2015 report of the Children and Young People’s Mental Health Taskforce identified multiple problems with current provision, including:
- Lack of data about current services for young people and how well they are working.
- Increases in the number and severity of referrals to services, and resulting increases in waiting times.
- Lack of consistency in crisis services for young people across the UK.
- Children & young people finding it difficult to access suitable services, even when they definitely need support.
Key recommendations from the taskforce to improve services were:
- Services built around the needs of children, young people and their families so they get the right support from the right service at the right time. This would include better experience of moving from children’s services to adult services.
- Different ways of offering services to children and young people. With more funding, this would include ‘one-stop-shops’ and other services where lots of what young people need is there under one roof.
- Professionals who work with children and young people are trained in child development and mental health, and understand what can be done to provide help and support for those who need it.
1625ip’s Future 4 Me project (2013 – 2019) took these recommendations and explored a new way of working with young people around their mental health which offered a more integrated approach.
Integrated Mental Health Support
In 2012,1625 Independent People developed Future 4 Me (F4M) funded by the Big Lottery Fund (now the National Lottery Community Fund) and the original 4 year project was extended in 2016 until 2019. At its core the programme sought to radically improve the support available for our young people with the most complex needs and to do this through an integrated team of specialist workers, including 2 specialist mental health workers.
To support the development and delivery of F4M, 1625ip established and chaired the Community of Practice for Young People’s Mental Health (Bristol). This brought together voluntary and statutory mental health services across both children and adult services, including providers and commissioners. Through this forum 1625ip achieved a strong consensus on the need to bring mental health support closer to young people and the relationships they have within the voluntary sector, and agreement on how F4M could be part of this. We gained the support of statutory mental health services to support our project outcomes through clearer pathways into services.
We worked closely with Jonny Matthews (YJB), the CEO and Clinical Director of Off the Record in Bristol, senior local authority officers and the Mental Health Strategy Group in South Gloucestershire to establish high level support for our approach to bringing mental health services closer to Future 4 Me service users.
Unmet Needs
We know that many of the young people we work with experience childhood trauma, abuse, poor attachments, loss, feelings of being unwanted and unloved. On top of the problems of adolescence generally experienced, some young people present with behaviour that services find challenging and fail to understand. Failing to understand and work with experiences of trauma can result in young people being unsupported, becoming homeless and excluded from services.
We recognise that young people are often reluctant or not ready to access specialist mental health services. Those that do succeed in engaging often struggle with the transition from youth to adult services.
Young people with the most complex needs, including mental health needs, are some of the most likely to be unable to access and sustain suitable accommodation and positive activity, increasing the likelihood of challenges escalating.
In particular, we identified:
- The need to better equip organisations and partnerships with the tools to offer young people consistent trusted relationships – which we know are key to supporting lasting change in their life trajectories.
- The need for relationships to be supported through a range of specialist input, including the involvement of psychologists and mental health specialists, to bring mental health support to young people who do not engage or access mental health services and struggle to self-manage their behaviours, regulate their emotions, and trust others.
The Mental Health Specialist Role
We employed 2 full time mental health specialists within the Future 4 Me team. Their remit included:
- Providing intensive 1:1 support for young people through transitions from local authority care and custody, bringing experience and specialist skills in mental health.
- Sharing mental health expertise (through training and coaching) across the Future 4 Me team and more widely with colleagues within 1625ip.
- Providing additional 1:1 and group work support to young people with mental health problems who are supported by other 1625ip teams and associated supported housing providers.
- Maintaining and developing strong links and joint working with health related services, including those in the secure estate, leaving care teams and YOTs.
To support the introduction of the mental health specialist roles, we also contracted a psychologist to provide clinical supervision to the F4M team, and guidance around the implementation of the Trauma Recovery Model.
1:1 Mental Health Support for Young People
The project offered two options for 1:1 support.
- Short term support of 4-6 sessions for up to 3 months for young people with an identified need for mental health support, who were already working with another 1625ip support team.
- Longer term support of 9-12 months with the length, frequency and format of sessions tailored to suit the individual. Referrals for this work were taken from Social Services leaving care teams and Youth Offending Teams.
In both cases, support was relationship based, requiring the project worker to get to know the young person and tailor support to build on their interests and meet their needs.
As well as time spent getting to know the young person, support included: identifying blocks and barriers to being able to access mental health support, advocacy, introducing tools young people could use themselves, and enabling access to positive activities to support mental wellbeing such as gym passes, music sessions, and boxing.
