How can the development of youth work-led mental health and wellbeing projects be supported?

What Right Here learnt about creating, funding, managing, evaluating, and nurturing effective youth work-led mental health and wellbeing projects.

Right Here was a young people’s mental health and wellbeing programme developed and managed by Paul Hamlyn Foundation and the Mental Health Foundation that ran from 2009 to 2014. 

It funded four local partnerships – in Brighton and Hove, Fermanagh, the London Borough of Newham, and Sheffield – which worked with young people to co-produce and deliver a range of mental health and wellbeing activities, projects, research and opportunities.

The independent evaluation of Right Here, undertaken by the Institute for Voluntary Action Research (IVAR), provided a number of insights into how youth work-led young people’s mental health and wellbeing projects can be developed and nurtured.

The Right Here approach was about working with young people to develop opportunities that help them and others to make progress in terms of their mental health and wellbeing. If you give young people the opportunity, they will often point out the gaps in existing young people’s services and how they might be filled. Right Here demonstrated that this thirst for change can make young people strong partners in improving mental health and wellbeing for themselves and others.

First and foremost, the Right Here approach requires commissioners and funders to recognise and want to do something about the gaps in services that young people have identified. It is about aligning commissioners and a responsibility for the young with the desire that exists among young people for change and for better mental health for young people.

The question is, what more is needed to make co-produced, mental health-informed youth work happen?

What did Right Here learn?

Local vision

In the five years in which Right Here operated, it became clear that a strong local vision for young people’s health and wellbeing was vital. In the areas where NHS commissioners, local authorities, voluntary sector bodies and young people initially agreed on a direction of travel for young people’s mental health and wellbeing, the foundations were laid for mental health-informed youth work to flourish. Involving young people in thinking through the changes to be achieved was seen as critical, and the earlier this happened, the better. As IVAR noted: “Future initiatives might benefit from thinking less about youth participation in fixed structures and more about enabling young people to decide what they want to achieve and where they might best put their efforts in order to exert influence.”

In areas where this early, collective agreement hadn’t happened, project stakeholders had to invest much more time in managing differences within the partnership, including between the young stakeholders and others, and in trying to make the case for their work to local decision makers.

Find the right young people – work with the enthusiasts

The Right Here partnerships benefited greatly from having a core group of young people who wanted to make things happen.

Indeed, the very first building block for establishing young people-led mental health-informed youth work should be identifying young people who want to make changes in the subject of mental health and wellbeing, and who may already be doing so. Having a group of committed young enthusiasts is essential for the necessary co-production to develop appropriate and accessible services and opportunities for other young people. When this approach works well, some of the young people who have been involved from the start will stay involved, growing into roles and responsibilities, including paid work, as the project evolves.

Get the right youth work organisation

Youth work organisations with a strong local position and good local knowledge will be the best seedbeds for approaches like that of Right Here. They will use their knowledge and connections to reach out to young people where they are, and to spread practice and knowledge. Youth work organisations also need to walk the walk of being young-people friendly and need to balance experience in reaching out to young people with a willingness to think about ways that mental health outcomes can be maximised.

As IVAR’s evaluation of Right Here found, merging youth work and mental health works best where organisations have highly experienced youth workers who are “mostly conversant with theory as well as practice in their own field, and able to assimilate learning from mental health practice into their own reflective practice”. This subtle infusion of mental health expertise into youth work practice gives youth workers much-needed confidence in their work to support young people’s mental health and wellbeing, as “youth workers could now give this element of their work a name and value it”, and helps them to think differently about “the boundaries between youth work and other forms of support (for example, delineating group work and individual therapies and findings ways to enable young people to move between these)”.

Provide access to mental health knowledge

Originally, it was hoped that Right Here would create long-term partnerships between NHS mental health services and youth charities, and this would facilitate an exchange of skills and knowledge, helping youth organisations to do their work even better and mental health professionals to loosen up and do things in a more youth-friendly way. While these formal partnerships did not materialise, the lead charities in each local Right Here partnership did access training on a range of topics from mental health professionals, including from NHS Child and Adolescent Mental Health Service (CAMHS) professionals. The charities valued this input both in terms of their day-to-day practice with young people and support for their workers, and in terms of providing an overall framework “which a clinical model offered them, particularly in relation to assessing and explaining the outcomes of their work”.

