Access all areas: The role of advocates in supporting young people’s access to mental health services

Access all areas: The role of advocates in supporting young people’s access to mental health services

When seeking support for a mental health condition, young people are often required to navigate a complex system of statutory and voluntary sector services, with considerable waiting times. Barriers to finding out about and accessing relevant mental health services persist, often for those who need them the most. In this blog, Dina Papamichael outlines the potential to learn from existing advocacy models to improve young people’s awareness and take up of various health services.

While this turbulent year has prompted new concern around mental health, the mental health of young people in the UK was deteriorating before the pandemic – probable mental health conditions increased from 10.8% in 2017 to 16% in July 2020 across all age, sex, and ethnic groups [1]. Looking ahead, research from Young Minds has shown that 67% of young people believe that the pandemic will have a long-term negative effect on their mental health [2] . Against this backdrop, it is crucial that young people understand their rights and choices; and face open doors when seeking out support.

A bumpy road to help

The journey from identifying a need for mental health support to accessing appropriate care is often fraught with obstacles. Rocket Science’s recent research for Young Westminster Foundation has highlighted that a significant proportion of young people (43%) find it difficult to find out about mental health services, and an even higher proportion (47%) find it difficult to access services [3]. Even when young people are aware that support is out there, concerns around confidentiality, cost, stigma and waiting times can reduce willingness to engage.

 A wide range of providers and services exist to support young people’s mental health in the UK, including:

  • Local NHS Child and Adolescent Mental Health Services (CAMHS)

  • Voluntary sector services such as Relate or Off the Record

  • Private/independent sector counselling

  • Support provided within schools e.g. by Schools Mental Health Practitioners

  • Primary care – It is estimated that one third of GP appointments involve a mental health component [4]

While many young people can rely on a family member, teacher, or youth worker to help them understand and navigate options for support, this is far from universal. This means that young people can be left in crisis without feeling listened to or empowered to get help.

A need for advocacy

Advocates help young people to navigate complex service landscapes by listening to their needs, helping them to understand their options, accompanying them to appointments or acting on their behalf e.g. writing letters or making phone calls.

The National Standards for the Provision of Children’s Advocacy Services define advocacy as follows: ‘Advocacy is about speaking up for children and young people. Advocacy is about empowering children and young people to make sure that their rights are respected and their views and wishes are heard at all times. Advocacy is about representing the views, wishes and needs of children and young people to decision-makers, and helping them to navigate the system.’ [5]

Examples of existing youth advocacy models within youth justice; mental health recovery settings and homelessness include:

  • Just for Kids Law – Youth Advocates work with young people to help them access legal support and other specialist services they need to resolve issues relating to e.g. housing; immigration and residency status; finance and social services

  • National Youth Advocacy Service – Advocates work within a variety of locked, rehabilitative, and residential mental health recovery settings within the Priory for children and adolescents to help them be actively involved in decisions that affect their care and treatment

  • Coram Voice – Homelessness Outreach Advocates help young people to move into safe housing and access the financial, housing and educational benefits which they are entitled to.

Alongside advocacy services, link workers with a strong knowledge of voluntary sector services are increasingly being used to signpost individuals in the community, reducing a reliance on GPs to keep up with a continuously evolving service landscape.

Learning from existing youth advocacy and link worker models can be used to inform local initiatives which put those most at risk of mental health issues, and least empowered to navigate the system at their core.

Making advocacy work for young people

Established principles for good advocacy services include building up young people’s personal power; working at the individual’s pace and following their instructions; earning trust and being there for a young person; learning from young people’s views to constantly improve [6]. Within a mental health context, it is important that advocacy services are:

Communicative – this includes reaching young people in spaces where they are comfortable and providing clarity on what the advocacy service can offer

  • Simple, equitable and easy to contact – addressing barriers to access and providing options for young people to reach out e.g. email, social media, call or webchat

  • Trauma informed – having an awareness of the prevalence of trauma amongst young people and minimising risks of re-traumatisation

  • Culturally informed – ensuring that young people feel understood and that the advocacy offer is tailored to their needs and experiences

  • Support the transition to adult services – Including young people between 18 – 25 to ensure no one falls through the crack during the transition to adult services

  • Picking up on specific service issues – such as missed appointments or where the level of support they receive isn’t right

Dina Papamichael is a Principal Consultant in our London Office. If you would like more information on our work or how we can help you please get in touch with dina.papamichael@rocketsciencelab.co.uk

Youth in the time of COVID-19: How is the pandemic impacting under 25s?

