Survey of Internet Mental Health Issues (SIMHI)

Summary. The Survey of Internet Mental Health Issues is a nationwide mail survey of over 30,000 mental health professionals to assess their encounters with clients having problematic Internet experiences. Case characteristics were collected on 1,504 youth and adult clients relating to demographic characteristics, conventional problems, Internet use and experiences, and diagnoses. This study was funded by the Department of Justice, Office of Juvenile Justice & Delinquency Prevention.


The Internet is a growing factor in the lives of young people, and as it occupies more time and energy in their lives, it is likely becoming a growing factor in the distress and well being of this population. Mental health and victim service professionals, such as victim advocates, crisis intervention specialists, counselors, clinicians, and social workers have an important and unique view of the lives and experiences of youth and adults. Their perspectives and insights into these populations may reveal occurrences and aspects of problematic Internet experiences, such as the nature of its impact and the reactions of individuals, which may not be revealed from other perspectives. In order to develop a more complete understanding about problematic Internet experiences and its impact, it is valuable to assess the experiences and needs of mental health and victim service professionals so they can effectively recognize and treat these experiences.

Goals and Objectives

  • To identify characteristics of problematic Internet experiences coming to the attention of mental health and victim service professionals including victim advocates, crisis intervention specialists, counselors, clinicians, and social workers;
  • To identify the types of professionals working with problematic Internet experiences;
  • To assess the needs of professionals regarding the recognition and treatment of problematic Internet experiences;
  • To provide data about the impact of problematic Internet experiences; and
  • To formulate recommendations and guidelines from these findings and disseminate them to practitioners and policy makers.


This study used mail surveys to gather quantitative and qualitative data from mental health and victim service professionals about their needs and experiences with problematic Internet experiences. An initial postcard will be sent to professionals who belong to a variety of different professional organizations to determine whether they have worked with clients with problematic Internet experiences. Professionals were then asked to complete a detailed survey about these clients, along with questions about their own needs associated with Internet victimization cases. In order to more completely measure professionals' own Internet use and needs associated with problematic Internet experiences, a sub-sample of professionals who had not dealt with these types of cases was sent a shorter survey asking about their own use, experiences and needs.

Summary of Findings

As part of the SIMHI study, researchers and clinicians identified a wide variety of problematic Internet behaviors and experiences among youth and adult clients receiving mental health treatment. From this, we developed an 11-category inventory of problematic Internet experiences. These non-mutually exclusive problematic Internet experiences involved:

  • Overuse of the Internet (61% of clients) - either in general or for specific types of behaviors, such as pornography viewing or sexual chat rooms;
  • Internet pornography use (56% of clients) - involving general overuse of this material; partner or family conflict over its use; distress over unwanted exposure; development of deviant sexual interests; involvement with illegal pornography (i.e., child pornography); and inappropriate exposure through neglect or poor boundaries;
  • Sexual exploitation and abuse (16% of clients) - involving seduction and attempted seduction that was illegal, unwanted or problematic; inappropriate or sexual involvement with children; and adult exploitation and rape (the problems in this category were further broken down into perpetration and victimization experiences);
  • Online infidelity (21% of clients) - involving romances formed online and acted on in real life; online infatuation that does not move offline; sexual conversations with others in chat rooms; and simulated sexual acts with others;
  • Gaming, gambling or fantasy role-play (15% of clients) - involving online gambling; solitary gaming (e.g., solitaire); interpersonal gaming with other people online (both known and unknown in person); and fantasy games involving role-playing;
  • Harassment (10% of clients) - involving posting defamatory or embarrassing personal information about others; impersonating others online; stalking people online; threatening violence; and physical or emotional abuse (e.g., resulting from an online encounter or relationship) (the problems in this category were further broken down into perpetration and victimization experiences);
  • Isolative-avoidant behavior (10% of clients) - involving clients who chose to have all their social interactions online with little or no social interaction offline; and clients who spent so much time with online pursuits that they isolated themselves from family, friends, and social engagements;
  • Fraud, stealing or deception (9% of clients) - involving online relationships that resulted in the transfer of a large amount of money or gifts; online scams and false merchandise (e.g., online auctions); stealing credit cards or credit card numbers to gain access to web sites or purchase items online; and identity deception (e.g., false age, gender, sexual motives) (the problems in this category were further broken down into perpetration and victimization experiences);
  • Failed online relationship (4% of clients) - involving meeting people online, developing romances or emotional feelings, and finding that the other individual: did not reciprocate those feelings; ended the relationship abruptly; was not who they portrayed themselves as; or resulted in abuse;
  • Harmful influence material (3% of clients) - involving material on web sites that posed a harmful influence of a nonsexual nature such as too much shopping or auctions; and topics relating to self-mutilation; encouragement of eating disorders; bomb- and other weapon-making instruction; hate crimes’ and extreme gore and violence;
  • Risky or inappropriate use, not otherwise specified (13% of clients) - a residual category involving activities that were not exploitative or otherwise criminal, did not involve infidelity, and were not inherently problematic, but raised concerns due to their risky or inappropriate nature such as sexual behavior and interaction with other individuals that began online and sometimes progressed into the real world.