P wegot99 reccomendations

PROJECT 99: PARTNER RECOMMENDATIONS THE RECOMMENDATIONS MADE BY THE PROJECT PARTNERS AS A RESULT OF ALL PROJECT99 DETAILED FINDINGS.

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.

embedded in the report documentation, which is a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International Licence, its main conditions being:

Note that the material presented in the Project 99 reports is the result of combined work from the commissioned partners and the participating young people and does not represent the views of GGCNHS.

· The work is not resold or used for any commercial purposes

GGCNHS is keen to make this work available to any interested party, while retaining the copyright. We have therefore applied an open access policy to this work which allows anyone to access the report material online without charge. Anyone can download, save or distribute this work in any format, including translation, without permission.

This is subject to the terms of the licence

· GGCNHS and the three commissioned partners – Mental Health Foundation, Snook and Young Scot are credited · This summary and the address www. wegot99.com are displayed · Creation and distribution of derivative works is permissible, but only under the same or a compatible licence

· A copy of the work or link to its use online is sent to GGCNHS via the contact form on wegot99.com

You are welcome to ask for permission to use this work for purposes other than those covered by the creative commons license.

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.

In recognising the emerging nature of this agenda, the Health Board would welcome dialogue with partners and potential partners who may be interested in collaborating in aspects of this work, and in discussion with agencies who may already be engaged in similar work, with a view to sharing good practice.

For further discussions please contact us via the wegot99.com contact form.

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CHAPTER 7: SUMMARY PROCESS The recommendations made in this chapter have been catergorised into four sections as follows:

1. A co-design approach,

with a framework for on-going engagement with young people is the default for any projects seeking to develop digital assets for youth mental health.

2. GGC NHS should develop

a youth engagement framework to support this on-going engagement, with potential internships for young people.

DIGITAL ASSETS A digital springboard (or gateway) consisting iterative, user-centred content focused on supporting mental wellbeing (not solely focused on mental health issues) should be developed. This would ideally contain the following elements:

Within this digital springboard specific areas should focus on supporting individual young people, including:

Emergency 24 hour Instant Messaging tools

1. Service directory 2. Advice directory 3. Tool kit for wellbeing 4. Links to and connections

Empathy tools

Access to forums for group support

Access to tools which help maintain good mental health

Practical day to day tips on managing common mental health problems

with wider services

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CHAPTER 7: SUMMARY WIDER IMPACT 1. GGC NHS should develop an emotional literacy programme as part of educational curriculum.

2. A ‘first responder for mental health’ training scheme should be developed to allow support within schools.

3. A campaign should be

developed through which young people are encouraged and incentivised to find ‘a third space’.

NHS USE OF SOCIAL MEDIA NGS GGC should appoint young people as social media managers for peer related content.

NHS GGC social media strategy should include:

1. Creation of interesting,

2. Find appropriate health

3. Monitor and respond

4. Blog developments in

relevant, engaging content which young people would want to share.

to trends (both positive and negative) with appropriate content.

related and user-generated content to share.

digital asset strategy.

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7. CHAPTER OVERVIEW The following recommendations are drawn from the findings detailed in the previous section of this report and from a resulting co-design workshop with members of GGC NHS and the project partners.

The diverse range of insights we have collected through the research process has allowed us to create a series of recommendations for future mental health support strategies for young people, falling into the following categories: 7.1 Recommendations for development of digital assets 7.2 Wider recommendations 7.3 Recommendations for use of existing social media sites by the NHS

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7. RECOMMENDATIONS: SUSTAINED YOUTH ENGAGEMENT Sustaining a participatory approach All recommendations are made with the view that any subsequent development of digital assets should be carried out in close collaboration with young people through continued use of a codesign based approach. We have made the case for the importance of such processes throughout this report:

Refer to page 12 for a detailed case in favour of a co-design and co-production based approach to health care improvement.

“ ... a Participatory Design approach helps us to develop interventions that are engaging to young people and therefore are more likely to be used, increasing the overall reach and impact of the intervention ... From a political standpoint, the commitment of Participatory Design to participation by users is an assertion of the rights of young people to define their own wellbeing goals and participate in their own care. It is an approach that seeks to effect social change, and builds more equitable relationships between health professionals and young people as key partners in the design process.”

(Young and Well CRC, 2012)

It is crucial that youth involvement does not cease at this early stage, but continues throughout the design and development of any digital asset. Additionally, sustained youth input will be valuable even after a digital product has

been produced; frequent re-evaluation and modifications will be required in order to maintain the relevance and effectiveness of any asset. To again cite Young and Well CRC:

“Ongoing involvement by young people throughout the design process increases the feasibility and acceptability of the proposed concepts and ideas and ensures that recommendations generated by young people, and then interpreted by researchers or designers into ‘design proposals’, still effectively reflect young people’s input. Continuous engagement also helps keep pace with the fast-changing uses of technology, mitigating some of the impacts of the inherent time lag of translating research and evaluation findings into practice.”

Such an approach can prove beneficial in a variety of ways, not only to the success of the digital asset being created, but also to the young people involved in the process. As both the literature and the outcomes of this project show, the opportunity to feel that you are helping others plays an important role in a young person’s sense of wellbeing. Providing a creative environment in which young people feel that their opinions are being taken into account - and crucially seeing tangible outcomes as a result - is valuable in

Refer to insights gathered from Greig’s case study on pages 19 and 23, from Jenny’s case study on page 17 and from our engagement sessions on page 65 on the benefits of volunteering and helping others for young people.

Refer to page 97 for a discussion of the role of creativity and communal creative activities in boosting self esteem and forming identity.

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7. RECOMMENDATIONS: SUSTAINED YOUTH ENGAGEMENT boosting self-esteem and a sense of purpose; and both literature and the co-design outputs here show the important role creativity has to play selfrealisation and identity formation.

Refer to page 27 of Jenny’s case study.

Jenny’s case study also demonstrates the value that involvement in such youth engagement projects, and becoming involved in mental health support in a professional or peer support context, can have in assisting recovery and self-management.. Participation would also provide the young people with a significant ‘third space’ (a space out with school or home). When structured correctly, involvement in such co-design processes also have significant benefits to a young person’s skill development and professional progression.

We therefore recommend the creation of a youth engagement structure by the NHS. The structure would be pyramid in form, beginning with the formation of a diverse collaborative network of schools, and then active youth groups and organisations within the GGC area. GGC NHS already has many links with such groups and should look to strengthen and expand this network.

Engagement would begin at this level in a manner similar to the processes and activities outlined in this report. Young people attending these groups who demonstrate an interest would then be invited or elected by their peers to join a specially created youth council. This council would work more closely and extensively with designers and

developers in the both the creation and maintenance of digital assets.

A parallel training and development scheme could run in conjunction to this for young people interested in progressing into a career (or simply increasing their knowledge and skill sets) in the fields of mental health support or digital media development.

The engagement structure could culminate in an NHS sponsored digital internship programme for interested young people. They would aid in the management and development of digital and social media assets within the NHS, gaining professional experience and a further advanced skill sets. The presence of young people within the NHS and their innate understanding of current digital media trends would prove invaluable in allowing the NHS to bridge the intergenerational gap highlighted in evidence, and utilise digital and social media assets in such ways that would stay current, relevant and attractive to young people.

