Empowering young people to play an active role in their care is key to tackling health inequalities

11 October 2021

The theme for this year’s World Mental Health Day is ‘mental health in an unequal world’; a very timely theme as we reflect on more than eighteen months of living through a pandemic that has cast a stark light on health inequalities across London, the UK, and throughout the world. 

We know that emotional distress amongst children and young people has surged throughout the pandemic, with a recent report from the Royal College of Psychiatrists revealing that 200,000 young people were referred to mental health services in April – June 2021. This is nearly double the pre-pandemic demand for child and adolescent mental health services, with a disproportionate representation from minority ethnic and LGBTQI+ backgrounds, suggesting that the pandemic has exacerbated pre-existing health inequalities. Waiting lists are getting longer, as over-stretched services struggle to cope not only with the additional demand, and the impact of the pandemic on the workforce, but also because of the way emotional health and wellbeing services are being delivered.

Long waiting lists can contribute to a deterioration in mental health and wellbeing for children and young people in need of support. However, if we were to solve the problem of waiting lists tomorrow, there would still be much work to do to ensure that every child or young person receives support that truly meets their needs. Too many young people have reported negative experiences with mental health services, and have been left feeling alienated and disempowered.

world mental health day 2021

The reality is that mental health services haven’t done enough to put young people, and their unique needs, at the heart of their care. This is why, at the Tavistock and Portman NHS Trust, we are working hard to implement the THRIVE Framework for system change within our own services. We are also working in partnership across health, education, social care, and the voluntary sectors to enable more integrated system working, and ensure equity of provision across the UK, to help improve outcomes for the children, young people and families in their care.

The THRIVE Framework for System Change (Wolpert et al, 2019) was developed by Tavistock clinicians in partnership with other mental health experts to transform emotional health and wellbeing services so that they really work for young people. Talking about severity and mental health diagnoses doesn’t work – this language can lead to stigma, and can result in young people being unable to access care if their needs don’t fit with a particular category or service model. Worst of all, they were often turned away from services because their symptoms were not bad enough, only to return when their needs had escalated and met a given ‘threshold’.

The THRIVE Framework is needs-led. This means that needs are defined by children and young people themselves, and together with professionals they choose the kind of support that meets their needs through personalised, shared decision-making. It means talking about emotional health and wellbeing using a common language, so that everyone can fully understand the process, the agreed care plan, and their role within it.

Early intervention and prevention is also key to improving emotional health and wellbeing outcomes for young people. Nobody should have to wait until they’re at crisis point before accessing high quality needs-led help and support. The THRIVE Framework shares the principle that it’s important to create a proactive and preventative mental health and wellbeing culture in schools and other settings where children and young people ordinarily go. It promotes emotional health and wellbeing as being everyone’s business, and the vital importance of providing the children’s workforce with the appropriate training, and support for their own wellbeing, to carry out this important work.

The long term impact of mental health needs for today’s children and young people on current and future generations provides the Government with a clear call to action. We must prioritise the delivery of a national strategy and investment to genuinely transform the way we deliver children and young people’s  emotional health and wellbeing services. It’s crucial that we do so, to ensure that every child and young person has the opportunity to overcome emotional health and wellbeing struggles, and live a life where they are thriving, not just surviving.

Rachel James, Director of Child, Young Adult and Family Services and Clinical Director for the National i-THRIVE Programme 

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The THRIVE Framework for system change (Wolpert et al., 2019)

The THRIVE Framework for system change (Wolpert et al., 2019) is an integrated, person centred and needs led approach to delivering mental health...