YoungMinds – Written Evidence (LOL0099)
- YoungMinds is the leading children and young people’s mental health charity in the UK, and we put the experiences of children, young people and families at the heart of everything we do. This submission will draw on the insights and lived experiences of the children, young people, parents, carers and professionals that we work and wider research.
- To inform our response to this submission, we consulted with a number of young people during December 2020 through a virtual insight workshop. The submission will draw on this and wider work that we have completed at YoungMinds.
- Young people’s use of digital technology has increased during the COVID-19 pandemic, with many young people using technology to engage with school, college or work and to connect with their friends and families.
- The majority of mental health support has also been delivered remotely through digital or virtual means since the first set of lockdown measures were introduced in March 2020. Young people have very variable experiences of accessing mental health support virtually and digitally. Some young people find expressing their feelings easier when they are not in person and when they can write information down. However, other young people do not find virtual or digital support as effective compared to face to face support. Digital support should increasingly be considered as part of the mental health support for young people. However, it should not be seen as a replacement for face to face support.
- The evidence around the impact of screen time and social media use on young people’s mental health is mixed. However, there are important considerations to ensure that young people are not exposed to harmful content and have the skills to navigate the online world in a positive way.
Young people’s use of digital technology
- Young people use technology in many different ways which can include watching television, using social media, doing work or for their education and gaming. A 2019 survey carried out by CensusWide of 2,000 families with children below the age of 14 found that children were spending an average of 23 hours a week looking at screens on their smartphones or similar devices.
- Young people that we spoke to agreed that for them and their friends, time spent using digital technology has increased during the pandemic. They highlighted that for many young people, using digital technology has been the only way of carrying on working or studying. For example, whilst many young people have now returned to school or college, some still need to continue their studies at home, and the majority of university students are still accessing their courses online.
- Additionally, digital technology has played an important role in allowing young people to speak to their friends, their families and stay connected during the lockdown pandemic. For some young people, such as young people in care, technology provides an important way of connecting with their family. As one of our Youth Activists told us:
“We've all experienced having to use technology to stay in touch with loved ones over the pandemic, but as a kid in care, I would never speak to my biological family if not for technology.”
- Therefore, for many young people, the ability for digital technology to increase social interactions was noted as a significant positive attribute that will continue to be important beyond the pandemic.
- Beyond this, social media and the online world can allow young people to connect with others with similar experiences, identities and interests. Notably, social media has been shown to play an important role in young people feeling less lonely through the connection with like-minded peers. In the insight work that we conducted to inform this submission, young people told us that having access to forums and social media platforms allowed them to develop friendships with people with from different communities, town and countries in a way that they didn’t feel able to otherwise. This may be particularly important for young people who experience marginalisation and discrimination in their communities. For example, research shows that online spaces can provide young LGBTQI+ people with opportunities to access important knowledge and information, as well as connect them with young people with similar experiences.
- However, some of the young people that we work with also highlighted some of the negative elements that being socially connected online can have, including a feeling of being constantly available when people message. Some young people also noted that an expectation that others might be available can be difficult if they do not reply to messages, given that many communication platforms highlight to the sender that the message has been received. As one young person told us:
“The "sent, delivered, seen" ticks by messages can be damaging, I sometimes go on to see if people are active if I wish I could talk to them”.
- A further important point to consider when discussing young people’s use of digital technology is access. Digital exclusion is a term used to describe lack of access or difficulty accessing, technology or services that take place online. In 2019, it was estimated that 60,000 11-18-year olds did not have any form of internet connectivity at home, with a further 700,000 lacking a desktop, laptop or tablet at home. As the Children’s Commissioner highlights, ‘while some connectivity is better than none, these children are still very limited in what they can do online.’
- Additionally, the lack of digital access to technology is exacerbated by inequalities that persist in society. For example, the likelihood of having access to the internet from home increases along with income, such that only 51% of households earning between £6000-10,000 had home internet access compared with 99% of households with an income of over £40,001.
- The consequence of this is that not all young people have the means to engage with digital technology. Additionally, some of the young people that we consulted to form our response to this submission highlighted that, in their experience, not having access to the most up to date technology such as mobile phones led to bullying from peers at school. Given the necessity to have the correct technology to engage in education, work and to maintain a social connection during the pandemic, the Committee should consider the impact of digital exclusion on young people.