WE RECOMMEND THE CREATION OF A PROGRESSIVE YOUTH ENGAGEMENT STRUCTURE. IT WOULD INCLUDE A PARALLEL TRAINING & DEVELOPMENT SCHEME FOR YOUNG PEOPLE, CULMINATING WITH THE POSSIBILITY OF A DIGITAL INTERNSHIP WITHIN THE NHS. 130

7. RECOMMENDATIONS: SUSTAINED YOUTH ENGAGEMENT The project partners can cite successful examples of such youth engagement structures within our own bodies of work. >>>

SUCCESSFUL YOUTH ENGAGEMENT PROJECTS The Matter Snook and Young Scot have recently worked together to produce ‘The Matter’.

It is a programmes that teaches young people how to research, design and publish a newspaper.

A brief from an affiliated organisation or council in the form of an issue-based question is handed over to a temporary enterprise of 6-10 young people They are taken through a series of workshops and provided with The Matter digital platform to manage their research and newspaper deadline. The young people undertake the research themselves, guide by facilitators. The group is then provided with a copy writer and graphic designer that they take control of to deliver their newspaper in time for the final presentation back to their client.

It is a co-creative process that allows organisations to find out what young people think and it offers young people the opportunity to learn some employability skills, increase their engagement in the world and contribute to issues that Matter in society.

Youth Commissioner’s Model The Youth Commissioner’s model, as used by Young Scot, puts young people at the heart of decision making. The Youth Commission on Smoking Prevention (ongoing 2013-2014) and the Youth Commission on Alcohol (2010) have given young people a remit to carry out local investigations and present the findings back to decision makers, in both cases, the Scottish Government.

This model provides a great opportunity to make sure young people’s voices are heard and taken seriously. A similar model could be used

by GCC NHS to explore how young people would like to be communicated with through digital media by an organisation such as the NHS. The Digital Creative Modern Apprentice programme gives young people the opportunity to earn a qualification (SCQF) while on placement at a partner organisation on a one year working contract.

This can encourage employers to take on young people and have them involved in the digital production of the organisation. However, what we have found is that otherwise inexperienced young people are often more

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7. RECOMMENDATIONS: SUSTAINED YOUTH ENGAGEMENT

SUCCESSFUL YOUTH ENGAGEMENT PROJECTS Right Here

WE RECOMMEND EMPLOYING YOUNG PEOPLE IN AREAS IN WHICH THEY ARE ABLE TO CONTRIBUTE TO THE NHS’S DIGITAL OUTPUT.

familiar with social networks and digital technology than many of the established workforce and can have a good impact on the digital skills and culture of these organisations. They quickly become valuable and in some case invaluable assets particularly in cases where there is an element of youth engagement through digital and social channels.

We would recommend that GCC NHS considers the possibility of employing young people in areas in which they can affect digital decision making and contribute to the digital output of the NHS.

Mental Health Foundation worked with Comic Relief, Paul Hamlyn Foundation, and Nominet Trust to establish and support Innovation Labs as part of Right Here, a five centre national project to enable young people to be more involved in their mental health support.

Right Here has published a range of learning about best practice youth involvement in mental health activities, and the Innovation Labs programme has maintained youth involvement both in strategic grant management of the project, and in the design and delivery of the seven projects under development.

As discussed previously in this report, such a youth engagement and (and in general, a user engagement) centred approach has gained considerable credence nationally and internationally.

The effectiveness of the series of recommendations to follow relies on any further developments continuing to utilise a co-design led approach, sustaining close youth involvement throughout.

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7.1 RECOMMENDATIONS: DEVELOPMENT OF DIGITAL ASSETS Overview As the snapshot mapping of existing digital assets demonstrates (see the appendices) there are a wide variety of digital resources already available or currently under development; a great deal more than could be covered in the scope of this study. Many of the services and approaches they provide directly align with the evidence, and with suggestions from the young people and with insights arising from our engagement and codesign sessions.

It is clear that services targeted at young people should work in a similar way.

From the information we have gathered, web use in young people seems to be centred around browsing a select few platforms which act as springboards for content and external sites (for the most part these will be social media platforms; the likes of Facebook and YouTube are the most common but there are a variety of others that vary depending on personal preference and social groups). A more organic and flexible approach is required in order to produce sustainable and wide reaching impact.

An on-going intelligence gathering and mapping function could enable NHS GGC to make the best possible use of existing (and developing) services, to benefit from emerging evidence, and avoid duplication of effort.

Refer to page 50 for a discussion of the blurring of the offline and online world.

As the pace of digital innovation and change can outstrip the development and publication of conventional peer reviewed evidence, boards should seek other tools for validation of impact and quality marking, collaborating with existing NHS structures for validating health apps, and working with Scottish Government/NHS24 on validation standards.

It is clear both from the youth engagement work within the project and the published evidence that the development of a single stand-alone app or website is unlikely to make significant impact on the digital landscape. Young people move seamlessly between digital and non-digital modalities, and indeed use both simultaneously.

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7.1 RECOMMENDATIONS: DEVELOPMENT OF DIGITAL ASSETS

The recommendations in this segment fall into two strands, which will be preceded by a series of overriding principles that apply to both:

Recommendations for a digital ‘springboard’: In this section (please see 7.1.2) we suggest a series of principles for the creation of an NHS digital ‘springboard’ to be used by young people seeking mental health support. This would include an iterative, usercentred and part crowd-sourced / part curated online directory of available mental health support services as a key component. However, it should be more comprehensive than a simple sign-posting site and act instead as a flexible digital toolkit that young people could mould to meet their individual requirements.

Recommendations for individual digital assets: In this section (please see 7.1.3) we present recommendations for the kinds of digital mental health support assets this active service directory and toolkit should contain. Some may be existing assets that users could be directed to, or could be purchased or funded by the NHS. There are also further concepts the NHS may wish to consider developing.

In keeping with the commitment to co-design and youth involvement throughout, we draw readers attention to the fact that these recommendations are based on the discussions we had with the groups we reached. We would urge further testing and scoping of ideas with young people in Glasgow to ensure future developments remain closely aligned with young people’s needs and priorities in the target audiences sought.

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7.1 RECOMMENDATIONS: KEY OVERRIDING PRINCIPLES Prior to detailing sections 7.1.2 and 7.1.3, we suggest some overriding principles that are relevant to both sets of recommendations:

Problem-Sharing There was a consensus amongst the young people that we worked with that the ability to understand, express and share problems and emotions appropriately and constructively is crucial to mental wellbeing. It was generally understood that this would not necessarily prevent the onset of mental illness, but that such an ability was necessary for positive selfmanagement.

Four basic steps to wellbeing emerged and the subsequent suggestions they made for support services could be seen to align to these.

This is of course a simplistic and broad approach, but is useful in contextualising any planned digital assets and in illustrating a key principle; A digital strategy to supporting mental health must take into account this desire for holistic and long term support.

FOUR STEPS TO WELLBEING

1.

Help young people to express, understand and contextualise their emotions and problems.

2.

