Written evidence submitted by Evidence From MeeToo Education Ltd (CYP0122)

My name is Suzi Godson. I am the co-founder of MeeToo Education. We have developed the MeeToo mental help app, a scalable digital peer-support solution that has been independently evaluated and proven to improve mental health in young people. We have done extensive research into the problems with existing mental healthcare pathways and we are happy to share our findings and expertise to help the Government tackle this serious social problem.

The Problem

1.       There has been a measurable increase in the number of young people requiring support with their mental health.

In the last three years, the likelihood of young people having a mental health problem has increased by 50%. One in six children now has a mental health disorder, but 75% of CYP with mental health issues do not get the treatment they need (Children’s society, 2021). COVID has made everything worse. A 2020 Royal College of Paediatrics and Child Health snapshot survey of paediatricians across England, Scotland and Wales found a three - or fourfold increase in cases of children and young people with eating disorders at the end of 2020.

2.       There has been a measurable decrease in mental healthcare provision.

Reliance on 1-2-1 counselling models ensures that the Child and Adolescent Mental Health Service (CAMHS) cannot cope with demand. There is such a severe shortage of counsellors and many of the people delivering counselling are not yet fully trained. Staff shortages mean that at least 34% of young people who get referred into NHS mental health services are not accepted into treatment (Children’s society, 2021), and 54% of GP referrals for high risk young people aged 11-18 are rejected (Stem4, 2019). Somewhat inevitably, re-referrals make up 35.9% of all CAMHS referrals (Hansen 2021).

3.       Long wait times disadvantage the most disadvantaged.

More than 338,000 children were referred to CAMHS in 2017, but less than a third received treatment within the year. Young people who are accepted into treatment can expect a 2 to 12 month wait time and 75% of CYP referred to CAMHS wait so long to be seen that their condition deteriorates (Young Minds 2020). Ethnic minority patients have a higher risk of treatment dropout if waiting lists are long (de Haan, 2017).

4.       There are no measures for successful outcomes within CAMHS

Unlike the adult NHS mental health ‘Dashboard’, the indicators for children and young people do not include recovery rates or information on types of treatment and ‘successful’ treatment is counted as

turning up to two appointments (Jennings 2018). The bar for mental healthcare for young people is so low that everyone who is involved should hang their heads in shame.

5.       Less than half of all state schools have a school counsellor

Only 48% of state schools offer on site mental health counselling for pupils. That figure was higher in 2010 (The Institute of Public Policy, 2021)

6.       The Youth Mental Health First Aid One Day training course is neither a scalable, nor cost effective way to deliver systemic change.

In response to the 2018 green paper on young people’s mental health, the government committed to providing mental health awareness training to every secondary school by 2019 and every primary school by 2022. This training was aimed at equipping a staff member from each school with the skills to spot signs and symptoms of mental ill health, and to signpost.

An Evaluation of Phase One of the Youth Mental Health First Aid (MHFA) in Schools programme which was conducted by Dr. Guy Robert-Holmes, Dr. Sveta Mayer, Prof. Phil Jones and Siew Fung Lee in 2018 found encouraging signs that educating staff about mental health led to increased confidence in knowledge, skills and awareness of the complexities surrounding young people’s mental health, however, the training was largely confined to a small number of core pastoral staff and did not extend to teachers. This meant that the knowledge base was limited to a small number of staff who were probably the most knowledgeable about mental health to begin with.

As one staff member put it “what worries me is all this training and knowledge just disappears to two or three of us people, and then that’s that.”

The government may have already decided that the £200 per person cost of this programme is too high and the impact is too low to justify continued expansion. Following a Freedom of Information (FOI) request by Schools Week, the DHSC admitted it had decided “not to implement” the primary mental health awareness training. The department claimed this was based on feedback from “busy schools”, adding they had instead brought in “other mental health support measures”.

