Improving the experience of young people in mental health crisis

Introduction

In 2017, with support from Health Education England, led by Healthy Teen Minds and working in conjunction with Barts Health NHS Trust, the We Can Talk programme for acute NHS staff was developed. This was based on work with staff who identified a need to improve confidence and competency to support young people presenting in mental health crisis, as well as young people reporting too many negative experiences when attending hospital due to their mental health. These experiences had a negative impact on the young person’s ability to cope and engage with services once discharged.

This unique training programme was coproduced with a team of young advisers who have lived experience of receiving mental health care in hospital. This project began by coproducing a set of principles on what emergency department and acute staff need to know to support children and young people (CYP) in mental health crisis.

The We Can Talk Core Curriculum is based on real-life experiences and delivered by young people, acute staff and mental health experts. It recognises the role hospital staff already play in caring for this group of patients, and builds on their knowledge, confidence and skills. This work has shown us that what matters to CYP is not the clinical experience and expertise of the staff member but the approach and engagement of these professionals.

Acute and mental health trusts who have received We Can Talk training report:

• A reduction in the number of risk incidents involving CYP attending for their mental health;
• Improved management of those awaiting mental health assessment, including a reduction in the use of out-of-hours child and adolescent mental health services (CAMHS);
• An improved relationship between wards and local CAMHS teams.

Independent analysis by the Child Outcomes Research Consortium (CORC) showed that 98% of staff who completed the Core Curriculum reported that the training will make a difference to how they do their job.

Following the outbreak of Covid-19 in the UK, the We Can Talk Core Curriculum delivered face-to-face in acute hospitals had to be paused. There were huge concerns from senior stakeholders as CYP would still present to acute hospitals in mental health crisis and need appropriate staff support.

“A unique patient-centred approach to education and support for staff in the acute setting, which has the ability to grow and develop across multiple settings, nationally and internationally” (Judges’ feedback)

Online training tool

Our young advisers repeatedly tell us they do not need experts in mental health to support them, they just need to be treated with kindness and compassion – the same as any other patient presenting to hospital. It was vital that young people’s voices were still heard, despite it not being possible to run the face-to-face training. We Can Talk wanted to make sure that staff had access to education during the pandemic so they could still support CYP in crisis. As such, Fundamentals of Compassionate Care, an online, free, easily accessible module for staff was developed. This ensured that multidisciplinary staff everywhere could access education that was based on the lived experiences of CYP.

This hour-long online training highlights that care and compassion is the singular most important thing to CYP in crisis. Uniquely, its content is delivered solely by young people who have lived experience of mental health crisis.

Production

On 23 March 2020, following the pause on face-to face training, the We Can Talk team identified elements and competencies of the core curriculum that could be translated into an online module.

Once essential components had been agreed by the team and mapped against the core competencies, the content was scripted by one of the young advisers. All of the scripts and content were reviewed by the whole team ready for production. Several options for platforms were explored to make sure appropriate functionality was available and that the best user experience could be created.

At this point, the UK had just gone into its first full lockdown. Planning, creation and delivery of the module had to be done while in isolation. Discussions were held via video calls and the young advisers were given online tutorials by the filmmaker, who showed them how to use the equipment so they could record the material independently. This was then edited to create the final content.

To test the site and educational components, the online module was sent out to staff who had already completed the face-to-face training. After this ‘soft’ launch, the module was released nationally – just six weeks after the project began.

Impact

To date, more than 15,000 people have accessed the online education module. Data independently analysed in January 2021 by our partners at CORC showed that, following training, 98% of staff said there would be a significant or moderate difference in the way they do their roles and respond to CYP presenting in crisis. In addition, 99% of staff who used the training would recommend it. For a non-mandatory, online module, this is testament to the team’s hard work to ensure content was engaging and informative.

In post-module evaluation, staff also reported feeling far more confident in their knowledge and understanding when talking to CYP about the challenges they face in hospital, and about their emotional and mental health needs.

Specific feedback was also received on how informative the videos from young people with lived experience were. One trainee noted:

“Before this training, I did not feel confident in dealing with children and young people, or adults even, with mental health issues and one of my biggest fears was not saying the right thing. It has been great to learn that being my compassionate self will be enough, even if that’s all I have to offer, as I do care, and I do care about the mental health of others and feel this needs to be a priority.

“The videos made such a difference, hearing from young people about their needs first-hand carries so much more weight than a PowerPoint.”

Moving forward

When restarting the We Can Talk programme in March 2021, Fundamentals of Compassionate Care was formally introduced in 25 acute trusts where face-to-face training had been paused. The phenomenal success of this module has given We Can Talk the confidence to understand that the Core Curriculum, usually delivered in face-to-face training, can be translated into an online medium that is engaging and informative, while still achieving the required competence.

The numbers of CYP in hospital with mental health crisis is increasing as we move to a post-pandemic world, and we are currently in the process of developing the programme to make sure it can continue to deliver this vital education, regardless of any possible future restrictions. Building on what we learnt from Fundamentals of Compassionate Care, the online Core Curriculum was launched in July 2021. This face-to-face equivalent now consists of online, self-directed, bitesize components. Keeping true to the ethos of the organisation, it has been coproduced with CYP and acute and mental health specialists. We are currently accepting expressions of interest from organisations for fully funded access to this programme.

Conclusion

As the pandemic hit, we needed an alternative way to provide education. To have created, coproduced and delivered something so powerful that will have a huge impact on the experience of CYP in just six weeks, during a national lockdown, is nothing short of remarkable. It clearly shows the extraordinary drive and passion the team has to improve this area of care.

Our team of young advisers helped make this possible and, when they recognised the immense pressure hospital staff were under, they wanted to support those who have cared for them and their peers. At We Can Talk, we have now built on our learning from developing this resource and will continue to offer online learning as a part of what we do.