Help young people to share these emotions and problems in a constructive, supported way.

As outlined in the insights derived from our co-design sessions.

See page 84.

3.

Help young people to manage or work through their own problems and emotions; to get the appropriate support to achieve this; and to encourage them to help others to do the same.

4.

To help young people to maintain and promote mental wellbeing.

It must also recognise that an approach to mental health support is perhaps as much about the management/self-management of emotions and ‘distress’ as it is about the management and understanding of mental illness.

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7.1 KEY PRINCIPLES: POSITIVE FRAMING / WELLBEING OF OTHERS

Refer to page to insights gathered from Greig’s case study on page 22 for a discussion of the ingrained negative framing in young people, and to page 63 for discussion of need for positive framing in mental health support.

Positive Framing

The Wellbeing of Friends and Family

Building from the previous point, we would in fact suggest that any new digital assets be developed as mainstream assets targeting all young people, ensuring that those who do experience distress or mental ill health are able to access and use them. Digital innovation should be equality impact assessed to ensure that the approach works with those at particular risk of mental ill health. A universal approach can also include measures to address particular groups. Whilst we did not work with young people within CAMHS settings, work in other parts of the UK has developed digital assets to positively support recovery and selfmanagement in these populations.

There should be more encouragement and recognition of young peoples’ natural tendency to look out for the wellbeing of their friends and family. Young people are often caring for the mental health of others without even realising fully that this is what they are doing. They should be provided with the proper support and resources so that they might do this to maximum effectiveness and safeguard their own wellbeing at the same time. Digital peer support and communities of interest have potential as a further option in this regard.

The focus on wellbeing for everyone was important in the youth groups we worked with.

There was a sense of the communal aspect of mental health. There was a tendency to discuss mental health in relation to others; and recognise that individual’s mental health is affected by - and has a profound influence on - family, friends and wider social circles.

Therefore, it may be that some young people that are hard to reach in terms of mental health support can only be accessed through concerned friends and peers, especially where family relationships may be complex, and trusted adults not available. There is potential to link development in this regard to peer support principles, as well as to reach young people who explore solutions to their own concerns by seeking information for ‘friends’.

IT MAY BE THAT SOME YOUNG PEOPLE THAT ARE HARD TO REACH IN TERMS OF MENTAL HEALTH SUPPORT CAN BE ACCESSED THROUGH CONCERNED FRIENDS AND PEERS.

Refer to Ben’s case study on pages 43 and 47 for a discussion of peer support, and to a discussion on the importance of emotional openness in social networks in Lisa’s case study, page 41.

See pages 65 and 105 for further discussion of peer support.

Refer to Support2 idea on page 79 and insights gathered from codesign sessions on page 82 ...

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7.1 KEY PRINCIPLES: WIDER CAMPAIGNING / MESSAGES OF PROGRESSION Wider Mental Health Campaigning

Refer to insights gathered from Greig’s case study on page 22, and page 63 for insights from engagement sessions, for a further discussion of the level of expertise in mental health matters amongst some young people with diagnosed mental health problems.

From our work with young people there was a real appetite and ability to discuss and promote mental wellbeing in a very mature fashion. In general, the young people that were most aware of the need to take active care of their own mental health were those that had already been diagnosed with a mental illness / condition. That is not to say that some of the other participants weren’t taking very good care of their mental health; only that they weren’t doing it consciously.

There is scope to build a campaigning approach to mental health awareness amongst young people, drawing on successful online campaigns such as ‘It Gets Better’ and the Butterfly Project, using young people’s idealism and media literacy to develop multimedia approaches that peers will use. Positive messages that emphasise and celebrate the tools young people already use daily to manage challenges could connect to broader anti-stigma campaigning and online communities of interest. It seems likely that the renewed ‘see me’ programme being managed by Mental Health Foundation and SAMH will have the opportunity to engage the wider movement of young people in co-design and delivering innovative messages to young people using digital tools.

The idea of recovery as a journey is a key message across all age groups when discussing mental health. Young people are particularly open to the idea of ‘progress’ and change over time.

Therefore, it may be appropriate to emphasise messages of progression and improvement when framing mental health issues for young people.

This fits well with the promotion of personal recovery stories by peers who are a little older, to show young people in current distress that progress can come quickly. YouthNet for instance uses older young people as moderators on TheSite specifically because they are through their difficulties, but still immediately relevant to young people.

Care should also be taken to ensure young people are aware of the consequences of sharing publicly details of their mental health in terms of managing their digital footprint in the future, given how rapidly their feelings can change.

‘Progression’ as a Message to Young People

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7.1 KEY PRINCIPLES: AESTHETICS & FUNCTIONALITY OF DIGITAL ASSETS Aesthetics of Digital Assets

Refer to the Button Wall concept on page 78 and insights gathered from the co-design sessions on page 83 for young people’s thoughts on the importance of aesthetics in creating a positive digital space.

Any digital asset created should have distinct, interesting and beautiful identity and ethos, and clear expectations for use and behaviour. It is important to set the mood and personality of a digital space as carefully as that of a physical space. When a digital space is bland and without clear rules and aims, its identity becomes solely defined by a critical mass of users. Whilst this may create positive results, it also allows negative behaviours to push to the fore unchecked: Askfm is a worst case example of this. The more specific a sites identity however, the narrower the range of people it will appeal to; hence the need for a whole range of digital assets, rather than one catch-all site.

Funtionality of Digital Assets: Active vs Passive Use The ways in which young people will interact with any one digital asset will vary greatly. However, particularly in relation to social media, use patterns can be loosely defined as being more passive or more active. Active users (or people going through a phase of more active behaviour) will generate a lot of content, participate in and possibly lead any online conversations and engage with a wide range of the assets functionalities. More passive users will simply browse this generated content and are unlikely

to generate their own. Any digital assets created should allow both kinds of user to benefit from the service. However, active, supported use of and engagement with an asset should be encouraged; there is an important shift in going from passively browsing mental health related content to taking active steps to self-manage wellbeing or actively asking for (or giving) support. This is a key point in consideration of impact measurement, where consideration should be given to assessing the benefits of passive engagement.

DIGITAL ASSETS SHOULD HAVE DISTINCT, AND BEAUTIFUL IDENTITIES. IT IS IMPORTANT TO SET THE MOOD AND PERSONALITY OF A DIGITAL SPACE AS CAREFULLY AS THAT OF A PHYSICAL SPACE.

Refer to insights from Greig’s case study on page 21, and insights gathered from the engagement sessions on page 55, for a discussion of active vs. passive use of digital & social media.

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7.1 KEY PRINCIPLES: AESTHETICS & FUNCTIONALITY OF DIGITAL ASSETS External Links and Support

Refer to pages 23 of insights form Greig’s case study for discussion of importance of offline support groups and of the ‘third space’.

The importance of also discussing mental wellbeing related issues and receiving support in an offline environment should be encouraged and there should be clear links to offline services available. Digital assets, including online peer support, can be key in encouraging young people to seek help. Tools such as DocReady, the first Innovation Labs project to launch, can assist with planning appointments and managing expectations.

