‘Just what is the point of you?’ Research and young people’s mental health

Research is the job of understanding things and finding what’s true. How can research help young people’s mental health if it avoids understanding them?

A screen grab of Amy in Doctor Who asking ‘Then What is the point of you?’

The following is a transcript of a speech given by Mark Brown to the Health Service Research UK conference at Nottingham Conference Centre on July 5th 2018

Over the last twenty years the issue of young people’s mental health , or lack of it, has risen slowly up the political agenda, developing from a focus on particular conditions or experiences which fitted with broader political or social concerns to the current enveloping narrative that young people’s mental health is at boiling point. There is, everyone agrees, a crisis in young people’s mental health. But what role has research to play in this unfolding drama of need and frustration and potential?

I’m not a young person. I’m not a researcher. I’m not a policy maker. I’m not a practitioner. I’m not even a parent. I am someone who experienced mental health difficulties when I was younger and continues to experience mental health difficulties today. I’m also someone who has been lucky enough to hang out with young people in the context of helping the creation of things intended to make their lives better.

It’s the 70th birthday of the NHS today. Our ideas of what makes good mental health for everyone are much younger than that. We bolted our developing ideas onto the grand edifice we began building in 1948. If the NHS is evidence of anything its that policy can make things change overnight. We can assume that the world as we see it will remain the same forever and that the systems we have will be the systems we will always have. But the NHS, like the EU referendum result, show that things can change and can change drastically. Young people today are joining a world where the future is not fixed.

We love to decide what young people should do and feel

In many ways, we know more about young people now than we have ever known because, for the first time, young people can chronicle in public their own lives and interests and understandings. We talk about the almost mystical powers of millennials to undermine our social structures; our methods of business; our interactions with each other. In fact, the oldest millennials, those born around 1980, are old enough to be creeping up on 40 soon. They were called the ‘me generation’ for being selfish, narcissistic and politically uninvolved. Then they were the greatest threat to civilisation ever with their riots and Occupy and occupations. Then they were the ‘snowflake generation’ of social justice warriors and 4chan shitposters and angry pepe’s and trolls. And now they’re the generation having a mental health crisis. We swing between wanting to protect young people and telling the world they’re worst thing ever.

As I wrote recently about our desire to criticise young people for always being on the phones:“Discomforts around young people’s social media use often come coated in nostalgia and prescriptions for a life which for many young people has no chance of existing. Running through fields of wheat and filling an i-spy book with bullfinches and grebes is not on the agenda for many teenagers right now. Young people are growing to adulthood in a country that is different from the country that existed before the arrival of ubiquitous connection via smartphones and social media. Social media went big at the same point that austerity did. We lost our libraries, youth clubs and schools funding but we got smartphones and snapchat instead.”

And now they’re the generation in the midst of a mental health crisis.

Discussion of young people’s mental health often becomes a proxy discussion about the woes of society; a repository of our fears for the future. But young people aren’t living in the future, they’re doing their best to make their way in the now, the present. They’re making the best of the world as they find it and trying to find a way through it that works for them.

Today’s young people are living in an historical moment that has never happened before, as all young people have. The challenges faced by someone who is ten now are not the challenges faced by someone who is now in their mid twenties. Class, culture, ethnic heritage, national heritage, gender, sexuality, material circumstances interact with broader social changes, broader policy changes, broader political changes. Some challenges remain constant, some fluctuate and some are novel. Mental health and young people is an area where who a young person is meets what is happening to them meets social assumptions meets broader cultural narratives about what young people should be. Young people do not make the world they were born into.

The kids are alright. Except for the ones that aren’t

Yesterday saw the launch of Birmingham University’s Mental Health Policy Commission Report ‘Investing in a Resilient Generation’. Chaired by Liberal Democrat Paul Burstow, the report calls for huge investment to “systematically deploy evidence-informed practices and programmes that maximise resilience and minimise risk factors” and claims this would put halving the number of people living with life-long mental health within a generation “in our grasp.”

The recommendations focus on:

  • supporting parents mental health;
  • ensuring families have income, housing, access to services and employment;
  • schools that firmly put their pupils mental health on the agenda and which actively work to reduce adverse experiences;
  • community based approaches to reduce adverse childhood experiences such as abuse, victimisation, domestic violence or bullying;
  • and focus on supporting young people through transitions between schools and from school to work and encouraging employers to support the wellbeing of their workers.

The report also recommends the development of ‘one-stop shop’ style young people’s services codesigned with young people and a broader investment in making sure that the places young people live have a social infrastructure that reflects their needs.

There are three things that are notable about yesterday’s report.

Firstly, as a room full of health researchers, what you’ll notice is that the majority of what’s being suggested is intended to happen certainly outside of traditional NHS spaces and currently existing structures and most probably outside of the NHS entirely. It seems that the Libdems have learned something from the experience of working with conservatives in coalition. In quite a wiley move, the commission asked NHS Benchmarking to profile what the NHS workforce implications would be of scaling-up access to specialist treatment for all young people concluding that it would take 23,800 additional staff and would cost 1.77billion pounds. In other words, accept our recommendations because meeting the needs created by skimping is something you won’t want to pay.

