Juliet Snell joins Thea Joshi to discuss how we can better support children’s mental wellbeing. Drawing on our evaluation of a BBC Children in Need programme, Juliet talks about the rediscovering the power of relationships, fun, creativity, and self-expression in building children’s mental health.
- Read the evaluation report on A Million & Me, The power of the ordinary
- Learn more about the ten-year delay facing children
- Check out our mental health spectrum
- Learn more about the A Million & Me programme
- Our recent work with Project Future and Centre 33, on the need for flexible, informal access to children’s mental health support
Music by scottholmesmusic.com
Alethea Joshi (AJ): Hello and welcome to Centre for Mental Health’s podcast, where we explore ideas around mental health, equality, and social justice. I’m Thea Joshi, and on the podcast we chat to people who are working towards equality in mental health. I recently heard from Juliet Snell, one of our associates, about our evaluation of a BBC Children in Need programme focused on supporting children’s emotional wellbeing. We talked about rediscovering the role of fun, creativity, and self-expression in promoting children’s wellbeing, something which can seem so obvious but is often missing from a deficit approach to children’s mental health care. Juliet highlighted how important relationships with parents and trusted adults are, as an end in themselves, for children’s wellbeing. And we talked about how A Million & Me has supported and equipped adults to step into that vital role.
Alethea Joshi (AJ): So welcome Juliet to the podcast.
Juliet Snell (JS): Thank you very much. It’s lovely to be here.
AJ: So you’re one of Centre for Mental Health Associates. I really wanted to get you on the podcast today to talk specifically about our new report, which is an evaluation of BBC Children In Need’s “A Million And Me” programme. I wondered if you could just start by talking us through the sort of purpose behind the programme.
JS: Yeah, happy to. So, BBC Children in Need set out about three years ago. Maybe they started the thinking four years ago, to set up a 10 million pound programme. So a large programme. An investment for them into understanding how children who might be starting to struggle with their mental health could be helped. I think they were driven to that by their growing recognition that a high proportion of the children that they already support within the Children In Need profile are children who are starting to struggle with mental ill health. Their understanding from research is that a high proportion of adults with mental health problems have begun to struggle before the age of 14. And really, their recognition that mental health services in the more traditional sense, were really struggling to meet demand. So they were needing more and more resource to try and meet the needs that that are out there. So they were thinking about how to reach out to more children, earlier on in order to prevent mental health problems. Yeah, that was the programme in a nutshell.
AJ: So the focus was on 8 to 13 year olds, primarily because they wanted to be reaching young people before they started to kind of show signs of mental ill health. Is that right?
JS: Yes, I think so. I think BBC Children In Need does have a focus on childhood, it’s kind of obvious from the title. So, they have a particular expertise and footprint across children’s projects around the UK (one of the UK is largest funders). So they’re interested in childhood, anyway. I think it was an opportunity to really think about mental wellbeing in childhood. Where quite often the eyes are drawn to adolescents, when we talk about children and young people’s mental health, we do tend to think about adolescents. Not always, of course. I think it was an opportunity where BBC Children In Need knew they already had that focus on children. I think it’s maybe worth also mentioning, alongside prevention, the fact that during those years (8-13), you see children go through a number of really important transitions. So, the most obvious one being there transition from primary school to secondary school, and with all that we know about what happens during that transition, particularly for some children who already facing adversity. Also, children’s emerging identity during that period of time. They sort of begin at age eight with an identity that’s quite merged with their family, and that they leave age 13 from that age range with their own emerging identity and a more focus on peers, their passions, their interests, and their personalities will have developed and evolved during that time. So, it’s a really exciting age group to have a mental well being focus on. And I think that’s where that came from.
AJ: That’s so helpful to understand, because I think previous research that we’ve done, has highlighted that, on average, children and young people go about 10 years between sort of their first symptoms, and getting any sort of help for their mental health. So I guess, my understanding of the programme is that it’s trying to reach people before we get to that stage to build up their understanding of mental health and how they can support themselves and maintain that.
