Written evidence submitted by The National Lottery Community Fund (CYP0063)

 

Introduction 

 

We welcome the opportunity to respond to this timely inquiry, given the coronavirus pandemic and the impact it has had on mental health and emotional wellbeing in the UK. This pandemic has particularly highlighted and exacerbated the growing crisis of mental health problems amongst children and young people. In light of this, we support the Committee’s considerations into the progress that has been made to improve children and young people’s mental health provision and whether the system should adopt a holistic approach to mental health with an emphasis on the importance of intervention and prevention. 

 

Prior to the pandemic, mental health issues amongst children and young people were increasing[1]. The incidence of emotions such as sadness, anger, stress, anxiety and depression were already high within different communities across the country. Without preventative interventions, more serious dysfunctions can develop in later life and can be attributed to both individual and community-level issues such as social isolation, physical health complications, and youth violence. Emerging evidence indicates that the impact of covid-19 will likely worsen many young people’s mental health, both in the short and long-term.  

 

Our response outlines our commitment to, and investment in, supporting and innovating new ways to improve the mental health and wellbeing of children and young people across the ages and stages. We highlight key learnings from our approach, which places people in the lead and enables communities to thrive. As the largest funder of children and young people activity across the UK, we ensure that young people have their voices heard on mental health issues and that they can shape the decisions that affect them. 

 

Our funding also focuses on prevention and early intervention, to improve children and young people’s resilience, mental and emotional wellbeing, to prevent serious mental health issues from developing and reducing longer-term problems. We fund activities that encourage youth social action, which has a range of benefits for children, young people and their communities. Based on our insights, we conclude with a series of key recommendations, which could help inform wider changes needed in the system as a whole. 

 

Key messages 

 

  1. The National Lottery Community Fund is a significant funder of mental health projects and partnerships, distributing millions of pounds to communities in order to support children and young people’s mental health. The projects and work we fund generate insights and evidence to help inform and improve future provision.

 

  1. How the Government can learn from examples of best practice: young people and communities in the lead 

 

 

  1. The wider changes needed in the system as a whole and to what extent it should be reformed in favour of a model that focuses on early intervention in children and young people’s mental health to prevent more severe illness developing  

 

 

  1. Conclusion and Recommendations 

 

The National Lottery Community Fund 

 

The National Lottery Community Fund is the largest community funder in the UK. We are proud to award money raised by National Lottery players to communities across England, Scotland, Wales and Northern Ireland. At the heart of our work is the belief that when people are in the lead, communities thrive. Every year we distribute over £600 million to communities across the UK, making around 11,000 grants. We fund thousands of local groups, driven by small numbers of motivated, enterprising individuals, who help many more people in their villages, towns and counties with small grants of £300 to larger multimillion-pound investments. Over 80% of our grants are under £10,000 and over 60% of awards go to organisations with turnovers of less than £100,000.   

 

We are based in the communities we serve, funding and engaging with local communities across the UK. In the last five years, our funding has reached every constituency, every local authority and 90% of all wards. Half of our funding went to projects based outside London and other core cities, with 30% of our funding going to projects in the 20% most deprived areas. We have a focus on delivering grants to new organisations, not just existing grantees. Last year, over 40% of organisations funded received grants from us for the first time.   

 

Throughout our 26-year history, we have awarded grants to organisations that aim to support and improve children and young people’s mental health in communities across the country. Over the last five years, in England alone, we have invested over £1.2 billion in projects supporting children, young people and families.  

 

We have specifically awarded 4,680 grants worth £481,495,663 to projects that support the mental health and wellbeing of children and young people in England. We invest into programmes such as HeadStart, a five-year £56 million initiative which aims to improve the mental health and wellbeing of young people aged 10 to 16. In recognition of the impact of the pandemic on mental health, last year we allocated an additional £8.7 million across our six HeadStart partnerships. This will enable them to deliver existing work and have a revised focus on supporting marginalised young people to access the help they need and respond to the increased demand during the pandemic.   

 

Examples of Best Practice: Young People and Communities in the Lead 

 

Funding community-based organisations and partnerships 

 

At The National Lottery Community Fund, we believe that when people are in the lead, communities thrive. People understand what’s needed in their communities better than anyone. We are based in the communities we serve and support ideas and projects that matter to people and communities. We use our funding and relationships to boost positive wellbeing at individual and community level. This helps create stronger, more connected and more resilient communities now and for the future.  

