Ep. 8: Where research transforms children's mental health

Host and Producer

• Dr Rosie Anderson, Research Fellow, Public Health Policy team, UCL

Guests

• Professor Jessica Deighton, Child Mental Health and Wellbeing, UCL and the Anna Freud Centre
• Sarah Reeves, Mental Health and Coproduction Lead, Newham HeadStart
• Libby, young woman from Newham

Transcript

Rosie Anderson  0:04   

Hello, and welcome or welcome back to the podcast where research transforms lives. I'm Dr. Rosie Anderson, and every Thursday this summer, I'm inviting you to take a deep dive with me into the UCL research that has changed the world around you. For some of us, our years at secondary school are the best of our lives. For more of us, it's probably a mixed bag. And for everyone, it's a time of huge change in which we go from being seen as a child to being an adult in almost every sense. For an increasing number of pupils, though, these years will be some of the most challenging they face, and when mental health issues will become parts of their lives for a long while to come. As a society, it can feel like we've come a long way in taking children and mental health seriously. But it isn't easy to get to grips with the scale of this issue because the people facing it are at a double disadvantage. There's still stigma around mental ill health and dismissiveness towards young people. What we do know is that the number of young people in the UK experiencing mental ill health stands at one in six and has risen sharply in recent years. Professor Jess Deighton at UCL's Evidence Based Practice Unit and the Anna Freud centre was funded by the National Lottery community fund to take the temperature of the mental health of children and young people in the UK, and to test new ways to improve their mental well being. Through the Headstart project, she ran a national survey of their experiences with questions shaped by young people themselves. And she has worked with councils across England to put what she found into practice. I spoke with Jess and two people from Newman, London, one of those local areas, Sarah Reeves, a children and young people's mental health and well being lead, and Libby, a young person growing up in the borough. 

  

Welcome, Jess, Sarah and Libby, I wanted to start by asking you, Sarah, you work as a youth participation practitioner, co-production lead, you have had a lot of experience of working with young people and children. And I wanted you to just tell me a little bit about your experiences over the years of where children's mental health support was at, especially prior to the Headstart work and recent developments. What did that mental health and well being support mean, in schools in services that you come into contact with? 

  

Sarah Reeves  2:30   

The main mental health support that everybody would think of would have been cams? And actually, I worked in a different borough before this job and, but a neighboring borough and it would have, actually, that would have been the only support and I think people generally, so mental health support as that very clinical counselling or professional services in that way, you know, through the NHS, or who plans or something like that, in schools, again, it was down to sort of counselling services like, you know, place to be, and who do offer those like, counselling sessions for young people. And so very much the view was of mental health support, it was that looking from a very medical and clinical perspective, rather than looking at it from more of a social model. And looking at actually the power of informal education to actually help address some issues and address that system change.  

  

Rosie Anderson  3:45   

could you just explain what you mean by social model? 

  

Sarah Reeves  3:49   

Yes. So looking more at the factors around a young person, so looking at that whole system approach, reflecting upon actually how the system around that young person impacts on their mental health, but also seeing less clinical or medical interventions as also in a therapeutic way. I definitely feel like that's been missing from a lot of mental health support, pre stuff like Headstart and those sorts of programmes.  

  

Rosie Anderson  4:23   

Thinking back, was there anything about the way that that support was provided that, you know, felt puzzling to you, frustrating? I think you've hinted at it there.  

  

Sarah Reeves  4:35   

Yeah, my professional life in this field sort of started off when I was maybe 24, quite a while ago. I'm not gonna reveal too much. But so I you know, I've always been a kind of community youth worker. And I think within that role as a practitioner, as a youth worker, you understand the benefits You see the impact on young people, you see the development of young people and you do, actually a lot of the time when you are supporting individuals, you are supporting them with their mental health. I think the frustration for me back then was that actually it's not recognised. It's seen as the pink shrimps and playing ball model of supporting young people. 

  

Rosie Anderson  5:23   

I'm sorry, the what?  

