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research-article2018
NMS0010.1177/1461444818784303new media & societyMcCosker

Article

new media & society

Engaging mental health

1­–17
© The Author(s) 2018
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DOI: 10.1177/1461444818784303
https://doi.org/10.1177/1461444818784303
beyondblue’s forum journals.sagepub.com/home/nms

influencers

Anthony McCosker
Swinburne University of Technology, Australia

Abstract
Digital platforms offer an important means for improving the reach, scale and accessibility
of community-based support for those dealing with mental health issues. They enable
new forms of health participation. A research gap remains in understanding the role of
peer mentors in building effective digital environments for mental health support. This
article presents part of a larger study centred on the digital interventions of prominent
mental health organisation beyondblue. It combines qualitative content analysis and
interviews with prominent peer mentors. The analysis presents insights into how some
peer mentors are able to act as mental health influencers and examines their impact and
role in activating supportive mental health publics. Effective mental health influencers
build demonstrable non-professional expertise and authority and, through affective
practices, play an active role in framing and re-framing mental health and recovery,
stimulating cohesion-generating cycles of impact feedback among forum participants.

Keywords
Affect, expertise, influencers, mental health, moderation, online forums, peer mentors

Introduction
In 2014, the Australian Report of the National Review of Mental Health Programmes and
Services emphasised the ongoing importance of online forums among other digital media
tools for offering peer support and addressing mental health issues ‘in the community’.

Corresponding author:
Anthony McCosker, Department of Media and Communication, Swinburne University of Technology, John
Street, Hawthorn, Melbourne, VIC 3122, Australia.
Email: amccosker@swin.edu.au
2 new media & society 00(0)

Recommendation 11 stressed the need to ‘Promote easy access to self-help options to

help people, their families and communities to support themselves and each other’
(National Mental Health Commission [NMHC], 2014: 87). Likewise, the National
Institute for Mental Health in the United Kingdom points to the way digital technology
‘has opened a new frontier in mental health support and data collection’ in its effort to
promote research exploring new technology-based interventions for mental health sup-
port (National Institute of Mental Health, 2017). Similar proclamations in the United
States follow decades of advocacy from patients and health organisations alike for the
need to address mental health issues through community-based and peer-run programmes
(Clay, 2005).
Over the last decade, social media platforms have reconfigured communication
beyond geographical boundaries, and hence seem to offer a potential solution to address-
ing public health issues at scale and through peer-led interventions. As Kivitz (2013)
notes, the Internet and social media have ‘made new experiences of health and illness
possible’ (p. 223). But with the diversification of the ‘e-mental health ecosystem’ span-
ning promotion, treatment, recovery and prevention (Burns et al., 2016: 589), mental
health organisations have to make choices about how to allocate limited funding to sup-
port services, raising questions about which digital tools to invest in and how effective
they might actually be. Digital platforms not only provide an avenue for health informa-
tion access and sharing, they actively alter the ‘public-professional relationship’ (Kivitz,
2013: 220–221) or the ‘expert-client relationship’ (Mowlabocus et al., 2015), and intro-
duce the potential for peer-led support practices (Tanis, 2008). In fact, across high- and
low-income countries, many health organisations see peer networks and health influenc-
ers as crucial for effective digital interventions (Campbell et al., 2007; Castañeda et al.,
2010). A research gap remains in understanding the role of peer mentors in building
effective digital contexts for mental health support, and particularly the work of the vari-
ously named community champions, intermediaries or health influencers, that drive and
modulate interaction and support often outside of health organisations’ communication,
outreach and health campaign efforts.
This article presents part of a larger study of online mental health support centred on
the digital interventions of prominent Australian mental health organisation beyondblue
(McCosker, 2017; McCosker and Hartup, 2018). In this article, I draw on qualitative
content analysis and interviews with prominent peer mentors to explore experiences and
activities within beyondblue’s online forums. The forums offer a site in which to examine
the broader potential of peer mentors as health influencers in the context of organised
online mental health support. How do peer mentors and moderators act as change agents
in this context? What forms of influence and impact do they achieve? What is the value
and productive capacity of their affective labour to bring into being and sustain support-
ive mental health communities? The analytical framework developed and applied draws
from a growing body of work addressing peer mentors and health influencers, along with
approaches to intermediation and moderation practices.
The analysis presents insights into how some peer mentors act as mental health influ-
encers in online, and the platform features that contribute to a supportive environment
for vulnerable publics. It details the generative qualities of the aversive affects (McCosker,
2013) associated with mental ill-health and the empathy practices that underpin the
McCosker 3

expertise of mental health influencers. In this context, effective health influencers build
demonstrable non-professional expertise and authority, play an active role in framing
and re-framing mental health and recovery practices, and stimulate cohesion-generating
cycles of impact and feedback among forum participants.

