title: The future of mental health care: peer-to-peer support and social media.
abstract: OBJECTIVE
  People with serious mental illness are increasingly turning to popular social media, including Facebook, Twitter or YouTube, to share their illness experiences or seek advice from others with similar health conditions. This emerging form of unsolicited communication among self-forming online communities of patients and individuals with diverse health concerns is referred to as peer-to-peer support. We offer a perspective on how online peer-to-peer connections among people with serious mental illness could advance efforts to promote mental and physical wellbeing in this group.
  
  
  METHODS
  In this commentary, we take the perspective that when an individual with serious mental illness decides to connect with similar others online it represents a critical point in their illness experience. We propose a conceptual model to illustrate how online peer-to-peer connections may afford opportunities for individuals with serious mental illness to challenge stigma, increase consumer activation and access online interventions for mental and physical wellbeing.
  
  
  RESULTS
  People with serious mental illness report benefits from interacting with peers online from greater social connectedness, feelings of group belonging and by sharing personal stories and strategies for coping with day-to-day challenges of living with a mental illness. Within online communities, individuals with serious mental illness could challenge stigma through personal empowerment and providing hope. By learning from peers online, these individuals may gain insight about important health care decisions, which could promote mental health care seeking behaviours. These individuals could also access interventions for mental and physical wellbeing delivered through social media that could incorporate mutual support between peers, help promote treatment engagement and reach a wider demographic. Unforeseen risks may include exposure to misleading information, facing hostile or derogatory comments from others, or feeling more uncertain about one's health condition. However, given the evidence to date, the benefits of online peer-to-peer support appear to outweigh the potential risks.
  
  
  CONCLUSIONS
  Future research must explore these opportunities to support and empower people with serious mental illness through online peer networks while carefully considering potential risks that may arise from online peer-to-peer interactions. Efforts will also need to address methodological challenges in the form of evaluating interventions delivered through social media and collecting objective mental and physical health outcome measures online. A key challenge will be to determine whether skills learned from peers in online networks translate into tangible and meaningful improvements in recovery, employment, or mental and physical wellbeing in the offline world.
authors.affiliation: Health Promotion Research Center at Dartmouth,Lebanon,New Hampshire,USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Naslund
authors.affiliation: Health Promotion Research Center at Dartmouth,Lebanon,New Hampshire,USA.
authors.forename: K A
authors.initials: KA
authors.lastname: Aschbrenner
authors.affiliation: Department of Psychiatry,Geisel School of Medicine at Dartmouth,Lebanon,New Hampshire,USA.
authors.forename: L A
authors.initials: LA
authors.lastname: Marsch
authors.affiliation: Health Promotion Research Center at Dartmouth,Lebanon,New Hampshire,USA.
authors.forename: S J
authors.initials: SJ
authors.lastname: Bartels
mesh_terms: D006801:Humans; D007398:Interpersonal Relations; D001523:Mental Disorders; D008603:Mental Health; D010379:Peer Group; D000067074:Peer Influence; D061108:Social Media; D012944:Social Support
keywords: Internet; mental health; mental illness stigma; peer support; social network