  

Sarah Reeves  5:25   

Oh, sorry. I've had it described as pink shrimps and playing ball. So table tennis. So like young people come to the centre, you fill them up with you fill them up with sweets. They play some games, and it's kind of distracts them. Yeah. And I think for me, that's what was frustrating. And as on a very on a personal level. I mean, I've had a history of mental health difficulties myself. So growing up in a system where, you know, actually, the only solution that is ever offered to you is go and see a counsellor go and see a psychologist is not always helpful.  

  

Rosie Anderson  6:03   

And Libby, I want to turn to you now because I want to ask you, Libby, about your own observations about the transition from child to young person to adults, particularly that thing about going from primary to secondary school, and particularly the challenges of going through secondary school. And that well being that mental health, not just in the kind of narrow sense of those words, but in the way that Sarah just described about the way it affects everybody's sense of who they are. 

  

Libby  6:32   

So I think the move from primary to secondary is especially hard, because you're probably like, What eleven/twelve, going into this massive kind of building of hierarchy. So it's always teachers, and then it's year 11, 10, 9, 8, 7. And then you're right at the bottom yet again, it brings a lot of stress and anxiety onto it knowing Oh, my God, am I going to make any friends? Or is the work is going to be really hard? Or what am I going to have to do? What if I get a detention or a sanction? So I think it brings a lot of anxiety into young people. And that transition for me especially I found it quite difficult because I went to a school completely out of my borough, and no one else was going there. And I did feel very overwhelmed. I used to always cry the mornings before school, not as oh my god, I don't want to go like not in a in a typical quote unquote, bratty way. But in a genuine, I don't want to go back to that place. And I feel like we young people aren't exactly helped in terms of school, there is not enough guidance in place. So when a student is feeling anxious about it, they do brush it off and say most of the time Oh, okay. But everyone goes through and it's gonna be fine soon.  

  

Rosie Anderson  7:56   

And is there anything specific to girls experience about that journey? Do you think 

  

Libby  8:06   

so not many people do think it's not real, but they brush up on it a lot. Because they just bit make up the excuses. And especially the boys, actually, they say a lot of days, like, Okay, you're just stressed because of exams, they don't understand that people, especially women who have already had such a strong history in the world of being neglected and segregated and abused emotionally, and physically. Yeah, it is very much always kind of pushed onto Oh, my God, are you on your period? Or no, you're just a bit upset, because you're it's that time of the month, but they don't understand that women are going through things like depression and anxiety, and that it's not spoken about enough. And when we do speak about it, it's always they always go straight to the opposite side of the spectrum. So it's always like, men have it as well. But they're not understanding that we're not saying that men don't have mental health issues. We just want some help with ours right now. 

  

Rosie Anderson  9:06   

Thank you for a really honest answer there Libby and so Jess, why did you want to do this research bringing you in? 

  

Jess Deighton  9:16   

Thank you. Yeah, that's really powerful Libby. And I think some of that sort of probably makes the case for why this research is important. I think for me, my interest in mental health and well being kind of predated my interest in research, really, because I think when I went to school, I remember lot lots of people my age actually really struggling and really clutching at straws to get any support within schools and thinking, you know, mental health well being is just so fundamental, isn't it to who we are and how we function that? Surely that's a cool place to start if you're going to, you know, support people to you get the most out of life, really. So I think that's where my genuine interest comes from the research quite Oh, Often that the headlines tend to be around what we can see at a population level. So you'll get, you'll get statistics about one in what's that post COVID is one in six children, young people experiencing probable mental disorder, I think is how they frame it. And that's obviously really important to know, because we can keep an eye on the fact that those rates increase. But I think some of that experience of different groups gets masked by those very broad figures. In terms of Headstart more generally, my role is very much on the evaluation side. And it's really new and the other partnerships that do the brilliant work putting the support in and I just try and sort of help understand whether that's working. But But that being that evaluation also gave us a brilliant opportunity to collect really large scale data from children and people to hopefully amplify their voices around what they were finding challenging. And obviously, from that, we could see that girls and young women were really saying, Actually, their mental health is really being challenged and really being undermined. So that felt like an important message. And when we look at the research that's out there, that's there to be seen, actually. But for whatever reason, I think it's a bit like what Libby was saying, it doesn't really gets dismissed and doesn't really get paid attention to so it felt really important for this specific piece to draw more attention to that. 