Online mental health support: intermediaries and health

influencers
There is strong evidence of the benefits of community-based health, social support and
peer networks in aiding the ongoing recovery aspects of mental ill-health in combination
with clinical or acute care (Campbell, 2005; Moorhead et al., 2013). When isolating the
range of health benefits associated with digital technologies, empowerment is often
emphasised, with some also focusing on how health empowerment plays out in practice
or in specific online contexts, and the emotional and affective labour that accompanies
health participation (McCosker and Darcy, 2013; Stage, 2017; Tucker and Goodings,
2017). Hardt and Negri (2004) defined the concept of affective labour as ‘the labour that
produces or manipulates affects such as a feeling of ease, well-being, satisfaction, excite-
ment, or passion’ (p. 108). This resonates with Hochschild’s (2003) accounts of the
blurred lines between caring or health service work and ‘feeling management’. These
factors should be taken into account when considering the benefits of digital platforms,
which have been understood to increase information access and sharing; strengthen self-
reflexive, self-directed health practice; and increase opportunities for finding supportive
relationships beyond geographical or immediate social networks (Moorhead et al., 2013).
Like all spheres of digitally mediated social life, health participation is uneven. Digital
technologies such as online forums, mobile apps and social media platforms do not auto-
matically solve the issues of social inclusion and exclusion that affect those living with
mental health problems (Boardman, 2010) and may in some cases exacerbate them (e.g.
Royal Society for Public Health, 2017). However, one point of focus is the role that peer
mentors can play in engaging the ‘hardly reached’ (Sokol and Fisher, 2016) in health out-
reach and support. Davidson et al. (2012) point out that while peer support is generally
attributed to the mental health service user movement in the 1970s, it can be traced back
at least to the writings of Jean-Baptiste Pussin in the late 18th century, along with prac-
tices of hiring recovered patients to staff psychiatric inpatient units in the United States in
the 1920s (p. 123). Significant benefits have been identified in peer support programmes,
where positive self-disclosure builds hope regarding control over debilitating conditions
and symptoms; role modelling introduces strategies for self-care and recovery through
embodied, experiential knowledge; and peer provider and recipient relationships develop
trust, exhibit empathy and conditional regard, and hence better address conditions through
professional services (Clay, 2005; Davidson et al., 2012).
There is growing interest in the ways health organisations might benefit from peer
mentors and health influencers. This includes the widespread use of ‘community health
workers’, especially in development health programmes in the global south (e.g. Choi
et al., 2016); ‘champions’ in programmes such as chronic disease risk reduction (Aoun
et al., 2013), or ‘community health champions’ and ‘lay public health workers’ supported
4 new media & society 00(0)

in the United Kingdom (Woodall et al., 2013); and ‘health influencers’ in tobacco control
(Campbell et al., 2007; Castañeda et al., 2010). ‘Patient navigators’ have played a similar
role in stewarding marginalised people through complicated health systems and institu-
tional practices (Natale-Pereira et al., 2011). ‘Brokers’, ‘boundary spanners’ or ‘bridges’
are understood, often in relation to network theory (Barabási, 2003), to facilitate transac-
tions and information flow or enrol marginalised people into health programmes and
services and are crucial for building collaborative networks in health care contexts,
where isolation, silos, marginalisation and other forms of social and health exclusion
occur (Long et al., 2013). In health outreach and promotion, the intermediary role of
digital platforms combines with the ‘digital expertise’ of outreach workers (Mowlabocus
et al., 2015). Social capital and expertise are crucial to these roles and encompass a level
of health knowledge and also the ability to navigate the perils of the publicness of online
support (Mowlabocus et al., 2015). In the case of online mental health support, connec-
tors, intermediaries or influencers designate those who act with a degree of vernacular
authority to bridge professional and non-professional divides, establish and sustain sup-
portive online communities and help to frame and re-frame others’ experiences of mental
ill-health.

Identifying expertise, qualifying influence

The analytical approach developed in this article targets the embodied expertise and
influence of peer mentorship. While the ‘public-professional’ dichotomy has been instru-
mental in health practices and power dynamics, there has been a ‘destabilisation of
expertise in the modern era’, particularly through the impact of digital platforms and peer
networks (Kivitz, 2013: 221). There is debate about the politics and power dynamics in
essentialising forms of lived experience (e.g. Voronka, 2016); however, lived experience
challenges notions of expertise, whether health, biomedical or cultural, inspiring attempts
to mobilise new forms of community-oriented and personalised public health interven-
tion through digitally mediated peer practices. Questions of risk associated with support
provided by non-medically trained intermediaries do persist (Hendry et al., 2017), as
expertise in this context involves a complex mix of trust, authority and authenticity
related to peer and social influence, rather than health training. Forum members, for
instance, apply a range of techniques to assess credibility and are particularly drawn to
experiential information (Lederman et al., 2014). Moreover, trust in ‘official’ sources of
health communication can be diminished and inverted by emergent social media norms,
where peers provide greater access and cut-through than other sources of ‘official’ health
information (Evers et al., 2013; Byron, 2015).
The distinction I am drawing here between peer mentors and health influencer is sub-
tle. Both might offer social support in relation to their embodied experience, potentially
in an ‘official’ role as a Champion, for instance. However, the elements of influence,
authority and developed expertise offer a key point of distinction and are the target of this
article. The peer mentors and health influencers I refer to in this research do not have a
direct role in content moderation, which is the domain of content filters and beyond-
blue’s community manager, but rather in interaction modulation, shaping conversations
and framing practices in the forums.
McCosker 5

