“Why am I the only person going mad?”

This quote is from one of the young people who spoke at the recent ‘Shout out for Youth Mental Health’ dissemination event, which took place on 7 June 2016 at the Midlands Arts Centre (MAC) in Birmingham. The quote encapsulates the feelings of a young person experiencing mental health issues, afraid and confused by the overwhelming nature of what is happening to them and unsure about how, when and where to seek help.

Mental health problems during adolescence are unfortunately all too common. Half of all mental illness in adulthood has begun by the age of 14 and, if left untreated, can have serious consequences for a young person as they move into young adulthood[1]. Yet despite this evidence, a report produced from an independent Mental Health Taskforce for NHS in England in February 2016, The Five Year Forward View for Mental Health, highlighted the continued difficulties that young people face in accessing services and the consequential impact this can have on them and wider society.

“One in ten children aged 5-16 has a diagnosable problem such as conduct disorder (6 per cent), anxiety disorder (3 per cent), attention deficit hyperactivity disorder (ADHD) (2 per cent) or depression (2 per cent). Children from low income families are at highest risk, three times that of those from the highest. Those with conduct disorder - persistent, disobedient, disruptive and aggressive behaviour - are twice as likely to leave school without any qualifications, three times more likely to become a teenage parent, four times more likely to become dependent on drugs and 20 times more likely to end up in prison. Yet most children and young people get no support. Even for those that do the average wait for routine appointments for psychological therapy was 32 weeks in 2015/16. A small group need inpatient services but, owing to inequity in provision, they may be sent anywhere in the country, requiring their families to travel long distances.”[2]

This makes uncomfortable reading, which is why CLAHRC WM is trying to find effective ways of better dealing with youth mental health. It has been estimated that a quarter to a half of mental health problems could be prevented through the implementation of early intervention/prevention programmes in childhood and adolescence (‘…interventions occurring before onset of clinically diagnosed disorder’ – Institute of Medicine), and result in ‘positive social and economic consequences’, enabling young people to be supported in a timely manner and before crisis occurs.

Driven by their previous research conducted in CLAHRC BBC, which focused on improving the care pathways of young people with first-episode psychosis, the youth mental health theme in CLAHRC West Midlands have continued to undertake world-leading research. We have published several BITES reporting the findings: Designing youth mental health services for the 21st Century; What factors contribute to the Delay in Untreated Psychosis?; School mobility as a pathway to psychosis in young people; A ground-breaking early intervention service in Birmingham to offer mental health services for young people, 0-25 years; Don't Turn Your Back on the Symptoms of Psychosis.

Their research showed that the delay between the onset of a first episode of psychosis and receipt of treatment (Duration of Untreated Psychosis (DUP), for young people in Birmingham, was often caused by help-seeking delays, young people and their families uncertain about how, when and where to seek help. Most importantly, however, their findings revealed that it was the delays experienced within mental health services themselves, which prevented young people from accessing specialist care. Following these findings, the research team implemented a proof of principle experimental intervention to target and reduce these care pathway delays[3]. The intervention consisted of the introduction of a direct care pathway for 16-25 year olds, alongside a community psychosis awareness campaign. Evaluation of the intervention revealed that DUP was reduced from an average of 285 days to 104 days, with delays within mental health services and help-seeking also reduced, suggesting that such a targeted approach may be successful in improving the care pathways of young people with first-episode psychosis.

Our CLAHRC WM SuperBITE, ‘A ground-breaking early intervention service in Birmingham to offer mental health services for young people, 0-25 years’, describes how the youth mental health team’s research has influenced the transformation of youth mental health services in Birmingham. Consultations and collaborative working with young people, their families, mental health services, commissioners and the research team, highlighted how, despite the majority of mental health problems having their onset during adolescence, many begin in later adolescence and young adulthood. Existing care provision, however, with traditional cut-off at 18 years, have failed to meet these needs, often resulting in long care pathway delays and difficult transitions between child and adult services. This ground-breaking work has led to a re-structuring of youth mental health services in Birmingham, better designed to better suit the needs of young people. The new service, ‘Forward Thinking Birmingham’, was launched in April 2016. CLAHRC WM celebrated this achievement by ‘Shouting out’ about it on 7^th June.

