P wegot99 casestudies

PROJECT 99: CASE STUDIES STORIES AND INSIGHTS GATHERED THROUGH INTERVIEWS CARRIED OUT WITH SELECTED YOUNG PEOPLE. ALL INTERVIEWS HAVE BEEN ANONYMISED.

SNOOK

OUR APPROACH TO SHARING THE PROJECT 99 REPORT MATERIALS: Open Access, Some Rights Reserved The outputs of the Project 99 exploration of internet-based approaches to support youth mental health have emerged through a coproduction approach, involving Greater Glasgow and Clyde NHS (GGCNHS) as commissioning body, a three agency consortium (consisting of Mental Health Foundation, Snook and Young Scot) and young people, all supported by a multi-agency steering group. In turn, this project is an agreed action within the Board’s Strategic Framework for Child and Youth Mental Health Improvement, ratified by the Child and Maternal Health Strategy Group in June 2012.

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GGCNHS gratefully acknowledges the work of Creative Commons in inspiring our approach to copyright for this report. To find out more go to www. creativecommons.org Potential for Future Development and Collaboration GGCNHS and its local community planning partners will now be actively considering all the material and recommendations contained in this work with a view to formulating a response and a forward development programme, as part of the wider body of work to improve child and youth mental health in Greater Glasgow and Clyde.

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2.1 CASE STUDY: GREIG, 19 Digital Life Greig is a young carer living with his family in Govan. His mother lives with mental health problems and he and his younger brother are both on the autistic spectrum. He also has severe dyslexia. Greig often has to share access to the internet with the rest of his family.

Greig has a mobile phone, but it is not a smartphone. Due to his severe dyslexia he chooses to phone rather than text, unless he is able to reply with a one or two word answer.

Therefore if someone texts him, by and large he will phone them back.

rarely posts things himself. If sent a message he will reply as soon as possible - he hates “ignoring people” - but he is unlikely to instigate many conversations. He also spends a lot of time playing facebook based games.

He is able to access the internet through the shared family desktop computer at home, and through a laptop he shares with his brother.

This often causes arguments as to who gets to use the internet and for how long, and denies Greig privacy and autonomy in his use.

Aside from this, he uses internet for research for his college work. Due to his dyslexia he will avoid websites with large amounts of text and options, and those with complex layouts. For this reason he never reads blogs; video is his preferred medium for obtaining information.

He has his own Xbox and is able to access YouTube via Xbox Live (which allows Xbox users some internet access and social networking). His YouTube use is heavy, with sessions lasting hours. It is common for him to be watching videos on YouTube all evening from 5pm until 1am.

YouTube is the site he uses the most by far. Aside from Youtube, Facebook and online games are central to Greig’s internet use. His use of Facebook is passive; he likes to scroll through what his friends post and keep up with news from the pages he follows. He very

Greig makes very little use of digital and social media in the direct management of his mental wellbeing. In the past he has attempted to search for information on Asperger’s Syndrome and his mother’s condition. However, he found very little that was of much use to him as someone managing his own condition on a daily basis, and even less that was in a form that was easy for him to digest. He does receive email updates from a few support groups that he has been signed up to by his college, but most he treats as spam.

“MY BROTHERS SAY I SPEND WAY TOO MUCH TIME ON YOUTUBE AND IT CAUSES ARGUMENTS SOMETIMES. I DON’T THINK I DO! WELL, I MEAN ... ITS NOT LIKE I HAVE ANYTHING BETTER TO DO.”

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2.1 CASE STUDY: GREIG, 19 Mental Wellbeing Greig lives with Asperger’s Syndrome, but was not diagnosed until high school. He had experienced an extreme trauma as a young child; his behaviour was attributed to this and the Asperger’s was masked. His mother also lived with mental health difficulties which - according to Greig - led her to “dramatise and exaggerate” his symptoms.

Primary School was extremely difficult. There was no awareness or support for either his or his mother’s condition. He became extremely frustrated and disruptive as a result. He found it difficult to make friends.

Photo by George Redgrave under a Creative Commons License

At High School things improved slightly following accurate diagnosis.

The school were also aware of his mother’s condition. However, they did not have adequate support measures in place for him. Learning was very difficult compounded by his severe dyslexia. He continued to have angry outbursts. This was made far worse by the fact that he was being bullied by many of his classmates; in the face of the bullying he began to strike out. The

school punished Greig rather than his bullies.

He was told to stay home if he woke up in a dark mood, knowing that this would make him more likely to have an outburst. This solution was both a relief and a frustration for Greig. He was eventually provided with a learning support teacher, but only during home economics class, as a precaution to ensure he wouldn’t become angry whilst using kitchen implements.

In the end he left mainstream education to attend a school specialising in support for people with autism. The teaching better suited his style of learning - he was taught largely through the use of puzzles, games and quizzes - and helped greatly by the designated ‘chill out’ room. However, he still felt slightly out of place, feeling that he was probably one of the most intelligent students and a little held back.

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2.1 CASE STUDY: GREIG, 19 “THE KIDS AT CHURCH SAY I KEEP THEM HAPPY, BUT IT’S THE OTHER WAY ROUND.”

As Greig receives a lot of support in his own life, it is vital for his wellbeing that he is able to help others in return. However, it is also important that he does so in a supported environment, to ensure that he doesn’t take on other’s burdens as his own and to manage any ill effects he experiences from hearing other’s problems.

He is now in college and continues to receive learning support, but finally feels more in control of the management of his condition and home situation.

He attributes this improvement to the support he has received from a Young Carers group and from his Church. He joined the Young Carers support group when he was 13 and attends weekly group sessions there. He is able to contact the support workers at any time; whilst they might not be able to meet him immediately, they will always make an appointment to see him straight away. The head support worker texts or calls Greig at intervals to see how he is getting on, without prompting from him.

community there. Perhaps the most important aspect of his church going is his voluntary work as a youth group leader. He often supports the young people with their problems, and recognises that this ability to help others in return is vital to his own sense of wellbeing.

He describes the Young Carers group as family, and even though his peers at the group “drive him mad sometimes” their friendship and community is extremely important.

He is the longest standing member and enjoys a kind of senior status.

He also attends Church twice weekly and volunteers as a youth worker there. He feels able to relax and be truly himself at Church and enjoys the kind, caring nature of the

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2.1.1 CASE STUDY INSIGHTS: DIGITAL LIFE - LEARNINGS FROM GREIG. Private internet access

Video

“We’ve just got a family computer ... it causes arguments ... who gets to go on when, and how long I’ve been on it for!”

