Mental health is complex and critical. As well as tackling the stigma associated with talking about it and seeking help, there is the spectre of unmet demand which we know can lead to unnecessary suffering as issues escalate and require more intensive and expensive treatment. If we are serious about tackling mental health for everyone then we have to start early and we have to focus on choice.
It seems an obvious point but choice is key here. Offering a range of therapeutic approaches and building a healthy therapeutic environment around a young person gives us the best chance of getting them the support they need.
This is all part of addressing mental health holistically rather than applying one solution. As Dr Terry Hanley, programme director of the doctorate in counselling psychology at the University of Manchester, has often commented, in mental health one size does not fit all. We need to be more creative in our approach and we need to listen closely to what young people want.
Because to meet demand, we must be able to meet need.
This need may be met through the provision of psycho-educational material and self-help resources. It may be that a child or young person wants to use a goal-setting or mood-tracking tool to help them better understand and navigate their way through feelings of anxiety or depression. It may be that they need counselling with a professional therapist who can offer them a variety of approaches: from talking and music, to drama or art-based therapy.
There are many other important components to a therapeutic environment. One is a young person’s friendship group. We know young people are influenced by their friends often more than their family. This is why we see peer support as a critical area for development.
The research on peer-to-peer mental health support for children and young people is scant. But we do know that it can yield positive outcomes.
The Department for Education’s “Peer support and children and young people’s mental health” Research Review last year cited a report (Horgan et al 2013) which saw online peer support as having strengths in offering users anonymity, also stating that there is evidence that young people with mental health issues “are more likely to turn to the internet for support than to professionals”.
We also know that young people are comfortable talking online and do so often without the inhibition sometimes associated with face-to-face counselling. Online moderated live forums are an appealing way for young people to share and support each other in this way.
We see increasing numbers of children and young people regularly taking part in such forums; threads are read extensively too, with over 16,000 views of various Kooth forums last month.
We are now focused on bringing our experience in online counselling, emotional wellbeing support and live forums together to extend the peer support element of our service.
To this end, we recently bid for and won funding to train a new cohort of young online peer supporters through a specially-developed multi-media learning portal. The innovative project is supported by SBRI Healthcare, an NHS England initiative, led by the Academic Health Science Networks (AHSNs), and aims to reduce the pressure on specialist services and address the stigma associated with mental health by helping young people offer supervised online support to peers.
We are now shaping a training and assessment programme which will see a new cohort of young peer supporters primed and ready to offer their support to others.
The training programme will consist of four main elements, covering volunteering and participation, health and wellbeing, personal skills development and helping others. Young people will be fully supported throughout and we’ll be talking to them and carefully monitoring the impact on their own wellbeing throughout.
We are also working hard on ways to deliver the training in a fresh and engaging way. Our aim is for the peer supporters to feel knowledgeable and supported, while closely involved with the programme. Each will choose an avatar when completing their online training, with virtual awards being given at various stages of the course. We are also ‘gamifying’ aspects of the training to appeal directly to the young people completing the process.
The mental heath crisis we find ourselves in won’t solve itself. In thinking about early intervention and prevention and about a therapeutic environment for children and young people, it’s vital that we apply new thinking and continue to talk to young people about what their experience is and draw out from them what they want from mental health support services.
The peer supporters project is seeing us work closely with around 20 young people who are co-producing the programme with us. Giving them direct influence over a new aspect of support is an incredibly positive step towards effective early help for mental health.
It is certainly not ‘the answer’, but it is a powerful element in a therapeutic environment and is grounds for continuing to focus on finding as many ways as we can to help those who need our support more than ever.