Listen Up - Social Welfare Portal

listenup!Person-centred approaches to help young peopleexperiencing mental health and emotional problemsInes GarciaChristina VasiliouKim Penketh

listenup!Contents | 01ContentsAbout the art work 02‘Butterfly Soup’: A young person’s story 03Acknowledgements 04Terminology 05Foreword 06An introduction to the report 071. Children and young people’s mental health 092. Project background, aims, methodology and limitations 153. What young people want from services 214. The partner sites’ experience of what works 295. Delivering a successful service: Providing choice 336. Delivering a successful service: Providing accessible services 417. Delivering a successful service: Providing support at all stages 498. Young person participation 579. Young people’s experiences of service user participation 6810. Making a difference to young people’s lives 7211. Key challenges 7612. Recommendations 84Appendix 1: Wish list for services 86Appendix 2: Partner site case studies 87Bibliography 118

listenup!02 | About the artworkAbout the artworkAll the artwork in this report was created by youngpeople who were using or had previously usedthe services involved in this project. Each of thoseservices put forward one piece of artwork, and thesewere entered into a competition. The competitionwas judged by a group made up of five youngpeople taking part in the Tate Modern’s ‘Raw Canvas’art initiative for young people, and by the Chair ofthe Mental Health Foundation.All the entries submitted to the competition areincluded within this report. The winning piece, asculpture, has been photographed and appears onthe front cover.About the front cover“This piece was created by several Foyer tenants(16-25 yr olds). The background images were createdin the first of the art workshops and doing thisenabled the young people to relax and familiarisethemselves with the materials. The figures in thepiece are life-size cardboard cut-outs of some of thetenants who took part in creating the installation.There are also images of two of the Foyer tenants’children, which symbolise the future. The youngpeople then placed all the figures, signs and imagestogether in a way which was meaningful to them.The more you look, the more things are revealed thatare symbolic of these individuals’ journey throughAberdeen Foyer.”Our thanks for creating the artwork go to:Aberdeen Foyer, Aberdeen: Terri Deans and herdaughter, Richard Fake, Mhairi Newman, KerriMcFarlane and her son, Andy Begg, Leanne Binnie,and other Foyer tenants who helped make the piecesof art in the background.Experience in Mind, Mind in Brighton and Hove, andHove YMCA, Brighton and Hove: Zoe Green, DavidPatrick, Sam Thomas and Jordan Halls.Support @ The Junction, The Junction,Colchester: Ed Ryan.The Market Place, Leeds: the HYPE group.The Zone, Plymouth: David WhiteAnd to the young people who completed art workfor the competition at Community Links, CanningTown; Barnardo’s Marlborough Road Partnership,Cardiff; Streetwise, Newcastle.Our thanks also go to our judges:Raw Canvas, Tate Modern youth groupHarvinder Bahra, Assistant Curator: YouthProgrammes, Tate ModernDavid Sachon, Chair, Mental Health FoundationJamie Patterson, Community Health Manager,Aberdeen Foyer, Aberdeen

listenup!A young person’s story | 03‘Butterfly Soup’:A young person’s storyStreetwise. A big black door. A door so big, words can’t describe.In hindsight, how my legs carried me there after the rejectionsI had hitherto experienced is bewildering. My nerves werejumping, jangling, rattling and I felt certain that my heart wasbeating visibly, pounding for all to see.One word: terrified. I was literally terrified. I had already made a bargain with myself;sure, I’d come to Streetwise, I’d give it a crack on the condition that with the first sign ofcondescension, my legs would carry me out of there as quickly as they had carried mein – seemed fair enough. I’m no quitter, but the truth is, I’d expected negativity – thatwas the sole reason for the butterflies which had hatched in the darkness of my stomachand were now fluttering their way up my oesophagus. I swallowed them back as mycounsellor approached. The smile I gave was a smile of genuine relief – she looked normal– not a double knit sweater in sight – nor did she look pained on meeting me, a look somany health professionals, I have since learned, reserve for the young (I suspect it is cast instone in their handbook).Where would I begin and where would I end in describing the huge, gaping contrastbetween my previous experience and that of Streetwise? The most significant thing is thesimple fact that I was heard. I have also since learned that there is a distinct and crucialdifference between listening and hearing. Not only was I heard, but I was heard for awhole hour, week in, week out. My counsellor never tired of me, never judged me, andnever criticised me. I talked and talked until my words ran dry, until there was nothing leftto say, until I felt relief. Words fail me as I strive to describe the relief.I had been drowning in emotion and scared completely numb. Life had seemed terrifyingand threatening. Through Streetwise, I learned that I can be strong and I can deal withwhat life has thrown at me – maybe not always with a smile, but Rome wasn’t built in aday and I’m no architect either! I am, at last, slowly getting there. I am certain that withoutStreetwise, I would be in a very different place right now. I would undoubtedly have givenup, given in and become statistically forgettable, immortalised in a replaceable yearly poll.Written by Nicola, a young person who attended Streetwise in Newcastle

listenup!04 | AcknowledgementsAcknowledgementsYoung PeopleFirst and foremost, the authors would like to say a specialthank you to the young people around the UK involvedin the interviews, focus groups and art competition fortheir time and valuable input into the project.Project sitesWe would like to thank all the staff involved in theinterviews, data collection and local events, includingthose who are not mentioned by name below.Sorted Not Screwed Up, Aberdeen Foyer, AberdeenJamie Patterson, community health manager andJennifer Upson, community health workerExperience in Mind, Mind in Brighton and Hove,and Hove YMCA, Brighton and HoveShirley Gray, project manager; Enrico Dummett,Experience in Mind co-ordinator (until January 2007);and Sam Taylor, Experience in Mind co-ordinator(from January 2007)Caterpillar Service, Barnardo’s Marlborough RoadPartnership, CardiffSally Jenkins, children’s service manager and SarahSmith, practice policy and development officerSupport @ The Junction, The Junction, ColchesterCathy Constable, project co-ordinatorThe Market Place, LeedsLizzie Neill, participation and development workerand Sally Dawson, project managerCommunity Links, Canning TownJan Marr, co-ordinator, Phoenix Project and KevinJenkins, director of children and youth workStreetwise, NewcastleHeidi Douglas, managerIceBreak, The Zone, PlymouthRuth Marriott, chief executive, and Matt Walsh,health managerReference groupKim Penketh, young person consultant,Mental Health FoundationDr Tony Kaplan, consultant adolescent psychiatrist,New Beginning crisis recovery unit, Barnet, Enfieldand Haringey Mental Health NHS Trust, and RoyalCollege of PsychiatristsDr. David Ward, consultant adolescent psychiatrist,Newcastle CAMHS and Early Intervention in Psychosisservice, Northumberland, Tyne and Wear NHS TrustCatherine Wilson, development managercounselling service, Youth AccessDr Cathy Street, previously research consultant,YoungMinds (reference group member for the firsttwo years of the project)Carly Raby, young people’s participation manager,YoungMindsMental Health Foundation teamMain project team:Ines Garcia, project manager (from July 2006 onwards)Christina Vasiliou, senior researcher and evaluation leadKim Penketh, young person consultant andevaluation associateKathryn Hill, director of mental health programmesDr Kamaldeep Dhillon, head of researchRena Diamond, project manager (until May 2006)Lucy Leon, project officer (until 2005)And also to:Dr Andrew McCulloch, chief executive and all theother staff at the Mental Health Foundation offices inLondon and Glasgow who made a contribution.Others:Alice Trouncer, freelance editorDeborah Cornah, consultantLaura McGrath, evaluation associateOur funders:Esmée Fairbairn FoundationComic ReliefClyde & Co LLPJohn Lewis Partnership

listenup!06 | ForewordForewordAdolescence and young adulthood is a key time of change and stress inevery young person’s life.Finishing education, finding work and finding partners all pose challenges. And while most people enjoygood physical and mental health during this period – and this helps them rise to the challenges theyface – it is also a critical time in the development of mental ill health for a substantial minority. This is theperiod when adult severe mental disorders such as schizophrenia first manifest themselves, but it is alsothe period when many common mental disorders such as depression start to occur more regularly.At the Mental Health Foundation, we are interested in both promoting good mental health andwellbeing, and in preventing mental illness. Mental health is a key asset for all of us, but during thetransition to adulthood it is particularly important. It is at this point that many of the choices, accidentsand opportunities happen that determine the nature of our adult life. Compromised mental health atthis point can interfere with education, work and life in ways which damage opportunity later. Equally,positive experiences can pave the way to more positive experiences later in life.This is why we embarked on the programme described in this report, to look at the developmentof voluntary sector provision for young people. In previous work we have done, young peoplefacing problems told us that the voluntary sector was the place they looked to for responsive, nonbureaucraticand welcoming services. At a time when there is increasing government focus on thesector, it makes sense to spell out what it can offer for young people’s mental wellbeing.I should like to pay tribute to the eight sites we worked with across the UK. They show the diversityof what is being done, but also some of the common themes that define good practice. As with ourprevious work, young people’s voices remain a strong influence on the report. A common strength ofthe sites was the young person-centred approach they employed.Whether we like it or not, most young people will only engage reluctantly with public services labelled‘mental health’, ‘social services’ or ‘social care’. Many young people have made a positive choice to engagewith voluntary services and their experience has often been positive, sometimes life changing. It is nowtime for government and commissioners to go beyond the rhetoric and to embed long-term financialand other support for the voluntary sector in tackling the challenge of young people’s mental health.Dr Andrew McCullochChief ExecutiveMental Health Foundation

listenup!8 | Chapter 1Aberdeen FoyerAberdeen

listenup!Chapter 1 | 9Children &young people’smental health1

listenup!10 | Chapter 1Children and youngpeople’s mental healthThe importance of children and young people beingmentally healthy is that it underpins their ability to:• develop psychologically, emotionally, creatively,intellectually and spiritually• initiate, develop and sustain mutually satisfyingpersonal relationships• use and enjoy solitude• become aware of others and empathise with them• play and learn• develop a sense of right and wrong• resolve (face) problems and setbacks and learnfrom them(Mental Health Foundation and Office of HealthEconomics, 2004)However, as many as one in ten children aged 5-16,in the UK are experiencing a mental health problemat any one time (Office for National Statistics (ONS),2005). Department of Health statistics show thatabout 40 percent of those children are not receivinga specialist service but only getting help from GPsand others including the voluntary sector (DfES, DH,2004). Unfortunately, there is no data that specificallylooks at young people’s mental health in the 16-25age range – those who bridge the gap betweenchildhood and adulthood. What we do know is thatfor young people in this age range, self-harm (mostcommonly cutting themselves) is a serious concern.The national inquiry into self-harm focused on 11-25 year olds and the inquiry team concluded thatself-harm was a symptom of an underlying problem– ‘an emotional or psychological trauma’ (MentalHealth Foundation and Camelot Foundation, 2006).In assessing available research findings, the team alsostated that these indicated that self-harming affectsat least one in 15 young people in the UK.The Office for National Statistics (ONS) surveyconducted in 2004 covered England, Scotland andWales and showed that the prevalence of mentalillness in children and young people increased wherecertain socio-economic factors were present (ONS,2005). For example, the data showed that childrenand young people were more likely to suffer from amental disorder if they were part of a family whereneither parent was working; if their family was ona low income; or if they were part of a one-parentor reconstituted family (ONS, 2005). It is, however,unlikely that this relationship between individualsocio-economic factors and increased prevalence ofmental illness is a straightforward one; YoungMindshas suggested that there is, instead, a ‘subtle andcomplex interplay of many different factors’ (2006).There is much discussion and debate about just whatthose other potential factors might be. Suggestionshave included academic pressure, alcohol anddrug misuse, junk food, sedentary lifestyles, mediainfluences and others. In response to concerns aboutthe mental health and wellbeing of children andyoung people, the Children’s Society has launchedthe Good Childhood Inquiry. This seeks to promotea better understanding of childhood and to provideevidence-based recommendations on ways to helpimprove the lives of children and young people(www.childrenssociety.org.uk).Some of the factors associated with poor mentalhealth in childhood and adolescence are also thosethat leave a young person vulnerable to mentalhealth problems in adulthood and later life. Researchconducted by Kim-Cohen et al. (2003) showed thatin a sample of 1,037 26-year-olds, half had been firstdiagnosed with mental health problems betweenthe ages of 11 and 15, and over three-quarters hadbeen diagnosed by the time they were 18. Therefore,there is vital need for mental health promotion,prevention and early intervention.Vulnerability during thetransitional years“Few mental health services deal adequatelywith the 16-21 age group.”Office of the Deputy Prime Minister, 2005

listenup!Chapter 1 | 11The importance of psychological wellbeingin children and young people, for their health,emotional, social, physical, cognitive and educationaldevelopment, is well-recognised.DfES, DH, 2004Young people face increased vulnerability in relationto their mental health, particularly during thetransitions of adolescence and into early adulthood,which are unparalleled at any other stage of theirlives. However, for young people with mental healthproblems, this critical period is also the time whenstatutory mental health support becomes less clearcut.Services that have an age-specific, dedicatedservice for young adults are not universally available(Pugh & Meier, 2006) and the only statutory mentalhealth service that must be available to span thisage group is the Early Intervention in PsychosisTeam (DH, 2001). In 2003, the Commission for HealthImprovement reported that at least 26 Trusts in theUK did not have agreed and established writtenarrangements to ensure transition of care forservice users between child and adolescent mentalhealth services (CAMHS) and adult mental healthservices (AMHS) (CHI, 2003). This is reflected in theinconsistencies between different services. Whilstsome end their support when the young personreaches 16 years old others do so at 18 or 19 years old(DH, 2004). In some areas, AMHS can start up to threeyears after CAMHS has withdrawn support, meaningthat vulnerable young people can disappear entirelyfrom statutory services (YoungMinds, 2000). As theage of 16 is also the cut-off age for other statutoryservices such as compulsory education and care, thisgap can easily leave vulnerable young people with asevere lack of adult support in their lives. YoungMindslooking at the 16–25 age range recommend that:“CAMHS [children and adolescent mental healthservice] and AMHS [adult mental health services]commissioners need to unite to support youngpeople and create an integrated system of localplanning that includes the widest possible networksof agencies that work with young people.”YoungMinds, 2006Young people are often inappropriately admittedto adult mental health wards. The Mental HealthAct Commission (MHAC) (England and Wales) haveargued that there should be robust admission criteriafor the admission of a minor to an adult ward, andthat protocols should be in place to ensure thattransfer arrangements are made as soon as a moreappropriate placement in a child or adolescentservice can be located. They also recommended thatpolicies should ensure that every child or adolescentthat is admitted to an adult ward is individually riskassessed, so that ward staff are aware of any risksto the young person from other patients (MHAC,2007). MHAC also explicitly argued that during thistime, children and young people should be keptas fully informed as possible about their care andtreatment, and their views and wishes should betaken in account, while having regard to their ageand understanding.These issues are echoed by the HealthcareCommission and the Children’s Commissioner forEngland, whose recent report reveals that, despitea number of improvements in the last few years,young people with mental health problems arereceiving inappropriate and inadequate care onadult wards because of a continuing shortage ofhospital beds and facilities for under-18-year-olds.Although this report concluded that some youngpeople experienced a good level of care andsupport on adult psychiatric wards, the majority ofyoung people involved in the consultation reportednegative experiences. Many were “…left feelingisolated, bored, uninformed and uninvolved indecisions about their mental health care” (Children’sCommissioner for England, 2007). At the time ofgoing to press, the Mental Health Bill (England andWales) was nearing completion and, in this, is acommitment to ensure age-appropriate inpatientenvironments for children and young people.In Wales, the Healthcare Inspectorate Wales and theWales Audit Office have begun a review of childand adolescent mental health services in responseto concerns over progress on the “development

listenup!12 | Chapter 1of comprehensive and equitable CAMHS acrossWales” as set out in the CAMHS strategy Everybody’sBusiness (Welsh Assembly, 2001). The review willinclude looking at current service provision, planningand commissioning, and collecting information onthe experiences of children and young people aswell as their carers on accessing and using services.In Scotland, The Mental Health of Children andYoung People: A Framework for Promotion,Prevention and Care was published in 2005 and isa multi-agency framework aimed at supporting anintegrated approach to the planning and deliveryof services (Scottish Executive, 2005). The deliveryplan for services, Delivering Mental Health outlinesa commitment to implement this framework by2015 and states children and young people are apriority (Scottish Executive, 2006). There is a targetset of 2008 for the allocation of a named mentalhealth link person in every school and basic mentalhealth training for all those looking after childrenand young people in care. A further target of 2009is set for halving the number of children and youngpeople’s admissions to adult wards. This builds on theprinciples of the Mental Health (Care and Treatment)(Scotland) Act 2003 to ensure sufficient services andaccommodation for children and young people whoare admitted into hospital.Mental Health Foundation’s WorkThe Mental Health Foundation recognises that themental health and emotional wellbeing of childrenand young people is an urgent priority for serviceprovision, policy and research. This is reflected by thenumber of publications it has produced in the lastdecade that have sought to understand how best todevelop services that serve the mental health needsof this group.Bright Futures (Mental Health Foundation, 1999)reported on a three-year programme of work thatexamined the factors affecting children and youngpeople’s mental health and emotional development.Contributions to the report included over 1,000pieces of written evidence, alongside testimonyfrom relevant professionals in education, health andsocial care, as well as academics, representatives ofvoluntary sector agencies, parents and young peoplethemselves.A key finding of the report was the importance ofearly intervention and the role of families, schools,primary health care and voluntary agencies inincreasing resilience to mental health problemsin childhood and adolescence. Bright Futures alsoidentified four groups of children and young peoplewho were particularly vulnerable to developingmental health problems – those with emotionaland behavioural problems; homeless young people;looked-after children; and young people in the youthjustice system. Subsequent work arising from BrightFutures also established that a significant gap inservice provision exists for young people betweenthe ages of 16 and 25 years, and their views wereheard in the report Turned Upside Down (MentalHealth Foundation, 2001).One of the key findings of Turned Upside Downwas that neither children’s nor adult services wereequipped to provide adequate care for young peoplegoing through the transition from childhood toadulthood. The implication of this finding is thatby the time a young person is identified by adultservices, they may have already developed severeand enduring mental health problems, which couldhave been prevented or reduced if managed sooner.The 45 young people involved in the project madea number of suggestions concerning this issue andargued strongly that the involvement of service usersand ex-users in developing and running serviceswould go some way in helping to create servicesthat are more appropriate to their specific needs.They also emphasised the benefit of peer support– service users or ex-users of services can befriend,advise and support young people in crisis.

listenup!Chapter 1 | 13A number of key themes run across all the projectssupported by the Foundation in this area. These include:• The need for a holistic approachA broad consensus emerged from these researchprojects advocating a preventative/earlyintervention, holistic approach to mental healthand emotional wellbeing.• Better inter-agency workingBright Futures revealed that some young peoplewere in contact with several agencies, althoughwithout a specific problem that was serious enoughto warrant action by any particular one. Alternatively,young people could be under the care of severalagencies at once, dealing with many professionals,each overseeing different strands of their lives, whichcan be confusing, frustrating and isolating.• Young person participation in the way servicesare run and developedListening to what young people have to say aboutservices is fundamental to developing new andexisting services. As well as being a part of theMental Health Foundation’s general policy to makeservice users central to the research process, theinvolvement of young people is also an attempt tocounteract the wider lack of a young person’s voicein the development of services.The Mental Health Foundation and CamelotFoundation’s national enquiry into self-harm amongyoung people (2006) found that health, educationand social care professionals were not receiving thetraining or guidance they needed to support youngpeople who self-harm. The research shows that selfharmis related to underlying emotional or mentaldistress, and therefore a comprehensive self-harmstrategy requires both a broad, generic focus onpromoting positive wellbeing, and behaviour-specificinformation, training and intervention.

listenup!14 | Chapter 1Experience in MindMind in Brighton & Hove, and Hove YMCA

listenup!About the Chapter artwork 1 | 02 15methodology2Projectbackground, aims,& limitations

listenup!16 | Chapter 2Project background, aims,methodology & limitationsThis report is the result of informationgathered from the Mental HealthFoundation’s project looking atservices working with young peoplewith mental health and emotionalproblems. The project had two phases:Youth Crisis I and Listen Up.The first phase, Youth Crisis IIn 2002, the Mental Health Foundation (the‘Foundation’) initiated the Youth Crisis Project. Thefirst stage of the project, ‘Youth Crisis I’, was a twoyearconsultation project to find out from youngpeople what they wanted from services when theywere experiencing mental health problems. Theconsultation was hosted by four organisations: Mindin Brighton and Hove; Barnardo’s Marlborough RoadPartnership in Cardiff; Streetwise in Newcastle; andthe Glasgow office of the Mental Health Foundation.Almost 200 young people were consulted as part ofYouth Crisis I, culminating in the creation of a ‘wishlist’ for developing the ‘ideal’ mental health servicefor young people (see Appendix 1). Some of the keyfindings of Youth Crisis I included the need for: fasttrackaccess to treatment and care; the opportunityfor each young person to build a rapport with oneperson to guide them through services; greatersensitivity from service professionals in times ofcrisis; alternatives to medication; and preventativestrategies and access to resources prior to crisis point.The second phase, Listen UpAs a result of the Youth Crisis I consultation, theFoundation decided to set up a second phaseof the project working with eight ‘partner sites’,voluntary organisations in the UK who were willingto develop their services in line with the ‘wish list’.This part of the project began in 2004 and ran untilSeptember 2007. The main focus was on youngpeople aged between 16 and 25, although agelimits did vary from place to place.This part of the project focused on exploring youngpeople’s actual experiences of using services ingreater depth. Participants were asked to explainwhat parts of the service they attended worked wellfor them, in terms of the environment of the serviceand the staff working there, and what they felt couldbe improved in services to better meet their needs.

listenup!Chapter 2 | 17They were asked to describe not only how they usedthe service, but why, and what prevented themfrom disengaging from it. They were also asked tocompare the service they were using at the time toones they were no longer attending.We chose to rename this part of the project fromYouth Crisis II to ‘Listen Up’, removing the term ‘crisis’,following feedback from young people. Youngpeople may not be happy using the term ‘crisis’,as it can mean different things to different peopleand having a service based on ‘crisis’ could meanthat young people on a pathway to crisis could beexcluded from receiving support. The partner sitesechoed the views of young people in not wanting todefine young people or their services by the severityof the problems being experienced, but to see eachyoung person as individual, and work with themaccording to their needs. All the services thereforeworked not only with young people who might bedeemed as being in crisis or at risk of crisis e.g. whowere self-harming or had attempted to commitsuicide, but also with young people who had a rangeof other mental health, emotional or social problems.In addition, young people had made clear in YouthCrisis I that they wanted a greater emphasis onprevention. Listen Up showed that the organisationswere providing services which offered mental healthpromotion, prevention and, most frequently, earlyintervention – identifying problems in their earlystages and working with the young person to stopthis developing into a more major problem.The eight partner sites were chosen because theywere examples of positive practice (following anassessment by an expert panel) and because of theirinvolvement with young people and their willingnessto take responsive, creative and new approaches totheir work. They became part of a positive practicegroup (PPG) that met quarterly to share ideas,knowledge and examples of positive practice. Eachsite was provided with a small amount of fundingto help with the development of their service in linewith the key needs identified by young people in theYouth Crisis I. The eight partner sites were:• Sorted Not Screwed Up, Aberdeen Foyer, Aberdeen• Experience in Mind, Mind in Brighton and Hove,and Hove YMCA, Brighton and Hove• Community Links, Canning Town• Caterpillar Service, Barnardo’s Marlborough RoadPartnership, Cardiff• Support @ The Junction, The Junction, Colchester• The Market Place, Leeds• Streetwise, Newcastle• IceBreak, The Zone, Plymouth,Further details of each organisation are presented ascase studies in Appendix 2.AimsThis report looks at the work of eight voluntaryorganisations working with young people withmental health and emotional problems, to findout how these organisations work to ensure theirservices deliver what young people want, particularlyas identified on the ‘wish list’. The report also aimsto show, in a more general way, what the voluntarysector can offer.There is no ‘one size fits all’ approach to providingservices for young people; much will depend onlocal need and funding. The eight partner sites werediverse in terms of their size, geographic locationsand organisational structures, but all were based inthe community – often placed within or offeringa generic service. Seven of the eight organisationsprovided services directly to young people needingsupport and information. The eighth, the Experiencein Mind project run by Mind in Brighton and Hove andHove YMCA, was set up to involve young people whohad used mental health services in the creation anddelivery of training to those who came in contact withyoung people with mental health problems such as

listenup!18 | Chapter 2staff working in Child and Adolescent Mental HealthServices (CAMHS) and colleges. All eight organisationswork as part of a wider network of services for youngpeople which includes CAMHS and other statutoryservices. The partner sites made clear that establishingand maintaining good working relationships withall other agencies is vital for improving services andworking towards the provision of seamless support foryoung people.There are a number of core principles in deliveringservices to young people that all eight partner sitesagreed upon, including having an overall approachwhich is ‘person-centred’. This means putting theindividual young person at the core of what servicesdo, and looking at their needs in a holistic way. Thereport looks at how the eight sites achieved thisapproach and sets out the core principles. It is hopedthat this will be of use to those commissioning andfunding services for young people, as well as thoseworking with young people or wishing to set uporganisations for young people.Fundamental to taking a young-person-centredapproach is engaging and involving young people inservice design and improvements. The report showshow the eight organisations achieved this, and whatit means to young people.MethodologyThis project is based on a number of sources ofinformation, as outlined in the rest of this section.1. Information gathered during Youth Crisis IYouth Crisis I consisted of an in-depth consultationwith almost 200 young people to find out what theywanted from services and, the ‘wish list’ they drew upis included as Appendix 1.2. Focus groups and interviews with youngpeople in the project sitesThe Foundation drew up questions to ask youngpeople at the eight partner sites. The questions weredeveloped in consultation with both a young personservice user consultant at the Foundation, and withyoung people at the sites, to make sure the languageused was clear and sensitive. Staff at the sites thenselected young people (aged 16 to 25) who werecurrently using the service, or who had done in thepast, to take part in the survey. The young peoplewere asked if they wanted to take part, and, if so,when they would be available and whether theywould prefer to be interviewed one-to-one, or aspart of a group. Based on this information, staff ateach site advised the Foundation on how to conductthe survey; focus groups were held at six of the sites,and face-to-face interviews at two.EthicsWhen the survey was undertaken, each project sitealready had its own ethical guidelines in place forgroup and one-to-one work with young people,and each site worked to its own guidelines for thesurvey, to ensure a consistent approach. However,the ethical guidelines were very similar in eachsite, and were broadly in line with the Foundation’sinternal standards.Each young person taking part was given aparticipant information sheet which stated thepurpose of the study and what they would be doingas part of the survey, and was informed about theanonymity and confidentiality of any data collected,meeting data protection requirements. All theparticipants provided informed written consentto take part. A member of staff was on hand toprovide support to manage any difficult emotionsfor any participant who had been affected by thefocus group or interview. Participants were free towithdraw at any time.The focus group/interview processIn total, 32 young people were interviewed, either aspart of focus groups or one-to-one. Each focus groupor interview lasted between 45 and 90 minutes.