  

Rosie Anderson  11:22   

Yeah, and what you're talking about requires a massive, was a massive research project. It was it's gathering a lot of information from right across the country really, ultimately. And how do you go about doing such a huge survey in order to answer those questions, and they are about difficult, quote unquote, difficult, difficult things, aren't they? Those questions too, 

  

Jess Deighton  11:49   

we were really lucky at the beginning of this project, to be able to have a period of time to work with all the different partnerships like Neerim, who were involved in Headstart to think about, you know, if this is a programme that's going to be embedded, what are we really trying to achieve change what we really want to see for children, young people, and and to talk to the schools and the young people themselves about what was important to them. So so that was where we started from. And we really let that drive the content of the survey. And then as researchers, we then said, okay, where does the research evidence, say, the best measures are of those kinds of things of well being of mental health of, you know, how connected young people feel to school, what you know, how they're supported, they feel by their family, by their friends, and so on. And so we use that as a base to build the survey. And then really, it was about a partnership between researchers, young people, the partnerships themselves and the schools to really embed this because it takes significant effort really on the side of the schools, and the local authorities more than it does us by that point. So they did brilliant work, sort of emphasising why this was important. And I hope we honoured that by also feeding back to the schools, what we'd learnt and, and some kind of sense for them of what the strengths and needs of their students were so that they could use that to plan the kind of support they put in place as well. So it's about trying to make something reciprocal, and mutually useful that everybody gets to have a say in, I suppose. 

  

Rosie Anderson  13:21   

And Sarah, and actually Libby as well, that reciprocity, I mean, just as describe the how, you know, it started with a conversation, which was about defining, like, really establishing what, what young people feel about this, and what schools feel about this and what be useful to them. And also, these were very time consuming things to do both back first phase, but then also going out and actually doing the survey doing gathering in the information, the data, the evidence about this. So why was it important to do it that way? If it is time consuming? Why is it worth doing in that way, you know, 

  

Sarah Reeves  13:59   

it's really important to actually gain an understanding of where people are at and starting where they're at, without that mutual respect and understanding that those journeys that you're going to be taken together are really, really, they're quite hard and quite challenging. Those relationships need to be built, and they get built through mutual understanding and trust. And, you know, that Relational Approach is vitally important because like for schools, you are, you know, you're kind of looking at the practice, you know, for them to trust you to do that in a way that is supportive and useful when helpful, you know, that needs to come from a place of trust, you know, we we have had experiences where, throughout the programme where a school didn't feel like that, and then they felt that they were being attacked and it it destroys the whole relationship. You know, this is a programme that is about young people and putting them at the centre and But working holistically, you know, in the systems around them as well. So who better to speak about the experience of a young person than a young person? 

  

Rosie Anderson  15:11   

Well, that's a perfect segway into Libby. Libby, that's a really important point that do you think that our assumptions made about young people and their, their well being their mental health in particular? And what quote unquote, is normal in growing up? 

  

Libby  15:36   

Yeah, I don't think there's any doubt about the assumptions. Because a lot of the assumptions come with age, it's always if you're under, like, what 10, you're not supposed to, or you're just being dramatic. And you're just probably just a bit angry that the biscuits run out or something. People don't see that. They are also childhood, there's childhood trauma that exists. And that can start from a very, very young age. And then there's also assumptions regarding women as well. And the mental of like I said before, about the whole period thing that if someone is woman is going through something, it's automatically linked to hormones, 

  

Rosie Anderson  16:18   

I've got to say it's it. I'm slightly saddened on a personal level, to be honest. listening to you talk Libby, because I recognise so Well, exactly what you describe about your journey from primary school to secondary school. I had that experience of, you know, crying before school, and just generally having quite a rough ride of it. And, and I remember people being very dismissive, not just my feelings, but of children in general, and young people as we got older. So I've been sitting here thinking, gosh, yeah, I really, really recognise that I keep on telling myself, I'm sure it's better now. And it's sad to hear that it's not necessarily Libby, but just I'm aware as a researcher myself, of how much I am bringing myself into this. You know, as soon as I start talking about growing up, I think about my own experiences growing up, and presumably, you grew up as well Jess! or, to some degree enough to now be now be researching growing up at least you grew up that much. So there's a serious point, there isn't the about how you approach a subject, which you do have direct experience of, and you possibly have quite strong feelings about, you know, as a researcher, how does that work? How did you work with that? 