‘Shout Out for Youth Mental Health’, was conceived by the youth mental health theme and ably supported by the NIHR young person’s steering group for the West Midlands, with the aim of bringing together an eclectic mix of young people, academics, researchers and commissioners and provide the opportunity to talk about the journey which led up to the launch of ‘Forward Thinking Birmingham’. In addition to a range of presentations from young people, clinicians, academics and the Rt Hon. Norman Lamb, youth mental health was celebrated with dance performances from Shenley Academy school in Weoley Castle and two specially commissioned poems, written and performed by Birmingham’s former young poet laureate (2007) Matt Windle.

The team also wanted to ensure that there were opportunities not only to reflect on achievements but also to consider the future of youth mental health services and the challenges that need to be faced. There were a range of breakout sessions throughout the day, giving attendees the chance to network and share ideas in a safe and open forum. A final ‘lockdown’ session, feeding back their thoughts on the day, sharing their wisdom, personal stories, hopes for the future and a Q & A with the audience, was delivered by the NIHR young person’s steering group, and proudly displayed the ‘Wall of Support for youth mental health’ signed by everyone who had attended the event during the day.

It was incredibly rewarding to hear how years of discussions, meetings, research and planning had finally been successfully translated into this innovative new youth mental health service. It was evident that ‘Forward Thinking Birmingham’ truly represents the vision of passionate young people, their families, researchers, commissioners and clinicians and is set to transform the face of youth mental health services in England. Diane Reeves, Chief Accountable Officer for South Birmingham Clinical Commissioning Group, and Denise McLellan, Managing Director of Forward Thinking Birmingham, described the background leading up to the new service design and how it was brought to life, and emphasised the flexibility of the new system and its early intervention approach which aims to respond to the mental health needs of young people in a youth friendly way. We also heard about the ’Pause’ service in the centre of Birmingham, Forward Thinking Birmingham’s non-stigmatising, youth friendly drop-in centre, which will ensure that young people with questions and concerns about mental health are able to seek help and access resources and support with no diagnosis and no appointment necessary. Following an inspirational talk from Rt Hon. Norman Lamb (West Midlands Mental Health Commissioning Group), several commissioners from across the West Midlands, and Prof Swaran Singh from University of Warwick and West Midlands Commission for Mental Health, attended a break out session to discuss the wider implications of youth mental health service transformation. We felt this opportunity was incredibly important as we are aware many commissioning groups are keen to transform their own youth mental health services in a similar way to Birmingham.

We cannot underestimate the importance of dissemination events such as ‘Shout Out for Youth Mental Health’ and how they are crucial in leading change. The seeds of Forward Thinking Birmingham were initially planted following a previous dissemination event in September 2013 where the CLAHRC WM youth mental health research was first presented. Forward Thinking Birmingham has now been launched and we regard this narrative as a prime example of how dissemination has played a fundamental role in the implementation and translation of applied research to improve outcomes for young people.

CLAHRC WM has been commissioned to evaluate the new service, and we will follow with interest its on-going development and its impact on the mental health of young people in Birmingham. But whilst we should be proud of our achievements and ‘shout out’ about the pioneering work done in the design, development and delivery of ‘Forward Thinking Birmingham’, we should also make sure that we continue to ‘shout out’ about the continuing challenges we face in the implementation and translation of applied health research.
Following this successful event we would like to build on the momentum and ‘shout out’ across all areas of the West Midlands, holding similar knowledge exchange events over the next 12 months. We would like to engage further with AHSN and commissioners/providers to develop these ideas.

Feeling inspired?

If you would like more information about how to get involved in the Youth Mental Health Theme, you would like discuss the organisation of a ‘Shout Out for Youth Mental Health’ event in your area, or if you have any ideas on how we can capitalise on the momentum of the event, please contact:

charlotte.connor@warwick.ac.uk
Sunita.channa@bsmhft.nhs.uk
M.T.Skrybant@bham.ac.uk

[1] Confident Communities, Brighter Futures. A framework for developing well-being. Department of Health, 2010.

[2] The Five Year Forward View for Mental Health. A report from the Independent Mental Health Taskforce to the NHS in England. The Mental Health Taskforce, February 2016.

[3] Connor C, Birchwood M, Freemantle N, Palmer C, Channa S, Barker C, Patterson P and Singh S. Don’t turn your back on the symptoms of psychosis: the results of a proof-ofprinciple, quasi-experimental intervention to reduce duration of untreated psychosis. BMC Psychiatry (2016) 16:127DOI 10.1186/s12888-016-0816-7

-- Magdalena Skrybant, PPIE Lead
-- Charlotte Connor, Senior Research Fellow