7.       The pressure from students is having a knock on effect on teachers

The absence of professional help puts additional pressure on teachers. Although teachers do not go into teaching to become mental health experts, they are the most commonly cited (48.5%) source of support for young people with mental health issues (MHCYP, 2018).

In 2019, the Education Support wellbeing Index found that 78% of all education professionals were experiencing either behavioural, psychological or physical symptoms due to the stress of their work.

Lack of training is a huge problem; 71% of teachers believe that they lack the training to help pupils who have mental health problems (MHFS, 2018). However, school staff who were given the Youth Mental Health First Aid One Day training course complained that they did not get any support or supervision to offload the stress of supporting young people with their mental health (Robert-Holmes, 2018).

“The thing is there isn’t really that structure in the school. There isn’t that in any school where it might happen that you’ve got a line manager who’s in a position to listen you know. If you’re… well I mean in my case I’m 25 years from training - no one’s ever… no one’s ever taught the senior leadership team how to listen to that sort of stuff. So… unless you happen to have it – how do you deal with your staff who are dealing with that sort of secondary trauma? – you can’t just ignore them. (West Midlands)”

8.       We need to fund prevention and early intervention, even if it can’t be measured.

The current mental healthcare system is built entirely around crisis care. We wait for children to fall off a cliff before we offer them any support. Even the MHFA program is designed around spotting signs of existing or emerging mental illness. There is zero emphasis on prevention, or early intervention. This is largely because you can’t measure prevention, and therefore, no one is willing to fund it. However this is a completely false economy. Late intervention in youth mental-health costs public services £17bn pa (Oppenhim, 2015).

Despite a very robust evidence base confirming that early interventions generate substantive positive returns on investment, not just for health, but for other sectors such as education, criminal justice, and social welfare (McDaid, 2011), local authority spending on early intervention services for CYP fell by 46% between 2011 and 2018 (Action for Children, 2020).

9.       Early intervention won’t work without youth engagement.

Training school staff to spot signs of mental illness is important, but teaching young people to integrate preventative mental health strategies into everyday behaviour, is much, much more so. It’s not an easy thing to do.

The key to successful early intervention is persuading young people who are well, to voluntarily engage with preventative solutions that will support them, if and when they experience distress. This is not something that the NHS or the education system is equipped to do.

10.   Face-to-face interventions are problematic for young people

Face-to-face solutions have been difficult to access. In 2016, 157,000 CAMHS appointments were missed at a cost of £45m and repeat missed appointments lead to discharge (Abdinasir, 2017).

School based face-to-face solutions are equally problematic. Young people who were interviewed for Dr. Guy Robert-Holmes (2018) evaluation of phase one of the Youth Mental Health First Aid (MHFA) in Schools programme told researchers that they found it difficult to talk openly about mental health issues with staff or their peers because there was so much stigma around it. It is important to listen to these young people because, as is always the case, a useful solution will only be found if the problem is interrogated honestly.

However valuable we think it is to train school staff, the fact remains that young people find talking about mental health issues face to face very very difficult.

I feel awkward and not comfortable and ashamed. (North London, girl, year 9)

I don’t think people would feel comfortable going to a teacher. (South Coast, gender and year group not given)

I’m very open and have a lot of opinions on the subject but I feel quite closed off to speak up as hardly anyone talks about it in and out of class. (West Midlands, girl year 10)

I don’t think anybody wants others to know due to bullying so I want the school to be more aware of bullying and kids that are getting bullied. I need them to listen more about that. (North East, boy, year 7)

I would feel embarrassed to go and talk about it. (West Midlands, boy year 9) They might be shy to tell a teacher. (East Midlands, boy, year 9)

They normally do not speak to other students about their issues because it is awkward. (East Midlands, boy, year 10)

I think students are reluctant to go ask for help from teachers and their peers because talking about mh issues are often something to be embarrassed about so that is why students do not ask for help. (East Midlands, girl, year 11)

