Thematic Analysis Of #Camhs On TikTok

Foster, M., Frith, H., & John, M. (2024). ‘I’m still su!c!dal when you’re done with the paperwork’: An inductive framework thematic analysis of #camhs on TikTok. Journal of Child Psychology and Psychiatry, 65(10), 1258–1269. https://doi.org/10.1111/jcpp.14002

Rationale

The study aims to explore how CAMHS is represented on TikTok, a popular social media platform among young people.

This investigation is crucial as young people increasingly share their mental health experiences online (Yeo, 2021) and use social media to search for mental health information (Ofcom, 2023).

Previous research has identified barriers to young people accessing mental health support, including negative perceptions about treatment effectiveness and fear of not being taken seriously (Radez et al., 2021).

However, little is known about the content of TikTok videos discussing CAMHS and their potential influence on young people’s attitudes towards seeking professional mental health support.

This study seeks to fill this gap by analyzing #camhs TikTok videos to understand how the service is portrayed and the potential implications for help-seeking behavior.

Method

The study employed a participatory inductive framework thematic analysis to explore 100 TikTok videos using the hashtag #camhs.

Videos were selected based on specific criteria: downloadable, person speaking to camera, and content explicitly relating to CAMHS services.

The researchers used a research-only TikTok account and an incognito browser to avoid influence from browsing history. Video length, date of upload, caption, perceived gender of creator, and engagement metrics (views, likes, comments) were recorded.

Five young co-researchers (aged 15-17) were recruited from a secondary school to participate in data analysis.

The co-researchers took part in a 5-hour data coding workshop at their school, which involved recognizing identity and reflexivity, an introduction to framework analysis, data coding, and reflection on video content.

The analysis followed the five stages of framework thematic analysis outlined by Gale et al. (2013) and Ritchie and Spencer (1994): familiarization and preliminary coding, identifying a framework, indexing, charting, and mapping and interpretation.

NVivo software was used for systematic coding and analysis.

Sample

The sample consisted of 100 TikTok videos posted under the hashtag #camhs between 2019 and 2021, with 80% posted in 2021. Video creators were perceived to be predominantly White, female adolescents.

The videos had diverse patterns of audience engagement, with an average of 226,383 views (SD = 567,077), 46,454 likes (SD = 139,237), and 587 comments (SD = 1,414).

Results

Four primary themes were identified:

Theme 1: CAMHS can be frustrating and unhelpful, but sometimes life-saving

This theme captures the varied experiences of young people with CAMHS, highlighting both significant frustrations and life-saving interventions.

These contrasting experiences highlight the variability in CAMHS care and underscore the importance of collaborative, person-centered approaches.

While many young people feel frustrated and let down by the service, others have found it to be literally life-saving, demonstrating the potential positive impact when young people feel heard and supported.

It consists of three sub-themes:

1a. A mismatch between distress and the help offered:

Many young people expressed dissatisfaction with the advice and interventions provided by CAMHS, often feeling that these were inadequate or dismissive of their distress.

For example, one creator sarcastically stated: “telling me to have a bath is not help” (Video 90). Another video dramatized a conversation with CAMHS, where the young person responds to generic advice by saying: “listen I don’t need a cup of tea, I need some fucking help…have you got any actual advice?” (Video 1).

These quotes illustrate the frustration felt when offered seemingly simplistic solutions to complex mental health issues.

1b. There is a long wait for help:

Creators frequently highlighted the long waiting times for CAMHS support, which exacerbated their distress.

One poignant quote encapsulates this: “two years ago i was ready to commit – I would throw up every morning from anxiety, my legs would ache from shaking, I couldn’t sit through a full lesson. All CAMHs did was put me on a waiting list” (Video 58).

This quote vividly illustrates the severe impact of mental health difficulties on daily life while waiting for professional help.

1c. It helps to feel listened to and cared about:

Despite the predominance of negative experiences, some videos shared positive interactions with CAMHS.

These often centered around feeling genuinely listened to and involved in care decisions.

One creator shared: “camhs involve me in any decision about my care and let me have a say in it bcs [because] I know what’s best for me” (Video 84). Another expressed gratitude for life-saving interventions: “I owe my life to many CAMHS workers. I’d be d3ad without my inpatient treatments. They kept me alive” (Video 46).

Theme 2: Young people can feel their distress is invalidated by CAMHS

This theme explores how young people often feel that their experiences and distress are dismissed or minimized by CAMHS professionals.

Overall, this theme highlights a significant power imbalance in CAMHS, where young people often feel their experiences are invalidated or minimized by professionals.

This invalidation occurs through various means – lack of diagnosis, privileging professional knowledge over lived experience, and age-based dismissal – all of which can leave young people feeling unheard and unsupported in their mental health struggles.

It is comprised of three sub-themes:

2a. Absence of diagnosis invalidates distress:

Many young people expressed frustration at not receiving formal diagnoses, feeling that this undermined the legitimacy of their struggles.

One creator highlighted this by contrasting CAMHS’ assessment with their own experience: “they consider it low mood instead of actual, you know, depression” (Video 39).

