The thesis, In the strictest confidence, examines how mental health is conveyed in the Internet-based mental health services in Norway and Sweden. Challenges regarding community mental health from a public health perspective are brought to light. Web-based health services do not only work as extensions of already existing services, but also as independent channels of communication regarding issues of mental health. They are used as ‘virtual dressing-rooms’ where the users get to explain their thoughts, concerning themselves and their relations with other people, to the counselors online.
– Virtual rooms are created where people can access information, learn and try out different ways of understanding themselves as well as other people. The services give the users feedback on their thoughts and suggestions on how to handle difficult situations, says Anders Johan Wickstrøm Andersen, who works as a senior lecturer at the University of Agder in Norway.

Health- and social services within the field of mental health online can also work as society’s ’ear’, and Andersen emphasizes the responsibility of the services; to bring the experiences of the users to society’s attention by making anonymous comments and posts public.
– In this way the services can contribute to strengthen the marginalized groups in the Nordic welfare states, Andersen claims.

The study shows great variety when it comes to the profiles of the various Internet-based mental health services, as well as the user expectations and the content of the comments and posts. Andersen says that there are unexploited possibilities in the use of the Internet, especially when it comes to mental health issues. People save both time and money, and appreciate the anonymity offered online.
– This form of faceless communication is considered valuable, since the services become more accessible that way, Andersen says.

The thesis reveals that issues concerning mental health first and foremost deal with relations between people. The mental health state of people seems to be dependent on recognition from others.
– The content of the messages posted online emphasizes human vulnerability and our dependence on each other, Andersen claims.

Andersen is concerned by the fact that the replies published by the web-based services were dominated by individual interpretations, which contribute to place the responsibility of a socially created mental ill-health on the individual. Questions about mental health are strongly connected with social and cultural conditions.
– By stressing the responsibility of the individual, the socially created ill-health and the political responsibility are concealed, says Andersen.

Title: In the strictest confidence. An examination of messages posted on Internet-based mental health services in Norway and Sweden
Author: Anders Johan W. Andersen
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