I feel nervous and scared talking about mh. (East Midlands, girl, year 11) I might feel sad talking about mental health. (East Midlands boy, year 11)

I feel scared because I don’t want people to know that I listen to my friends in my head. (North East, boy, year 7)

I feel embarrassed and I don’t know anyone who doesn’t. (North East, boy, year 7)

11.   Self-harm is more prevalent than anyone realises

It is never easy to gather accurate data on behaviours that are secret or stigmatised, however, data which was collected between 2018 and 2019 as part of the Millenium Cohort Study, found that by the age of 17, 28.2% of females and 20.1% of males reported having self-harmed in the previous year. A 2018 YouGov Poll which was carried out by Self-Harm UK, The Mix and YoungMinds found that 24% of 16-25 year-olds boys in the UK had self-harmed as a result of depression, anxiety and stress.

Caroline Clements research suggests that the number of incidents of self-harm episodes recorded by hospitals is underestimated by 60% (Clements et al., 2016) because A&E attendances that don’t result in admissions are not recorded. However, it also relates to the way that presenting symptoms are coded.

Because self-harm is a behaviour rather than a diagnosis the presenting symptoms might read ‘cut’ for self-injury, or ‘stomach pain/nausea’ for overdose. Misrecording at A&E is particularly pertinent to boys because research shows that when a young male turns up at A&E having punched a wall, or drunk a bottle of vodka, they are not asked about underlying issues or given a psychiatric assessment. Depending on the extent of the injury they are either sent home, or referred to a fracture clinic where their physical injuries will improve, but their mental health issues won’t (Oxley et al., 2017).

Solutions are available

12.   MeeToo is a fully moderated, evidence-based, anonymous, peer support app for young people.

MeeToo builds on the empirical success of the peer support model - where young people help each other - by creating a free, standardised, and scalable solution that is accessible to the 90% of UK teenagers who have a smartphone. MeeToo is 100% pre-moderated by humans so every post and reply is checked before it goes live. High risk posts are redirected to our in-house counselling team. Within the app, volunteer undergraduate psychology students are trained to work as super-peers within the app.

They provide model replies and ensure that every question gets a fully rounded solution. MeeToo is a creative hub where young people are encouraged to express themselves artistically. Users can access a personalisable directory of crisis and specialist support groups, apps, books, Ted talks, videos and self help tools through a closed loop system.

13.   MeeToo is proven to improve mental health in young people

In 2021, an independent evaluation of the MeeToo app was conducted by the Evidence Based Practice Unit (EBPU), a collaboration between UCL’s faculty of Brain Sciences and the Anna Freud Centre. The study, which involved 876 young people, found that anonymity made it easier for young people to be open and they were able to connect with other young people with similar experiences in a safe but meaningful way. They felt comfortable in expressing their feelings, thoughts, and experiences freely, without worrying about being judged, and using the app led to a statistically significant increase in young people’s confidence, knowledge and mental health management skills. Overall, young people using the app reported feeling better and less alone and using the app helped them to gain confidence in both connecting to, and helping others on and offline.

14.     MeeToo has unique expertise in youth engagement.

MeeToo is a best practice example of what great early intervention in the mental health space should look like. We are specialists in youth engagement and social media marketing and we exist independently of schools, CAMHS and charities which means that young people trust us. MeeToo is part of the NHS apps library and supports 60,000 young people in the UK. Because MeeToo supports young people from the age of 11 to the age of 25, we can support young people aged 18+ who are making the difficult transition to adult care.

15.   MeeToo is a scalable solution

MeeToo currently has a capacity to support 16,000 young people a month, with just 4 (FTE) paid moderators and 3 (FTE) counsellors. With existing technology we could support 1M young people a month with 250 (FTE) moderators and 180 (FTE) counsellors.