listenup!Chapter 2 | 19Each young person was given a payment of £15in recognition of their time and travel. The focusgroups and interviews were largely arranged for theearly evening, as this was the preferred time for theparticipants, and refreshments were provided.All the focus groups and interviews were taperecordedand transcribed, and the transcripts weresent to the young people at the project sites forverification before being used in the report. Thetranscripts have been quoted from throughout thereport, and each participant is identified simply as‘young person’, to maintain anonymity.3. One-to-one interviews with staff at theproject sitesIn total, 31 staff from the project sites wereinterviewed, 14 in person and 17 by telephone.Most sites opted to divide the interview questionsamong different staff to avoid some staff membershaving to take on a much-increased workload,and so that the most appropriate staff memberanswered each question.All interviews were tape-recorded, transcribed andsent to the project sites for verification before beingincluded in the report. Anonymity was assured in thesame way as for the young people’s interviews. Thetranscripts have been quoted from throughout thereport, and each participant is identified simply as‘project worker’, to maintain anonymity.4. Data collected from the project sitesEach project site was asked to supply informationon: the set up, structure and mission statement ofthe organisation; characteristics of the young peopleusing the service such as their age, gender andwhy they were using the service; links with otheragencies; and the local context, which included thecatchment area for the service and gaps in serviceprovision in the local community. This data providesa snapshot of the organisation.LimitationsAs discussed earlier, the eight organisations featuredas project sites were considered as examples ofpositive practice. All sites used their own monitoringand evaluative procedures, as well as those requiredby their funders. Measuring the outcomes of theservices was beyond the remit of this project,although some information on this was providedthrough the views of the young people who tookpart in the focus groups and interviews.

listenup!20 | Chapter 1Community LinksCanning Town

listenup!Chapter 1 | 21Whatyoung people wantfrom services3

listenup!22 | Chapter 3What young peoplewant from servicesNo matter what my progresswas… I could take two steps forwardand four steps back and theywould say ‘OK, so let’s try a differentapproach this time and see whatworks’… I wasn’t made to feel bad.Young personFrom the ‘wish list’ young people drew up during thefirst phase of the project, Youth Crisis I (see Appendix1), and from interviews conducted with youngpeople as part of the second phase of the project,Listen Up, four main key themes of what they wantedfrom a service emerged. These related to serviceenvironment; support to be free of discrimination; theneed for a range of opportunities for engagementand personal development; and the need for servicesto practise holistically and offer a diverse range ofsupport to meet young people’s mental health,emotional wellbeing and practical needs.Service EnvironmentFriendlyThe young people we spoke to said they valuedservices that encouraged a welcoming, relaxedand informal culture combined with a homelyenvironment. They all thought that the attitude andapproach of staff were very important in creatingthis atmosphere, and in achieving successful serviceprovision and delivery.“I felt really comfortable when I came here… it wassuch a happy place to be.”Young personYoung people commented that something assimple as being offered a cup of tea and biscuitsby a member of staff might seem a small gesture,but that it was typical of these services’ approach; itcreates a sense of a ‘personal touch’ and encouragesengagement with staff.“I was apprehensive at first, but once you come it’ssuch a nice atmosphere it makes you want tocome back.”Young personA friendly approach from staff can help tobreak down the initial barriers to young peoplecommunicating openly with staff when they first

listenup!24 | Chapter 1Support, free from discriminationNon-judgementalThe young people also wanted staff to be genuinelyinterested in listening to them, and to be nonjudgemental.They all valued staff who were not toointrusive and who understood that young peoplemight need time and space to feel comfortable withdiscussing why they were attending the service andwith disclosing personal information.“They don’t judge you, it’s not like they’re trying tofigure out why you’re there… you can just sit andyou get offered a drink as well. It’s informal.”Young personRespect and equalityThe interviewees also said that services should befounded on a basis of respect for all young people,regardless of their issues or perspectives, and ensuretheir equal status as individuals.“Being equal rather than someone above trying tosort out someone lower than them.”Young personThe young people felt that services should foster andpromote greater equality between young peopleand service staff, as opposed to drawing distinctboundaries between them. This was seen as animportant factor in establishing trust and successfullyengaging individuals. Young people frequentlyfelt they were not respected or treated as equalindividuals by professionals within statutory services.This was typically due to the environment, theapproach taken by staff, and the procedures beingtoo rigid and formal.“You might walk into their office, they might havea really high desk and be sat really far back and youmight have a tiny chair that’s like at the other end ofthe room.”Young personOpportunities for self-discoveryOn entering a service, the majority of young peoplesaid they felt the need to have the time, space andsupport to engage with staff on a ‘journey of selfdiscovery’.Young people required help from staffto gain an objective perspective on the challengesthey faced in their lives. They valued help from staffin identifying their specific needs and exploring theoptions on offer to meet those needs. This providesyoung people with a sense of direction, helps themto find resolutions to issues, and helps them plan fortheir future development. Young people felt that thisjourney of self discovery is best engaged through thedevelopment of their person-centred care plan.“I was seeking for a sense of self-discovery.”Young personOpportunities to escape, have fun andbe creativeYoung people interviewed said they were seekinga sanctuary to escape to, from the challenges theyfaced in their lives. Some said that to begin with theydid not want support with their emotional wellbeingor mental health problems, but just a place to go toafter school or during the day as a break away fromtheir isolated and stressful home life.All young people said that services should offer afun and creative element to their support and care.They recommended that this should take the formof participation through a youth advisory board(see Chapter 7), as well as organised activities at theservice such as art, music, drama, games or groupday trips. Young people said that having a structureto their day was crucial in supporting their recovery.“If you don’t go to college or get a job, you just getdepressed… You need something else to thinkabout.”Young person

listenup!Chapter 1 | 25A small handful of young people who had spenttime on an inpatient ward said how much theyvalued the rare opportunity to engage in a funand creative group run by an external voluntarysector organisation. This group encouraged youngpeople to look forward to engaging with voluntarycommunity-based services on their discharge frominpatient care. This also acted as a way of preparingyoung people for their return into the community.“[It was] a bit of fun because the inpatient unit wasreally intense and it’s nice to be able to go to agroup where you didn’t have to talk about issues andproblems, and just have a laugh.”Young personOpportunities to build friendshipswith peers“A nice break and escape and a distraction because itwas just so fun and you got to know the other youngpeople better.”Young personSome of the young people we spoke to suggestedthat it would be valuable for the mental healthservice to operate a ‘buddying’ scheme, wherebyyoung people with experience of using the mentalhealth system could support other young people andprovide advice and information. This would includeadvice on which services might meet their needs andhow to access them, as well as support with usingthese services. All young people said that being withother young people who had had similar experiencesand were on the road to recovery could be reassuring,inspiring and a positive encouragement for them towork on their own recovery.Being involved in various group activities can offerthe opportunity for the young people to makefriends with people of similar ages. Young peoplewho had had these opportunities valued beingable to socialise with their peers, because it helpedthem build a social network, which many individualshad previously lacked. Some young people saidgroup activities had helped them overcomevarious challenges in their lives. Many said they hadcontinued to socialise with peers from the groupsoutside of the service, and some had become theirclosest friends.

listenup!26 | Chapter 1Opportunities to build self-confidenceand esteem, gain experience anddevelop skillsYoung people said they were looking for services tohelp build their confidence and self esteem. Manywanted not only to increase their confidence inorder to be able to socialise more and communicatewith others, but also to build and develop copingstrategies and life skills that would be transferableto their education or career. The significant numberof individuals who gained in confidence throughusing the services cited this to be, in part, a resultof engaging in successful professional relationshipswith staff and with peers through various group andone-to-one activities. Through these interactions,young people were encouraged to draw on a rangeof emotional, social, cognitive and creative skills,thus developing their range of personal skills, whichwere then transferable to other social, educationand work settings.Holistic and diverse range of supportand adviceSupport with mental health and emotionalwellbeing needsYoung people said that they needed a wide rangeof care, support, advice and information to meettheir mental health and emotional wellbeing needs.They stressed that young people have diverse needs– as one young person put it, “everyone’s different”– and these needs may change over time, so servicesneed to be flexible and adapt to these changes tosupport young people fully. Young people felt thatmore services needed to practice holistically, andincorporate a multidisciplinary team which couldoffer not only specialist mental health support, butalso generic emotional wellbeing support. They saidthey wanted to be seen as “individuals, and not acollection of symptoms”.Young people said that the road to recovery is aboutenabling them to maintain stability and consistencyin their lives, by striking a balance between theirmental health and emotional wellbeing, andequipping them with the skills and strategies to dothis. This requires services to focus on improving allaspects of young people’s lives:“To understand that it’s not all about mentalhealth… that you are a person and you’ve got likesand dislikes and you have interests and goals and Idon’t wanna be a mental health patient all my life.”Young personYoung people cited the main issues they wantedsupport with and advice on as: sexual health; finance;housing; education and career development; and, insome cases, how to be a good parent and meet theneeds of their dependants.Support with practical issuesSome young people were experiencing a period ofhomelessness, and said statutory sector staff andothers were not providing sufficient support to themwith approaching the housing and benefits services.They said some staff in the housing and benefitsservices were unhelpful and lacked understanding oftheir needs, and that, in some cases, it was difficult toaccess accurate information. The young people feltthat financial support and advice from mental healthservices would be exceptionally valuable, particularlyto help those who are trying to be re-housed or areexperiencing difficulties accessing money for basicneeds such as food.“Young people have to know the homelesslegislation and your rights to get any help.”Young personYoung people said they often felt ‘trapped’ within thebenefits and housing system. They found statutorysystems to be very confusing and discovered thatthey can sometimes even make it more difficult for ayoung person to work or go to college.

listenup!Chapter 1 | 27Case Study“If you’re not living with your parents andyou’re 18 and on income support, youcan’t go to college because you’ll lose yourbenefits, unless it’s 16 hours a week and it’shard to find a course within those hours.You want to get a job but you get a deadendjob, so you want to go to college to geta better job, and they’re saying, ‘Well, wecan’t support you’. You have to think abouteverything you do. You want to come offthe benefits, but they don’t give you theopportunity… you panic that you’ll lose yourhouse and all your income if you try to gointo college or get a job…”Finally, young people wanted to be made moreaware of the support and information on offer froma range of services, so that they could access servicesat an earlier stage. It was felt that services had to becarefully targeted and focused, with a clear purpose,so that young people did not get confused andcould decide for themselves which service wouldmeet their specific needs.“Most of the time some services don’t even knowwhat they’re there for.”Young personYoung personThe young people interviewed understood andappreciated the fact that one service could notmeet all their needs, so they felt that ‘signposting’to help them know what other services mightmeet their needs, and helping them access thoseservices, were essential, as well as providingaccurate, up-to-date, friendly, and understandableinformation on a range of issues.“It is hard to know where to go… You don’t knowwhere to start or how to get help… There should bemore information out there.”Young person

listenup!28 | Chapter 1The Caterpillar ServiceBarnardo’s Marlborough Road Partnership, Cardiff

listenup!Chapter 1 | 29The partnersites’ experienceof what works4

listenup!30 | Chapter 4The partner sites’experience of what worksYoung people should not bepassive recipients of services butshould be actively involved inchoosing the support that bestsuits them, and how it is deliveredand developed. Services workingin this way will help to build trustand empower young people.This foundation of involvement andparticipation can be developedto provide other opportunitiesfor young people to participatein the way the service is operatedon an organisational level, fromgiving advice on the physicalenvironment, to being involvedin the recruitment of service staff,including the chief executive.Partner sites, positive practice group (PPG), 2006In February 2006, a two-day facilitated workshopwas held with the eight partner sites to explore andshare knowledge of what did and did not work indelivering services for young people aged 16–25who were experiencing mental health and emotionalproblems. The individual services had developedtheir own approaches based on what worked bestfor them, and the workshop revealed that theseapproaches had a number of key elements incommon. This led to the development of a sharedstatement (see left) and a set of 16 core principles– what works well for all the organisations.Not all of these principles will apply to everyservice that is being provided for young peopleexperiencing mental health or emotional problems.For example, self-referral may not be appropriatefor some specialist services, particularly those in thestatutory sector. However, this statement and setof principles are a starting point for both setting upnew services and developing existing ones.The rest of this report is divided into sections whichencompass the main themes of these sharedprinciples, and of what young people said theywanted from services (see chapter 3 and appendix 1)– the provision of a choice-based, accessible servicewhich supports young people in a holistic waythrough all stages of their need and which involvesthem in service development.Shared Core Principles01 The organisation should make their servicereadily available and accessible by offeringimmediate support, different paths for referralincluding self-referral, and providing a range ofways that young people can contact the service(text messaging, e-mail, telephone, face to face).02 Where possible, services should be providedwithin the community, helping to reducestigma and improve access.

listenup!Chapter 4 | 3103 The organisation should provide a professionalservice whilst at the same time puttingyoung people at ease by creating an informalambience. This can be done through use oflanguage, not having rigid timetables, casualdress, décor etc.04 Young people should be provided with a choiceof both the type of support they receive and thelevel of approach such as whether they wantadvice and a listening ear or require regularcounselling sessions. The pace and level of thework should be led by the young person.05 The organisation should be responsive to botha young person’s immediate and longer-termneeds. The organisation should provide a rangeof services that are focused on the recoveryprocess and staff should reassure young peoplethat support will be continued through therecovery process, not just in times of crisis.06 Young people should be prepared andsupported in moving on from the servicewhether this is into independent living orreferral/signposting to on to different services.07 The organisation should consider youngpeople’s basic practical needs, such as food,housing, personal finances, benefits etc. as partof a holistic approach. This may be throughoffering direct help with these, help with accessto other services or signposting young peopleto places where they can receive that help.08 The organisation should be socially inclusive,identifying the needs of all young people withinthe community and working to meet those needs.09 The organisation should have a clearly definedethos that all staff and young people are madeaware of either verbally or in writing. This ethosshould underpin the entire organisation’s workincluding that with outside agencies.10 The promotion of physical and mental healthand emotional wellbeing should be at the coreof the organisation’s work with young people.11 Decision making processes in the organisationshould be transparent. Where possible youngpeople should be involved in decision makingsuch as on the design and décor of the serviceand setting ‘rules and ‘boundaries’ for how theyand other young people use the service.12 All policies including confidentiality andcomplaints procedures should be well-definedand explained to young people who attend theservice.13 Staff in the organisation should form aneffective multidisciplinary team, having a rangeof different and appropriate skills and should betrained specifically to work with young people.14 Staff should be valued, invested in throughsupervision, training and development andencouraged to participate in the service’sdevelopment.15 The organisation should have a creative andqualitative means of gathering evidence,including listening to and consulting withyoung people, in order to help reflect on whatit is doing, to identify any gaps in service, and tolearn how to improve the service in the future.16 The organisation should seek actively toestablish and maintain working relationshipswith outside agencies in order to: improveknowledge and information sharing and; aimtowards the provision of seamless support foryoung people.

listenup!32 | Chapter 1Support @ The JunctionThe Junction, Colchester

listenup!Chapter 1 | 33choice5Delivering asuccessful service:Providing

listenup!34 | Chapter 5Delivering a successful service:Providing choiceChoice is at the core of the person-centred and holistic services offered bythe eight organisations involved in this project; a young person should beable to choose not only the type of care and support they receive but alsohis or her keyworker.Choice of care and supportThe organisations in the project offered a very widerange of choice in terms of the type of care andsupport offered. Below are some examples of thetypes of support offered. This is not a definitive listbut gives the main areas.Drop-ins, one-to-one support, therapies andgroup workFive of the organisations offered a formal dropinwhereby young people could turn up withoutappointments and be provided with emotionaland/or practical support.“The drop-in service supports clients with complexneeds and experiencing crisis and where maintainingregular appointments can be difficult. This facilityis regarded to be equally as valuable as the moreformal appointment-based counselling service.”Project worker, The Market Place, Leeds“I’ve been advised and guided and it’s been brilliant,and when I found out there was a drop-in servicethat was an added bonus.”Young personOne-to-one support is offered to young people byall the partner sites. This support may include helpwith life skills, discussing care options such as groupwork and counselling, looking at certain situationsand how the young person can cope with those, anddiscussing progress with the young person. There isnot a fixed format and the sessions will be guided bythe young person and the staff member.Talking therapy was offered by all the services in thisproject. Most offered counselling, and Aberdeen Foyeroffered cognitive behavioural therapy (CBT). As wellas being offered on the premises, some organisationswere able to offer counselling in young people’s homes,another suitable environment or within schools.Case StudyStreetwise in Newcastle offers counsellingin two large secondary schools, open toany young person aged 13 or above. This isfunded by Connexions, the national servicefor young people aged 13-19. Sessions,lasting between 50 minutes and an hour,take place on school premises in term-timeand on Streetwise premises out of termtime. Since September 2004, over 1,100sessions have been offered.Referrals are made by school staff, parents,GPs, social services, child and adolescentmental health services (CAMHS). Youngpeople can also refer themselves. The mainissues arising are bullying, alcohol andrelationships.

listenup!Chapter 5 | 35I’ve always had a choice, and with thatchoice comes a piece of advice and support.Young personIn addition to counselling, the services offeredother therapies such as formal art therapy and otheropportunities for creativity. Some organisations wereable to offer more specialised help, such as AberdeenFoyer which uses imagery with some young people.Case Study“We offer a technique which helps youngpeople to develop a compassionate mindset [towards self]. Some clients have notexperienced a sense of feeling loved whengrowing up, due to emotional neglector a hostile environment. This may resultin an individual lacking in ‘self-soothing’abilities, thus influencing the developmentof coping strategies such as self-harm andsubstance misuse.“Using compassionate imagery techniquescan be one way to help individuals becomemore aware a self-soothing experience.This can also assist in the reframing ofdistressing self-critical thoughts, offeringnew insights and perspectives on current orpast difficulties.”Project worker, Sorted Not Screwed Up, AberdeenFoyer, AberdeenGroup work is an important element of theseorganisations’ work and was offered by all the services.The types of groups offered were determined by localneed and in consultation with young people.Case StudyThe Zone in Plymouth has earlyintervention services in both personalitydisorder and psychosis. The Zone has set upa variety of group programmes open to arange of young people, such as emotionalliteracy, a women’s group, a footballgroup and others. These groups enableyoung people with serious mental healthproblems who attend one of the earlyintervention services to join with otheryoung people.This not only helps to ensure socialinclusion for these young people, but alsoprovides an informal ‘step-down’, whenyoung people no longer need an intensiveservice but still require some support.Practical supportAll the partner sites recognised the importance ofpractical support for young people using the service.For instance, IceBreak, The Zone, Plymouth, offeredyoung people the option to have a member ofstaff accompany them to the supermarket for theweekly shop, and the Caterpillar Service, Barnardo’sMarlborough Road Partnership, Cardiff supported ayoung person through a court case.

listenup!36 | Chapter 5Case StudyThe Youth Employment Project wasdesigned to support young people aged16 to 25 experiencing mental healthproblems, into education, training oremployment. This included support in lifeskills and therapeutic input where required.“We believe in having services that focus onemployment, housing, education, and thatincludes personal development programmesand access to support and counselling.”Project worker, Community Links,Canning TownPractical support can also take the form of directingor signposting young people to other appropriateagencies that can support them. The services didthis verbally, via leaflets and written information orby providing access to phones. Young people acrossthe organisations emphasised how valuable thisinformation could be in meeting the full spectrumof their needs and how much they valued theknowledge of staff at the services.Complementary therapiesTwo of the organisations involved in the project,Sorted Not Screwed Up, Aberdeen Foyer, Aberdeenand Support @ the Junction, The Junction, Colchester,took up the specific call from Youth Crisis I forchoice to be opened out to include complementarytherapies (see the wish list for services in Appendix 1).In addition, staff at Streetwise, Newcastle were, at thetime of going to press, receiving training in auricular(ear) acupuncture with the view to offering this toyoung people in the near future.“It is important to be flexible and take risks intrying out new ideas, such as yoga groups, whilstalso evaluating all new practice to ensure that it iseffective.”Project worker, Support @ The Junction,The Junction, ColchesterFunding from the Mental Health Foundation wasused by Aberdeen to fund a range of therapiessuch as shiatsu, Reiki, Indian head massage andacupuncture. These were found to be very popularand not only helped in times of crisis but acted as aform of early intervention too:“these are… offered to clients at any stage of theirstay. This service can be used when young peopledetect early warning signs of/or to reduce furtherdeterioration.”Project worker, Sorted Not Screwed Up,Aberdeen Foyer, AberdeenThese complementary therapies were providedso that young people could have a choice, andeither opt for something less conventional than, forinstance, counselling, or have the complementarytherapies in addition to more conventional therapies.Young people explained that having different typesof support brought them into contact with morepeople, helped them to form relationships and buildtrust, and provided them with a wider range ofsupport mechanisms.

listenup!Chapter 5 | 37Support @ The Junction offered regulararomatherapy sessions to young people; ‘familyrelaxation’ classes, which involved relaxationtechniques and yoga; and a drumming workshop.Young people commented that aromatherapyin particular had helped to alleviate anger andstress. However, staff noted that young peopledid not always attend sessions that they hadsigned up for and said that it would be useful inthe future to evaluate with young people whythis was. Staff at Support @ The Junction foundthat once young people were engaged with thearomatherapist they often came along regularly.Those that attended the appointments were askedto evaluate their experience at the end and theyreported that they found it a useful way to relaxand learn relaxation skills.“It is a useful form of health promotion, even earlyintervention.”Project worker, Support @ The Junction,The Junction, ColchesterSocialising and fun activitiesAll the services in the project recognised the needto work with young people in a range of ways.“Our desire to respond to the basics of life suchas food, warmth, play etc. can be interpreted assimplistic and not meeting the clinical needs ofthe young person… but we know providing theseare as important to the young person and theirdevelopment as the therapeutic intervention theywill also receive.”Project worker, Community Links, Canning TownThe Marlborough Road Project in Cardiff used playand fun in their approach as they had found this tobe an important way of engaging young people.Young people were clear on how having ‘fun’opportunities had been able to help them. Oneyoung person told us how this had enabled them tochange their perspective on a pattern of behaviour:“It’s really helped to go to social activities like playingpool in the pub… It made me realise I can go to thepub and enjoy myself without getting messed upwith drink – it’s a big shift for me.”Young personCase Study“The project is highly successful in engaging young people in unusual and creative ways that donot place focus on reiterating to the young person that they are unwell. Service users who are incontact with many professionals from different agencies have often become blasé about servicesand this approach can be useful in winning back their attention.”Project worker, Caterpillar Service, Barnardo’s Marlborough Road Partnership, CardiffIn March 2007, the project held a ‘fun’ day for 30 young people. A range of activities were offeredincluding yoga, making fruit smoothies, playing drums, making cards and others. By having fun itis hoped that the young people will feel more relaxed about returning to the service and that trustwill begin to build with the staff.