 

Our focus on supporting communities to thrive runs through the heart of our work to support children and young people’s mental health. Evidence has indicated that some children and young people do not feel comfortable engaging with traditional mental health services, whether Child and Adolescent Mental Health Services (CAMHS), local GPs, or school-based counselling. This is particularly prevalent among Black, Asian and Minority Ethnic (BAME) children and young people.[2] We provide funding to trusted organisations based in the communities they serve and facilitate partnerships with schools, charities, community and public services. This has helped to ensure more children and young people are able to engage with a range of activities. Community-based approaches have enabled support to be tailored to local needs and real or perceived barriers to participation to be overcome, achieving wider impact for communities.

 

Beyond traditional mental health support  

 

We fund a diverse range of activities and approaches that improve mental health and wellbeing, which go beyond traditional mental health support and settings. Creative and sports activities, for example, are an excellent way for young people to develop new or existing hobbies, skills, interests and relationships with other young people. As a result, self-development and forming positive relationships with others helps to build young people’s confidence, which they could apply to other areas of their lives.[3]  

 

 

 

 

 

 

 

 

Putting young people in the lead  

 

As over a third of our funding goes to projects which ensure that children and young people succeed, we want to make sure that their voices are included in all our work, whether it’s through the grants we make, the people we influence or things we learn. We fund projects which meaningfully engage with children and young people and involve them in influencing services which are designed for their benefit. As Elen, a young person involved in our work, said “The National Lottery Community Fund is putting young people as the focus of their plans and projects, and how young people can influence and lead on how money is invested.” 

 

This is particularly crucial for our funding which aims to support and improve children and young people’s mental health and wellbeing. Young people with first-hand experience of the issues they face are best placed to shape potential solutions. Because of this, they play a key role in all aspects of funded programmes, including design, commissioning, delivery and evaluation. The HeadStart Wolverhampton partnership recounted, “Young people have been at the centre of everything we have done […] we listen to them, consult them, and give them responsibility for decision-making about what we do, and how money is spent.”  

 

Programmes such as our HeadStart initiative are founded on co-production, running through all aspects of the approach. Co-production means working together to achieve a common goal and where everyone, including beneficiaries, are involved in every step of the process. Each of our HeadStart partnerships has a panel of young people that contributes to and shapes the design of services in that area. They can get involved through awareness raising campaigns, mentoring, online surveys and advisory groups, and are even involved in the recruitment of new HeadStart staff. Our HeadStart Hull partnership, for instance, has harnessed co-production to identify the key issues for children and young people and shape the development and delivery of the HeadStart model in the area. Young people who participated also noted how peer relationships provided crucial support and enabled them to collectively design resources.

 

It is clear from our funding, and indeed other research, that involving young people with mental health issues can help them to feel empowered and increase the quality, efficiency and outcomes of support. However, analysis has indicated that just 15% of Clinical Commissioning Groups in England had used a co-production approach at least once in mental health commissioning.[4] Children and young people are eager to be, and should be, part of all conversations on what is needed to support their mental health. They are experts with lived experience who can help design future thinking in this space which will, ultimately, help improve their experiences and outcomes. 

 

Wider benefits for the community  

 

Giving children and young people an opportunity for their voice to be heard and have their wellbeing supported also has positive implications for the whole community. Evidence suggests investment in local youth provision increases pro-social behaviour, reduces use of public services, results in positive life choices by young people and increases tax revenue from improved lifetime earnings.[5]  

 

Initiatives such as the £40 million Youth Investment Fund, which we jointly fund with the Department for Digital, Culture, Media and Sport (DCMS), supports organisations to deliver, expand and create high-quality local youth provision in targeted communities across England. This helps to create new opportunities for young people to develop their skills and confidence and benefits the community. Funded organisations offered young people the chance to engage and contribute to community events and activities, which helped young people develop a greater sense of being part of their local community.

 

Additionally, organisations worked closely with schools to address and respond to anti-social behaviour and promote community cohesion and integration[6]. Putting young people in the lead also provides an opportunity for community-based partnerships to improve the way they work with young people, and to improve the community’s understanding of mental health and emotional wellbeing. As one young person told us: “Young People in the Lead, for me, means young people being valued and included in conversations about us. I want to raise awareness of mental health and how it underlies so many aspects of community projects.” 

 

 

 

 

Prevention and Early Intervention 

 

The importance of prevention and early intervention 

 

Children and young people of every age, ethnicity and background can experience mental health issues as a result of numerous contributing factors, including the pressure from school, bullying, social media and family problems. Stigma also contributes to poor mental health, with 75% of young people believing that people with mental health difficulties are treated negatively[7]. Furthermore, since the beginning of the pandemic, young people have faced additional difficulties as a result of home-schooling, increased isolation and a lack of socialisation. 