  

Jess Deighton  17:44   

Yeah, it's funny, isn't it and and in a way listening to Libby talk, they're like you say Rosie. So it brings a heavy weight. So sometimes the large numbers and the large quantative datasets don't. So I think it's times like this really where it feels, sometimes nearest the surface. But yeah, I think we're getting better as, as researchers, I hope that owning that and using it as a strength and not something that we try and partition away. I can really identify with some of the things that you're saying, Libby about, you know, that sort of feeling of being trivialised in terms of your own experience and how it doesn't help you to manage actually does it? And, and I can really identify with that. And also, I think I can see some of the findings, some of the explanations that have emerged from the literature around why the experience of young women might be particularly challenging. And sometimes they're over really oversimplified. And I can think of lots of different explanations that I can possibly draw. From my own experience. I can remember times when, particularly in secondary school, I really felt the pressure to meet the mark on too many things that felt like ridiculously big expectations. And I think often, girls and young women will just try and meet those expectations because they assume, you know, cope, whatever the costs sort of thing. And so I think being able to draw on that lived experience really helps you to question contextualise identify. But I suppose also recognise that, you know, you can't generalise your experience to everyone else's experience. And there are different stories. 

  

Rosie Anderson  19:24   

well, let's talk about some of those stories that emerged from your research then. What would you say were the big themes that came out? And did any of them surprise you? 

  

Jess Deighton  19:33   

Yeah. So obviously, the one we're we're talking about most is is sort of the experience of girls and young women and how the distinction between that experience for girls and young women versus boys and young men was quite different. And in some ways, that wasn't surprising because as I said it was it was in the research already. But I think that that that gap is getting bigger and starker. In the research, we can see that so it's not just not just in terms of in recent years, but also, as girls and young women move through adolescence, we can see where that gap start. And it is, you know, at the beginning of secondary school, we can see those things, you know, girls and boys started apart in terms of their experience of mental health. And so it wasn't absolutely a surprise. But it was, I think, that was the point of which I absorbed fully the extent of that. And that felt quite surprising. I think, some of the qualitative research that we've carried out as well, which we've talked about a bit less, I think that comes as more of a surprise to me, because that's where you can really get a sense of what's potentially driving some of these factors. But also, you know, the, the remarkable resilience of young people who have quite challenging life experiences actually being able to show that direct relationship really between what support is available in your immediate environment, and how you are then able to manage the challenges that life throws at you, I think that feels like a really important thing to do not just to state that there's a relationship there. But to be able to describe that in someone's own words. That's been really powerful. I think, 

  

Rosie Anderson  21:11   

just backtracking slightly, could you go into a little bit more detail about those different patterns between girls and young women and boys and young men and the journey through secondary school in particular, could you just explain the details of that a little bit, 

  

Jess Deighton  21:26   

we started carrying out those surveys with a group when they were in year seven, and we followed them through each academic year to year 11. So when when we looked at their responses, we looked at their reports of their emotional difficulties. So in terms of feelings of anxiety, or low mood, for example, in terms of behavioural difficulty, so how much they sort of got angry lashed out. And there were and also general sort of well being so how positive they felt about their life. And, yeah, the satisfaction they derive from it, I suppose. And what we found was that in the first year, so when the young people were age, sort of 11ish, 12. They were definitely differences. And we can see gender differences between boys and girls that looked a bit like the way we described with the research is, girls tend to be socialised to respond to psychological distress in a more emotional way. So they tend to what we call internalise those, that distress, whereas boys tend to be socialised more to externalise it, so show it as sort of behavioural difficulties. And we definitely can see that difference in the data. But it's sort of smallish, I suppose that first year of data collection. And then as young people moved further into adolescence, we saw that girl's emotional difficulties, actually began to escalate quite a bit. And boys there stayed very stable over time. And again, the same was true for behaviour. So although boys started out with higher scores, they stayed quite stable over time, whereas the girls started lower, but actually, their rates of what what they saw as their behavioural difficulties began to creep up, as time went on. And, and correspondingly, their well being took a dip over that period of time. And again, boys stayed very similar. Now, I think we have to bear in mind that it may be that boys are less willing to report mental health problems. And there's, there's something about that. But I think reflecting on Libby's point from before, we'd be careful not to dismiss the experience of girls and young women in that. So if they're saying that things get worse as they go into adolescence, I think we have to, we have to take them at face value on that and believe them. Yeah, so that's what the data was really showing us. And in fact, when you look at other data sources, you know, you could almost track that. And when you get to sort of young adulthood, so between 16 and 19, that gap is really, really quite big, actually, between young women and young men, you see really quite high rates of emotional difficulties, you know, edging up to about a quarter of young women experiencing significant mental health problems by that age.  