listenup!38 | Chapter 5Another spoke of how important the option ofhaving fun was to them:“If you want to have a jokey day and escape all yourproblems and have a bit of fun you can do that… butif you just really need to talk you can do that as well.”Young personYoung people’s sayYoung people using the services at theseorganisations were encouraged by their keyworkerto express their opinions and preferences about thecare and support they received and were supportedto take an active role in making these decisions.To help them make these decisions, theorganisations presented to each young personthe range of care and support the organisationcould offer them, talked through the pros and consof each type of care and support, and providedguidance as to which approach or approachesmight best meet their needs. The young personthen had the final choice of what care or supportthey would receive.“Individuals are encouraged to try a range ofapproaches if they wish until finding an option whichbest meets their needs.”Project worker, Streetwise, NewcastleThe young person’s progress was monitored by theirkeyworker on a regular basis. If they felt the care andsupport they were receiving was not meeting theirneeds, they could renegotiate their care plan withtheir keyworker. For all young people, having a say intheir care and support was a very empowering andpositive experience.Even so, choice is not without difficulties, as youngpeople may not be used to making decisionsabout their support and care or about their lives ingeneral. They reported that having choice could beoverwhelming and they were frightened of makingthe wrong decision. Some reported that they hadonly used statutory services before, where choiceand their power to influence their care had been verylimited, so the culture of choice was somewhat aliento them at first.Other young people reported that it took time to feelcomfortable in expressing preferences and openlysaying that they were unhappy with their supportand wished to try alternatives. One said they had justdecided to “grin and bear it in case workers say theywon’t help you”.Choice of keyworkersEach organisation involved in this projectacknowledged that young people might responddifferently to different workers, according to theirown personal preferences.“Staff recognise clients will naturally form betterrelationships with some workers more than othersand accept that young people’s perspectives mustbe considered carefully when or if they expressany concerns or preferences in reference to theirkeyworker.”Project worker, Sorted Not Screwed Up,Aberdeen Foyer, AberdeenIf at any point a young person felt they wouldbenefit from changing to a different keyworker, theywere provided with the opportunity to explore thereasons for this further. These requests were alwayshandled with care:“Considering the difficulties that the client groupoften have in forming and maintaining relationships,the project is wary of changing care co-ordinatorstoo readily. The reasons behind the young person’spreferences and issues are carefully considered, and,if it may be beneficial to the young person, staff willwork with them to try to overcome the barriers.”Project worker, Icebreak, The Zone, Plymouth

listenup!Chapter 5 | 39Each project had its own process for dealing witha young person’s request to change keyworker.However, they all followed the same basic pattern.Firstly, a member of staff consulted with the youngperson as to why they felt their relationship with theircurrent keyworker was not meeting their needs, andthen worked with them to explore ways to resolvethese issues. Finally, if the young person and theirkeyworker felt they could not resolve the issues, theyoung person was provided with the opportunity tochange keyworkers.“You don’t feel like you’re upsetting anyone by sayingyou don’t want to speak to them.”Young personYoung people said that staff made this process feelsafe and comfortable, and they were re-assuredthat it would not hinder the support they receivedin any way. Overall, young people felt that they hadvery positive and beneficial relationships with theirkeyworkers and other staff at the services. Threestated that they had to change their keyworker, andin two cases it was due to a preference in supportstyles used by the keyworkers.Case StudyOne young person at Aberdeen Foyer,Aberdeen described her relationshipwith their first keyworker as very positive.Unfortunately, the keyworker left theproject to go on a training course and theyoung person had to be allocated a newkeyworker. The young person didn’t findthe new keyworker’s approach to be helpfulto them and felt it would not be beneficialto continue. They were able to discuss theproblem with one of the other workerswithout any problem or prejudice. Theyoung person was soon allocated anotherkeyworker, and this proved successful.“They don’t make you feel bad for wantingto change workers … they just understand.”

listenup!40 | Chapter 1The Market PlaceLeeds

listenup!Chapter 1 | 416successful service:ProvidingDelivering aaccessible services

listenup!42 | Chapter 6Delivering a successful service:Providing accessible servicesOne of the most importantelements of the services offeredby the partner sites was theiraccessibility to young people.The organisations offered verydifferent services and approachedthe accessibility issue in differentways, but all sought to offer fastand easy access to their services.How young people heard about theorganisationsMany young people heard about the organisationsthrough word of mouth such as friends or family;often, young people feel more encouragedand reassured to access a service when it isrecommended through their peers.The organisations also undertook some advertising.Distributing leaflets and posters was the mostcommon method, and these were most oftenplaced in GP practices, schools, colleges andcommunity centres.The organisations also raised awareness of theirservices through other channels, such as throughcampaigning, or having meetings or open days andinviting professionals from other agencies to givethem information about the organisation’s services.Some organisations also visited schools to informstaff and pupils about their work. Community Linksservice in Canning Town ran the ‘Teenage HealthProject’, which worked with schools:“When Community Links runs presentationsin schools, workers use these opportunities toeducate young people and raise awareness ofwhat emotional wellbeing means. This aims to helpyoung people to understand their physical, socialand mental health needs and the close relationshipbetween all those.”Project worker, Community Links, Canning TownAll the organisations had websites which providedcontact details and information on the type ofservice available, written in language designed to beaccessible to young people.Young people also heard about the service throughother professionals such as GPs, social workers, youthworkers, teachers etc. and from other services whomay formally refer the young person onto the serviceor informally suggest that they contact the service.

listenup!Chapter 6 | 43Being socially inclusiveStaff were asked if they worked to ensure that theservices were equally accessible to all young people,including those from black and minority ethnicgroups (BME); lesbian, gay, bisexual and transsexual(LGBT) young people; refugees and asylum seekers;drug and alcohol users; and homeless people.It is mandatory for all public sector organisationssuch as the NHS and those that take public fundsin other sectors to record and monitor ethnicity.This is to ensure that young people from all ethnicgroups are equally able to access the services; wherea particular group or groups is under-represented,the organisation can then look at undertaking moretargeted work. Recording of ethnicity was carried outby all but one organisation in the project, althoughthis was a priority for review by that organisation.Organisations then need to obtain local data to seeif the breakdown of people accessing the servicematches the ethnic make-up of the local area. Thisdata can largely be accessed through local authoritywebsites or via the Office for National Statistics (ONS).It was not clear from the data collected and staffinterviews how many organisations in this projectwere making the comparison. It should be notedthat the data from local authorities and ONS can beseveral years out of date, because it is typically basedon the most recent census (at the time of goingto press, this was 2001), and there are particulardifficulties in obtaining data regarding the arrivalof new Eastern European migrants into differentlocalities. This can mean that organisations werereliant on word-of-mouth and local networks to gaina sense of local population changes and thereforeto ascertain whether they were meeting the needsof all young people in their catchment area. Thiscan be time-consuming, particularly for smallerorganisations with low staff numbers, and thosenetworks may not be available in all locations.Streetwise in Newcastle carried out a significantamount of work on ensuring socially inclusivepractice. They developed a strong monitoring systemand were therefore able to check whether certaingroups of young people were not accessing partsof their service; if so, staff could then take action toremedy this.Case Study“Streetwise liaise with local projects thatspecialise in dealing with particular groupsof young people such as young gay men orBME young people in order to ensure thatthere is not a gap in local service provision. ““The numbers of young people from BMEgroups accessing the project has recentlybeen greatly increased by the establishmentof the social group designed to attractyoung people from these groups.”Project worker, Streetwise, NewcastleCommunity Links in Canning Town is based in oneof the most ethnically diverse communities in theUK and they took a different approach in meetingthe needs of young people from groups which wereharder to reach:“Whilst workers recognise that some groups ofyoung people have specific needs, the projectsdo not have specific projects or group work forparticular groups and meet client’s needs through anintegrated and holistic approach.”Project worker, Community Links, Canning TownThe way that organisations decide to tackle theissue of how to approach working with youngpeople from specific groups is an area becomingincreasingly under the spotlight:

listenup!44 | Chapter 6“A current debate within the project is whether tobegin to offer some more specific groups to caterfor clients who will only access groups that aresmaller and consist of young people with similarexperiences.”Project worker, Icebreak, The Zone, PlymouthIt is important to state that although some of theseorganisations recognise that their current monitoringneeds enhancing, they nevertheless all share asocially inclusive approach which is exemplified in astatement by a project worker in Brighton and Hove:“… successful service accessibility is dependenton implementing a policy which respects equalopportunity, inclusiveness and diversity.”Project worker, Experience in Mind, Mind in Brightonand Hove, and Hove YMCA, Brighton and HoveMonitoring sexuality is a more complex issue, asthe people accessing some of the organisationscan be as young as 11 years old. It may also notbe appropriate to ask a young person about theirsexuality when they first come to access the service,but once trust has been built then this may bediscussed. The Market Place in Leeds is taking this onas an area for review.Other groups that are supported by theseorganisations include care leavers, refugees, thosewith alcohol and drug problems and youngoffenders and others.“Many young people are within the typical high-riskgroups who fall through the gap of mainstreamservices.”Project worker, Sorted Not Screwed Up,Aberdeen Foyer, Aberdeen“Recently it was noted that there were nocounselling services in Newcastle catering for youngunaccompanied asylum seekers and refugees, so theStreetwise service has been promoted specifically inthose communities.”Project worker, Streetwise, NewcastleKeeping the doors open to a range of young peoplewithout setting up too many restrictions and criteriawas important to these organisations.“The holistic approach of the service meansprojecting an image that the Market Place is notspecifically focusing on young people with seriousmental health problems, but is built on the beliefthat ALL young people need to feel safe, secure andcontent.”Project worker, The Market Place, LeedsThis approach can be particularly important for someyoung people who may not be able to express orunderstand their feelings easily. One young personstated how they had felt initially when going to theservice:“I just came here because it was a kind of relief afterschool to relax before I went home.”Young personAllowing young people to access the service in thisinclusive way means that they can access differentkinds of support when they need it – after a periodof time, the young person quoted above was ableto turn to the service for the emotional support thatthey needed. In the situation where a service wasunable to directly meet the needs of a young person,they would be signposted on to other services orreferred somewhere else.Ways of getting in touchAll the organisations provided a range of ways foryoung people to make contact. Initially, this maybe through a phone call to a helpline or by callingin to the premises. The organisations were keen toembrace newer technologies and most also usedtext messaging, with three also using e-mail asadditional ways to keep in touch. Although onlysome offered a drop-in facility, the others did allowyoung people to call in.

listenup!Chapter 6 | 45Groups are run in the evenings – theservice mostly operates out-of-hours, allowingyoung people at attend after school or work.Staff are used to working unsocial hours.Project worker, Support @ The Junction, The Junction, ColchesterCase StudyCommunity Links in Canning Town foundthat some young people went throughseveral stages before actually using theservice. This could involve carrying thetelephone helpline number around withthem for a while, then deciding to call butfeeling unable to speak or just asking asimple question.They set up a text messaging service, whichmakes it easier for young people to makethe first contact quickly, because theyknow they can do so without having tospeak to anyone. They can ask a questionto which they’ll get a text reply. This can bethe stepping stone for the young person tothen access the service, and means they getsupport more quickly.Fitting in with young people’s livesThe organisations aimed to be as accommodatingas possible, and recognised that young peoplehad other commitments such as school, collegeand work. They also recognised that young peoplemay feel initially intimidated by a service and thatthere was therefore a risk of the young person notengaging with the service.The participants in Youth Crisis I stressed the need forservices that provided out-of-hours help (see wish listfor services at Appendix 1). The interviews with staffCase Study“Staff are flexible in where they agreeto meet young people and recogniseit is crucial that the young person iscomfortable. Sessions may be held, forexample, at a young person’s home, atschool or in a café. Outreach drug work isconducted on local estates and round thecentre of town in conjunction withthe YMCA.”The service also needs to be flexiblewhen young people begin to want to liveindependently:“Once this happens, young people oftenbegin to disengage and are less willing tojoin groups or visit a mental health worker.Support @ The Junction is pro-activein outreach work to attempt to engageindividuals who still need support but arereluctant to attend the service.”Project worker, Support @ The Junction,The Junction, Colchesterduring the Listen Up phase of the research revealedthat the amount of out-of-hours help available wasoften restricted by resources. Some services alsofound that there was insufficient local need for theseservices; for example, Streetwise in Newcastle foundthere was little uptake in the counselling serviceoffered on Saturdays.

listenup!46 | Chapter 6There was considerable variation in opening hoursand out-of-hours services at each organisation, butall offer evening work with young people. Someorganisations were able to offer greater out-of-hourssupport, sometimes depending on need:“An out-of-hours telephone service is providedso that those who are at high risk can contact theproject at any time.”Project worker, IceBreak, The Zone, Plymouth“If there is a major issue in the life of the youngperson, staff will ring them in the evenings, and inextreme circumstances staff will leave their mobileson so that the young person can contact them.”Project worker, Caterpillar Service,Barnardo’s Marlborough Road Partnership, CardiffFast accessThe seven partner sites which provided servicesdirectly to young people who needed support(Experience in Mind in Brighton and Hove providedtraining) were asked for specific details on how easyit was for young people to access their services, andhow quickly they could do so. In terms of location,all seven organisations stated that they were easilyaccessible for all or most of their catchment area.The average waiting time from referral to initialassessment/appointment was more varied. Oneorganisation was able to offer this on the same day.Four organisations offered this within two weeks,one within three weeks and one within four weeks.In addition, some organisations had drop-in servicesthat could be used during the waiting time.All seven organisations were able to provide a fast-trackservice for young people who were deemed to be ina state of crisis or urgent need for help. In each case,this was for more than just a one-off appointment, andusually included full access to the service or a longerterminterim service such as in The Market Place.Case Study“There is a fast-access service availablefor any young person a worker may beparticularly concerned about, for example,those having suicidal thoughts, those whohave attempted suicide or are otherwiseparticularly vulnerable.“Young people can be offered fourcounselling sessions to start almostimmediately, that can be used to help theyoung person create strategies for copingwhilst they are waiting for long-termcounselling.”Managing numbersProject worker, The Market Place, LeedsAlthough all the organisations were able to offer afast-track service for those in urgent need, there wasthe need for waiting lists in some places for nonurgentaccess. This was due not only to the volumeof young people trying to access the services, asIceBreak in Plymouth found:“As the project has progressed, the clients accessingthe service have had increasingly high levels ofneeds, with around three-quarters of young peoplepresenting with self-harm or suicide.”Project worker, IceBreak, The Zone, PlymouthThis has necessitated a process of assessing andprioritising young people by need, but to date thishas not let to any real difficulties.This approach is also taken by the Market Place inLeeds, which had seen an increase in the number ofyoung people wanting to use the service:

listenup!Chapter 6 | 47“Young people are assessed and if their problemis not critical or life-threatening then they go ona waiting list… the drop-in service can also actas a buffer while waiting to be allocated to thecounselling service.”Project worker, The Market Place, LeedsThe Caterpillar Service in Cardiff had devised a planfor managing workload which worked well for theirservice:“Rather than all workers being allocated a certainnumber of young people, all staff members have thesame number of contacts over a weekly period. So,a worker who is dealing with a young person with ahigh level of needs would see fewer young people.”Project worker, Caterpillar Service,Barnardo’s Marlborough Road Partnership, CardiffOverall, the size of the organisation and its premises,staff numbers and funding (particularly a lack ofsustainable funding) all had a strong impact infuture plans and the ways that the services couldexpand to meet service demands. As a result of thoseconstraints, some of the organisations stated thatthey did not wish to over-promote their services,as they would not be able to provide the currentlevel of accessibility if they had more young peoplewanting to use their services.

listenup!48 | Chapter 1StreetwiseNewcastle

listenup!Chapter 1 | 497Providing supportDelivering asuccessful service:at all stages

listenup!50 | Chapter 7Delivering a successful service:Providing support at all stagesThe participants in Youth Crisis I saidthey wanted more preventative andearly intervention service provisionto help them find ways to avoiddeveloping more severe problems, aswell as greater sensitivity to their needswhen they were in serious difficulty.All stages of needAll eight partner sites adopted an ethos of patientchoice, giving young people a choice of supportthrough all stages of their engagement with theservice, from a one-off drop-in session, to long-termcounselling, and encompassing health promotion,prevention and early intervention, as well as intensivesupport for those in severe difficulty. All these formsof support are intrinsically linked to one anotheras part of a person-centred and holistic approach.For example, a young person may be havingintensive counselling to help them through a timeof emotional crisis but also be receiving support andadvice to prevent a housing situation from gettingworse – all as part of the whole package offered byan organisation.“I was surprised at the wide range of things in yourlife that’s covered, like finance, housing, eatingdisorders, self-harm and suicide… In the past,although I had good treatment in other places,you can’t just treat one thing. The eating disorder,self-harm and depression and all comes together.IceBreak [The Zone, Plymouth] has achieved that…you’re not a statistic. You’re treated like an individual.”Young personYoung people may initially contact one of theorganisations for advice on housing or contraception,and only once they have engaged with the serviceask for help with an emotional or mental healthproblem. One young person said they had startedattending a service because it was somewhere “tohang out with friends”, and only later had they beenable to access the emotional support they needed:“One day, I let my emotions out and one of thepersonal advisors was there and heard what I had tosay, and we started having meetings, and that’s howshe got around to helping me.”Young personAll of the organisations also placed considerableimportance on helping the young people usingtheir service in their transition from the organisation,perhaps because the person has reached the upperage limit, no longer requires support or needssupport from elsewhere.Health promotionThe promotion of good physical health, mentalhealth and emotional wellbeing is essential to thework of all the organisations. Different approachesto health promotion were taken by each project siteand included:• drug and alcohol awareness initiatives;• smoking cessation initiatives;• sexual health support and advice (e.g. offering freecondoms, contraceptive advice and Chlamydiatesting);• information to educate young people and raiseawareness of mental health and wellbeing, includingself-help and other young-person-friendly materials;• complementary therapies such as aromatherapyand acupuncture to help relieve stress and tension.Offering different types of health promotionfacilities can help engage young people in a servicebefore they experience a crisis. Staff working in theorganisations involved the project felt that it couldprovide an opportunity for the young person to learnabout and assess the organisation, what it offers andthe people working in it, so the young person canbuild trust with the organisation:

listenup!Chapter 7 | 51“… when young people access the service, ofteninitially for condoms, they are also fully informed ofall other aspects of the project.”Project worker, Streetwise, NewcastlePrevention and early interventionThe project sites considered prevention in terms ofeither stopping a situation, such as a mental healthcrisis, from happening in the first place, or preventinga situation from happening again or getting worse.Many of the approaches offered by the project sitesaid both these types of prevention:“CBT [cognitive behavioural therapy] aims to helpyoung people develop helpful thinking patternsand show how these may influence emotional andcoping responses in future difficulties.”Project worker, Aberdeen Foyer, AberdeenSome of the prevention work carried out by theorganisations did not have a specific mental healthfocus, but took the form of practical support, helpingyoung people to develop a range of life skills andcoping strategies.“A young person might, for instance, want someoneto accompany them on the bus to college for twoweeks while they learn the route, or come shoppingwith them to find clothes that are trendy and yetcover scars caused by self-harm.”Project worker, Caterpillar Service,Barnardo’s Marlborough Road Partnership, CardiffEarly intervention is a term often used to describeworking with young people aged 14 to 35 whoare presenting with symptoms of psychosis (DH,2001) and The Zone in Plymouth had a specific earlyintervention in psychosis programme (Insight). Thisconcept of providing support at the early stagesof problems was used by all the organisations,including The Zone, to help not just with psychosisbut with a wide range of emotional and mentalhealth problems.Case StudyIcebreak at The Zone in Plymouth is the onlyservice in the country for young people withemerging personality disorder.“Icebreak is designed as an ‘earlyintervention/preventative’ project… Theaim is to work to prevent young peoplefrom either developing the label ofpersonality disorder, or, if they have beengiven that label, to prevent them fromdeveloping secondary problems associatedwith the stigma and social exclusionthat often accompanies a diagnosis ofpersonality disorder.”(Project worker, IceBreak, The Zone, Plymouth)The project has an official partnership withPlymouth Primary Care Trust (PCT) andcurrently sees approximately 90 youngpeople. Another unique aspect of thisproject is that the trust staff are seconded into work with staff at the Zone, so the serviceis based in a youth organisation rather thanin a statutory mental health service.“Through interaction in settings such as schools andyouth clubs, Community Links are able to engageyoung people before they reach the point of crisisand require specialist mental health services – thusproviding an opportunity for early intervention.”Project worker, Community Links, Canning Town

listenup!52 | Chapter 7The emphasis is on supportingthe young people to gain the skillsto improve their life, and part of thisprocess involves the young peopledefining what ‘getting worse’would involve – in a sense, definingwhat it is they wish to prevent.Project worker, The Market Place, LeedsSensitivity to young people in distressPart of a holistic approachAlthough the organisations worked with youngpeople to help prevent them from developingproblems or to prevent problems getting worse,there were times when it was not possible to preventa crisis. Additionally, some young people accessedtheir service for the first time at a time when theywere already in urgent need of help. Services weretherefore sometimes faced with young people whowere contemplating suicide or self-harming. Theyworked to support young people through thosetimes, and often continued to work with them afterthese periods of extreme distress.Case Study“We offer intense support over 24-48hour periods for young people goingthrough a crisis who do not wish to involveother agencies. We also offer support toindividuals in custody who may be in crisis.“In all instances of crisis support, weensure that the follow-through of the crisisis sustained and maintained until suchtime that there is mutual agreement withthe young person that they are happy tocontinue without.”Project worker, Community Links, Canning TownSome organisations provided this support as part of anongoing programme working specifically with youngpeople who were experiencing severe difficulties:“IceBreak concentrates on young peoplecontemplating suicide, talking about self-harm orwith attachment difficulties.”Project worker, IceBreak, The Zone, Plymouth

listenup!Chapter 7 | 53The staff at the partner sites assessed each youngperson and then made a decision about whetherthey could support them, or if they needed to referthe young person to statutory services. However, itwas not always easy to find an appropriate service torefer the young person to:“Recently, a young man accessed Streetwisewho had been a former cannabis user and wasexperiencing hallucinations. As he was not residentin Newcastle, he could not be referred on to thepsychosis intervention team that Streetwise hasconnections with, and so had to be sent to a GP toget a local referral.Project worker, Streetwise, NewcastleGoing into hospitalSome young people said they had had badexperiences in accident and emergency (A&E)departments.“The doctors get quite abusive… one of themactually turned round and said ‘I hope you’re happy, Icould be out there saving lives’.”Young person“… they [A&E staff ] said ‘if you do it again you’ll endup in the mental institute across the road’… myfriend ended up in there and when she came out shewas in a worse state than when she went in.”Young personThe organisations had not yet undertaken workwith A&E departments to explore ways of improvingthe experience of young people, but at the timeof going to press, the Caterpillar Service in Cardiffand Experience in Mind in Brighton and Hove wereplanning to do more on this in future.Similarly, some young people reported havingnegative experiences during hospital admission:“Hospitals treat you like a patient before a person.”Young person“They just give you drugs and leave you to it.”Young personThe Caterpillar Service at Barnardo’s MarlboroughRoad Partnership in Cardiff was set up in April 2004to work primarily with young people who had beenadmitted as inpatients. The project aimed to providesupport for young people through the hospitaladmission process, to act as advocate for them andto provide help with adjusting to staying on theward. The service was established as a direct result ofconsultation with young people in Youth Crisis I.The service worked largely with young people on theadolescent unit in Cardiff, who were either voluntarypatients, or had been detained under the MentalHealth Act. The young people were aged from 11 to18 years, and had a range of mental health issues.Some had attempted suicide.However, young people are also sometimes admittedto adult wards, and the service built a relationshipwith staff on those wards and worked with theyoung people there. They reported one situation ofa young person being held for several months on anadult ward:“We established our role pretty well and worked welltogether. Since that time, we are trying to work withadult facilities to try and raise awareness of what wedo and to pick up any young person who may arriveon adult wards.”Project worker, Caterpillar Service,Barnardo’s Marlborough Road Partnership, Cardiff“[Being on an adult ward] was scary and knowingthat this [Caterpillar project] was there just helpedyou get through it.”Young person

listenup!54 | Chapter 7A project worker from the service went into theadolescent unit once a week to run activities andprovide social support. These activities aimed tomake the young people feel happy; providing themwith something fun to do can help distract themfrom their problems and enable them to deal betterwith those problems:“It is important that young people are able to havea part of their life that focuses on them as a personrather than just what is wrong with them.”Project worker, the Caterpillar Service,Barnardo’s Marlborough Road Partnership, CardiffSome young people may find it difficult to engage infun activities and allow themselves to express positiveemotions, in the fear that this will be misinterpretedto mean they are no longer experiencing difficultiesor have high support needs. The Caterpillar Serviceprovided young people with a safe place and timeto enjoy themselves, along with the reassurancethat their support would not be minimised as aconsequence of engaging in such activities.These fun and creative activities can also help createa bond between the young person and the projectworker which may then make it easier for the youngperson to talk about difficult issues.This project developed further and project workersbegan to see and work with young people whohad left hospital. A young person’s transition frominpatient life back to community living presentsmany challenges. Having an existing trustedrelationship with workers during this transition phasecan provide young people with a sense of security,stability and support which they can draw on to helpovercome the barriers they may face.In some instances, project workers from the servicetook young people off the ward for activities. Thisrequired building a strong and trusting relationshipwith the statutory sector:“Critics of the project’s approach take the view thatit is irresponsible to take someone who is unwellout to cafes or to go bowling and the only place forthem is in hospital… Explaining to statutory servicesthat these activities do have a therapeutic purposebut are just carried out in a social rather than clinicalsetting has helped in alleviating some of thesemisunderstandings.”Project worker, Caterpillar Service,Barnardo’s Marlborough Road Partnership, CardiffThe project also worked to help young peoplethrough the transitional phase between youth andadult services. At the time of going to press, therewas only one adolescent inpatient unit, so youngpeople were often either placed on adult wards orsent out of the country.Moving on from the serviceWhen a young person first accesses an organisation,the service needs to make immediately clear whatthe upper age limit of the service is (25 years formost of the organisations involved in the project).This transparency is important, as it means that theyoung person knows what to expect. In addition tothis, the organisations need to be clear as early aspossible about what they have to offer the youngperson, and if their service is not appropriate,they need to help them find somewhere elsefor support, such as another voluntary sectororganisation or statutory services.

