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Psychologist talking to teenage boy

Mental health support for young people: promoting choice, improving access

This RCN Mental Health Forum factsheet was undertaken in collaboration with Mind. The purpose of this resource is to help nurses understand and promote choice in how children and young people can access mental health services.

Mental health

  • Related mental health topics

Introduction and background


Nurses, across a range of clinical settings, will have seen the negative impact of the pandemic and lockdown on the mental health of children and young people. The number of young people reporting new mental health problems, and the mental health of those with pre-existing mental health problems, has seen a dramatic increase throughout the pandemic (CfMH, 2021).

Mental health nurses have led on new remote support for mental health, such as helplines and chat services. The advent of coronavirus has changed the way mental health support for young people is delivered, with many services moving to phone or video calls instead of face-to-face sessions.

It is often assumed that the increased use of digital technology and telemedicinal support is more popular amongst young people. It is believed that they are more likely to want to access mental health support online via an app, remotely by phone or video call. However, research by Mind and Young Minds suggests this is not the case. 

 

What does the research tell us?


Mind’s 2020 survey into the impacts of the coronavirus pandemic found that compared to adults, young people (13-24) were more likely to feel uncomfortable accessing mental health support over the phone or a video call. Almost a third of young people (30%) who accessed or tried to access support said that the technology was a barrier for them, compared to 17% of adults.

A survey conducted by Young Minds in the summer of 2020 found that many young people lack access to technology and are concerned about privacy or simply do not feel safe opening up about their feelings online.

In Mind’s 2021 Trying to connect report, nearly three quarters (72%) of the 193 young people surveyed who took up the offer of remote mental health support would have preferred to receive support face-to-face. Only 8% preferred getting support in this way.

“I don’t think it’s the same and wouldn’t work for me. I would prefer face to face and for someone to be there with me that I trust for support.” (13-17 year old).

“I have much preferred the phone sessions as getting out of the house to attend face to face appointments has always been difficult and was the main reason I hadn’t sought help earlier”. (18-24 year old).

I found it hard as I couldn’t talk to someone face to face and they couldn’t see in person how much I was struggling. (13-17 year old).

Source for quotes: Mind (2021) Trying to connect: the importance of choice in mental health services

Experiences of young people who have used remote support during the pandemic

Father and son on laptop
“I definitely wouldn’t be doing therapy if I had to do it at home. Just the nature of stuff that you bring up in therapy, there’s always the worry that someone will overhear you but it’s also just you don’t want to be bringing that stuff up at home because you can’t escape from it” (18-24 year old).

Click on each of the boxes below to view the positive and negative experiences reported by young people using digital technology and other forms of remote mental health support.

Source for content and quote: Mind (2021) Trying to connect: the importance of choice in mental health services

Positive experiences include:

  • Some young people find digital technology easy to use.
  • It might be more convenient to be able to have an appointment at home or a place of their choice.
  • Some young people prefer not having to travel – if they live far from services or have mental health problems making travelling difficult.
  • There may be more flexibility in appointment times. 
  • The anonymity of online can make things easier for some young people – distance may make it easier to open up. 
  • Sometimes the wait for support can be shorter – especially if accessing digital support apps or programmes.

Source for content and quote: Mind (2021) Trying to connect: the importance of choice in mental health services

Negative experiences include:

  • Remote support can be difficult to use – some young people may lack technology, or the skills to use it.
  • Concerns about privacy – it might be difficult to find a place at home or elsewhere where a young person can talk freely without fear of being overheard. This is especially the case for those who might have difficult relationships at home, or other safeguarding issues. 
  • Not being able to keep mental health treatment separate from the home environment.
  • A young person’s mental health condition may make it difficult to speak on the phone or on video call – e.g., phone anxiety, paranoia, hearing voices, hallucinations, or dissociation.
  • Technology issues – problems with Wi-Fi or their device.
  • Warning signs and safeguarding concerns may be missed - it is more difficult to pick up on social or physical cues.

Young people and access to remote mental health support

Girl and healthcare professional Below are two different scenarios (one positive and one less so) looking at some of the practical issues that nurses might encounter when providing remote mental health support for young people. They illustrate the importance of finding out what works best for young people and providing choice in service delivery. 