  

Rosie Anderson  24:07   

Libby, how does it feel to hear Jess, a researcher who's done this work? Describe that those findings? 

  

Libby  24:17   

Yeah, it actually makes me feel a little bit relieved in a way that there are some people out there who do understand where I see young people are coming from when we do talk about it. And it's also quite shocked me a little bit as well, that boys started off quite higher than girls because, again, I think it's stereotypical that men don't have the mental health issues and women do. So it's quite surprising eye opening in a way to hear that. They've started the stats in a way have were higher for boys initially than girls. And I think it's definitely going to help We understand and be a bit more understandable and gentle in approaches to talking to young people as well younger people, because I currently have a placement at my primary school where I work with about a 11 year olds. So it will make me understand that just because this boy right here is laughing, and he's having fun with his friends and is being quite, quote unquote, boisterous. He could probably be going through some things as well that he's hiding, 

  

Rosie Anderson  25:27   

just when you have findings like this in a project that shows such a clear and probably, at least to some degree and unmet need. How do you act on that as a researcher? 

  

Jess Deighton  25:39   

Yeah, it's a good question, because, as researchers recent article, it's a bit tricky to know how well we can, we're not the clinicians, right, or, you know, we're not always in the best position to take action. But I think there are definitely steps we can take. I think the first one is really raising awareness. Because, as I say, even when these things are in plain sight, they can often somehow managed to go under the radar. And that can sound a bit sort of passive. But actually, because we have these lovely mechanisms through the headstock project where we have such strong relationships with our colleagues in new home and other other partnerships. We've got, you know, a really powerful funder behind this, and the National Lottery community funds who are really invested in amplifying the voices of young people who can help us with that. And we have a sort of direct line into the schools as well to alert them to the needs of their students. So we're in good relationships with those who can, you know, really act on these data, these findings and say, well, here's where we place our support, then we, and I think we can also try to say, Well, our next job then is to understand why this happens. And can we bring to light some explanations of of why this is the experience of girls and young women and bringing young women's voices to the fore is really important in that. So I think that's why these kind of conversations, but also qualitative research is really important. And then obviously, we we can play a role in finding what works, there's still a lot of gaps in the evidence base around what good support looks like for mental health. And it's our job to make sure we do better understanding that not assume that our job stops are writing their research paper, which I know many of us, most of us don't think that's where our jobs stop.  

  

Rosie Anderson  27:25   

So Sarah, in Newham, what has all that look like then, you know, knowing something needs improving, and then knowing how best to change, it can be different things. So so how did you decide on what to do? 

  

Sarah Reeves  27:39   

I mean, I, you know, I would love to say, It's all fixed. I don't think that's true. Everyone's okay. 

  

Rosie Anderson  27:51   

Jess you can go home. 

