support group. Ask what times of the day they go online, this could highlight when support is needed. If they mostly browse at night, consider signposting them to 24 hour services, such as Samaritans.
Explore their online/offline balance
Ask about the frequency and duration of their internet use. If they spend a lot of time online, you may encourage them to explore more offline sources of support. Ask if there are people at home or in other areas of their life that they can talk to. Where this isn’t the case, help them access additional support and work with them to build their confidence talking about their feelings.
Question bank for talking about online use
To talk about online activity safely, we recommend that you use broad open questions. Try using some of the following to explore a person’s online use in an open and non-judgemental way.
- Could you describe what you’d normally look at online?
- Could you share with me the sites you normally use?
- Are you part of any groups online where you seek support for how you're feeling?
- Can you tell me why you find going online helpful?
- Can you tell me how viewing this content makes you feel?
- How much time do you normally spend online?
- Can you share with me what support you get offline?
- Can you describe what you enjoy doing offline?
Make sure there’s no judgement or shame in the reaction. Accept why they might be accessing it even if they don’t think it’s a good idea and be very careful about getting them to stop. It has to be their decision if they’re going to give up viewing that content.
Person with lived experience on how they'd like practitioners to talk about online use
What advice can I give on how to stay safe online?
Explain the risks
Where a person is using the internet to discuss feelings around suicide and self-harm, it’s important that they’re aware of the potential risks. Although young people may be more familiar with using different sites and technologies, they’re often not as aware of the risks relating to engaging with suicide and self-harm related content.
Help them manage their exposure to harmful content
Talk to people about how they can manage the information they see and what they should do if they are finding content distressing. Talk to them about making decisions to unfollow people or block and report certain types of content. Our user resources have more information on how to use these safety features.
Encourage them to report anything that concerns them
If they see anything online that makes them feel worse, encourage them to speak to someone they trust or report that content to the platform. For guidance on how to report content, see our guidance on reporting worrying content.
Encourage them to post about their experiences safely
There are lots of small things someone can do to make their posts safer, such as using trigger warnings and avoiding discussing methods of harm or sharing graphic content. Read our advice for more information on how to post safely.
Signpost them to support
Direct them to safer online spaces, such as Togetherall, Side by Side, Mental health forum or The Mix. Make sure that any online peer support forums are moderated and have clear community guidelines. It can also help to signpost them to offline support as this might reduce the time they spend online and their exposure to harmful content.
When I assess someone, especially in the A&E department, sometimes we’ve only got 45 minutes with somebody, potentially less if they need to leave, so I would be asking about their online activity early on in the assessment. Obviously you need to establish a bit of a rapport there, but the first thing to look at is what triggered this incident. I’d feel less confident in the assessment if I hadn’t explored that issue.
Frequently asked questions
Do I have the right skills and experience to be able to talk about online use?
Talking about online use does not require specialist skills or experience. The important thing is to use the time you have with a person to discuss their internet use around suicide and self-harm together. These conversations can increase an individual’s awareness of the risks, encourage them to consider how their online use affects them, and be an opportunity to signpost them to support.
Effective conversations about online use primarily rely on the core principles of good communication, which you’ll already be familiar with. For more help, advice or further reminders on how to have supportive, person-centred interactions even in brief meetings, see Make Every Contact Count’s ‘Ask, Advise and Assist’ Framework – a simple tool that you can use as a conversation guide.
What if I don’t feel confident in my knowledge of online platforms?
The internet is vast and the way in which platforms are used is constantly changing. It’s ok to admit that you’re not familiar with a platform or activity. Try asking clarifying questions and ask them to explain it to you. Often a person will find it encouraging and empowering to be able to talk about their experiences in their own terms. They may even find that explaining it to you helps them.
Remember that confidence comes with experience and these conversations will get easier the more you have them. We have lots more information and support to help you increase your understanding on the online environment and the types of content available: sign up to join our research webinars or email our advisory service for support. You can also try asking for support from a supervisor or a colleague.