listenup!Chapter 7 | 55The whole process of supporting the young personthrough the service and then preparing them formoving on was essential to all the partner sites.“A client’s contact with IceBreak is divided intothree stages: the engagement, middle andending… Leaving the project is carefully managedto support young people in both letting go ofthe service and their particular care co-ordinator,whilst also ensuring that they are well linked withagencies and individuals who can support themafter leaving the project.”Project worker, IceBreak, The Zone, Plymouth“All young people chose their own level ofparticipation with the project, this includes whenthey might stop engaging… measures are in placeto take account of young people’s needs and provideeffective support through transitions.”Project worker, Experience in Mind, Mind in Brightonand Hove, and Hove YMCA, Brighton and HoveTo assist with this, they set up a programme called‘Move On’, which was run by student social workerson placements and was aimed largely at those youngpeople who had emerging mental health problems.One organisation was able to take a highlypersonalised approach to the leaving process:“Leaving is made into as positive and happyexperience as possible. Young people are taken outfor an activity special to them, and are also givengifts and mementos… such as photographs, cardsor poems. It is made clear to the young people thatstaff are still interested to hear from them.”Project worker, Caterpillar Service,Barnardo’s Marlborough Road Partnership, CardiffSignposting and helping the young person toestablish links and support networks outside theorganisations was an important part of the workundertaken. This work could happen at whatevertime the young person wished to move on from theorganisation and was not just limited to when theyreached the age limit.Providing this was not without its difficulties for thesmallest of the organisations involved in the project,due to resource issues:“It is rare for a young person to leave the projectwithout either wanting to or having something elseto go on to, but more staff are needed to ensure thishappens consistently.”Project worker, Support @ The Junction,The Junction, Colchester

listenup!56 | Chapter 1IceBreak, The ZonePlymouth

listenup!Chapter 1 | 57Young personparticipation8

listenup!58 | Chapter 8Young person participationThis chapter describes the range ofmethods used by the organisationsin the project to consult with andinvolve young people in servicepractice development and deliveryfrom grass roots up to a strategic andoperational level.All eight partner sites prioritised the participationof the young people using the service, anddemonstrated successful, effective and meaningfulyoung person participation in developing manydifferent aspects of the service.“Young people participating in the project haveshown a high level of commitment and enthusiasmwhich suggests that it is meeting a need for theirvoice to be heard.”Project worker, Experience in Mind, Mind In Brightonand Hove, and Hove YMCAYoung person participation brings added valuein terms of benefits, positive outcomes and/orchanges to both young people’s lives (see chapter9) and the services they access. For services,benefits included improved access for youngpeople; development of a more responsive serviceto meet the range of needs of all young people inthe local community; increased accountability totheir funders and other organisations they workwith; and more informed training to service staffwith regards to young people’s mental health andemotional wellbeing needs.Young person participation can sometimes bechallenging for organisations to achieve, mainlydue to lack of human or financial resources. All theorganisations strived to overcome these challengesthrough a variety of strategies.“It is essential to not become blasé about thesuccess of service user participation, but instead tolook constantly for ways to improve or build uponthe ways in which young people are involved inthe service… projects must adapt their manner ofworking to suit each new set of young people.”Project Worker, Caterpillar Service,Barnardo’s Marlborough Road Partnership, CardiffServices need to devote sufficient staff, time andmoney to achieving effective and meaningful youngperson participation that is not just tokenistic. They

listenup!Chapter 8 | 59also need to develop structures and processes foryoung person participation, and for respondingto their views. This aspect of service provision candrop down the list of priorities when resources arestretched or when there is an increased workload.Services can ensure this does not happen byidentifying what they hope to achieve from youngperson participation, and reviewing these objectiveson a regular basis.“… you often involve young people at the beginning,such as in the development of the service, and peopleassume that this is young people involvement, butafter the initial developments have been made in theservice, young people involvement can slip… thisprocess has happened to us, so we are now havingto try and recapture and re-evaluate their continualinvolvement in service development.”Project worker, Sorted Not Screwed Up,Aberdeen Foyer, AberdeenA dedicated youth participation project worker canhelp to ensure young person participation remainshigh on the agenda. Although only one serviceinvolved in this project had a dedicated memberof staff working on this, others were consideringseeking, or already seeking funding for a new post.“… a dedicated worker is essential in ensuring thatservice user participation retains the priority thatit should be given… it requires someone who isfocused entirely on developing strategies for keepingyoung people engaged and motivated, as well asmaking the process fun.”Project worker, IceBreak, The Zone, PlymouthThe organisations involved in this project used anumber of methods for consulting with youngpeople, including:• setting up formal youth advisory boards forconsultation on all aspects of the service (see p60)• asking young people to provide feedback throughmonitoring and evaluation forms and surveys• running informal group and individual feedbacksessions with keyworkers• having formal panel board meetings with youngpeople and senior management• asking young people to provide anonymousfeedback through suggestion boxes or ‘post-itnote’ postings• running focus groups on understanding specificidentified issues• giving young people the opportunity to provideexpressive feedback through art, music, dramaor poetry.Consultation with young people at all organisationswas described as a continual process. Staffrecognised that successful participation wasdependent on maintaining an honest dialoguewith young people to ensure the organisation wasdelivering a service reflective of their needs. All theorganisations engendered a culture whereby staffwere approachable:“Being open, honest and transparent about what weare and what we’re doing [means] they will knowthey have no need to fear us… Some services are tooclosed and young people become suspicious… sohaving good, clear communication is important.”Project Worker, Streetwise, NewcastleSome organisations reported that it was not alwayseasy to ensure young people’s participation was trulyrepresentative, as there tended to be a core groupof young people who wanted to contribute, but thevoices of other young service users were not heard,such as those using the service on an ad hoc basis orthose less willing to give their views.“It is difficult when some service users have suchchaotic lives… feedback is not always representativeof all the young people accessing the service.”Project Worker, Streetwise, Newcastle

listenup!60 | Chapter 8The rest of this chapter explores the different waysyoung people can be consulted and involved in theservices they use.Youth advisory boards“We’re consulted on all things… even down to thecost of the group.”Young personFive of the eight partner sites ran a youth advisoryboard to provide young people with a forumin which they had an effective voice within theorganisation. Through these boards, young peoplecan have the opportunity to influence organisationaldevelopment, provision and delivery from the ‘grassroots’ up to strategic and operational level. They canalso become powerful advocates of the organisationto the wider community and contribute to theyoung persons’ mental health agenda on a local andnational level.These boards varied in nature and size, but were allseen as an essential part of achieving meaningfuland effective young person participation, and all metat regular intervals throughout the year. All youngpeople were welcome to be a member of the board.At some services, young people who had movedon from the organisation were also welcome tocontinue their membership for a period of time.All boards were allocated a member of staff as coordinator,to provide relevant information about theorganisation to the board, and to keep the board’sdiscussions focused and purposeful. Young peopleat Experience in Mind, run by Mind in Brightonand Hove and Hove YMCA, stressed that the youngpeople on the board were the major decisionmakers,not the project worker.“He [project worker] won’t accept he’s part of thegroup – he says it’s our project.”Young personAll members of each board were involved indecisions on the running, development anddirection of the board. Each of the boards wasprovided with a small amount of annual fundingfor activities, events and equipment, for which theyoung people were responsible.Case StudyA group of young people who used the service at The Market Place in Leeds were members of theHYPE youth advisory board group – ‘Helping Young People through Experience’. The group metmonthly and had a valued and crucial role in shaping organisation provision and delivery, from the‘grass roots’ to the operational and strategic level. HYPE were consulted on the physical environmentof the organisation (e.g. decoration, colour schemes) and staff recruitment and training, and helpedto write funding applications, design promotional materials including leaflets, posters and thewebsite, and decide on the types of groups and activities on offer. They also consulted with externalprofessionals such as policy makers and commissioners.All members felt confident that The Market Place was fully committed to listening to their feedbackand using this to influence all aspects of service and practice development. The HYPE groupviewed their role as a voice for both their peers within the organisation, and for peers in the widercommunity to advocate for young people’s needs and challenge stigma and discrimination.

listenup!Chapter 8 | 61“Our advisory board enriches the project not onlyin promoting the project but also from the buzzcreated by having young people involved. It is alsoreally positive to see the confidence of young peoplegrow as they develop through the service frominitially beginning group work and then movingonto working on the advisory board, giving theminvaluable experience.”Project worker, Support @ The Junction,The Junction, ColchesterAll staff within the projectfrom grass roots upwardsmust share the same visionand philosophy of serviceuser involvement.Project Worker, Sorted Not Screwed Up,Aberdeen Foyer, AberdeenTypes of young person participation“Always have confidence in young people’s abilitiesand potential.”Project worker, Experience in Mind,Mind in Brighton and Hove, and Hove YMCAYoung people in these services were involved inorganisational development in a number of ways,as described in this section. Some were facilitatedthrough discussion as part of a youth advisory board,and some happened independently.Helping develop the environment and design ofthe organisationAll organisations consulted with young peopleon the internal environment and design of theorganisation. This included the type and positioningof furniture, colour schemes, the information andartwork displayed in the building, and the overallatmosphere of the service.This issue led to some debate in the organisationsinvolved in this project. Some young people liked boldcolours and said they kept them focused and motivatedduring sessions with their worker, while others preferredcalming pastel colours, saying bold colours were toodistracting and made them feel stressed.

listenup!62 | Chapter 8Marketing, promoting and campaigning forthe organisation and producing young personfriendlyinformationAll eight organisations involved young people inmarketing and promotional activities. This involvedthe development of marketing materials such asflyers and the organisation’s website, includingdeciding on content, language (including how‘formal’ it should be) and design.Young people were also involved in developing andproducing information products for young people.For example, Streetwise in Newcastle developeda ‘Crisis Card’. This was used by young people todisplay their name, contact number and the serviceswhich should be contacted when the individualis experiencing a crisis. At the Caterpillar Service,Barnardo’s Marlborough Road Partnership, youngpeople were involved in producing the Barnardo’snewspaper which was sent out to Barnardo’s services.Young people at IceBreak, the Zone, Plymouthproduced a 30-minute DVD which involvedsharing their personal experiences and thiswas presented at a national conference. Someorganisations were particularly keen to get youngCase StudySeveral young people at Experience inMind, Mind in Brighton and Hove, and HoveYMCA, were interviewed by BBC SouthernCounties Radio as part of a 5-day series onthe Experience in Mind project.Press releases promoting the project havealso resulted in articles in local newspapersand magazines. One young persontook the initiative of contacting a localmagazine direct to ensure something onthe project was included in their mentalhealth issue.people involved in campaigning and to experienceworking with the media.Planning and organising events and socialactivitiesAll the organisations provided young people with theopportunity to plan, organise and run various eventsand social activities. The majority of social activitiesoccurred during school holidays and included tripsto the cinema, beach, and eateries, as well as bowlingand shopping trips. Most organisations also heldopen evenings where creative and fun activities weremade available for all young people and staff to join in,including arts, music and drama productions. At someevents, external professionals such as practitioners andcommissioners were also invited, so they could meetyoung people and take part in activities.Helping develop publicationsAt all eight of the organisations, young people’sfeedback was used to inform the development andproduction of publications including annual reports,information sheets and research reports.Case StudySorted Not Screwed Up, Aberdeen Foyer,Aberdeen, produced a number of in-housepublications based on consultations withyoung people who accessed their services.For example, “Sorted Not Screwed Up”Young People’s Survey Results (2005) wasproduced following a small survey of clientswithin the Foyer accommodation, lookingat issues including their relationships withfriends and family; the history of theirhousing status; information on their generalhealth; information on their mental health;what services they accessed within theFoyer; and how beneficial they perceivedthose services to be.

listenup!Chapter 8 | 63Taking work experience at the organisations“Helping out as a volunteer enables me to makeother young people’s experiences more comfortableand better.”Young personMost of the organisations involved in this projectprovided a range of opportunities for young peopleto undertake work experience within the organisation.These included helping out with administrative tasks;handing out information leaflets to young people;helping with events and activities; peer mentoring;and assisting in the running or delivery of drop-in orgroup work sessions alongside staff.“I feel like one of the staff – they put me in charge ofdrop-in, which is every Tuesday.”Young personCase StudyOver the summer months, Community Linksin Canning Town ran a project based on theBBC TV programme The Apprentice. Overthe course of eight weeks, young peoplecompleted tasks from different aspects ofservice delivery, and one young person was‘fired’ each week. In the end, there werethree winners, as the judges could notdecide between them.Each of these young people won a week’spaid work in the project at junior workerrates. This type of activity helped youngpeople to build up valuable and transferablework-related skills. The project was sosuccessful that there are plans to run iteach year at the same time as the BBCprogramme is on television.At Support @ The Junction, at The Junction inColchester, a small group of young people weretrained by an external researcher from Anglia RuskinUniversity’s Health and Social Care Departmentin Chelmsford to conduct an evaluation ofthe organisation. This involved assisting in thedevelopment of the evaluation tool, as well ascollecting data from young people and staff. Suchopportunities help young people to develop skillsand knowledge to fulfil their potential for futureemployment.The need to maintain confidentiality regardingother young people accessing the organisation canoften place limitations on the type and level of workthat young people can undertake as volunteers forthe organisation. It is particularly important thatinformation regarding young people is protected. Itis not usually appropriate for volunteers to be givenany kind of information about other young people.Staff said that if it was thought it would be beneficialfor a volunteer to be, for instance, made aware of ayoung person’s diagnosis, then the young person’spermission would be sought before any informationwas disclosed to the volunteer. In addition, allCase StudyCommunity Links in Canning Town ran a juniorworker programme for young people aged15-18. Workers were paid £10 per day. Theywere given small tasks and responsibilitiesso that they could gain experience in theplanning, delivery and evaluation of sessions.One worker supervised a drop-in session oncea week where young people could come intothe project for practical help, such as withusing the internet. Young people felt that thiswas part of a wider policy of encouragingthe ‘older’ young people to help support theyounger ones in accessing the service.

listenup!64 | Chapter 8Case StudyThe HYPE group at The Market Place in Leeds took an innovative and creative approach tointerviewing applicants, and developed a method called ‘speed interviewing’, which was takenfrom the concept of ‘speed dating’.Firstly, the group agreed on a list of interview questions designed to make candidates reflecton and learn from ‘what a young person needs from a counsellor’. Each young person was thenallocated one question to ask, and the interview room was set up with each young person sittingat a table with two chairs. The candidates were invited to circulate the room until they had visitedeach table and answered each young person’s question. The young people then set up feedbacksessions where they discussed their views on each of the candidates with one another, and thenreported back to staff.While the group recognised they did not have the final say in who was recruited, they knew thatstaff noted and took their opinions seriously. Young people reported that doing this was “wicked!”Candidates also found this approach extremely beneficial; one candidate told the young people that:“It was really helpful to talk to you about how you want counsellors to be... you have helped meto put things into a more realistic context.”Staff at The Market Place also felt that HYPE’s involvement in staff recruitment was an effectiveway of continuing to learn from the young people using the service, and of ensuring the service isresponding to what young people felt they needed:“It’s always interesting, I’m really grateful for HYPE’s time and feedback.”Project worker, The Market Place, Leedsorganisations provided young people who werevolunteering with sufficient training, and with clearguidelines on confidentially.Being involved in staff recruitment and induction“When recruiting staff, it is crucial to be selectiveand ensure they are equipped with the necessaryprofessional and interpersonal skills, experience andqualifications to successfully engage with youngpeople. Thus, young people must be involved in therecruitment panel as a standard measure.”Project worker, Experience in Mind,Mind in Brighton and Hove, and Hove YMCA,Brighton and HoveAt six out of the eight organisations, young peoplewere involved in the recruitment of staff, includingshortlisting candidates and sitting on the interviewpanel. These organisations also involved youngpeople in staff inductions. This provided youngpeople with the opportunity to engage in groupdiscussions or presentations highlighting keyaspects of organisational delivery that they felt newstaff should be made aware of. Members of staffsupported young people in their preparations forbeing on interview panels:

listenup!Chapter 8 | 65“If young people are sitting on interview panels, theyare briefed about ethics and it is explained to them indetail what kind of person is needed for the role.”Project worker, the Caterpillar Service,Barnardo’s Marlborough Road Partnership, CardiffTaking part in external eventsAll eight organisations encouraged and supportedyoung people to take part in external eventsand consultations, and to network with otherorganisations and professionals.Young people from the partner sites attended,presented and ran workshops at local and nationalevents and conferences aimed at raising awarenessof mental health and emotional wellbeing andtackling stigma. Young people also presented theirpersonal stories and shared their experiences, asCase StudyThe Caterpillar Service at Barnardo’sMarlborough Road Partnership in Cardiff,was involved in several national consultationexercises, including the first stage of thisproject, Youth Crisis I; The National Self-HarmInquiry (Camelot Foundation and the MentalHealth Foundation); and a project with theSamaritans looking at how young peopleused text messages and mobile phones,with regard to exploring the benefits ofusing this form of communication betweenprofessionals and young people.YoungMinds and Mind consulted theorganisation on the content of theinformation they provided to young people,and young people at the service gave theiropinions on the service’s promotionalmaterial, sat on interview panels, and helpeddelivering training to external professionals.well as participating in discussions with a range ofkey stakeholders.“I have gained a big boost in confidence by talking infront of adults in a big room.”Young personThe youth advisory board at Support @ TheJunction, was consulted by external professionalson the best way to talk to young people aboutself-harm, and representatives were invited bythe local NHS trust to present ideas on how toimprove services for young people. A young personfrom Streetwise was asked to speak to Ofsted, theschools inspectorate, to share their experience andtheir opinions of the service. Young people fromExperience in Mind attended external events suchas meetings of the Child and Adolescent MentalHealth Service (CAMHS) at the local NHS trust, andthe trust’s annual general meeting.At all times, young people’s involvement in externalactivities was flexible, and they were able tocontribute at a level they felt comfortable with.Members of staff were always on hand to providesupport for young people preparing for activities,and to debrief them after participation work.“The process of preparing for a presentation takesup to eight weeks of workshops to ensure thatyoung people are confident, polished and fullyrehearsed… young people are briefed not only onthe content of what they would be doing, but alsopracticalities such as the protocol of the day andsuitable clothing.”Project worker, the Caterpillar Service,Barnardo’s Marlborough Road Partnership, CardiffTraining staff in other agenciesMany young people consulted as part of YouthCrisis I wanted to be involved in the training of staff.This reflected young people’s need to be listenedto and respected, particularly in times of potentialcrisis and/or powerlessness. Young people felt that

listenup!66 | Chapter 8psychiatrists, community psychiatric nurses, GPs,social workers, police officers, and A&E workerswould provide more sensitive services if theyreceived such training, and heard from young peopleabout their experiences of mental health issues.“Sharing their personal experience of mental healthproblems is a powerful tool in de-stigmatising anddispelling myths.”Project worker, Experience in Mind,Mind in Brighton and Hove, and Hove YMCAExperience in Mind, a partnership between Mindin Brighton and Hove, and Hove YMCA, was verydifferent from the seven other organisations asit did not offer mental health services for youngpeople, but asked young people with experience ofmental health problems to train staff from outsideagencies. The training package, developed anddelivered by young people, covered four main areas:communication; self-harm; depression; and stress.The training was ‘experiential’: based on youngpeople’s actual experience as opposed to theory.“We want to reduce the stigma… and not be seenjust as people with mental health difficulties, but aspeople like everyone else.”Young personYoung people who wanted to deliver the traininghad the opportunity to take a Level 2 OCN (OpenCollege Network) accredited course, ‘Trainingthrough Experience’, to learn the necessary trainingskills, such as presentation and group work skills.The training used a variety of techniques, includingshowing films and making presentations as wellas role play, discussion and quizzes. Each trainingsession was tailor-made to its audience, based ontheir needs and their mental health awareness,and could last from one hour to a whole day, withthe usual length being three hours. The youngpeople were paid for the training they delivered inrecognition of the experience and skills they brought.In March 2007, the training was piloted with Mindand YMCA professionals, and at the time of going topress, training sessions were being booked by otheragencies. A number of colleges, youth groups andorganisations in the local housing sector had alsoexpressed an interest in taking the training, as well associal workers and A&E staff.Young people were involved in all areas of theproject, from designing the training through to itsmarketing; this meant they felt they had ‘ownership’of the project. As a result of this high level ofinvolvement, the young people were able to developa wide range of skills, alongside training skills, whichwere important not just for their self confidenceand relationships, but for future employmentopportunities as well:• respect – learning how to work effectively in a group;• appreciation of others – understanding diversity;• tact – the ability to express opinions whilstrespecting other points of view;• trust – confidentiality; keeping informationdisclosed within group work confidential;• courage – the ability to express traumatic eventsobjectively and publicly;• understanding of different learning styles;• time keeping;• target setting – planning for the future;• working as a reference group, helping to makestrategic decisions;• increased self confidence;• raised self awareness;• optimism – accepting past and present difficultiesas tools of learning;• tolerance;• taking responsibility for themselves.