Youth in the time of COVID-19: How is the pandemic impacting under 25s?

Rocket Science’s training and support for young peer researchers has been an effective method for exploring this cohort’s needs. As the current pandemic causes fundamental shifts in day-to-day life across society, Dina Papamichael examines the current and potential impacts of COVID-19 for those under 25.

Rocket Science’s engagement with young people has shown the unique pressures they face relating to career success, mental health and social media. COVID-19 has disrupted day-to-day life for young people who must now access education and training online; are confronted with insecurity in future employment; and face an indefinite period indoors without their usual connections or routines.

Young people face uncertainty about their education and career prospects

Rocket Science’s pre-COVID-19 research with over 200 young people in one London borough showed that ‘doing well in school or exams’ and ‘getting a job or having a successful career’ were the most frequent areas of worry for 16-25 year olds. The current pandemic is likely to have increased these worries as education provision is shut down (or moved online), workplaces are closed, and recruitment is frozen across sectors. Beyond these immediate impacts, young people face uncertain futures while headlines warn of global recession resulting from COVID-19. Seven in ten 18 to 24 year olds now worry that the coronavirus will harm the job market and cause higher unemployment for a long time [1].

An April 2020 IFS study has highlighted that the current lockdown will hit young workers the hardest:  Employees aged under 25 are about two and a half times more likely to work in a sector that has now shut down (such as non-food retail or hotels) when compared to other employees, with young people who are not living with parents left particularly vulnerable through lost employment. Some at school or college are concerned that their hard work will go to waste as they are not able to sit exams, while others may experience relief from being able to avoid a stressful exam period [2]. There will be disruptions to graduate employment with many employers now reporting that they will be recruiting fewer entry-level employees as a result of COVID-19 [3].

Social distancing has disrupted regular social engagement and routines

Young people are being asked to stay at home for the foreseeable future, and while 83% of over 65s feel positive about their living situation at this time, only 56% of 18-24 year olds feel this way [4]. In an open letter to the Government, several youth organisations have outlined concern that despite the best efforts of youth organisations, young people at present do not have access to the range of sports, arts and social activities that they would usually have through youth services [5]. While many young people are staying connected through social media and video calling apps, not all youth have digital access, and this can leave the most vulnerable further isolated [6].

Rocket Science’s recent youth consultation demonstrated that 16-25 year olds do not generally see social media as having a negative impact on their lives. They described growing up with social media and feelings of knowing how to safely navigate online spaces. Despite this, over half of young people stated that they would want to spend less time on social mediaWhile social distancing measures are enforced, young people face unlimited screen time as their phones become their primary method of staying connected. In this context, young people are being advised to limit time spent checking the news and ensure that they are following positive online content to prevent low mood [7].

Existing mental health needs will likely be exacerbated in the current climate, but support is available

Mental health issues amongst young people are prevalent: one in 10 primary school children, one in seven 11-16 year olds, and one in six 17 to 19 year olds experience mental health difficulties in the UK [8]. Many young people with existing mental health issues including (but not limited to) anxiety, depression, a panic disorder or eating disorder are likely to find the current pandemic particularly challenging. While access to face-to-face mental health support is limited, a range of online chat or text support services are available including The Mix, Shout and Beat Eating Disorders.

Young people are well equipped to navigate online spaces; however, it will be essential that services extend their offer to those who have previously relied on in-person support. Boosted funding to online support services will be important in light of increasing demand – for example, Beat Eating Disorders has reported a 30% increase in use of their services during the current crisis. Charities and funders have been quick to collaborate and respond to the crisis – for example, UK Youth have released a range of resources, #iwill are inviting organisations to share information about their responses to the pandemic and the London Community Response Fund has been made available to support organisations responding to the needs of communities affected by the current crisis.

How can youth organisations successfully adapt during the current pandemic?

Youth organisations can adopt a range of approaches to best meet the needs of under 25s during and after COVID-19 including:

  • Moving face-to-face services online utilising the apps and software that young people are comfortable accessing, ensuring appropriate safeguarding arrangements are in place
  • Promoting and facilitating peer support (particularly in light of increased demand for services and limits to youth worker staff capacity)
  • Collating and sharing updated resources as they become available (for example, government guidelines or advice on wellbeing)
  • Engaging directly with and empowering young people to co-design adapted youth services and content
  • Providing additional support in translating policies that will impact young people into language that is easy to understand, for example benefit changes and legislation relating to housing
  • Encouraging the use of this time for skills development, for example promoting online learning opportunities and providing templates for young people to plan their next career steps
  • Gathering feedback and recording learning points throughout this period to support post-COVID-19 service improvements, for example around the types of online content most frequently sought by young people and the extent to which face-to-face services can be effectively provided online.

