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NO NO NO NO NO

JOB HOME MONEY FRIENDS H O PE

You’d be mad too! An independent evaluation of how YASP helps young people, with mental health and well being issues, to achieve step-change in their lives.

Published: Feb 2011

Author: Steve Kenny


“YASP is like a helping hand reaching out to you. You can hold onto it when ever you need extra support. It gives you the courage to keep going� (YASP service user)


Contents

Page

Key Points

3

Introduction

4

The transition needs of 15-25 year olds

5

The mental health of young adults

6

The impact of mental health and associated problems on young adults

8

Young people’s information, advice, counselling and support services (YIACS)

10

YASP: an evidence-based service

11

YASP monitoring information

15

Service User Evaluation: Key findings

18

Service User Evaluation: The service user poll

22

Service User Evaluation: Young people’s overall assessment of YASP

27

Recommendations

28

References

29

Appendixes

33


Key points In September 2010, SK Associates was commissioned to undertake an independent evaluation of YASP. This included a literature search, a review of effective evidence-based practice within the service and a service user evaluation. This paper presents the evaluation findings and sets them within the research and evidence based context. The following key points emerge from the evaluation: ɲɲ Young people with mental

ɲɲ Access to an Internet Café and

health problems experience

a volunteering programme

multiple practical problems

have been identified by young

as well as reduced confidence

people as valuable sources of

and increased isolation.

support.

ɲɲ Services for young people with

ɲɲ Advice needs to be linked to a

mental health problems need

volunteering service to ensure

to recognise and meet the

young people can enjoy their

multiple needs and difficulties

volunteering opportunities

being faced.

with stability.

ɲɲ Young people appreciate it

ɲɲ Young people particularly

when their needs are met

appreciate a shop front.

holistically. ɲɲ YASP is an effective service at ɲɲ Young people favour destigmatised venues for this.

meeting the needs of these young people. Any service aiming to meet the needs of this vulnerable group should try and adopt this operational model.

3


Introduction

YASP

(Young Adult Advice & Support Project) comprises a multidisciplinary team providing ‘wrap around’ services for 15-25 year olds with mental health problems. The team is committed to reducing the stresses faced by young people by providing a combination of social welfare advice, counselling sessions and a volunteering programme. The service has a young person’s internet café providing cheap and nutritious food and this small space is often the first point of contact with the service. YASP has an open referral system allowing 15-25 year olds to simply ‘walk in off the street’. They also accept agency referrals and are able to work in partnership linking in with other agencies and staff to ensure young people receive co-ordinated services.

What YASP service users say:

I don’t feel so alone now and it really helps knowing that other people also have similar mental health problems but are OK.

‘ ‘

’ ’

see p.11

The important thing is I know I can always come back.

see p.13

YASP

helps

to

build

up

confidence and helps you to reach your goals in life.

see p.14

YASP works closely with service users to achieve their goals. YASP is based in Levenshulme which is an area of central Manchester with a diverse population and high levels of social need.

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1 . The transition needs of 15-25 year olds According to population projections prior to the 2011 Census, there are approximately 210,000 young people and young adults aged between 15 and 25 years in Manchester.1

a) Transition from adolescence and adulthood There is a general societal expectation that by the time they are 25 years old, most young people will have made three significant transitions: from education to work; from a dependent relationship on an adult to being independent; and from dependent living in a home environment, to creating their own living environment. In addition some will be parents. A research report by Young Minds2 has pointed out that there is no other period in life where so many transitions are expected to be the norm. New psychological and biological research indicates that the brain does not reach full maturity until at least 253, with the early adult years critical for the formation of self-image, social skills and impulse control, and that therefore society’s expectations for young people’s planning, organisational and self-regulating capacities can often be misplaced 4 5 6 A Social Exclusion Unit report on transition suggests that differences in social class, gender, ethnicity, disability, and geographical location interact to restrict the opportunities available to some young adults. For example, many young people in areas with a depressed labour market are now much more likely to stay on in training, or to become unemployed, than get a full-time job, and for an increasing number of these young people this will mean they remain economically dependent upon their families until well into their mid-twenties. In addition, for some groups of young people a lack of family assistance and support may mean that they struggle even more through the transition period into adulthood7.8 Research by Revolving Doors Agency (RDA) and Young Minds9 draws particular attention to 1625 year-olds who are vulnerable to mental ill health, and who face the additional stresses and strains of making the transition from adolescence to adulthood, which can compound the problems already faced by these young people, heighten the personal costs to individuals of unfulfilled potential and the financial costs to society.10

YASP specifically targets those groups of young adults aged 15-25 years who are most vulnerable to mental ill health.

