Evaluating projects designed to alleviate mental health inequalities

Introduction to the Emerging Minds funded cross sector placement with Centre for Mental Health.

Dr Yasmin Ahmadzadeh, Postdoctoral Researcher from King’s College London.

Mental health inequality

There are many risk factors that can influence our mental health in negative ways, and these factors do not affect all people equally. Unfortunately, some population groups face far higher risk of poor mental health compared to other groups, due to material, racial and/or social disadvantage.

For people in these disadvantaged groups, mental health problems can be further exacerbated by lower access to mental health support services, in comparison to those in more privileged groups. When people from disadvantaged groups do gain access to support services, their experiences and outcomes are often poorer and, in some instances, cause further harm.

Centre for Mental Health describe this process as the ‘triple barrier’ of mental health inequality, affecting large numbers of people from different sections of society.

[see more information in this report by Centre for Mental Health]

Young people in contact with the criminal justice system

Government reports state that young people affected by ‘gangs and antisocial behaviour’ represent the 5% of young people responsible for 50% of youth crime (H.M. Government, 2011). These young people are most commonly depicted in the context of criminal activity. But many are among the poorest and most excluded in our society, dealing with multi-systemic risk factors such as poverty, racism, deprived communities, domestic violence, abuse, neglect, leaving care and homelessness (H.M. Government, 2013; Youth Justice Work Group, 2012). These individuals have high mental health needs, that are often unmet.

Research shows that young people in contact with the criminal justice system are three times more likely than other young people to have an unmet mental health need (Hagell, 2002). When these young people are able to access traditional health services, they are frequently regarded as a ‘difficult’ group (Chitsabesan et al., 2006). Most psychological interventions offered to young offenders are short term, disempowering and provoking. Evidence based interventions and therapies for those affected by ‘gangs’ are lacking (Fisher, Montgomery and Gardner, 2008).

[see more information in this report by Centre for Mental Health]

Centre for Mental Health and the Emerging Minds placement

Centre for Mental Health is a charity that provides research, economic analysis and policy influence in mental health. They aim to understand mental illness, to promote mental health and wellbeing, and to challenge inequality and disadvantage throughout the life course. Through the Emerging Minds placement at Centre for Mental Health (which has been a 3-month, part-time position), I’ve had the opportunity to support the team on several ongoing projects. These have included two independent evaluations of projects designed to support the mental health needs of young people who are in contact with, or at high risk of becoming in contact with, the criminal justice system.

The first project was based at a youth club in Haringey.1 Here, a programme has been set up to integrate mental health professionals within the youth club team, to offer accessible, flexible, culturally appropriate psychological support for young men. Many of the young people are exposed to chronic intergenerational patterns of disadvantage, linked to health, social and racial inequality. The aim of the intervention, delivered by Project Future, is to improve access to mental health and well-being support, by meeting young people in spaces that are safe and comfortable. Here, mental health professionals deliver evidence-based interventions in flexible and adaptive ways (e.g., via youth-led activities, informal conversations, etc.). Through the Emerging Minds placement, I have conducted semi-structured interviews and focus groups with the staff and young people involved, to feed into the independent evaluation of the project by Centre for Mental Health.

The second project was based in liaison and diversion (L&D) services across London.2 Here, a pilot intervention has been set up to integrate mental health professionals within L&D services, to offer long-term psychological support for young people. L&D services are designed to identify people with mental health or substance misuse difficulties, learning disabilities or other developmental vulnerabilities, when they first come into contact with the criminal justice system (as suspects, defendants or offenders). L&D services support people through the early stages of the criminal justice pathway, make referrals for appropriate health or social care, or divert individuals away from the criminal justice system to a more appropriate setting. The pilot intervention, delivered by St Giles Trust and Gateway, offers longer term, accessible, flexible and psychologically informed support, directly through L&D services. Through the Emerging Minds placement, I have conducted thematic analyses of reflective diaries written by staff on the project, to again feed into the independent evaluation of the project by Centre for Mental Health.

My work on these projects has highlighted to me the importance of providing flexible, long-term support to young people from disadvantaged groups, who present with multi-faceted needs, who often require family-wide support, and who have previously struggled to build trust with traditional, professional services. These are important steps to take if we are to address mental health inequalities in our society.

If you are interested in finding out more about this placement, please contact Yasmin Ahmadzadeh.

Email: yasmin.ahmadzadeh@kcl.ac.uk

Twitter: @yaszadeh

References

Chitsabesan, P., Kroll, L., Bailey, S., Kenning, C., Sneider, S., MacDonald, W. and Theodosiou, L. (2006). Mental health needs of young offenders in custody and in the community. British Journal of Psychiatry, 188(6), pp. 534-540.

Fisher, H., Montgomery, P., & Gardner, F. (2008). Opportunities provision for preventing youth gang involvement for children and young people (7-16). The Cochrane Library.

Hagell, A. (2002). The mental health of young offenders: Bright Futures – Working with vulnerable young people. London: Mental Health Foundation.

Home Office H.M. Government (2011) Ending Gang and Youth Violence: A Cross Government Report including further evidence and good practice case studies [online]. Available from: https://www.gov.uk/government/publications/ending-gang-and-youth-violence-cross-government-report [Last accessed 1 March 2021]

Youth Justice Working Group (2012) Rules of Engagement: Changing the heart of youth justice [online]. Available from: http://www. centreforsocialjustice.org.uk/library/rules-engagement-changing-heart-youth-justice [ast accessed 6 February 2017].

Footnotes

1 This pilot project is funded by Comic Relief.

2 This pilot project is funded by NHS London, run in partnership with the Metropolitan Police Service, St Giles Trust, Barnet Enfield & Haringey NHS Mental Health Trust, and Mind in Haringey.


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