How do you help prevent mental health issues in adults? Let’s talk about what young people need

Warnings: This article contains themes of suicide and suicidal ideation

“One day I was walking home and decided to go a completely different way. I walked across the bridge. I just watched everything beneath me and I began to think a lot of dark thoughts. My thoughts were so intense.” TeenMentalHealthBlogs - Instagram

These were the words of one teenager we talked to when gathering stories from people with poor mental health. Although we were seeking adult voices to inform our work, the circumstances of this young woman provided an excellent insight into the different experiences of young people and gave Living Well the chance to explore their needs and ideas in much greater depth.

Over the past 10 years, Living Well sites have focused on creating new systems of mental health support for adults. Yet we know that one out of every five under-18s has struggled with their mental health from a young age and 70% of young people (1) have found it hard to find support - with a quarter of all young people considering taking their own lives (2).

The challenge for mental health services for children and young people isn’t a hidden problem, with millions of additional investment (3) already being made by the UK government.

The problem is deepening, with the pandemic leading to 80% of young people reporting their mental health worsened (4). Getting support right for young people is critical, with 50% of mental health problems being established by age 14 and 75% by age 24 (5). As our Storybook, “Waiting for Something Better”, revealed, many of our contributors’ mental health issues had stemmed from their childhood traumas.

At Living Well, we’ve always placed people’s stories at the heart of system transformation and - although we focus on adults’ lived experiences when we’re designing adult mental health services - it was through story collection that we first heard the voice of one young person who was experiencing suicidal thoughts.

Just as we explore with adults where they find their support, we asked our teenager where she sought help. She revealed the adults in her life were deeply important to her emotional wellbeing - her mum and school teacher - but it was a local charity’s peer-to-peer sessions that she found most beneficial.

As we dug deeper, we found she valued not just the charity’s support, but the opportunity to use her story to help others. From feeling like a burden - like for many young people (6) - these peer relationships allowed her “to feel like she wasn’t the only one going through these problems” and revealed the power her experiences could hold for other young people.

Social media gave her a way to explore her voice further and she began to share thoughts and experiences though her Instagram account. She posts as TeenMentalHealthBlogs and, from her bedroom in a small town in the UK, she now inspires and supports over 1,400 young people around the world.

“It is powerful to recognise the value of our experiences and what they teach us about our mental health. This can be of great value to ourselves and to other people. Of course, you will have low days, weeks or months, but these do not define you as a person.” TeenMentalHealthBlogs

Knowing the importance of good mental health from an early age, one of our pioneering sites saw the potential of taking Living Well’s principles and ideas into supporting children and young people.

And so, during 2019 and 2020, Living Well helped Tameside & Glossop to establish a collaborative for children’s and young people’s mental health and facilitate a process to create a new vision for a whole system approach to emotional and mental wellbeing for young people.

Working with Worth-It, a Community Interest Company supporting schools, colleges and organisations on mental health we ran online interactive workshops which brought together over 50 young people, carers, family members, practitioners, managers, clinicians and commissioners to explore together existing experiences of support, design new approaches and create a whole system vision.

At the heart was a fundamental shift in how mental health professionals understood the potential and capacity of young people to support one another - a shift driven by the experiences and voices of young people themselves and by the practitioners who work with them everyday.

Both recognised the central importance of peer relationships in young people’s emotional and mental wellbeing - how poor relationships can affect wellbeing and how peer support is the most relevant and effective way to improvement

“My friends because I feel like I can tell them anything. They won’t judge me, they’ll give me good advice on what to do.” a young person in Tameside & Glossop, describing their support system (7)

The new vision shaped a new set of system outcomes for children’s and young people’s emotional health and wellbeing:

• Growing capacity to support themselves and each other

• Having control of and able to mould support to you and your problem

• Easy & inclusive access into supportive relationships

• Gain awareness and understanding of emotional & mental wellbeing

This is a radical vision, challenging traditional mental health support and instead delivering support through and with young people.

Tameside & Glossop is in the process of commissioning this new approach locally with a collaborative approach of integrated working between diverse providers and a commitment to co-production between practitioners and with young people.

Moving towards such radical visions requires a new system context of collaboration to harness the power of insights and expertise of lived experience. When we create this context, we can shine a light on what is possible and start to create a preventative and sustainable system of support.

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If you’d like to talk to us about Living Well, including developing a programme in your area, then please email lwuk@innovationunit.org and we’d be delighted to start a conversation.

Living Well UK Programme is funded by The National Lottery Community Fund, the largest funder of community activity in the UK.

How does giving up power transform mental health systems? Let's look at real co-production

In the mental health space, we often hear people talking about the use of co-production in relation to practice. What takes more commitment, however, is the leadership and courage to weave co-production into the fabric of a system.

At Living Well, we place co-production at the heart of our programmes - and when we say co-production, we mean co-production - with each stakeholders’ experience and ideas sought and given equal weight as we design new systems for everyone who benefits from, or works in, them.