According to IVAR, one of the key benefits of this exchange between mental health professionals and youth workers was that “mental health work got reframed in the context of activities which approached the subject of mental health more obliquely, which young people found useful in all four projects and which project workers appreciated”.

It is a vital task for any commissioner or funder of such work in the future to work out exactly what additional mental health input youth work organisations need to deliver better mental health and wellbeing outcomes for young people in their area.

Get the structures right

PHF’s principal stipulations for funding local partnerships were: (a) a common structure, a youth panel, for the involvement of young people in the governance and delivery of the local partnerships; and (b) that applicants must build a partnership of voluntary and statutory youth and mental health organisations (even if one did not exist) to oversee the project, encouraging multi-sector ‘buy-in’ and potentially helping secure local funding for the work. PHF stipulated that a youth work organisation should be the lead partner in this relationship.

By the end of 2010, the first year of delivery for the projects, it was clear that the youth panel idea was not working as well as expected. This prompted a change in emphasis. To use IVAR’s words, there was “a relaxation of the expectations around youth panels in local projects to encompass a wider range of participatory approaches than the original ‘blueprint’ set out at the beginning of Right Here. Practically, this meant that local involvement strategies that did not involve a formally recognised panel were accepted as valid... By the summer of 2011, the youth panels became more activity-based with less of a focus on governance and decision making… By the end of the initiative, the projects felt that these adapted participation processes had worked well and ‘that young people had become an integral part of the projects’.”

PHF’s requirement for a particular kind of partnership working draws a more mixed picture from IVAR. On the one hand, IVAR reflected that “in the context of considerable upheaval across local services in both sectors [voluntary and statutory], participants highlighted the positive contribution of Right Here to the retention of a commitment to cross-sector partnership”. According to IVAR, this commitment enabled useful dialogue between the mental health and youth work sectors and an acknowledgement of what the voluntary sector has to offer. On the other hand, in a report of a learning event attended by the projects and foundation staff, IVAR reflects that more thought should have been given at an early stage to thinking through the type of partnership needed to carry out the work, as well as to the development support needed to help each partnership grow. Most tellingly, IVAR states: “It was a mistake to make formalised partnerships [between lead voluntary sector organisations and key public bodies] a prerequisite for the award. Rather, with the benefit of hindsight, joint exploration of existing and potential future partnerships with applicants might have been a more fruitful approach.” This advice is particularly pertinent to those local partnerships where the bidding organisations only came together during the application process and which consequently faced significant challenges ironing out the terms of their partnership as the work unfolded.

Overall, the learning from Right Here suggests that it is better to focus on ways to enable and support the development of structures that are suited to the goals and activities of the initiative and which can ‘get the job done’. These structures may need to be adapted as circumstances change during the lifetime of a project. This process of evolution should be welcomed as long as sufficient thought has been given to the design and suitability of alternative arrangements.

Back experimentation

Co-production is challenging to traditional methods of working. You are commissioning a process by which outcomes are created. This can feel like a jump into the dark, both for youth work organisations and for the bodies funding them. Instead of devising a service specification and a toolkit for service implementation, this method of working requires a shared commitment to a theory of change and the time and means to experiment, learn and adapt.

Evaluation is crucial to this process, as is the right relationship between funders and funded projects.

IVAR’s evaluation of Right Here makes clear that while the long-term nature of the Right Here funding enabled the projects to maintain focus on their aims in spite of the upheaval taking place across health and social care, more could have been done to foster innovation and experimentation.

Specifically, IVAR found that:

  • The style of impact evaluation the foundations originally commissioned from the Tavistock Institute left “insufficient scope for reflection and adaptation as the initiative unfolded, and local projects were unable to benefit from the support of their evaluator because the focus was on eliciting impact data rather than supporting development. Moreover, some of the projects’ aims and activities were not well suited to a standardised approach to outcomes measurement.”
  • The foundations’ oversight and management of the initiative “could sometimes constrain rather than foster innovation and exploration. Although the funding was for five years, both the central initiative team and the local projects seemed to have felt under pressure to demonstrate results from the start and annually.”