The concept of health influencer adopted here not only builds on the research sur-
rounding peer mentors in public health communication and outreach but also shares
some characteristics of the fame and commercially oriented ‘ordinary celebrities’
(Turner, 2010) of contemporary media cultures, or ‘microcelebrities’ of Instagram,
YouTube or Twitter (Abidin, 2016; Mavroudis and Milne, 2016; Senft, 2013). In these
studies, ‘influencer’ describes social media actors who have developed a niche but prom-
inent level of notice and a large follower or friend base while sharing their everyday lives
across a range of platforms (Abidin, 2016). For Senft (2008, 2013), this involves the use
of mediated self-presentation to project a coherent branded identity maintained as if an
artist or entrepreneur (see also Marwick, 2013). Influencer practices address the potential
of social media for generating peer-led forms of social participation in contexts that shift
some emphasis towards participatory acts capable of mobilising populations outside of
traditional communication channels. Health influencers have been shown to effectively
mobilise informal communication networks even where they lack core health knowledge
(Castañeda et al., 2010). Expertise is of a different kind to the knowledge-based training
of health and medical professionals. Health influencers intermediate legitimate positive
health frames and are able to build effective communities of practice through skilled
interpersonal action, and this is enhanced when training is available (Castañeda et al.,
2010).
The framework I apply emphasises the establishment of embodied expertise and tar-
gets the strategies and devices that generate observable types of influence. Other impor-
tant analytical approaches could be taken here to account for the activities and experiences
of the forums focusing, for example, on cultural legitimacy and capital in Bourdieu’s
sense, the competing knowledge systems and discourse production processes, or a more
targeted focus on affective, emotional and immaterial labour (e.g. McCosker and Darcy,
2013; Tucker and Goodings, 2017). I examine expertise and influencer practices here as
a pragmatic approach to understanding and applying the insights of those who drive and
sustain engagement in the forums. Cultural intermediary theory and research offers some
specific and useful reference points (Hutchinson, 2017; Smith Maguire and Matthews,
2012); however, this research tradition is primarily concerned with the contextual and
mediating factors in markets and the link between production and consumption (McFall,
2014). I draw from this approach Smith Maguire and Matthews’s (2012) key elements of
cultural intermediary to examine (a) expertise, (b) framing and (c) influence. Like other
social media contexts in which community, sociality or publics are dynamically formed
and mediated by socio-technical and affective factors (McCosker, 2015), there is an une-
venness to participation characterised by the prominence and influence of certain actors,
and the intimacy, affect, intensity and transience of acts of participation. The aim is to
characterise the participants and the pathway from expertise to influence to enhance their
effects.

Methods and data collection

One of the challenges of studying any online forum or community platform is identifying
and accessing the practices, motivations and perceptions of the key influential participants,
particularly in relation to sensitive social and health issues, and where pseudonymity is
6 new media & society 00(0)

mandated. This study applied digital ethnographic observation of activity across beyond-
blue’s online support sites over several years. The starting point was to identify and gain
access to key informants and prominent, influential forum participants, and then observe
practices, events and activities in the forums over time. The approach draws from social
media ethnography (Postill and Pink, 2012), applying a sensitivity to practices – what peo-
ple do with and on social media – and the features of the platforms that also act to shape
and influence sociality, enabling the dynamic, and often contested formation of vulnerable
publics (McCosker and Wilken, 2017).
The methods combine interviews with peer mentors and key informants with a quan-
titative and qualitative content analysis of a sample of forum data (5 forums, 14 threads,
1140 posts). Ten Community Champions were recruited by invitation via the private
Champions’ forum, a process facilitated by beyondblue’s community manager. In-depth
interviews focused on how Champions understand and undertake their role in the forums,
and the challenges and benefits of engaging with mental health issues online. Interviews
were conducted by phone due to the geographical distribution of participants, between
February and April 2017. Thematic analysis involved both inductive and deductive pro-
cesses, guided by a priori categories related to the analytical framework discussed above.
The Champions involved in the interviews are identified by their pseudonymous forum
usernames by their own preference and in accordance with the ethical consent obtained:
White Rose, Kazzl, Wednesday, white knight, Just Sara, Starwolf, Geoff, Mark JT, Croix
and Gruffudd. Other non-champion participants quoted have been attributed an alterna-
tive pseudonym or double de-identified. The beyondblue does not collect personal infor-
mation or display any information for a forum user other than a pseudonym. The
Association of Internet Researchers Ethical processes were considered throughout.
While posts are publicly accessible through the forum, sensitivity to the context and
purpose of posting to the forum have been weighed when relocating those posts to this
research article. In addition to double de-identification, the posts reproduced have been
chosen as representations of the kinds of activities and patterns observed and have mini-
mal reference to specific circumstances or experience. The forums are publicly accessi-
ble by organisational policy because they also stand as a resource for others to read,
follow and learn from, and this is made clear to participants in terms of use. Any possible
harm in reproducing them in this research is also weighed against those objectives.
Communication with beyondblue’s community manager regarding process and ethical
oversite was constant, beginning with research design, formal ethical review and through
sign-off for any publications. The findings have helped inform training workshops for
Community Champions at the organisation.
Observations of the forums took place between 2015 and 2018, with a sample of
forum interactions extracted in December 2016. The selection is broadly representative
of forum activity, with three people-oriented forums that focus on the Champions,
young people, and partners and carers, along with two illness-focused forums. The
forums were as follows: ‘Welcome & Orientation’ (1 thread, 120 posts), ‘Depression’ (4
threads, 390 posts), ‘Anxiety’ (4 threads, 360 posts), ‘Young People’ (1 thread, 60 posts)
and ‘Supporting Family and Friends (carers)’ (4 threads, 210 posts). Analysis of the
forums occurred in two phases. An initial phase helped identify key influencers and
explored broad patterns of interactions and content themes. A second phase occurred
McCosker 7

