Project 99, now known as AyeMind
NHS Greater Glasgow & Clyde
As part of work to create a strategic approach to promote good mental health in young people, NHS Greater Glasgow & Clyde (NHS GG&C) and its partners were keen to explore the potential of digital tools and resources. This was not just about going ahead and making an ‘app’ but about working to engage directly with young people. This was about enabling the partners to better understand young people’s needs and issues; to get a better feel for how they use (or might use) digital resources; and above all to tap into their skills and imagination in designing possible solutions. For all these reasons a co-production approach seemed an ideal route to pursue.
Partners included NHS GG&C (including health improvement and clinical service colleagues), local authority and third sector partners (including youth provider agencies), a commissioned three agency consortium consisting of Young Scot, Snook (a local service design agency) and the Mental Health Foundation. Most important was the contribution of young people themselves which was achieved through working in partnership with five different local youth-related groups. These ranged from general youth projects to an initiative that supports young carers whose parents have mental health problems.
All involved were keen to learn as much as possible about the potential of digital technology in promoting good mental health in young people, but each partner had particular interests. For example, clinical partners were keen to learn how digital tools might add value to clinical care situations, health improvement and youth work partners had interests in general engagement with young people and learning more about wider issues in their lives. Young people themselves were interested to share their experiences (some very challenging – e.g. supporting peers as they underwent various forms of stress and distress), to learn more themselves about the potential of digital technology, and also to see what kinds of practical contributions they could make as “co-designers”.
The first task involved developing a contract with the commissioned partner consortium. This was followed by important preparatory work which included identifying the ethics of engagement for co-production – e.g. creating protocols for when mental health issues were raised by young people so that they would be supported. Staff training, including Youth Mental Health First Aid was also provided. This was followed by recruitment of youth projects as participants, using a pre- existing multi-partner network. Desk research included a mini- literature review – to scope global evidence of existing good practice – and mapping of digital ‘assets’ focused on young people’s mental health. Through a variety of youth work contacts a number of young people were identified who were able to provide some in-depth (anonymised) case study material, which yielded tremendous insights into experiences of mental issues, use of digital technologies and how these two might relate to each other.
A series of engagement and co-design events were then run, both with individual youth projects and with volunteers combined from several projects to enable more in-depth design sessions. These led to the development of an exciting portfolio of design prototypes from the young people, supported by service designers, which were then packaged up for consideration by partner agencies. Young people then had the opportunity to present their experiences and ideas to senior health and education colleagues in what was a very lively and productive joint event. The suite of outputs from this work and final report was completed and published.
Project 99 was then awarded a major European grant, in recognition of what had been achieved so far, to take the project forward. This will involve developing a suite of functional digital resources for young people, as well as a toolkit for practitioners who work with young people to enable them to get the most out of the digital resources. The co-production approach which has got the project this far will continue in this new phase of work.
There were lots of challenges to overcome, including:
- wide ranging ambitions due to an enthusiasm to explore as much as possible of this exciting territory, but with very limited financial and time resource available to progress the work;
- the very wide range of experience (or lack of it) of using digital communication assets;
- different notions of the level of risk;
- numerous technological barriers (organisational web blocking systems, incompatible IT such as browsers);
- the pace that both youth work and service design methods can operate at, which is often at odds with the pace that large public sector organisations move at; and,
- the legal requirements of tendering and procurement processes which can be quite rigid in responding to emerging learning and opportunities.
Underpinning many of these challenges was a very different set of life experiences, cultures and communication practices between young people and the “adult world” – a hurdle to some extent, but an issue that was used as a way of sparking the project and sharing experiences.
The project faced some lows, many of which were more the drip, drip, drip of small scale barriers, challenges, delays, organisational custom and practices, as well as the occasional negative attitude from some colleagues (who don’t “get” the potential of digital technologies). However, none of these had a major limiting impact.
The bigger challenge is the time, effort and sometimes good fortune (e.g. European bid) to mobilise the next steps. Also that this kind of timescale makes it very hard to keep a continuous presence and relationship with participating young people – their lives and transitions quite often move at a faster pace than the organisations involved.
“The highs were seeing the enthusiasm, creativity and determination of the young people who took part and the sense of satisfaction that we were able to create a situation where they genuinely made an impact on the views and future thinking of a set of organisations at a crucial time.”
Project 99 set out to discover something substantial about the potential of digital resources in promoting good mental health in young people, and (perhaps unwritten) to discover as a group of partner agencies how to work together to make this learning as valuable as possible.
The project has delivered a suite of output resources, based on young people’s lived experience (e.g. the young people’s briefing session on their ideas) which amply demonstrates that public agencies and their partners should be treating digital tools as part of the future of service delivery and youth engagement and dialogue.
This is not the same as saying that instant action or change will follow, but the initiative definitely is a major push in that direction, helping to transform thinking about how public sector agencies should design services aimed at helping young people, and realising that digital resources offer a serious contribution to that agenda.
Why is this co-production?
Project 99 was developed on a strong ethos of co-production – recognising that to be able to use digital technology to improve young people’s mental health, it was vital to work with young people and co-design the output.
Even the project name was co-produced, with Project 99 relating to a certain well known rap song and some of the spin-off phraseology that this conjured for young people and youth workers:
“We got 99 problems, but getting help shouldn’t be one”
Assets - young people were given the opportunity to show they could contribute directly to service design and not simply be passive recipients of a service – in this case, a digital one. The young people involved surpassed this and went “well beyond the brief”. For example, one group produced their own youth mental health manifesto as a challenge and call to action to the system.
Capacity – the notion of enabling and supporting peer help was one of the major issues to emerge from the work. It was evident that capacity building was essential and promoting good mental health in young people was not simply about connecting to service delivery pathways for clinical support.
Networks – the active use of inter-agency professional networks (e.g. making connections with local youth projects) and also young people’s own networks were critical to the project’s success. This is best demonstrated by the enthusiasm that participants showed in sharing their pride in the project through their own social media networks as the work progressed.
Mutuality – this was also a feature – with incentives for young people to engage including:
- significant skills and confidence building opportunities for young people who took part;
- the pride of achievement and recognition for their efforts; and
- the knowledge that this was an opportunity to influence the whole system.
Catalysts – the catalyst role very much embodied the approach adopted by Project 99, with the lead agency (NHS GG&C) acting as a facilitator and enabler (and learner) rather than directing the work and content produced.
Lessons and learning
One of the key learning points for the future was the need to be prepared to have assumptions challenged. Therefore it is important to be flexible in every sense of the word – in terms of timescales, resources, partner availability, and even the final destination of the work. This will help to clear blockages to genuine joint working.
This case study was produced as part of the resource ‘Co -production – how we make a difference together’, developed by the Scottish Co-production Network, the Joint Improvement Team, the Health and Social Care Alliance Scotland and Governance International.
You can find out more about this case study from Dr Trevor Lakey, Health Improvement and Inequalities Manager, Greater Glasgow and Clyde NHS; Trevor.email@example.com
All of the main outputs are available to view and download via www.wegot99.com – these can all be shared and used in accordance with a creative commons licence approach (details on the site). A Herald newspaper article about the work, featuring an interview with members of one of the participating youth projects can be found here: http://www.heraldscotland.com/news/health/young- people-help-themselves-tackle-mental-health-online.23774789