This quote illustrates the disconnect between professional categorization and personal experience of mental health difficulties.

2b. Young people feel professional knowledge is privileged:

Creators often portrayed CAMHS professionals as dismissive of their lived experiences, prioritizing professional knowledge instead.

A particularly poignant quote captures this sentiment: “I hate that doctors think that they know more about conditions than people who actually have the conditions. Because it’s like yeah, okay, you might have attended a one-hour lecture on my specific condition, but the fact that I’ve been living with it for my whole life, surely I know more about it than you?” (Video 88).

This quote vividly expresses the frustration young people feel when their expertise gained through lived experience is not acknowledged.

2c. Young people feel dismissed due to their age:

Many videos depicted CAMHS professionals attributing mental health issues to normal teenage experiences, effectively dismissing the severity of young people’s distress.

One creator roleplayed a CAMHS worker saying: “you’re just a teenager that’s had, you know, a bit of stuff go on so you’re just a bit sad…this isn’t mental illness, it’s just teenage sadness really” (Video 24). Another reported being told: “I think you’re gonna grow out of [feeling suicidal] at some stage” (Video 59).

These quotes illustrate how young people’s mental health concerns can be trivialized due to their age.

Theme 3: CAMHS makes young people feel responsible for their distress

This theme explores how interactions with CAMHS can lead young people to feel burdened with responsibility for their own mental health struggles and for improving the system.

Overall, this theme highlights how interactions with CAMHS can inadvertently place undue responsibility on young people.

Whether it’s feeling obligated to improve the system, minimize inconvenience to others, or prove the severity of their distress, these expectations can exacerbate young people’s mental health struggles and create additional barriers to seeking help.

This dynamic appears to reinforce a system where young people feel disempowered and unsupported in their mental health journey.

It consists of three sub-themes:

3a. Young people feel a responsibility to improve services for others:

Many creators expressed a sense of duty to prevent others from having similar negative experiences with CAMHS.

One poignant quote illustrates this: “8 years later im [sic] training to be a doctor…this hell made me want to fight for others” (Video 34).

This quote demonstrates how some young people feel compelled to enter the mental health field themselves to drive change, suggesting a lack of faith in the system’s ability to improve from within.

3b. Young people feel responsible for minimizing adult inconvenience:

Videos often portrayed CAMHS professionals as prioritizing the convenience of parents or the healthcare system over the needs of young people.

A roleplay of a clinician exemplifies this: “You see I think you need to think about your Mum here. She doesn’t want to be sat on a ward all night and tomorrow. She wants to go to work tomorrow. And I’m sure you’ve read in the news that there’s a strain on hospital beds right now” (Video 65).

This quote illustrates how young people can be made to feel that their mental health needs are a burden on others.

3c. Young people feel responsible for demonstrating need:

Many creators described feeling pressure to prove that their mental health issues were severe enough to warrant help.

One quote starkly illustrates this: “your sh [self-harm] is only superficial, people do it a lot worse” (Video 93). Another creator shared that their CAMHS Psychiatrist “told me they won’t help me with my a0r3x€ıa because my weight isn’t low enough” (Video 67).

These quotes demonstrate how young people can feel responsible for escalating their symptoms to access care, potentially encouraging dangerous behaviors.

Theme 4: Young people may not feel CAMHS professionals are trustworthy

Overall, this theme highlights a fundamental breakdown in trust between young people and CAMHS professionals.

Whether through breaches of confidentiality or perceived insincerity, these experiences can lead young people to feel unsafe and unsupported in their interactions with CAMHS.

This lack of trust can have serious implications for young people’s willingness to engage with mental health services and their ability to be open and honest about their struggles.

It underscores the critical importance of maintaining clear boundaries, respecting confidentiality, and fostering authentic relationships in mental health care for young people.

It consists of two sub-themes:

4a. CAMHS lacks confidentiality:

Many videos portrayed CAMHS as a service that does not respect patient confidentiality, particularly when it comes to sharing information with parents.

This breach of trust is vividly illustrated in one creator’s experience: “when camhs told me it was all confidential and then a week later I came home to my parents reading a detailed report of my sessions” (Video 107).

This quote demonstrates the sense of betrayal and violation of privacy that young people can experience when confidentiality is not maintained.

Another creator highlighted the potential consequences of such breaches: “and just like that ive been kicked out because of an email from camhs” (Video 97).

This quote underscores the serious real-world impacts that can result from unexpected disclosures to parents.

4b. CAMHS workers are perceived as inauthentic:

Many videos depicted CAMHS professionals as insincere, particularly in their interactions with parents versus their interactions with young people alone.

One roleplay titled “Camhs worker who changes around parents” illustrates this dramatically. When alone with the young person, the ‘clinician’ says: “I don’t think you’re trying hard enough…I’m not overly impressed with you”. However, when the parent enters, the tone changes completely: “I know she’s trying her absolute hardest…I am impressed with how hard you are trying, I really am” (Video 78).

