Human rights cannot be an afterthought in times of crisis — and we now face the biggest international crisis in generations ... human rights can and must guide COVID-19 response and recovery ... The message is clear: People — and their rights — must be front and centre.
Secretary-General of the United Nations
Even before the Covid-19 pandemic, the mental health system was notoriously poorly equipped to meet young people’s needs. But, as we emerge from the coronavirus lockdown, the scale of mental health need and related social issues facing young people is unlike anything we’ve ever seen before. At a time when it’s most needed, mental health support has become uniquely difficult to access.
Young people have reported the sharpest rise in mental health concerns during lockdown, experiencing higher increases in rates of depression, anxiety and loneliness than any other age group. More likely to be in junior roles in the workplace, in precarious employment or renting, young people have seen their jobs and incomes suffer, with a higher proportion of their spending going on accommodation and essential items. They are also showing the lowest levels of life satisfaction during the pandemic, with a concerning 20% of 16-25-year-olds in one lockdown survey believing their life will amount to nothing, no matter how hard they try.
The coronavirus pandemic has entrenched and exacerbated preexisting mental health inequalities. Those young people already experiencing the worst mental health before the crisis have been the most negatively affected by it. It is well known that individuals with experience of adversity are more likely to develop trauma in reaction to new stressors, a fact that should clarify the focus of policymakers in all crisis preparation and response. But coronavirus presents a unique set of novel challenges to the most vulnerable young members of society, often stripping away the lifelines that may ordinarily have bolstered their mental health and wellbeing in the face of hardship and distress. In times like these, anything less than a bold and transformative approach to supporting young people’s mental health is not good enough; an unprecedented challenge requires an unprecedented response.
Facing such challenges may seem like a daunting, even insurmountable, task. Fortunately, we already have a blueprint for what a mental health system that is up to the job looks like, laid out clearly in the human right to health. This right, written into international law and encoded in the first principles of the NHS, says that every one of us is entitled to the best possible standard of mental, as well as physical, health. To help us get there, it sets out four key principles for what a rights-respecting health system should look like: healthcare should be available and accessible to all, offering appropriate and high quality care.
What are the four principles of a human rights-based approach to mental health?
Availability
Our human rights say young people are entitled to support that is available to everyone who need it, when and where they need it. This includes taking preventative action against mental health problems developing in the first place, as well as designing a system that looks out for and provides care during the early signs of distress, and not just at crisis point.
Accessibility
Mental health support – and information about where to receive it – must be easily accessible for everyone, without discrimination. This means recognising where the existing barriers to young people accessing support are and taking a tailored, proactive approach to remove them and ensure everyone is accessing high quality support that meets their needs.
Acceptability
Services must also be acceptable, which means they are sensitive and responsive to the specific needs of different age groups, communities and cultures. We have long known that one size doesn’t fit all and, indeed, personalised care has become a cornerstone of plans for transformation of the NHS. But this is our human right, too, and respecting this right requires listening to and engaging communities and individuals – including young people with disabilities, Black and Asian young people, carers, care leavers and the LGBTQ+ community – and working with them to co-design tailored, inclusive support.
Quality
Finally, human rights say young people’s mental health support must be high quality – something that should go without saying but is too often not the case. Crucially, our human rights recognise that quality can only be achieved by listening to and engaging the individuals and communities in need of support so that they have a say not only in their own care, but what the system looks like as a whole.
To find out more about the human right to mental health, read our #MyRightsMyMind briefing.
How will we get there?
Ensuring that young people’s mental health rights are met in the wake of the coronavirus pandemic will require a nimble, flexible, cross-sector approach that is led by young people and built to last. We believe the following four points are fundamental to this goal:
1) Commit to equality and non-discrimination
Underpinning all human rights is a commitment to equality and non-discrimination. But making sure that everyone has access to appropriate support doesn’t mean scaling up the status quo and waiting for young people to turn up: this isn't about treating everyone the same.
A rights-based approach calls for particular attention to be paid to the needs of young people who are more likely to suffer with their mental health, whose mental health problems intersect with wider societal issues and discrimination, and whose path to accessing quality support is more likely to be blocked. This includes young people from Black, Asian and minority ethnic, LGBTQ+ and disabled communities. It includes young carers, those who have grown up in care, young people with experience of abuse and severe childhood trauma and young refugees.
