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Trusted relationships and mental wellbeing: what we learned from HeadStart

Professor Jess Deighton, Head of the Evidence Based Practice Unit at Anna Freud and lead on the HeadStart Learning Programme, writes about what the final evaluation report tells us about the importance of trusted relationships in a young person's life. 

There is no one, single intervention that will always help a child who is struggling with their mental wellbeing. But by pulling all the levers that impact a child’s life – from the systems they interact with, to the school they attend and their home – we can make a difference. We can help them to develop resilience even when faced with difficult challenges.

That’s why HeadStart was so important. A huge, £67.4 million investment from The National Lottery Community Fund, HeadStart enabled six local authorities in England to explore and test new ways to improve the mental health and wellbeing of young people and prevent serious mental health issues from developing. HeadStart involved schools, families, charities, and community and public services in testing out new interventions, helping us to better understand the factors that underpin young people’s mental health, wellbeing and resilience.

The HeadStart Learning Team that I headed here at Anna Freud has just released its final evaluation report, which sits alongside an extensive programme of research into HeadStart’s impact, building a wider understanding of the picture of young people’s mental health in England.

There has been a wealth of learning from the evaluation programme. One of the standout findings was how HeadStart increased our understanding of the risk factors for children who have poor mental health and wellbeing, as well as what can help prevent these issues from developing. Those factors help to inform what effective mental health support for young people might look like.

This builds on what we already know – what the researcher Professor Ann Masten calls ‘ordinary magic’, which includes having good relationships with parents and carers, a sense of belonging at school and feeling like there are people in your life that you can trust. Taken in combination, this can give young people a sense of safety and confidence.

HeadStart brings that into even greater focus. Our research, especially our interviews with the young people that took part across the six HeadStart areas – from Blackpool to Cornwall – shows the real value of what we call ‘trusted relationships’. Trust for these young people is about having others in their lives who are reliable and consistent, and with whom they have a rapport.

We were able to categorise the young people we interviewed into different groups that reflected how well they were managing with their mental wellbeing, and how this interacted with the support networks available to them. For example, one group included children and young people who were managing well and who had a lot of different support systems to call upon. Another had more uncertain sources of support – they really struggled to draw on anyone consistently. This group of young people may have friends and family but, for reasons ranging from illness to separation, are unable to see them or rely on them as often as they would like. The findings from our large-scale survey data told us that where young people didn’t feel they had social support from these kinds of relationships, their mental health and wellbeing was impacted.

Relationships also have a bearing on the effectiveness of any single mental health intervention. School-based counselling, for example, can be an effective intervention – but the impact of such targeted support is enhanced when it’s delivered within a supportive school setting where young people feel they can trust and rely on the adults and peers in that environment.

Developing these trusted relationships for young people can be achieved by building capacity in people who don't necessarily see themselves as a mental health support for young people, but certainly do have a relationship with them. For example, there was a lot of investment from the HeadStart partnerships in building capacity among school staff to understand what mental health challenges were and to be able to recognise when young people were struggling.

School staff are not mental health professionals, and nor should they be. But staff can be encouraged to understand how being a consistent, trusted person in a young person’s life is as important. Some of the HeadStart partnerships focused on a trauma-informed approach in schools, building a relational style that looks beyond challenging behaviour to consider the experiences that might be driving it, and incorporates other factors that might shape the way staff think about young people. Through our interviews, young people told us that these kinds of relational approaches had helped them to cope better with situations because they’ve had a person to talk to who they felt was on their side. Young people also highlighted how important it was to them that these supportive relationships were sustained over long periods, not just provided as part of brief interventions.

While HeadStart showed us many examples of interventions and approaches that young people felt benefitted them, these measures must exist in a wider supportive ecosystem. Some HeadStart areas tested community-based approaches, working with young people outside school. Others trialled community hubs, offering young people a place where they can go and get some support. HeadStart has shown us that building resilience in young people isn’t just about developing an individual’s internal strengths – it is actually about building resilience in a whole place. Not just at a school or family level, but within services, communities and local authorities – they all play a part in building healthier, happier young people in their locale, listening to and responding to young people’s voices.

Building resilience is not about one source of support or one intervention, it’s about a multi-layered approach. Think about it like building with layers of Swiss cheese. There will be gaps at each layer, and if you’re relying on just one of those layers there’s a greater chance of falling through the gap. But the more layers you build with, the more gaps are closed.

By building these layers of social and structural support on top of fostering the development of young people’s own internal skills and resources, we can help young people get to a point where they feel they have agency, can grow in confidence and ultimately flourish as they move through childhood and adolescence and into adult life.