This stark contrast portrays CAMHS workers as potentially duplicitous, prioritizing parental approval over genuine support for the young person.

Insight and Depth

This study provides valuable insights into young people’s perceptions of CAMHS as represented on TikTok.

It highlights a significant disconnect between service users’ expectations and experiences, and the care provided by CAMHS.

The research reveals how social media platforms like TikTok can serve as a space for young people to share their experiences, potentially influencing others’ help-seeking behavior.

The study also demonstrates the complex power dynamics at play in mental health services for young people, where they often feel disempowered and invalidated.

This research is particularly informative as it captures young people’s voices in their own words and mode of expression, providing a unique perspective that may not be captured through traditional research methods or service evaluations.

The findings of this study underscore the importance of listening to young people’s voices and involving them in service development and evaluation.

As mental health services continue to evolve, it is essential to consider the perspectives shared on platforms like TikTok to ensure that services are truly meeting the needs of the young people they aim to support.

Strengths

1. Participatory approach involving young co-researchers in data analysis
2. Use of a popular social media platform (TikTok) to access young people’s authentic expressions
3. Rigorous qualitative analysis using framework thematic analysis
4. Consideration of ethical issues in social media research
5. Inclusion of both positive and negative experiences of CAMHS
6. Rich, illustrative quotes to support themes

Limitations

1. Sample may not be representative of all CAMHS users (predominantly White, female adolescents)
2. Potential bias towards negative experiences, as dissatisfied users may be more likely to post videos
3. Unable to verify the authenticity of experiences shared in videos
4. Limited to English-language content
5. Analysis based on a snapshot in time (mostly 2021), which may not reflect current experiences
6. Unable to explore the impact of these videos on viewers’ help-seeking behavior

Clinical Implications

The findings have significant implications for CAMHS and mental health professionals working with young people:

1. Need for more person-centered, collaborative approaches in CAMHS
2. Importance of clear communication about confidentiality, diagnoses, and treatment rationales
3. Recognition of young people’s lived experiences and expertise
4. Addressing systemic issues such as long waiting times and resource allocation
5. Potential for using social media platforms to engage with young people and gather feedback
6. Need for mental health literacy education to help young people navigate online information about mental health services

The results suggest that CAMHS and other mental health services for young people should critically examine their practices and how they are perceived by service users.

There is a clear need for more collaborative, transparent, and empowering approaches to mental health care for young people.

Further research is needed to explore the impact of social media representations of mental health services on help-seeking behavior and to investigate the experiences of underrepresented groups.

Additionally, studies examining how CAMHS and other mental health services can effectively address the concerns raised in these videos would be valuable.

References

Primary reference

Foster, M., Frith, H., & John, M. (2024). ‘I’m still su!c!dal when you’re done with the paperwork’: An inductive framework thematic analysis of #camhs on TikTok. Journal of Child Psychology and Psychiatry, 65(10), 1258–1269. https://doi.org/10.1111/jcpp.14002

Other references

Gale, N.K., Heath, G., Cameron, E., Rashid, S., & Redwood, S. (2013). Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Medical Research Methodology, 13, 117.

Ofcom. (2023). Children and parents: Media use and attitudes report 2023. Retrieved from https://www.ofcom.org.uk/__data/assets/pdf_file/0027/255852/childrens-media-use-and-attitudes-report-2023.pdf

Radez, J., Reardon, T., Creswell, C., Lawrence, P.J., Evdoka-Burton, G., & Waite, P. (2021). Why do children and adolescents (not) seek and access professional help for their mental health problems? A systematic review of quantitative and qualitative studies. European Child & Adolescent Psychiatry, 30, 183-211.

Ritchie, J., & Spencer, L. (1994). Qualitative data analysis for applied policy research. In A. Bryman & R.G. Burgess (Eds.), Analyzing Qualitative Data (pp. 173-194). London: Routledge.

Yeo, T.E.D. (2021). “Do you know how much I suffer?”: How young people negotiate the tellability of their mental health disruption in anonymous distress narratives on social media. Health Communication, 36, 1606-1615.

Keep Learning

Suggested Socratic questions for a college class discussion:

1. How might the representation of CAMHS on TikTok influence young people’s help-seeking behavior? What are the potential positive and negative consequences?
2. In what ways could mental health professionals address the concerns raised in these TikTok videos? How can services balance risk management with person-centered care?
3. How does the power dynamic between young people and mental health professionals, as portrayed in these videos, reflect broader societal attitudes towards youth and mental health?
4. What ethical considerations arise from using social media content for research purposes? How can researchers balance the need for insight with privacy concerns?
5. How might the experiences shared on TikTok differ from those captured through traditional service evaluations? What are the strengths and limitations of each approach?
6. Given the limitations of the study, particularly the lack of diversity in the sample, how might the experiences of underrepresented groups differ? How could future research address this gap?
7. How can mental health services effectively incorporate young people’s voices in service development and evaluation? What are the potential challenges and benefits of this approach?
8. How might the COVID-19 pandemic have influenced the experiences shared in these TikTok videos, given that most were posted in 2021?