listenup!Chapter 8 | 67Case StudyThe young people at Experience in Mind developed a way of helping others to understand what itis like to hear voices in your head.At the training session, trainees were asked to undertake a number of activities such as adding upnumbers and answering questions, while a CD of voices saying things, often negative, was playedcontinuously. The recording was based on the voices some of the young people themselveshad experienced. When the CD was stopped, the trainees were also asked what the voices weresaying. The purpose of this exercise was to show how difficult it can be to undertake tasks, at thesame time as listening and recalling information accurately.Following the exercise, trainees were asked to talk about how it felt, and to ask young people whohad experienced hearing voices what it was like for them.“Often, not only do young people with schizophrenia struggle with their own inner world, theyalso have a struggle with social networks, relationships and lack of understanding and prejudicetoward their diagnosis.“The reason we are sharing these experiences is because communication and understanding fromthe world around young people with schizophrenia is ineffective, and this can impact severely ontheir mental wellbeing.”Experience in Mind, Mind in Brighton and Hove, and Hove YMCA,Brighton and Hove, Training pack (to be published in July 2007)The project worker explained that in addition tothese, the peer support element of this work wasimportant:“… being part of Experience in Mind allows theyoung people to gain a greater understanding oftheir own mental health, having built relationshipswith others who have had similar experiences.”Project Worker, Experience in Mind,Mind in Brighton and Hove, and Hove YMCA,Brighton and HoveThe young people were clear about what the projectcould offer to help improve services for other youngpeople, and this could be remarkably simple:“It feels like such basic things – just the way peoplecommunicate can make such a difference, and we’veall been there.”Young personAnother young person reflected upon the currentproblems for young people using services, and theiraspirations for the future. They hoped they couldcontribute to changes that would mean that:“… in 10 years’ time, people won’t be having theproblems we’re having.”Young person

9Young people’sexperiencesof service userparticipation

listenup!Chapter 9 | 69Young people’s experiencesof service user participationYoung people were asked abouttheir experiences of being consultedwith and involved in decisionsabout service provision and delivery,as well as external events andconsultations. They were asked toreflect upon both the barriers theyhad encountered in participating,and the positive impact it had hadon their personal development. Theyalso shared their views on its valueand importance beyond meetingtheir personal needs. This chaptersummarises their responses.Barriers to participationYoung people said that they had encounteredonly one main barrier to meaningful young personparticipation: tokenism. Some young peoplereported feeling that consultations with someorganisations, particularly in statutory settings, felttokenistic, and said that they did not think theirfeedback would inform change within the mentalhealth agenda. For example, they reported that,at times, external professionals did not take themseriously, which resulted in them feeling devalued.However, one young person stated:“Coupled with the confidence I have gained fromthe service I attend, if I go to conferences and they’renot listening to me, I tell myself it’s their choice andI know I’m doing my part and all I can do is givesomething back to the service.”Young personOther young people commented that their feelingsof being devalued due to negative experiences wereoften short-lived and made them more determinedto have their voice heard afterwards. Such motivationthen encouraged young people to educateprofessionals about the work they were doing andhow it could influence change. Many young peopleacknowledged that just because some professionalsdid not want to listen, there would always be othersthat did.“I think it’s because they just think that we are littlekids and we’ve got problems, but once they see thatwe are making a difference in what we are doing, wethen prove them wrong.”Young personAll the organisations in the project aimed toreduce tokenistic participation by actively buildingrelationships with external organisations andnegotiating in advance with other professionals themethods of involving young people in consultationsand at events. In addition, service staff informed

listenup!70 | Chapter 9It is a positive and empoweringexperience and provides theopportunity to voice our opinions.Young personexternal professionals on the benefits to them ofconsulting with young people and assured them ofthe young people’s ability to engage effectively.“We try to encourage other professionals to includeservice users, but only when we feel a young personwants to be involved and that is appropriate…we’ve had conversations with the young personand considered what it would mean for them to beinvolved with that particular activity.”Project worker, The Caterpillar Service,The Marlborough Road Partnership, CardiffPersonal developmentFeeling empowered, independent and in controlYoung people said that being provided withthe choice and flexibility to make decisionsabout the support they received, as well as thesecurity of knowing they could change theirkeyworker if necessary, gave them a strong senseof empowerment and control over their lives.Consequentially, they became more confident inmaking decisions on other aspects of their lives.Having the opportunity to ‘shape’ internal serviceprovision and delivery as well as being involved inexternal events and consultations enabled youngpeople to strike a healthy balance between receivingsupport and enhancing their confidence to beresponsible and independent adults.Acquiring specialised knowledge and languageYoung people felt that, through their involvementwith the organisation on a strategic level, they hadacquired a clear understanding of the directionand purpose of the organisation they attended.Involvement in external events and consultationsalso provided them with a better understandingof policy and practice in other sectors of themental health system. They felt that this specialisedknowledge had enhanced their ability to navigateindependently through and access a selection ofservices to meet their needs. In addition, they feltthey had gained a better insight into their rights andentitlements as a young person and could pass thisknowledge on to other young people who werefacing similar experiences. Finally, they felt more ableto contribute significantly to the ongoing mentalhealth agenda.The opportunity to network with professionalsfrom other services, and in some cases with policymakers and commissioners, helped the youngpeople develop their communication skills. Thiswas, in fact, a two-way process; young peopleeducated professionals on how to use languagethat young people could understand, whilesimultaneously learning to adapt to different stylesof language and terminology used by professionals.This presented a number of challenges for youngpeople, because the language used by professionalsdiffers between sectors, and in some cases thesame terminology can have different meanings. Byadapting and pitching their language to differentprofessionals, young people felt they were ableto engage with and influence a wider range ofprofessionals more successfully, for example duringnetworking, presenting at conferences or engagingin consultations.Gaining transferable skillsYoung people said that their engagement in theactivities involved in service user participation– public speaking, networking, consultation activities,organising and engaging in fun events, recruitmentand training of professionals, health promotion,marketing their organisation – had helped themdevelop a wide range of transferable skills. Theseincluded organisation and time management skills,communication and language skills, life skills andcoping strategies, and relationship developmentskills. Overall, participation helped young peopleto develop the necessary skills to make progress inother aspects of their lives.

listenup!Chapter 9 | 71Value and importance withina wider contextInfluencing change and making a differenceYoung people saw their involvement as a valuableopportunity to voice their opinions, not justwithin their organisation but in the mental healthand public arena. Being in a position where theirviewpoint was valued was described as empowering:“You’re not ignored… your opinion is heard…”Young personMany said their participation was an excellentopportunity to play an active role in contributingto the children’s and young people’s mental healthagenda, and helping to influence change positivelyat a local and national level. Young people werepassionate about designing and utilising participationso that it could make a real difference to the lives ofother young people experiencing similar issues:“… not only can we make a difference to our lives,but also to the lives of others.”Young personRaising awareness, and reducing stigma anddiscriminationThe level of stigma attached to mental healthproblems and using services had led to someyoung people experiencing discrimination fromfamily and friends. One young person foundthemselves being ostracised from close friends andfamily who no longer wished to speak to her andcalled her a “psycho”.Participation provides young people with theopportunity to help raise awareness of the issuesencountered by young people with mental healthproblems. The young people we spoke to wanted toshare their personal experiences with others so theycould see that:“Basically… I’m a person, you’re a person, whateverproblems we have.”Young personYoung people felt that raising awareness of mentalhealth problems, combined with promoting theimportance and value of emotional wellbeingand happiness to the general public, would helpto reduce stigma and discrimination. In order toachieve this, they felt that all relevant organisationsworking with young people, as well as families,needed more education and training developedand led by young people:“I think what needs to happen really is that peopleneed to be educated from a young age, just likethere’s sex education – do like… a mental healtheducation in schools.”Young person“It’d be good to educate family as well asprofessionals, because at the end of the dayprofessionals do know a bit more than our parents,and our parents need to know, because they have tolook after us and they don’t get to read books aboutit, they only have their experience.”Young personGiving something back to the serviceYoung people also felt that being involved ininternal participation as well as external events andconsultations was a way to support the service in itsaim to promote best practice to meet the needs ofall young people. Supporting the service in this waywas seen as a way of showing their gratitude andgiving something back to the service for the valuablesupport they had received:“It’s nice to give something back for all the help theygave us… I just feel like I owe them so much, [and]this is the only way I can do it.”Young person

10Makingadifferenceto youngpeople’s lives

listenup!Chapter 10 | 73Making a differenceto young people’s livesYoung people attending all the services involved in the project reported theways that attending them had changed their lives in some way for the better.We did not have any negative responses, althoughwe recognise that the positivity of the responses mayhave been affected by the fact that all of these youngpeople were currently or had recently been engagedwith these services.Increased confidence, self esteemand self awarenessA growth in confidence and self esteem wasreported by almost all of the young peopleinterviewed.“To start with, I wanted to just hide, but I’m not aswithdrawn any more and am getting back to morelike my old self.”Young personYoung people from one service said they had gaineda sense of hope and a more positive outlook on thefuture. This, in turn, has improved their self esteemand their motivation to do something productivewith their lives. Young people accessing otherservices expressed similar feelings:“They show you a better way of life.”Young person“They make a care plan with you and help youvisualise what you want to achieve.”Young personYoung people reported that an increase inconfidence had improved their lives in a number ofways, such as: relationships; education and careerdevelopment; the number and variety of socialactivities; being able to access and engage in mentalhealth and youth services independently; and feelingable to talk to other people, including strangers.They also felt more able to express their feelings andneeds more clearly to professionals, friends, familyand partners.Improved relationshipsAn increase in confidence and self worth and animprovement in communication skills contributedto young people developing trusting relationshipswith both staff at the services and with their peers.The development of trusting ‘adult’ relationships, inturn, helped young people form positive relationshippatterns. Some spoke of developing greaterempathy, understanding and acceptance of othersand not judging on first impressions. They said thesechanges led to improved social lives and healthier,more open relationships with family and peers, withsome expressing how they were also more ableto develop successful working relationships withprofessionals from other services, as well as with theirteachers.“Now I’ve joined this group, I’ve seen what afriendship really is.”Young person“I wouldn’t be getting married if I hadn’t come here.”Young personDevelopment of coping strategies andlife skillsMany young people spoke of having learned,through the services, coping strategies to help themdeal more effectively with the challenges they facedin their lives. The majority of young people alsosuccessfully developed essential life skills, such ascooking, shopping, dealing with finances, generalproblem-solving skills, and generally how to care forthemselves independently.Some were taught coping strategies and life skillsin one-to-one sessions with their keyworker ortherapist. Others took part in group activities, andlearned from other young people’s experiences

listenup!74 | Chapter 10about how to cope with certain situations.Supporting their peers in these groups also helpedthem to develop skills:“As we’re learning to help other people deal withcertain situations, we’re also learning from each other.”Young personEducation and career developmentYoung people at three of the services spokespecifically about having been encouraged tocontinue going to college.“I don’t think I’d be the person I am now [if I hadn’tused the service]… I’d be on the streets… I wouldn’tbe studying.”Young personWorkers helped young people to manage thechallenges in their lives and helped prevent thesefrom interfering with their college commitments.Another young person reported that staff from theservice had liaised with their teachers in problematictimes to ensure the teachers had a soundunderstanding of the young person’s needs.“I did a vocational 12-week course and managedto go to every one [class], which I have never beenable to do [before]… I am also doing an ongoing ITcourse and looking into voluntary work.”Young personSome young people said they had managed to enterpaid employment, and keep their jobs successfully,with the support of service staff. Others becamemore focused and clear about their future careerdevelopment goals. One young person said theyhad been inspired by workers and peers to pursue acareer in young people’s mental health:“It’s inspired me… I’ve learnt what I want to do as aliving… I look at the workers here, and think, yeah, Iwant to do this.”Young personAnother young person said the support andinformation she had gained from the staff at theservice helped her become a special needs assistant,and supported her so she could keep her job:“I wouldn’t be able to do the job that I do [if I didn’tuse the service]… I work in a school helping pupilswith behavioural problems… if it wasn’t for theinformation I get here I wouldn’t have a service I canrecommend to the children and school… Also, Icouldn’t handle their [the children’s] problems as wellas I do now.”Young personHousingSome services provided specialist help with housing,and this was very important for many young people.“So when you’ve been in a crap home to start off, andthen you get put in foster care, then hostels wherethere’s drug users for your next-door neighbours…[then] you get a home for the first time, and youvalue that.”Young personOne young person spoke of how the service hadacted as an intermediary in securing housing. Socialservices had refused to recognise that the youngperson was homeless, even though they had beenunable to live at home because of their mother’sbehaviour. Staff at the service then contacted theHomeless Persons’ Unit, which immediately agreed toplace the young person in a hostel.“She [the service worker] phoned up people sheknows and asked for their advice about housingme… She phoned social services and they said theydidn’t see why I was homeless, then spoke to mykeyworker at the Homeless Persons’ Unit… I wasn’treally involved – she did all the talking for me and Igot housed.”Young person

listenup!Chapter 10 | 75I wouldn’t be at university, Iwouldn’t have found my self worth,wouldn’t have found my dignity... I’ddefinitely have been self-harming.Young personBroader perspective on lifeOne young person said the service had helpedthem to put their life and problems into perspective.Others said that they had welcomed the opportunityto see their own experience in a new way:“Standing here two weeks into it [project], andalready you’re looking at things in a completelydifferent way.”Young personAnother young person said that they had found itbeneficial to hear the viewpoint of someone outsidetheir social circle.No longer needing medicationTwo young people spoke of no longer needing touse medication as a result of having support fromtheir respective services.“I’m not in hospital and not on medication anymore.I’ve gone from being in hospital to supportedhousing to living on my own… I don’t feel the needto be on medication, I don’t feel as depressed as Iwas. I do have days when I feel down but I know onthose days I’ve got support.”Young personReduction of harmful behavioursSome young people reported that they had endedor decreased harmful behaviours, such as excessivedrinking, self-harm and violence.Others benefited from having had help with angermanagement.“I used to really lash out, I was brought up to lashout physically. They [the project] teach you it’s okayto cry sometimes and to feel down and you’re notabnormal for feeling that way.”Young personAnother young person admitted that, although theyhad better control over their anger, this was stilldependent on the situation.Preventing problems from leading tocrises or suicideA considerable number of young people acrossthese services said they doubted whether theywould still be alive without having had the inputfrom the service.“I really wouldn’t be here right now.”Young person“I don’t think they realise half the time what a greatjob they do… I wouldn’t be here if it wasn’t for them.”Young personOthers spoke of serious consequences to their liveswithout the support they had received, such ascontinuing destructive behaviour, withdrawal, beingconfined to the house, not having a relationshipwith their families, getting trapped in negativerelationships with partners or, for one young person,putting themselves at risk of having their baby takeninto care.“Just the thought scares me of not having all that…I’d be lost.”Young person“I would have just continued getting worse or juststopped doing anything.”Young personOverall, the services supported all young people todevelop and maintain consistent and stable lifestyles,thereby contributing to a long-term positive impacton their lives.

listenup!76 | Chapter 111 Keychallenges

listenup!Chapter 11 | 77Key challengesWhilst there is growing recognition ofthe valuable contribution to be madeby voluntary sector organisations likethose involved in Listen Up, thereare still a number of inter-linkedchallenges to overcome to make thiscontribution a reality.Funding is not the least of these, with organisationsoften having to weigh up the planning anddevelopment of their services against what isavailable: often short-term and piecemeal funding.There is an increasing drive from the governmentfor the statutory sector to work with thevoluntary sector in order to meet the needs ofthe community. This can potentially be a positiveexperience, but has its own challenges, suchas finding ways to develop shared goals andnavigating through a range of cultural differences.The organisations involved in this project work withyoung people aged between 16 and 25, a timeof ongoing transition between adolescence andadulthood. This is substantially different from moststatutory organisations who define adulthood asbeing between the ages of 16 and 18.In order for voluntary sector services to becommissioned and funded, they need to be able toshow what it is they do and where their expertiselies. Monitoring and evaluating their services playsa crucial role in this, but there is a no ‘one size fits all’approach that will capture what a diverse range ofvoluntary sector organisations are achieving. Fundersand commissioners can work alongside voluntarysector organisations on this, and take an importantlead in looking at different and flexible approachesto what they want from the sector in terms ofmonitoring and evaluation.Funding“Whilst the workers have a wealth of innovative ideasand skills the service need sufficient funds to actuallyturn these into reality.”Project worker, Sorted Not Screwed Up,Aberdeen Foyer, AberdeenIt is unsurprising that one of the main problems thatall our partner sites faced was funding, particularlysourcing sustainable funding. During the lifetime ofthe project, two of the organisations found themselves

listenup!78 | Chapter 11Throughout the country, there are programmes being delivered bycharities, social enterprises and voluntary groups that work brilliantly. It isgroups like these at the front line of delivery who know about what works andwhat doesn’t. Their creativity, their innovation, their energy, and their capacityto build trust are helping us to meet the tough challenges ahead and to driveimprovements, to extend choice and to give a voice to the public.Tony Blair, Prime Minister, Cabinet Office,Office of the Third Sector, 2006in difficulty. One had funding stopped at short noticeand, at the time of going to press, was campaigninghard to prevent its successful counselling servicefrom being closed down. The other was informedthat it was unlikely funding would continue beyonda basic level, but a last-minute change meant thatthey actually received a higher level of funding thanexpected. Although this was good news, the latenotice had led to their services being wound downand all staff had been served notice of redundancy.Such funding issues can have a huge impact onthe stability of voluntary sector organisations, cannegatively affect staff morale and hinder creative andinnovative planning. It can also stifle the expansion ofservices in high demand which are restricted by thesize of their premises and/or staffing levels. Withoutlonger-term funding they are unable to fully assesswhether it is a viable option to expand.Smaller organisations also struggled with bidsfor funding as they did not have the time orstaff expertise that would be available in largerorganisations. In addition, some funders specifiedthat money had to be spent on certain types orprogrammes of work, meaning that the organisationhad to decide whether they could fit potentialfunded work in with their broader organisationalaims and goals. One partner site said this can leadto programmes of work being funding-driven ratherthan based on local need.There are a number of organisations that helpvoluntary sector organisations source funding. TheNational Council for Voluntary Organisations (NCVO)provides training and opportunities for networking, aswell as running a sustainable funding project whichhelps voluntary sector organisations to find all the bestopportunities for funding (www.ncvo-vol.org.uk).VCS Engage is a programme funded by theDepartment for Education and Skills (DfES) whichaims to strengthen the engagement of thoseworking with children and young people in thevoluntary and community sectors in the planning,commissioning and delivery of services(www.vcsengage.org.uk). This is a time of bigchange as children’s trusts are being developed andarrangements for integrated working are currentlybeing developed by local authorities in England.The Community Sector Partnership for Childrenand Young People, supported by VCS Engage, areencouraging voluntary and community sectororganisations to keep involved in the planning anddelivery of services as these changes occur.

listenup!Chapter 11 | 79“Community groups and organisations are, by theirnature, small in scale and big in number and manyare simply off the radar of local statutory services.This has led many smaller community groups andorganisations to fear that their informal youth serviceor children’s service will be lost in the push to formalisearrangements. Larger groups fear the loss of funding aswell as their knowledge of local needs and concerns.”The Community Sector Partnership for Childrenand Young People (2006a)They suggest a number of ways that the voluntaryand community sector can be involved in the changeprocess, such as staff members becoming members ofa local children’s trust board. They have also publisheda set of recommendations aimed at children’s truststo facilitate and open up discussion on how trustscan engage and work effectively with voluntary andcommunity sector organisations.Gaining awareness about policy, programmesand support offered can be a challenge in itself,particularly for smaller organisations that may haveless time, people and funds to devote to strategy,planning and conferences. Staff at the partner sitessaid that forming local networks was one successfulway that the organisations shared information,although one organisation called for “stronger localvoluntary sector infrastructure and support”.The 16 to 25 age rangeWhere funding was received by the partner sites fromstatutory mental health services this was primarilyfrom child and adolescent mental health servicesas opposed to adult services. However, all the sitesworked with young people over the age of 18 and,for some, this age group was the majority. Thesevoluntary sector organisations acknowledged thatyoung people particularly need help over this periodof transition from adolescence to adulthood. This wasrecognised by the Social Exclusion Unit who reportedspecifically on the needs of the young people withcomplex needs aged between 16 and 25:“Policy structures have tended to lag behindthe reality of people’s lives: the ways in whichyoung people become adults has become morecomplicated and diverse but policies have generallyfailed to keep up with such changes. The agestructuring on which many policies are based isoften complex, inconsistent, and working against theprinciple of resources following need.”Cabinet Office, Office of the Deputy Prime Minister, 2005There is a real need for co-ordination ofcommissioning of services for young people aged16 - 25 and the involvement of the voluntary sectorin this process as well as the statutory sector healthand social care communities.Working with statutory sector andother agenciesThis report has shown that the voluntary sector, aspart of a larger network of services including thestatutory sector, has much to offer in providingservices to the community. This has also beenrecognised by the government:“The positive attributes of the third sector aredifferent from those of government, and the twosectors working together can achieve far more thaneither can achieve alone.”Cabinet Office, Office of the Third Sector, 2006Continuing to develop good working relationshipswith other sectors will be an essential componentof improving the overall services available to youngpeople experiencing mental health and emotionaldifficulties in the future.“IceBreak has been successful in bringing together thedifferent cultures of the health and voluntary sectorsin designing a service that best helps young people.Working across these two cultures has been not somuch a constraint as a challenge for the project.”Project worker, IceBreak, The Zone, Plymouth

listenup!80 | Chapter 11Generally, the organisations were very positive aboutworking with other sectors and were able to relate anumber of success stories.“Some of the groups have only been possiblethrough joint working with other agencies. The selfharmgroup, ‘Release’, is run in conjunction with localmental health services.”Project worker, Support @ The Junction,The Junction, ColchesterHowever, staff also mentioned a number of culturaland organisational differences, particularly in thegoals the organisations in the different sectors wereworking towards, that led to problems.“Despite strong working relationships with externalpartners, often there can be a conflict of interest withagencies presenting different agendas which can bedifficult to manage.”Project worker, Community Links, Canning TownAll the organisations stated that the way to resolvesuch issues was through good communicationand taking a transparent and consistent approachwhile being flexible where possible. However, it wasnoted that where issues were overcome betweenindividuals, they still needed to be filtered throughthe organisations:“It is often difficult to translate the goodcommunication and relationships that the managersof different agencies have with each other intogood communication with the staff members ofthe organisations – they are more remote from thepartnerships.”Project worker, Support @ The Junction,The Junction, ColchesterAll the organisations participating in this projecthave undertaken joint working with a variety oforganisations which includes a range of publicservices: children and adolescent mental healthservices (CAMHS); social services; schools andcolleges; Connexions; other voluntary sectororganisations; youth offending teams; probationservices; drug and alcohol teams etc. All the projectworkers stated the importance of working to buildand sustain those relationships.“We recognise it is important not to becomecomplacent, and we are constantly reviewing theservice and exploring ways to improve partnershipsworking. This includes regular reviews of partnershipagreements.”Project worker, Sorted Not Screwed Up,Aberdeen Foyer, AberdeenThere was a consensus amongst the organisationsthat working with other agencies can add value tothe organisations and the services they offer. Theydefined this value of working with others as:• provides a more holistic approach: a broader rangeof people have input, and the work can improvecross-agency referral• improves access: young people can access awider range of help, and both statutory sector andvoluntary sector organisations can access a greaternumber of young people ie. those in statutoryservices will see young people usually only seen bythe voluntary sector and vice versa• shares learning: there is the opportunity to learnfrom each other, support and advise each other,share information and positive practice• promotes services: meetings and networkingprovide opportunities for organisations to hearabout what other services are doing and topromote their own work• reduces the costs of projects: by working withother organisations, there are opportunities todivide costs and pool resources• provides a network of support: can increase thesupport from a range of different professional groups.

listenup!Chapter 11 | 81Showing what the voluntary sector does“Voluntary organisations want to show that they areworking to high standards and that they really aremaking a difference. They are also under increasingpressure from funders.”Charities Evaluation Services, 2002Services offered by the voluntary sector differ sowidely in size and type that it can sometimes bedifficult for other organisations and individualssuch as commissioners and funders to understandwhat the voluntary sector can really offer. Findingways to explain and make clear what is availableis a challenge. As part of Listen Up, a number ofevents were arranged for the partner sites to buildlocal networks, share information and showcasetheir work. Attendees included commissioners,senior staff from primary care trusts (PCTs) andsocial services, staff from other voluntary sectororganisations and others. The style and content ofthe events was varied: Experience in Mind, Mindin Brighton and Hove, and Hove YMCA, organiseda launch of their training pack to be delivered byyoung people, while Streetwise in Newcastle ran anevent focusing on counselling services, with a seriesof speakers.Promoting services is becoming increasingly importantin order to gain funding; the organisations canshowcase their skills, expertise and networks, and focuson how valuable these could be to the statutory andother sectors. Barriers to this, particularly for smallerorganisations, may include: difficulties in gainingaccess to the ‘right’ people; not having enough staff toallocate sufficient time to be spent on promoting theirwork; a lack of skills in this area; not being fully aware ofwhere and how their expertise could fill gaps in otherservices; and not being able to clearly and consistentlydemonstrate what works and why.Monitoring and evaluationThere is currently no standard way for voluntarysector organisations to monitor and evaluatetheir work. Findings from the three-year NationalOutcomes Programme reported on by the CharitiesEvaluation Services (CES) recommend having an‘outcomes’ approach:Case StudyThe Market Place in Leeds held an event which focused on young people’s participation andincluded a number of interactive elements such as being asked to:• rate from 1–10 where delegates felt that young people’s views and involvement in thecommunity was currently placed• hug a hoody – this stall was designed and facilitated by young people and delegates werephotographed hugging a mannequin dressed in a hoody with the serious aim behind the fun oflooking at stigma and discrimination• say what the best things were about being young and how young people were viewedin the community.All of these elements aimed to give delegates first-hand experience of interactive techniques ofengagement, as well as to encourage delegates to think about their own views of young peopleand those of the community, and to open up discussion.

