Why is focusing on relationships vital to improving young people’s mental health and wellbeing?

How young people’s relationships with trusted adults and peers can help them to flourish.

In mental health, as in other areas of public and charity sectors, we tend to think in terms of 'services'.

In the young people’s mental health and wellbeing sector, we often find ourselves speaking about Child and Adolescent Mental Health Services (CAMHS) as if they were synonymous with the needs of young people. There is often a belief that only those with pronounced mental health difficulties will find their way to CAMHS, and that using CAMHS is evidence of having pronounced needs. Generally speaking, CAMHS is a series of medically informed services based upon a therapeutic health-based model. As part of the NHS, it has grown and changed over time but still remains within that model.

In contrast, Right Here, a national programme managed by Paul Hamlyn Foundation and the Mental Health Foundation, was conceived to try and develop new forms of cross-sector work to support and develop young people’s mental health and wellbeing. It firmly placed the non-medical youth work-led sector in the driving seat of four regional partnerships and aimed to ask how new approaches to young people’s mental health and wellbeing might be developed and evaluated. Reflecting young people’s wishes to be seen not as patients but as individuals, the four regional partnerships – in Brighton and Hove, Fermanagh, Newham, and Sheffield – used personal development, youth involvement and activity-based interactions to help young people better understand – and, for some, improve – their mental health and wellbeing.

This emphasis on youth work-led approaches was intentional, as the programme sought to achieve things that existing service models couldn’t or didn’t. Young people’s dissatisfaction with those models and their desire for support and help early on, from the people they trust, was part of the impetus for Right Here. Over the lifetime of the five-year programme, it became clear that it was the relationships formed through young people delivering Right Here activities and opportunities to their peers and with youth workers that made the biggest difference to many of the young people involved.

What did Right Here find out?

Right Here successfully combined youth work with mental health expertise, resulting in shifts in understanding and the implementation of new approaches. Experienced youth workers added value to each element of their project. They reached out to and supported young people to take part, and facilitated a wide range of enjoyable, physical and creative activities with built-in mental health promotion (many were developed with the young people themselves).

The youth workers stood behind young people as they took their messages and ideas to commissioners and others.

Relationships grow from repeated exposure, trust, constancy and reciprocity. It can sometimes be transformational simply to find in another person someone who remains a point of constancy when other areas of your life are in flux. Finding someone who is interested in you as a person, rather than as a patient or client, can be revelatory for young people who have had difficult lives.

This focus on individual relationships is often an aspiration for mental health services but is the basis of youth work. Organisational pressures and a focus on services often work against the establishment of long-term stable relationships with professionals. Different professionals may be with a young person for different parts of their journey through a service. The role of that professional is often a specialist one related to meeting a particular treatment need; once that need is met, the professional’s role in that young person’s life is finished. As such, the time to talk and to be together is often not there. Such time is fundamental to youth work, however. As one worker told the Institute for Voluntary Action (IVAR) team evaluating Right Here: “Everything about youth work is fundamentally about having a positive relationship with the young person. You can’t do youth work without that really. It’s the core. If they don’t feel OK with that worker, if they don’t feel they can talk to them, that will be the thing that will break the effectiveness of anything you are doing more than everything else. It’s human, isn’t it? Sometimes I feel that people have got so service-focused that they have forgotten that all of this is about human interaction.”

The IVAR evaluation notes that for some of the young people involved in Right Here, the quality of the relationships made with the youth or key workers (and with each other) was the transformational element of the project.

More broadly, IVAR concluded that it was the social contact that often made the difference for young people: "We learned that many of the young people who became Right Here 'regulars', participating in a blend of activities and volunteering over time, had been isolated, lonely, without a friendship group and experiencing difficulties in their relationships with parents and relatives. Young people said that the warmth and companionship of Right Here had enabled them to grow and develop relationships with their peers (sometimes blossoming into friendships), to 'find their voice' so that they were able to speak to new people, and to make some changes in family relationships. One project worker explained: 'They have created friendships and groups for the first time. Many have been quite isolated. They have been able to discuss their issues, they have formed a network.'""

What can we conclude?

With relationships at the core of youth work practice, Right Here found that it provided something for young people that they otherwise might not have been able to access.

While mental health treatment may be vital to removing barriers for young people looking to find ways of moving their lives forward, it is the opportunity to be involved in activities and relationships that is such treatment’s natural companion.

By supercharging existing youth work by adding a mental health focus, Right Here found that it was possible to help young people forge relationships with both adults and their peers. These relationships provided the springboard for these young people to begin to flourish in a way that other forms of support had not.

The strength of this finding is that already-existing youth work can be used as a foundation upon which additional mental health and wellbeing knowledge and practice can be developed. At a time when young people find themselves under increasing pressure and living through times of growing uncertainty, the value of mental health and wellbeing-informed youth work may prove vital in providing supportive spaces and relationships where young people can grow and learn.

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