The second thing that’s notable is that a lot of what is recommended would, if put into action benefit everyone, not just young people who have mental health difficulties. Make the world better, and then measure whether that reduces demand.

The third thing is the focus on local development and multiple agencies and actors. No steamrollering this through based on one model. It’s going to be developing complex new things in real places with real working parts and actual real people. Health is not what happens in health systems, it’s what happens outside of them.

According to the most recent Office for National Statistics Young People’s Wellbeing Stats (2017), between April 2015 and March 2016 73.7% of young people aged 20–24 rated their happiness as either high or very high. 78.5% of 16 to 24 year olds agreed. 8.6% of 20–24 year olds in the same year rated their personal happiness as low, 7.39 of 16–20 year olds stating the same. During the same period 18.4% of 16 to 19 year olds rated their anxiety yesterday as high, and 17.4% of 20–24 year olds expressed the same.

So, it would seem that, mostly, the kids are alright. Except for the ones that aren’t.

Young people want to be understood

I think the role for researchers in making sure all the kids have the best chance of being alright is a complex one. It’s inconceivable that there will ever be a time where young people do not need specialist services for the way their brain works or does not work. Not all mental health conditions are preventable and not all things that cause young people problems will be resolvable purely by improving overall wellbeing for the population as a whole. So in that sense, there will always be a role for traditional NHS focused health research.

Where I do think is there is changing and evolving role for research is in everything but CAMHS.

When we picture young people we draw upon the stereotypes we have based on the young people our structures can see. We can see kids at school. We can see young people at university. Everyone else, unless they fall into crime or they belong to a group society of the time really doesn’t like, like young black men or trans people, become shuffled into the general adult population. We see either the young people our systems and structures make us see or the young people the court of public opinion stands in judgement of. If research cannot see them, and politicians and policy makers want to denigrate or play to the gallery, the realities of young people’s lives are invisible to the process by which policy shapes the world. Young people tell me they want to be heard which means what they want is to matter to the people who make the decisions that shape their lives.

We don’t really know very much about young people and their lives as they are lived now. If the future is to be based more closely on meeting young people’s needs, then understanding the young people who have them becomes vital.

Design cannot be done from statistics, nor by committee. The two things that are needed are better ideas of what works — effective mechanisms — and better ideas of how those mechanisms might be built into things that are meaningful and accessible to young people. It is easy to carry over assumptions and for the realities of young people’s lives to become lost in a kind of fog of war where the moment a plan is embarked upon all becomes unclear until things are finished and the victor declared.

We’ve got your back

Research has a very particular role to play here. Research as a body of knowledge has something young people are less likely to have: perspective and depth. Research is the long game of knowledge. Young people have insight into what it is to be them and to be painfully, gloriously alive right now. Their knowledge of their world and their motivations is deep, but it doesn’t stretch into what came before them. The worst of all worlds is where ‘involving young people’ involves research guessing what they’re like and young people guessing at what solutions will work and neither doing the bit of the job to which they’re best suited..

Research, both in young people’s mental health and mental health more widely, needs to win the trust required to be able to say ‘we’ve got your back’; it’s you the end user that we’re working on behalf of here. Research is, ultimately, about trying to find what’s true and who it is true for. It’s about finding things out. We heard yesterday about thinking like a system but acting like an entrepreneur. Acting like an entrepreneur is very simply about spotting chances to generate value and taking them. Research can put flesh on the bones of ideas. Research can challenge and help shape. Research can help stop things happening.

At the moment our public discourse is awash with speculation about how the world affects young people. The world is also awash with ideas about what should help young people who are having problems.This is the stuff of politics, of assumption, of proxy wars about how young people should be, not how they are. ‘Doing it for our children’s futures’ has guided everything from the argument for Brexit to a third runway at Heathrow. But young people are living now, not in some distant future land of ambrosia and jam.

For research to really help young people’s mental health, the research community will have to get to know young people and be aware that it must constantly refresh that knowledge. Young people turn into older people and are replaced by new young people. Neither the world nor young people remain static. Research must tell us what has happened and must shape what happens next

In fact the only thing about young people that remains unchanging from generation to generation is the feeling that no one understands what you’re going through. And that’s what clever people like researchers do for a living: they understand things and help others to understand them.

Research, of course, must fight for funding and exists within structures and strictures. But if researchers truly wish to make the mental health of young people better it involves asking at the start of every working day ‘what does this mean for young people and what does it tell us needs to happen right now?’

And if you’re not, well, young people have every right to ask: what’s the point of you?

A gif of Amy from Doctor Who asking ‘Then what is the point of you?’

Mark Brown is @markoneinfour on twitter