An integrated approach to youth mental health

A mass exodus of all students and staff for a half-hour walk at 2.30pm every day for five weeks. The transformation of a concrete yard with paint and planting in pots. Mindfulness sessions and all-female boxercise classes. The introduction of a “healthy” vending machine that contains no fizzy drinks, chocolate or sweets.

These are just a few examples of the holistic approach to healthier lifestyles at Sligo’s community training centre (CTC).

“Health promotion underpins everything we do,” says tutor Mary O’Hara, who is co-ordinator of the centre’s health-promotion committee.

Inevitably the focus of the CTC’s funders is on the qualifications the 90 trainees aged 16 to 21 can achieve there, in “second chance” education for early school-leavers.

Courses range from computers and catering to hairdressing and sports and recreation.

“But what makes the centre unique is that we are trying to develop the whole person,” she says. Yes, mental health is a big issue, but it is not approached in isolation. The national youth health programme (NYHP), to which the centre is affiliated, recognises four other dimensions of health: physical, social, sexual and spiritual.

The Sligo centre has achieved the gold standard in the health quality mark (HQM) awarded by the programme, which is run by the National Youth Council of Ireland (NYCI) and funded by the Health Service Executive and the Department of Children and Youth Affairs.

The HQM is a whole-organisation approach, says Ailish O’Neill, senior project officer with the NYHP. The precursor is for a member of an organisation to complete the certificate in youth health promotion, credited by NUI Galway, so they can bring back knowledge and skills to start the process of fulfilling the award criteria.

Health-conscious

Before the introduction of the HQM in 2000, youth organisations were implementing pieces of health promotion “but they weren’t getting recognised for what they were doing and also they weren’t looking at it in a joined-up way”, she says.

With the Sligo centre having completed all the steps, through bronze and silver to the highest level of the HQM, O’Hara says the 14 staff are now very health conscious and “very aware of the impact we can have on all areas of trainees’ lives” – and not just on them but on their families and friends too.

In terms of mental health, it doesn’t have to be a formal response, O’Hara points out. “It can be informal: just listening, being respectful and open can mean as much as any programme we might put on.”

The HQM has also helped the centre to broaden not only its programmes but also its vision for what can be achieved there.

“It’s a real opportunity to promote health in a non-threatening way. We’re not preaching.

“We say [to the trainees]: ‘We are going to give you the information and let you experience new things. It’s up to you to make an informed choice around how you want to live your life.’ ” The trainees have their own health-promotion committee.

The NYHP, which was established in 1990, “moves in line with evidence-based and evidence-informed practice”, O’Neill stresses, rather than with fads or untested notions.

And the NYCI, which represents more than 40 national voluntary youth work organisations working with more than 380,000 young people, brings what is happening on the ground back to the policymakers.

However, issues tend to develop at grassroots level far quicker than national authorities can respond. For instance, just as we think we are catching up with the challenge of social media, it changes again, says O’Neill.

A national youth strategy being developed by the department has just gone through a consultation phase.

“The key thing that came out was mental health and wellbeing,” says O’Neill. But issues of positive self-image and sexual health and relationships were also to the fore.

Swan youth service

On the opposite side of the country from Sligo, in a very different centre, the Swan youth service in north inner-city Dublin also has a gold-standard HQM.

Eleven staff work with “at-risk” young people aged 10 to 24, six days a week from its main centre on Dunne Street in North Strand and a small community flat on Sheriff Street.

While previously the service would have run specific programmes about, say, healthy eating or sexual health, now everything they do is looked at “through a health-promotion lens”, says its director, Mairéad Mahon.

Staff even began to question why their own celebrations were always parties in pubs. And everyone working there, including the caretaker and receptionist, now gets supervision; ie support and education opportunities through regular reviews.

Mental health and stress among the young people is a big issue. While there is a low level of homelessness, there is a high number of young people living on couches, says Mahon.

On the positive side, people in the community are willing to take young people in. But some homes are very overcrowded as a result.

She knows of one grandmother who has seven young people in her house, all due to different circumstances.

The lack of privacy and economic challenges of this lifestyle put a lot of pressure on teenagers, she says.

Integrated approach

The fallout is tackled through an integrated approach at the service. For example, counsellors are available; staff serve on care teams in the schools; and the service runs Parenting Plus programmes for young parents.

Overall, the HQM gives them a clear, consistent framework on which to base their work, which is always facing new challenges.

“At the moment we are trying to work around the realities of sexual health and young people’s sexual lives,” to which the official response in the Republic is far behind.

Their work is much more reflective and person-centred now. One change was moving away from extensive timetabling of activities to more open access.

“It’s about making the space their space. They just come in, make sandwiches, play guitar.

“It’s very much part of health promotion for us that they have their space, ” she says. And they run their own smoothie bar.

The young people have also started a small community garden. The external environment in the area is very bleak, from the young people’s points of view, compared with other parts of the city, she points out.