One of the strengths of internet based mental health support is the protection felt from the sense of anonymity; vulnerable (or otherwise) young people are able to find information privately and express themselves in ways they may not feel confident doing in an environment where they are known. However, a reliance on digital media alone as a means to self-realisation, support and social interactions was felt by the young people we worked with to be insufficient for a prolonged sense of wellbeing.

Users should be encouraged and provided with the information that will allow them to make best use of NHS offline support services and those of relevant third sector groups. Ideally this would also work vice versa, with offline NHS services helping young people to manage their online behaviour. Online and offline services should complement each other, rather than one being seen as a replacement or addition to the other.

A person’s online life should be part of their assessment on referral to CAMHS or other services, with support given to both positively managing problematic online activities and harnessing the benefits of helpful online activity in both inpatient and outpatient settings. This relies on clinical staff being able to undertake these assessments and implement activities in care planning.

ONLINE AND OFFLINE SERVICES SHOULD COMPLEMENT EACH OTHER, RATHER THAN ONE BEING SEEN AS A REPLACEMENT TO THE OTHER. ONLINE BEHAVIOURS NEED TO BE MANAGED AS MUCH AS OFFLINE BEHAVIOURS.

Refer to page 50 for discussion of blurring of young people’s online and offline world’s.

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7.1 KEY PRINCIPLES: EMERGENCY CONTACTS / AGE GUIDELINES / HUMOUR

Refer to insights gathered from codesign sessions on page 83 for young people’s ideas on Emergency Instant messaging and the importance of humour.

Emergency Contacts

Age and Maturity Guidelines

Any digital asset created must have emergency contact options clearly available for those who are in distress, or supporting those who are.

There is also a clear desire amongst young people for an emergency instant messaging service to complement the phone lines and drop in options provided by organisations such as the Samaritans.

Not being patronised was a key concern of the young people we worked with. When thinking about target age groups, there was not a huge deal of difference in our sessions between the 15 years olds and the 21 year olds in terms of their awareness of mental health issues and ability to discuss these. We would therefore recommend that any work be targeted at the older end of any age bracket or even that age would not be a key concern, favouring instead individual circumstance and emotional maturity.

‘Humour’ as a Support Tool Humour, used appropriately, is a powerful tool.

There was a sense of frustration amongst many of the young people with recognised mental health problems that issues surrounding mental health were either addressed too delicately and seriously / clinically or with ignorant insensitivity.

The young people we worked with felt that a well-informed, humorous approach would be favourable; careful co-design would be required in order to gauge this. It is a case of humour being used as a tool to enable young people to make light of their own situation in a constructive way in order to better cope with it and to share it; simultaneously insensitive jokes need to be called out as unacceptable.

It is clear that absolute age boundaries are not helpful, and in wider discussions with stakeholders, it is clear that both younger young people, and older young people outwith the ‘traditional’ secondary school age bracket can be missed. It was outwith the scope of this project to investigate the use of digital assets in mental health for primary aged children, but this would be a key area for further exploration, given that whilst younger young people will seek information, and assets for teenagers may not be appropriate for younger children, however mature.

Refer to insights gathered from Jenny’s case study and the engagement sessions on page 64 for young people’s concerns as regards feeling patronised / not taken seriously...

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7.1.2 RECOMMENDATIONS FOR A ‘DIGITAL SPRINGBOARD’ Central to our recommendations is the concept of a digital platform to enable young people to access a range of mental health assets. This could include an iterative, user-centred and part crowd-sourced / part curated online directory of available mental health support services.

It was clear though, that such a platform should be more comprehensive than a simple signposting site and act instead as a flexible digital toolkit that young people could use in a variety of ways to meet their individual requirements.

The platform would be aimed at all young people, not only those in distress or with a recognised mental health problem. The specificity for young people, and the universal targeting of the platform would differentiate this from Project Ginsberg, although there could be commonality in approach and shared assets or tools if appropriate. Equally, the use of APIs might enable other assets like ALISS to provided content.

There are several examples of service directory development in current use. WellHappy in NHS London, and WhereToGoFor in Brighton and Hove both have listings for assets in a specific local area, and would be useful examples to study, and potentially collaborate with. Rating systems are challenging when rating public services, and organisations such as Patient Opinion might be useful partners to consider in terms of enabling rating and reviewing within appropriate boundaries. Finally, work by NHS Tayside on Need2Talk shows that a small amount of time from NHS staff can maintain a digital service without large capacity concerns.

NHS GGC should be aware of the future developments planned for Breathing Space and other ehealth initiatives in Scotland in this regard, as well as databases such as ALISS. There is an on-going question as to whether the NHS and public service should seek to duplicate the offer of third sector providers, or whether these providers have sought to use multimedia and social media to connect to young people when the NHS is not. Key examples such as TheSite, SelfHarm.co.uk and Life.Live It show the value of multimedia content.

A DIGITAL SPRINGBOARD (OR GATEWAY) CONSISTING ITERATIVE, USER-CENTRED AND IN PART USERGENERATED CONTENT SHOULD BE DEVELOPED. IT SHOULD FOCUS ON SUPPORTING MENTAL WELLBEING (IE. NOT SOLELY ON MENTAL HEALTH ISSUES). THE PLATFORM SHOULD INCORPORATE A DIRECTORY OF USEFUL SERVICES, BUT GO BEYOND SIMPLY ACTING AS A SIGNPOSTING SITE, ALSO PROVIDING A FLEXIBLE DIGITAL TOOLKIT FOR YOUNG PEOPLE.

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7.1.2 DIGITAL SPRINGBOARD: PHASE 1: SERVICE DIRECTORY The aims of this ‘springboard’ can be best envisioned in four phases, based on discussions with young people in the project sessions.

PHASE 1: SERVICE DIRECTORY PHASE 2: ADVICE DIRECTORY PHASE 3: TOOLKIT FOR WELLBEING PHASE 4: LINKS & CONNECTIONS

TO WIDER SERVICES. These four phases could be developed simultaneously if possible, but also allow for a staggered approach. This staggered approach is perhaps more desirable in regards to the flexibility it offers. Building in this agile way would allow for greater responsiveness to emerging use patterns.

PHASE 1: SERVICE DIRECTORY The creation of a reliable and officially approved directory of both online and offline support services is key. There are a wealth of resources available that are lost in the noise and no reliable guide to test their quality, effectiveness and safety.

Initially, we recommend this directory would be curated and reviewed by mental health experts.

This would create a base of approved resources for all aspects of mental health support and the general promotion of mental wellbeing; such as, websites, forums, apps, social media streams as well as a broad selection of offline services.

Ideally, this initial curation would also include resources (and reviews of these) suggested by young people with lived experience in a coproduced stage of development. Crucially, the service users could then begin to add to the directory once live. This will ensure the directory remains up to date and relevant. Users could offer their reviews of the services within the directory and suggestions for new resources to be added.

