From SMS/texting

One step on from when you called me

Tree of Hands

In this month’s Lancet Psychiatry I’ve written a comment piece Agony, misery, woe: a new role for media advice columns about the history and purpose of media advice giving, the changing role of the agony aunt/uncle, and the agony aunt as witness to the crisis around austerity and poverty and the harms these bring.

Expanding on the comment piece I am joined by Lancet Psychiatry Editor Niall Boyce and journalist Anna Raeburn in a podcast where we talk about how advice giving has changed (or not), what it can deliver, and why practitioners may be missing this important media resource and the tools and experiences it may hold.

Anna starts the podcast talking about how advice columns have developed, with a particular focus on radio and the power of the voice in reaching out to others. In addition Anna touches on the problems posed to modern media due to financial cuts and a lack of investment in community programming/features and particularly local radio and press. Explaining that the need for advice and information is higher than before but the opportunity for advice givers to work effectively is “significantly less”.

From this Anna moves to talk about advice giving as storytelling, sharing experiences, and how it’s okay to say you aren’t sure about a person’s situation. While discussing the strengths and weakness of advice giving on television, newspapers, magazines and new media.

When asked what role agony aunts fulfill, Anna replies:
“I would describe myself as a bridge….I have a very modest idea of what I can do. I want you to walk over me to the next stage of your life….I want, very modestly, to move you one step on from when you called me”

This is helpful in the context of advice giving as it sets out very simply what advice giving can achieve. And highlights where it may be a bridge between individuals and services but also part of a wider chain of help seeking behaviours people engage in. We don’t assume agony aunts have all the answers, or advice columns can solve all our problems, but if we consider it as a small step forward it reminds us that advice columns should never be excluded or forgotten about in wider conversations on physical or psychological health, help seeking or behaviour change.

In the second part of the podcast Niall asks me about evidence and whether we can we be evidence based around advice giving? This echoes other questions I’m increasingly asked about how agony aunts know they are doing a good job – something I’ll be returning to in future blog posts.

I reflect in the podcast on what agony aunts and audiences think evidence means when it comes to media advice giving. Plus what we already know about media advice giving, what we don’t know, and where we can draw parallels of evaluated work on self-help and public health campaigns. I have a bit of a grumble about how academic and journalistic snobbery can lead to advice giving being overlooked or denigrated – and why this is improvident.

For me the crux of the podcast focuses on the issue of how cuts to benefits, austerity measures, poverty and funding problems within the NHS are leading to staff and patients/service users feeling increasingly pressured, distressed and excluded. This may be an area where agony aunts and mental health services might work together, particularly in poor communities who are far less likely to be able to access and use mental health services. Another agony aunt Denise Robertson had previously suggested to me one role of the agony aunt in modern times was to bear witness to the damage caused by poverty, inequalities, and the blaming and shaming of those in need. The podcast explores more on why this has happened and whether there is a role for advice columnists and NHS staff and patients to work together to highlight theses issues and consider possible solutions.

This brings us to what form advice might take and how the traditional focus of the advice column has often been to refer people to a charity or a GP (Family Practitioner/Doctor), or helpline. But how in these cash-strapped times people are arriving at their conversation with advice columnists by telling them what services they have already tried – and failed – to access. The podcast reflects on why this is and what we might do about it in ways that do not further denigrate either those in need or health/social care staff who are also under huge pressure and struggling to do their job.

Rather than just seeing advice giving as asking for help, reaching out or being supported by others the podcast considers advice giving as advocating models of activism and resistance using the example of Focus E15 Mothers campaigning for housing and rights.

By contrast examples from the global south where advice giving through radio, TV, text and newspapers has had particular success are shared as examples of good practice. Particularly around the ideas of citizen journalism and self-care. I talk about trailblazers such as Hesperian and BBC Media Action within this context (although other examples of good practice can be found within this site).

The podcast ends with a reflection that if services across media, health and social care and the third sector are massively stretched. And where there is no immediate change to the current climate then we need to think about ways to help ourselves

“No-one is going to help us at the moment. That’s quite obvious. So how do we help ourselves and what do we do together to make things a bit easier for those in need where there may not be immediate help available?”

The resources below are ones I use myself within these limitations, and may help those who want to know more about working effectively where barriers exist.

Although broadcast after this podcast the actor Michael Sheen also picks up on some of the problems around the NHS and ways for us to defend and stand up for it.

Further Reading
Psychological First Aid
In or Out?
Community Psychology
Augusto Boal
Paulo Friere
Kerry Frizelle 2011 What is critical community psychology?
Carolyn Kagan et al 2011 Critical community psychology. Critical action and social change


Ways to offer advice

There are numerous different ways people can seek help via the media. Recently I was reading Scarleteen (the sex and relationships advice website) and the different ways they offer direct support for those in need.

Their direct services include:
– Message boards.
– SMS/texting service.
– Live chat service.
– Advice column.

What interests me is how Scarleteen set out for their site users what each of these services involve, how and why they might suit different people at different times, and how quickly replies can be delivered via each service.

If you are considering offering an advice column or perhaps already have an advice service in one form of media you may want to think about whether you could provide advice on one or more of additional formats. Some of these also compliment existing services – for example a SMS/texting service that informs the content of a live radio show on people’s problems. Or a live chat service that can be used after a TV programme on a particular issue has been aired where people can get more information about their specific situation. Or the opportunity to view a website or be sent a help sheet after reading an advice column in a magazine or newspaper.

Offering different services is also dependent on the needs of your audience. So offering an SMS service may be highly effective in some African countries where SMS/texting is popular and access to mobile phones is high. But if your audience is made up of older people who’re not familiar with texting then this wouldn’t be a good use of resources.

The advantages of offering multiple ways to access information and advice means you’ve a better chance of reaching people at different times and in ways that suit them better. If you’re using advice giving to promote a particular issue – for example hand washing, or awareness of a particular infection or vaccination programme – then sharing the same message through a variety of platforms makes it more likely to be heard. Add to this a means for people to be actively involved in a dialogue around issues it’s even more likely your messages might lead to the changes you’re hoping for (e.g. fewer infections or deaths due to poor hygiene).

However this is costly and time consuming to get right. And important to note that providing different ways to deliver messages or enable people to ask for advice is not the same thing as people feeling involved with a service or actually using it or acting on the information shared. So all of this needs careful research and piloting before implementation and a thorough evaluation to see if the services suit your audience and are useful to them.

Whatever you decide you may want to follow Scarleteen’s example of making it clear to your audience not only what services you offer but how they differ from and compliment each other and what you can expect if you use them.