Scenario 1

“Having a video call meant I didn’t have to miss time from college. I found it easier to talk on the video call as I didn’t have to worry so much about what the person was thinking about me and because I had a private room available there which I do not have at home. It meant we could work together to plan what care I needed".

Charlie recently started studying A levels at Sixth Form College. Charlie meets regularly with their community mental health nurse and because they are keen not to miss anytime from College, Charlie asked if some of these meetings could be by video call.

Charlie was able to book a private room in the College and access the video visit by mobile phone. Charlie already has a good therapeutic relationship with their community mental health nurse and was able to talk freely about their mental health and current side effects they were having from medication. Together they were able to update Charlie’s care and risk plan collaboratively, and Charlie gave the mental health nurse permission to call their parents after the video call with an update on the care they were receiving. 

Scenario 2

“I had already let the team know that I find telephone calls unhelpful, but they said it had to happen this way due to staffing. Even though the person that called was ok - because it was on the phone it felt like they didn’t care about what I wanted and I found it harder to open up to them, and I turned down any further support from the team because of this. I ended up getting really unwell and needing inpatient care which I think would not have happened if I had got community support”.

Ashley was due to be supported by the crisis team after presenting to A and E experiencing intense distress, an increase in suicidal ideation and an increase in self-harm. Ashley’s concerns about visits or appointments by telephone were already known and recorded, but a telephone visit from a nurse was arranged because of staff shortages. During the call, Ashley was clear about not feeling comfortable with a telephone call. He was unable to discuss suicidal ideation and self-harm because he felt unable to connect with the nurse not being face-to-face. Ashley left the conversation feeling that he had been unable to discuss his needs and that he hadn’t been listened to. The nurse carrying out the telephone visit was unable to do a proper assessment of Ashley’s needs and risks. Because Ashley’s wishes and needs were not respected, he did not want to engage with the service any longer, increasing his risk of reaching crisis again and impacting on his trust in services.  

Service recovery and the importance of choice

Girl on mobile phone
While engaging with mental health services remotely may be easier for services and some young people (though not all), it must not be seen as ‘the solution’ to addressing extortionate waiting times.

When providing remote mental health services for young people in your care, we recommend that the following points are considered: 

  • Service recovery plans must consider “lessons learnt” regarding new ways of working and take opportunities to provide efficient and effective services to young people within an agile and responsive working environment for staff.
  • Safeguarding policies should be continually reviewed with regards to remote consultation and kept up to date. Safeguarding training should cover risks associated with safeguarding and remote consultations, and staff should be aware of the increased risks of missing physical and social cues.  
  • Staff should consider any risk of coercion that may be increased through a remote consultation format. If there are any concerns with regards to safeguarding, clinicians should strongly consider offering a face-to-face appointment. 
  • Nurses must be confident in offering young people choice - providing clear information on care and treatment options, as well as outlining the benefits and risks of each method of service delivery. 
  • It is paramount that nurses at all service levels ensure choice is ‘real’. We must always ask ourselves whether or not young people’s choices are being limited because of service pressures or an organisational shift towards increased remote working. 
  • The preferred method of service delivery must be reviewed with young people on a regular basis, ensuring the right care is provided in the right way at the right time. Some young people may choose one method of delivery and be happy with that throughout their contact with services. For others, how they want to access services may change over time.
  • Wherever possible, the same digital platform should be used for online consultations to promote consistency and to limit the number of applications that young people need to master. Clear information on how to use an online platform should always be provided.
  • Nurses need be aware of the problems some young people may have with accessing remote services (as per table on page 3). Considerations should be made to determine if there are other ways may enable a young person access services – e.g., having remote and/or face-to-face appointments in a safe venue outside home (at an education setting or charity).  

Acknowledgements

Psychologist talking to teenage boy

This work was supported by colleagues at MIND, the RCN’s Mental Health Forum, CYP: Staying Healthy Forum, CYP: Acute Care Forum and Learning Disabilities Nursing Forum. Recognising the research contributions of Young Minds and thanking all the children and young people who made that research possible.

Authors

Helen Rees, Mental Health Forum Committee Member at the RCN
Leila Reyburn, Policy and Campaigns Manager at Mind
Moya Lenaghan, Policy and Campaigns Officer at Mind
Stephen Jones, Professional Lead for Mental Health at the RCN