Video is an inclusive and engaging medium for information dissemination. In our engagement sessions, YouTube (alongside Facebook) was found to be the most popular social media site.

Not all young people possess a personal device with which to connect to the internet; they may be sharing access with parents, siblings, classmates. This affects the autonomy and privacy of their internet use, impacting upon what they search for and interact with on the internet, and how long they do so for.

Text messaging Despite the social media revolution, text messaging or now BBM (Blackberry’s instant messaging service) seems to remain a key part of direct, one on one communication for young people.

Gaming

“The games are what I like best about Facebook ... sometimes I’m on there for up to a few hours at a time.”

Increasingly, young people (particularly young men) are accessing the internet through games consoles and some games include social media elements. Many young people spend very long hours gaming and it could prove a useful means by which to access socially isolated individuals.

Continuous social media use

Social media and news

“My brothers say I spend way too mcuh on YouTube and it causes arguments sometimes. I don’t think I do! Well, I mean ... its not like I have anything better to do!”

“I like that I get to know whats happening [on Facebook]”

The excessive amount of time Greig spends online in the evening was found to be common amongst the young people taking part in our sessions. Whilst they may not be actively trawling the internet, they may be checking Facebook and other such sites every few minutes for this duration. Many echoed his contradictory stance; initially denying an excessive use of social media sites, but afterwards seeming to show vague feelings of guilt or regret for the amount of time spent, and to see that time as wasted.

Social media sites seem to be young people’s main source for news; be that about friends and family or current affairs on a larger scale.

See page 96 for a further evidenced discussion on the importance of media literacy.

See page 101 for a further evidenced discussion of gaming.

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2.1.1 CASE STUDY INSIGHTS: DIGITAL LIFE - LEARNINGS FROM GREIG. Passive vs active users

“I do post things on Facebook sometimes, but its mainly to reply to things that other people have posted. I reply more than I post.”

Young people talk about social media use as falling into two camps, with users being described as either ‘a talker or a stalker’.

‘Talkers’ are active users, who generate and disseminate a lot of content. ‘Stalkers’ are passive users, consuming content created by the ‘talkers’. Individuals fit the catergories to varying extent and may shift between them depending on various factors.

Information Overload Young people are constantly subject to information overload; competition for their attention is fierce. Fast judgements will be made as to the interest of any information. Certain content and trends will stand out from the noise and “go viral” amongst young people, rapidly being disseminated through the sharing of links. What kind of information this will be is quite unpredictable and the factors for this require further examination.

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2.1.2 CASE STUDY INSIGHTS: MENTAL WELLBEING - LEARNINGS FROM GREIG. Negative framing of mental health

“My mum’s got mental health ... ”

When describing his mother’s situation, Greig says: “she’s got mental health” - meaning that she is mentally ‘unhealthy’. This was a common turn of phrase and mentality at our engagement sessions; mental health is by default viewed in the negative and as something that is only relevant when you are unwell.

Bullying and mental health

Diagnosis

Expertise amongst young people

Bullying and mental health problems seem to go hand in hand for Greig and the young people at our sessions. Bullying was almost classed as a mental health problem in its own right, rather than a cause of difficulties.

Having a concrete diagnosis can be regarded by young people as a critical point of change in the young person’s mindset and in the way in which they will seek and gain support. The effect of a diagnosis may not always be clearly positive or negative, but can cause a shift in experience and framing.

Greig has made himself something of an expert on mental health, helping him contextualise his situation. He has taken various courses on the subject and demonstrated impressive and extensive knowledge and interest.

This was also the case of a few young carers we spoke to during our engagement sessions.

Mediation through parents Inconsistent support in schools “It took the doctors a while to figure out there was something wrong with me ... because my mum’s got mental health as well, the way that she would tell them would be ... dramatised.”

A young person’s interaction with a GP or other medical professionals is often mediated via a parent. This will more than likely alter/restrict the information the young person is willing to share.

See the ‘Doc Ready’ example on pg 17 of the mapping document in the appendices.

“Apparently my brother is getting better support than I did in mainstream school now ... that’s only because they’ve got a different headteacher.”

The availability and quality of support for mental health issues is not consistent across schools. It will often depend on individual teachers and workers and the priorities of the heads of school.

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2.1.2 CASE STUDY INSIGHTS: MENTAL WELLBEING - LEARNINGS FROM GREIG. Value of support groups

“... I’ve been coming here [to GAMH] longer than most of the workers! I like that they are there to give you the support when you need it. They can’t always give it to you straight away, but they give it when they can.”

Greig and all the young carers we spoke to found the Young Carer support groups extremely important to their well being. The success can perhaps be attributed to these factors: • Able to contact a careworker at all times via phone, text or email and receive a quick response.

• The onus of taking the step to ask for help is removed, as the support workers will call or text to check up at intervals.

See page 108 for further evidenced discussion of these points.

for vital peer support. Importantly, this support is within a controlled environment, managed by care workers.

• Mixture of workers: some just a bit older and trained (who become older brother/sister figures) and the ‘mother figure’ that is the lead care worker.

Helper Theory

“The kids at church say I keep them happy but its the other way round.”

For those receiving a lot of support, being able to help others in return is important for their wellbeing. It creates a sense of balance, helps prevent the young person from becoming a passive ‘victim’ and allows them to actualise (and better understand through sharing) some of the advice they have received themselves.

The third space

“I’ve got my church ... to keep me going. I go twice a week and I’m a leader at the youth group as well.”

Having a ‘third social space’, a space of shared interest, with friends and peers other than those from the ‘first space’ that is home and the ‘second space’ of school or college, is important for wellbeing.

The third social space helps a young person to define who they are and to meet other people who have also chosen that particular space.

See The Mental Health Foundation’s work on the ‘Third Space’ for a further discussion.

• Encouraged to attend meet ups at the centre with other young carers

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2.2 CASE STUDY: JENNY, 24 Digital Life

“I LIKE TO UPLOAD AN IMAGE OF SOMETHING THAT’S MADE ME SMILE, SOMETHING TO BE GRATEFUL FOR, EVERYDAY. IT SOUNDS CHEESY BUT IT KEEPS ME GOING.”

Jenny has been in the mental health system since the age of 14. In the past she has been seriously ill.

She became anorexic, leading to psychosis and suicide attempts.

She has been hospitalised on several occassions.

She is now on stable ground and feeling healthy. She works full time in the third sector; she uses her lived experiences, and recounts her personal story in a professional context.

She lives with her parents, and they provide her with great support, helping her to self manage and to keep relapse at bay.