listenup!82 | Chapter 11“Planning and managing the work so as to bringabout particular outcomes – and then finding outwhat outcomes, intended and unintended, you areactually achieving.”CES, 2006The organisations in our project reported thatfunding applications and the different types ofmonitoring and evaluation required by differentfunders and commissioners could prove to be timeconsumingand not always appropriate.“The project has three different funders so theproject has to meet different monitoring criteria. Attimes these requirements can prove time consuming.However, the project does make efforts to rationalisethe data it collates so that each funder receives whatthey require.”Project worker, Experience in Mind,Mind in Brighton and Hove, and Hove YMCAOne project worker explained that their organisationhad found a clear gap in service provision for youngpeople presenting ‘high risk behaviours’. They hadapproached commissioners for funding, but thecommissioners had asked for evidence of this gap inthe form of consultation with young people usingthe service:“Although service user involvement is at the coreof Streetwise… due to the nature of ‘high riskbehaviours’ [such as drug taking] some young peopleare actively involved in, it is difficult to always be ableto engage them in consultations and ask them toarticulate their needs.”Project worker, Streetwise, NewcastleIn their briefing for commissioners, funders andpolicy makers, NCVO confirmed that some formsof monitoring and evaluation could be undulyburdensome and did not necessarily fit in with thework undertaken by the voluntary sector. Thosetaking part in the NCVO research from the voluntarysector gave suggestions such as:“… innovative thinking should be applied tomonitoring and evaluation methods where outputsand outcomes monitoring could entail on-site visitsby funders and face-to-face contact rather than justhaving to submit forms.”NCVO, 2005“… [having ] funders who are willing to attend eventsand accept alternative evidence of outcomes such asvideos, DVDs, and CD-ROMS.”NCVO, 2005IT systems can be a useful aid to monitoring andevaluation. One partner site raised the issue of usingIT systems to keep track of data and the lack ofknowledge their staff had in setting these up. As partof the project, partner sites were asked for a rangeof referral data and it became apparent that this wasan issue for several sites who could not easily accesscollated information.Recording and monitoring ethnicityIt is mandatory for all public sector organisationsand those that take public funds in other sectorsto record and monitor ethnicity. This is therefore aprerequisite for organisations looking for fundingfrom statutory organisations. At the time ofundertaking the research, we found that seven outof eight of the partner sites were recording ethnicitybut that there were potential difficulties in ongoingmonitoring: this is explored further in chapter 6. Aparticular barrier to undertaking effective monitoringis the fact that it is difficult to compare dataeffectively with the ethnic breakdown of the localcommunity, because local data may be based on themost recent census (2001). The need for better localauthority monitoring is therefore essential in helpingvoluntary sector organisations to meet the needs ofall young people in the community.

listenup!Chapter 11 | 83Counselling“There is a wide consensus among service providerswithin the voluntary and community sector thatpsychological therapy or counselling for youngpeople – on issues like depression, eating disorders,or bereavement – can be beneficial… There isevidence that young adults benefit from counsellingwhen they receive it.”Cabinet Office, Office of the Deputy Prime Minister, 2005Counselling forms a significant part of the work thatthese organisations carry out. Finding ways to ensurequality is important to show that the organisationmeets a certain standard, not only for the youngpeople using the service but also for attractingfunding. We found that organisations were using avariety of different ways to evaluate their services.Youth Access (the national membership organisationfor young people’s information, advice, counsellingand support services (YIACS), www.youthaccess.org.uk) recommends a quality framework which takesinto account different service models but requiresorganisations to work through a quality manual:It is important that the valuable role of the voluntarysector in delivering services to young people is bothrecognised and funded. Tackling the challengesoutlined cannot be done by the voluntary sectoralone. Strengthening partnerships has the potentialto improve services for children and young people.Ultimately, making the most of what the voluntarysector has to offer is as much a challenge for thoseworking in other sectors and particularly those whocommission and fund services. As this project hasshown, there are some difficulties but also manypositive examples of good relationships whichshow what can be achieved and can form a strongfoundation for future work.“Youth Access wants to enable users, staff,managers and funders to be clear about, and beable to communicate and secure, best practice. Thestandards are therefore intended to be used as atool in a process in which an agency assesses andevaluates its services.”Youth Access, 1999Youth Access has recently published two freeresources: one is a toolkit offering evidence, adviceand guidance to assist busy front-line agenciessuch as the ones in this project to meet localand national needs, outcomes and targets, plus auseful guide for commissioners on commissioningcounselling in the voluntary and community sectors(Youth Access, 2007).

listenup!84 | Chapter 1112Recommendations

listenup!Chapter 12 | 85RecommendationsOverarching principles for policyand practice01 Services for young people must be personcentred,holistic and inclusive. They need touse a range of approaches derived from theevidence and from what young people sayworks, including mainstream health and socialcare interventions, but also interventions centred,for example, around arts, creativity, leisure,participation, sport, education and spirituality.02 Although specialist services are required forcomplex or serious mental health issues, thebasic service model for young people needsfundamental change. Access to services shouldbe possible whatever the entry point. Servicesmust be able to integrate their response todiffering needs (e.g. mental health, sexual healthand housing) at the point of entry, which willusually be in a non-mental health setting. Staffshould be able actively to support young peopleto navigate the system and address their needswithout labelling or badging the response.Recommendations for Commissioners03 Each health and social care community/economy must designate a lead agency andperson to co-ordinate the commissioning ofservices for young people aged 16-25.04 This agency and person should convene a localpartnership board to steer commissioningfor young people, that includes all the keyvoluntary and statutory sector agencies.05 The partnership board should agree a clear setof principles for commissioning that are basedon the principles summarised above. As partof this framework, monitoring and evaluationframeworks should be developed so thatvoluntary and statutory sector providers areexpected to measure outcomes based on theavailable evidence and on young people’s viewsof what the outcomes should be.06 Voluntary sector organisations should becommissioned for time periods of betweenthree and five years, to allow for appropriatereview, evaluation, service development andsustainability of young person-centred services.Recommendations for Providers07 Young people should be involved in thedevelopment and delivery of experientialtraining of both generic and specialist mentalhealth staff across a range of settings, includingprimary care, secondary care, accident andemergency departments, benefits agencies andhousing agencies.08 Each provider should have a strategy foryoung people’s participation that coversoperational policy and practice, strategy and thepresentation of the services and should monitorto make sure that participation is happening.Support and training for young people must bebuilt in to the strategy.09 Services should seek to develop a cohort ofyoung ‘experts’ who can help deliver buddyschemes, peer support and peer navigationthrough services. This will require training, support,supervision and monitoring to be put in place.

listenup!86 | Appendix 1Appendix 1: Wish list for servicesYouth Crisis 1 consisted of a consultation with youngpeople in four project sites to find out what kinds ofcrisis services they wanted. The result was a ‘wish list’drawn up from the key needs they identified.• Telephone helplines, available at night, in theevenings and at weekends, specifically foryoung people, and staffed by skilled telephonecounsellors, who know what local services areavailable for young people.• Places to go for young people that are informal; areopen in the evenings; work on a drop-in rather thanappointment basis; and are staffed by skilled youthworkers with knowledge of mental health issues.• Services targeted specifically at 16-25 year olds, whichare ‘young-people-friendly’ in design and approach.• Alternative treatments such as reflexology andacupuncture instead of prescription drugs. Theseare available to many adults experiencing mentaldistress but difficult to access for young people.• Fast-track access to treatment, support and care foryoung people, to enable them to resolve seriousdifficulties before they become embedded.• Choice of workers so that young people can builda rapport with someone who meets theirindividual needs.• Young person input into staff training – youngpeople felt that mental health workers such aspsychiatrists, community psychiatric nurses, GPs,social workers, police officers, and accident andemergency workers would provide more sensitiveservice if they received such training.• Greater sensitivity to young people in crisis,particularly at A&E departments (e.g. after self-harmor suicide attempt), providing privacy, support andreferral to relevant specialist community services.• Peer support in schools and youth work settings.More training for teachers in mental health issueswould raise awareness of how to support themental health of vulnerable young people.• Services for people at risk of crisis. Crisis servicesshould work with young people who feel they areat risk of falling into crisis, helping them to developstrategies and access resources to avoid crisis.• Naming ‘crisis services’ with care; the term ‘crisis’may have the effect of preventing some receivinghelp, as either the professionals or the youngpeople themselves may regard it as excludingyoung people who are on a pathway to, but notactually in, crisis.

listenup!Appendix 2 | 87Appendix 2:Partner site case studiesThis appendix provides detailed case studiesof the work of each partner site’s service. Eachcase study begins with a tree diagram which is apictorial representation and snapshot of the serviceillustrating what it has to offer to meet the needs ofyoung people. In the diagrams:• roots represent the service’s foundations andbuilding blocks, such as who provides funding, theservice ethos, what gaps the service is filling withinthe local community, and why they set up theservice in the first place• branches represent the different types of serviceprovision offered• leaves represent the different elements related toeach type of provision such as activities, types ofinterventions and support etc.The diagrams were inspired by the tree diagram in anAberdeen Foyer publication (Kennedy, 2004).An overview of each service is then given, whichincludes its mission statement, current activitiesand programme priorities. Information on the localcontext is also given and this helps to highlight thediversity of the partner sites, how they work to meetthe needs of their communities and some of thebarriers and constraints they face.Each partner site was provided with a small amountof funding by the Mental Health Foundation todevelop its service as part of the Listen Up project.The case studies show the broad range of ways thatthis money was spent and what has been achievedas a result.It should be noted that the referral data does notcontain standard clinical diagnoses as, for the mostpart, these are not used by the project sites, plusmany referrals are self-referrals by young people.

listenup!88 | Case Study 1Case Study 1:Sorted Not Screwed Up,Aberdeen Foyer, AberdeenMission statement“All young people need a home, support and aspringboard into independent living, learning andwork. Some don’t have it. Aberdeen Foyer helps fillthe gap.”Overview of the serviceAberdeen Foyer is a registered charity whichsupports vulnerable young people. It provides arange of services that aim to give a young person aperiod of stability during which they can learn to livesuccessful, independent lives.Aberdeen Foyer evolved out of a city centre youthproject for disadvantaged young people, and it becamea registered charity in 1995. In 2001, funding wassourced from the Diana Princess of Wales MemorialFund to set up a mental health and wellbeing initiativefor the young people accessing Aberdeen Foyer. Thefirst two years of the project were guided by a steeringgroup comprising young people and representativesfrom the statutory services including housing services,the NHS and social services. In 2002, this initiative wasnamed, by the young people themselves, Sorted NotScrewed Up (SNSU).The emphasis of SNSU is on providing youngperson-friendly, holistic, readily-accessibleservices to prevent a young person’s mentalhealth difficulties from worsening. It supports thetransition to independent living by helping youngpeople develop life skills, improving their mentalhealth, tackling stigma and discrimination andworking towards reducing suicide risk and self-harmthrough a mixture of short-term interventions andlonger-term work such as counselling.From April 2004, following three years of funding fromthe Diana Princess of Wales Memorial Fund, the projectreceived its core funding the Scottish Executive’ssuicide prevention strategy. This encouraged a greaterfocus on targeting young people in crisis, in particularreducing rates of suicide and self-harm.Service development work carried out as part ofthe Mental Health Foundation projectThe main focus of SNSU service development hasbeen the increase of access to complementarytherapies for young people experiencing mentalhealth difficulties. A regular shiatsu massage servicehas been offered to the different Foyer sites inAberdeen City and Aberdeenshire. Rotating where themassage is provided has meant access to the service isas equal as possible. Other therapies and activities thathave been offered include Reiki, Indian head massageand African drumming. All the therapists involvedwere suitably qualified in their profession.Providing these complementary services isimportant, as it offers the young person choice; ifthey do not wish to engage with more traditionalforms of assistance such as counselling, they canstill use the service, opting for something that theybelieve will help them. Having complementarytherapy options is also one way to help a youngperson to engage with the service and build trust.Initially, it had been planned to use part of themoney from the Mental Health Foundation todevelop a website, but the complementary therapieswere so popular that it was decided to use theremaining funding to continue providing these.Service catchment areaAberdeen Foyer has supported housing andeducation and training sites in Aberdeen Cityand parts of Aberdeenshire including Peterhead,Fraserburgh, Stonehaven, Banchory and Banff. Dueto the geographical spread, SNSU staff are unable totimetable a full mental health programme at everysite. Recently, SNSU has targeted the supportedhousing sites for young people, and certain FoyerLearning sites that offer education and training.

listenup!Case Study 1 | 89ReferralsSNSU accepts self-referrals from young peoplealready using other Foyer services, and referrals fromFoyer support workers.Referral details in January-March 2006During this three-month period, there was a total of 12new referrals to SNSU’s initial counselling assessmentstage. Young people were often referred for morethan one reason, the main ones being low mood/depression (83%), anxiety/stress (42%), addiction (25%)and relationship problems (25%). 58% of individualsreferred during this period were assessed as having apotential risk of self-harm or suicide.Referred young people’s details in January– March 200658% of the young people were aged between 22and 25, and 42% were aged between 16 and 21. 58%were female and 42% male. 100% were White British.What the service offers• rapid response/follow-up to crisis• person-centred therapy• Cognitive Behavioural Therapy• staff advisory/consultation role• referral/signposting• advocacy• promotion of arts-based activities• student/volunteer placements (e.g. art therapystudent)• complementary therapies• health awareness campaigns (leaflets, posters,brochures).Family/carer involvementSNSU is designed to focus on the young person’sneeds, so working with family/carers is not a formalpart of the service. However, if a young person requeststhis type of support, staff can help them to exploreways of resolving difficulties and building bridges.Current programme prioritiesi. Monitoring and evaluationA pilot referral procedure has recently beenimplemented to promote better communicationand track referral pathways in-house. Staff nowmeet weekly to discuss new referrals, and thepattern of referrals from the different sites is beingmonitored. Staff have implemented the use of acounselling service monitoring and evaluationsystem called CORE (Clinical Outcomes in RoutineEvaluation). Staff are also being trained to useother project evaluation systems such as theWeaver’s Triangle and LEAP. Other methods includesuggestion boxes, focus groups, DVDs detailingyoung people’s views, and service exit evaluations.ii. Service delivery and capacityRapid organisational growth has lead to anincrease in the potential client base for SNSU(and other Foyer Health services). Explorationof how to maintain effective service delivery tothose in need is therefore a priority. The servicehas worked to do this through using studentcounsellors, health volunteers and, NHS healthvisitors, as well as providing self-help pointsand building an enhanced network of externalservices and referral routes.iii. Young person involvementYoung person involvement was central to SNSU’sinitial design and development. The service isprioritising the retention and improvement ofthis crucial involvement in its current and futuredevelopments. Many of the monitoring andevaluation methods would help achieve this priority.A Young Persons’ Forum already exists at AberdeenFoyer, but a dedicated Foyer Health forum for youngpeople could be another possibility.

listenup!90 | Case Study 1iv. FundingA range of both long and short-term fundingstreams support SNSU, resulting in a complexand insecure financial environment. Currently,the Foyer is discussing solutions to the problemof securing mainstream health funding, includinglinking its work more closely with health andhomelessness agendas.How the project addresses gaps in localservice provisionAberdeen Foyer supports people experiencingmultiple and complex needs. Young people witha dual diagnosis generally do not ‘fit neatly’ intoexternal services and are therefore at risk of fallingthrough gaps in provision. This can be exacerbatedby the requirement of some services that the youngperson address their drug and/or alcohol issuesbefore they can be offered help with mental healthproblems. Aberdeen Foyer does not have such rigidcriteria for accessing its services and takes a moreholistic, needs-led approach. This approach hasenabled the Foyer to gain funding from the ScottishExecutive’s Multiple and Complex Needs fundingstream to support this group of young people ina project called ‘Positively Sorted’ which looks atbuilding skills in optimism.Barriers and constraints which impedeeffective provisionThe statutory sector is increasingly recognising therole of the voluntary sector in providing holistic carefor young people. However, despite this, SNSU isstill experiencing short-term funding problems; forexample, current core funding runs from 2006 to2008 only.The project also has to rely on multiple funders, andthis can be very challenging as each funder stipulatesdifferent criteria and requires different evaluationstructures and reporting mechanisms.ContactsSorted Not Screwed UpAberdeen Foyer, Marywell CentreMarywell StreetAberdeen, AB11 6JFTelephone: 01224 212924Website: www.aberdeenfoyer.com

listenup!Case Study 1 | 91Sorted Not Screwed Up – Holistic Service TreeStaff training(internal/external)CAPACITYBUILDINGAccess toresources/info forstaff and youngpeopleFoyer policyand proceduredevelopmentShiatsu & ReikiAccess to arange of healthimprovement servicesAccess to selfhelpmaterialsStaff advisory/consultation rolePromotionof optimism in staffand young peoplePOSITIVEHEALTH &WELLBEINGAccess tolifestyle/fitnesschecksLinking withexternal servicesMusic‘Sortedwith the Arts’eventsHOLISTIC APPROACHArt supportART &CREATIVITYSpecific projects(eg. SNSU DVD)Health andhomelessnessMental HealthFoundation (ListenUp! project)AdvocacySTRATEGICWORKPerson-centredcounsellingNational Programmefor Improving MentalHealth and WellbeingChoose Life(suicideprevention)INDIVIDUALSUPPORTArt TherapyCBTNeedsAssessmentExternal staffcounsellingserviceScottish Executive(Creating Better Services forPeople with Multiple andComplex needs)Young people presenting with mental/emotional health difficultiesChallenging stigma and promotingmessages of recovery and optimismSupport staff needs(information, skills, reassurance)Gaps in, and problems accessingappropriate mental health supportsuited to the needs of young peopleAberdeen Foyercommitment to communitydevelopment and inclusion

listenup!92 | Case Study 2Case Study 2:Experience in Mind, Mind inBrighton and Hove, and Hove YMCAMission statementsExperience in Mind is a partnership project betweenMind in Brighton and Hove, and Hove YMCA“Mind in Brighton and Hove seeks to empower andsupport people who have experience of mental distress.”“Hove YMCA is a Christian charity that offers allyoung people, their families and communities anopportunity to develop mentally, physically andspiritually. We seek in particular to enable those whoare disadvantaged to reach their full potential.”Overview of the serviceMind in Brighton and Hove worked in partnershipwith Hove YMCA on the Experience in Mind project,to respond to some of the key needs identified inthe first stage of consultation with young people inYouth Crisis I. Mind in Brighton and Hove broughtexpertise in mental health and Hove YMCA expertisein working with young people.The Experience in Mind project was designed togive young people with experience of mental healthdifficulties a voice in shaping the services available tothem. This included giving their input in the strategicdevelopment of these services, as well as providingspecialist training to a range of professionals workingwith young people. The aim was to improve theresponsiveness and effectiveness of mental healthservices for young people by helping professionalsto understand young people’s needs better, and bychallenging stereotypes about young people andmental health.A training pack was developed as part of the project,based on young people’s views and experiences.Each young person shared their experiences in aone-to-one meeting with the project co-ordinator,and then the young people met in groups todevelop the training material.Young people who wanted to deliver the trainingcould then take a Level 2 Open College Network(OCN) accredited course, ‘Training throughExperience’, to learn the necessary skills. Thiseight-week course was divided into five modules:group work skills; self development; mental healthdifficulties; training skills; and young people’s issues.At the time of going to press, this course had beenrun twice.The project was funded by the Mental HealthFoundation, the Tudor Trust and Brighton andHove Equal.Service development work carried out as part ofthe Mental Health Foundation projectThe funding that was given by the Mental HealthFoundation contributed towards the setting-up andrunning of the project. It also allowed the service toconsider broadening its target audience. Originally, ithad been felt that clinical-based professionals werethe target audience, but in 2006, due to the successof the pilot, this was broadened to include otherprofessionals: teachers, police officers, GP surgeryreception staff, youth workers, Connexions’ personaladvisors, drug workers and social workers.Catchment areaAll young people who are part of the project havelived in Brighton and Hove and have used statutorymental health services.

listenup!Case Study 2 | 93Recruitment of young people16 young people joined the project betweenFebruary 2006 and December 2006. In January 2007,13 were still actively engaged on the project andthree had moved on.Young people were originally recruited usingtargeted promotional material which was e-mailed toapproximately 65 different contacts within agenciesin Brighton and Hove. Hard copies were sent torelevant city agencies working with young people. Atthe time of going to press, half of the young peopleengaged in the project had self-referred.Other participants were informed directly of theproject by a professional already working withthem. Professionals have included Connexionspersonal advisors based in schools and colleges andadvisors and advocates based at other organisationsincluding Mind in Brighton and Hove.Recruitment details from February 2006–January 200777% of the young people were aged between16 and 21, and 23% between 22 and 25.54% were female and 46% male. 12 of the youngpeople recruited were White British, and the otheryoung person was of mixed ethnic background.Family/carer involvementFamily members and carers were not directlyinvolved, but young people wanted to expand theproject so that they could train with families andcarers in the future.Current programme prioritiesi. Development of the training packageA group of young people with experience ofmental health difficulties and using services havebeen recruited and are developing a trainingpackage. It will use multimedia techniques such asfilm and sound to help young people express theirexperiences in the most effective way possible.The young people have their own steering groupthat influences the development of the overallproject, and feeds into strategic forums andcity networks such as the Child and AdolescentMental Health Service Strategic Planning Group.ii. Delivery of the training packageThe training was piloted with relevant agenciesidentified by the young people and the advisorygroup. Course participants will be charged afee and this will contribute towards the trainingprovision costs.The young people will deliver the training inpairs to groups of up to 15 professionals ata time, from across Brighton and Hove, bothwithin and outside the clinical sector. They willreceive payment at an hourly rate for time spentpreparing for and delivering courses. Once thefirst group of young people have experience ofdelivering training, they will be encouraged tobecome ‘peer trainers’ and support others.