after interviews with Champions, where a coding frame was established to identify the
characteristics, practices and expressed impact of the forums’ influencers. This coding
frame was developed through a mix of inductive and deductive processes, and was
tested for consistency between two researchers, with subcodes adjusted through an iter-
ative process.

Moderated forums and distributed support: enabling

ordinary influencers
It is not surprising that online forums have emerged and remain a persistent, organic
source of community support from the early days of the Internet. Forums have operated
in this capacity alongside bulletin boards, email lists and other tools for issue- or interest-
oriented sharing and interaction, well before current social media platforms (Baym,
2015). In fact, notions of online community and participatory practices have predomi-
nantly been understood with reference to forums, and they share continuity with promi-
nent ‘community forums’ like Reddit, to use Massanari’s term (Massanari, 2015). Forums
offer a shared sense of space, practices, resources and support (emotional, esteem, infor-
mation support), along with shared identities and interpersonal relationships (Baym,
2015: 82–100). Health forums have been found to facilitate participation and inclusion
in health and well-being processes and information gathering, expand personal networks,
offer anonymity for stigmatised and vulnerable populations, and increase access to sup-
port mechanisms particularly for those isolated or of restricted mobility (Tanis, 2008).
Tucker and Goodings (2017) detail the ‘digital atmosphere’ generated by the transmis-
sion of affects on forums like the UK-based mental health forum Elefriends but also the
way ‘caring for oneself becomes bound up in the ambiguities of caring for others’ (p.
629). These findings resonate strongly with the beyondblue forums.
A growing number of around 88,000 people access beyondblue’s mental health sup-
port forums monthly (McCosker, 2017). The forums have been in operation since 2003
and are currently managed by two paid moderators and around 20 unpaid ‘Community
Champions’. The beyondblue developed its Champions programme in a relatively ad hoc
way, initially drawing from a small number of prominent forum influencers already
active – those who posted often and were well known to help and support others. All
Champions have lived experience of mental ill-health as well as demonstrated promi-
nence over time (digital expertise). They receive some training through workshops run
annually and also have access to a dedicated closed forum where they can seek advice,
information or strategies from the other Champions, or interact with beyondblue’s com-
munity manager. Champions also have access to one-on-one clinical debriefing if they
are distressed by any interaction on the forum. An automated, three-tiered filtering sys-
tem assesses posts for levels of risk on the basis of flagging protocols, with about 20% of
higher risk posts held back for review. The moderation protocol flags posts that among
other criteria promote services or particular pharmaceuticals, are aggressive or talk about
suicidality with specific reference to time and place or methods. Users cannot themselves
flag posts in the current iteration of the forum, although Champions can and do direct
concerns to the community manager. Along with the community manager, clinically
trained moderators can step in where a high risk is identified. On the rare instance where
8 new media & society 00(0)

an emergency situation is identified, local authorities can be directed to a location derived

from the Internet Protocol address of the forum member. Posts are limited to text, 2500
characters long, and are publicly accessible through search engines; however, member-
ship through a sign-on process is required in order to post or reply, and membership is
restricted to people located in Australia by IP address.
Survey work undertaken in 2016 found most members accessed the forums because
they ‘felt depressed or anxious and I wanted support’ (55%), ‘wanted to connect with
others anonymously’ (33%) or ‘felt suicidal’ (26%) (Hall & Partners Open Mind, 2016:
13), the latter being higher for 18- to 24-year-olds (36%) who post at much higher rates
to the ‘Suicidal Thoughts and Self-Harm’ forum (McCosker and Hartup, 2018). Notably,
a substantial number (18%) explicitly ‘wanted to provide help’ to others. A range of fac-
tors contribute to enabling engagement with the forums but central would be the require-
ment for anonymity. Unlike platforms with a real name premise (Van der Nagel and
Frith, 2015), the forums require pseudonyms to encourage intimate self-disclosure with-
out the social and identity risks associated with mental ill-health’s persistent stigma.
Interview participants uniformly saw this as essential. For Starwolf, anonymity ‘is actu-
ally a necessity. That’s what allows people to open up’. For Gruffudd,

it’s important for trust and confidence … When people find the forums, life isn’t great. They
have relatives or employers giving them a pretty hard time. And they are a little bit worried
about that conversation being shared with those people.