JS: Yeah, I think, I think the idea of prevention and early intervention, so if we see children, it’s quite a simplistic way of looking at it, but see all children on the spectrum of mental health. I know that’s an idea we talk about quite often at the Centre. I think there was definitely a focus on those children who had not yet reached that stage where there might be needing to access clinical support from the NHS, for example, but who are nevertheless having experiences and feelings that might put them at risk of becoming unwell at some point in the future. It’s really worrying to know that children and that statistic you mentioned is despite many of those families and children seeking help, so it’s not that it’s about wanting help, or even children and families who are looking for help often have sort of unacceptable delay. It’s one of the things we talk about the most, isn’t it when we’re talking about children, young people’s mental health is the wait and delay that children have before they get help. So it’s just really interesting that A Million & Me thought about that group of children in particular. Also, I think thought about rather than a new and different support for them, what could be done to enhance the existing support around those children. I know, we’ll come to talk about it shortly, but really just to think about what’s already there around those children. What is there in their communities, in their families in their spaces, their schools, their youth services, and so on. So, what can we do to enhance that space and make it really more able to support their mental wellbeing and protect them future ill health.
AJ: That’s so interesting because it seems that, instead of going for an approach where we sort of parachute in an intervention that is going to help a child. Instead, it is, as you say, embedding and building up the structures and the systems that are already in place to support them, and as you say, enhancing and strengthening those. So a more organic approach, maybe?
JS: Exactly. Of course, the voluntary and community sector, who were the main delivery partners. Well, the only delivery partners, really of the A Million & Me project, is already part of that organic system. So, these were organisations that already knew the children that were being reached. In most cases, were already understanding and learning about their mental wellbeing and A Million & Me just gave them time and space to think about scaling up and sustaining that kind of support. So, doing more or thinking about how to do it differently. So I think that sort of organic development didn’t apply just to the children’s systems around them, but also applied to the voluntary sector, that already has those relationships, in many cases, that know how that understanding, that engagement, that knowledge of those children and their families.
AJ: Yeah. So, could you talk me through the role of the Centre in this. Then, maybe about a few projects that we’re involved in delivering support to the young people?
JS: Sure. I mean, I think we’ve already spoken a bit about organic and evolving ideas. And I think actually, our role was organic and evolving, which is lovely to work alongside a programme as a learning partner, and to be free to let that roll, develop and change over time. And to respond to what was happening in the programme was quite an experimental programme in some ways. We were there to observe and record, for sure, but we also had the opportunity to feed in learning all the way through. And that part of the project actually became more and more prominent, I would say, as evaluators, we took more and more of an active role in noticing interesting new things happening, or noticing gaps or noticing challenges, and also putting different elements of the programme together to help them learn together. So, for example, one partner might be struggling with something that they were trying to achieve, and another partner might have some interesting learning or ideas about how to do that. Which, I think is one of the real strengths of the programme.
In terms of, you asked about the kinds of projects. So I think, having worked on a number of different programmes like this, for the Centre in the past. The thing that really stands out for me three years on is the diversity of the projects in A Million & Me. So, they ranged from projects that worked right across the UK, reaching out to many 1000s of children through, for example, text based support. So crisis, text line, or website or app based support that that reached out across the UK, to projects that were really about learning and research. So projects that had a focus on, for example, piloting different ways of commissioning or delivering services, or projects that thought about particular groups of children. So children who were facing a particular kind of adversity or children who were occupying a different space, a particular space. And the programme was designed that way. So, rather than just waiting to see what kinds of proposals come in, which is quite common in philanthropic programmes, what A Million & Me did, was that they almost designed an ecosystem. I’m quite into biology, so it helps me to think about ecosystems. It’s like an ecosystem, and they thought about the niches in that ecosystem. They thought, Okay! We’re going to need somebody who is thinking about this aspect, and somebody is going to be thinking about that aspect, and they’ve recruited into those spaces in quite a proactive way. The end result is a genuine system that has been mindfully and purposely put together.
