Written evidence submitted by the Prince’s Trust (CYP0091)

About The Prince’s Trust:

1. Youth charity The Prince’s Trust helps young people to develop the confidence and skills they need to realise their ambitions, so that they can live, learn and earn. Founded by HRH The Prince of Wales in 1976, the charity supports 11 to 30 year-olds who are unemployed, struggling at school and at risk of exclusion. The Trust has helped over a million young people to date, and in 2019/20 alone, we supported over 70,000 individuals. 

2. Many of the young people helped by The Trust are in or leaving care, facing issues such as homelessness, mental health problems, or have been in trouble with the law.  The programmes offered by the charity give vulnerable young people the practical and financial support needed to stabilise their lives, helping develop self-esteem and skills for work.  Three in four young people supported by The Prince’s Trust move into work, education, or training.

Our work around mental health and wellbeing:

3. The Prince’s Trust is not a clinical mental health specialist but does offer young people the chance to develop their mental wellbeing through personal development, sport, active citizenship, healthy lifestyles and preparation for work. The Prince’s Trust provides support for young people's mental wellbeing across all of it's programmes and it's youth support workers are online every day to help those in need. Throughout the pandemic, The Prince’s Trust has been delivering an increased number of one-to-one wellbeing sessions, alongside a shift to online delivery of many of our programmes. We recognise the importance that everyone who works with young people should have the skills and training to feel equipped should mental health needs arise.

4. The Prince’s Trust publishes an annual Youth Index that looks at the mental health and wellbeing of 16-25 year olds across the UK – and have also recently published a report in partnership with the Education Policy Institute, and supported by Tesco, which looks at the drivers of mental health and wellbeing in secondary school-aged young people. We draw on both pieces of research to help inform our response.

5. Our own internal data reflects wider findings for young people’s mental health; the incidence of reported mental health problems on our programmes increased from 1 in 5 to 1 in 3 between 2015/16 and 2019/20.

6. Whilst the pandemic has brought the issue of access to reactive support to the fore, we know that the challenges young people face are not new – and it remains essential to also consider the role of preventative measures in curbing a longer-term crisis of mental health in children and young people.

This evidence:

7. Drawing on our own experiences with supporting young people, our own research, and external analysis, this submission sets out the following key points:

• Urgent action is needed to address the increased strain the pandemic has placed on the mental health of children and young people, as well as the already stretched mental health services.
• To curb a mental health crisis for an entire generation, services for young people need to be adequately resourced and accessible to meet new demand.
• An early intervention, ‘mental health in all policies’ approach could be preventative by creating conditions conducive to good mental health and wellbeing.
• Integrating communication between organisations for young people can create a streamlined, holistic model of support that is both preventative and reactive.

Urgent action is needed to address the increased strain the pandemic has placed on the mental health of children and young people, as well as the already stretched mental health services

8. In the year before the pandemic, children’s mental health services saw referrals increase by 35%[1]. However, this was not matched by supply as the number of children accessing treatment only increased by 4%[2]. Since the Pandemic, the NHS have reported that 1 in 6 children now have a probable mental health condition[3], meaning that demand for these already stretched services has increased. The impact of the pandemic on mental health and wellbeing is yet to be fully known, but action is needed immediately to minimise the long-term effects on young people.

9. The Prince’s Trust Annual Youth Index[4] provides a robust insight into the effect of the pandemic on young people. Now in its 12th year, the Youth Index tracks changing trends in the wellbeing of young people, this year capturing the consequences of the pandemic. This research showed that since the pandemic began, one in five young people (21 per cent) have experienced suicidal thoughts, rising to 28% for young people who are not in education, employment, or training (NEET). Over half (55 per cent) reported that the political and economic events of 2020 had made their mental health worse. Again, NEET young people are shown to have increased struggles with their mental health across the measures in the index, suggesting that this group is particularly vulnerable.

10. Our findings appear to show a link between employment and self-esteem, with 65% of NEET young people stating that the longer they are jobless, the worse they feel about themselves[5]. Compounding this, a quarter of young people say the pandemic has destroyed their career hopes, with 60% saying getting a new job feels impossible now because of increased competition in the labour market[6]. Employment statistics substantiate these fears, showing that youth employment has suffered as a result of the pandemic, largely linked to lockdowns closing the sectors that young people are more likely to work in[7]. A focus on supporting young people into work and education alongside provision of mental health support could help to prevent them becoming trapped in a negative cycle.

11. 80% of young people who had a history of mental illness reported their conditions have worsened since the pandemic[8]. The same report suggests that losses of routine and social isolation are two of the most common catalysts in the deterioration of young people’s mental health, as they can no longer utilise these as coping mechanisms. Additionally, reports throughout the pandemic have highlighted the increases in abuse[9], bereavement[10], and mental ill health[11]. Concerningly, research identifies these factors as common risk factors for suicide in young people[12]. These findings may help to explain the increased demand for support seen since the start of the pandemic - something we can expect to continue while society remains under restrictions.

