Community Support

A Tale of Two Networks: Possibilities and Perils for Mental Health Internet Discussion Groups

Discussion

Analysis of List Dynamics

The different fates of OUTCMTEN and LEGALTEN can be explained in terms of a chain of events beginning with the topical goals of the two networks. The topics discussed on OUTCMTEN dealt with research and evaluation methods. The topics discussed on LEGALTEN dealt with aspects of mental health systems and treatments that can be construed as mechanisms of social control (Lemert, 1967). As a result of their different topics, the two networks appear to have attracted different members. OUTCMTEN seems to have attracted primarily scientists and research oriented clinical professionals. LEGALTEN seems to have attracted providers of mental health treatments (e.g., psychiatrists who had administered psychotherapy, drugs, and electro-shock treatment), persons who had directly experienced some of the treatments discussed (e.g., persons who had received electro-shock therapy) and persons working in the legal system (e.g., parole officers). It gave them a novel forum for making their voices heard.

Members of OUTCMTEN generally had been socialized by their scientific and professional training to engage in a more restrained style of discourse. As a result of very different personal histories and interests, some subscribers to LEGALTEN had very different value systems and styles of communicating.

As a result of these factors, discussions on OUTCMTEN were very technical and participants shared similar views and norms for communicating them. On LEGALTEN, topics of discussion were a great deal more controversial and personal. Members of the mental health consumer community took advantage of the unique opportunity that the electronic environment presented them - a level playing field - and actively questioned the values of the mental health and judicial systems. The discussions that resulted were very intense and differences of opinion were often exacerbated by differing communication styles.

Differences in opinion on very personal issues were exacerbated by stylistic differences in communicating those opinions. To express themselves, some subscribers used language that other subscribers considered distracting, too passionate, or inappropriate. Several participants found the discussions on values extremely insightful, while others found the discussions repetitive, exhausting, counter-productive, and insulting. Attempts to use negotiation skills to reduce conflict and achieve consensus were often deluged by intense discussions led by a few individuals that often became personal attacks.

In discussions of difficult topics involving persons with widely divergent views, it is not uncommon for one party to misunderstand a statement of disagreement from another party as a challenge or personal attack. The offended party will respond in kind and soon the negotiation escalates into conflict. The use of polarized language, verbal immediacy and language intensity seem to have the same potential effects in electronic discussions. Given this environment in LEGALTEN (which again, for many of the participants, was not the original intent), this list was a stressful environment for many of the participants on all sides of the argument.

Given the unique and valuable opportunity for many to discuss mental health care issues with all relevant parties, including consumers/survivors/ex-patients, what does it take to develop a learning environment in electronic lists? As the experiences from OUTCMTEN and LEGALTEN illustrate, the level playing field that both lists provided participants was only one important element in developing a forum for constructive dialogue. Two other elements of equal importance were:

The existence of a common set of communication norms so that differences could be understood by all parties.
The need for the discussion environment to be safe for all participants.

These elements raise a number of important questions, such as: Whose responsibility is it to ensure that a level playing field, a safe environment, and a common language for communication exist? Should these be developed by the participants themselves or by the list owner? These are important issues for future research.

Role of the List Moderators

One powerful mechanism that has evolved to deal with these elements is that of a moderator. Such a mechanism is supported by Lewicki et al. (1994). As they note, negotiation over critical issues may reach an impasse, where the parties are unable to move the process beyond a particular sticking point. At these points, third party intervention may be productive At a minimum, third parties can provide and even enforce the stability, civility, and forward momentum necessary to re-address the problems at hand.

On LEGALTEN, attempts by the Chair to defuse conflict and create consensus were unsuccessful because individuals continued to issue personal attacks and the Chair was unable to enforce a safer environment. This need not be the case, however. Moderators with the power to take participants off the list have been able to maintain constructive learning environments where individuals are able to express themselves as they wish, as long as they do not personally attack anyone else. It is the role of the moderator to make everyone feel comfortable enough to share their thoughts.

