Smartphone and social media harms: why we failed in our duty of care

The Netflix series Adolescence is hard to escape. One of the judges at our South Asia Awards in Delhi last weekend told me that his family were gripped by the drama about a teenage schoolboy in England who, influenced by the “manosphere,” murders a female student.1 While the universally acclaimed series might have further explored the harms posed by the manosphere (doi:10.1136/bmj.p2947),2 it makes us confront some difficult issues, themes that resonate powerfully around the globe. One of these is smartphone use by children and the access it gives them to social media. Where should we stand on this?

Many of us began by viewing social media and smartphones as a force for good. The benefits, we imagined, outweighed the harms. And perhaps that’s still true given the unprecedented access to information, current affairs, and entertainment. Social media can make you feel part of a community or help you find support in a moment of need. For some people, as Victoria Goodyear and colleagues argue (doi:10.1136/bmj-2024-082569),3 a smartphone is a lifeline. Yet we can’t escape the fact that access to smartphones may well be causing harm (doi:10.1136/bmj-2024-079828).4 That’s the central issue. It remains a reasonable hypothesis that smartphones and social media are driving upsurges in male toxicity and in negative body image in girls, making mental illness in children and adolescents more common.

There are other reasons, of course. One is the impact of austerity measures and how they drive mental illness, especially in young people. As a strategy to get people back to work, the stick of denying welfare benefits achieves the exact opposite of government’s ambition for a healthy workforce to boost economic growth. Gerry McCartney and colleagues spell out in the clearest possible way that poor UK outcome statistics are the result of austerity measures begun in 2012 (doi:10.1136/bmj.r593).5 The UK has since seen the OECD’s largest rise in child poverty, with subsequent impacts on mental health leading to difficulties in young people finding meaningful work. Ironically, this sequence of events increases social security spending in the long term.

A government that seeks a return to austerity, by deed if not by name, will cause premature deaths and plunge many more people into poverty. A better way is to improve population health and create more “high quality” jobs. Nobody claims that any of this is easy to plan, finance, or deliver—but the tough should get going at times like these. As professionals and citizens our duty is to speak up when welfare reforms will harm health. Our duty extends to supporting colleagues whose lives are being ruined by maladministration of professional exams (doi:10.1136/bmj.r635)6 or by broken schemes for career progression (doi:10.1136/bmj.r587).7 Often, as in the case of the MRCP exam, women are affected most (doi:10.1136/bmj.r534).8 How do we find capacity to consider the implications of new research (doi:10.1136/bmj-2024-082104 doi:10.1136/bmj.r539 doi:10.1136/bmj-2024-082945 doi:10.1136/bmj.r507 doi:10.1136/bmj-2024-080507)910111213—or where we should stand on planned NHS reforms (doi:10.1136/bmj.r641 doi:10.1136/bmj.r630 doi:10.1136/bmj.r610)?141516 The human brain has only so much capacity, and individuals can’t tackle these challenges alone.

And, perhaps, that’s the pertinent lesson regarding social media and smartphones. Individuals might cut their smartphone use, schools might restrict them, but the problem of adolescent mental illness will continue to grow unless we face up to the complex societal factors that drive it and the equally complex, multipronged governmental and regulatory solutions that must be considered. These matters extend beyond smartphones and beyond adolescence. Why has it taken a Netflix show to focus minds and ignite interest in the serious consequences of social media’s nurturing of male toxicity and how this is enabled by smartphones? We owed a duty of care. We failed to honour it.