12. Recent findings in a report from The Education Policy Institute and The Prince’s Trust highlight the importance of school as an environment that fosters children’s wellbeing[13]. With schools closed, pandemic-related stress for children may then have been exacerbated by this disruption to their routine and social setting. At the same time, young people participating in a focus group convened by The Prince’s Trust reflected that, whilst their mental health had improved when they could start seeing other people again, going back to school was not the same as ‘normal’ socialising. Notably, attention was drawn to the level of stress associated with schoolwork. As policy currently (and rightly) focuses on catch-up funding for lost learning, government should consider introducing additional funding to support a ‘wellbeing catch-up’ alongside academic catch up funding. A wellbeing package would allow schools, where required, to hire additional staff to deliver mental health support to pupils and teaching staff, run interventions to address socio-emotional skills’ gaps, improve links with local CAMHS, and deliver training to teachers.

Quotes from secondary school pupils participating in focus groups run by The Prince’s Trust:

“You find yourself putting a lot of pressure on yourself with revising and stuff.”

“Sometimes you set yourself goals that you know you can’t achieve – pushing yourself over the limit, and that has a massive impact on your mind because you’re always thinking I could be doing better.”

To curb a mental health crisis for an entire generation, services for young people need to be adequately resourced and accessible to meet new demand

13. While the provision of online learning has been prominent in headlines, we have also seen an impressive and rapid shift to digital alternatives for support: 74% of young people who had been accessing mental health support before lockdown say they are still receiving support in some form[14]. However, of the 26% that are unable to access support, school closures, inability to attend groups, concerns over privacy, and difficulty accessing technology were all cited as barriers to care[15]. Research suggests that approximately one million children and young people do not have adequate access to a device or connectivity at home[16]. Of those who do, there are additional concerns that online support is less effective, particularly due to lack of privacy in the home[17]. The longevity of online support must be considered through the lens of accessibility; if it can only reach those with access, it is likely that those who need it most are slipping through the cracks. The government have made welcome effort to tackle the digital divide and this should continue to ensure digital access does not become a barrier to support in a world that is becoming increasingly online.

14. Although digital adaptations have facilitated the maintenance of mental health treatment for people already being supported before the pandemic, the statistics highlighted earlier in this report show that services were already struggling to meet increasing demand pre-pandemic. This, in addition to the findings that probable mental illness has increased amongst children and young people, indicate an ever-increasing demand for services that needs to be met urgently with increased supply. The levels of resourcing and funding for CAMHS must be assessed as part of this to ensure the level of support needed by young people is provided in a timely manner.

15. Alongside this, resourcing through the aforementioned “wellbeing package” in schools could help children to access support available to them - with better training for staff and improved links with local CAMHS to allow for improved identification of young people who need formal support and enhanced ease of referrals. It is important that any additional requirements placed on schools surrounding mental health and wellbeing should be met with funding, training and the support needed to improve outcomes for young people.

16. It is not the job of teachers to provide mental healthcare, but we know that most teachers will encounter these issues in the classroom at some point. As such, it would be beneficial for the local Mental Health Support Teams, currently being piloted in a number of areas, to deliver training to school staff to ensure that mental health support is embedded across the school community.

17. The utilisation of mental health teams in schools could be a positive part of an early intervention approach, but it is essential they don’t become a box ticking measure and are adequately funded so that they are available and accessible for all children to benefit from.

18. Fast and immediate care for young people must continue to be a priority. New findings that 7% of young people have attempted suicide by the age of 17 and 24% of respondents having self-harmed in the same year[18] indicate serious need for support for this age group. Timely care is important to alleviate psychological distress and identify young people with severe mental health difficulties. Government should publish a plan for rollout of a four-week waiting time for specialist mental healthcare across the country including clear details about funding and staffing requirements. Results showing large inequalities in mental health outcomes for young people from low income households[19] also indicate the need for targeted local infrastructure to support these communities. Increasing access to timely care must continue to be a priority for those children who need it, and the government should make clear when and how all children in the country will be able to quickly access the treatment they need.

An early intervention, ‘mental health in all policies’ approach could be preventative by creating conditions conducive to good mental health and wellbeing

19. Prevention is about creating the conditions that are conducive to healthy psychological development and functioning. This means policies that go beyond the mental health sector to include economic and social factors, the upstream determinants of mental health – also known as a mental health in all policies approach. Research suggests that half of all mental health problems are established by the age of 14, underlining the need for early intervention alongside this broader focus in policy making[20].