The challenge to the moderators becomes finding the right balance between control and freedom to achieve the goals of the list. The ultimate amount of central authority depends on the purpose of the electronic group, often determined by its founder or founders, the nature of the participants, and the number of persons who refuse to abide by the guidelines of participation (on the Internet, such persons are sometimes referred to as "gate crashers" [Shea, 1994]).

It is very important to establish the purposes and rules of participation on a list from the beginning. Most lists accomplish this in their Frequently Asked Questions (FAQ) section, a message sent to all new members explaining the topic and the guidelines for participation on the list). Anyone can participate in the list as long as they follow the guidelines stated in the FAQ. It becomes the social contract between the list manager and the participants.

Once a list is able to start going on its own, moderators must be on the look out for ad hominum exchanges, known on the Internet as "flame wars." The difficulty is identifying when a flame war is about to erupt and extinguish it as quickly and productively as possible.

Some lists attract more gate crashers than others, depending on the subject of the list. Social issues, for example, often attract gate crashers. Some lists try to prevent gate crashing by requiring that participants go through an elaborate subscription process. But this is often not very effective because on the Internet it is impossible to know who is really behind an email address. It also compromises the notion that a list is open to anyone who shares that interest, and that one should not judge someone at the door but by what they write.

Another way to prevent gate crashers or flame wars is to switch the list to fully moderated. In such an instance, all messages posted to the electronic discussion group are first read by the moderator, who then posts them to the group. Depending on the frequency of messages, this can be extremely time consuming for a moderator, and it takes away much of the spontaneity of an electronic discussion. But, it is effective when used temporarily to control a certain problem.

Implications for Managing Mental Health Electronic Discussion Lists

For the policy makers, planners or evaluators interested in bringing together diverse stakeholders to discuss and learn from each other's experiences and to better understand each other, electronic discussion groups can be very powerful tools for achieving these goals. Yet if electronic discussion groups are not managed well, they could potentially worsen relations among participants.

As a result of its open structure, LEGALTEN was successful at bringing together a diverse set of views to a level playing field yet it was unable to maintain a safe and constructive environment for many of the subscribers. The experiences of LEGALTEN highlight that some rules of behavior needed to be established and enforced. With a basic set of rules, one can maintain an open environment where individuals can express themselves as they wish and group safety is enforced.

To leverage an electronic discussion group successfully, the policy and strategy planner is encouraged to consider following recommendations derived from this analysis of OUTCMTEN and LEGALTEN, and from the experiences of other list moderators. These recommendations assume that the goal of the list owner is to create a forum where learning can take place. To establish the trust needed for maximum learning, all participants must feel safe to express themselves openly. Recommendations for achieving this are summarized below.

Have a list moderator with the authority to unsubscribe any participant from the subscription list. The role of the moderator would be to encourage constructive dialogue.
The rules for decision making used by a moderator should be made available to all participants and enforced evenhandedly in order to establish trust and respect from the participants.
Each subscriber should be greeted to the list with:
- a description of the purpose of the list;
- an explanation of who owns and moderates the list;
- a description of the technical basics for participating;
- a description of what kind of behavior is inappropriate and what will happen if there is inappropriate behavior.
Personal attacks should be prohibited.
Persons who post personal attacks should be confronted privately, off-list, with a general message posted to the list reminding people that personal attacks are not permitted on the list. The general message should summarize the key points of the discussion and encourage dialogue to continue.
Where personal attacks continue, the offenders should be removed from the list. A general message to the list should explain why the person was removed and encourage comments on the action.
If a discussion veers towards conflict, negotiation techniques such as active listening (Lewicki, Litterer, Minton & Saunders, 1994) should be used to encourage subscribers to understand the other parties.
Messages that adhere to the stated topical goals of the list and do not take the form of personal attacks should be distributed to list members without censorship.

The future of electronic lists depends on the success of those actively participating to make sure the potential of this technology is not constrained by poor usage. For mental health policy makers, consumers, planners and evaluators, the opportunity to hear and learn from each other can be invaluable. Managed well, electronic discussion forums, where people located all over the world can discuss, debate and develop consensus and policies on a level playing field, promise to be one of the most powerful uses of the Internet.

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