These suggested additions by users would need to be moderated. Ideally this would be done officially by a mental health expert. However, the feasibility of this would depend on the scale of user activity. If the directory were to get a large amount of traffic, it may be that the amount of expert moderators needed to respond quickly

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7.1.2 DIGITAL SPRINGBOARD: PHASE 2: ADVICE DIRECTORY PHASE 2: ADVICE DIRECTORY

Refer to insights drawn from Greig’s case study on page 21 in regards to the problem of information overload. Also refer to page 16 for considerations for young people with dyslexia.

enough to keep the directory current would not be economically viable. In this instance, user-led moderation could be considered. In order to make this as low-risk an option as possible, the service directory would need to be framed correctly, with a clear identity, ethos and code of expected behaviours (as outlined in the principles in the previous section.) The kinds of services being suggested as effective would also provide key insights into the attitudes and needs of young people and help to detect trends (as would any reviews given of the directory entries.)

The ways in which users could search through the directory would be vital to its success. In depth research would need to be conducted to understand the kinds of search terms young people are using (and not using) in order to find information about mental wellbeing. New ways of thinking may be required in helping young people to find the content they need; it may be that searches need to be based more on emotions or specific situations than given mental illnesses, conditions or symptoms. A tool (or tools) may also be required that helps young people to define exactly what it is that they are searching for. Careful consideration would of course also need to be given for the ways in which the search results were displayed and filtered. Long lists of information can be off putting and difficult to process.

An extension of the service directory as described in phase 1 could be realised through the creation of a separate directory of advice, practical tips and inspiration for maintaining mental wellbeing and managing mental health problems. Many of the services the young people would discover through the service directory would provide them with this kind of information. However, creating a central, easy to navigate directory would be extremely valuable; again, this would be part expert curated and part user generated with appropriate moderation strategies. A step would be deleted in trying to find answers to quick queries and information browsing. It should follow the same principles and processes as the service directory; again, the balance of expert and user generated content is key.

The advice and tips should come in a variety of audio-visual formats and be quick and easy to digest and, crucially, to share. Video clips, short quotes with attractive images, songs and inspiring talks are likely to be disseminated to young people through other forms of social media (Facebook and Twitter in particular) and hence reach a wider audience.

Refer to the young people’s ideas on page 75 and in particular the Button Wall and Support2 concepts on pages 76 and 79, as a illustration of the importance of both expert curated and user-generated advice and tips to young people in regards to mental health support.

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7.1.2 DIGITAL SPRINGBOARD: PHASE 3: TOOLKIT FOR WELLBEING PHASE 3:TOOLKIT FOR WELLBEING

Refer to page 76 for a description of the young people’s ‘Button Wall’ concept.

Once the directories are in place, more active use of the ‘springboard’ can be encouraged. Users would be able to collect and store the sites, forums, apps, tips and advice as widgets and information streams to return to, creating their own unique ‘toolkit’. By information streams, we are not simply implying that the content gathered would be stored in a chronological, linear “wall” like arrangement (as is the case with many digital and social media platforms). More intuitive ways of storing, grouping and searching for information is required so that users may shape their ‘toolkit’ to their specific needs. The ‘Button Wall’ concept devised by the young people in our co-design sessions provides an interesting starting point in conceiving ways in which this could be done.

More co-design, prototyping and user-testing is however required to establish how exactly these streams could work; different kinds of streams may well be required depending on the user’s situation and reasons for using the ‘toolkit’.

Advice should be given and parameters for use should be put in place in order for the ‘toolkit’ to become the most effective self-management tool possible. Users could be led through suggestions and helped to work out (through cleverly designed questions) what kinds of tools and advice would be useful for a given situation.

There could even be a variety of ready-made ‘skeleton’ templates available, designed for

different user groups and which the young user could then add to or detract from as works for them. These templates should give a sense of structure and progression; the four basic steps for wellbeing outlined at the beginning of this section could provide a base for this structure, with suggestions of tools and advice provided for each step.

Users of the toolkit should also be prompted to reflect on their use process at regular intervals and encouraged to evaluate its effectiveness. We recognise the possibility for addictive behaviour to develop in the use of digital and social media; it is easy to become stuck in habitual use patterns that may not have the most long term positive effect on mental wellbeing.

Leading questions would prompt users to think about the exact ways in which they are using any tools and advice, if they are actioning positive behaviours on- and offline as a result of using the toolkit, and encourage them to reflect on and monitor their mood and sense of general wellbeing. Importantly, users would be asked to consider if they are managing to maintain positive mental wellbeing without further support. Clear direction and encouragement to contact offline NHS and third sector support services would be provided for those who feel they are struggling to cope with self-management. Further to this, there

Refer to page 52 for a discussion of excessive use of social media amongst young people.

Refer to insights drawn from Jenny’s case study on page 33 and Greig’s case study on page 23 for a discussion of the importance of sustained background support and ‘mini check ups’ for young people with mental health oproblems.

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7.1.2 DIGITAL SPRINGBOARD: PHASE 4: CONNECTIONS TO WIDER SERVICES PHASE 4: CONNECTIONS TO WIDER SERVICES is great potential for the toolkit to join up with wider NHS services in more concrete fashion, as will be outlined in the explanation of phase 4.

Refer to insights from Greig’s case study on page 21, and insights gathered from the engagement sessions on page 55 for a discussion of active vs. passive use of digital & social media.

This phase assumes an active use pattern and is deliberate in doing so; as discussed in the previous section, moving from more passive information browsing to active self-management is an important shift. However, it is also important that benefits can be derived from more passive use. There may be many users who don’t feel ready or even the need to take more active steps to self-management; there may be users who simply wouldn’t intuitively use or feel uncomfortable using digital media in this sense and will have their own means of selfmanagement. To this end, it should be possible for users to browse example ‘toolkits’ without actively using their own. There should also be the possibility for users to anonymously share their own toolkits and tips (after moderation).

The sharing of content is the crux of any thriving social media platform and as we have seen, the sense of helping and sharing advice with others is beneficial to wellbeing.

In addition to the inclusion of offline NHS and third sector services in the service directory (and the opportunity for users to review and recommend these services) there is potential for the development of direct connections with wider service provision. We would suggest that such connections will be important in ensuring the long term success of any digital asset developed.

Online assets should not be seen in isolation from offline ones, in much the same way as a young person’s online behaviour should not be viewed as distinct from their offline life.

As a bank of reliable digital tools builds up, a number of these could become points of interface with GPs, counsellors or CAMHS team members, or even additions to prescribed treatments. Advanced mood trackers and emotion management tools, story sharing and medication logs immediately stand out as possible candidates, but this is by no means represents an exhaustive list. Coordination with a service such as ‘Doc Ready’ - the remit of which is to prepare young people affected by mental health issues to make the best possible use of an upcoming consultation with their GP could also prove extremely valuable in this regard.

Refer to pages 23 of insights form Greig’s case study for discussion of importance of offline support groups and of the ‘third space’ ...

Refer to page 17 of the mapping document in the appendices for further explanation of the Doc Ready service.

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7.1.2 DIGITAL SPRINGBOARD: PHASE 4: CONNECTIONS TO WIDER SERVICES PHASE 4: CONNECTIONS TO WIDER SERVICES A well designed digital toolkit could provide an important ‘touchpoint’ and sense of support and structure before and in between appointments for young people within the mental health system.

It could also aid in the joining up of the different NHS services that a person uses. As we have seen from the case studies contained within this report, connections between different arms of service provision are not as effective for some users as they would expect and can cause problems.

