This is a hugely positive day for public health, and the safety and wellbeing of children and adolescents.
I listened to the announcement from Keir Starmer this morning, that social media would be banned for <16s, and I felt a surge of optimism that I have not had for a long time, about the future mental health of young people in the UK.
Over the last decade I have watched with dismay the hundreds of children coming through my clinic in CAMHS, who have been directly and unequivocally damaged by their exposure to both the quantity and nature of the online content they have seen. This goes beyond the more obvious subject matter related to self-harm, suicidality, and eating disorders (although these have been the most visible to me). This also relates to online bullying and abuse, the rise of racism and misogyny in young men, and even on a more basic level, the countless hours lost, scrolling in a mind-numbing fashion over videos with no value, be it educational or ‘social’; children compulsively drawn to AI ‘slop’ and now, most recently, chatbots offering some sort of proxy for companionship, romance or even sexual interest. The online word has become (for many <18s, as well as adults) a place of hostility, and anonymised conflict, rather than interest and support.
I have seen so many shocking cases as a child psychiatrist, with clear links to social media. Boys groomed by county lines (drug running gangs) whilst sitting in school toilets at lunchtime. Girls agreeing to meet with male strangers, whom they have spoken to for the first time, from their bedrooms, on their smartphones. Teenagers sending nude images of themselves, to one another, without understanding why, simply because they feel it is expected of them – and possible at the touch of a button. A generation of young adults who believe that sex involves strangulation.
I have met countless children spending every waking hour online, with huge impacts on sleep, and secondary reductions in physical exercise – the same children who will shout and scream when their access to their phones is limited, by parents now scared to set boundaries for the fear of the sometimes violent responses they might be met with.
In the scientific study of addiction, “salience” means that a substance or behaviour becomes the most important and attention-grabbing thing in a person’s life. It starts to dominate their thoughts, emotions, and behaviour. Many a parent and child reading that will immediately make a connection to their own lived experience. Social media is little different from a street drug.
I am aware that the young people I meet are perhaps the “tip of the iceberg” – those most harmed by what they have encountered online. I meet the most vulnerable kids in society, often already damaged by neglect, trauma and abuse. At times I have had to check myself – are my views skewed because of the nature of my work? Then I remind myself that the majority of an iceberg is hidden from view. There are hundreds of thousands of kids who have been negatively impacted, without the realisation of their parents/carers, or even themselves. These are children who have experienced a decline in their happiness and an increase in their anxiety, of imperceptibly small increments, over several years. Whilst their “social” worlds online have expanded, their abilities to connect and communicate face-to-face have declined. We thought that the Pandemic was to blame. In some ways, COVID-19 was highly convenient for social media companies: it could be the problem they would site as the principal issue regarding the rise of distress in young people. But it was just one part of a bigger story – the loss of childhood innocence and safety.
Let’s not forget that many of the owners of the social media companies have said that they themselves do not allow their own children on the sites that they have made. Apps like SnapChat and Instagram have been developed based on gambling principles. The very design is optimised to bring young people back time and time again. No child realised when the “like” button or “streaks” were introduced to Facebook or Snapchat etc that these were functions dreamt up in boardrooms that were no different to the alluring lighting and noises of slot machines in Las Vegas. To use the word “toxic” to describe the effects of excess online expose is not hyperbole.
I highly recommend Johnathan Haidt’s book “The Anxious Generation”. This argues that it is not only the impact of the online world that has been problematic, but the loss of children’s access to outdoors (green) spaces, and the encouragement to explore and experiment in the real world. Ironically, parents increasingly concerned about their children’s safety may have inadvertently prevented them roaming free “come home when the street lights come on”, but instead kept them indoors, handing them devices that put them at far more unseen risk of encountering strangers, who might look to prey on them.
Haidt’s book became the talk of the playground amongst many of the parents of middle- class children. I wondered at the time if the message would spread widely enough. I saw parents taking measures, but only within small social groups. Progress has been made. The book’s impact surely included the countrywide measures to ban smartphones in schools. Similarly, the wonderful Netflix series “Adolescence” made waves and started conversations, drawing attention to the manosphere and the expanding dangers of Incel culture – a generation of young men believing that women aren’t to be trusted or respected. As usual, Louis Theroux brought his own brilliant journalistic style to this area, too.
As a child psychiatrist, I am interested particularly in the strong hypotheses that the apparent increase in inattention in both children and adults may relate to the nature in which content is thrust towards us online, in ‘infinitely’ scrolled small, fast chunks. Developing brains are now expecting to hovver and move on, often not completing the task in front of them. I see this in myself as I click to the next newspaper article quicker than I ever used to. Children now increasingly sit with subtitles on whilst they watch TV, as this is how they are learning to interact with verbal information. Recently I came across some of my medical students watching a video lecture I had made for them – they were choosing to view it at 1.5 normal speed “this is what we do with everything!” they told me, seemingly intolerant of receiving something at a measured and thoughtful pace. The irony was not lost on me that the recorded lecture was on self harm in young people….
There is evidence that the verbal abilities of young children are declining, too. I have no doubt this relates to pre-schoolers sitting staring at screens – and observing their parents and carers doing the same. We have been slowly losing the vital connections involved in reciprocal communication, and also emotional attachment.
The children harmed in recent years will be the young adults of coming decades, some unable to even work secondary to a lack of ability to negotiate through measured dialogue, having spent their formative observing others firing off abuse into the ether.
So where do public health measures, and politics come in? We take for granted that if our children are learning to cycle at primary school, they will be made to wear reflective vests and helmets. This is not because anyone anticipates all of the children falling off and sustaining head injuries. It’s about the possibility that even ONE child might do so, and there is no way of knowing which child that might be. So, there is a rationale for a blanket intervention which will protect even a small number of people. The greatest good, for the greatest number.
In England, the Smoking Ban came into force on 1 July 2007 under the Health Act 2006. It’s easy to forget now, but before then people could legally smoke inside pubs, bars, restaurants, workplaces, and even many offices. The ban was quite controversial at the time, but it is now widely accepted. The evidence built in the face of corporate resistance, until it was undeniably a necessary step.
I imagine we will look back on this ban in a similar way. Why on earth did we take so long, to act?
“The safety of our children must come first”, says Starmer – I absolutely agree and hope that these measures can be taken up swiftly, and effectively.
Connected Child Health 