16.   MeeToo has a successful track record in helping young people to stop self-harming.

Because self-harm is a coping mechanism, young people will not voluntarily disclose self-harm to parents and teachers because they know that as soon as they do, their coping mechanism will be taken away from them. MeeToo is an app which allows young people to access safe, anonymous personalised peer support through an app. MeeToo is 100% pre-moderated by humans so every post and reply is checked before it goes live to eliminate all bullying, judgment or humiliation. High risk posts are redirected to our in-house counselling team. Our high level safeguarding means MeeToo is the only peer support app that is safe for children as young as 11. MeeToo is part of the NHS apps library and supports 60,000 young people in the UK.

The MeeToo app allows young people to open up anonymously about their self harm and to talk with other young people who have had the same experience. Within MeeToo, young people have the agency to attempt to stop self harming without fear. If they try and fail, there is no judgement. They just get the support they need to try again.

Cosmickiwihacker is a 15 year old girl who joined MeeToo in May 2021. She was self-harming, not eating, afraid to talk to people and feeling suicidal. Five months later, Cosmickiwihacker has been clean - not self harming - for two months. She is eating 2 or 3 meals a day, balancing college with a part time job and she credits the MeeToo community for helping her to achieve all of this.

17.   MeeToo is at the technological forefront of suicide prevention and prediction.

Suicide is the leading cause of death in UK Children and Young People (ONS ,2018) and for every completed suicide, there are 20 attempts (WHO, 2018). Boys are three times more likley to die by suicide but girls are more likley to make a suicide attempt (O'Loughlin & Sherwood, 2005)

Existing suicide support services provide suicidal young people with access to safety plans, education, or helplines, but they have to actively seek out this support at a time when they feel they have ‘gone past help’ (Biddle, 2020).

Because 40% of young people who complete sucide have had no contact with the mental-health system (Rodway, 2020), successful prevention requires integrated ‘upstream’ interventions to anticipate suicidality and deliver support early.

MeeToo is currently developing a state of the art innovation, in collaboration with Bristol University Medical School and University of Sussex Department of Informatics, which integrates NLP and ML into the MeeToo app in order to analyse semantic content, understand behaviour patterns and predict risk. When risk is detected, young people are automatically diverted into a specific suicide support stream, where they receive clinical supervision and peer support from qualified counsellors rather than same age peers. Crucially, young people don’t have to ask for help, nor do they have to self-identify as suicidal.

When their distress deescalates, young people rejoin their peers for ongoing support and monitoring.

What should the Government do?

18.   Integrate mental health training into teacher training courses as standard.

Although teachers do not go into teaching to become mental health experts, they are the most commonly cited (48.5%) source of support for young people with mental health issues (MHCYP, 2018) so integrating mental health training into teacher training and teaching assistant qualifications should be standard.

19.   Make Ofsted focus on happiness and mental wellbeing as much as they do on academic attainment

One of the fundamental problems for schools is that Ofsted do not measure schools on mental health and wellbeing so there is very little incentive for them to prioritise early intervention. As one staff member in Robert-Holmes (2018) investigation of the MHFA programme said “I mean when you’re running a school you’re not going to get judged on the emotional wellbeing of your children are you?”

20.   Insist that the NHS data dashboard records valid recovery outcomes for CAMHS, not turning up for two sessions

The government needs to raise the bar by setting clear standards for CAMHS on what constitutes a good outcome. The current NHS data dashboard has no recovery outcomes data and considers attending two sessions as a successful ‘treatment’. That is simply not good enough.

21.   Fund the roll out of the MeeToo app to every child, in every secondary school, in the UK.

Continuing to invest in mental health solutions that will never, ever, be able to meet demand is an irresponsible waste of taxpayers money. MeeToo offers the government a fast, evidence based, and

cost-effective way to provide all secondary school children with immediate access to 365 day support. We are specialists in youth engagement and offer young people immediate access to safe, 100%

pre-moderated peer support and a vast directory of self help tools.

Nov 2021