Jenny accesses the internet through her smart phone and personal laptop. She mainly uses her laptop for work purposes, so prefers to use her smart phone in the evening for ‘leisure’ web use. She is constantly connected to Twitter and Facebook through her phone and feels dependent on it, becoming anxious if she ever forgets it.

Jenny uses social media very actively, generating a lot of content.

Her use when she was ill is very different from now. Currently, aside from her professional engagement with social media at work - she has to keep a Facebook page and Twitter stream updated and uses Youtube as a research tool - she describes her main use as uploading comical videos of pets and recounting humerous details of her day .

Being conscious of using digital media positively has been a part of Jenny’s recovery. She makes a point of uploading a positive image everyday. She uses apps to aid her sleep and relaxation, although says that when having a bad day she does begin to use a calorie counting

app. She is able to self regulate, however, always deleting the app when she feels stronger. She keeps an open blog, making sure to keep it as a positive account of the successful management of her mental health problems (although rarely writes on it.)

When ill she would use online journals and blogs obsessively to track her weight, food consumption, exercise and negative “rants”. The frequency of use increased when she got her own laptop and no longer needed to use the family computer. She developed a cycle of creating private blogs, then giving out the password, but later deleting the blog after deciding she didn’t want it read. The longest she kept a blog was two years, and described eventually deleting it as cathartic.

She would also look up readliy available ‘thinsperation’ videos and set exercise reminders on her phone. She would use forums, seeking vital support from fellow sufferers. However, it was easy to become trapped in a competitive negative spiral; “people were trying to get iller than each other”.

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2.2 CASE STUDY: JENNY, 24 Mental Wellbeing Jenny became seriously unwell when she was 14. She had begun to self harm and develop suicidal thoughts.

At school she would frequently break into hysterical sobbing during lessons. Her behaviour was deemed ‘disruptive’ and as a result she was intially sent to the Behavioural Support Unit (which was commonly known as the ‘Bad Boys Unit’).

Although it was a relief for her to be taken out of mainstream lessons, she found it understandably difficult in the ‘Bad Boys Unit’ and began working from home. Her parents stayed at home to care for her and took her to see a GP; initially she was diagnosed with anxiety, prescribed medication and told to eat healthily.

The support she received from school at the time was mixed.

A few teachers were extremely understanding, even offering outside tutoring. Others were less supportive, and she felt as she had been written off. This, however, only made her more determined to gain highers and go to University.

She would have to attend many meetings with the heads of school and an educational psychologist,

who insisted that she must be being bullied, despite this not currently being the case.

Her condition was not improving , and very soon she was referred to CAMHS. She received CBT and for a while her eating disorder went unnoticed due to her deliberate wearing of baggy clothes. When it was recognised, she began seeing a dietician in addition to the head psychiatrist. However, these sessions didn’t feel very helpful. She already felt she knew a lot about food and how she should be eating; having the desire to apply this was the problem.

externalise elements. Her parents also appreciated meetings with the pyschiatrist, as it helped them to understand what was going on.

However, there were some major problems in Jenny’s eyes. Despite getting on very well with the head psychiatrist, she felt he “knew a lot about illness, but just didn’t understand teenage girls.” The main issue, however, was the disconnect between CAMHS and the wider services Jenny was using.

Jenny stayed with CAMHS until she was 20, and had mixed experiences.

In her words: “Well, do you know what, it kept me alive. So I can’t say it was totally unhelpful ... its difficult to know what could have been done differently.” She found practical input most valuable; being helped to make a list of things to do that would help her get back to some kind of normality - building up to leaving the house etc - made recovery seem like a practical process and to help her

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2.2 CASE STUDY: JENNY, 24 Whilst within CAMHS, Jenny was also visiting her GP frequently and at some points was admitted to different hospitals. The services, however, didn’t talk effectively to one another; neither would know entirely what care medication she had received. Jenny’s GP was unaware that she had been discharged from hospital. The onus was on her parents to act as connections between the different services.

Once she left CAMHS, Jenny was supported by adult care. Her first visit to hospital felt especially difficult after this transition. At this point, her stays in hospital were long, and she would be sent to different hospitals each time. This felt difficult when the hospitals were located far from home.* During her lengthy hospital stays, Jenny found it impossible to keep in touch with friends, but her parents would visit every night. Sadly, this often triggered feelings of guilt as other patients were not receiving the same kind of parental support.

These other patients became close friends - a makeshift “family” - and Jenny found their support invaluable at the time. However, she is unsure

now whether her lengthy stay in a specialist eating disorder unit in particular was beneficial in the long run; being surrounded by others with eating disorders for her created a sense of a negative spiral. Being discharged from these hospital visits always felt stressful and unsupported in that she would need to wait a week before seeing a psychiatrist: “well, ok, what do I do for that week?”

Jenny described her illness as coming in phases. When at University, despite being quite physically unwell, her enjoyment of University life kept her going.

Once leaving, the uncertainty made her illness more difficult to deal with emotionally for a period.

However, her hospital visits began to get shorter, and finally were unnecessary as she became able to self manage effectively. She feels that her involvement in youth volunteer projects has been a large part of her recovery. They gave her a sense of confidence, purpose, and worth. This lead on to her securing a full time job in the mental health sector. This feeling of being able to use her experiences to help others has been invaluable.

“YOU’RE TREATING ILLNESS, BUT THERE IS A WHOLE PERSON ATTACHED TO THAT.” Jenny feels that “whole person support” was missing from the care she was given by NHS services. She feels she should have been encouraged and aided to have a more active social life; instead she was told to conserve her energy. Now she feels that it is “all the non-medical things” keeping her healthy; her job, volunteering, properly structured exercise, massage and new friends.

*There were also disadvantages of being sent to the same hospital on consecutive visits. A few members of the nursing staff who recognised her when she returned for a short stay, made her feel - through throwaway remarks - that she would be in and of of the hospital on a permanent basis, doing little to inspire hope of recovery.

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2.2.1 CASE STUDY INSIGHTS: DIGITAL LIFE - LEARNINGS FROM JENNY. Digital media ‘withdrawal’

Management of social media use

Blogging and online diaries

“I walked to the shop the other day without my phone. To start with I was like “Oh no, I forgot my phone.” But then it was actually so nice to go for a walk without my phone, when I stopped worrying about it ...”

“There was a lot of upsetting stuff online recently by this feminist - I can’t remember her name - talking about rape and violence towards women. I actually had to mute the hashtag because I was like “I just don’t want to see this on my stream just now. I was talking to a few people who did the same.”

“I had a blog I used everyday for two years ... but eventually I got rid of it because it was quite negative. Then I started another blog, but I mistakenly gave some people the password and realised I didn’t want them to read it, so I deleted that one too. ”

Some young people check their social media accounts and phones with such regularity that they experience withdrawal like symptoms and mild anxiety when they become unable to do so, even for very short periods of time.

