Embodying the Zeitgeist. Introducing States of Mind as a new approach to youth mental health care through co-production.
There is a new spirit in the air. It is one that has been slowly emerging out of the challenges and changes of 2017 that carried with them a sense of collective fear, a questioning of what would emerge in the unknown future. It applies not only to conversations around mental health but to many aspects of society and social campaigning. New ways of working, new ways of thinking and new ways of speaking are emerging that aim to capture the authentic needs of people in their everyday life. Co-working spaces that facilitate communication and knowledge sharing, jargon less conversations within start-ups and government enquiries into how to better integrate the views of citizen and state. This new spirit is a mindset, a collective recognition that the outdated systems of the past do not hold a place in our future. That as a society, we must not only confront unhelpful or harmful ideas and behaviors but actively challenge them, together. There is a momentum and direction to this grassroots approach to social change and it is beginning to link individuals across the country, through a new value system that desires and demands that this time, we get things right. It seems that both individuals and organisations are beginning to look out, to connect and strengthen their value systems through mutual aid, collaboration and co-production. If we have the same mission, then we are part of the same tribe. The defining feature of this new approach is the recognition that in the creation of a better society, those who use services and infrastructures of support should have a voice in their development and growth. The Government, companies and services will never truly be experts if they don’t listen to the voices of those they serve.
This new paradigm is particularly interesting in terms of the developments that are happening as a result of the conceptual and practical debates regarding the future of mental health care and in particular, the way in which we will move forward. This process is unfolding in a two way process, top-down and bottom up, bringing a new way of thinking about these experiences that we have not yet seen before. Perhaps one of the most inspiring and innovative (in the best sense of the word) grassroots systems that conveys this is the Hearing Voices Network. Now a worldwide movement, the Hearing Voices Network is a supportive new framework for individuals who hear voices or ‘auditory hallucinations’ viewing them not as a mental illness, but as ‘a meaningful and understandable, although unusual, human variation’. Turning the ideology of the psychiatric system on its head, the HVN has shown that by ‘looking out’ to the social and psychological nature of adversity, these experiences can be understood and responded to in a different, more human way. Since the formation of this community based support system, thousands of individuals have been brought out of isolation into a shared understanding of what these experiences may mean and has provided people, often viewed as the most different, into a new space where their experiences are part of a wide ranging spectrum of human experience; experiences that can be explored without fear but with curiosity and compassion. The results have been inspiring: reducing admissions to hospital wards and propelling knowledge around non-medical ways to respond to distressing experiences. It has created a system of communal support that moves away from isolation and difference into connection and growth.
This example of how ‘extreme’ distress can be reworked and understood into a new framework is interesting to consider when thinking about the next generation and the renewed focus on young people’s mental health. Last week, a panel was held to discuss the release of the Government’s Green Paper on mental health provision for children and young people. Acknowledging the lack of support that is available for young people to understand and respond to deviations from mental wellness, this paper sets out plans for an unprecedented focus on improving service provision across the country. In a display of top down co-production, Individuals from Government, public services and research committes held a panel discussion around how this would be achieved. The most obvious thought that came to mind was, in this panel discussing the co-working of different systems to support young people.. where were the young people themselves? If this system is to support the next generation, why are all of these individuals, shaping public policy, over 50?
If, like the Hearing Voices Network, we are to move forward with systems that can create meaning from adversity, the voices of those who the systems serve must be central to the design and implementation of those systems themselves. Yes, there must be an integration of the experience and evidenced based wisdom of professionals with these ideas but the views and expertise of young people themselves must provide the colour to the emerging landscape of solutions. States of Mind was formed from the recognition that there was an obvious and unfortunate lack of infrastructure that allowed young people’s views and experiences of mental distress to be captured, to be thought about and to be responded to. By placing young people at the center of the design process for States Of Mind, it allowed a protective shield to the organization itself. If their voices were shaping the process, it means that there was less space for error further down the line when the model was brought forward, to other young people. It was this focus on language and context that had been missing from other systems and which, since the development of the model, has only attracted young people to the system itself. There were key themes that emerged, simple truths that had not been heard before which began to weave a picture that had not been taken into account.
In a society that has for so long focused on the language of disorder, young people were rejecting the idea of being identified by their distress and wanted a new way of exploring these experiences that instead of differentiating them, connected them. In a system that so often spoke of extreme cases, they wanted to know about the everyday nature of psychological and emotional distress. In a system that focused on symptoms, young people were desperate to know the causes. Instead of a model that focused on the problem of the individual, young people were concerned with their friends and family, the networks around them and how they could support others. They were not so concerned with the ‘what’ but were craving to understand the ‘why’.
It is this insight that co-production supports. It is a process that unties the blindfold that the power structures of the medical model have unfortunately created. A phenomenological gap filler. Young people, more than ever recognize that mental health represents a reflection on human experience and that because of this, there must be a choice in how we speak about and respond to these experiences in our lives. There must also be a choice of different avenues of support in respect for the diverse range of individual traits and preferences.
As States Of Mind begins its journey to create a relevant and useful system for the next generation, this respect for the process of co-production means that it cannot stand alone. Two projects are underway in 2018 that will work alongside individuals, organisations and teams to feed into the model of early intervention. It is a co-production pilot that will investigate the impact of bringing together the voices of young people with the experience of different fields of psychology. It is a model that starts with young people and is supported by those who want to help them. Co-production is an intuitive process that allows a bridge between citizen and state and perhaps most importantly, shifts the role of the young person from a passive recipient into an active shaper of their future world. Co-production allows adaptation, iterative learning and stimulates critical thinking in the minds of all engaged in the process. It ‘looks out’ to integrate perspectives by placing an inherent value on autonomy and difference.
Perhaps the reason we have not yet embraced the process of co-production is because it invites an inherent sense of the unknown. It involves a letting go of fixed structures of thought and demands a more open, constantly changing process of trial, error and discovery. For many suffering from the weight of emotional and psychological distress and for those who seek to address it, the idea of embracing the unknown is difficult. However, after two years of engaging with a process of co-productive reflection through psychotherapy, my most valuable insight was that so much of my own distress was a result of trying to take control, often through perpetual rumination, of the unknown. My anxiety was in many ways a desperate attempt to control and pin down something that couldn’t be, the unpredictable nature of the world around me. Nobody can change the fact that the future is and always will be an unknown landscape. The only thing we can do is work together, support each other and learn from each other as we navigate it. Co-production, in whatever form it takes, facilitates knowledge, strength and hope through the most fundamental aspect of our lives as human beings; connection with those around us. The question that needs to be explored is how will these top down and bottom up approaches meet to create something that brings power to the individual and allows the state to employ approaches created by citizens, instead of casting rigid structures that restrain individual freedom.