b) Transition from children and young people’s mental health services to adult mental health services Most state services still take an age-bounded approach with children’s and adults’ services separated from 18 years, and there are relatively few examples of public services that specifically address the needs of 16- to 25-year-olds in the round or ensure an effective transition from youth services to adult services11 12 13 14. As stated above, young adults face a wide range of changes as they move towards adulthood, and often need additional support at this time, adult services are often not appropriate for them and young adults are often not socially or developmentally ready to cope on their own and may therefore be at risk of ‘falling through the gap’ between child and adult services.15 In terms of mental health services, it has been acknowledged that even though adolescence is one of the riskiest periods for the emergence of serious mental disorders, this has not been adequately reflected in service provision.16 17 18 19 In particular, it is known that the needs of some young people who are particularly vulnerable to poor outcomes are still not being addressed, for example those with learning disabilities; those with an illness or disability; those from black and other minority ethnic communities; asylum seekers; those with conduct disorder or emerging borderline personality disorder; those requiring emergency mental health care; and looked after young people (especially those placed out of authority), and those attempting to make the transition to adult services.20 21 22 23. YASP specifically targets those groups of young adults aged 15-25 years who are most vulnerable to mental ill health, who are in transition between youth and adulthood, and whose needs can often not be effectively met by either young people’s or adult services. 5


2. The mental health of young adults a) An overview of the prevalence of mental health needs amongst young people aged 16-24 year olds The most recent national survey of mental health needs amongst 16-24 year olds estimated that in England 24: ɲɲ Almost a third of 16-24 year olds (32%) were affected by one or more psychiatric disorder. This was higher than for all adults (23%). ɲɲ Twelve percent of 16-24 year olds were affected by two or more disorders, compared to 7% of all adults. ɲɲ Eighteen percent in this age group met the threshold for clinical diagnosis of common mental disorders (principally anxiety and depression). The same survey reported the following breakdown for mental health problems affecting 16-24 year olds most frequently. ɲɲ 17.5per cent had common mental disorders including: mixed anxiety and depressive disorder, generalized anxiety disorder, depressive episode, phobia, obsessive-compulsive disorder, panic. ɲɲ 4.7per cent had post traumatic stress disorder (PTSD). ɲɲ 3.5per cent had an eating disorder which had a ‘significant impact’ (where respondents said that their feelings about food interfered with their ability to work, meet personal responsibilities, and/or enjoy a social life). ɲɲ 11.2per cent had a mild alcohol dependence. ɲɲ 10.2per cent had a drug dependence (mainly cannabis). ɲɲ 1.2per cent had a problem with gambling. There is a lack of consistent national data on the overall psychological well-being of young adults in England, and the prevalence of ‘lower-level’ mental health problems that do not meet the criteria for a clinical diagnosis. 25 However, a European study which took into account economic, health, educational, family, friendships, risk-taking and life satisfaction factors found that well-being amongst young

People on low incomes [are] more likely to experience poor mental health and those with mental health

problems

[are]

more

likely to be living in poverty.

people in the UK was lower than in twenty other industrialised countries.26

b) Research into key factors that contribute to mental health problems in young people There are many acknowledged risk factors that contribute to mental health problems in young people. Research has evaluated the predominance of certain early experiences with a higher incidence of problems with emotional and mental health. The factors identified include: family circumstances (parental mental health and drug misuse having a bearing on the mental health of any children in the household); expose to stressful events (such as bereavement, divorce or serious illness); exposure to domestic violence, and experience of emotional, sexual or physical abuse and neglect. Social class, low income and poverty have also been found to be significant factors, with people on low incomes being more likely to experience poor mental health and those with mental health problems more likely to be living in poverty. Experiences of bullying and the quality of peer relationships have also been identified as critical to the mental and emotional well-being of young people. It has also been found that young people’s responses to these circumstances can lead to a second level of difficulties around their mental health: this includes higher levels of substance misuse, eating disorders, self-harm and suicide attempts

6


c) Research into the onset and persistence of mental health risk factors and problems In 2007, a review of recent epidemiological research on age-of-onset of mental disorders focusing on the WHO World Mental Health Surveys was undertaken.27 The research found that the first onset of most mental disorders usually occurred in childhood or adolescence, although treatment typically did not occur until a number of years later. The previous government’s mental health policy28 also reported that over half of all adults with mental health problems will have begun to develop them by the time they were 14 years. A study29 which tracked the emotional wellbeing of a sample of children and young people between 2004 and 2007 reviewed the factors likely to be associated with the persistence of existing mental health disorders. It was found that thirty per cent of children diagnosed as having emotional disorders in 2004 still had them three years later, with family, household and social characteristics strongly linked to persistence. The study also considered factors which may protect against the onset, or help children recover from, emotional and behavioural disorders. In both cases ‘social capital’ factors such networks of family and friends, participation in clubs and groups and perceived safety in the neighbourhood were strongly linked with emotional wellbeing.

