In one clip viewed 2.3 million times, captioned "running away from my 1:1", Mia films herself giving a thumbs up to the camera before bolting out of the door the moment the song drops, leaving her startled supervisor to chase after her.
Since time immemorial, mental illness has been characterised as something to fear and mental health institutions have formed a backdrop for horror films. These TikTok glimpses are hardly representative of the UK's mental health services, of course, which are at breaking point due to severe underfunding and a shortage of beds – a situation exacerbated by coronavirus. Yet unlike the hackneyed portrayals of psychiatric wards in both pop culture and the media, which reinforce widespread and outdated stigma, 'Psych Ward' TikTok is humanising inpatients.
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"I didn’t get in any trouble," Mia tells me, "because I only do pranks with staff who will get the joke and I ask for their permission before uploading the video." Her videos, which see nurses performing TikTok dances and laughing down the camera lens while Mia waxes their legs, show a lighter side to life on a mental health ward.
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Social isolation is one of the most harmful things for people with debilitating mental illnesses. It's associated with very, very poor outcomes in terms of recovery.
Dr John Naslund
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Mia isn’t the only TikToker filming her time inside a ward for the app. The hashtag #psychward has amassed over 267 million views on TikTok, with some users racking up thousands of likes just for documenting a typical day, transforming the seemingly mundane into viral fodder.
In a video titled "Things In My Psychiatric Ward Bedroom That Just Make Sense", TikTok user @ezandcat walks viewers through the extensive features in her room to prevent her from harming herself, prompting users to flood the clip’s comments with the app’s ubiquitous 'eye mouth eye' emoji, which has become shorthand for "it is what it is".
Much of the intrigue surrounding these mental health ward videos stems from the question of how inpatients are accessing TikTok in the first place. Rules around phones and internet access vary from ward to ward, and those which do allow phones sometimes ban photography and video footage. Mia says that out of the nine NHS wards she's been admitted to over the past 18 months, five have allowed phones.
Less common is the presence of contraband phones, which is how Siobhan, an 18-year-old former inpatient from Toronto, managed to make her viral video – a parody of the different types of people in wards. "My mum snuck my phone in," she explains, "so I could stay up to date and feel less alone." Eventually, she had to return her device to her mum. "Technology runs so rampant in our society, so I just didn’t understand why my phone had to be taken away."
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Siobhan’s frustration is understandable. Studies show that boredom is endemic on mental health wards, as is loneliness, and both issues have become all the more acute with COVID-19 placing restrictions on visitors. "Social isolation is one of the most harmful things for people with debilitating mental illnesses," says Dr John Naslund, a global health and social medicine expert at Harvard Medical School. "It’s associated with very, very poor outcomes in terms of recovery."
It should come as little surprise, then, that inpatients are increasingly turning to TikTok not only as a source of entertainment but as a way of staying connected to the outside world.
According to Mia, finding others on TikTok with similar experiences of mental illness is helping her recovery. Her dancing videos and memes cover heavy topics – from "rating places I've had a mental breakdown" to "when a plastic knife goes missing at the psych ward" – with a macabre sense of humour.
"The main purpose of my videos is to make people feel less alone with what they’re going through," Mia explains, "and to bring some light and laughter to the situation."
Dr Naslund says that for inpatients like Mia, supportive online communities can be "life-saving". "There is research showing that even just disclosing your mental illness, but then also sharing and connecting with others, can really help people cope," he says.
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The main purpose of my videos is to make people feel less alone with what they're going through and to bring some light and laughter to the situation.
mia, 18
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Gemma, a 20-year-old currently on a ward in Australia, also promotes open dialogue around mental health issues on her TikTok, with a sardonic spin – like an IRL doomer girl meme. "At first, I was making TikToks purely out of boredom," she tells me. "Only recently it blew up and I realised I could use it for something good and, hopefully, encourage people to get help."
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In one video, Gemma mocks TikTok's pervasive "how to lose weight really fast" formats, replacing the usual pictures of salads and smoothies with messages of self-love – a respite from the deluge of pernicious pro-ana (pro-anorexia) content on the app.
Like Mia, Gemma’s videos touch on sensitive topics. She worries about the impact this could have on TikTok’s predominantly younger audience: Gen Z are, after all, more likely to experience depression, self-harm and poor body image compared to the generation that came before them.
"I don’t want to trigger them or give them any ideas," she says. But it's nearly impossible to avoid triggering content on TikTok and because of the nature of the app's For You page, users can easily become trapped, scrolling through suggested content curated to their specific triggers.
Amid this fraught online environment, Gemma has become someone people regularly turn to for advice on the platform. "I’m not always in the space to be able to help them," she says. "It can be draining sometimes." Gemma admits that while her TikTok self may appear "super happy", this is hardly always the reality. "Often, I’m struggling."
Rachel Ambrose, an NHS nurse working on an acute child and adolescent ward, worries about the pressure this places on young inpatients. "If people are messaging you for advice, when actually it's you that needs help, it makes the days when you feel like mental illness has sucked you back in really difficult," she explains.
While Gemma says she is "astonished" by the number of supportive messages she’s received, 'Psych Ward' TikTokers also make themselves particularly vulnerable to scrutiny. Siobhan claims her video elicited mixed reactions: some TikTok users reached out to her for guidance, while others accused her of "making fun" of psychiatric wards. "I was trying to make humour out of a situation that was really hard for me," Siobhan explains. "That’s the way I cope with everything that’s going on."
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These negative comments rarely take into account the mental state of the person posting the video. "There have been things that I have uploaded during something I deal with called dissociation or depersonalisation," says Gemma, "and I’ve realised later how toxic that video may have been, and deleted it."
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We need mental health services to work with young people who might be on TikTok to understand what's important to them, what the benefits are, what the risks are, and then co-produce really good guidelines around social media use.
Victoria Betton
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It’s a situation Ambrose is all too familiar with as well. "A lot of the time, patients regret what they’ve shared online when they’re in the headspace to see how unhelpful it has been," she says. It also means that inpatients, particularly those who’ve gone viral on the app, no longer get to choose whether or how to tell friends where they've been after they leave hospital. "Often, they don’t necessarily want to say, or aren’t ready to explain," says Ambrose.
Using social media as an inpatient can, as Ambrose puts it, "reinforce a cycle that patients have spent weeks, sometimes months, trying to come out of," particularly when it comes to the prevalence of eating disorder content on TikTok. Gemma agrees that while "it’s good to escape social media", there is also a balance. "People are already really isolated with the pandemic happening, and this is how we connect."
"If you take away someone’s phone, you could be taking away a lifeline for them," says Victoria Betton, author of Teen Mental Health in an Online World. Part of the solution, she says, comes down to policies which educate inpatients and help them to have a better relationship with social media, instead of banning their access to it altogether.
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Betton gives the example of legally binding documents which mean that when a patient is well, they can say how they want to be treated should their mental health deteriorate, which could include having their phone confiscated.
"We need mental health services to work with young people who might be on TikTok to understand what's important to them, what the benefits are, what the risks are, and then co-produce really good guidelines around social media use," says Betton.
On a platform like TikTok, where toxicity is rife, the importance of candid discussions around mental health is clear. But how much of the burden inpatients themselves should carry when it comes to educating others and breaking down stigma is another question. Systemic changes need to take place so that 'Psych Ward' TikTok is no longer something to gawp at but a space to empower individuals in their illness, and maybe bring some lightness to those who are struggling.
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