Agency, Social Identity & Justice in Mental Health: A Collaboration with Young People, Clinicians & Academics across Philosophy, Ethics & Neuroscience

The field of youth mental health presents particular challenges and opportunities. The majority of mental health difficulties emerge before the age of 25 and this is also the time of greatest opportunity for positive change in terms of personal, social and neurological development. Young peoples' sense of agency and social identity is developing. Healthcare interactions offer access to treatment and support. From our consultations with young people, we are aware how disenfranchised they can feel, when supports and services seem to speak a different language that does not involve them, address their needs, respect their agency and treat them fairly. Not being involved and treated as an active agent impacts negatively on young peoples' wider sense of agency and identity, which in turn effects their relationships, school and transition to employment during this critical developmental phase.

It is therefore crucial to study the consequences of mental healthcare interactions for young peoples' wider sense of agency and social identity in their lives, i.e., how young people feel helped or harmed by these social interactions. This requires a greater understanding both of helpful interactions to improve outcomes for young people and also of harmful interactions in order to avoid harm and mitigate risk. Ultimately, we are interested in how young people feel enabled to be active agents in their care and identify solutions they feel will help rather than harm them.

We have three aims in this project. Firstly, we will conduct a launch workshop to establish a new collaboration involving young people, their families, clinicians and academics across philosophy, ethics (the study of what is right and wrong), psychology and neuroscience (the study of the brain) to investigate agency, identity and justice in youth mental health. Secondly, we will (i) analyse verbal and non-verbal communication in 16 mental healthcare encounters involving young people to examine how agency is fostered or thwarted in these encounters and (ii) test novel interview methods with 25 young people to identify their preferences on how best to interview them about their experience of agency and justice. Thirdly, we will conduct a further 3 workshops to develop a new study idea to investigate the effect on the developing brain of high and low agency in social interaction.

The field of youth mental health presents particular challenges and opportunities. Most mental health difficulties emerge before the age of 25, which is also the time of greatest opportunity for positive personal, social and neurological development. Young peoples' sense of agency and social identity is developing. Healthcare interactions offer access to treatment and support. From our consultations with young people, we are aware how disenfranchised they can feel, when supports and services seem to speak a different language that does not involve them, address their needs, respect their agency and treat them fairly. Not being involved as an active agent impacts negatively on young peoples' wider sense of agency and identity, which in turn effects their relationships, school and transition to employment during this critical developmental phase.

We have three aims. Firstly, we will conduct a launch workshops to establish a new collaboration involving young people, their families, clinicians and academics across philosophy, ethics, psychology and neuroscience to investigate agency, identity and justice in youth mental health. Secondly, we will micro-analyse 16 mental healthcare encounters to examine how agency is fostered or thwarted in these encounters and test novel interview methods with 25 young people to access experiences of agency. Thirdly, we will conduct a further 3 workshops to develop a study protocol to investigate the neural correlates of agency in the developing brain in social interaction. We will deliver (1) new conceptual insights in philosophy and ethics (2) novel methodological work on how agency can be examined in social interaction and accessed by novel interview methods (3) clinical implications for how agency in adolescence is fostered or thwarted in social interactions in youth mental health care and (4) a study protocol to investigate the neural correlates of agency in the developing brain in social interaction.

Our aim is to improve relationships between clinicians and young people with mental health problems in order to ultimately improve their quality of life and ability to engage in relationships with peers, families and in school. We will engage with young people, their families, healthcare professionals and academics to better understand agency for young people in mental health encounters and develop plans for a future study on agency, mental health and the developing brain.

We will work closely with a group of young people who will meet four times throughout the project. We will share our findings in a lay format via the McPin Foundation, the Youth Advisory Group at the University of Birmingham and more widely with young peoples' advisory groups in the UK via the NIHR Generation R's project and globally via the ICAN programme.

We will hold a public engagement event run by the project team as part of the Arts and Science Festival at the University of Birmingham (open to the public) where we discuss the factors affecting agency and how maintaining a positive sense of agency (especially as someone producing and sharing knowledge credibly and authoritatively) can be challenged in the healthcare encounter in mental health contexts. We will invite young people from local schools to attend and participate.

Based on previous studies we have conducted analysing healthcare encounters (e.g. in psychosis, dementia, depression in primary care) we anticipate that our findings on how agency in adolescence is fostered or thwarted in social interactions in youth mental health care will have clear implications for clinical practice in the NHS. We will conduct a workshop with clinicians to present the findings to them using video and interview extracts. Working with real practice examples is appealing to clinicians as much clinical training/reflection is based on idealised role plays/clinical scenarios. We will advertise the workshop to clinicians including those in primary care, child and adolescent mental health teams and early intervention mental health teams. We will use our strong clinical links in East London NHS Foundation Trust (McCabe) and Birmingham Women's and Children's NHS Foundation Trust (Broome).