Just Health

• They co-created a vision for emotional health support within youth justice, in partnership with health and justice professionals
  
  
• Recommendations led to NHS England developing a Young Commissioners project, enabling young people to work as equal partners in commissioning health and wellbeing services for peers

ACTION

Just Health, an enquiry into the emotional health and wellbeing of young people in the youth justice system, was commissioned by NHS England's London region, to gather young people's previously-unheard views on the changes needed in the system to improve their emotional health. NHS England entrusted this task to Peer Power, a charity specialising in co-production.

The main focus was NHS England-commissioned Liaison and Diversion (L&D) services. These all-age early intervention services are provided in London by a mix of child and adult mental health and youth justice providers, who screen new entrants into the justice system for mental health and other needs, diverting them into support services where appropriate.

"What I wasn't sure about was whether the model was quite right for young people in London," says Sinéad Dervin, senior health and justice commissioner for NHS England's London region. "So we wanted to consult them to better understand their health and wellbeing experiences in the justice system."

Peer Power chief executive Anne-Marie Douglas describes professionals' difficulties in approaching, engaging and assessing young people in custody suites as a core theme in the charity's work with organisations. "Young people have told us they won't speak to anyone in the custody suite, as they need a relationship with them first," she explains.

Paid "peer leaders" modelled this relationship building during the consultation's first stage from June last year, leading five focus groups involving seventeen 13- to 17-year-olds, recruited through youth offending teams (YOTs), health providers and youth services.

The peer leaders had also been through the youth justice system and shared their backgrounds first, an approach that Douglas says "engenders trust and breaks down barriers". This helped them gather young people's experiences of services, showing how they could be improved and the barriers to their engagement. "Peer leaders are skilled facilitators and can keep a conversation going by using relatable things," she explains.

Douglas says Peer Power engaged young people in Just Health by offering them ongoing opportunities to participate in something meaningful and longer-term than just a consultation, emphasising throughout that they could leave at any time.

Opportunities included making a film about their experiences, translating them into poetry and music, jointly finding solutions with decision-makers, then in the longer term, training as peer leaders. "Some young people are over-consulted in tickbox exercises," explains Douglas. "But true co-production enables an ongoing relationship with them."

A pan-London event in November enabled young people, YOT workers, mental health professionals, commissioners and others to co-create a vision for emotional health support within youth justice. Group and individual consultation activities uncovered the services delegates most wanted investment in, the best people to provide it, the qualities they needed and the barriers to young people seeking help.

Participants' testimonials suggested L&D workers were not reaching young people effectively, hampered by their lack of trusting relationships with their young clients. The report's recommendations include a co-produced redesign of these services; research into the effectiveness of emotional intelligence training for young people to help identify needs earlier; and involving them in decisions about what services they are offered.

"When young people who haven't had their voices heard feel confident that what they're saying is being listened to and acted on, it's transformational: both individually and for services," says Douglas. "I believe storytelling as part of that contributes to desistence from crime and has emotional health and wellbeing benefits in its own right."

IMPACT

Dervin says the findings confirmed her feeling that L&D services "aren't always responsive" to young people's needs, "often focussing on what is ‘wrong' with the young person, rather than trying to engage the young person and understand their world."

She is now developing with Douglas a young commissioners' project, which will involve Peer Power recruiting, training and supporting young people to help commission health and wellbeing services for peers in the youth justice system. The charity will work in partnership with Inspirit, an organisation commissioned by NHS England to facilitate meaningful participation of adult healthcare users in the justice system.

At least two young "commissioning technicians" will support NHS England as equal partners through the tendering, commissioning and awarding of contracts in London, starting with the re-tendering of the contract for Feltham Young Offender Institution, due to start this month (April). NHS England is working with Peer Power to ensure Feltham's young people are consulted on the quality of services, and plans to recruit young people to help shape its work programme for health and wellbeing services in youth justice, acting as a sounding board for new policies and helping with quality assurance.