Young people’s access to digital mental health support
- In 2017, 1 in 9 children and young people were estimated to have a diagnosable mental health condition. Since then, the pandemic has created a new crisis for our nation’s mental health, with recent NHS Digital data showing a substantial rise in prevalence. Research also suggests that the pandemic and measures taken to respond to it have increased risk factors associated with mental illness including increased exposure to trauma or adversity, loneliness and social isolation and higher numbers of young people with low wellbeing. Groups that were already marginalised or disadvantaged are likely to have been disproportionately affected given the unequal impact that the pandemic has had on different groups including black and minority ethnic communities and people who have disabilities.
- Research conducted by YoungMinds suggests that the pandemic has negatively impacted on the mental health of young people. In a survey conducted in June 2020, 80% of young people with existing mental health difficulties indicating that the pandemic had made their mental health worse in July 2020.
- Our research also suggested that the coronavirus pandemic has affected young people’s access to mental health services. During the lockdown period, referrals to young people’s mental health services were reduced or disrupted. In our survey with young people, among the respondents who were accessing mental health support in the lead-up to the crisis, 31% said that they were no longer able to do so. Some young people had experienced cancellations due to a disruption in NHS support, schools closing, not being able to attend peer support groups or because services that had been delivered face-to-face could not be provided online or by phone.
- To address the reduction in support available to young people, NHS England rapidly introduced urgent 24/7 mental health helplines to provide mental health support, including to children, young people and parents, across England. These helplines are only intended for use by young people that are experiencing a mental health crisis as opposed to a long term and sustained mental health intervention. Therefore, the Government also funded Public Health England to develop new resources targeted at young people and parents, as part of the digital campaign Every Minds Matters.
- Additionally, many NHS and VCSE services transformed their ways of working during the pandemic which has resulted in a rapid increased in the availability of remote support to young people. The professionals in these services deserve enormous credit for their efforts to change their ways of working and to continue to support young people through the pandemic. This shift meant that the most prominent medium of delivering mental health support during the coronavirus pandemic has been digital or virtual support.
- Our work with young people suggests that for some, digital and virtual support provides an effective way of accessing support for their mental health. In the insight work that we conducted to inform our submission, young people told us that digital or virtual support can be less daunting than support provided face to face because it can be difficult to talk about how they are feeling in person. In addition, previous research provides evidence to suggest that remote interventions may be more accessible for young people who experience stigma or shame related to their mental health or related to challenges linked, for example, to their gender identity or sexuality.
- Additionally, young people highlighted that access to support such as counselling or therapy remotely can be more flexible and easier to fit into a schedule or routine in a way that may be difficult when accessing support face to face. This may because it is easier to fit around school, college or work and there is no need to travel to a place in person. This may be particularly important for young people that live in rural areas who need to travel long distances for face to face support. Additionally, not needing to travel to a physical location ensures that support is available to young people who do not feel able to leave the house or have accessibility issues.
- For other young people, digital and virtual support is not always appropriate or accessible. This may be due to, as discussed previously, not having access to the technology to utilise digital and virtual forms of support. Even when young people have access to technology, young people face may difficulties with utilising support that is available online. One issue that was raised in our work throughout the pandemic was a concern about privacy when accessing remote support that requires a young person to speak, particularly when they are at home. This may be due to a fear of their family overhearing the session, or in some cases, family relationships are at the centre of young people’s therapy, and so it would be difficult to discuss concerns while at home. In other cases, young people said that their families did not know that they were receiving mental health support and they did not want them to find out.
- For this reason, some of the young people in the insight work that we conducted to inform this submission outlined their preference of engaging in text-based remote support such as by email or webchat. They highlighted that services such as SHOUT messenger and Childline 1-2-1 chat are a useful way of accessing support in a text-based format.
- Additionally, some young people highlighted to us that it is not always as easy to build relationships when support is being carried out remotely compared to in person because there are different social cues involved in support that is provided on the telephone or by video call. This had led some young people to find that virtual support is not as effective online. Past research shows that building a trusted relationship can be an important element of providing effective support. The Early Intervention Foundation also highlights that there is evidence to indicate that the quality of relationships is positively correlated with improving outcomes across a range of therapeutic approaches and mental health issues.