The conscious and positive management of online behaviour is arguably as important as that of offline behaviour in relation to a young person’s mental health.

Most young people are able to self regulate effectively. However, self regulation becomes more difficult and unlikely for vulnerable young people. Some tools - trigger filters, for example - already exist on social media sites to aid self management.

See page 109 for a further evidenced discussion of perspectives on risk and vulnerability.

The keeping of diaries is not a behaviour restricted to the online world. However, the key difference in keeping an online journal or blog is that it is very rarely done in isolation from other users, and can be made entirely public in the click of a button. Even private blogs are likely to be hosted on a platform shared by countless other users, many of whom will be posting publically. This can have positive consequences for vulnerable young people using blogs, fostering a feeling of support if they read the posts of others in similar positions. However, these blogging ‘communities’ can be negative in nature; there are a many proanorexia and pro-self harm blogs in

existence, for example. There is also the possibility of attracting abuse and misplaced advice.

There are also concerns that the level of digital literacy may not be high enough in many young people to enable an understanding of appropriate levels of identity sharing.

See page 109 for a further evidenced discussion of perspectives on risk and vulnerability.

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2.2.1 CASE STUDY INSIGHTS: DIGITAL LIFE - LEARNINGS FROM JENNY. Private internet access

Readily available negative content

Benefits and risks of forums

“I used Livejournal when I first got ill to track my weight going down and stuff, but I didn’t have it for long ... those were the days when you only had a shared family computer, so ...”

“The targeted ads on Facebook I find quite difficult ... I get a lot of the ‘Lose Two Stone In A Week’ type adverts ... sometimes I’m like, ‘Oh if they’re sending me this I must need to lose weight.’”

“You can think you’re doing everything right, everything positive ... BEAT is a good example, they’ve got their forums, you can’t mention numbers, you can’t mention food, all these things ruled out, but you can still see that people are competing, and thats just part of the illness ... You just see people trying to get iller than each other, and I think that will happen everywhere, in terms of eating disorders .... and same with self harm, I would say.”

In a development of the insight discussed following Greig’s case study, we see that negative effects can arise due to the recent proliferation of personal internet access amongst young people through smart phone and laptop ownership. The fact that young people are able to access the internet anytime and in their own personal space - away from a shared computer at home or school - allows negative online behaviours to go largely unchecked. The very knowledge that this is the case - that they are not being watchedcan lower a young person’s threshold of self regulation.

Content which is potentially damaging to a young person’s mental health is readliy available online. It is easy for a young person to find and access without constraint. Young people may also be exposed at some point to negative content that they haven’t purposefully looked for. This could be via posts left on Facebook streams by other young people, via links seemingly incongruous made through other unrelated content, or through viruses. Even the targeted advertisments on Facebook and other social media sites can prove damaging to vulnerable young people in certain circumstances.

Forums can provide important means of support for young people with mental health problems. The anonymity they afford means that many young people feel free to express thoughts and ask questions in a way that they may be unable to do with family and friends, due to various emotional barriers.

Reading the comments of those in similar positions also allows them to contextualise their on situation and to feel less isolated, more understood. Some forum users can also provide invaluable positive advice. However, there are risks that are quite difficult to fully mitigate. Whilst the majority of users are very well intentioned, creating communities of vulnerable people can have negative effects.

Advice may be misplaced and even potentially damaging. Users may become overly dependent on and comfortable within the community, which could prolong recovery in some cases.

See page 106 for further discussion.

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2.2.1 CASE STUDY INSIGHTS: DIGITAL LIFE - LEARNINGS FROM JENNY. Facebook vs Twitter: use distinctions

“Self harm and suicide ‘threats’ seem more common on Twitter than on Facebook ... perhaps its not because there isn’t stuff on Facebook, just that you have to be friends with people to see it ... where as on Twitter it is easier to access this kind of stuff, it just involves searching a certain hashtag.”

In Jenny’s experience, self harm and suicide ‘threats’ seem far more prevalent on Twitter than on Facebook. She reflects that this may not in fact be the case; there may be a similar amount of such content on Facebook, but you are less likely to come across it due to the fact that you would have to be friends with the people posting such material in order to see it. The nature of Twitter means that you are able to see any such posted content via a simple hashtag search, and may even come across material accidentally.

Jenny’s and other’s use of Twitter that may mean that such material is in fact more prevelant. Young people’s Facebook networks contain close friends and, increasingly in the past couple of years, older family members. As we have seen for the preference for anonymous forum and blog use, many vulnerable young people are unlikely - or feel unable to - share deeply personal and negative thoughts related to their mental health in such company. Twitter networks tend to be wider, often made up of complete strangers or more distant social associates. Jenny speculated on this herself.

However, there are distinctions in

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2.2.2 CASE STUDY INSIGHTS: MENTAL WELLBEING - LEARNINGS FROM JENNY. Negative framing in schools

Support for parents

“I got sent to the ‘Bad Boys Unit’ ... for being disruptive ... I didn’t mean to be disruptive in class, but I guess that someone in hysterical tears in the corner is disruptive.”

“I can only imagine what is must have been like for my mum and dad, when they were the only people trying to keep an eye on me, trying to keep me safe”

A positive, practical approach is needed when addressing all disclosure of distress in schools.

This enables and discouages earlier help seeking and helps frame response to serious incidents.

Young people suffering from mental health problems should not be made to feel that they are receiving punishment as a consequence.

This positive framing needs to be comprehensive and reflected in every step of procedures. Naming a unit ‘Behavioural Support Unit’, for example, is not enough if it is not seen in this way by the school pupils.

Supporting a young person through mental illness can place an great emotional strain on parents and the wider family. The strain can be practical and financial too, especially if time off work is required to care for their child.

Whilst it is important that the young person at the centre needs to take ownership of their own self management if they are to make a long term recovery, intense care giving from parents may be required for prolonged periods of time. The parents themselves may well need support to do this.

Practical steps

Disconnect within NHS services

Young people may gain benefit from being helped to view recovery in small practical increments. Being able to take tangible steps and to tick off ‘achievements’ helps them to externalise their condition, rather than seeing it as a part of themselves and personality.

“The NHS services don’t talk to each other ... that was a massive problem ... it was worse for my parents ... it was always them that ended up being the communicator between CAMHS and the GP.”

Generation gap Young people can feel misunderstood and sometimes even patronised by medical professionals, and other adult figures of authority rom whom they receive advice and support. This does not necessarily mean that they won’t appreciate and take on board this advice, but obviously has a negative impact on their response to offered support.