AJ: Thank you, it seems it seems so distinctive as a model in quite a few ways. When you were talking about commissioners, and especially with voluntary sector services, they can be quite reactive. So it’s quite kind of, as you said, you see who applied and you give where it seems relevant. Whereas this is kind of going, let’s design an entire system, and also this idea of the Centre’s role as a sharing and learning between partners. Rather than being seen as competitors, or each doing their own thing, just creating and facilitating this space to actually learn and get alongside one another and partner as part of the same system. That seems distinctive and a really interesting approach.
JS: Yeah, and what that’s meant is that we as learning partner could actually even influence the intake of new projects. So, we could even think about, well, perhaps something that’s missing in this ecosystem we’ve envisaged is – a really good example is – we noticed that we hadn’t done as much in the programme as maybe we had hoped around the people who work with children already. So we call them trusted adults within the programme. So we noticed that gap in year one. We were saying, well, perhaps we need to focus attention on this group of people and how they fit into this scaffolding around children. That then informed the appointment of a partner to really focus on that. We might notice particular groups of children whose needs weren’t particularly well met. So, for example, we had a focus on children in rural, coastal and island communities. We really did some work to think about those children. We did some research to think about those children in Year Two, and some focus on that set of experiences is coming into the programme quite late on. The word that quite often springs to mind is an iterative approach. Interestingly, that’s an approach that you see in the tech sector and A Million & Me had lots of tech partners within it, there’s quite a lot of technology or technology based products.
AJ: You mentioned there about children whose needs perhaps weren’t being met by the initial iteration of the project. I’m aware that kind of at BBC Children In Need, and within A Million & Me, you know, inequalities facing children is a big part of that. So I wonder if you could tell us a little bit about how the projects themselves and the programme more widely sought to kind of address those inequalities?
JS: Yeah, I think it was very explicit and clear that A Million & Me was for all children. So it was to be there for children across the spectrum of mental health, including children who are well, and who just want to learn or have fun or feel better and across to children who are really struggling. From that starting point of A Million & Me being for everybody, I think, of course, we at Centre for Mental Health, and anyone who works in children’s mental health understands that we are facing really large health inequality in childhood, around mental health. The programme thought about this in different ways, in different projects. So there were some targeted projects, and some projects that were just for particular groups of children who we would expect to have a higher risk of poor mental health.
So, for example, that was a project that supported newly arrived asylum-seekers. There was also projects that just thought about particular groups of children. So there was a project that was only for girls, and just to try and understand their own experiences, not just of being female, but also the experiences of intersectionality, the experience of being female and potentially facing other worries or concerns in their lives. Other projects were there for all children, but purposely marketed in order to reach particular groups of children. For example, through, I mentioned a lot of the projects with digital so they might use particular social media targeting strategies to try and reach particular groups of children. So children from communities facing racism, for example.
Then there were some projects that didn’t start with a focus on inequality at all, but because we were there alongside as learning partners, we started to notice that some children were attracted to certain kinds of projects. I suppose the most notable of those was the digital projects, we noticed were being reached by more disabled children’s, so children who reported that they had a disability and by more trans, non non-binary children and by girls. So, we noticed that these projects were seeing that higher rate quite remarkably higher in some cases. We were then able to offer support as a whole programme to those projects. We had a partner who had a particular interest in LGBTQ+ identity, so that partner was able to come alongside their colleague organisation and offer a bit of advice and support. We had quite a lot of input around working around neurodiversity. So, I think we had that range of approaches from very universal to quite targeted. That just really enhanced our learning about inequality. I think we leave the programme with a bit more of a sophisticated view of inequality in childhood, and how children experience it.
AJ: Amazing. Thank you so much for shedding more light on that. So, you’ve been evaluating A Million & Me for the last three years. And obviously, you know, now as the programme draws to a close, I mean, what would you say, are the key elements you’ve identified to wellbeing support and approaches for this kind of 8 to 13 year old group?