 

The pandemic has exacerbated many of these problems particularly for vulnerable groups and in areas of high deprivation. Research published by The Lancet Psychiatry has identified children, young people and families as being particularly vulnerable as a result of the pandemic[8]. Many children have missed out on vital socialisation during the pandemic, as well as a significant part of their schooling, which may be both educationally and emotionally damaging. Mental health difficulties at a young age can lead to a decline in an individual’s physical health, educational attainment and employment in addition to affecting school attendance, behaviour and engagement[9]. 

 

The implementation of preventative intervention during childhood and adolescence can have many positive outcomes when integrated into mental health services, both on the individual and the wider community. Early-stage intervention is crucial in minimising the impact of adverse childhood experiences (ACEs) which are the leading determinants of all mental illnesses, many pervasive societal problems and the ten leading causes of death in the Western world, including cancer, diabetes and stroke[10]. Prevention and early intervention also generate long-term returns on investment. The uptake of interventions leads to considerable benefits, both for the individual and communities in the long and short term. Research has shown that primary prevention reduces the likelihood of mental illness, lower lifetime earnings, and crime in adulthood[11].  

 

Prevention and early intervention in practice 

 

As coronavirus restrictions are eased, children and young people will start returning to school. It is vital that, along with a comprehensive educational catch-up programme, wellbeing is supported and the impact of the pandemic on young people’s mental health is addressed. Children will have experienced extended periods of time away from school, friends and regular routines. Ensuring children’s mental health and wellbeing is supported will act as the foundation from which learning loss and educational inequalities can be tackled. The wellbeing of children and young people should be valued at the heart of our education system, as we emerge from the pandemic. 

 

As we outline below, we fund projects and partnerships which intervene early across all ages and stages. These projects give communities the skills and knowledge they need to prevent poor mental health. In addition, we hope this will help to bring about a shift in culture and spend towards support and services for children and families that is prevention-focused. 

 

A Better Start 

 

A Better Start is our 10-year, £215 million programme, which consists of five local partnerships to improve the life chances of children aged 0-3 years. The programme funds local partnerships in five areas across England to explore new ways of strengthening early years support services for families, so children can have the best possible start in life.  

 

Case study: Lambeth Early Action Partnership (LEAP)

 

The Lambeth Early Action Partnership (LEAP) is the first specialised parent-infant team in south-east London which provides a tiered system of preventative intervention, allowing families to move between group and one-to-one support. Interventions include two universal access groups which enable families experiencing difficulties to access psychodynamic support in the community without a formal mental health referral. For families with more complex difficulties, parent-infant psychotherapy is available. Insights from the project show that LEAP has helped to raise awareness of early infant relationships, social-emotional development and the benefits of psychodynamic intervention. 

 

 

HeadStart 

 

Our HeadStart programme supports young people aged between 10 and 16, considering how their mental wellbeing is affected by their experiences at school, their ability to access the community services they need, their home life and relationships with family members, along with their interaction with digital technology. One HeadStart participant told us in 2018, “HeadStart makes mental health something everyone can and does talk about.”

 

The HeadStart partnerships are located in six local authority areas across England:  Blackpool, Cornwall, Hull, Kent, Newham and Wolverhampton. They are working with local young people, schools, families, charities, community and public services to design, test and implement different approaches to build young people’s emotional resilience and respond to the early signs of common mental health problems. We work closely with our grant holders to capture the wealth of knowledge, learning and reflections from the communities in order to share examples of good practice. 

 

Research conducted by the HeadStart programme indicates that, when looking at children’s self-reported difficulties, around one in five report high levels of mental health difficulties. The findings highlight the importance of prevention and early intervention to prevent mental health problems escalating, particularly during the transitional period between primary and secondary school. Interventions tackling emotional and wellbeing difficulties can be particularly beneficial. Young people involved in the HeadStart programme reported that the strategies, advice or instrumental support that their peer mentors or HeadStart intervention leads had given them helped them to deal with their problems or difficulties. These measures included: 

 

 

Without early intervention in childhood or adolescence, the likelihood of problems in adulthood such as violence, criminality or further mental health problems increases significantly.[12] Research from the HeadStart programme shows that interventions which aim to tackle emotional difficulties may prove particularly beneficial to prevent problems escalating. The HeadStart Blackpool partnership provides ‘Moving on Up’ support for children aged 10 to 11, focused on identifying and supporting those with low or medium resilience. Young people have been supported to feel more confident about their transition to secondary school and helps them reduce anxieties, as well as increase their confidence and self-esteem.  