Different NHS services do not talk to each other effectively enough. The onus is placed on the user or their parents to fill gaps in information transfer and take control of their care. This causes extra stress to people already in a vulnerable state, and can lead to a variety of problems and misinformation.

See page 90 for further discussion of the intergenerational gap in attitudes to digital and social media

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2.2.2 CASE STUDY INSIGHTS: MENTAL WELLBEING - LEARNINGS FROM JENNY. Hospital visits and social isolation

Relative nature of wellbeing

Whole person support

Importance of spatial design

“I lost touch with most people at school when I was in hospital for a long time. That was before Facebook.”

“I did get really unwell at Uni, but at the same time I was OK ... like I might have got quite physically unwell, really low weight, but I was doing something that I enjoyed, so I was OK.”

“You’re treating illness, but there is a whole person attached that.”

“There were pictures up on the walls in the waiting room, pictures drawn by kids. The one that always sticks in my head was picture of a gun, picture of a knife, picture of mum and dad and it said ‘Home at Christmas’. And I’m like ... take it down, take it down!”

It is difficult for young people admitted to hospital for acute mental health care to keep in touch with friends. This can be damaging to their recovery in long run. During long hopsital stays, fellow patients become the centre of their social life, which can deny a sense of normality. However, Jenny mentioned that Facebook was helpful in this repsect; in later, shorter hospital visits when she was using Facebook regularly and had strong network of friends online, she was able to keep in touch. This was particularly valuable at night if unable to sleep; friends would often be online and available to chat.

Wellbeing is not only dependent on the level of seriousness of a young person’s mental health condition.

How effectively they are able to self manage their condition, how supported they feel in doing so, previous experiences of mental health problems and the state of their home, working and social lives are key factors. Someone suffering from a relatively mild mental health problems may have a lower sense of wellbeing depending on these factors than someone with a more severe condition.

Care should not be illness / service centred. Recovery is only really possible if the young person’s life - aside from their illness - is in positive shape. It is vital that they are helped lead active and healthy social and working lives, and to have focus and purpose away from their illness and services.

By placing primary focus on a young person’s illness, rather than on the young person as a whole, can create the sense that their condition in some way defines who they are.

The design of a space - both offline and online - affects the emotional state of the user. Waiting and consulting rooms can be places that inspire or sustain anxiety in patients. An attention to detail is important; Jenny vividly remembers finding the graphic illness posters in waiting rooms unsettling before appointments. Effort needs to be put into creating a positive and calming care giving environment.

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2.2.2 CASE STUDY INSIGHTS: MENTAL WELLBEING - LEARNINGS FROM JENNY. Trusted figures

Sustained support

Urgency and acute distress

“I don’t like social workers ... I just don’t! ... If its a NHS thing or its got an NHS badge, that might turn me off as well, because I’m already involved with the NHS so much.”

“Something that really helped after coming out of hospital a few years ago was having a nurse I could always contact, and they’d get back to you in 24 hours ... I haven’t used it that much but just knowing that it is there is good.”

“Even a day is a long time when you are contemplating killing yourself. Even an hour is a long time.”

Who young people feel that they can trust for sound advice and support with mental health issues will vary on individual basis. It is important to recognise that what might work for some young people may not for others. Some may build up negative associations with NHS services and other authority figures.

In this case, lateral thinking is needed to enable a varied system of trusted and well informed figures, who are in turn supported to be able to provide effective aid.

For young people dealing with mental health problems, having a named professional (such as a support nurse) that they can contact at any time, and receive a response from within a relatively short and clearly determined timeline is extremely valuable. Even if the young person rarely makes contact, if at all, the thought that someone is always there is very reassuring and provides a safety net. It is important that support feels sustained, rather than being made up soley of individual appointments with NHS services.

A fast response time is absolutely crucial when dealing with young people in acute distress.

Bureaucracy should not cause of any delay in support.

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2.3 CASE STUDY: LISA, 22 Digital Life Lisa recently secured part time employment after graduating from University the previous year, which has allowed her to move out of her parents’ house and into a shared flat. She has been diagnosed and treated for depression and anxiety.

“I CAN TELL THAT MY MENTAL STATE ISN’T AT ITS BEST IF I START SPENDING TOO MUCH TIME BROWSING ON FACEBOOK.”

Lisa’s main connection to the internet is through her laptop.

When she is at home, she will have this on almost constantly, even if just to listen to music. There is no television in the house, and her and her flatmate will use their laptops to watch films and videos. She has a mobile phone, but it is not a smart phone. She is very slow at replying to text messages and prefers to make phone calls to friends and family.

vacancies. She is currently employed part time as shop assistant and looking for a job that relates to her degree. She checks the same sites each day. When she finds the search for employment stressful she will often distract herself for long periods of time using social media sites. On realising how much time she has spent on these sites when she was supposed to be searching for work, however, she starts to feel guilty and her stress levels increase.

She has a Facebook account and checks it regularly throughout the day. If her laptop is on, she will normally leave a window open on her Facebook news feed. She has Twitter account (in order to follow her favourite celebrities) but doesn’t post from it much. She also has Tumblr account, and enjoys browsing and collect interesting photos, images and quotes; she will often spend an hour or so at a time doing so. She uses Spotify and Youtube to listen to music at all hours and likes to spend time compiling playlists.

When living with depression, she began to become socially isolated.

As she did so, she would spend long periods of time checking and browsing her Facebook wall, but would post very little, messaging friends only if they wrote to her first. This became addictive and gave her the illusion of keeping in touch with friends, despite not socialising very much offline.

Eventually, she realised that this behaviour was contributing to her unhappiness. She began to make an effort to socialise offline more, and to use her Facebook account in a more active way, sending messages to friends and instigating ‘chats’ rather than waiting to be spoken to.

Her main internet use aside from this is to search sites for job

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2.3 CASE STUDY: LISA, 22 “I WAS ALWAYS AFRAID OF GOING TO THE DOCTOR IN CASE THEY TOLD ME SOMETHING WAS REALLY WRONG WITH ME.” Mental Wellbeing Lisa’s mental health difficulties began whilst at high school, but she was able to self manage to an extent and didn’t have a diagnosed ‘problem’ or condition, nor did she seek any support. She studied intensely and obsessively, to the detriment of her social life.

She found it difficult to manage her work load and to maintain a healthy work-life balance, leading her to work late into the night most weekdays and throughout

the weekend. She also exercised obsessively and was very conscious of what she ate, tackling feelings of guilt and anxiety if she ate anything she deemed as unhealthy. However, she was physically healthy and not underweight. She was aware of a general feeling of underlying unhappiness, and was restless to leave school and home.

