Children, young people and the future of mental health

Ahead of our centenary talk: The Next 100 years: Innovations and insights for the 21st century, we interviewed Emilios Lemoniatis, Consultant Child and Adolescent Psychiatrist & Digital Innovation Lead, about his perspectives on the future of mental health for children and young people. Emilios was recently featured in a recent Guardian article on end of lockdown anxiety. 

1. What developments do you anticipate for children and young people’s mental health?

My main view of the future is that the experience of mental illness is going to change. For many years mental illness has been viewed as a stigma and as something to be ashamed of and difficult to talk about. Also, it has been viewed as something to be wary of and something which created distance between us. This is changing significantly and will continue to change to the extent that having experienced adversity will be seen as a strength and also a ‘superpower’.  What will become valued in society is the ability to empathise and see things from different perspectives. Young people who have experience of mental difficulty are re-constructing their identity from one of illness/damage/ to one of perspective/ independence of mind/authenticity and creativity. There are organisations now for example which seek out young people with ‘specialist skills previously considered as mental disabilities’ and matching them with key roles in really high-end organisations.

This is not to ignore the pain and real suffering that can be associated with mental illness. We will move from a deficit model to a state of mind/model. Whereas we may be limited in what we can do to the brain currently, we are not limited to what we can do around someone who is experiencing difficulty.  

I see children talking about the experience of mental illness. It’s becoming a part of the natural discourse with teenagers. It is part of their conversation and you’re not considered strange or unusual to talk about those things. There was a stigma about studying psychology in the 80s and 90s. Teachers wondered if you had a mental health problem that you were trying to solve as opposed to being immensely curious about psychology and people. The truth is that you have always to be open to greater self-understanding and reflection.

What I also see now is so many people from a variety of disciplines congregating around the mind and mental health. There is a greater effort in developing and innovating in order to help people’s minds. People trying to help in this area are not just scientists, they come from all backgrounds and forms of expertise. Fundamentally I think this support from all angles has helped us within mental health to be more creative and challenge the way we as professionals see things. People coming at the question of mental health from lived experience and also arts as well as science backgrounds is amazing and has really opened up the way people think about mental difficulty. 

This is not something that was mainstream ten years ago. It was not how people thought, though now we are more comfortable with disruption and need mash-up cultures and ways of thinking so that we can learn more from each other and gain from overlaps. Lots of people are interested in this creative space. One example is Neurocreate who are developing platforms that support innovation and creativity. I see creativity as fundamental to mental well-being and would be interested in how a platform like this could support depression.  The idea of one kind of way of thinking or ‘epistemology’ which holds the truth about mental health has weakened considerably. We have to identify ourselves completely and broadly as humans to understand where mental illness sits– biologically, genetically, culturally and spiritually.

2. What innovation would you like to see in mental health?

We’re also learning about innovation itself and the science of innovation. As an NHSE Clinical Entrepreneur, I see at the Tavi we have a real opportunity to harness innovation and develop it. Many clinicians have their own strong allegiances to the ways in which they have been trained to work within the CAMHS system. In order to truly innovate and do the best for the young people we work with, we need to work hard to let go in terms of some of what we value, and the concepts we were trained with. Looking at statistics of the outcome of mental health services, a lot of the children we see as patients need us to develop something new. Something that works differently. There is also a greater number of them, so whatever we create needs to meet the needs of many rather than the few who meet our threshold and can wait for our services. It is a matter of resources, though also a matter of application of resources.

For example, at the moment we are suffering a different kind of epidemic issue that we have very little control over. And that’s county lines of vulnerable young people. The techniques and approaches that the drug dealers are using to capture these children and manipulate them are more effective than what we as clinicians in CAMHS are providing, which is why it is so difficult for us to help them once they have been entrapped. So these drug dealers are in essence very skilled ‘psychologists’ because they have learned and are using techniques to entrap, manipulate and abuse young people for their own benefit. At the moment, it is really difficult for us to compete with them and we need to acknowledge that. We need to put our resources into coming up with something innovative that can make a change. In order to do this, we need to challenge the traditional structures around us, the social care system and health care systems which we value and challenge our own political views if we want to make a real change. The Level-Up programme at the Tavistock and Portman has made an amazing start at this with younger children. We need to try and create something for the older ones as well though that is going to be harder as it really is a complex area. But that’s what we are about, right!?