listenup!94 | Case Study 2iii. Monitoring and evaluationThe project’s progress is monitored by its partnerorganisations, the advisory group and the youngpeople’s steering group to ensure it meets itsobjectives.Young people are actively involved in all aspectsof monitoring and evaluation.The training package will be piloted, reviewedand amended throughout its delivery to ensureits effectiveness.Young people have designed feedback formsfor trainees on the relevance of trainingmaterial, quality of trainers and usefulness of theinformation, and changes may be made based onthis feedback.How the project addresses gaps in localservice provisionThe gap in young people’s participation indelivering training was clearly identified in YouthCrisis I. The methods used in the project, whichare all young people-led, aim to improve the wayservices are provided and how they respond toyoung people’s needs.Barriers and constraints which impedeeffective provisionThere is no established formal structure outside theproject for young people to have a voice on thetypes of services available to them and how thoseservices are delivered. This can lead to young peoplefeeling alienated from services and falling throughthe gaps.Current funding runs until February 2008 and furtherfunding is now being sought so that the project cancontinue. There are a significant number of ideas onhow this training can be taken forward in the future,such as working in schools.ContactsExperience in Mind projectMind in Brighton & Hove79 Buckingham RoadBrighton, BN1 3RJTelephone: 01273 749600Website: www.mindcharity.co.uk

listenup!Case Study 2 | 95Experience the Mind – Holistic Service TreeDiversityGroup workSTRATEGICWORKPartnershipworkingInclusionHealingAccessibilityOwn accreditedtrainingDEVELOPMENTOF TRAININGPACKAGERaisingmental healthawarenessProfessionalsbeing trained byyoung peopleOne-to-onesupportPublicityLocal needsprovisionMental HealthFoundation(Listen Up!)HOLISTIC APPROACHUnique vehicle for youngpeople to raise awareness ofmental health issuesThe Tudor TrustUnique vehicle to help tackle thegap between CAMHS and adultmental health servicesYoung person-ledOriginated in young peopleexpressing concern that professionalsfrom all sectors are ill-equippedBrighton and HoveOffering youngpeopleGrew from the Mental HealthFoundation’s Youth Crisis 1

listenup!96 | Case Study 3Case Study 3:Community Links, Canning TownMission statement“Our founding philosophy is empowerment and abelief that everyone who receives has something togive in return.”Overview of the serviceCommunity Links was founded in 1977 and is ageneric children and young people’s organisationthat delivers an extensive network of projects andservices to over 1,000 16-25 year-olds each weekacross East London. The project was first establishedby two youth workers, Kevin Jenkins OBE andDavid Robinson OBE, who identified the need for abroader range of opportunities for young peopleand more community-led initiatives in the localarea. Subsequent growth of the project has beendetermined by the needs and demands of youngpeople in the local community and in consultationwith them. Funding throughout the history of theservice has come from various sources, includingNewham Council, trusts, private companies and localcommunity fundraising.The community focus of the project means thatmuch of the mental health work it carries out ispreventative. Generic advice, advocacy and supportservices are provided to help young people copewith situations, such as unemployment and familybreakdown, that could potentially lead to mentaldistress. Outreach projects also form a large part ofthe service, for instance carrying out mental healthpromotion work in local schools, and working withyoung people in custody. More traditional mentalhealth support is also offered, in the form of one-toonecounselling and structured group work focusingon particular issues, such as bereavement or selfharm.For those experiencing distress/crisis a largevariety of services are available including: drop-in;support with attending other services; intensivesupport over 24–48-hour periods; and childcare.Accessibility is considered key, and the service can becontacted by text, phone or email.Central objectives of the work carried out are toempower young people, to facilitate equality ofaccess, to combat stigma and to provide servicesthat are responsive and useful to young people’sactual needs. Peer support and mentoring aretherefore central to the project and many youngpeople who first access the project for help go on tosupport other young people in the future.Service development work carried out as part ofthe Mental Health Foundation projectCommunity Links have recently set up a textmessaging service which complements the e-mailand telephone helplines they already have. The serviceenables a young person to text the service and themessage is relayed via a computer. This means thatstaff can type a response to the young person andthis will go their mobile. The helpline is manned everyweekday and Saturday mornings but is often checkedmore frequently. This service provides another wayfor young people to access and test out the service.It may be easier for a young person initially to makecontact via text rather than having to speak tosomeone, which can be more daunting.Mental Health Foundation funding was also used forthe initial release of staff at Community Links, whodid not work specifically with young people withmental health problems, to have training to increaseawareness and knowledge. Child and adolescentmental health services provide the training and theaim is to help those staff gain a better understandingof young people’s emotional and mental healthneeds. This in turn improves the first contact a youngperson may have with the service. At the time ofgoing to press, Community Links had taken overfunding this work so it can continue.

listenup!Case Study 3 | 97Service catchment areaThe London Borough of Newham, with additional workin some of the surrounding East London boroughs.ReferralsCommunity Links accepts referrals from all professionals,as well as families, friends and self-referrals from youngpeople. Internal referrals within the different parts ofCommunity Links are also common.Referral details in January - March 2006Referral details were collected during this period bythe many different projects within Community Links.However, these were not available in a collated total.Referred young people’s details in January– March 2006Referral details were not available (see above).What the service offers• one-to-one counselling• therapeutic group work on specific areas• information and advice• creative arts, writing and poetry• sports• a safe social space• support in attending other services• drop-in• intensive support through crisis• support to young people in custody• childcare• advocacy• peer support• practical support into employment• outreach work in the community• mental health promotion.Family/carer involvementIn general, Community Links have found that theinvolvement of families can act as an additionalbarrier preventing young people from accessingthe service. However, workers are willing to contactfamilies or carers at the request of the young person,often to help resolve conflict or access support forthe rest of the family.Current programme prioritiesi. Education and prevention servicesThere are plans to continue to develop educationand prevention services for 14–19 year-olds and19–25 year-olds that are quick to respond to theever-changing emotional health and wellbeingneeds of young people.ii. Responding to early signs and symptoms ofmental health problemsThis will include the extended training for genericproject staff in being able to recognise thesesigns and symptoms and feel comfortable inproviding an appropriate response. In addition,there are plans to place mental health specialistswithin other parts of the service, to ensure bothongoing mental health promotion as well asprovision of immediate support to young peopleexperiencing crisis.iii. CounsellingThere are plans to increase the provision ofcounselling within the Community Links adviceand advocacy services for 14 - 25 year olds. Therewill be greater participation of young serviceusers in developing this aspect of the service.iv. Review of the serviceCommunity Links plans to undertake a fullanalysis of its current work.

listenup!98 | Case Study 3How the project addresses gaps in localservice provisionThe population of the London Borough of Newhamis incredibly diverse, comprising large communitiesfrom all over the world and with over 80 languagesbeing spoken in schools. There are high numbers ofrefugees and asylum seekers, and unaccompaniedminors arrive every year. Social deprivation is high,and housing is poor, dense and overcrowded.Additionally, the borough has the youngestpopulation in the country.Resistance to accessing traditional services is high;the general problems that young people havein feeling alienated from statutory services arecompounded in this area by language and culturalbarriers. Community Links has attempted to addressthese issues through projects that reach out tothe community, and aims to offer services thatare sensitive to different cultural needs as well asyoung person-friendly. The mental health provisiongrew from the identification of a lack of accessiblecounselling services in the area; services were foundto be formal and to have long waiting lists. A lack ofholistic support for young people with mental healthproblems also drove the development of the YouthEmployment Project, offering combined practicaland therapeutic support.Barriers and constraints which impedeeffective provisionObtaining funding is challenging, due to theinnovative nature of the service; mainstream moneyfrom the statutory sector tends to be granted tomore conventional services. This can be frustrating,particularly when the service identifies a need in thecommunity and finds it difficult to raise monies todeliver a short-term project to respond to this need. Ingeneral, the service has found that the nature of thecommissioning process, where priorities are set by thefunding bodies, can inhibit the community’s ability torespond to local need and find solutions together.ContactsCommunity Links105 Barking RoadCanning TownLondon, E16 4HQTelephone: 020 74732270Website: www.community-links.org

listenup!Case Study 3 | 99(Canning Town) Community Links – Holistic Service TreeYour healthand youHEALTH &INTENSIVESUPPORTHealthpromotionActivity daysMental HealthPromotionHealthy SchoolsLinks TeamCrisis supportLocal planningpartnershipsPartnershipswith East LondonboroughsBusiness/volunteer linksCommunityprojectsCHANGING OURWORLDParticipationactivitiesWe are whatwe doHolidays/residentialprogrammeInternationalexpeditions/exchangesPARTICIPATIONParticipationworkersNewhamChildren’sParliamentCommunityConsultationEventsPhotographyExpress (art, drama,story therapy)AfricandrummingCreative teachingmethodsCREATIVITYMusic/mediaroomsPoetryprojectsLarge-scaleart worksHOLISTIC APPROACHApprenticesPublicationsPREVENTIONBenefits, legaland financialadviceStreetworkHealth promotionthrough all servicesMentorprogrammeEarly relationships withvulnerable young people(CAMHS; After school)Building strong relationships with childrenand their families that are not dependenton short-term or issue-based fundingWorking closelywith localspecialised agenciesInstant response service and24-hour support fill the gapleft by other servicesProviding positive, ongoing playfulrelationships as much as ‘being there’when an individual or family is in crisisSupporting a young person in crisis consistently,maintaining a level of support available to them regardlessof difficulties they may be experiencing with other services.

listenup!100 | Case Study 4Case Study 4:The Caterpillar Service, Barnardo’sMarlborough Road Partnership, CardiffMission statement“The lives of all children should be free from poverty,abuse and discrimination. Our purpose is to help allchildren and young people transform their lives andfulfil their full potential.”Overview of the serviceThe Caterpillar Service offers holistic, flexible supportto young people with mental health problems agedbetween 12 and 21. Working both in hospital settingsand in the community, the project offers group andone-to-one support for young people covering allaspects of their lives, from emotional support topractical help with medication, housing, employmentand education. The type of support is determinedby each individual’s needs and interests; emphasis isplaced on treating young people as whole peoplerather than concentrating on their problems, so muchof the support involves fun activities.The service is run as part of the Barnardo’sMarlborough Road Partnership. A leading UKchildren’s charity, Barnardo’s runs over 380 servicesacross the UK designed to support vulnerableand disadvantaged young people in establishingthemselves as independent citizens within theircommunities. The Marlborough Road Partnership,one of 40 Barnardo’s services in Wales, offers generichelp and support to young people in Cardiffand Newport and took part in the Youth Crisis Iconsultation. Young people in the consultation saidthat statutory mental health provision was limited,difficult to access, rigid, stigmatising and offered onlya medical perspective. Building on these findings,Barnardo’s spent two years reviewing policy andconsulting a wide range of stakeholders includingyoung people, parents, carers and professionalsbefore establishing the Caterpillar Service. Originally,the project was designed for young people agedbetween 16 and 25; this was however changedwhen it became possible to collaborate with thelocal adolescent psychiatric ward which works withchildren under 16.Funding was initially provided by Barnardo’s. In 2006,the Caterpillar Service successfully bid for fundingfrom the lottery and this has led to a significantexpansion of their service. Cymorth funding hasenabled the Caterpillar Service to start its work inschools with young people who are at risk of or havesome signs of mental health problems.Service development work carried out as part ofthe Mental Health Foundation projectFor the first year, the Mental Health Foundation partfundedthe post of the project worker employedto run the Caterpillar Service. To start with, thisentailed group work in the hospital setting whichincluded undertaking activities and providing socialsupport. Over time, as well as the inpatient groupwork one-to-one work was offered. This could takeplace anywhere from the Barnardo’s office to alocal coffee shop. Part of the project worker’s rolehas included ongoing policy and campaign workwhich has included running workshops and doingpresentations with young people.Service catchment areaThe catchment area of the service is Cardiff, althoughstaff also travel to visit young people who have beenplaced in psychiatric units outside the area.ReferralsYoung people must have an acknowledged mentalhealth problem and be seeking help for this. Referralsare accepted from any source including voluntary andstatutory agencies, friends, family members or self-referral.Referral details in January - March 2006In this period, 28 young people were referred to theCaterpillar Service. Of these, one had self-referred,while the remainder had been referred throughstatutory services. The majority (60%) came throughChild and Adolescent Mental Health Services.The young people accessing the project havecomplex needs and so it was difficult to identify onereason only for referral. All of the young people in

listenup!Case Study 4 | 101this referral period had been experiencing emotionaldifficulties, with half demonstrating self-harmbehaviours. 43% had received a clinical diagnosis,25% were misusing drugs or alcohol and 18% hadeating problems. In addition, 7% of the young peoplewere homeless, 14% were care leavers, 7% wereyoung parents and 11% were young offenders.Referred young people’s details in January– March 200660% of the young people accessing the CaterpillarService were aged 12–16, while 40% were aged 16–21.64% were female, and 36% male. 79% of the youngpeople were of White British origin. One young personwas of Black Caribbean origin, one was of Pakistaniorigin, and one of Black African origin. Three youngpeople (14%) were of mixed ethnic background.What the service offers• hospital based support• fun activities and treats• one-to-one support• group work• support with understanding and dealingwith medication• outreachFamily/carer involvementTo keep the service young person-centred, the CaterpillarService does not involve the families and carers of youngpeople directly in the support that is offered.Current programme prioritiesi. FundingThe project is currently concentrating onobtaining sustainable funding streams.ii. Early interventionPreventative work is one area that the CaterpillarService is keen to develop. The project would liketo be able to do more work with young people tobuild up their emotional resilience and confidence,enabling them to deal productively with issuesbefore they escalate into mental health problems.A new outreach project is being developed alongthese lines with Year 11 children in local schools,offering support as they begin to negotiate thetransition between school and independence.How the project addresses gaps in localservice provisionA scoping exercise carried out in the first six months ofthe project confirmed that the Cardiff area, like muchof Wales, provided little support for young people withmental health problems. The Caterpillar Service aimsto take a person-centred approach that does not viewpeople on the basis of diagnostic criteria.Barriers and constraints which impedeeffective provisionThere is not enough funding available for mentalhealth services for young people, on either a localand national level.Although the project generally has good localrelationships with statutory services, there are stillissues on a national level in reconciling the twocultures. Voluntary sector agencies are trying to betaken more seriously whilst overstretched statutoryservices can be wary of the approaches taken bysome smaller voluntary agencies. This can impact onthe work of the Caterpillar Service.Awareness needs to be raised of the difficulties intransition from youth to adult services, especiallyin appreciating the different situations that youngpeople can face. Listening to what young peoplewant is an essential part of developing effectiveprovision at this transitional time.ContactsCaterpillar ServiceBarnardo’s Marlborough Road Partnership46 Marlborough Road, RoathCardiff, CF23 5BXTelephone: 029 20497531Website: www.barnardos.org.uk/marlboroughroad

listenup!102 | Case Study 4(Cardiff) Caterpillar Service – Holistic Service TreeBefriendingAdvocacyPhysicalhealthEducation/employmentAppointmentsOffendingINDIVIDUALSSpecialistadviceBenefitsPartiesTripsArt groupGROUPSTaster DaysHospitalgroupsEVENTSTheatre/cinemaConferencesGivingevidencePOLICY &INFLUENCINGWorkshoppresentationsTrainingConsultationSafelychallengeStrategies foremotional safetyUnconditionalsupportSelf esteemSUPPORTNeedsbasedConfidencebuildingFriends andfamilyGirls’ groupArticle andfeaturesSpecialist pressMEDIAAwarenessraisingAnti-stigma workLocal papers,TV and radioHOLISTIC APPROACHConsultation with young people demonstrated aneed for a holistic model providing wide rangingsupport for young people with mental health issuesYoung people wanted a package of support from oneagency based on a ‘trusted adult’ model with socialsupport as a key building a strong relationshipFunding from Barnardo’s, Cymorth(Cardiff Children and YoungPeople’s Partnership), Big LotteryWales, Young People’s Fund

listenup!Case Study 5 | 103Case Study 5:Support @ The Junction,The Junction, ColchesterMission statement“Our objective is to provide a positive, supportiveand safe environment in which young people canaddress their emotional and behavioural difficultiesin a wide range of therapies. Young people will beencouraged to be involved in the setting up andrunning of the service. The Young Person’s AdvisoryBoard will be involved in the development of theservice.”Overview of the serviceSupport @ The Junction was established in 2002 toprovide support to young people aged 11–18 whowere not able to access statutory services. It is one ofthe services offered by Mind in Colchester. Support@ The Junction was originally funded and set up inaccordance with the local primary care trust’s HealthImprovement and Maintenance Plan, which aimed toprovide an out-of-hours service for young people atrisk from mental health problems, drugs and alcohol.This service developed and grew out of the Childand Adolescent Advocacy Service set up in 1999to provide advocacy for young people in a localpsychiatric unit. Alongside this service, a YoungPeople’s Advisory Board was set up to promoteservice user involvement. It was feedback from thisboard that drove the development of the provisionat Support @ The Junction. When the service gainedits own site, the three services – advocacy, the YoungPeople’s Advisory Board and Support @ The Junction–were brought together under the umbrella of ‘TheJunction’.Service development work carried out as part ofthe Mental Health Foundation projectThe funding from the Mental Health Foundationenabled The Junction to commission Anglia RuskinUniversity to undertake an evaluation of the servicesit provides. As part of this, two young people fromthe Young Person’s Advisory Board at The Junctionwere trained by the university to undertake some ofthe research.The evaluation was undertaken to help increase theprofile and credibility of the service with funders,which, in turn, helps to secure the future of theproject. The young people who helped conduct theresearch have gained both new skills and confidence.An important element of this evaluation has been togive a ‘voice’ to young people who use the serviceand their feedback by means of focus groups hasinformed the evaluation report.Key findings of the evaluation included: shorttermand piecemeal funding led to difficulties insustaining and developing the service; young peoplereported that they were not keen to go to statutoryservices; and marketing of The Junction was neededbut difficult due to staffing levels.Service catchment areaColchesterReferralsSupport @ The Junction accepts all 11-18 year oldswith emotional, behavioural or substance misuseissues either through self, parental or statutoryreferral. If an initial assessment indicates that a youngperson would also benefit from being referred toanother agency including statutory services, thenSupport @ The Junction will make contact.Public sector organisations referring to the serviceinclude: education institutions, the youth judiciarysystem, A&E departments, GPs, youth services, socialservices, the local primary care trust, mental healthtrusts and drug and alcohol services and others.Referral details in April–June 2006During this three-month period, 21 young peoplewere referred to the service. Young people were oftenreferred for more than one reason. The main reasonswere behavioural problems (56%) and anger (48%).Referred young people’s details inApril – June 200686% of the young people were aged 16 or under, and14% were aged between 17 and 21. 62% were male

listenup!104 | Case Study 5and 38% female. No data on the ethnic origin of theyoung people was collected during this period (seecurrent priorities).What the service offers• information and support• assessment• groups for those who self-harm• groups for 11-16 year olds with emotional andbehavioural difficulties• support group for 15-21 year olds focused oncommunication skills for vulnerable, isolatedyoung people• substance misuse advice• peer support• advocacy• support to young people trying to access or reengagewith education, employment and daily life• aromatherapy• relaxation• art therapy groupsFamily/carer involvementSupport @ The Junction is keen to involve familiesand carers in its work programme as it acknowledgesthat young people are part of a wider network. Thereis a family support group as well as more informalforms of contact such as telephone conversations. Inaddition, families and carers are welcome to cometo assessments and reviews as long at the youngperson consents to this. The friendly and voluntarystatus of Support @ The Junction means that theservice can potentially be seen as less threateningthan statutory services, so it is rare for either theyoung person or the family to object.Current programme prioritiesi. ConsultationThe further development of consultation isplanned. This will include organising a youngperson’s consultation event every summerbringing together professionals and youngpeople who use services.ii. Service developmentNew groups are being set up including an angermanagement group.iii. Sexual healthThe Junction is in the process of liaising withthe Trust’s Sexual Health Service regarding theintegration of this service with those on offer atthe Junction.iv. Monitoring of ethnicityIn line with a review of national Mind policy, theJunction is about to begin the monitoring ofethnicity of both staff and young people usingthe service.How the project addresses gaps in local serviceprovisionThe service was set up to provide an approachable,non-statutory, young person-centred servicetackling behavioural and emotional issues as well assubstance misuse. It is the only voluntary service inthe local area that works solely with young people inthis group.Barriers and constraints which impedeeffective provisionThe main issues are a lack of funding, particularlylong-term funding.Staff shortages have meant that Support @ TheJunction has had to abandon its keyworker systemwhich used to offer effective support in involvingfamilies and carers, as it allowed time for extra oneto-onesupport and meetings.ContactsSupport @ The JunctionThe Junction78 Maldon RoadColchesterEssex, CO3 3AL.Telephone: 01206 541841Website: www.colchestermind.org/yp-services.php

listenup!Case Study 5 | 105Support @ The Junction – Holistic Service TreeClosed and openart therapyGROUP WORKMonday Nites11-16yrsDVD projecton emotionalwellbeingSelf harmsupport groupParent’s supportgroupBiscuits andCarrotsticks 16-18peer support groupYoung Person’sAdvisory BoardAdvocacy servicereferrals anddrop-insYOUNG PERSONINVOLVEMENTOutreach:substance abuseand assessmentsReferral andassessmentSubstancemisuse support‘Moving On’workINDIVIDUALSUPPORTLeaving andAfter Careyoung people’sprogrammeSignpostingto otheragenciesCounselling foryoung peoplefrom Leaving andAfter CareSexual healthtalksYogaHEALTHYWELLBEINGConnexionsSTRATEGICWORKNorth East EssexCAMHSMental HealthFoundation(Listen UP!)Healthy eatingAromatherapySmokingcessationHOLISTIC APPROACHPrimary Careand TrustColchester Young PersonsStrategic PartnershipsYouth GroupLeaving andAfter CareFunding from the Primary Care Trust,Connexions, Essex County Council andthe Drug Action TeamUsing a multiagencyjoint workingapproachWorking with the Young Person’sAdvisory Board to create a youngperson friendly serviceThree services for young people under oneroof: Support @ The Junction, Advocacyand the Young People’s Advisory Board

listenup!106 | Case Study 6Case Study 6:The Market Place, LeedsMission statement“All young people have the right to feel safe andsecure in their lives, be treated with respect and tofeel good about themselves. The Market Place offersspace, time and information to help this happen.We support and believe in young people so thatthey can develop their own emotional resilience.We accept young people as individuals andencourage them to live their own lives in the waythat they choose.”Overview of the serviceThe Market Place provides a service to youngpeople aged between 13 and 25 years, tacklinga range of mental health problems; emotional,relationship and practical difficulties. Acknowledgingthat young people’s problems are both interlinkedand individual, the organisation strives to adapt toeach young person’s needs by working holisticallywith their particular issues and background. Freeconfidential support is delivered through a mixtureof youth work and mental health models including adrop-in centre, a counselling service and individualsupport offering either generic support (one-to-one)or personal development planning (My Plan).Established in 1989 following a consultation withlocal young people, the Market Place projectdeveloped from the Market District Boys’ Club whichwas founded in 1896 by Leeds Parish Church. Youngpeople in a school counselling service and otherlocal organisations expressed a need for support,information and counselling geared specifically toyoung people and available in a generic setting inthe city centre, not in school.Initial funding was provided equally by Leeds CityCouncil and the Paul Getty Trust. More diversefunding streams have subsequently been found forthe project, currently including Child and AdolescentMental Health Services (CAMHS), Safer Leeds andLeeds Youth Service. Maintaining The Market Place’sservice goals despite pressures from differentfunding streams is crucially important to the MarketPlace. Central to consideration of any new servicedevelopment are the reasons why young peopleaccess the organisation.Service development work carried out as part ofthe Mental Health Foundation projectService development at the Market Place hasconcentrated on developing consultation andservice user involvement practises.Firstly, a Young Person’s Advisory Group has beenestablished to more fully involve young people inthe development of the service. The group has beennamed ‘Helping Young People Through Experience’(HYPE) by the young people and its first session washeld in July 2005. Some sessions are used as ‘thinktank’ slots, where The Market Place asks the groupfor advice and input on particular issues. Under theguidance of a dedicated Participation Worker, the restof the work is young person led and has includedproducing a magazine, and making a short film.The Market Place had also developed a youngperson friendly tool to evaluate its one-to-oneservices. Researched and designed by service users,the ‘rate your life’ tool is based on emoticons whichare drawings of faces used to denote emotions.Young people are sent one sheet of emoticonsalong with a set of self assessment scales beforeaccessing the service and another when they havecompleted a block of sessions, asking them torate how they feel. The tool uses language that is

listenup!Case Study 6 | 107not technical and which avoids pathologising andstigmatising. This tool enables The Market Place toassess the impact of its one-to-one support and hasbeen in use since July 2005.Service catchment areaYoung people from the Leeds area can access theMarket Place.ReferralsThe Market Place accepts referrals from all sources.Self referrals are actively encouraged, although theorganisation also receives referrals from a numberof statutory services, including GP and Child andAdolescent Mental Health Services (CAMHS) allyoung people at the Market Place have the samerights of access. Staff working within differentparts of the project also make internal referrals; if ayoung person attending counselling was in need ofmore practical support, for instance, they can referthemselves to either the Drop-in, One-to-one or MyPlan services.Referral details in January-March 2006During this three-month period, there were a totalof 161 referrals to The Market Place. Self referralsaccounted for 59% of initial appointments, with afurther 20% being referred by a parent or friend, and19% by various professionals in the statutory sector.Individual reasons for referral were not recorded forthis period as these are instead collected annually toprovide a snapshot of the diversity and complexity ofthe issues raised at the point of referral.Referred young people’s details in January– March 2006In this time period, 52 young people age 16 andunder were offered an appointment of which 36(70%) attended. 58 young people between 17 and19 were offered an appointment of which 37 (64%)attended. 37 young people between 20 and 25 wereoffered an appointment of which 25 (68%) attended.Gender data was not available.The majority (84%) of the young people were of WhiteBritish origin. Of the 16% who identified as beingfrom a minority ethnic group, 2% were of Indian andPakistani origin, 1% of British Asian, 2% White other, 1%Black other, 1% other mixed race and 3% Black British.The largest of the minority groups were of Caribbeanorigin, with 2% identified as Black Caribbean and 4%as mixed White and Black Caribbean.What the service offers• drop-in service offering support, information andsignposting• counselling• individual emotional and practical support• ‘My Plan’ personal development• early intervention in crisis• long-term support• the opportunity to join a participation group.Family/carer involvementThe Market Place often supports parents makingreferrals to the organisation. There is also oftenan impact on the family circumstances whensupporting young people. However, The MarketPlace does not work directly with families or carers,helping to ensure that the project’s position as aconfidential, young person centred space is retained.If a young person were though to request that theservice take a more active role in supporting theirfamily relationship then staff would suggest a moreappropriate organisation that was experienced inworking with the whole family unit.