Upon leaving home for university, Lisa began to enjoy a far more active social life and maintain a healthier work balance. She built a large group of friends and was well liked. However, she found romantic relationships extremely difficult and developed intimacy anxieties. This was not something, however, that she thought to seek help for despite it weighing on her mind. She felt unable to admit these worries to anyone.

As she reached her third year at university, Lisa once more started to feel unable to cope with the increasing work load. She began to withdraw socially and would spend long hours attempting to work, but feeling physically incapable. This lead to a cycle of long periods of frustrated inaction and listlessness, followed by bursts of frantic activity.

She felt unable to enjoy anything and her usual energy was lacking.

She became worried that something was wrong with her physical health.

However, she remained outwardly cheerful around others, and her condition went unnoticed until she spent a few weeks with her parents. Having suffered depression himself and without the social facade, her father recognised the signs and after a heated argument, recommended she go to a GP. Lisa’s instant reaction was to rebel against this. She became more determined than before that she could work through any difficulties alone. It wasn’t until after the pressure of a missed work deadline that “something inside broke.” She eventually made an appointment with her GP after constant prompting and reassuring from her mother. She was diagnosed with depression and given medication.

She responded well to the medication and felt able to stop using it after six months or so.

She felt healthy again, until a few months after graduation. She had been unable to find a job and had to move back into her parents home. She became extremely

socially isolated, spending all day alone in the house and very rarely going out in the evenings.

Her confidence wained after every rejected job application. She felt trapped and fell back into a state of depression, which then led to anxiety. She began having panic attacks, which built up until she was, at one point, experiencing them on a daily basis. She managed to partially control them through breathing techniques and in that way kept her state hidden from her family. At first she didn’t understand what was happening to her and became convinced there was something wrong with her heart. Conversely, this deterred her from seeing her GP, as she was terrified she would be diagnosed with a serious illness. This decision not to seek help was then strengthened after self-diagnosing through the NHS website and online forums as suffering from panic attacks; after believing she had a heart problem this came as a relief: “they were just panic attacks! That was fine, I could handle that.”

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2.3 CASE STUDY: LISA, 22

“I SHOULD HAVE MADE THAT COUNSELLING APPOINTMENT. THE MEDICATION JUST MADE ME FEEL I COULD HANDLE THINGS ALONE.”

Whilst the medication she has received for both depression and anxiety has been effective, Lisa feels it may have played a part in preventing her from confronting some underlying emotional issues. Whilst she feels her mental wellbeing and self-management skills have gradually progressed despite set backs, she remains in two minds whether to seek counselling.

After making the decision to leave her parents house and live with a friend, Lisa became less socially isolated and managed to find part time work in a shop. The panic attacks receeded and stopped, and Lisa was able to find her own flat.

However, after a few months, her work hours reduced and she found it difficult to afford to live. She began experiencing panic attacks again, and they once more built up to be daily occurrences. It was only once a friend admitted to her that she suffered panic attacks that Lisa felt able to talk to anyone about what she was going through. She booked an appointment with her GP and was prescribed medication. She was also advised to self refer herself for counselling, which she did immediately. A couple of weeks later she received an assesment phone call and was placed on a waiting list. She was told a letter would arrive that would notify her when she could make an appointment.

By the time this letter eventually came, however she felt much stronger emotionally. Medication had stopped the panic attacks and money problems had eased. She had a two week deadline to make the appointment and decided not to.

She gradually came off the medication and felt healthier than ever. However, she began to feel low again after a relationship difficulty. This was not as serious a low as she had experienced in the past, but she realised that there were underlying issues that she had not addressed and regretted not having made the counselling appointment.

Now that she is feeling relatively healthy, she is wrestling with the idea. She fears “opening up” but is aware that it may help her in the long run. She is currently feeling extremely well supported by friends and family, however, which is causing her to question the need to go.

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2.3.1 CASE STUDY INSIGHTS: DIGITAL LIFE - LEARNINGS FROM LISA. Rise of the personal device

Social media and the arts

Social media and deferral

Social media and social isolation

“We don’t have a TV in the flat, so our laptops are pretty much on all the time when we’re home so we can listen to music, the radio and watch DVDs or stuff on YouTube ...

There’s a few podcasts and shows that I listen to regularly for news, but mainly the news I get, and things I decide to read or watch are what other people post links to on Facebook. Or show me on YouTube.”

“One of my favourite things to do is to trawl the internet for really interesting photos and illustrations.

Sometimes I share links to them on Facebook, but I mainly collect them on my Tumblr and save the .jpgs in a folder so I can look through them when I need a bit of a break.”

“Sometimes, even though I should of been looking for a job, I would find myself spending ages procrastinating online; just scrolling Facebook and Tumblr, reading blog articles and watching stuff on YouTube. Its weird, I knew I was wasting so much time and looking at complete rubbish, but it was like I couldn’t stop and bring myself to do what I should have been doing.”

“I got into bad habits when I moved back in with my parents. I was hardly going out and doing any real socialising at all, just talking to people on Facebook and reading their posts. The less I saw people, the less I wanted to, or the less I felt like I could.”

News, information, entertainment and digital content in general are being increasingly consumed in ways tailored by the individual.

Television, radio, magazines, newspapers: all have reduced levels of control in terms of information curation. Young people are used to gathering content from wide variety of unofficial sources; most frequently via one another through shared links and social media posts.

Social media use is not restricted to talking to others. It is also important in the wide dissemination of the arts; of music, film, photography etc. Special interest groups flourish on social media platforms. This may be very important in regards to mental health as a means to aid self realisation and development. Artistic content may also be used as a more imaginative and pervasive means of spreading information and enabling empathy.

See page 99 for further evidenced discussion of creativity in relation to digital media.

Young people use social media as means of distraction. This can be innocuous and part of normal teenage behaviour; they may spend long hours on social media sites rather than facing the responsibilities of homework, for example. However, this can enter more serious territory if feeding into the listlessness and inability to perform even simple daily tasks that can be a part of depression.

Socialising online can be an important lifeline for otherwise socially isolated individuals.

However, if this remains a young person’s only form of social interaction for long periods of time and begins to entirely replace physical social interaction, it can be damaging and prolong periods of reclusiveness.

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2.3.1 CASE STUDY INSIGHTS: DIGITAL LIFE - LEARNINGS FROM LISA. Social media use patterns

“I can tell that my mental state isn’t at it’s best if I start spending too much time browsing on Facebook ... like, just scrolling through my Facebook news feed without actually commenting on anything or posting anything myself.”

