Patterns of Internet Use in People with Severe Mental Ill Health: A Typology and Outline of Difficulties and Potential Protective Strategies. (Preprint)

BACKGROUND People with Severe Mental Ill health (SMI) face profound health inequalities, which may be exacerbated by increased rates of digital exclusion and the movement of health services and provisions to being offered online. OBJECTIVE To explore internet and digital technology usage for those with SMI, with particular focus on the drivers of the relationship between high internet use and poorer self-reported mental health. METHODS We carried out a qualitative interview study with 16 participants with SMI. The participant sample was drawn from a wider investigation of the impacts of the pandemic and restrictions on the health and wellbeing of people with SMI. Data was analysed using framework analysis. RESULTS Participant experiences fell into three broad categories; those who had a positive or neutral online experience, those who had negative or difficult experiences of being online and low users / those with low digital literacy. Of the participants with difficult experiences (those who reported strong unpleasant feelings) our analysis revealed two interesting categories, those with worries and fears related to the online world and those who had difficulty limiting their internet use. Also of note was the description of conscious / mindful interaction with the online world. CONCLUSIONS People with SMI (along with the general population) are expected to conduct more of their activities of daily living online in the post pandemic world. This research shows that the majority of internet users with SMI have positive or neutral experiences. However, our typology reveals subgroups of the SMI population for whom there is a relationship between internet use and difficult feelings. These subgroups can be identified by asking questions about online activities, time spent online, feelings, difficulties / issues experienced and use of gambling, dating, adult content, and conspiracy theory websites online. Our conclusions point to further work in collaboration with people with lived experience to modify and test this typology.