If actions truly speak louder than words, then the skyrocketing number of children presenting to Child and Adolescent Mental Health Services (CAMHS) could not be clearer: our younger generation are not ok. Intuitively, it’s not difficult to understand why. The impact of the pandemic and months of missed school, the stress and uncertainty of the rising cost of living, the ever-looming urgency of the climate crisis… times are tough for many parents and their children. The ongoing ‘pressure trifecta’ on CAMHS (workforce challenge, limited resource, and escalating demand) leaves mental health support for children fragmented and reactive as services pull down the hatches and focus on children in crisis, leaving many without any support at all. With no clear route for improvement, trust that the system can adequately respond to the needs of children is at an all-time low.
Shifting the power
What can we do? The truth is that for mental health services to deliver for the young people who need them, the current crisis-orientated approach must be challenged. One route forward is co-production: putting young people in the driving seat of service change. Co-production is rooted in the principle that those in need of a service are best placed to decide what that service should look like. And indeed, when we asked one of the young researchers working on our Kailo project – an initiative aimed at addressing the root causes of young people’s mental ill health – what she felt made it unique, she replied “We listen to [young people] instead of presenting them with what we think is best for them”. Simple, straightforward, sincere; right?
Partnering young people with system change-makers
In practice, genuine co-production can be much trickier than it sounds. We’ve heard for years about the importance of co-production for mental health services, but what does it actually mean to listen to the voices of young people? And should they really be in a driving seat, of any kind? The answer is yes, kind of: our young people are closer to the things that are wrong in their lives, and thoughtful, collaborative approaches can help them to describe that need in a way that the system can get hold of. But as adults we need to be careful that in championing co-production, we don’t sub-contract out our own responsibilities in leading and delivering change for our youngest generations. It is much more about shifting the power dynamics so that young people become more visible and more genuinely respected in their views about what change is needed and how that change should occur.
Bringing our sharpest minds and strongest leaders to this space reveals novel opportunities to do this well. This is exactly the approach that Kailo takes, with a partnership of leading scientists, designers and practitioners working alongside young people and their communities to co-design strategies that address the underlying drivers of mental ill health in their area. The strategies and activities are underpinned by the latest scientific evidence around adolescent mental health promotion, tailored to address local needs and contexts. This not only allows for our young people to be seen and heard but simultaneously strengthens community assets in being able to respond and work alongside them.
Finding innovative solutions and targeting underserved groups
Of course, whilst co-production is vitally important, it’s just one part of the picture. Alongside this work, there is a great need for research and innovation in those parts of the system where mental health related distress is greatest, either because of particularly high demand, unmet need, or hidden complexity. Rapid, targeted innovation solutions for prioritised pathways will help reduce demand on the system and improve outcomes and experiences for those cohorts least served by the current system. But we still need co-production elements for this kind of work, otherwise ‘solutions’ risk missing the cause in favour of the symptom. In these instances, other involvement methodologies may be better placed to balance the need for pace with lived experience feedback.
The proof is in the data
Co-production is built into the blueprint for Integrated Care Systems. If actualised, they provide us with the first genuine opportunity to nurture and grow the insights of young people by making it easier to work across organisational boundaries and to a more united, population-health level agenda. We’ve seen early signs of this new way of working already in the work of the Kailo project, with support pledged from local authorities, healthcare providers and voluntary organisations.
It is our hope that by listening to young people’s voices now, we will empower children, young people and their families to be better equipped to influence their mental health, care and outcomes, paving the way for our future generations to thrive in an increasingly complex world.