Ways in which young people use social media vary greatly. We have previously discussed two broad use catergories - that of active and passive users - but it is far more nuanced than this. What is important, however, is not so much to attempt to catergorise and explain different types of social media use, but instead to recognise that a change in a young person’s use pattern will more than likely indicate a change in state of mind.

This can be translated to being an important indicator and point of discussion in monitoring an individuals mental wellbeing and emotional state.

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2.3.2 CASE STUDY INSIGHTS: MENTAL WELLBEING - LEARNINGS FROM LISA. At risk groups

Emotional barriers to support

Support beyond medication

Self referral

“I guess my problems started quite early on in high school. I was working too much and not socialising too much ... I was also pretty anxious about what I ate and how much exercise I was doing. But no one really noticed, or thought it was actually a big problem.”

“I didn’t want to tell anyone how bad I was feeling. I’m always pretty cheerful and in control when I’m with my friends ... I didn’t want it to seem like there was something wrong with me ... I guess I like seeming like I’m the strong one and that nothing gets to me.”

“It really helped at the time I felt much better ... the medication just made me feel I could handle things on my own. But a little after I came off them I started to feel bad again, because I hadn’t really dealt with any of my issues.”

“It took a lot of building up for me to ring up for a counselling appointment .... the letter took so long to come that by time I felt better, so I didn’t ever book an appointment. I wish I had now, I think I still need it, but I don’t know if I’ll build up to it again.”

Young people at risk of developing mental health difficulties often go unnoticed until diagnosable signs do begin to appear. Early intervention, through the promotion and teaching of emotional literacy and self awareness on a universal basis could prevent some problems from escalating.

Help seeking by young people can be affected by a range of emotional barriers, such as pride, fear and guilt. Similar barriers affect their responsiveness to any support they do receive. Stigma and self-stigma are also factors.

Treatment of mental illness through medication alone is not really enough. For long term wellbeing, emotional, whole person support is needed in addition to the treatment of the physical side of the disease, for conditions of all levels of severity; not simply the most acute or long term.

Placing onus on vulnerable young people to self refer to counselling means that many users may be falling out of service provision before they should. It is difficult for young people in a vulnerable and emotionally volatile state to effectively self manage without prompts, and know what is best for themselves in long term.

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2.3.2 CASE STUDY INSIGHTS: MENTAL WELLBEING - LEARNINGS FROM LISA. Recovery as a non-linear process

Physical symptoms

Self Diagnosis

Emotional openess in social networks

“After I stopped taking the medication for anxiety I felt so much better. My life was much more sorted and back to normal. I thought that was it, but then a few monthes later I had a really low period again, it kind of took me by surprise.”

“It was having the panic attacks start again that made me go to the doctors. I was just having them so often, and even if I felt OK on a conscious level and wasn’t actually actively worrying about stuff, it was like my body couldn’t help itself. It was scary not having control.”

“I’m much better at just going now, but I was always terrified of going to the doctor in case they told me there was something really wrong with me. I always Googled my symptoms first to try and convince myself that I didn’t have some horrible disease!”

“I didn’t tell anyone I was having panic attacks until my friend told me that she had started having them recently. That made it easy to tell her ... then after that I told my mum and a few other friends ... it was much easier to deal with then.”

Recovery should never be explained in terms of a quick fix, or of a black and white distinction between ‘ill’ and ‘well’. Young people need to be prepared for set backs and possibility of relapse, but with an emphasis on gradual progress.

Many young people will often not seek or be given support until the physical manifestations or consequences of mental ill health begin overwhelm them, or become obvious to others.

There has been much recent discussion on the topic of self diagnosis via the internet and it is clear that it can have negative effects. In some cases, self diagnosis may help to prevent young people from seeking and coming into contact with support services, instead attempting to tackle problems alone when aren’t fully capable. However, it must be recognised that self diagnosis in this way is common; advice and support to self manage beyond this must be just as readily available.

Openness and honest conversations with friends and family are key to emotional wellbeing. For young people reluctant to seek support, hearing the honest discussion of experiences of mental health from people within their immediate social network can give them the courage or push they need in order to do so, or at least to voice their difficulties.

See page 107 for futher evidenced discussion.

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2.4 CASE STUDY: BEN, 16 Digital Life

“MY THREE BEST FRIENDS LIVE IN DIFFERENT PARTS OF THE COUNTRY, BUT WE SPEND EVERY EVENING GAMING AND TALKING ON XBOX LIVE. WE MIGHT AS WELL BE IN THE SAME ROOM.”

Ben is at high school and lives with his parents and brothers. He has no mental health problems of his own to speak of, but often finds himself acting as support for friends who do. He is extremely comfortable with digital technology. Online activities play an important and active part in his social life.

Ben has just acquired his first smart phone (thanks to his mum receiving an upgrade on her own phone), but his main access to the internet comes through his Xbox and laptop.

a separate console.

Ben’s Facebook use does not stretch much beyond sending game “cheats” to his closest friends and “having banter” with them and his mum. He also uses it to send In terms of social media use, Xbox private messages to his female Live is to him the most important friends, with whom he says he and is key to his social life. communicates quite differently; Circumstance and the fact that his he is more likely to discuss more family have lived in a couple of emotional issues at length via different parts of the country mean private messaging or on the phone. that his three closest friends live at quite a distance from him. Unable to Although Facebook is blocked at school, he and a few of his friends meet physically, they spend almost have found ways to trick the system every evening playing Xbox games in allowing them access; he is an online together, simultaneously adept user of technology. communicating on other forms of social media.

He does not have a Twitter account and the only other social media site After sending each other extremely he could say he has used is AskFm. brief texts alerting them to “go He joined because “everyone at online”, they will play a game school was on it” but stopped using together on Xbox Live, utilising the it after a week. He was unable microphone “chat” option at the to “see the point of it” and was same time (essentially a prolonged disgusted by the bullying nature four way Skype call). They will also of most of the comments. He is send each other links to YouTube confused by the behaviour of many videos, images and game “cheats” of his school friends, who complain on Facebook, which Ben will have open on his laptop. This is all done constantly about the site - often on Facebook - yet continue to use it. in the same room as his brother, who will also be playing games on

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2.4 CASE STUDY: BEN, 16 Mental Wellbeing Ben has no mental health issues of his own to speak of. He is extremely talkative and able to seems able to express himself freely, without the embarrassment or introversion that can be common in teenage males. He has a strong, healthy relationship with his mother, to whom he feels able to talk to about most things and to go to for advice.