JS: It’s been really nice, actually, in this final year. As you say, three years alongside the programme. It’s been really nice to reflect back on some of the original thinking as the programme began. Professor Miranda Wolpert wrote some important work at the beginning of the programme to advise and support BBC Children In Need as they were trying to scope and frame what they wanted to do. She drew on some thinking from an American Academic called Ann Masten, she uses a phrase called “Everyday Magic”. In a lot of ways, it’s only now, at the end of the programme that we’ve reflected as a learning team, on the evaluations of all the individual elements of the programme and of the programme as a whole. That idea has really resonated. That idea that actually, the things that were successful in the programme, and in the projects were everyday simple things that are already around children. Not, like, as you say not new things that need to be parachuted in, they’re already there, and that they have power. Ann Masten uses a phrase called powerful systems, I think that’s really interesting. So one of those is fun and happiness, the idea that, you know. The Children’s advisory group is a group of children from Scotland who supported the program’s learning, they drew on that straightaway, they highlighted the importance in their priorities of children having fun and children being helped to be happy. And it seems obvious, but I think the mental health system forget that actually. It’s just important to do fun things.
AJ: It does seem obvious from a child’s perspective, and I guess just us as humans, but I was really struck by that in the report, because I think, you know, mental health support is seen as you know, supporting people when they’re feeling bad, and it’s a therapeutic space, and you don’t really necessarily automatically think fun with that. So it’s actually, it’s maybe obvious, but kind of also feels a bit revolutionary.
JS: I agree. It’s quite deficit based, isn’t it? Our language around mental health isn’t it? Like you say, it’s about what you lack, or what are the problems. I think the children helped us focus on that idea of happiness and positivity, and access to play, and the importance of play was another really strong feature of the project, I think, quite often projects, think about play. So for example, positive activities within youth settings as a hook a way of bringing children in, but actually what the children helped us understand was, it’s an end in itself, it’s the feelings of wellbeing that come from doing happy, joyful things are a protective factor in themselves, and are there to support children’s mental well being.
AJ: I think this is wider than just mental health, but there’s almost a thing around fun, and doing fun things as being frivolous. I think especially when you think about kind of being funded to deliver support, it almost sometimes feels like it has to be quite dour and quite deficit based because ‘there is a problem and we are solving it’. Rather than just recognising, as you say, that fun and play can be in an end in itself, for improving wellbeing. It’s a new way of thinking about it, I think.
JS: It is! Well, a new and an old way, interestingly, of course. Fun is as old as a human race, but we almost needed to rediscover it as an element of mental health and to recognise how important it is to children, particularly, you know, to this younger age group. We can think about that. I guess related to that is a kind of second theme for me, which was about creativity and self expression. A lot of the projects identified that is a really important vehicle for children, who became quite interested in the concept of emotional literacy, particularly in the second year as we started to get the first sort of evaluation findings coming in. We had a real focus on what the tools were for self expression and creativity, so words and movement, and all sorts of things that help children recognise feelings, and be able to know they’re having feelings, being able to name them, and being able to express and share them and learn about them. That, again, became a really important building block for the projects.
Something that the projects realised was a space to really focus attention and energy on, to get that right, to get language right, to get the process of learning about emotions and feelings, right. So, that they could maximise children’s opportunity to get those tools in place at the right stage in their lives. I guess another important theme, maybe emerged a little bit later for us in the learning, but just as important was around relationships. We started to understand how important relationships were to children. Again, how the relationship was an end in itself, how children were seeking and wanting to form relationships with each other, with the adults in their lives, with their parents, to carers, and even actually, with digital products. So we started to understand that children were using characters in apps, for example, as a vehicle to build a relationship to have an important confidential relationship just for themselves.
So we started to really understand that we should value and validate those relationships that children already have and think about how we equip them. Probably the most prominent relationships that we recognise there was the parent-carer relationship and to think about what we can do to resource that relationship and help parents and carers feel confident in addressing mental wellbeing and addressing emotions with their children. They were very motivated already, we found that out from some of the research we did, that parents are already very motivated to think about their children’s emotional worlds, but often lacked confidence. The same, we then found it was true of trusted adults, such as sports coaches, you know, people worked in, in youth settings and so on. The level of motivation is there but there’s something about this deficit model that we were talking about earlier, that frightens people that they think that you need a special kind of qualification to be able to talk about emotional well being or mental health. Actually, what we really needed to do was just to help those adults step into that role, and feel confident and comfortable to do that.
