What do young people's services mean to young people?
Mark Brown from Social Spider reflects on the findings of a small research study into what young people felt about their involvement in the Right Here programme.
What happens if you begin to capture what a mental health and wellbeing project means in the context of people’s lives?
Right Here, the national five-year £6 million Paul Hamlyn Foundation/Mental Health Foundation initiative to develop new approaches to supporting the mental health and wellbeing of young people aged 16-25 did just that.
The Institute for Voluntary Action Research (IVAR) carried out the process of evaluation of Right Here (PDF), looking at the structures, processes and operation of the partnership between the two foundations and of the foundations’ partnerships with the four Right Here projects (Brighton and Hove, Fermanagh, Newham and Sheffield), each of whom delivered a variety of activities and opportunities, involving young people as decision-makers, commissioners and participants. The process evaluation also looked at at the role of young people in the projects and the initiative as a whole.
IVAR spoke to young people involved in the Right Here projects in a combination of focus groups and less controlled situations. IVAR found that their view of what the opportunities and projects mean to them revealed a number of ways in which the Right Here model of engagement and co-production generated value over and above providing a more traditional service.
These comments made by young people were so striking that IVAR compiled them into a report, entitled Right Here Evaluation: Young people’s perceptions of how the Right Here programme has helped them.
The comments collected by IVAR suggest that community-based projects provide flexibility and sociability and lessen power imbalances, and this is vital in offsetting the existing and continuing power imbalances present in other services. Young people volunteering their views were emotionally affected by services in a way of which services themselves are perhaps not aware. These comments comprised not only a complex picture of what being involved with a participatory project ‘means’ but also a critique of ways in which services have traditionally been delivered.
Emotional meaning vs. executing a function
Any service has an emotional impact, including those delivered in impersonal, inflexible and function-driven ways. It is often overlooked that any service is also a physical space; a set of relationships and part of the narrative of a person’s life. The experience of using a service or taking advantage of an opportunity is not just having a function executed on your behalf or for your benefit. While a service may be executing its function efficiently, this might not feel the same to its users, who might not feel that it is making their lives better.
Outside of Right Here, the young people IVAR spoke to appeared to expect that their views will not be taken seriously and that they would have minimal influence over events and activities delivered to them. Those who have had experience of mental ill-health seem to find it an isolating experience leading to self-limiting and negative ideas about the potential of the world to deliver fulfilment and opportunity.
Said one young person:
"The fact that you are taking young people from the streets and giving them choices is really amazing. Children and young people as a whole round here are normally quite brushed off. Adults don’t take on board what they say. That’s silly Children are the future."
Agency, ownership and respect
There is a difference between being involved by choice in a project where your ownership of that project can influence its outcome and being a willing or unwilling passive recipient of a service. While there are many situations where a client relationship to a service is entirely appropriate, projects that intend to empower and build resilience require something different - a greater sense of agency and ownership.
The young people indicated to IVAR a level of ownership over the Right Here projects:
"I think that I have done quite a lot with [name of activity] in the short space of time I have been here. I would like to think I have moved it on a bit."
Some of those who offered views indicated a kind of reciprocity where effort from young people was mirrored by effort from staff, especially where the opportunity to take leadership of tasks was offered:
"I’ve tried my best and I’ve been in a lot of groups before. This group is different – I’m a volunteer and take on a slight leadership role… I feel like I have tried my real best with this."
Says IVAR of this:
"Several young people mentioned that Right Here had given them a sense of being listened to, which seemed for some a novel experience. It is possible that this in turn was beginning to help re-frame their expectations of what the world could bring and how they would be treated...Certainly many of them were pleased and even incredulous at the attention and respect they had received."
"For me it has been a real big booster," said one young person. "The project has done so much for me, I can’t thank them enough, especially the workers - they are amazing. Any ideas that come out of your head they take them into account."
The sense of being respected by peers and by professionals is essential for dignity and trust.
Building social capital
The treatment model of mental health services provides little opportunity for building social capital. The patient attends the treatment opportunity alone, meets with a medical professional for some kind of therapeutic experience, then leaves, again, alone. This model tends to see the path to wellbeing as involving the fixing of the interior life of the individual so that they may better take on the exterior challenges of life. The model is not well-suited to generating changes in the exterior lives of the people it touches. It can help people to be ready for new relationships but it cannot generate them.