He is compassionate and caring, and often finds himself supporting others through difficulties, some quite serious. Within his group of friends, one struggles with bi-polar disorder, another with bulimia and self-harm. Two of his closest friends have quite recently lost parents, and another is a young carer with a heavy responsibility to bear at home.

Although demonstrating an awareness and understanding of mental illness, he didn’t make an easy and instant connection between the problems his friends were facing and mental health issues. He was unsure that bulimia “counted” as a mental health problem and didn’t think to seek support or advice when consoling

his friends, despite often feeling unsure what best to do or say.

He would often, however, discuss matters with his mother, even ringing her at the time in one case of particular urgency.

The supporting role that Ben provides to his friends has not had a damaging effect on his own mental health and he maintains a very positive outlook. He is thoughtful, and demonstrated an ability to discuss the issue of mental wellbeing in an extremely mature and insightful manner. He is particularly concerned that his female friends place far too much value in their appearance; for him “advertising is to blame ... and celebrities”. This concern extends into their Facebook use; he hates to see his friends posting so many “selfies” and wearing excessive amounts of make up. He is keen that everyone should be confident and happy to be an ‘individual’ and that this confidence would help people to treat each other better.

“ONE OF MY FRIENDS HAS BULIMIA. DOES THAT COUNT, IS THAT A MENTAL HEALTH PROBLEM?” Ben often finds himself consoling friends or trying to help them through quite serious problems. He doesn’t instinctively consider this as supporting them with mental health issues though. Despite sometimes not feeling like he knows what best to say and do on these occassions, he doesn’t think to seek formal advice or support for his friends.

In some situations he will ask his mother for advice, but this is not always the case.

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2.4.1 CASE STUDY INSIGHTS: DIGITAL LIFE - LEARNINGS FROM BEN. Long distance friendships

Gender differences

Technical expertise

“I’ve lived in a few different places, so my three best friends live in different parts of the country, but we spend every evening gaming and talking on Xbox Live. We might as well be in the same room. We talk on the Xbox mics and we send each other YouTube links on Facebook to stuff we are talking about ...”

“My girl friends often message me to talk about more emotional stuff, but the guys don’t. Its all just banter with the lads.”

“Yeah, Facebook is blocked on the school computers, but me and my mate have found a way of getting round it. We’re the only ones that know how to do it.”

Young people’s use of social media allows for long distance friendships to be maintained in active and frequent ways; friends living in different places can engage in the same game, talk to multiple people simultaneously and see each other in real time, almost creating the illusion that they are in the same room. They are, in fact, sharing the same space. Sites such as Facebook also have the positive effect of allowing disparate users to keep in touch in more passive way via

shared updates, and to have brief, yet meaningful interactions and conversations that wouldn’t otherwise happen.

Young people are also able to converse with and befriend strangers on the basis of shared interests and views rather than geographical circumstance. Online socialising can take up as much or more even time as offline meet ups.

The key to wellbeing is a balance of both.

Young women are seemingly more able to discuss emotions and admit distress; both to each other, and to male friends on an individual basis. Young men are often less able to, or unwilling to, express themselves as easily and freely. Peer support amongst young men takes a different form. They are often aware of each others problems, but their main supportive interactions tend to centre around jokes and shared deferral activities. Of course, this is not always the case and gender cannot be defined in such simple terms. Crucially though, this is the way in which most young people themselves perceive gender differences in communication, and hence can feed into an enactment of these roles. Differences do seem to generally reduce with maturity.

Many young people, as digital natives, are very knowledgable and creative internet users. Some are able to find their way around blocks and filters, and to create their own digital content of varying degrees of sophistication.

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2.4.1 CASE STUDY INSIGHTS: DIGITAL LIFE - LEARNINGS FROM BEN. Attraction to risk

Social media and narcissism

“I just don’t get why people still use AskFm. They use it, get a load of abuse, complain about it in their Facebook status, and then carry on using it!”

“Some of the girls at school just take so many selfies and put them on Facebook ... they’ll always be wearing loads of makeup and sometimes they comment on it with stuff like “feel so ugly today.” I hate it, I hate that people put so much importance on how they look. It’s advertising’s fault I think.”

It is common for teenagers to experiment with risk and to be attracted to activities and behaviours that they know to be potentially dangerous or damaging to their wellbeing. This is also the case online; AskFm providing a key example. There seems to have been a morbid fascination with the site amongst young people, despite (or perhaps because of ) its negative reputation and users frequently becoming victims of abuse and bullying.

Social media profiles allow young people to construct identity in a different and controlled, ‘editable’ way. Social media sites are by and large user profile centred, which can encourage narcissistic behaviours; young people are very conscious of shaping how they are perceived through their Facebook walls and their Twitter streams. Whilst it can be beneficial to have a good awareness of self, and social media could be seen to help with self realisation in this sense, there are some downsides. Self realisation needs to be conscious, which is

arguably not quite the case in the ways in which most young people are shaping their online personas; the emphasis is on how they will be perceived by others within their social network, rather than on true individual expression. Social media sites invite and cause young people to constantly present their lives as series of events, achievements and photographable moments and to compare themselves to others through these.

See page 99 for further discussion on identity in relation to social media.

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2.4.2 CASE STUDY INSIGHTS: MENTAL WELLBEING - LEARNINGS FROM BEN. Peer support

“One of my friend’s girlfriends self harms ... she’s had a difficult time since her mum died. I try to help out, but its hard to know what to say. I just try and listen.”

Most young people - who may not be experiencing mental health problems of their own - are acting in some way or another as a means of support for those who are, often without fully realising that this is what they are doing. Despite sometimes feeling unsure of what best to do and say in order to help, few seek any kind of formal advice.

Issues of trust may mean that these young people feel obliged to keep friend’s problems secret, despite this perhaps not be in their best interest.

Importance of parental figures

“My mum is great, I can tell her pretty much anything. She is the first person I talk to about stuff.”

All young people need an adult who they trust for good advice, go to for support and who will look out for their welbeing. A parental figure doesn’t necessarily have to be a parent specifically, and indeed is beneficial to young people to have an adult that they trust outside of family circle and all the emotional barriers this can entail.

Celebrating emotional intelligence Emotional intelligence is often under appreciated in schools and beyond. It needs to be celebrated and encouraged in same way as intellectual, artistic and sporting abilities and achievements. We should be nurturing those young people with natural emotional intelligence and compassion for others, and encouraging emotional learning in all young people. Most are very capable of discussing difficult and emotional issues in mature fashion when in the right environment and challenged and helped to do so.

Equally, it cannot be overlooked that there will be minority young people who abuse the trust of others using disclosed information to the detriment of friend’s who have told them things in confidence.

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