  

Sarah Reeves  27:56   

To having those just, you know, those conversations, it's like, you know, that that transition age especially, has been a massive focus for us over the last couple of years. Lots of young people, through some of our school programmes kind of identified that being a massive gap within scope within education generally, you know, been working with schools around, you know, developing their strategies around transition, working with young people to develop peer to peer resources, so that schools can then deliver those projects more effectively. And, you know, obviously, as a co-production lead, I would be very remiss not to, you know, obviously, champion actually the fact that, you know, having those young people having those young people involved in the co-design and the co-development of those spaces, but also those resources has really been key for us. Really working with the schools to understand what their needs are, and understand where they are and where their knowledge or capacity might be an issue and stepping into that space as well. Being prepared to step into that space to increase their capacity to offer that kind of support. It's interesting, because, you know, we've now, six years down the line, and I've been with Headstart since year one. And it's been amazing to see the stance change in some of those schools. And then taking more and more ownership as the year goes on kind of developing more confidence in not having to be a clinician not having to have a psychology degree, that actually, you know, even the small things that you do that alone, these sort of bespoke programmes around targeted groups of young people, you know, they make a difference. 

  

Rosie Anderson  29:58   

It seems like a good moment. Start thinking about looking ahead, actually, let's end on an optimistic note. If you could change one thing, big or small, to improve young people's, and if you want girls in particular, their mental health, what would that be? What would that one thing be? 

  

Jess Deighton  30:19   

Say for me, it would it alludes back to, I think what Sarah was saying when she was describing some of the support that's now in schools is, it's about getting the message across to every single person who has contact with you and people, that they all hold responsibility for supporting those young people's well being and mental health. So not not just often, we think it's the, you know, child mental health services that hold the expertise, and therefore, they must be the people who supports young people's mental health. But actually, what the research tells us is, you need lots of protective factors peppered throughout your environment. And the more the better, so the more people who can be a positive force for good in the young person's life, the better. And if that's on a very trivial level, then when you walk past a bunch of teenagers on the road, you don't go, you actually smile. Or if it's having a meaningful conversation as a school teacher who doesn't feel qualified as a mental health professional, but does really care about a young person in their class and is a bit worried that something might not quite be right. Or a parent who doesn't know how to tackle the topic of mental health. It's worried about their child. Yeah, all of that. I think if we can empower those people to think of themselves as a potential support, that that would be a really good service, it would be a start. 

  

Rosie Anderson  31:42   

Sarah Libby? 

  

Sarah Reeves  31:45   

I don't know. It's a big one. It is. I mean, 

  

Rosie Anderson  31:49   

it's quite a mean question. 

  

Sarah Reeves  31:54   

I think, especially for young women, I think what I hear a lot is a sense of guilt, about not being in the right, in a good place, have a sense of shame, about not being in a good place, like like, they're letting somebody down. Obviously, I would rather it not happen at all, I've been a good place all of your life. But, you know, not to feel that sense of responsibility and guilt, about just feeling and being human,  

  

Rosie Anderson  32:27   

I think I think it might even have been Libby who originally brought up this idea of having to be perfect, is part of becoming a woman in a way, in a in a really unhealthy way. Obviously not, not in a that's not natural. That's something that our society does to us, but but how that has an impact on how you approach things and how other people approach you going through things. So, Libby, any any final thoughts? 

  

Libby  32:56   

Um, so I when you asked the question, my mind went straight back to the past. I don't know if it's the history geek in me talking. But I think if it was something that I wish didn't happen, not for the sense of like economics and stuff, but it would genuinely be war in politics, because without war, I think that astigmatism vine would have been snapped before it could grow. So the there would have been issues today, yes, without what, probably 100%. But it wouldn't have been as detrimental. Because then mental health issues wouldn't have been passed down just by childhood trauma. 

  

Rosie Anderson  33:43   

Well, obviously, we live in a world it is not free from war, as we speak. So that's a message which has got plenty of resonance for the world we live in. It's not just the history lesson, I think. Anyway, thank you so much for your time, it's been a real pleasure talking to all of you. So thank you for being so generous with your time and your experiences. That's all for now. I hope to see you next time where I will be talking to Professor Kate Jones of the Centre for biodiversity and environmental research, about how her work into how diseases jump between species has shone a light on the link between the health of humans and the health of the planet. If you can't wait until then, and want to hear more about the impact of UCLA research on society in the world, then why not take a listen to me at UCL presented and produced by our students. Finally, I want to thank Libby and Sarah Reeves from new and Headstart and professor Jess Deighton, our guests, and of course you our listeners. This podcast is brought to you by UCL minds, bringing together UCL knowledge, insight and expertise through events, digital content and activities that are open to everyone. 

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