Being involved in a project based on working with and alongside other people exposes a person to new thoughts, new experiences and new views. The opportunity to come into a space where mental health and wellbeing are openly discussed and contextualised can help an individual to understand their own condition more clearly.
The comments of the young people interviewed placed a strong emphasis on Right Here as a means of meeting and getting to know people, indicating that working together for a shared purpose generates valuable social capital through friendship, kinship and peer fellow-feeling:
"The best thing I have got out of all this is that I have gained a lot of confidence. I am meeting new people and friends and at the same time learning about mental health as well. I’m talking about things I wouldn’t otherwise have talked about."
"The big challenges for me before were talking to strangers. And also I used to not be able to go on public transport. I used to be very nervous about that, and about public spaces. But that’s getting better. And I’m realising it’s not just me who feels like this."
Building new social connections seems to have contributed to the ‘opening out’ of the horizons for some of the young people involved, especially those who have travelled to visit either national Right Here events or those who have visited other Right Here regions:
"You learn to accept how you are and where you live. I realize from going away that there are positives to coming from Newham…. It has opened my eyes to living in the world."
"Right Here seemed to be providing a step out [for young people] of feeling stuck in their lives. Interviewees spoke about the fact that they felt that their options were limited, and that this had begun to open their eyes to what else might be possible."
The IVAR report quotes a number of interviewees testifying to the change in their own sense of personal resilience:
"I really feel better. My community psychiatric nurse was talking about the last four years, and said that they had really noticed the difference in my confidence and my talking. Those have been the biggest improvements, I think. I would have been wary of talking to you two years ago, but it doesn’t seem so scary now. I also seem to have more energy. I am not afraid to go out and do activities. I was locking myself away. My hope for myself is to move to Australia. And I haven’t given up on that yet, I am hoping some day that I will have the confidence and the will to go and do it."
"Alchemising bad experiences"
For some of the young people who expressed views, the opportunity to be involved with a project that both listens to them and their experiences and which provides an opportunity to influence future activities was a way of using previous negative experiences to make positive things happens. Say IVAR: "Several young people spoke about having had, or having witnessed, negative experiences of health services. For them, part of the benefit of Right Here was that it was alchemising that negative experience into something positive." IVAR refers to this as Right Here providing an opportunity to‘re-script’ experiences of health and support services. For some of those involved, Right Here has acted as a corrective to previous experiences of feeling disempowered and devalued by services.
One of the most challenging ideas coming from comments collected by IVAR is that non-medical mental health and wellbeing projects are not simply filling in the gaps between statutory, outcome-driven or function-driven services but actively involved in helping to repair or correct some of the unintended emotional or experiential damage caused by their activities. This damage, such as an experience of bad care or professional indifference, can lead to cynicism and despair. As some of the young people attest, given the right space and the right context of support, it can also help to drive positive actions:
Said one young person:
"I have had a few bad experiences of mental health myself, and services – that’s why I do this. I have got stuff out of it, they have kept me involved, now I want to go on being engaged."
"I suffer from depression myself. There was never anything to help me and nobody knew what to do. Everything I did to get better was down to me. So this is about getting other people information, talking through things."
Similar sentiments are expressed by a third:
"One of the best things for me about Right Here is that you help more people… you have got more of a national influence. If you help more people you feel good about yourself. It helps you feel better."
So what does this tell us about services?
While the sample of young people is small in the IVAR report, it captures something fundamental, which is applicable equally to adult services. Right Here has a general ethos of involvement in the programme and a strong feeling that it ‘belongs’ to the young people involved in contrast to experiences of statutory services when young people are clients, rather than partners in service delivery. When we commission, plan or deliver services we have numerous opportunities to make sure that they generate optimism, create social capital and either repair or at least do not compound the damage that may have been inflicted by previous involvement with services.
Two questions, both sizeable, are:
- Is it possible to capture robust evidence of social capital-building, horizon-shifting and the restoration of resilience and hope?
- How do we convince those who hold the purse strings – who to date overwhelmingly fund services that are function-driven – to recognise the value of projects that take place outside of the traditional medical boundaries?
The current period is one of redefinition of the relationship between health and social care and of shifting boundaries of responsibility and strategic leadership. The spectre of 'efficiency savings' hovers ready to pare back services to essential functions. Who will make the case for the vital role for organisations - led and steered by the kinds of people to whom they provide services – in helping young people develop, grow, make relationships, build resilience and, if they need to, recover from their experiences with other services?