No ‘one size fits all’: three years of Someone To Talk To

Offering flexible support without the need for stringent eligibility criteria is an effective way to engage young people so that they get the right support for their mental health

Three years ago, we launched the Someone To Talk To pilot – a ground-breaking piece of work which has become a standard part of our drop-in model today. Read how we challenged how ‘hard to reach’ young people are perceived and included in Centre 33’s services and what impact our new model has on their mental health.

How did this work come about?

In 2018 we invested in some data collection and noticed a pattern of young people who weren’t responding to our ‘traditional’ offer of 6 structured counselling appointments. These young people were generally engaging less consistently with support and showing poorer outcomes.

We identified these groups as having higher health inequalities and more complex and inter-related needs than their peers.

Research shows that young people with high levels of structural challenges including homelessness, financial deprivation, and Adverse Childhood Experiences, generally have poorer access to mental health services and poor outcomes.

We believed these groups of young people didn’t have the structural and social capital around them to:

1. Find and access this rigid structure of help
2. Consistently engage with it.

We knew they were not well served locally, and we wanted to do something about it.

With funding from the Department of Health and Social Care VCSE Wellbeing Fund and support from the Centre for Mental Health we embarked on a project within our ‘Someone to Talk to’ drop-in model to tackle this troubling health inequality and piloted a more flexible and engagement-focussed service offer directed at those young people who we were not successfully reaching.

The project was launched at the end of 2019.

What did we do?

We look at the whole person

We know that 81% of young people seeking support from us have a mental health issue alongside another issue. This could be to do with housing, budgeting, sexual health, education, or employment.

We know that it’s often the ‘other issue’ that gets them through the door and is negatively impacting their already fragile mental health. We employ Engagement and Support workers who work proactively to address young people’s immediate needs, build on their strengths, and work to reduce the complexity in their lives.

I was there to get counselling; a young couple came in with a baby asking for food parcels and I thought 'this is great'

We have drawn on the Adaptive Mentalization Based Integrative Treatment, which looks at other relationships around the young person, and work closely with agencies supporting with social care, housing etc.

We know that young people resist having to retell their stories – at Centre 33 they get advocates who are concurrently developing their autonomy. It is not uncommon for staff to spend hours on the phone sourcing accommodation or specialist support for young people to stabilise their situations.

I didn't have to be referred and hear back and go through a questionnaire and then told you are too ill or not ill enough

Our engagement is tenacious

Acknowledging the difficulties of maintaining engagement in some groups of young people requires longer term, tenacious, flexible, and patient support.

We abolished strict attendance criteria and invested in a ’trusted relationship’ with a youth engagement worker which allows the young person to communicate their situation and their capacity to engage without rejection.

“So I would just rock up on a Thursday afternoon at the walk in centre [without appointment] I would just get there … and then mosey in. Pre-Covid always a drop in, but I preferred that… I liked not having the fear and anxiety of cancelling an appointment or the fear of losing any help… Yes, if I’d had a particularly taxing day and the thought of having to bring everything back up again and then going home, which was kind of my issue at the time, it just wouldn’t have worked. At the time I didn’t have the capacity to explain that”

We are purposely flexible - adapting to individual needs

The model offers young people more flexibility and longer-term support – allowing them to dip in and out depending on their life situations without penalty. This innovation moves away from a culture of blame or hopelessness around a young person’s struggle to engage and towards a responsive solution.

We work together

A mental health support plan is co-produced with the young person to encourage agency. Plus, we offer a wider range of responses for support, using strong relationships with the young person to maximise their likelihood of engaging with help for their mental health:

• flexible support
• regular contact through check in calls
• counselling at times that suit them
• safety planning
• peer support or targeted group work.

It was good, every two weeks they called me just to check up and ask me a few questions

What is the impact of our work?

The Centre for Mental health has found that due to our flexible model:

• there is increased engagement in the non-traditional/structured group
• the trend of non-engagement is being reversed
• the more flexible model of non-traditional support has just as effective outcomes as the traditional model for their peers
• not only did the young people with more complex needs access more meetings with staff and more support minutes, but they achieved better mental health outcomes and were as likely to achieve their goals.

Interviews also support the findings – young people in this cohort are experiencing general mental health improvement, better understanding of their own mental health and ability to communicate about it.

“Without them I wouldn’t be where I am. They seem informal, but it’s been the best out of everywhere I’ve been.”

It seems that this group of young people are ‘not so hard to reach after all’. And our services just needed to flex to their needs.

Our determination to support those with health inequalities is paying off and we are proud of the progress we are making and the positive difference it’s making to the lives of young people.

No 'one size fits all'

Deputy Chief Executive from Centre 33, Meg Platt said “we have long known that involving young people in the design of their own support always results in better engagement. This pilot has enabled us to back this up with evidence of the strong correlation between flexibility, engagement, and better outcomes for young people’s mental health. It’s particularly evident in those facing health inequalities and it’s a huge piece of learning that we are very excited about.”

Centre for Mental Health chief executive Dr Sarah Hughes said: “Young people with mental health difficulties are not ‘hard to reach’ as they are sometimes labelled. Too often, services don’t reach out or they’re not flexible enough. Centre 33’s Someone to Talk To pilot shows that with the right offer of support, young people are easy to reach, and they use services according to what they actually need.

We need to look again at how mental health services work to ensure they don’t exclude young people whose lives are more complex and who need more bespoke support. Services should offer young people more choices about the support they get and how they want to access it. No one size fits all, and for young people it’s especially important that mental health support is compassionate, consistent, and responsive to what’s going on in their lives.”

If you want to read more about this project you can see the executive summary for the Centre for Mental Health report here and the full report here.

You can see more about our mental health support here.

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