Establishing expertise
In any social context, there is commonly an ‘asymmetry of influence’ (Smith Maguire
and Matthews, 2012), and this holds true for forums generally (Baym, 2015). For digital
environments, the important question is how expertise is established, or how some indi-
viduals become distinguished through implicit and explicit claims to privileged experi-
ences and through legitimising techniques and affective, influential digital acts. Factors
contributing to this asymmetry of influence might include experiential knowledge
(including cultural or vernacular knowledge), duration of participation, social capital or
network size and visibility, acknowledged skills, capacities or proximity to service pro-
viders. Legitimacy, authority and expertise are characterised in online forums by demon-
strable skill and the sustained application of affective labour in managing micro-public
conversations about sensitive and context-specific issues.
The beyondblue’s forums foster a particular kind of asymmetrical influence among
members most explicitly through markers of expertise and experience indicated by a pro-
file badge (Community Champion, Valued Contributor, blueVoices Member) and visible
number of posts. While some noted that badges have been contentious at times, they
emphasised that they are almost always ‘deserved’ and saw the important role they play in
conveying a sense of ‘reward’ for effort and involvement over time ‘recognition’, ‘valida-
tion’ and ‘acknowledgement’, and in signalling the esteem associated with Champion
roles. Badges in this sense can be understood as ‘professionalising devices’, a contingent
accomplishment not only attributed by beyondblue moderators but also legitimised by
forum members through cycles of feedback and acknowledgement of the impact that
McCosker 9

Champions have for others at times of need. For Gruffudd, ‘It’s why it’s quite nice to be a
rainbow champion, have a brightly coloured bus that’s a little bit different’. This has a
double effect of signalling a safe environment for new LGBTI members and a specific
kind of support expertise: ‘if someone from an LGBTI background is coming into the
forums, there’s someone else there that’s identifiable without having to ask. And then it’s
okay and it’s clearly a safe place because that conversation is already there’ (Gruffudd).
In the forum analysis and interviews with Champions, a number of themes and prac-
tices emerged that gave insight into how expertise was established. Over a long period,
those who achieved the status of Valued Contributor or Champion relay in intimate detail
personal mental health and life circumstances often involving times of severe mental ill-
health and transitions towards successful coping and recovery practices. Just Sara
describes this last quality of transition and its non-linear characteristics:

when you first become a CC, there’s a transition that has to happen, and it’s going from a
‘needy’ Member to a Member with accountability and responsibility. And you sort of lose
yourself a bit in that transition, because all your time is spent helping others, and you’re still
going through your own stuff. You just can’t lose your own needs.

This involves a kind of managed or performed intimacy through which peer influenc-
ers are able to connect on an intimate level while retaining some distance. Just Sara goes
on to explain this:

personal experience is very important. I usually gauge whether or not to tell a little bit about
myself. I used to, in the beginning, tell a lot about myself, and then I thought no, there’s too
much redirecting there, so I usually just put a few statements about my experience if I need to.

The ‘Introducing’ thread repeatedly pairs personal mental health issues and difficult
life experiences with coping and recovery strategies as credentialing practice or indica-
tors of expertise. In one post, Lori says, ‘I am 18 years of age … I have experience with
depression and anxiety myself and if there’s ever a time when I can help another I will
…’ (Lori7, Forum: Welcome & Orientation). Age, depression and anxiety feature upfront
here as the identifiers of supportive capacity. In some cases, a professional credential is
put forward, such as role as nurse, psychology student. Just Sara noted,

It basically has replaced my career. I’ve always been in the helping professions … Becoming a
Champ, although it was quite confusing in the beginning because I went through a lot of
emotional stuff, it has become my work, and very, very important to me.

Embodied personal experience is central to how forum influencers operate, as Croix

notes in interview: ‘If it’s talking about being hospitalised, fine. If it’s talking about being
suicidal, fine. … Whereas some things are so alien that I really feel that it’s a last resort
for me to [respond]’. For Kazzl, personal experience establishes authority and relatability:
‘I think it’s, what’s the word I’m looking for, credibility in what we say to people, because
by sharing our own experiences they can see the credibility in what we’re saying’. But
embodied experience is not in itself enough to distinguish key influencers. Champions
and other influencers demonstrate an ability to draw on and express personal mental
10 new media & society 00(0)

health experiences in a way that builds trust, encourages communication and nurtures
relationships among forum members to counteract the negative social norms around men-
tal ill-health. A significant part of the authority achieved by influencers derives from their
capacity to transform the aversive affects of their own encounters with mental illness into
a mechanism for connecting – or connecting with – others. Kazzl sees the role as both
‘validating people’s experience’ and challenging the persistent idea ‘that it’s a character
flaw, it’s a weakness’. This validation becomes reciprocal over time through cycles of
feedback and forms the basis of a durable portfolio of authority and expertise.