Equality and non-discrimination require recognition of the fact that for lots of young people, ‘traditional’ mental health support doesn’t cater to their needs, and that reversing this starts with meeting young people where they are at, listening and responding to their specific needs. It means developing a racially- and culturally-aware practice and rooting out cognitive bias that affects how different groups of young people are perceived and treated. It also means dispensing with the term ‘hard-to-reach’: it’s the mental health system that so often represents an elusive, remote entity to young people, not the other way round.
2) Be led by young people
Any plan for the future of the mental health system must begin with the voices of young people. As we emerge from the pandemic, we need to take the time to acknowledge and reflect on what has happened. We support the calls of our colleagues in the sector for a focus on wellbeing in the return to schools, and believe this should extend to all areas of society. This includes specific measures to target young people outside of mainstream education and employment to ensure the needs of no young person are missed.
Crucially, youth participation cannot be treated as a tick-box exercise. It must instead create true leadership roles for young people from diverse backgrounds and with diverse needs to help shape, oversee and evaluate a mental health system that respects their rights.
3) Involve the voluntary sector
It has been truly inspirational to see the resourcefulness and innovation of the mental health sector in adapting to the immediate shutdown of face-to-face services, including the acceleration of plans to roll out 24/7 mental health crisis lines across the country. But support remains out of reach for far too many young people, and has become all the more difficult to access for some.
A system that is able to support the needs of all young people, including those who have been unable to get help during lockdown or are experiencing mental health issues for the first time, must also have a clear role for the voluntary sector. Youth Access is proud to represent nearly 200 community-based organisations, whose youth-led, holistic approach to mental health has long been lauded as an exemplary model of support - especially for some of society’s most vulnerable young people who fall outside of mainstream provision or don’t feel comfortable in traditional mental health settings. They have also been at the forefront of innovation in care during lockdown, in the face of major challenges, and will be key to ensuring a rights-based approach to recovery that leaves no young person behind.
Supporting these organisations will require, at a minimum, flexible, ringfenced funding, training in adapted models of working for practitioners and a commitment to giving them a seat at the table in mental health planning at a local and national level.
4) Build for the future
Any post-lockdown response must also be aware of the fact that the effects of the pandemic on the mental health of our young generations are far from being fully felt. Traumatic symptoms may be unpredictable and not appear for months or even years, long after the immediate threat of the virus is over. Meanwhile the long-term economic repercussions on young people’s lives and livelihoods are as yet unknown, and this could have a knock-on effect on mental wellbeing. We must therefore ensure that the mental health system looks beyond a crisis response and is built for the long-term.
At the very least, this will require a recommitment to the goals set out in the NHS Long Term Plan and an investment in building up cross-sector capacity to support every young person who needs it. In our part, as the voluntary sector, we must double down on our commitment to delivering enduring and sustainable support for young people. We must refuse to be satisfied with short-term or knee jerk ‘crisis response’ packages which fail to meet the long-term needs of young people, or consider the aim of the game to ‘get back to’ a normal that was never good enough.
In the present context, this means expanding plans to improve digital and telephone connectivity, and ensuring its affordability, to all young people currently without access. It also means recognising that for many young people, the barriers to accessing remote support go beyond digital, and that clear guidelines are needed to ensure that they can be offered alternative support in a safe way.
As lockdown is eased, this means ensuring that face-to-face support acknowledges the specific needs of individuals, for example those who have health concerns or live with vulnerable family members, as well as embedding and building on innovations that have emerged in remote mental health provision during lockdown. For some young people, such developments have improved their access to support and to return simply to business-as-usual would be a considerable step backwards. We need to build for a future where a blended model of remote and in-person support is the norm.
But this is only the start, and we will need to go much further to build a mental health system that is fit for purpose. The coronavirus pandemic has presented an incomparable set of challenges to protecting young people’s health and wellbeing that cannot be ignored. But we believe it also represents a once-in-a-lifetime opportunity, to transform the system into one that truly listens to young people and stands up for their rights.
Our upcoming webinar Planning for a rights-based recovery will look at the challenges, strategic considerations and practicalities for youth advice and counselling services as we emerge from lockdown. The webinar will take place on Thursday 9 July from 10:00-11:30am, and registrations are open here. The webinar is exclusive to senior managers at Youth Access member organisations.