- When considering the different digital platforms that are available to children and young people for their mental health, it was noted that many digital interventions are focused predominantly on responding to behaviours and symptoms related to anxiety and depression. As one of our Activists told us:
‘Mental health support online can feel systematic and like it’s “one size fits all”.’
Therefore, when considering the development of digital forms of support, information and interventions in the future, there must be a consideration of how they ensure that there is advice for a more diverse range of feelings, behaviours and experiences.
- Based on both the positive experiences that young people have with accessing mental health support digitally and virtually, as we recover from the COVID-19 pandemic, digital and virtual support should be seen as part of the support offered for young people. However, past research that was identified in a systematic review by Youth Access indicates that when young people do not have a choice about whether they access remote support (for example in studies where they were randomly selected to receive a remote intervention) they reported low engagement. Drop-out rates were seen to be lower when it is a young person’s choice to access this type of support. Therefore, virtual and digital support should be maintained so that young people can access it if they think it works best for them. Additionally, efforts should be made to involve young people in the design of services to ensure that the platforms meet their needs. Help should also be given to young people to navigate the types of digital and virtual forms of support.
- However, digital and virtual support should not be seen as an alternative or replacement for mental health support for children and young people. Children and young people's mental health services (CYPMHS) have historically been disjointed and inconsistent across the country, with waiting times and access criteria vary considerably between local areas. Before the pandemic, only 1 in 3 children and young people with a diagnosable mental health condition received any NHS care or treatment and access to early support for their mental health was difficult to access.
- For many young people, this lack of access to services and long waiting times can lead to an unnecessary escalation in their mental health needs. Despite additional investment and commitments to increase access through the NHS Long-Term Plan and the Green Paper on Children and Young People’s Mental Health, young people are still likely to struggle to access support. To meet the needs of young people as we recover from the vast economic and social repercussions of the COVID-19 pandemic, we need a new and systematic approach to mental health support that prioritises community-based early intervention so that difficulties can be tackled before they become more acute.
- For this reason, we recommend that the Government rolls out open access hubs to every area across England. Open access hubs offer easy-to-access, drop-in support on a self-referral basis for young people who do not meet the threshold for Children and Young People’s Mental Health Services (CYPMHS) or with emerging mental health needs, up to age 25. They can be delivered through the NHS, in partnership with local authorities, or through the voluntary sector depending on local need and existing infrastructure. A mix of clinical staff, counsellors, youth workers and volunteers would provide a range of support on issues related to wellbeing while additional services can be co-located under one roof; offering wrap-around support across, for example, psychological therapies, employment advice, youth services and sexual health.
- Building on the existing evidence base for these services in the UK and internationally, the hubs would reduce pressures on the NHS and improve young people’s life chances by providing a community space to access flexible support for emotional wellbeing. This would sit alongside advice about sexual health and access to education or employment. Previous evidence from the UK, Australia, Denmark and Ireland demonstrates that open-access mental health hubs can reduce psychological distress amongst young people; attract young people that are less likely to engage with NHS mental health support and save costs to a range of services across the health system and more widely. Additionally, the services should link to existing digital resources and services where available, to build an element of digital support into their design. This would improve access and increase flexibility for young people that feel that they have benefited from online support during the pandemic.
Impact of digital technology on young people’s mental health
- Much of the research on the impact of digital technology on mental health is focused on screen time and social media. However, the evidence in this area is mixed and it is not currently possible to conclude that screen use causes reduced wellbeing. Additionally, it is also important to recognise that the current research on the impact of social media on young people’s mental health had demonstrated an association, but studies have not been able to demonstrate a causal link. We would therefore that more research is conducted on the relationship between social media and young people’s mental health. The Government must ensure that funding is provided to understand the complex relationship between social media and young people’s mental health.
- The young people that we work with often tell us that social media can simultaneously have positive and negative impacts on their lives, including the aforementioned ability to connect with others, explore their own identities and discover new interests. However, there are some important considerations when thinking about social media specifically.