Framing and re-framing mental health: durability, credibility and empathy

A second element of focus is the role that forum influencers play in framing practices,
which refers to both the act of expertly articulating mental health experiences and recov-
ery strategies, and the durable frames, points of reference, key posts, ideas, practices and
behaviours that hold sway or take shape as norms or conventions – particularly through
the interpersonal flow of affects and the generation and management of empathy.
Individuals who achieve a level expertise and influence do so in large part by effectively
framing and re-framing ideas, ways of thinking and behaviours, and likewise, because
they have established expertise and authority, they are better able to make choices and
strategies credible to others. In this way, they are implicated in providing legitimacy to
practices or even generating conventions (Smith Maguire and Matthews, 2012: 557).
Framing and empathy practices function as primary affective techniques, providing a
basis for facilitating ‘the “sociality” of emotion’, as Ahmed (2014: 8) puts it, that sustains
engagement within the forums.
The forum analysis and interviews revealed Champions’ active role in providing articu-
late, evocative, experience-oriented accounts of the symptoms and affects related to mental
health problems in ways that other members respond to. Blondguy is known for his evoca-
tive language and ability to articulate the qualities of mental illness. In one thread, in
response to an ongoing discussion about how to support an unwell partner, he explains,
‘Depression can close in on us like a fog. It dulls or removes senses, short circuits emo-
tions, makes thoughts all warpy and steals energy’ (Blondguy, Forum: Depression). Some
draw attention regularly to the chemical and biophysical aspects and effects of mental ill-
ness as a way of shifting frames of reference away from interpersonal problems or expres-
sions of low self-worth: ‘It feels that way because the chemistry in your head is a bit out of
kilter at the moment, it won’t be forever’ (Wednesday, Forum: Depression). Alternative
non-medical framing of the effects of anxiety also helps, for example, to explain behaviour
patterns and reflect on recovery strategies: ‘Anxiety is the pits. The mouse on the wheel
around and around and around is the anxiety’ – a metaphor Corn returns to on other occa-
sions, and others respond positively to (Corn, Forum: Anxiety).
In framing recovery practices for others, Champions repeatedly refer to strategies
developed from a mix of their own practiced approaches. This is exemplified by the
regular reference to mindfulness or techniques like cognitive-behavioural therapy (CBT).
Champion Mark JT offers a fairly prescriptive example of techniques that work for him:
‘Do you practise mindfulness? If not, start. It is awesome and one of three key subjects
that i do daily to keep and continue to build my resilience’ (Mark JT, Forum: Depression).
McCosker 11

Some posts and ideas achieve durability despite the relative transience of posts as new
content emerges. For example, framing her top recovery strategies, White Rose offers a
list that is both personal and generally applicable; the top 4 on her list are as follows:

1. Sit outside and watch/admire my garden.

2. Meditate. I can also do this outside once general peace of the garden has settled me.
3. Phone a friend. No guarantee someone will be available so I tell myself I can talk later.
4. I like craft work, especially if it needs a lot of attention. This stops me focusing on my
misery. (White Rose, Forum: Depression)

White Rose and others refer back to this post or versions of it regularly, and each of
the elements remain central to her approach to helping others address their own circum-
stances. Such a post stands as a point of reference or convention, against which the legiti-
macy of personal recovery approaches is oriented and understood or negotiated by
others. Members refer back to White Rose’s list as an already substantiated version of a
point they are making:

Hi Mary [White Rose]. Thank you so much. I love the way you explained everything and it all
makes sense to me. […] I Can relate to your strategies and will definitely try them. I Will revisit
your post when i am feeling lonely next time so thank you. (Penny, Forum: Depression)

White Rose (who also goes by another alias, Mary) clearly understands the durability
of some posts, as this reply to her advice regarding a psychologist’s appointment sug-
gests: ‘Mary that’s not a bad idea about printing out my original post and taking it with
me … would she read it? I could read it out to her perhaps’ (Moonshadow, Forum:
Depression). The relative stability and archival form of the forums, the visibility of
threads over time, but also these deliberate techniques in fixing affective reference points
in posts, establish a base for rendering frames, strategies and interactions durable, and
represent the primary digital labour and expertise of peer influencers.
Forum influencers are particularly skilled at re-orienting others’ negative experiences
and helping other members to think more positively and strategically in redressing their
particular circumstances and problems through techniques of empathy. These techniques
involve the management or modulation of the negative affects and emotions associated
with critical moments of mental ill-health. In interviews, Champions Kazzl and Geoff
explain how they go about this:

[I] ask them to think back to before they became so depressed and what kinds of things they
enjoyed doing, because it’s something that we can forget, that life can be actually pleasurable;
and then just say to them what do you like to do and take it from there. (Kazzl)

[I try] to put myself into their situation. Make them understand that I’ve been through it as well
and come out the other end. It’s always negative thoughts, and I can well and truly understand
that. Just trying to relay to them that what they’re going through is terrible, but then I try and
think back to what I went through, then mention what I’ve been through, not as me saying it,
but what they could do instead. (Geoff)

In these instances, and in each of the interviews, Champions relay the importance of
empathy practices. They talk about empathy as a vital attribute and competency, a tool
12 new media & society 00(0)

for maintaining connections with other members long enough to understand and re-
frame problems. As Starwolf explains, ‘this is what gives people, gradually sometimes,
the incentive to open up a little bit more. Feeling that they are not judged, they’re under-
stood and somebody cares. It’s just a matter of building up a trust relationship’ (Starwolf).
Not only do techniques of empathy in interactions facilitate connections and relation-
ships over time, they are generative of developed expertise and authority. For Kazzl, this
involves two stages: using empathy to ‘reflect back to them what they’re experiencing’
and then drawing them out: ‘I don’t think you can ever really resolve something that’s
going on in one post, so I always try and get them to tell me more, draw them out, though
not “please can you tell me everything”’ (Kazzl). What became clear through the inter-
views, and observing empathy practices in the forums, is that influencers excel at gener-
ating and mobilising empathy as a form of skilful affective labour, the result of which is
to bring into being and sustain supportive mental health communities. This is facilitated
by recurring cycles of feedback impact.

Cycles of feedback: levers of influence

The impact of forum interactions and drivers of influence are always uncertain but involve
observable cycles of feedback. The work of influencers in these cycles is to structure
ongoing modes of engagement, develop and manage relationships and strengthen com-
munity norms or conventions. These practices ultimately shape conversations as a kind of
community-driven ‘public mental health pedagogy’ (Fullagar et al., 2017). The cycles of
impact feedback resonate with work on affective economies, where the sentiment, or the
feeling of affirmation (in a context of aversive emotional and affective states and experi-
ences), attains an autonomy and not only circulates (Massumi, 2002) but also constitutes
the sociality of emotion (Ahmed, 2014), its publicness and its public modulation. That is,
expressions of feedback circulate an affective, relational force that sustains the ‘feeling’ of
community. Smith Maguire and Matthews (2012) note that a central aim of cultural inter-
mediaries is to ‘make their impact durable … such that it extends beyond their particular
interactions and accomplishments and takes on the quality of a convention’ (p. 557). The
various signs of impact observable in the forums offer a clue as to how this happens in
practice. I categorise the impact signalled and exchanged through feedback as acknowl-
edgement and recognition, agreement, and actioning. These forms of exchange carry an
important visibility or publicness and take a cyclical and durable form.
Acknowledgement and recognition of others’ input or specific comments is the most
common form of impact feedback. It expresses a fundamental appreciation and main-
tains a connection. It may be relayed in an expression of thanks – generally or targeting
an individual: ‘Thank you so much for your post and your generous words. The BB
forum has kept me going so it works both ways’ (Wednesday, Forum: Depression). Or it
may involve ‘calling out’ others:

Hi Wednesday Thanks big time for replying :-) James, Bluguru and Carol are legends on the
forums that I have learnt a lot from since they been ‘on the air’. It really makes me feel mega
grateful that they are here. (Blondguy, Forum: Depression)
McCosker 13

That recognition might signal the impact of the forum community as a whole: ‘Thank
you, it means a lot, even to have support from a stranger xx’ (Rach1, Forum: Young
People).
Agreement takes the signal of impact further than recognition or expressions of appre-
ciation. These are buttressing statements: ‘You’re right sometimes it is just having some-
one to listen that helps’ (Wednesday, Forum: Depression). They also help to acknowledge
and maintain contact and supportive relations, but can gesture towards a reinforcement
or even shift of thinking, with the possibility of more positive action: ‘Geoff and Mary
– I will try to not hang onto any self-control seeing the psych. I don’t put on a facade
deliberately believe me – I don’t think I could tomorrow anyway’ (Moonshadow, Forum:
Depression).
When cycles of feedback move towards specific enacted responses, or actioning,
influence becomes explicit and visible to others. Actioning signals impact and influence
in a way that indicates not only agreement and appreciation but material change. As one
of many examples of actioning, Shephard relays his attempts to overcome negative
thoughts and follow the advice of a non-Champion forum influencer Sun:

Even though i feel emotional i am doing what you suggested [Sun] and just letting go of my
negative thoughts, most of the negative thoughts i have are generally not based on reality and
are useless but I seem to fall for them way to many times. (Shephard, Forum: Depression)

