Just one thing….
Simone Spray, CEO, 42nd Street
I think the most critical thing for impactful mental health and wellbeing support for young people (and by that I mean 11-25 year olds) is choice. A lot of services for young people are still very clinical and are threshold and diagnosis driven, particularly as young people transition into adulthood. Also, and understandably with the limitations on resources and continued uncertainty, many are still dictated by efficiency rather than preparedness and resilience. All of which limits choice.
Young people have the right – and should have the power - to make decisions about issues that affect their lives but to do that, they need choice. Where we can, we offer recognised, more traditional clinical interventions alongside effective psychosocial interventions, peer support, creative opportunities and emerging digital approaches. Young people are able to choose, test out different approaches and develop the life tools that work for them, for themselves. One size can’t fit all.
We must allow for the adaptations and innovations needed to meet the changing needs and concerns of young people. For example, if we look at the issue of climate change, if we stick to the old ways of doing things we run the very real risk of missing the opportunities for shaping new interventions with young people and creating relevant approaches. Young people are telling us at 42nd Street that climate change is creating anxiety and isolation and that they need peer support where they can listen to and understand each other’s concerns and more opportunities to enjoy, celebrate and incorporate nature and the outside world in their 'treatment' e.g. in community allotments and on photograph walks.
To support more choice in the system, we would of course have to look differently at 'evidence-based practice'. I have recently become involved in an i-Minds national steering group where a group of amazing UK-wide clinicians and academics are researching new approaches to supporting young people who have experienced sexual abuse online. I feel very honoured to be involved as it shows how the team driving this new evidence-based treatment recognise some of the lessons learnt from the VCSE in terms of approaches to online work and engagement, and how these and other insights gained by talking directly to young people with lived experience will shape the approach to ensure it has real impact. At 42nd Street, like so many other VCSE organisations, we have a whole host of examples of where our practice has been – and is being – externally evaluated and we need to recognise these evidence bases and bake them into our system approach. For example, at the moment our online service is being externally evaluated by Health Innovation Manchester (NB also involving young people as co-evaluators) and this evidence base could (should?) inform future best practice around synchronous and asynchronous online support for vulnerable young people across the system.
A system without choice also makes it very difficult to address inequity and inequality, as it is very hard to build in approaches that provide for the specific needs for certain communities such as care experienced young people/care leavers, young carers, young black people, the Orthodox Jewish Community and LGBTQ+ young people (to name but a few). At 42nd Street, Cloud 42 is a care leavers peer group that has spoken to other care leavers and produced a report so they can campaign for the specific gaps in support for care leavers - hugely exacerbated by COVID-19. Their report is getting traction across Greater Manchester, but they need to see specific opportunities that recognise the unique needs of care leavers and the choices that will ensure that the needs of young people experiencing the care system do not continue to be missed – as has been the recognised story for far too long.
I also recognise that where there is choice, we need guidance and that young people – particularly those that are not supported by family or friends (or the system) - need advocates to help them navigate and make informed choices. Ideally these should be people who understand and have gone through similar situations. What young people have told us is that if they do not see people like themselves in the workforce, people they can identify with, then they find it very difficult to trust and use that service. We need to see a shift in the health and social care workforce so that we better represent the population of people we are here to support. I would also argue that if we build more choice into the system then that more diverse workforce will follow.
Finally, the very pressing issue for 42nd Street, which existed pre-COVID but even more of an issue today is demand; our referral rates are doubling, even tripling in some areas. These pressures are hitting the whole CAMHS system and we are not just seeing increased numbers, we are all seeing increased complexity and risk. This should not be dealt with by building in more thresholds and therefore potentially masking the real need; now should be the time to reconfigure resources to ensure young people are safe and to recognise that some of the more creative and less clinical approaches might help support this surge in demand across the system.
To do all this, I know we will need radical changes in resource allocation and collaboration and I am heartened by some of the conversations in the mental health world around ICS and Community Mental Health Transformation that seem to be looking at new ways of working to address the very real issues in front of us. We must look to examples of brave and radical commissioning which have worked in the past. For example, the Integrated Community Response Service delivered as a partnership across CAMHS, the VCSE (42nd Street, Salford Mind and Mind in Manchester) and the Early Help hubs in Salford and Manchester was a co-created programme designed around the lived experiences of young people falling through the system despite being known to many agencies and recognised as having complex, intersectional issues that impact their mental wellbeing and opportunities. This programme works because it has been designed collaboratively around young people’s needs, not single issues and single service responses, with choice at its heart.
This interview was featured in P&I Shorts, the fortnightly VCSE policy update. We interview leaders in our sector about their important current policy issue. To sign up to P&I Shorts, please click on this link.