20. The findings of our report with EPI demonstrate that socio-economic circumstances, according to both objective measures and children’s perceptions of their family’s socio-economic position, are strongly predictive of children’s wellbeing[21]. Investment in personal development interventions in schools that address socio-emotional skills’ gaps could also be useful to tackle the existing consequences of inequality identified in our research. But this should come alongside the development of a cross-government and cross-sector strategy to reduces family poverty and ensure young people feel safe in their communities.

21. The recent research project between the Education Policy Institute (EPI) and The Prince’s Trust analysed longitudinal data that tracked the wellbeing of a cohort of young people at ages 11, 14, and 17[22]. These findings, which highlighted changes in wellbeing during transitional periods, provide unique insight into the role that early intervention can play in preventing the later development of mental health issues  - further underlining the need to consider mental health and wellbeing throughout other areas of policy development.

22. A particularly notable example of this was the finding that girls’ self-esteem dropped most significantly between the ages of 11 to 14 and then remained broadly stable between the ages of 14 to 17[23] – indicating how aspects of wellbeing can be determined at an early age. As such. it would be interesting to explore how funding community-based interventions focused on younger age groups could help children experiencing symptoms of poor wellbeing that do not yet meet the diagnostic threshold, whilst also potentially preventing the development of more serious mental health problems for an entire generation. The startlingly high prevalence (16%) of psychological distress in young people alongside the 7% who reported having attempted suicide by the age of 17[24], indicates an imperative that psychological distress is not just treated but prevented from escalating.

23. Understanding predictors of poor mental health and wellbeing can identify areas for action – even those which appear to sit outside of the traditional remit of ‘mental health’. One such predictor is being bullied, which our research with EPI has found to predict worse emotional and psychological wellbeing[25]. A focus on evidence-based policy to prevent and tackle bullying with clear plans for funding, delivery and accountability – and with reference to the impact on the mental health of young people – would be helpful.

24. Lack of engagement in physical activity and being overweight are also shown in this research to correlate with poor well-being and self-esteem for young people[26]. Considering the impact on mental health and wellbeing in policies to address obesity and improve physical activity is vital, especially when considered alongside evidence from BEAT[27] which shows an undue focus on weight loss can also be linked to disordered eating – a problem we know has increased throughout the pandemic[28]. As poor physical and mental health both necessitate more costly, late interventions, putting pressure on squeezed health services[29], early intervention in this area could be particularly effective in alleviating pressure for the NHS.

25. Increased mental health literacy can empower young people to advocate for their own mental health and promote the importance of wellbeing in their community[30]. One way that this could be done is through building on existing mental health content in the Health Education and Relationships and Sex Education Curriculum, as well as supporting and encouraging schools to work with external organisations and charities working in this space. This would also provide an opportunity for young people to identify pathways of support and how they can be accessed. By improving the mental and emotional health literacy amongst young people they will be equipped to support their own wellbeing and that of their peers. Furthermore, this knowledge removes a barrier for hard-to-reach groups in need of support- promoting equity of access.

Integrating communication between organisations for young people can create a streamlined, holistic model of support that is both preventative and reactive

26. As described in our report with EPI[31], a strong collaborative relationship between schools, colleges, and specialist health services is a positive way of supporting young people with mental health issues to thrive. These relationships are key to ensuring young people receive care appropriate to their needs, whether it’s ongoing support from their school or college, or timely access to more specialist services. Sustainability should also be at the heart of any assessments of the trailblazer pilots instigated following the recommendations by The Green Paper. The best way to build capacity for schools and colleges to support young people in the long term is through upskilling the staff and building their capacity to support colleagues and young people in turn. External interventions in schools will be important in giving young people specialist support where needed, but without internal capacity building, schools and colleges may not be able to fulfil their commitments to young people in the long term. We recommend government centre the views of school and college staff in this assessment.

27. It is clear that school-based support is not sufficient for every child, and it is important that all young people are able to access timely specialist interventions when necessary. Provided they avoid the pitfalls discussed above, the introduction of local Mental Health Support Teams is a positive move in building strong, collaborative relationships between education and health providers, coordinating interventions, and giving schools and teachers access to rapid advice and referral paths for young people who need more specialist support.

28. Youth services such as those delivered by The Princes Trust drive positive outcomes for young people. Poor mental wellbeing is often associated with other factors that lead a young person to contact a youth service (such as being NEET or from a low-income background) and this is reflected in the fact that one third of young people self-report mental health concerns on our programmes. A lot of the work done on youth programmes is reactive, helping young people who are identified as needing additional support. At the same time, work such as that carried out by The Princes Trust is also preventative, because by helping young people with employability, confidence, and learning, they are then better equipped well into the future. The 81% positive outcome rate on our programmes reflects the difference these programmes make to the lives and consequently the wellbeing of the young people we support. Due to the nature of service user youth services attract, and the significance of these services in determining a young person’s future resilience, training programmes should also be extended to ensure the mental health literacy of youth workers.

February 2021