Refer to pages 25 and 31 of Jenny’s case study for a discussion of the problems of disconnect in NHS services.

Refer to insights gathered from codesign sessions on page 83 for young people’s ideas on Emergency Instant messaging

As should be the case with any digital asset created, emergency contact options to services such as the Samaritans should be very easy to find for those in distress. Additionally, there was a desire from some of the young people we worked with for an online mental health specific ‘NHS 24’ type service that was not an emergency contact, but that allowed you to send messages asking questions or for advice at any time. This could of course be a costly service to run and unlikely that instant responses would be possible, though low cost examples within the NHS, such as NHS Tayside Cool2Talk do exist. The effectiveness of such a service would therefore rely on the setting of clear parameters of use and user expectations; it should be made very clear who would be responding and within what timeframe, with emphasis placed upon the fact that the service should not be used for emergency queries.

Finally, we suggest a linking with wider cultural, sports and special interest groups. As has been discussed in the findings section of the report, self-realisation through interests away from home and educational spaces is very important in the well-being of young people. The ‘springboard’ should demonstrate this importance in imaginative ways and encourage users to join such groups. It could provide information on local groups and facilities and perhaps incorporate some kind of incentive scheme or subsidy program. Cultural organisations running arts (or other such) projects specifically related to mental health and self-realisation could also use the ‘springboard’ as a platform to advertise for participants and proposals, or to run competitions and online exhibitions.

Refer to page 97 of the literature study for a discussion of the importance of creativity and cultural activities in identity formation in young people.

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7.1.3 RECOMMENDATIONS FOR INDIVIDUAL DIGITAL ASSETS Recommendations for individual digital assets In this section we present recommendations for the kinds of digital mental health support assets that could be included in or hosted on a ‘digital springboard’ platform Some may be existing assets that users could be directed to, or could be purchased or funded by the NHS. There are also further concepts the NHS may wish to consider developing themselves.

An imaginative, multimedia ‘moodtracker’ / tool for expressing and understanding mood and emotions There is a clear need for a ‘moodtracker’ type tool that goes beyond recording emotions and states of mind in numerical or ‘sliding scale’ form. For the young people we worked with, the subtlety emotions were far better expressed and realised through images, animations and video clips, music, quotes from literature and poetry, and stories. An effective tool would ask young users to select and store such content in order to express their emotional state as richly as possible, but also prompt them to reflect on what they had chosen and to work out why they had done so.

Refer to the young people’s Button Wall concept on page 76.

Such a tool has great potential for linking with services provided by GPs, counsellors and CAMHS teams. In this case - particularly in regards to the tight timeframe GP appointments are governed by - it would be important that such a tool would prompt young users prior to an appointment to filter through and select the content they feel will be most useful to express their state of mind, and to work out how they could explain this to someone else. In lengthier counselling sessions, it may be feasible and advantageous to work through more of the content in greater detail.

For more ideas on how such a tool could work, we refer you back to the ‘Button Wall’ concept generated during our co-design sessions. Mood trackers and recovery journaling tools have consistently been identified by young people as

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7.1.3 INDIVIDUAL DIGITAL ASSETS: ONLINE SUPPORT COMMUNITIES digital assets they would wish to use. My Journey is an android app already available for use by young people in touch with early intervention services. Within the Innovation labs projects two mood tracker/metrics assets are being developed.

MiniMe will target young people experiencing mental health problems, enabling them to record their moods and relate these to events with a view to supporting recovery through developing insight. Mind’s Eye is being developed by MindApples, as a mood tracker with a social dimension, aimed at a general audience of young people who want to mentor their moods and connect with feelings.

Online support communities

Refer to the young people’s Support2 concept on page 79.

Online communities centred on mental health issues exist in abundance and thanks to the anonymity and solidarity they offer, vulnerable young people are often able to discuss and find support for issues that they otherwise might not offline. Users of informal online peer support communities often report their benefits, but there are on-going concerns that unmonitored communities can become detrimental to a young person’s wellbeing. There is certainly a need to better understand the dynamics of pro-ana and other forums that promote eating disordered behaviours or self-harm.

There was a desire amongst some of the young people we worked with) for properly controlled

and monitored forum environments, that allow young people to share advice, stories and support amongst themselves, but also to receive expert input and guidance.

Forum discussions could be monitored by professionals, who would offer official advice on the forum topic and respond to individual comments. They would essentially act as discussion invigilators, looking out for both the general mood of the discussions and for the wellbeing of the individual contributors. They would have the power to hide inappropriate comments and to contact any users they become concerned about through means of a private message. They would also be contactable for any users that become distressed or uncomfortable with comments made in the forum.

Such professional involvement could prove costly, so again, the effectiveness of such a service would depend on the correct managing of users’ expectations of the level of professional involvement, but also on fostering a positive forum environment that promotes self-regulation.

There could, for example, be allotted times at which users can ask questions directly to a mental health professional; at all other times their involvement would be far more ‘handsoff’, perhaps only acting only if alerted to something by forum members. Forum themes should be framed in a positive manner and clear parameters set for the expected behaviour of users. Each user could be asked to set trigger warnings and appropriate trigger filters would

Refer to pages 69 and 108 for a discussion of young people’s self management of risk in relation to social media.

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7.1.3 INDIVIDUAL DIGITAL ASSETS: ONLINE SUPPORT COMMUNITIES need to be in place. Users would be encouraged to report anything inappropriate or negative to the professional moderator and to be extremely mindful of their own and each other’s wellbeing.

More careful research and co-design would be needed to identify ways in which to foster the most positive forum environment possible, but, as was suggested by a young person in our core codesign team, the key to this may lie in creating a clear, beautiful and positive identity for the forum space and its ethos.

Refer to the mapping document in the appendices for more detail on managed mental health forums already in existence, such as Big White Wall.

As has been discussed previously in the report through the explanation of the young people’s ‘Support Squared’ idea, it is a natural instinct for young people to seek to build friendships with those that they feel they connect with on certain issues. From this instinct comes the desire to be able to talk to others they might find on a forum on a one to one basis. Private messaging between forum users is not, however a function that we would recommend, due to all manner of problems with risk. Users should be asked not to give out email addresses and personal details, and this need to be monitored by the discussion invigilator. Instead, forum users actively seeking friendship should be encouraged to attend local offline community and support groups.

Managed mental health forums for young people, and the general public do exist. Big White Wall provides a paid for/bought in by local NHS moderated space for self-expression and support. TheSite offers an online peer support environment, and YouthNet collaborated with

European partners to develop best practice guidelines for providing online peer support for young people who self-harm. Finally, the new BeatBullying platform MindFull combines elements of peers support with online counselling in a managed online space for young people.

Services specifically aimed at young people supporting other people with mental health problems This could include a host of services, including story sharing, forums, tips and advice on what best to say and do in different situations delivered through various imaginative and interesting means, etc. What we would like to emphasise through this recommendation, however, is the importance of framing a digital asset in this way.