- During July 2019, YoungMinds worked with Instagram to understand how young people use social media, with a particular emphasis on 14-25-year-olds that had lived experience of self-harm, self-injury, suicidal thoughts and/ or eating disorders. Some of the young people that were involved with the project told us that social media is designed to show the 'best and not the rest' and young people are at a loss for what’s real, what's not, and what they should be expecting from their own lives and journeys of recovery. When combined with the culture of competition on social media platforms, this can make young people hold themselves to unattainable standards and as a result impact on their self-esteem.
- The use of adverts and suggested content on social media platforms and the internet more widely was also highlighted as a concern in our work with young people. Several young people highlighted their experience with using the social media platform TikTok. They told us that following a search for content related to body image or eating disorders, either out of curiosity as to what is on the platform or when looking for supportive content, they noticed that they were being suggested more, and sometimes more extreme, content. As Beat’s media guidelines recognise, ‘people with eating disorders speak about being ‘triggered’ – how their eating disorder behaviour and negative mental state can be stimulated, encouraged or reinforced by certain words, images or situations’.
- We welcome steps taken by Instagram and others to include warnings when content may be triggering for young people. However, as we discuss below, there needs to be a much more systematic approach to regulating online platforms to ensuring that more is done to promote the positive impacts of social media and to mitigate any negative impacts.
Regulation and the Online Harms White Paper
- Findings from our research and participation activity have demonstrated that the voluntary approach to regulation has not successfully protected young people’s rights online. In addition, there are insufficient safeguards to ensure that rights are upheld online and that children and young people can navigate online environments safely and positively.
- Therefore, we welcome the proposals in the Online Harms White Paper to create a regulatory framework for online safety alongside a statutory ‘duty of care’ to ensure that technology companies take action on cyberbullying and other harmful content. The proposals included plans to create a regulatory framework for online safety alongside a statutory ‘duty of care’ to ensure that technology companies take action on cyberbullying and other harmful content. Alongside this, the White Paper outlined that an independent regulator would develop and publish a code of practice which sets out how companies are required to fulfil the requirements of the new legal duty and oversee and enforce the duty of care.
- The creation of an independent regulator alongside a code of practice which sets out how companies are required to fulfil the requirements of the new legal duty and oversee and enforce the duty of care is an important and welcomed step. Importantly, the code of practice must be meaningfully informed by young people and focus on their digital rights. To ensure that online companies take action to reduce the availability of harmful content and uphold young people’s rights, the Government must make faster progress in developing an Online Harms Bill.
- However, our research has shown that it is impossible to fully limit young people’s exposure to harmful online content. Therefore, to help young people navigate the online world safely, digital resilience should be embedded in children’s education so that young people can respond to the risks that social media and the internet can have. Importantly, the Government needs to work with partners to develop programmes that build digital resilience by teaching children and young people to be safe and responsible online and to help them to develop the emotional and social skills to mitigate online risks.
- Additionally, parents and carers play an important role in supporting the children in their care to use the online world and social media platforms safely and positively. It is therefore important for parents and carers to talk about digital resilience with their children from a young age and help them to have an awareness of sharing personal information online. To assist this, parents and carers may benefit from targeted campaigns or programmes to improve their digital literacy and awareness of digital safety.
- Importantly, decisions that affect young people should be informed by their experiences and views and young people should be at the heart of internet safety policy development. Therefore, we recommend that there is meaningful and regular engagement with young people by social media companies and policymakers. This could take the form of a Youth Engagement Forum attached to UKCIS.
- The Government should further invest in and roll out tailored training programmes on digital resilience to cover the nature and consequences of online behaviour and to complement the focus on digital safety and literacy in RSHE. These programmes should utilise multiple channels including schools and youth programmes, with more targeted programmes and outreach for parents who have low digital literacy and resilience.
- Bring forward legislation to introduce a new duty of care and independent regulator as outlined in the Online Harms White Paper with urgency to build a systematic approach to regulation for online companies.
- The Government should prioritise early intervention services in local communities, including a network of open access Mental Health Hubs to provide support to those with emerging needs, alongside advice on employment, housing and education. ‘Hub’ models have been shown to have similar clinical outcomes to NHS mental health services, while also being able to reach groups that are less likely to access NHS services.
- Young people should be informed by their experiences and views and young people should be at the heart of internet safety policy development by developing a Youth Engagement Forum to be involved in policy related to Online Harms.
11 December 2020