Shared Health is a small but mighty team, looking at communities and areas where health is impacted by poverty. With clinicians working in health and education, people with lived experience and passionate individuals from backgrounds of policy, strategy and business, we combine our skills and experiences to work out how best to improve health outcomes on the ground as well as at local and national policy level.
One of the themes we know has higher rates in areas of deprivation is poor mental health and self harm in young people. Prevention is always better than cure so if we could intervene at the earliest opportunity we could we help prevent complications and distress in the longer term.
We started by looking at research and strategies to support those who presented with self-harm specifically, but the more we learnt the more we realised self-harm was a symptom of something bigger, an element of emotional distress unique to an individual. Even more importantly, the people we met told us they were on a waiting list for specialist help. But that waiting list was a long time away, often longer than 6 months and in the meantime everyone was just waiting. And not really talking.
We started with looking at sessions that could be delivered in places that young people felt comfortable in, by people who they trusted and could provide continuity so they could continue to talk about what was bothering them; such as schools and youth centres.
This meant that the youth workers, teachers, school counsellors and support workers had to feel confident in what they were saying and doing. We used The Resilience Framework (Hart and Blincow, 2007) as a structure to stretch out from, and hopefully to help everyone see that mental health could be addressed using small and achievable blocks.
Our first resource looked at creative activities alongside conversations about wellbeing and resilience so that young people didn’t have to focus directly on talking about how they were feeling, but indirectly look at learning about emotional literacy; giving words to feelings and behaviours. This went down really well, but at our teaching sessions everyone asked ‘but how do I say the right thing?’ and ‘how do I know I won’t do any harm?’. This was in addition to our project leads (a Paediatrician and an A&E doctor) realising that many frontline healthcare staff were also scared of making things worse.
So we moved on to write a toolkit of tips and questions to help young people look at what was going on in their lives; from things that made them laugh, things they had going for them as well as some of the challenges that might need addressing plus coping strategies and tips for what they could do in the moment.
We wanted it to be something a professional could pick up quickly and remember how to focus on the individual as well as something that could be left on a table for a parent or young person to pick up themselves.
Our final resource was the addition of the journal as we wanted something that could weave it’s way between the other conversations so that processing emotions and thinking about mental wellbeing became a continuous interaction. This would create a way of communicating and looking at resilience over time, especially for those people who found talking in groups or directly to one person in a time of crisis more challenging.
For the doctors involved, it meant we could leave our patients with something to go home and think about while they waited for additional support. It wasn’t easy coming up with the right designs or wording and we know there definitely isn’t a one size fits all solution.
The Lemonade Project initially came from the phrase ‘if life gives you lemons, make lemonade’ as one of our first activities was squeezing lemons and thinking about ‘sour situations’. But we’re aware of restrictions to time, space and money so have tried to come up with low or no budget options too. We know for some of our cohorts language and groups and conversations do not come naturally so as our project grows we continue to look at different strategies for different groups. And we want lots of feedback on how to make it better too! Luckily our funders are passionate about the health of Greater Manchester so how it can reach everyone is still our target.
Since Covid-19 we had to consider how we could still get the message out, realising that school students were getting no face to face support and were struggling more than ever. Although Zoom sometimes has its technological challenges it is a great way of continuing to communicate. We have had to condense what is usually a half day training session with lots of time for interaction and flexibility into a straight through half hour session. One of the most important things is making sure that whoever is using the resources understands a little bit of the background to help them feel confident in having the skills to communicate. It’s delivered by our in-house paediatrician and covers mental health statistics and the current challenges with developing adolescent brains, the resilience framework and how to effectively use our resources.
We’re giving all our resources out for free to those working with young people in Greater Manchester, but we’ve had professionals as far as India logging onto our training!
We want the Lemonade project to grow so that anyone working with a young person feels equipped to have a conversation if they have a bad day and realises they don’t have to wait for a ‘specialist’. This includes nurses and doctors in hospitals who also sometimes wait for ‘the right person’ to be doing the talking.
We have already started a project looking at how we best support ‘angry boys’: those who express their emotional pain with methods that often mean they get reprimanded quickly for their behaviour and put in ‘isolation’ without often addressing what has triggered the action. Higher up the system we want to look at how we get fairer and easier access to mental health support for those living in deprivation or temporary living arrangements- the complexity of referrals and often computer based reasons for being removed from a waiting list means those who have the capabilities to fight and navigate the system often get the best care, and those who need it the most can be forgotten.
Words by Dr Sarah Cockman, Paediatrician in Greater Manchester
Published on August 19, 2020 at 11:18 am