So, A Million & Me offers this huge range of resources and ideas. One of the things we’re really encouraging BBC Children In Need to do, as the programme draws to close, is to make sure those resources are easily and widely shared, as there are some excellent things there that so many people could benefit from. It’s going to have a legacy for the programme, and also reached that ambition of scaling up. We talked early on about the sheer numbers of children that it would be really important to reach and the digital resources in particular do have the capacity to do that, to reach out to so many people. So, it’s really important kind of call to actions, the programme closes to make best use of those resources.
AJ: Yeah, I think it’s such an interesting point about, again, as we said earlier, this idea of enhancing and building up parents and carers and trusted adults in that role, because I think you’re right, there’s a lot of fear and uncertainty, I think we talked about children’s mental health and, and we know obviously, that parents can feel very helpless when their child is experiencing mental ill health. But again, can also feel sort of helpless as to know how, how to kind of have these conversations early on, and how to sort of embed the ideas around well being within conversation. So it sounds like this programme is really sort of equipping them to have the confidence, as you say, to sort of take that forward in their roles.
JS: Yeah, absolutely. Some of the projects that worked particularly or targeted work with parents particularly noted, for example, that outcomes were better if parents and children did things together. So it’s a really simple idea, actually, to just share that news with parents that really simple things like looking at an app or doing an activity or having a conversation or reading a story with a child that in itself improves their mental well being, particularly if you do that with a little bit of guidance and support from programmes such as A Million & Me. That, in itself is just a really powerful message to parents that validates their role and gives them a nudge to feel confident and feel enabled to open those conversations. We really recognise the power of those conversations and those relationships through the programme.
I think it’s such an obvious point, but it needs making that of course, children are different, and families are different, and communities are different, and they will be interested or attracted or have needs of different kinds of help at different points in their emotional lives. The ability to give agency to children by offering them flexible, easy access to all sorts of different ideas is a real feature of A Million & Me. So, they have access to apps that they can have on their phone, at any time of day or night, regardless of whether they have internet access at that point. They can access things independently of their parents, which I think is important for some children, or they also have access to support that comes via an adult, that their parent or carer can support with. So that, of course, helps us around the point where we’re speaking to earlier around inequalities, that diversity makes it easier for diverse children to get access to help. I think it’s just helpful for all children to have as much choice and range of health as possible, because we’ll have more chance of reaching more children that way.
AJ: It’s something we’ve talked about a lot, isn’t it about diverse and different ways of reaching out to children. Obviously, the more traditional model of CAMHS, etc, has an obvious role, but kind of going beyond just saying we need more of CAMHS and actually recognising what else is in the system, or what else is maybe further back in terms of preventative angle that can really, as you say, scaffold and strengthen young people before they potentially reach that crisis stage. I’ll link in the show notes to a couple of other pieces of what we’ve done in the last couple of months. One evaluating work of project future and one that you worked on, in fact about the Centre 33 projects in Cambridgeshire, which really speak to that need for more flexible, easy access to mental health and wellbeing support outside potentially those more traditional models with more eligibility criteria. So it’s something we’re sort of definitely thinking about at the moment.
JS: I would very much support that need for diversity and flexibility anyway, because I think it’s important that people have choice and easy access to things. But, we have a particular call to action now, don’t we? We have rising concerns, those of us who work around children and young people’s mental health, are really quite worried about some of the higher rates of mental distress that we’re seeing in childhood and younger. You know, so we’re very particularly concerned about this age group of primary aged children. We have to do things at scale, we can’t rely on clinical support only in order to support the mental health of our children. So, we absolutely have to think differently, it’s an imperative to transform the system in order to reach out to sadly to far more children and young people who are starting to feel distressed. So yeah, I think it’s both on the individual level, but also as a society, we need to think about mental health differently.