A huge number of young people, who may not be experiencing mental health problems of their own, are acting as support for those who are, often without fully realising that this is what they are doing. It is important that this is recognised and that they are provided with a space that will allow them to do this most effectively, but also allows them to vent concerns, and encourages them to look out for their own mental wellbeing whilst bearing another’s burden. As mentioned previously in the overriding recommendations at the beginning of this section, it may be that some young people, that are difficult for mental health support services to reach for a host of reasons, can only be accessed via concerned friends and

Refer to the young people’s Support2 idea on page 79.

Refer to Ben’s case study on pages 43 and 47 for a discussion of peer support, and to a discussion on the importance of emotional openness in social networks in Lisa’s case study, page 41.

See pages 65 and 105 for further discussion of peer support.

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7.1.3 INDIVIDUAL DIGITAL ASSETS: EMERGENCY INSTANT MESSAGING and peers. Equally, providing young people with the premise that they are seeking support for a friend rather than themselves may allow for greater engagement.

Emergency 24 hour Instant Messaging service for people in distress

Refer to insights gathered from codesign sessions on page 83 for young people’s ideas on Emergency Instant messaging

This would act as an addition to the phone lines and drop in options provided by organisations such as the Samaritans. Young people, as digital natives, are very much at home communicating via instant messaging and online chat functions.

For some vulnerable young people experiencing distress this would be a far more comfortable and intuitive option than a telephone conversation; some may even feel an inability to call for help.

This would of course require a great deal of training and for infrastructure to be put in place, but could be crucial.

We also recommend that training offered in terms of suicide prevention and mental health first aid should include the use of social media and IM to interact with peers and to conduct suicide prevention interventions.

Dissemination of advice on how to maintain positive mental health The young people we worked with found it difficult to name positive, everyday measures that would allow them to look after their mental health. This was in stark contrast to maintaining physical health, which all could discuss with confidence. Advice needs to be compiled and promoted that will encourage the day to day maintenance of good mental health. The most comprehensive and ambitious means to do so would be through an extensive campaign that would extend beyond a single digital online asset to the school curriculum, and would also attract opportunities for private companies and third sector groups. ‘see me’ produced and activities pack for schools and youth groups which was launched in 2012 and the Glasgow Anti-Stigma Partnership has run sessions in schools in Glasgow since 2009. There may be scope to build on these sessions with a mental health improvement message.

Refer to page 63 for discussion of need for positive framing in mental health support.

The power of rapid information dissemination online could be harnessed with a carefully thought through digital campaign, that targeted social media sites such as Facebook, YouTube and Twitter. This would need to utilise a range of techniques, mediums, styles (and most likely celebrity endorsements) that tied in with internet trends amongst young people at the time.

Crucially, the information would need to be in a format that young people could adapt and share easily and may require a well-publicised event to

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7.1.3 INDIVIDUAL DIGITAL ASSETS: PRACTICAL TIPS / EMPATHY TOOLS act to stimulate interest. The campaign could also encourage active user participation in order to create sustained impact; users could, for example, be encouraged to share a positive thought, image or action each day in a social media stream, or send a positive message to a friend.

Practical, day-to-day tips for self-management of common mental health problems

Refer to page 64 for a discussion of a favouring of self help amongst some young people. See page 83 for the young people’s ideas on self management

This is in close relation to the previous recommendation, but specifically targeted at those managing common mental health problems. The usefulness of creating ‘to-do’ lists and schedules that remind you to enact certain positive behaviours and give you a sense of reward for carrying out simple, daily tasks came up in both the engagement and co-design sessions. Feeling that you are able to take practical tangible steps to help you through the daily management of an illness is important. With the proliferation of smart phones, a calendar-type app designed specifically for different kinds of mental health management could prove a valuable digital asset.

There was also an interest in sharing practical tips and positive coping mechanisms; this could be realised in a variety of online formats, using both existing assets and looking for opportunities to develop new approaches.

Empathy tools There was a desire especially amongst the young people we worked with directly affected by mental health issues, to hear heartfelt, non-glamorised accounts of what it is like to live with mental illness on a practical, day-to-day basis. These could be in a variety of formats; video, audio, comic illustration, written etc. Such accounts were seen as not only important to those suffering from mental ill health as a means to contextualise their own situation, but also as a means to fight stigma. A digital space for sharing these, backed by a wider campaign, would be welcomed.

Further exploration of the possibilities of gaming Gaming was discussed quite frequently during our initial engagement sessions, but hardly featured in the later co-design stage. This may have due to the core co-design group being made up of young women (as discussed in the limitations section of the report), whilst the more lively conversations about gaming had come from mixed gender groups in the earlier stages of the project.

Whilst being unable to recommend any specific use for gaming in the mental health sphere, we would recommend further research to explore its potential and examining work that is already under way in this field. Many of the young people during our engagement group discussions saw potential in the role play aspect of games as an empathy, learning or enactment tool.

Refer to page 83 for a discussion of the young people’s ideas on empathy tools.

Refer to pages 20, 60 and 101 for further discussion of the potential of gaming.

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7.2 WIDER RECOMMENDATIONS The discussions we had with young people and the ideas they put forward for service improvement were not limited to digital and social media. For the young people, a sea change in perceptions of mental health was seen as pre-requisite for the lasting impact and success of any digital asset created. This has led us to make a series of wider recommendations that would not only compliment and strengthen any innovation in the digital and social media realm, but in fact play a crucial role in the success of a campaign for a more pro-active approach to mental wellbeing.

Online/Offline Duality For young people, the line between online and offline ‘life’ is increasingly blurred. They spend large amounts of time online; some are connected at all times (not always in an active capacity) to social networking sites via their mobile phones. Offline and online social interactions, activities and communication often happen in simultaneity. There needs to be an acknowledgement that online behaviour is quite simply behaviour; online habits, activities and occurrences play as important a role in the mental wellbeing of a young person as offline behaviours and happenings. Online behaviour needs to be discussed and managed when advising, counselling and working with young people; it needs to be seen as an important part of their behaviour in general. Relevant workforces will need to be given the proper training to enable them to do this effectively and with confidence.

Refer to page 50 for discussion of blurring of young people’s online and offline world’s.

Digital Innovation in Public Service Published good practice, and interviews with relevant stakeholders pointed to a need for NHS and public services to take the opportunity to use co-production and digital innovation techniques such as agile development, and lean start-up principles to design, prototype, and learn in delivery. NHS GGC has an opportunity to become an NHS centre for good practice in Scotland for encouraging learning and innovation, building

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7.2 WIDER RECOMMENDATIONS: REVERSE INEQUALITY / EMOTIONAL LITERACY on this work and incorporating learning from programmes such as Innovation Labs. Investment of relatively small sums to develop, prototype and learn from ideas developed through hack weekends and similar intensive development processes could make a significant contribution to emental health in Scotland and beyond.

Reverse Inequality Evidence from both published studies and the co-design sessions show that access to technology is not equally distributed in Scotland and in Glasgow. A cautious approach is often taken by the NHS as regards digital service provision, for fear of excluding those without access to technology. That said, it is clear that it isn’t always the technical barriers that inhibit participation. Most of the young people we spoke to had access to the internet, and functioned as digital citizens, even notwithstanding the various inequalities they experienced.

Evidence indicates that young people will prioritise digital connectivity, and therefore services should take account of these choices in accessing those they seek to connect with.