When is the right time to ask someone about their online use?
If you’re conducting risk assessments or exploring triggers for self-harm or suicide behaviours, it’s vital that you ask about someone’s online activity. Ask about online use early on, to get a better understanding of their risk or what happened in a specific incident. If you’re in a more therapeutic role, you may want to build rapport and trust first. Even if your sessions are normally led by the individual, we’d encourage you to find a way to explore online use. This is an increasingly important part of someone’s mental health experience and can have implications for their safety. We know time with a patient can be limited, so use your judgement on when to ask about online activity, but it's important not to skip these questions.
How can I make someone feel more comfortable talking about their online use?
The most common reason people give for not talking to practitioners was fear that they will have negative preconceptions of internet use around suicide and self-harm. Individuals may worry that this could result in judgement, having their access removed or that a practitioner may simply overlook the support and benefits that these spaces can offer.
When talking about online activity, it’s important to bear these concerns in mind and remain open and non-judgemental. Listen and engage with their individual experiences. Samaritans have compiled some listening tips to help you provide the best support you can. See the question below for what to do if you’re worried about someone’s safety.
What should I do if I’m worried about someone’s safety?
If you think a person's online use poses an immediate risk of harm, you may need to take further steps to protect them, for example, if you learn that they are using the internet to search for methods of harm. In these cases:
- encourage them to talk about how they are feeling with their support network, and include their network in any support plans that you make with them
- develop safety plans that recognise online harms and potential triggers
- establish whether they know how and where to seek support in a moment of crisis.
- Follow your standard safeguarding process, and seek support from your supervisor or manager for extra support if needed.
Be cautious about removing online access completely. You may inadvertently remove access to their online sources of support or damage trust in the relationship.
Could my questions encourage someone to look for potentially harmful information online?
There’s no evidence to show that asking people about their online activity will encourage them to seek out harmful content. It’s highly likely that they’ve already used the internet to look for information on their experiences. However, to reduce any risk of harm, avoid naming any specific sites or types of harmful content.
What if they think I’m invading their privacy?
People can be very private about their online use – their posts can be very personal and they might feel protective of them or worry that you’ll ask to see them. Developing trust can encourage them to open up, but they still may not want to disclose details. It can help to remind them of your confidentiality agreement and that you will respect their privacy. If they don’t tell you about their online activity, it can still help to discuss online risks and signpost them to safe spaces and other sources of support.
How can I support parents and caregivers?
Practitioners may also need to provide guidance to the parents and carers of young people who access online content around suicide and self-harm. Although caregivers may find their child’s online use upsetting, they should be encouraged to discuss their child’s online use in an open and non-judgmental way. Talking about their child’s online use could provide an important opportunity to explore difficult feelings that they’re having or other issues that they face. It’s important that children and young people feel able to seek support around their online use.
As a practitioner, you can support caregivers to learn about online safety features, such as blocking, reporting and unfollowing content. Encourage them to talk to their children about how they can use these tools to control what they view.
Caregivers can also set boundaries for internet use at home. Discuss options around limiting screen time or other ways to encourage them to spend time offline. Give caregivers information and advice on how to access mental health support. If they think that a child or young person in their care is at risk of harm, they should seek professional advice.
The following services can provide caregivers with further support: YoungMinds’ helpline for parents and caregivers with children under 25 years old, NSPCC’s helpline, email and online chat service, Childnet’s resources and support on online safety.
For younger people the internet plays a large role in their mental health. To some degree we all use it to trigger ourselves or to help ourselves and it's important for a practitioner to know which of the two it is.
Person with lived experience on how practitioners can help them navigate online risks
Help us shape the design of our new online safety hub
Do you support people at risk of suicide and self-harm? If so, we need your help. Samaritans are looking for practitioners to feed into the design of a new online safety hub. Learn more about the project and how you can get involved.