The Membership Team Off the Record in Bristol works with young people to support their mental health and wellbeing through co-produced activities and access to peer support, psychosocial groups, wellbeing projects and one-to-one support. Here they tell us about their approach to 'good help'.
OTR is focused on the mental health and wellbeing of children and young people aged 11-25. Our approach is more like a social movement than a typical mental health service. Membership (rather than ‘usership’) is built around a call-to-action; we believe young people must take back ownership of their mental health and wellbeing from health services. We believe prevention is better than cure and so our approach concentrates on peer and self-help/care even among members experiencing significant mental health difficulties. Everything we do is also co-produced and delivered by young people.
Membership means access to a diverse range of psychosocial groups, wellbeing projects, collaborations and one-to-one support and young people can use these however works best for them. Our organisational culture and approach mirror one another. We value self-directed help and peer support, purposeful activity, social action as self-care, relational and solution focused conversations, inclusion (bespoke responses) and transparency (around data, boundaries, expectations, and confidentiality).
Rather than prescribed sessions, the team now run drop-in days called ‘Hubs’, allowing young people to access a range of services at different times that suit them. The staffing team includes social workers, an occupational therapist and a social outreach worker working alongside lots of young people supporting each other.
Over 40 young people have completed ‘Peer Navigator’ training - peer navigators are an integral part of the OTR Hub and are often the first point of contact for young people reaching out for support. They have strength-based conversations with young people, supporting them to make informed choices, access and build on their resources; developing self-care plans and steps in making decisions about how they plan to care for their own mental health. It is hoped that this training will enable them to implement ‘good help’ practices into their daily lives, being advocates for open conversations around mental health.
We are learning that the way we do and offer ‘help’ in our Membership Team has all kinds of impact, some of it predictable, some of it completely unanticipated. The predictable stuff we can track and evidence are important outcomes like, improved confidence and self-esteem, self-efficacy, agency and self-care. Since our focus is on capabilities and participation, we see increased participation in purposeful social activity - getting young people ‘doing things’ - is also where we achieve significant impact.
The unanticipated impact is a result of the Membership Team’s approach, which has become an unexpected kind of intervention itself. Instead of functioning as the ‘front-door’ to the wider offer of OTR projects and support behind it, the Membership Team has created an environment and culture of practice that - as the very definition of ‘good help’ - seems to be the preferred option for a number of young people. There is a regular and growing number who get their mental health needs met by this team. This group are doing something exciting but unanticipated - they are using the space we host to connect with and support one another, share experiences and build peer relationships that are protective, therapeutic, and sustaining. In the last year, nine individuals have begun volunteering here, including as peer navigators (a trained young person aged 16-25 able to have helpful conversations in the Hub).
A second example of unanticipated impact is the growing number of parents dropping in to the Membership Team. The conversations with peer navigators has led to the creation of a new parent network - a peer group run by trained parents. We provide the space and offer some resources, insights and ideas to the group, and of course we signpost new parents to it but the network is owned and run by parents themselves.
High dropout rates were attributed to young people expecting to be told what to do, in order to ‘fix’ themselves - an unrealistic and ultimately unwanted and unhelpful dynamic. It also meant that those who were already hard to reach didn’t feel engaged. We also saw a massive rise in the need for support but we were never able to to supply enough ‘help’ to meet the growing demand. We recognised the one-to-one transactional model of care that was being offered was part of the problem, and that the sequential process of referral-assessment-triage-treatment-discharge was no longer fit for our purpose, if it ever was. The team realised they needed solutions and expectations to be broader. They believed that young people were best placed to decide what treatment methods would be effective for them.
Working in this way has not been without its challenges and our greatest challenge has come from changing the mindset and culture of our working practices both internally and in the systems around us that like to ‘refer’ young people. Communicating and enacting our approach demands behaviour change - including from young people - which is generally hard work! However, our greatest enablers, unsurprisingly, have been those young people who have grabbed the idea and run with it.