3. What services would you like to see in the future to support children and young people’s mental health?

I’d like to see a way in which we can truly creatively think about how we can help young people in terms of human relationships, medical and digital technology in a way that can overcome mental health difficulties. Close partnership with on-the-ground agencies can help us do that. One of the factors that is exciting to think about is how we can better engage with our young people from Black and minority ethnic communities and diverse groups. This really is an area that we can lead on and engage with. We work in the heart of really amazing and diverse communities and there are so many new ways that we can connect with our communities. To do this we have to really be prepared to challenge ourselves to think and work differently as well as consider the fact that we ourselves may need to changes, as well as sharing the social capital we hold as individuals and within our organisation. For me, it is really exciting to imagine how we can create more culturally informed services.

The other service we’re developing is the Thriving platform. I’m hoping it becomes a go-to place for the country if not the world for children, parents and carers as their first-stop resource in mental wellbeing. And there’s no reason why this platform can’t transcend national boundaries and support people in other countries, taking the message of how we work and think at the Tavistock and Portman across the world, as well as create a space for other start-ups – to facilitate other innovators to have their chance. It is also going to need new voices within the Tavi to help develop it and help make it mean something for our communities. We have hopefully created a platform that is a basis that people can develop and evolve.

The other thing I see is that young people themselves have a much greater input and purchase on the services we think of now. Having run Teens In AI Hackathon, I’ve seen young people develop products for young people, and as technology becomes much more available and less expensive, their capabilities are increasing, and have increased in ways that adults cannot match. We can have innovation fellowships. It allows people to start new ideas and develop them in a containing support structure. And I also think we should have an innovation fellowship for young people that recognises young people’s drive, ideas, creativity and contribution, moving away from this idea of patient co-development. They can be who they are. And they can lead, with us there to support when they need it. 

4. Do children and young people have enough of a voice in shaping mental health services?

No way! And there are two reasons for that. There is still a huge stigma around young people engaging with mental health services. We haven’t worked hard enough to engage with them in their spaces on their terms. We also have to really work on the give-and-the get. We have to work on the give – in the relationship between young people and services. 

The Teens in AI project was an example in that. We offered young people a real authentic development experience. We are not inviting young people who have experience to meet us so we can ask them what colour the mental health waiting room should be, we have run that experiment and the amount of young people who showed up was negligible. When you make an offer out to all young people, so that there is no stigma from the beginning and you give them opportunity to learn and develop new skills, have real agency, like we are going to give you the skills, so you can make your own mental health support services – then they are interested and are passionate and full of drive. The amazing thing also is that we as professionals learned as well along the way- it was a training experience for us too and we have changed how we work because of it. How cool is that? It becomes a shared learning experience for everyone!

Young people are so interested in making an impact on mental well-being and we need to capitalise on that. They know what they like and how to be communicated to. They want to develop their capabilities. This links back to innovation, we have to let go of our allegiance to our beliefs, trainings, professions and our power and superiority. And it doesn’t have to be one or the other. It’s about epistemic justice. When we talk to young people, we have to speak to them as if they are the knower of their own experience. They know their situation best and what might be useful for themselves and other young people. They see things that we don’t see and can’t see. And they are developing a culture amongst themselves that is different from ours. That change in culture is part of evolution and we need to be in conversation with young people to keep connected to it.

One of the things that I have learned over the last year on NHS England’s Clinical Entrepreneur Programme is that “if you can think it, you can create it.”  That creativity, imagination and making ideas a reality has never been so close. For young people, technically, this means that all they need to make a change happen is to voice a need AND to have the drive to make the development happen. This also brings in the issue of equalities and diversity and whether young people have access to resources and social equity in order to help them make these developments. On balance, I think it is the Trust’s and our role to support our young people to have agency, to help them develop these skills and to help them grow their ideas and opportunities.