Impact is not always made visible for Champions and forum influencers (to their
frustration), but when it is it affects motivations, interaction and support strategies.
Influence is multi-directional in this sense and cyclical. Its particular intensities can flow
towards forum influencers or from them to other members. white knight recounts one
instance of where feedback has affected him personally:

I had a young girl of 16 and she posted back after 18 months and she said that ‘I’d like to say
thank you to white knight, because his reply to me about 12 months ago’ I’ve printed it out and
I put it on the door of my bedroom and I read it every day. (white knight)

This kind of feedback also affects the way Champions adjust their approach to spe-
cific people. Just Sara says, ‘I’ll get some feedback to say you’ve been really helpful, or
that’s not what I meant when I was talking. So there is feedback to give me an idea of my
role’ (Just Sara). A key skill for peer influencers is knowing how to manage and modulate
feedback. Gruffudd explains the multiple layers of referential reinforcement from his
perspective:

When you see someone make a positive statement or a statement saying that they enjoy
something or value something [from the forum], repeating that back, summarising that back to
them and letting them just see their own words and value that, it’s a powerful thing, really.
(Gruffudd)

As public expression, feedback plays an important role in reinforcing and building a

personal and public sense of value as Champion. That is, it not only ‘makes it all worth-
while’ as Starwolf puts it, these are the visible markers of legitimacy, authority and
14 new media & society 00(0)

expertise – they ‘visiblise’ expertise and influence. Because the forums are searchable and
stand as a record of conversations, and generalisable emotional and mental states, their
impact can be made durable over time. Impact is hence able to move beyond the immedi-
ate sphere of interaction and influence through this expressed durability.

Conclusion: from engagement to influence

Mental health organisations have used social media mechanisms like forums for some time
now to scale services and maximise affordances such as anonymity and 24/7 peer-based
support. With tensions around the negative emotional impact of dominant social media
platforms like Facebook, Instagram and Twitter, the community orientation of health
forums deserves greater scrutiny. Furthermore, ‘we need to take seriously the cultural pro-
duction of legitimacy’, as Smith Maguire and Matthews (2012) have argued in their review
of research on the characteristics and effects of cultural intermediaries (p. 558). The same
could be said for health influencers and of the impact of the affective labour they expend.
In the context of online mental health support, understanding the production of legitimacy,
expertise and influence among peer mentors is a crucial step towards building better digital
interventions. While a critical lens could be levelled at organisations’ reliance on free
labour for mental health support, by doing so they offer an opportunity to intervene differ-
ently in the flow of negative affect and painful emotional states.
With scaled online mental health support comes the question of who is able to take on
the role of supporting others through chronic mental health conditions in the community,
through community forums and other social media channels. Contributing to an emerg-
ing field of work on moderation and work on influencers, the analysis shows that health
influencers act in beyondblue’s mental health forums in ways that establish authority and
legitimacy, frame and re-frame actions through empathy practices that sustain impactful
connections. Champion white knight sums up the capacity, drive and skill sets involved:

I may not be able to work but I have this information to spread and assist if I can. Having mental
illnesses doesn’t mean it’s all bad news. Mental illness has provided me with empathy, kindness
and care. These are the things I can do without feeling drained and tested. (white knight, Forum:
Welcome & Orientation)

Motivations for participating in this way vary, but the impact and benefits are demon-
strable: ‘By assuming socially valued identities, [supportive peer mentors] are no longer
restricted to passive patient roles relying solely on mental health professionals for direc-
tion and advice’ (Campbell, 2005: 34, citing Roberts et al., 1991). As an early advocate
of peer mentor programmes put it, ‘Our emotional life is no longer somebody else’s, the
medical profession’s specialty. We are the experts’ (Zinman, 1987: 11; cited in Campbell,
2005: 40). Influence and impact derive from a practiced and cultivated expertise, the
developed set of skills or competencies for dealing with mental health issues through
public digital platforms, along with an explicit willingness to apply these in helping oth-
ers through the forums. A broader programme of research can examine specific aspects
of social support in relation to suicidality and self-harm (McCosker and Hartup, 2018),
as well as platform features and moderation or modulation practices that alter the experi-
ences of those who engage in the forums. In addition, beyondblue, like other health
McCosker 15

organisations, is exploring options for automated and Artificial Intelligence-driven sup-

port services pointing to a significant area of research need as these services push what
is possible by mobilising social support online.

Acknowledgements
I wish to thank Christopher Banks at beyondblue for his input and support with this project, and
Michael Hartup for his tireless research assistance.

Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/
or publication of this article: This research was made possible by a Swinburne University Faculty
Research Grant.

ORCID iD
Anthony McCosker https://orcid.org/0000-0003-0666-3262

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Author biography
Anthony McCosker is deputy director of the Social Innovation Research Institute, and senior lec-
turer in the Department of Media and Communication, Swinburne University of Technology,
Melbourne. He is author of the book Intensive Media: Aversive Affect and Visual Culture, and
co-editor of the book Negotiating Digital Citizenship: Control, Contest and Culture. His current
research explores transformations of health and social participation through digital platforms and
practices.