 

While some young people can manage symptoms of an underlying mental health issue, such as anger or worry, others may need more support. HeadStart aims to raise awareness amongst adults who work with young people. The partnerships help carers, parents, guardians and other key adults to be aware of the contributing factors, triggers and signs around youth mental health and gives them the tools and knowledge to help intervene and support the individual in question. The programme provides a range of resources for schools and communities to intervene early in order to support children and young people who are struggling or showing early signs of mental health problems. As one teacher who was involved with HeadStart explained “Before the training I wouldn’t have had the confidence to approach a young person who was clearly distressed, but, because I’d had the training, I felt confident and the conversation flowed very naturally. The training made the difference.”[13] 

 

By summer 2019, over 131,000 young people had access to HeadStart’s universal support in schools and community-based organisations.[14] This includes access to safe spaces in schools and the community, where young people can take time out and find trusted adults to talk to, and opportunities to participate in campaigns and whole school resilience-building activities. With the additional £8.7 million investment in the programme, we aim to support many more young people now and as we embark upon our recovery from the impact of the pandemic.  

 

The #iwill Fund and the benefits of youth social action 

 

Youth social action has been associated with a range of direct, positive outcomes for young people who participate, including employment outcomes, attitudes to education, personal wellbeing and a sense of community. Moreover, research shows that participation in social action could reduce anxiety by a fifth, while exposure to natural environments through environmental social action can help to reduce stress, anxiety and depression.[15] There is also growing focus on the ’double benefit’ of social action and the potential positive impact on the health and wellbeing of others.[16] 

 

The #iwill Fund is an England-wide joint investment, originally bringing together £40 million in funding from the Department for Digital, Culture, Media and Sport and The National Lottery Community Fund. We distribute our investment through working in partnership with other funders and aim to make social action the norm for young people aged 10 to 20. The #iwill Fund currently supports over 1,750 youth social action opportunities across England. 

 

The #iwill Fund aims to: 

 

 

 

 

 

Conclusion and recommendations 

 

As the coronavirus restrictions are eased and schools re-open, it is important that we not only consider how we support children and young people post-pandemic, but how we design and utilise prevention and early intervention strategies to improve the short and long-term outlook for young people. We must ensure that a people-centred, experience-driven and evidence-based approach is taken which supports children and young people who understand what they need in order to thrive. 

 

Based on key learnings from our funding, we recommend that any changes in the wider system consider the following: 

 

  1. The value of children and young people playing a leading role in influencing mental health activities and services designed for their benefit.

  

  1.    The benefits of prevention and early intervention across ages and stages are considered as part of a wider system of support for children and young people. 

 

  1.    Maximise the societal benefits of raising awareness of mental health among peers and trusted adults such as teachers, youth workers and parents, underpinned by awareness training and resources.  

 

  1.    Support in communities to prioritise children and young people’s wellbeing with the return to schools, in order to prevent mental health issues arising or escalating. 

 

  1.    The importance of social action is recognised for improving youth mental health, as well as fostering resilience, a sense of community, and positive educational and employment outcomes.  

 

 

February 2021 

 

[1] NHS England (2020), Mental Health of Children and Young People in England, 2020: Wave 1 follow up to the 2017 survey

[2] Education Policy Institute (2017), Online mental health support for young people

[3] HeadStart Newham (2019), Creative and sports activities: a process evaluation of implementation and benefits for young people.

[4] Rethink Mental Illness (2017), Progress through Partnership: involvement of people with lived experience of mental illness in CCG commissioning

[5] New Philanthropy Capital (2019), Youth Investment Fund: Learning and Insight Paper Two

[6] New Philanthropy Capital (2020), Insights from the YIF qualitative process evaluation

[7] YMCA (2016), I Am Whole: A report investigating the stigma faced by young people experiencing mental health difficulties

[8] The Lancet (2020), Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science

[9] The National Lottery Community Fund (2019), HeadStart: Building young people’s resilience to support their mental and emotional wellbeing

[10] Felitti and Anda (2006), The Adverse Childhood Experiences Study

[11] Romeo, R., Knapp, M. and Scott, S. (2006), Economic cost of severe antisocial behaviour in children- and who pays it.

 

[12] Romeo, R., Knapp, M. and Scott, S. (2006), Economic cost of severe antisocial behaviour in children- and who pays it.

[13] The National Lottery Community Fund (2019), HeadStart: Building young people’s resilience to support their mental and emotional wellbeing

[14] The National Lottery Community Fund (2019), HeadStart: Building young people’s resilience to support their mental and emotional wellbeing

[15] The National Lottery Community Fund (2018), World Mental Health Day 2018: Youth social action improves health and wellbeing, #iwill.

[16] The National Lottery Community Fund (2016), #iwill Factsheet: Health and wellbeing.