AJ: Of course, and this is obviously in the context of a kind of, you know, cost of living crisis, rising inflation, etc. We’re likely to see higher rates of poverty, we know there already is a rise in child poverty. We know that there’s a massive link between poverty and mental ill health. So the need for this could not be more obvious, I think, at the moment.
JS: Absolutely agree. Services that are designed for children who are already unwell, of course, need extensive investment and support. Everything we can do that prevents a child ever having to need such help is important on an individual level and on a human rights level – a right to be happy and a right to be well, but also as a society, we need to do everything we can to protect those services for those children and young people who really, really need them.
AJ: 100%. Thank you so much Juliet. What I’d love to know as we end is, what would you say are the key call’s to action as a result of our work on this.
JS: So as you know, I’ve worked in children and young people’s mental health for quite a number of years. I’m probably as guilty as the next person of focusing attention, particularly on adolescents and young people. I think what I take away from A Million & Me is the importance of investing in younger children, and really thinking about younger children as having distinct and different needs to young people that they’re at a particular point in their lives where they need the kinds of support we’ve been describing, you know, access to fun, access to happiness, access to self expression, language, learning around their emotional world, so that that needs investment. That investment will of course, pay off in the way that we were just talking about. So, you know, investing earlier and younger, and also investing in prevention, that seems like such an obvious thing to do, but the mental health system, if you think about it, in the sort of public policy sense tends to not think about prevention nearly as much as it does about treatment.
Actually, it’s just a really, really important call to action to think about prevention as a target, an area that we should be focusing on. Probably attached to that is our learning in A Million & Me, drives me to think about diversity within programmes to think about this ecosystem idea of being rather than having lots of lots of the same kind of project and the same kind of approach to be able to design diverse offers for children and families. That in itself will help to challenge inequality amongst all the other things we talk about, for example, poverty, prevention, and trauma informed practice. I think finally, what I hope comes from this and of course, BBC Children in Need is well placed to do this going forward is to communicate these really important ideas. They’re quite simple ideas, but they’re quite important because what we learned is if you just help adults understand and appreciate their role, they’re well motivated to step into it, but, they do need support to have that confidence that we talked about. I think this programme is really well placed to share that idea.
AJ: That’s so helpful. Juliet, thank you so much. I will obviously make sure we put links to the report and all the other different bits in the show notes. Just to finish off, we like to ask guests on the podcast, to just tell us briefly about how you manage your own wellbeing and mental health. Juliet Snell
JS: So, thanks. You gave me a bit of warning that you’re going to ask me this question. Thanks. So then it occurred to me that here I am doing the exact opposite of the three things that I’m going to mention. I hope listeners can’t see me, but here I am, sat in a room by myself in an office looking at a screen and I think the things that support my well being are the exact opposite of those things. Which is essentially being in nature, so blessed with having dogs that need walking, so just getting out looking at the sky and trees and water at least once a day. Being with friends and family, so here I am in a room by myself, though is to see your face, but being with friends and family and chimes I guess with A Million & Me investing in those relationships, and letting those relationships work to support my mental health and having the courage to talk about mental health in those relationships, I think is really important. Probably I learned more and more as I get older. Then finally, I guess being kind to myself, and maybe that is particularly around rest. I think the last few years, we’ve all worked so much harder than we used to. I for one have. There’s something about this new world, isn’t it that is quite brutal in terms of that. I think it’s taught a lot of us that we need to think about kindness to ourselves. We are generally quite good at being kind to each other, I don’t know how good we are at being kind to ourselves. So that’s something I’m still working on, I wouldn’t say I’ve got that cracked yet.
AJ: I think we will all be keeping on working on that for the rest of our lives. But it’s a very, it’s a very good principle. Juliet, thank you so much for your time today. Thank you for all of your work on this. And yeah, for telling us more about it today. It’s been a real joy to hear more.
JS: Thanks very much. It’s been lovely to talk to you about it and I really hope it’s something that listeners can think about sharing with others as A Million & Me draws to a close.
AJ: Hope you enjoyed this episode! To join our fight for equality in mental health, you can donate at www.centreformentalhealth.org.uk/donate. See you next time