Dina is a Senior Consultant at Rocket Science. For more info about our research with young people, please get in touch at dina.papamichael@rocketsciencelab.co.uk

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Can trauma informed practice transform the criminal justice system?

Can trauma informed practice transform the criminal justice system?

In this blog, Dina Papamichael explores the relationship between experience of trauma and involvement in the criminal justice system; and outlines the emerging approaches from Scotland which have potential to transform justice outcomes across the UK. 

Links between childhood adversity, trauma and involvement in the criminal justice system are well evidenced. Those with four or more adverse childhood experiences (ACEs) are significantly more likely to be a victim of violence; perpetrator of violence; and be incarcerated during their lifetime. Experience of prolonged stress in childhood can disrupt healthy brain development and lead to risk-taking and offending in adulthood. Amongst those in prison in Scotland, just under half report personal experience of violence in their home as a child and 80% of those in prison in Wales report at least 1 ACE.

Links between adversity and offending can be broken

The association between childhood adversity and involvement in the criminal justice system informs two essential types of initiatives:

1. Recognising the impact of ACEs and trauma on individuals to prevent initial experience of the criminal justice system

2. Providing trauma informed interventions to those who already have experience of the criminal justice system to ensure risks of re-traumatisation are minimised.

In implementing these approaches, there is a need to ensure that those with ACEs are not stigmatised through implications that childhood adversity is inevitably associated with involvement with the criminal justice system.

There is a need to prevent initial involvement in the criminal justice system

Criminal justice processes such as being arrested, going to court and being imprisoned are often traumatising in themselves and should be avoided altogether wherever possible. Several innovative approaches which seek to understand the behaviours associated with adversity and reduce the likelihood of offending can be pursued:

Ensuring that at risk young people are not excluded from early crucial support: The Interventions for Vulnerable Youth (IVY) project is based at the Centre for Youth and Criminal Justice at Strathclyde University. It seeks to prevent offending amongst high risk youth by acknowledging and addressing traumatic experience, and providing risk assessment and treatment

• Extending support to the children of those with mental illness or problem alcohol or drug use: Having a parent with mental illness or problem alcohol

or drug use are types of childhood adversity. Health and care professionals can adopt holistic approaches which consider the whole family’s needs and extend support to children

Finding innovative ways to access those who may not be already linked in with support: Violence Reduction Unit Scotland’s Navigators reach out to those with traumatic injuries in accident and emergency departments to explore which support is needed to reduce the impact of violence on their lives.

Developing safe environments, promoting resilience and avoiding re-traumatisation are crucial for those with experience of the criminal justice system

When supporting those who have past or current involvement in the criminal justice system, services can be mindful of traumatic experience and take steps to build trust, reduce barriers to access and avoid re-traumatisation:

• Developing supportive, safe and trusting environments: Tomorrow’s Women Glasgow is a multi-agency centre which provides a wide variety of services to address the needs of women involved in the criminal justice system. The centre’s approach is trauma informed in that it prioritises safety, collaboration and trust for those accessing it. Services are offered in a low security environment which is important for supporting women to feel at ease and has not led to any increased risk for staff or other clients

• Equipping individuals with strategies to cope with the effects of trauma to support their resilience: Courses such as Survive and Thrive which explain the effects of complex trauma and provide coping strategies can be adapted for use in prison settings. This approach has been shown to lead to reductions in symptoms of anxiety and depression amongst clients

• Supporting staff to be mindful of trauma when interacting with clients: Staff working in criminal justice and related services can be provided with training on the behaviours associated with trauma, creating trauma informed environments and avoiding re-traumatisation.

Overall, the current climate of growing recognition around the impacts of adversity and trauma provides an opportune moment for innovation and collaboration in approaches to criminal justice. A growing body of evidence from trialled Scottish initiatives can be drawn on to inform trauma informed approaches across the UK.  

Dina is a Consultant in our London Office. For more information about our work in trauma informed practice and criminal justice, get in touch on 020 7253 6289