For some people experiencing poor mental health, it’s the first chance they’ve had to have their voice truly heard; for some professionals and system leaders, it’s the first time they’ve had to give up power. For everyone involved, the unwavering commitment and courage to listen, share and then co-produce is hard - yet the rewards in transforming systems for the long-term are already being reaped.

What is co-production?

Our Living Well programme started some 10 years ago in Lambeth, south London and over the past four years, thanks to The National Lottery Community Fund, we’ve been creating new systems of community mental health in Living Well sites across the UK including Edinburgh, Salford and Tameside and Glossop.

So far the programme has supported some 2,500 people who might not otherwise have been helped and generated over five million pounds of additional investment in local mental health systems - and we’ve recently expanded into Greater Manchester and Derbyshire.

Our depth of experience and expertise in the mental health space means we have significant knowledge of, and capability to manage, the power dynamics at play in co-production.

As a metaphor, to understand the powers at play let’s look at who is on the co-production dance floor and the different tunes being danced to.

You have people and professionals. People, or ‘service users’ are often seen as just that, users of a service with no real power over the service they are experiencing. Professionals can often dance to the tune of rescuers - ‘we are here to help, you have needs and we have expertise’, a compassionate ballad but one that can remove the agency of people to believe they can take action to improve their wellbeing. Added to this is the constant hum of the stigma attached to mental illness.

For professionals, however, the mental health landscape is yet more complicated. Mental Health Trusts bang a loud drum, they are large and have many resources dedicated to this work. In comparison, for the Local Authority, mental health services are only a small percentage of their overall responsibility. And the voluntary sector, a large but fragmented orchestra made up of many small organisations with limited capacity, can find it hard to play in symphony.

From what we’ve learned in Living Well, anyone who wants real co-production needs to help all these people and organisations to play in harmony, on an equal footing.

What is co-production in Living Well?

We know that the process you use to create the future world determines the world you end up in. With commitment and courage, co-production can change relationships, hierarchies and power dynamics - which means there needs to be a congruence between the way that professionals engage with people and the way they engage with each other.

In Living Well the redistribution of power starts with a commitment to honouring and amplifying the voice of lived experience, fostering collaboration and imagination, and supporting professionals to iterate and improve ideas based on real feedback and learning.

Specifically, the shift in professional ‘power’ has been achieved by:

• Moving staff from being fixers who focus on problems to catalysts that focus on working with people, using their abilities and agency to create solutions - and having the courage to know that such reframing could potentially threaten professional experience and expertise

• Embedding agency into the model in every way, for example managing risk with people rather than for them; meeting people where they want to meet; exploring what resources people have to draw upon

• Creating person-centred documentation that defines people by their strengths and needs, rather than their deficits

• Giving people the courage to self-author their care plans so they are in control of their support

• Paying attention to language - ‘people’ not ‘service user’, ‘work with’ not ‘help people to’

• Leaders committing to model an approach which carefully listens to the messages from below, even when they are difficult to hear and genuinely sharing power with each other

So what does co-production look like in practice?

• In Salford, professionals from across the system actively gathered and listened to stories of lived experience then used ‘prototyping labs’ to co-design new ideas with people

• In Lambeth, experts by experience sat alongside system leaders at a local pub at monthly collaborative meetings to make decisions about the future of their mental health system.

• In Edinburgh, there are robust processes to support peer workers who use their lived experience to support others and enable them to develop in their careers

And what can a system look like when people have the permission to work outside of existing power dynamics and professional roles?

• A support meeting between a professional and a person took place while toasting marshmallows around a bonfire

• A mental health nurse fetched their toolbox to help someone fix their fence, because that is what the person needed in that moment

• Grassroots initiatives and lived experience support groups grew after a collaborative decided how grants might be distributed in the local area

Of course, a commitment to co-production must continue in order for change to thrive. Living Well sites have embedded co-production values and mindsets into structures and spaces:

• Bringing different voices together in collaborative spaces to make joint decisions, and where communities have a say over the support that is delivered in their area

• Flattening hierarchies through multidisciplinary teams where staff understand each others’ skills and expand each others’ practice

• Dissolving boundaries between primary and secondary care and voluntary and statutory services through iIntegrated leadership and decision making groups

We’ve learned a great deal from our 10 years in Living Well. Our sites have sought to use co-production to share power, reconfigure permissions and democratise the system, so that staff and citizens are collectively responsible for holding each other to account for a better bolder vision for mental health.

No matter where we work, our starting point remains the same - that a serious commitment to transformation needs the courage to embed co-production in a way that continuously gives power back to those who usually have none.

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If you’d like to talk to us about Living Well, including developing a programme in your area, then please email lwuk@innovationunit.org and we’d be delighted to start a conversation.

Living Well UK Programme is funded by The National Lottery Community Fund, the largest funder of community activity in the UK.