Project evaluation identified challenges with the short-term offer:
- Inappropriate referrals – some young people were not eligible as there was no specific mental health need.
- Time barriers – it was difficult to build up a trusting relationship within the 3 month/ 4-6 session time frame.
- Some young people were resistant to the idea of separate sessions with a ‘new’ worker.
- Young people generally needed longer term support.
Some young people transitioned successfully from a short-term to a longer-term referral. Very few of those who engaged only with the short-term service completed the full 6 sessions.
Feedback from stakeholders, young people and project workers about the longer term 1:1 support was overwhelmingly positive. From this feedback we have identified the following key success factors:
Forming a trusting and non-judgmental relationship with the young person is fundamental to successful support.
Read how we did this
- Using the Trauma Recovery Model.
- Being consistent, predictable and reliable. Turning up to every appointment, rearranging if the young person doesn’t attend. Not giving up.
- Being able to focus entirely on forming a caring and supportive relationships with the young person, not compromised by other organisational or statutory restrictions.
- Ensuring workers had flexibility and time to engage and build positive, trusting relationships.
- Ensuring support included meeting the young person’s immediate physical needs, for example providing food or transport. Some of our most productive conversations happened whilst driving, when the young person does not have to maintain eye contact.
- Proving ourselves to be different, to break the cycle and pattern of non-engagement.
- ‘Tuning in’ to the young person and designing support based on what is important to them.
- Being flexible and boundaried.
Connecting young people to other services promotes resilience and sustainability.
Read how we did this
- Adopting a multi-agency approach to holistic support.
- Supporting young people transitioning from CAMHS to adult services.
- Referring young people to statutory services as needed (such as GP) or community based provision to support interests and skills (such as boxing, music, cooking sessions).
- Helping young people to prepare for assessments and interviews. Ensuring we understand the process and systems ourselves.
- Being a trusted person and a ‘bridge’ in unfamiliar environments, accompanying young people to appointments and assessments and/or providing transport.
- Identifying and reducing blocks and barriers to engagement. Advocating when necessary.
Staff working with complex young people need adequate support to protect their own health and wellbeing.
Read how we did this
- Providing clinical supervision monthly to all F4M colleagues.
- Holding monthly case reviews to promote peer support and learning within the team.
- Ensuring line management supervision at least every 4-6 weeks.
- Requiring all colleagues to participate in reflective practice monthly.
- Promoting autonomy, to enable each worker to structure their time to suit their caseload.
Sharing Mental Health Expertise Across the Organisation
The expertise that the Mental Health Specialists brought to their roles was shared across the organisation in a number of ways. These can be summarised as:
- Promoting a supportive environment for colleagues with opportunities for group reflection and the sharing of skills and knowledge – achieved through provision of clinical supervision, case reviews, reflective practice and team meetings.
- Providing coaching support provided by the Mental Health Specialists for 1625ip colleagues on a case by case basis.
- Providing training sessions, developed in response to organisational need.
“Sometimes the support worker can be blinded by the mental health element… by talking the case through we can help them see it’s not really the problem, but the consequence of all the other challenges the young person is facing - homelessness, no money, toxic relationships, isolation.” F4M Mental Health Specialist.
The specialist Mental Health workers were able to support colleagues across 1625ip (and some in partner agencies such as the YOTs and Social Services) to build their knowledge and skills by being available to act as ‘consultants’. This approach can help to minimise the number of workers that a young person has to share their story with, an important consideration for young people who have experienced trauma. It also contributes to increased confidence in the wider team, and can reduce inappropriate referrals to statutory mental health services.
It is recognised that dealing with mental health challenges in others is demanding and can put a great deal of strain on staff, especially if they feel out of their depth. Providing timely support and advice for them protects their wellbeing, as well as that of the young person.
“You need to be very mindful of not shaming colleagues, the same way you do with young people because again, they may come from a position of insecurity…I want to convey the message that mental health knowledge is accessible to everyone and should be accessible to everyone and we can all understand what mental health is about” F4M Mental Health Specialist.
Read more about coaching support in our Case Study
Employing colleagues with a mental health specialism provided a huge knowledge resource for the charity. The mental health specialists came from a variety of different backgrounds, and were able to contribute to developing staff training. Specific training sessions were developed focusing on dealing with mental health challenges, such as psychosis and personality disorders. They were also able to contribute to existing organisational training, such as sessions on Psychologically Informed Environments, and Restorative Approaches.