Systemic prevention of poor adolescent mental health and promotion of social connection and wellbeing

Our proposal represents an ambitious and radical approach to improving the mental health of adolescents. Young people face numerous and increasing challenges, including rapidly changing technology, environmental concerns and uncertainty about economic and employment prospects. All of this can affect their mental health. This is particularly true for Black/African/Caribbean young people growing up disadvantaged in urban communities, exposed to high levels of discrimination, violence and trauma, as well as young people growing up in isolated, remote and rural communities.
Typical approaches to supporting the mental health of vulnerable young people, whilst well-intentioned, often fall short of providing the help that young people need. Too often formal support is absent - most young people experiencing mental health difficulties do not receive help from services. If support is made available, it often comes too late once problems have taken hold. The support that is provided is often removed from the realities in which young people live, and can inadvertently foster a reliance on help from outside their communities.

We want to flip models of mental health support from 'top-down' service models of help that can never realistically meet the needs of young people, to community-led approaches in which young people develop in rich, supportive social ties and networks of support. There is strong evidence to support our view that social support, connection and strengths that already reside within communities may be the best source from which to prevent the debilitating and serious effects of poor mental health that is gripping many communities.

Our approach brings together leading scientists, designers and community champions to explore the local influences upon young people's mental health in two areas: Black/African/Caribbean young people in disadvantaged urban London communities, and young people living in rural, remote areas in Devon. These are two often neglected populations.

Our partnership is led by Professor Peter Fonagy at University College London - a world leading expert on adolescent mental health, and his teams at both UCL and Anna Freud National Centre for Children and Families (AFNCCF). Our partnership also includes experts in systems and data science (PenARC and Dartington Service Design Lab), service design (Hilary Cottam and Shift) and youth work embedded within communities (Redthread).

We know that each community is different, with their own challenges but also their own strengths. We will work with young people to deeply understand the realities of growing up in dense urban or remote/rural communities and to chart the opportunities and strengths that reside within these communities. We want to tackle the underlying causes of poor mental health, not just the visible symptoms. Together, we will design a series of innovative interventions that build social ties within and across communities so that the positive promotion of mental health is everyone's business, and that the whole community is well equipped to support young people to thrive.
We will also make sure that the interventions and support systems that are designed stand the test of time. We do not want our work to be a one-off, time-limited effort that fizzles away in a few years. Approaches will be embedded within communities over the long-term.

We will also design interventions and approaches that can be picked up, adopted and replicated elsewhere. We think every community should have the tools and approaches to capitalise on the strengths that exist in their area to promote young people's mental health.

As such, we'll be working with leading entrepreneurs and business-minded partners to ensure that our approaches can be widely adopted, yet still reflect the local nuance and needs of specific communities.

Poor adolescent mental health is a non-communicable disease, rising in prevalence, that represents a significant psychological and physical health burden on individuals, as well as affecting the economic and social welfare of communities and the state [1-3].

It is also a systems issue. Many presenting issues are typically manifestations of underlying patterns, structures and dynamics of the systems and communities within which adolescents develop [4].

Despite the systemic nature of poor mental health, too often it is conceptualised as an individualistic problem by siloed agencies responding to presenting manifestations, rather than tackling the underlying systemic patterns, structures and dynamics. Furthermore, current approaches run the risk of widening disparities in poor adolescent mental health: many of those populations most at risk of poor mental health receive disproportionately lower investments and engagement in supports and services.
We will undertake a comprehensive youth and community-led systemic enquiry into the antecedents and consequences of poor mental health in economically disadvantaged urban and rural/isolated environments. This will include causal loop diagramming, social network analysis, asset mapping and ethnography. Building on these insights we will facilitate a process of participatory group model building of system dynamic simulation models to guide community-based intervention design, prototyping of approaches and ongoing monitoring and systemic evaluation [5,6].

This systemic enquiry will inform an ambitious youth and community led design process in urban and rural places that capitalises on existing social assets and strengthens social ties and collective efficacy as a route to prevention of poor mental health. The process and intervention designs will be codified and disseminated so that they may be adapted for varying contexts across and inform national health policies.

This grant is funded by the UK Prevention Research Partnership (UKPRP) which is administered by the Medical Research Council on behalf of the UKPRP's 12 funding partners: British Heart Foundation; Cancer Research UK; Chief Scientist Office of the Scottish Government Health and Social Care Directorates; Engineering and Physical Sciences Research Council; Economic and Social Research Council; Health and Social Care Research and Development Division, Welsh Government; Health and Social Care Public Health Agency, Northern Ireland; Medical Research Council; Natural Environment Research Council; National Institute for Health Research; The Health Foundation; The Wellcome Trust.