Service users as the key to service change? The development of an innovative intervention for excluded young people

Young people affected by street gangs and those at risk of offending often have high levels of unmet mental health needs. Multi-agency and multi-component interventions seem most promising for meeting those needs according to research by Hodgkinson et al, 2009 and McMahon, 2013, but provision by local authorities and third sector organisations can be inconsistent and time-limited due to variable funding, and mental health components can be missing.

Evidence has found that there is a gap between statutory mental health services offered in the community and their take-up by these "hard-to-reach" young people. This may be partly explained by the use of an appointment-led approach to mental health provision, which creates barriers for excluded young people - from geographical barriers such as neighbourhood territories to psychological barriers, such as mistrust of professionals.

The Music and Change Project

The two-year Music and Change (M&C) project aimed to bridge the service gap for this group, focusing on building a trusted relationship between a keyworker and a young person. Attachment and mentalisation-based theory informed practice and understanding of young people's behaviours and mental health issues. Project development was "bottom-up" rather than "top-down", based on principles of strengths-based co-production with "little predetermined content, structure and processes".

The project took place in an inner-city, high-density housing estate, targeted at young people aged 14-25 not engaged in education, employment, training or youth services (other than the youth/criminal justice system) and at a high risk of offending or reoffending. Young people were identified through informal outreach and participatory methods - spending time where young people gathered (eg the local takeaway), building relationships with the local youth centre and by being identified as gang-affiliated through a relevant multi-agency panel and self-reporting by young people.

Mental health concerns were not in the inclusion criteria; staff informally assessed young people's needs throughout the intervention. Young people were able to self-refer by attending activities and often brought their peers along with them, which was actively encouraged. Exact demographic data was not known for all young people because they reported that such data collection was a barrier to coming.

Young people wanted the sessions to focus on music skills (DJ-ing and lyric-writing) as a vehicle for building relationships with staff and receiving support with a range of needs. Other professionals, such as a housing adviser, were invited to come and provide support around music sessions. Over time, as relationships with practitioners grew, young people became willing to explore their emotional experiences more deeply, especially if they could see a link to achieving their occupational and financial goals. Young people then met practitioners individually outside of music sessions.

The authors opted to use an ethnographic approach to understand young people's experiences of the project and to work with the fluidity of the population involved. Interviews and conversation with young people, stakeholders and staff were drawn on, with some of the young people acting as research consultants.

Findings

Young people viewed the following features of the project as being key to encouraging them to respond effectively, mirroring other findings by Hodgkinson et al (2009) and Pitts (2008):