IVAR concluded that, in the future, it “might be helpful to adopt a more collaborative approach to evaluation design, drawing in practitioners and evaluators, to ensure that there is a better fit between purpose and method. With Right Here, such an approach might have helped to shift the focus of the evaluation from trying to prove a theory through the local projects to learning about approaches from the ground up.”

IVAR also underlined the importance of giving due consideration to the purpose, design and implementation of arrangements for extra funding support, ‘funding plus’.

Commissioning co-produced projects is an exercise in trust that requires funders and funded projects to be honest with each other and to be flexible. Funded projects need to feel able to discuss challenges with funders in an open and mature fashion. The central management of Right Here tried to walk the line between focusing on overall programme goals and encouraging local partnerships to work iteratively. However, with the perceived pressure for early results and the need to report to Paul Hamlyn Foundation trustees on their investment, the central Right Here team sometimes erred too much on the side of performance management and did not always give the projects sufficient space to do things their own way and to think, learn and grow.

Be aware of power

Co-production and power are intimately linked and failure to acknowledge this can, as IVAR noted, create challenges for the funder and the people doing the funded work. IVAR identified three power relationships that affected the Right Here projects but were not adequately addressed or acknowledged:

  • Power dynamics within local partnerships, where the voluntary sector lead did not always have the experience or the confidence to lead the project with public sector and other voluntary sector partners.
  • Attitudes to young people’s involvement. “For some adults engaged in Right Here locally and nationally, the power of youth panels (for example, in Right Here Newham) felt disempowering or unsettling.” Other adults seemed to be more comfortable with young people’s involvement and there was a group that used their apparent understanding of young people to wield power over others. “If youth participation is the central premise of the initiative, you can always use it as a trump card.”
  • How the behaviour of the central team/the funders affected local activity and behaviour. IVAR cites the example of an apparent drive for outputs (high numbers of activities and participants) coming from the funders, which was at odds with the intensive working with small numbers that the projects could see was reaping the most benefits.

In each case, the gap between expectation and reality was never adequately acknowledged, and this created tensions and affected relationships, making co-production more difficult.

It is likely too that the funders’ and lead partners’ holding of the resources sometimes created power relationships that worked against honest discussion, with projects and partners not wishing to disclose problems for fear that resources might be withdrawn.

Of course, when funding is involved it will never be possible to completely dispel imbalances of power, but it is possible to go into the process aware of some of the potential challenges that may arise and with a willingness to acknowledge and work through these challenges.

What can we conclude?

As with the activities that the local partnerships delivered for young people, Right Here found that relationships and local knowledge are the bedrock for delivering youth work-led mental health.

Starting from existing relationships and local activists, and making available additional mental health support, knowledge and advice, can help mature and reflective local youth work organisations – both voluntary and statutory – deliver mental health outcomes.

Working with young people to help them define activities and outcomes requires a flexible approach from funders and commissioners. This flexibility needs to be built into any commissioning or funding from the beginning of the relationship. ‘Tick-box’ reporting is not appropriate to this form of work, but it is necessary from the outset to build a mature, open relationship between those funding the activity and those delivering it.

Not all activities and approaches will work immediately, nor will all experiments prove to be successful. It is vital that evaluation is not simply the monitoring of contracted agreements, but also a process built on collaboration with funded projects that can guide them in their future actions as well as capturing data for the funder or commissioner.

Trusting in the potential of young people and organisations to develop ideas and services that meet local needs underpins much of the learning from Right Here. The opportunity for young people to grow, adapt and change through their involvement in Right Here activities was paralleled by the realisation that organisations and partnerships often had to go through the same kinds of development.

Learning where, when and how to add additional resources, both in terms of knowledge and funding, to maximise possible mental health and wellbeing outcomes for young people is a vital challenge at a time when young people’s mental health and wellbeing is increasingly a focus for national debate. In conditions where demand for young people’s mental health services are rising during a period of increasing pressure on public resources overall, the Right Here approach to young people’s mental health and wellbeing presents a path to be explored by others.

Finding ways to further develop and build on the aspirations of young people for change in the area of mental health, and to further resource and develop youth work as another means of supporting young people’s mental health and wellbeing, may be a better way of utilising existing local resources.

Working with what we have and enabling that to grow is an approach to managing, evaluating and commissioning that is both pragmatic and likely to deliver great outcomes for young people, as Right Here found.

Read more about Right Here and making youth work led mental health for young people a reality.