listenup!108 | Case Study 6Current programme prioritiesi. Internal structureThe Market Place is a growing and changingorganisation, meaning that some structures andprocedures are still in place that need to catchup with increase in demand. Finding a balancebetween retaining the core of what has madethe organisation successful whilst developingnew ways to allow sections of the organisationto work more independently is a key challenge.The Market Place is keen to retain a service that isinformal, flexible and places equal weight on itsyouth work and more formal, appointment basedmental health elements in order to continue tosuccessfully engage with a wide range of serviceusers and their variety of needs.ii. Increasing staff numbersStaff are currently overstretched as there are notenough paid or voluntary staff to satisfactorilycover the number of young people who accessthe project. Negotiations are ongoing for fundingto employ more staff.How the project addresses gaps in localservice provisionThe funding that the project receives from LeedsCAMHS reflects the vital role The Market Place playsin fulfilling local needs, particularly for preventativeservices and those designed specifically for youngpeople. Providing mental health support in a nonstigmatising,generic setting ensures that The MarketPlace reaches young people who would be less likelyto access statutory services; a holistic approach alsomeans that the complex needs of young people areaddressed. High levels of self referrals demonstratethe accessibility of the project and its success inappealing directly to young people.Barriers and constraints which impedeeffective provisionThe service is stretched to capacity. The threeinterrelated problems of low staffing levels,insufficient funding and confined space prevent theproject from increasing capacity to alleviate theirwaiting lists.ContactsThe Market Place28 KirkgateLeeds, LS2 7DJTelephone: 0113 2461659http://www.tmpweb.org.uk/marketplace/

listenup!Case Study 6 | 109The Market Place – Holistic Service TreePostalconsultationfeedback(quantitative)YOUNG PEOPLEINVOLVEMENTPostalevaluation tool(quantitative)Drop infeedback weekStaff reflectionHYPE Youngpeople’s advisorygroupFeedback bulletinsfor all stakeholdersLeeds childrenand youngpeople strategicpartnershipNational forumsLocal forumsSTRATEGICWORKSupervisionand personaldevelopmentComplementarytherapy budgetfor staffSupervisionbudget for traineecounsellorsSTAFFSUPPORTEncourage informallearning andcommunicationSexual health(Condom Card)Pregnancy andChlamydiatestingInformationReferral routeDROP-INSERVICESSupportHOLISTIC APPROACHInitialappointmentONE-TO-ONESERVICES BYAPPOINTMENT‘My Plan’IndividualsupportCounsellingFunding from CAMHS, Leeds YouthService, Connexions, and Safer Leeds(Drug Action Team)City-wide, centrally based, providing thelargest young person counselling andsupport centre in LeedsConsultation of local young people: Theyrequested information, support and counsellingfrom a city centre base not in schoolHistorical cantext of church ethos- support for underprivileged youngpeople since nineteenth centuryHolistic, young person-centred support providedby a multi-disciplinary team. Designed to be openended,non-judgemental and easily accessible

listenup!110 | Case Study 7Case Study 7:Streetwise, NewcastleMission statement“We believe that young people have a right to highquality professional services that are responsive totheir needs, promote their wellbeing and activelyseek to be accessible and open to all young people.”Overview of the serviceStreetwise is an open access service used eachyear by over 6,500 young people aged between11 and 25. It was set up in 1991 when two youthworkers found that young homeless people in thecentre of Newcastle were not accessing healthservices. The focus of the project was to move awayfrom the medical model of service and provide anapproachable, integrated service to the vulnerableyoung people who were being failed by the existingsystem. Initial funding for the service was providedby the local health authority, with some additionalfunding from Comic Relief and the Tudor Trust.Today, the focus of the work lies within three keyareas: mental health; sexual health; and drug andalcohol misuse. In addition, the service offersadvice and information on housing, debt, benefits,training/education and careers. The majority ofStreetwise services are delivered from the citycentre premises, but the project does have anextensive outreach programme working withschools, providing counselling and sessions ondrug and alcohol misuse. Preventative work suchas smoking cessation and the condom distributionscheme is combined with counselling and othercrisis interventions, with the aim of offering acomplete service that caters to all the needs ofyoung people.Service development work carried out as partof the Mental Health Foundation projectThirty-three percent of counselling sessions run byStreetwise involve work with self-harm. Work hastherefore been focused on developing servicesfor young people who self-harm or have suicidalthinking. Streetwise has forged strong links withthe Child and Adolescent Mental Health Services’(CAMHS) self-harm team, working with them andaccepting regular referrals of young people toStreetwise for longer-term work. Streetwise hasdeveloped a self-harm and suicide risk assessmenttool which incorporates a therapeutic actionplanning process for the young person.Streetwise has also worked in partnerships withCAMHS and Newcastle Social Services in providingoutreach services to 90 unaccompanied minorand young refugees in Newcastle. This, alongsideother work at Streetwise with Black and MinorityEthnic (BME) groups, aims to ensure that the serviceproactively targets young people from a range ofbackgrounds.Service catchment areaStreetwise will accept any young person who is ableto travel to its location in the centre of Newcastle.The majority of young people are from Newcastle,although clients do travel from the surrounding areasof Gateshead, Northumberland and North Tyneside.ReferralsReferrals are accepted from any source, whethervoluntary or statutory agencies, families, carers, or theyoung person themselves.Referral details in January-March 2006In this period, 75 young people were referred to theStreetwise counselling service. Of these, 36% selfreferred, while 15% were referred by their families.Referrals from statutory services accounted for40% of young people, while 9% were referred byvoluntary agencies.

listenup!Case Study 7 | 111Referred young people’s details in January– March 2006The majority (63%) of the young people were agedbetween 16 and 21, with 28% being under 16 and9% aged between 22 and 25. 84% of those referredto Streetwise were female and 16% were male.Ethnicity data was not available for all young peoplein this time period. Of the 55 young people who didstate their ethnicity, 93% identified as White (British/European). One young person stated they were ofPakistani origin, one of Black African origin, and twoyoung people were of mixed ethnic origin.What the service offers• one-to-one counselling• counselling and group work in schools• drop-in service• information and advice• sexual health advice• self help library• social activities• smoking cessation clinic• drugs and alcohol awareness.Family/carer involvementAs a young person-centred organisation, Streetwisehas not traditionally involved parents and carers, asthe confidentiality of the service has been a majorfactor in young people deciding to access it. Atpresent, staff will talk to families where necessary orappropriate, although only with the permission ofthe young person.However, as the service has grown, so has theacknowledgement that working directly withfamilies can be useful for young people. The projectis now beginning to develop therapeutic workinvolving families.Current programme prioritiesi. AccreditationStreetwise aims to become accredited as acounselling training provider.ii. Integration with statutory servicesThe service is in the process of combiningpremises with the Young People’s ParticipationTeam, which will be brought under the Streetwiseumbrella, plus the integrated Young People’sDrug and Alcohol Service. This will provide youngpeople in the area with a single, integrated sitewhere they can access a range of services fromadvice and counselling to detoxification fromdrugs and alcohol. A new building needs to befound to enable this change.iii. Disabled accessA failing of Streetwise’s current location is the lackof disabled access; this will be a key priority inchoosing the new site.iv. Online counsellingAn online counselling service is planned tofurther expand accessibility.v. Training programme for parentsFunding has been sourced from CAMHS todevelop a training programme to equip parentswith the skills to support and help their children.vi. Group provisionThe service would like to create a stronger cultureof peer support through expanding the numberof support groups it offers; currently the majorityof its services are one-to-one.

listenup!112 | Case Study 7How the project addresses gaps in localservice provisionStreetwise was originally set up to counter theunder-use of health services by young people inthe area. Expansion of the service has similarly beengoverned by identifying gaps in provision. The twomain areas of work, as described above, are providingservices for young people who self-harm, andmaking services accessible to all young people, fromevery ethnic background. As part of this second areaof work, a monthly ‘positive’ hip hop event, called‘CRUNK’, has been was set up. This has an attendanceof over 100 young people (70% are BME) and ismanaged by a group of 20 young people, known asthe CRUNKERZ, who meet on a weekly basis. This hashelped to increase the number of BME young peoplewho use the service.Barriers and constraints which impedeeffective provisionInsufficient funding is the first major constraint onthe nature of the service that Streetwise is able tooffer. The counselling service, for instance, is currentlyonly able to operate four days a week, including onelate-night session. Better flexibility for young peoplecould be achieved by having the service availablemore often.The service has expanded greatly in the past fewyears but the project is still housed in the same smallbuilding. A lack of space not only constrains thenumber of workers, but also leads to overcrowding inthe waiting room.ContactsStreetwise35 – 37 The Groat MarketNewcastle Upon Tyne, NE1 1UQTelephone: 0191 2305400Website: www.streetwisenorth.co.uk

listenup!Case Study 7 | 113Streetwise – Holistic Service TreeLinks withexternal servicesCAPACITYBUILDINGAccess to selfhelpmaterialsLeaflets/accessto self helpmaterialsStaff consultation/advisory roleAccess to resourcesand informationfor staff and youngpeoplePOSITIVE HEALTH& WELLBEINGPromotingyoung people’sawarenessPolicy andproceduresdevelopmentArt materialsin counsellingroomsStaff traininginternal andexternalCrisis cardChill out CDand DVDART &CREATIVITYHOLISTIC APPROACHCreativeexercises withyoung peopleFace-to-face/online/telephonesupportEase ofreferralOpenaccess tonotesSelf-harmconsultationSTRATEGICWORKIntegrativeapproachPromotion ofStreetwise to thestatutory sectorOngoingindividualand serviceaccreditationCounsellingin schoolsINDIVIDUALSUPPORTSelf referral/joint referralVolunteercounsellorsService easilyaccessibleLeaflets in otherlanguages; accessto interpretersSupporting staff need through providingsupervision and reassurance as well asinformation and the opportunity to develop skillsYoung people presenting with problemsin their mental health and emotional andbehavioural difficultiesProactivelychallenging stigmaPromoting messages of optimism, recovery andchange with an emphasis on personal responsibility

listenup!114 | Case Study 8Case Study 8:IceBreak, The Zone, PlymouthMission statement“To assist young people in living healthy, secure andsatisfying lives, by enabling and supporting them inmaking informed choices.”Overview of the serviceThe Zone was established in 1990 and provides a widerange of services delivering holistic support in thePlymouth area to around 5,000 young people a year.Services are available six days a week and divide intothree main areas: community, education and health.The health stream concentrates on mental healthsupport and initially consisted of a counselling service.In the year 2000, the Insight project was establishedto deal specifically with young people having theirfirst experience of psychosis aged between 14and 25. However, there was still a lack of supportfor those young people who were experiencingemotional distress without psychosis, in particularthose who could be labelled as having a personalitydisorder. Although many of these young people wereaccessing the drop-in service, the need for morestructured, targeted and long-term support led to theestablishment of the IceBreak project in 2004.An early intervention service, IceBreak supportsyoung people aged 16 to 25 who are experiencingemotional and behavioural problems such asself-harm, depression, attachment issues andsuicidal tendencies. Support is mainly deliveredthrough a wide range of group work, coveringthree areas: expressive, such as art groups; personaldevelopment, which include physical activities likerock climbing; and emotional literacy groups whichcombine dialectical behaviour therapy, which is usedwith adults diagnosed with personality disorders,and a group programme developed by the Foyer (avoluntary sector organisation) to help young peopledevelop skills for living.To gain funding for the project, the Zone went intopartnership with Plymouth Primary Care Trust; theywere successful in gaining Department of Healthfunding for the first 18 months of the project. Theproject has now secured funding until March 2008.Service development work carried out as part ofthe Mental Health Foundation projectOne of the main areas of development has been onthe group work programme. A range of groups arerun at the Zone in Plymouth and funding from theMental Health Foundation has been used to pay forequipment and other resources, and to run activitiesand fund trips.A second stage of this was the commissioning of anevaluation of the group work programme duringearly 2006. The survey included questionnairescompleted by young people using the groups,young people who were accessing other parts of theZone, and staff. In addition, interviews were carriedout with staff and young people, documentationreviewed, and groups observed. A full report waswritten up with recommendations, including: theongoing consultation of young people within thisprogramme; the development of a standard meansof assessing and evaluating groups; the need foradditional funding to support groups work includingfacilities; changes in timeslots for certain groups toimprove attendance; and the need for a group workco-ordinator.Service catchment areaThe city of Plymouth, plus Tavistock and Ivybridge,form the catchment area for the project.

listenup!Case Study 8 | 115ReferralsIceBreak accepts referrals from any source, whetherprofessional agencies, friends, family or the youngperson themselves.Referral details in January-March 2006A total of 24 young people were referred to IceBreakduring this period for a variety of reasons. Many hadmore than one reason for referral with the mostcommon reasons being: self-harm (71%); drug andalcohol misuse (46%); and emotional difficulties (50%).Some were also referred because of eating problems(8%). A third of these young people were referredby voluntary services, including the Zone, while themajority (63%) came through statutory services.Referred young people’s details in January– March 200671% of the young people were aged between 16 and21, with the remaining 29% being aged between 22and 25. 46% of the young people were female and54% were male. All of the young people accessingthe service were of White British origin.What the service offers• provision of care co-ordination for young peopleentering the service• drop-in service• group work• personal development, emotional literacy andexpressive groups• dialectical behaviour therapy• development of life skills• links with other local activities and youth groups• flexible support.Family/carer involvementIf a young person is comfortable with theinvolvement of their family or carer, then this isactively encouraged. Direct requests from familiesare also considered. The form the involvement willtake depends on the individual’s situation and theirpreference. Families could be consulted on theprogress of the young person and whether there arefurther actions that IceBreak could take, or the familymay be brought into the project itself for sessionswith a family therapist.Current programme prioritiesi. ReferralsAt present, only approximately half the referralsmade to the project are appropriate. As an earlyintervention service, the project is not set up tocope with high numbers of young people whoare already experiencing crisis. A priority of theservice is to reassess and more tightly defineits referral criteria to ensure that the group ofyoung people who access the project can behelped by it. This process is constrained by thefunding environment; if the project continuesto be funded as a mental health project, thenthey have a duty to support young peoplepresenting with suicide tendencies, self-harmand serious emotional and behavioural problems.To pursue a more generic approach, fundingwould have to be sought as part of a supportedpeople programme or within a social services oreducation setting.ii. Linking with schoolsIceBreak’s personal development team is planningto develop work in schools, focusing on topicssuch as building confidence and self-esteem.

listenup!116 | Case Study 8iii. Service user participationCurrently funding is being sought for aparticipation worker to formalise service userinvolvement and ensure that it has a central andconsistent role in the organisation.iv. FundingThe Zone is aiming to establish a consortiumof local mental health agencies working withinthe voluntary sector to jointly bid for funding.This will enable these smaller agencies to bettercompete with large national organisationswhich have more resources available to devoteto tendering for money. It is also hoped that amore supportive local culture will be created asagencies will no longer be in competition witheach other for funding.How the project addresses gaps in localservice provisionA considerable gap in local service provision is theexistence of an accessible safety net for isolatedor socially-excluded young people who haveperhaps dropped out of the education system,have emotional or behavioural problems, historiesof abuse or neglect or other difficulties with themainstream working or social environment. IceBreakhas been founded to begin to meet this need,particularly for those young people who have hadthese kinds of problems over the long term.Barriers and constraints which impedeeffective provisionA lack of sufficient resources and funding are themajor barriers that the project faces to ensuringeffective provision. Although social inclusion isa priority of the government, it is still difficult tofind and then adequately support appropriatelytrained and skilled people to deliver programmes. Inaddition, whilst it is imperative for services to securetheir funding streams, the insecurity of funding forvoluntary services means they are forced to focus alarge part of the project’s energy into securing fundingfor the next year as opposed to delivering services.ContactsIceBreakThe Zone14-16 Union Street,Derry’s CrossPlymouthDevon, PL1 2SRTelephone: 01752 206626Website: www.thezoneplymouth.co.uk

listenup!Case Study 8 | 117The Zone – Holistic Service TreeCounsellingCARECO-ORDINATIONNeedsassessmentAdvocacyBenefitsAccess totherapeutic inputAccess to groupworkDevelopingsupportnetworksChallengingstigmaZone mentalhealth policydevelopmentResearchCAPACITYBUILDINGPartnership workwith externalagenciesSelf trainingStaff supervision(Clinical; peer;external)HOLISTIC APPROACHSTRATEGICWORKEarly interventioninto psychosisnational steeringgroupDepartment of Healthpersonality disorderpilot projectPrimaryCare TrustSelf-harmconsultationDual DiagnosisPathway SteeringGroupThe Zone project provide young people-focusedservices specifically designed to support a rangeof mental health problems which include IceBreakYoung people presenting with psychosis,personality disorders or other mental health,emotional and behavioural difficultiesFunding from theDepartment of Health

listenup!118 | BibliographyBibliographyCabinet Office, Office of the Third Sector (2006) Partnership in Public Services: An action plan for third sectorinvolvement. London: Cabinet Office.(Available from: www.cabinetoffice.gov.uk/third_sector/public_service_delivery/)Cabinet Office, Office of the Deputy Prime Minister (2005) Transitions: Young adults with complex needs.A Social Exclusion Unit final report. London: Cabinet Office.(Available from: http://archive.cabinetoffice.gov.uk/seu/)Charities Evaluation Services (2002) First steps in monitoring and evaluation. London: CES.(Available from: www.ces-vol.org.uk)Charities Evaluation Services (2006) Using an outcomes approach in the voluntary and community sector:A briefing for funders, commissioners and policy makers on the National Outcomes Programme. London: CES.(Available from: www.ces-vol.org.uk)Children’s Commissioner for England (2007) ‘Pushed into the Shadows’: Young people’s experience ofadult mental health facilities. (Available from: www.childrenscommissioner.org/adult/ccnews/index.cfm?id=1953&newsid=54 (Accessed 18 June 2007))Commission for Health Improvement (2003) Transition of care between CAMHS and adult services.(Available from: www.chi.nhs.uk/Ratings/Trust/Indicator/indicatorDescriptionFull.asp?indicatorId=3555(Accessed 20 June 2007))Community Sector Partnership for Children and Young People (2006a) Community Involvement in Children’sTrusts – Unlock your potential. London: National Council for Voluntary Youth Services.Community Sector Partnership for Children and Young People (2006b) Talking Trusts: Recommendations forchildren’s trusts working with voluntary and community sector organisations. London: National Council forVoluntary Youth Services.Department of Health (2001) Mental Health Policy Implementation Guide. London: DH.(Available from: www.dh.gov.uk)Department of Health and Department for Education and Skills and Department of Health (2004) NationalService Framework for Children, Young People and Maternity Services: The mental health and psychologicalwellbeing of children and young people. London: DH. (Available from: www.dh.gov.uk)Kennedy, A. (2004) Getting Sorted Not Screwed Up: A review of the first three years. Aberdeen: AberdeenFoyer and Celtic Health Connection.Kim-Cohen, J., Caspi, A., Moffitt, T.E., Harrington, H., Milne, B.J. and Poulton, R. (2003) ‘Prior juvenile diagnosesin adults with mental disorder – Developmental follow-back of a prospective longitudinal cohort’. Archives ofGeneral Psychiatry.60, 709-717.

listenup!Bibliography | 119Mental Health (Care and Treatment) (Scotland) Act 2003 (Available from:www.opsi.gov.uk/legislation/scotland/acts2003/asp_20030013_en.pdf (Accessed 4 July 2007))Mental Health Foundation (1999) Bright Futures: Promoting children and young people’s mental health.London: Mental Health Foundation.Mental Health Foundation and the Office of Health Economics (2005) Lifetime Impacts - Childhood andAdolescent Mental Health: understanding the lifetime impacts. London: Mental Health Foundation.(Available from: www.mentalhealth.org.uk/publications)Mental Health Foundation and Camelot Foundation (2006) Truth Hurts: Report of the National Inquiry intoSelf-harm among Young People. London: Mental Health Foundation.(Available from: www.mentalhealth.org.uk/publications)Mental Health Act Commission (2007) Issues Relating to Children and Adolescents (Under-18) AdmittedFormally under the Mental Health Act 1983 and Placed on an Adult Mental Health Ward.(Available from: www.mhac.org.uk/files/MHAC%20Children%20%20Minors.pdf (Accessed 5 June 2007))NCVO (2005) ‘Monitoring and Evaluation Processes’ Action Points for public services, Briefing paper 6.(Available from: www.ncvo-vol.org.uk/publicservices (Accessed 26 May 2007))Office for National Statistics (2005) Mental Health of Children and Young People in Great Britain, 2004.Hampshire: Palgrave Macmillan. (Available from www.statistics.gov.uk/downloads/theme_health/GB2004.pdf )Partner sites, positive practice group (PPG) (2006) Workshop discussion notes. (Unpublished).Pugh, K. and Meier, R. (2006) Stressed Out and Struggling Project Report 1: Service-mapping. London:YoungMinds. (Available from: www.youngminds.org.uk/sos/SOS_YM_ServiceMapping.pdf )Scottish Executive (2005) The Mental Health of Children and Young People: A Framework for Promotion,Prevention and Care. Edinburgh: Scottish Executive.(Available from: www.scotland.gov.uk/Resource/Doc/77843/0018686.pdf )Scottish Executive (2006) Delivering Mental Health. Edinburgh: Scottish Executive.(Available from: www.scotland.gov.uk/Publications/2006/11/30164829/0)Smith, K. and Leon, L. (2001) Turned Upside Down: Developing community-based crisis services for 16-25 yearolds experiencing a mental health crisis. London: Mental Health Foundation.(Available from: www.mentalhealth.org.uk/publications)Welsh Assembly (2001) Child and adolescent mental health services: Everybody’s Business. Cardiff: NationalAssembly for Wales. (Available from: http://www.wales.nhs.uk/publications/men-health-e.pdf )

listenup!120 | BibliographyYouth Access (1999) Quality Standards for Youth Information, Advice, Counselling and Support Services.London: Youth Access. (Available from www.youthaccess.org.uk)Youth Access (2007) Commissioning young people’s counselling services in YIACS: a toolkit for managers andfundraisers of YIACS. London: Youth Access.(Available from www.youthaccess.org.uk/news/upload/YA%20toolkit.pdf )Youth Access (2007) Commissioning counselling services for young people: a guide for commissioners.London: Youth Access. (Available from www.youthaccess.org.uk/news/upload/YA%20guide.pdf )YoungMinds (2000) Health Select Committee Inquiry into the provision of NHS Mental Health Services.Article in YoungMinds Magazine, no. 48, September/October 2000.YoungMinds (2006) A Call to Action: commissioning mental health services for 16–25 year-olds. London:YoungMinds. (Available from: www.youngminds.org.uk/sos/SOS_YM_Commissioning.pdf )

About the Mental Health FoundationFounded in 1949, the Mental Health Foundation is the leading UK charity working in mental health andlearning disabilities.We are unique in the way we work. We bring together teams that undertake research, develop services,design training, influence policy and raise public awareness within one organisation. We are keen totackle difficult issues and try different approaches, many of them led by service users themselves. Weuse our findings to promote survival, recovery and prevention. We do this by working with statutory andvoluntary organisations, from GP practices to primary schools. We enable them to provide better help forpeople with mental health problems or learning disabilities, and promote mental well-being.We also work to influence policy, including Government at the highest levels. We use our knowledge toraise awareness and to help tackle stigma attached to mental illness and learning disabilities. We reachmillions of people every year through our media work, information booklets and online services. We canonly continue our work with the support of many individuals, charitable trusts and companies. If you would like tomake a donation, please call us on 020 7803 1121.If you would like to find out more about our work, please contact us.The Mental Health FoundationScotland OfficeSea Containers HouseMerchants House20 Upper Ground 30 George SquareLondon, SE1 9QBGlasgow, G2 1EG020 7803 1100 0141 572 0125www.mentalhealth.org.ukRegistered charity number 801130© Mental Health Foundation 2007ISBN 978-1-906162-04-7