Many young people could be described as digitally dominant; they will wish to engage with services primarily through digital means. The digitally dominant should not be excluded by not providing for them.

We recommend realistic equality impact assessment of digital innovations. Whilst it is true that expensive devices like iPhones with unlimited data are hard for most young people to access, most people are able to use technology and email.

Any brief for digital development should ensure that developers understand the audience for the asset. An assessment of the type of device used by young people, and the restrictions they face is critical to ensure that the drive to use the newest cutting edge technology does not override the needs of the end-user.

Emotional Literacy The importance of emotional literacy was central to many of our discussions with young people.

Increasing the level of emotional literacy amongst young people was seen as a crucial to aid in the prevention and treatment of mental ill-health, and as a means to combat stigma surrounding mental health issues. The young people called for emotional literacy to become a core part of the school curriculum, and to be given as much importance as physical health in this regard (moreover, it shouldn’t been seen as entirely separate from physical health.) In light of a previous point, the discussion of emotionally healthy behaviours would include online actions.

The need for specialist teachers in this area was identified. At the very least, we would recommend

Refer to page 74 for the young people’s ideas for the improvement of emotional literacy through teaching in schools.

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7.2 WIDER RECOMMENDATIONS: FIRST RESPONSE IN SCHOOLS regular sessions delivered by visiting experts.

In line with previous recommendations, teaching should take a pro-active and positive approach to emotional wellbeing, not simply aiming to raise awareness of issues, but to outline and enact practical steps and techniques that young people can use on a daily basis.

First response in schools Refer to Greig and Jenny’s case studies on pages 17, 25 and 31 for a discussion of the importance of a good first response with in schools.

Many young people had negative experiences as regards the handling of mental health related issues in school, both in terms of wider policy based issues and the actions and comments of individual teachers. Comprehensive training is required for teachers in terms of conduct relating to emotional and mental health related matters, and in order to give them greater confidence, support and resources in providing the first response to a mental health related incident in school. ‘Youth Mental Health First Aid’ and appropriate courses on managing distress should also be a part of normal first aid training for teachers, and taught in schools to pupils, ideally by peers.

There was a desire amongst young people to have a designated, specially trained member of staff available in times of distress. In practice this may present many difficulties; young people very often do not want their friends and peers to be aware that they are experiencing emotional and

mental health difficulties, and may fear being seen discussing something with this designated member of staff. However, having more than one member of staff equipped to respond effectively to young people in distress would alleviate this.

School nurses could also provide an authority figure in this sense, given the correct training and support.

In terms of wider school policies, a positive outlook is required. The pro-active promotion of student (and staff ) mental wellbeing needs to be a top priority. It is crucial that young people experiencing emotional distress or difficulties with mental illness are not treated in a manner that gives the impression of punishment or disruption.

Self-realisation and cultural activities In the findings of this report and previous recommendations, we have acknowledged the importance of the ‘third space’ in regard to a young person’s mental wellbeing. Self-realisation through sport, the arts, and other hobby and extra-curricular activities is crucial. Importantly, these need to take place away from school, allowing the young person to gain friends in entirely different social circles, and form a different set of adult authority figures (ie. not teachers or family). A campaign is required to encourage all young people to have at least one such outlet, with incentives and subsidies provided as required. Cultural organisations and

Refer to page 97 of the literature study for a discussion of the importance of creativity and cultural activities in identity formation in young people.

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7.2 WIDER RECOMMENDATIONS: SELF REALISATION & CULTURAL ACTIVITIES programs should be approached as a means of promoting emotional and mental wellbeing. The more widespread the events, festivals, tv and radio shows, etc that have mental health as a concern, the more effective and wide-reaching the message.

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7.3 RECOMMENDATIONS: USE OF EXISTING SOCIAL MEDIA BY THE NHS Through the findings of this report and previous recommendations, we have demonstrated that a variety of specifically designed, individual digital spaces are needed in order to provide young people with effective mental health support. However, given the power of social networks such as Facebook, YouTube and Twitter in terms of rapid information dissemination to a very wide audience of young people, it is important to make best use of them.

The three specific social networks mentioned above - Facebook, YouTube, and to a lesser extent, Twitter - have been highlighted as they have demonstrated sustained use by young people over the last few years.

However, the digital landscape changes rapidly; the interactions that the aforementioned networks afford are often modified, and shifting trends see other social networks gaining or losing importance in young people’s internet use

Tribal Use of the Web Young people’s internet use tends to be tribal, both in terms of what social media platforms they use and how and why they use them.

These ‘tribal’ use patterns are not dependent on geography or even on a young person’s offline social circles, and will shift within individuals overtime. Therefore, the most sustainable form of recommendations that we can make in this regard centre around interactions that different social media platforms afford, rather than specifically looking at how to use any one network alone.

(We would also recommend the appointment of young people as social media managers, as they will be most aware of trending modes of social media use and best aware of how to disseminate information/use the appropriate channels.)

Content Generation and Sharing The sharing of links and pieces of individual content is a core interaction. Content most often shared by young people includes video (including ‘Vines’), music, images (including animated gif’s) and short clips of text in the form of a ‘tweet’ or ‘status update.’ We would recommend the creation of a body of such content, containing useful information, but that is crucially interesting and attractive for young people to consider sharing across a range of social networks. (tips/ info/advice) From the aforementioned, well made

Refer to the young people’s content sharing based concept ‘Button Wall’ on page 76.

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7.3 RECOMMENDATIONS: USE OF EXISTING SOCIAL MEDIA BY THE NHS and attractive videos are particularly useful in terms of their ability to deliver more complex content in an inclusive and engaging way.

As well as allowing the dissemination of fragmented pieces of useful content, specific awareness and public information campaigns could make very effective use of these channels.

NHS Brand

Refer to Jenny’s case study insights on page 33.

The NHS is without question a trusted brand with young people for health related information. There is a need for the NHS to understand better ways in which it can maximise this with young people, whilst also being mindful that some ‘tribes’ of young people who may need information may not be so welcoming of ‘official’ channels. It is possible that addressing information in a separate, linked brand may provide an avenue to explore this. WellHappy for instance chose the app route so that it could use a strong brand without and obvious NHS name in the title.

Public Conversations Including Young People It is possible to engage young people in more direct communication through tweets. comment feeds, forums etc. Even if not actively participating, young people can benefit from reading conversations of others (this makes impact of service difficult to measure). Clear parameters of use and expected behaviours need to be set.

There is the possibility of interrupting trending negative or potentially damaging conversations amongst young people through hashtags (such as #cutforbieber), commet feeds, forums etc with positive messages/advice/tips. This needs to be done with sensitivity and by an appropriate voice to ensure young people don’t feel intruded on, and subsequently wary of using the platform openly.

Blogging Blog posts provide for more passive use but allow more complex ideas and reflective personal pieces to be expressed. They could be used as empathy tools and give NHS services a more personal, relatable ‘face.’ Programs should be approached as a means of promoting emotional and mental wellbeing. The more widespread the events, festivals, TV and radio shows, etc that have mental health as a concern, the more effective and wide-reaching the message.

Refer to the young people’s ideas on multi-media campaigns on page 73.

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