Why is change so hard? Let's explore the human experience of transformation

Over the past four years, we’ve been creating new systems of community mental health in Living Well sites across the UK including Edinburgh, Salford and Tameside and Glossop. So far the programme has supported some 2,500 people who might not otherwise have been helped and generated over five million pounds of additional investment in local mental health systems.

Our story, however, starts 10 years ago when our team worked in partnership with Lambeth, south London, to build the pioneering Living Well approach.

Here we helped establish the initial collaborative group, supported them to develop and implement their radical vision for mental health - and here we started our own learning about the complex, sometimes messy, human experience of transformation.

In this blog, Living Well senior practice lead, Stacey Hemphill, reflects on her experience of, and learning from, transformation.

Being the new kid on the block

When I applied for the job as Triage Worker in the initial ‘go live’ team Lambeth’s Living Well Network Hub, I was hungry to do more to address the systemic problems I could not just see, but feel on a daily basis.

We began as a small fringe initiative with big strategic aspirations - we were the new kids on the block. We were given some permission to work in new ways whilst carrying high expectations for the wider system. We took our learning on the road - sharing our successes and failures. It was great to have an opportunity to talk about change and we felt that we were spreading a sense of hope.

Becoming the lightning rod for the conflict in the system

Challenging the system has its risks. As our vision and learning was increasingly shared across the system, it began to uncover a powerful, but seemingly dangerous idea, that there is more than one way to support people with their mental health. We stopped being simply a curiosity and became a threat - particularly when we started to draw resources away from traditional community mental health team offers.

Learning from Lambeth

Our experience of Lambeth led to our partnership with The National Lottery Community Fund to support sites across the UK to begin their Living Well journey. We have taken what we learned from Lambeth into our sites, creating ways of working that enable others in the system to accept these ‘new kids on the block’ as allies in a wider process of change and to recognise the need for leaders to support people through processes of adaption and integration.

Here are five ideas to build positive relationships throughout the process of transformation, recognising that the human experience needs as much attention as the process itself:

1. Build bridges not walls Cults and cliques feel safe and protected and let you get on with building your version of the world. But any ‘us’ deepens a sense of ‘them’. People need to feel part of the change to own it and take responsibility for it - an experience we heard in our storybook ‘Working for Something Better’ which captured practitioners’ stories of change. In sharing her story, Wendy, Chief Executive of Health in Mind, Edinburgh, described equality of voice and valuing all contributions as being “so important in bringing the different strengths, skills and experiences from each of the organisations involved.”
   

2. Tolerate hostility Those who do the work lead change - and change is often met with hostility as it challenges people’s status and identity. This can come from all parts of the system - from those receiving support, to strategic decision makers. Hostility needs to be met with humility and empathy - a point echoed by Trudy, Luton Live Well Network Coordinator: “Regardless of our backgrounds it's about how we can work together to help this person. It’s really important we have trust and respect for each other.”
   

3. Don’t think you are the only game in town It’s easy to slip into the mindset that our new practice is the best thing since sliced bread and that our way of working is the right and only way everyone should work. This mindset is experienced by others as telling them ‘they are no good and they don’t matter’. Instead our role must be to champion autonomy, diversity and creativity. Reflecting on the shared experience of different organisations prototyping a new service, Linda, Strategic Programme Manager for Mental Health and Wellbeing, Edinburgh said: “It’s given me a greater understanding of change management. It’s given me an opportunity to develop good peer relationships with people outside of my immediate surroundings.”
   

4. You are never the finished article You are never a 10/10. Being defensive about how great you are will only ever exclude people. Telling yourself you are a 2/10 can be motivating and energising. Always striving to learn and develop creates an invitation for people to join you in this learning. It creates a space for people to see themselves in as part of your shared endeavour. As Judd, Assistant Director, Integrated Commissioning in Salford, explained: “I might be in this role, I might be leading it, but I’m not the expert in this.”
   

5. Pace yourself As your new practice starts to demonstrate potential, the demand for you to scale at pace grows. Growing too fast, too soon is one of the greatest mistakes to make. Taking a stepped and paced approach enables you to grow, whilst embedding your new ways of working into the wider system. As Wendy reflected: “There were days when we came away thinking ‘this machine is too big it will never change. I can’t hold the responsibility of making this difference’. Other days we’re all in the same boat and it feels like we can do this!”
   

6. Experiencing the benefits The experience of transformation might be challenging but, as Linda explained, the emerging benefits of change: “... really inspired me to keep going and it really validated a lot of the pain that we had been through. All the endless governance I had to do, writing papers, etc. Ok, so it was all worth it!" “Seeing what it’s been like - really powerful quotes from staff. For example ‘This is why I went into nursing or occupational therapy in the first place …’ and ‘I’m looking forward to coming to work in the morning’.”

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If you’d like to talk to us about Living Well, including developing a programme in your area, then please email lwuk@innovationunit.org and we’d be delighted to start a conversation.

Living Well UK Programme is funded by The National Lottery Community Fund, the largest funder of community activity in the UK.