...social capital factors such as networks of family and friends, participation

in

clubs

and

groups and perceived safety in the neighbourhood were strongly linked with emotional

wellbeing.

d) Groups of young adults disproportionately affected by mental health problems Research shows that the following groups of young adults are disproportionately affected by poor mental health: ɲɲ Young men30 ɲɲ Young people and young adults who experience discrimination31 ɲɲ Young people and young adults from black and minority ethnic communities32 33 34 35 36 ɲɲ Asylum seekers and refugees37 38 ɲɲ Gay, lesbian, and bi-sexual young adults 39

40

ɲɲ Young people and young adults with special educational needs 41 42 ɲɲ Young people and young adults who are not in Education, Employment or Training (NEET) 43 ɲɲ Young people and young adults with disabilities and long-term illnesses44 45 46 ɲɲ Young people and young adults who have been abused 47 48 ɲɲ Young people and young adults who have been looked after 49 ɲɲ Young carers 50 ɲɲ Young people and young adults who misuse substances51 52 ɲɲ Young people and young adults in contact with the criminal justice system 53 54 ɲɲ Young homeless 55 56

57 58

ɲɲ Higher Education Students 59 60

7


3. The impact of mental health and associated problems on young adults In many cases it is clear that while mental health impacts and exacerbates other problems for young people, these problems in turn often impact upon a further deterioration in their mental health.

a) Stigma and mental health It is known that stigma has a negative impact on a young person’s sense of self-worth and can seriously impact upon their life chances 61. In particular, misconceptions and false beliefs about mental illness are likely to be absorbed by the young person62 and they may be rejected by peers, which can lead to isolation, strong feelings of shame and a sense of hopelessness. Such feelings have also been found to increase the chances of offending, substance misuse, self-harm and suicide.

b) The impact of poor mental health on social welfare and civil law problems Social welfare and civil law problems generally relate to employment, accommodation, homelessness and money/debt. The full extent to which mental health problems may cause social welfare law problems and vice versa is hard to determine, but there is evidence that people with mental health problems are more likely than those without, to experience a range of social welfare law and civil law problems, and that social welfare law and civil law problems can lead to and/or exacerbate stress and depression, and loss of confidence 63 64. For example, Youth Access, Pleasence and Balmer 65 and the English and Welsh Civil and Social Justice Survey66 report that among 18-24 year olds, social welfare law problems are reported much more often by those who have mental health problems, than those who have not. (As the reference period for the Civil and Social Justice Survey was the preceding three years, the authors surmised that some of the problems of those in the survey would almost certainly have been experienced when they were as young as 15, 16 or 17 years.) 67 The Civil and Social Justice Survey have also highlighted that many young people experience multiple problems, and that certain types of problems experienced by 18-24 year olds tend to cluster together.68

People often don’t know how to cope with their depression, they feel lonely and have no-one to help them. They feel like no-one understands them- they don’t want to do anything and might feel suicidal.

Pleasence and Balmer 69 found a particular association between the reporting of mental health problems and eight categories of problems, including employment, homelessness, and money/debt. For example, 35% of 18-24 year olds who reported mental health problems also reported housing problems, as did 50% of those who reported both mental health problems and long-standing illness/disability, and this was much higher than for older age groups. Links between debt and mental health are also well-established, 70 For example, Jenkins et al71 reported that overall, adults with common mental disorders, probable psychotic disorders, alcohol or drug dependence were three times as likely to be in debt, compared to those with none of the disorders (23% vs 8%) and that the likelihood of mental disorder increased with the number of debts. Some research specifically relates to young parents where worries about debt were associated with increased likelihood of depression.72 Additionally, evidence from the Civil and Social Justice Survey73 suggests that both mental health problems, and social welfare problems, are more common among 18-24 year olds who are not in education, employment or training (NEET). In particular, such young people were found to have a higher number of problems relating to rented housing (12% vs 6%), employment (10% vs 6%), welfare benefits (9% vs 2%) and homelessness/the threat of homelessness (8% vs 2%) compared to those in education, employment or training. It was also found that stress related illness, loss of confidence and worry, as a result of civil law problems were more common. The Pleasence and Balmer survey of 18-24 year old 8


respondents also revealed that 22% of civil law problems reported by them had led to stress-related illness, and mental health problems had been exacerbated by 41% of those who had already had them.

c) The impact of poor mental health on homelessness While mental health problems can exacerbate young people’s chances of becoming homeless, it has also been found to be the case that homelessness impacts in extremely negative ways on young people’s overall health and can exacerbate existing mental health problems or lead to the onset of new mental health problems such as depression. Substance misuse is widely reported within populations of homeless people and can be both a cause and outcome of being homeless. The English and Welsh Civil and Social Justice Survey 74 found that 15% of 18-24 year olds who reported mental health problems reported homelessness problems and approximately 35% reported housing problems more generally. Pleasance et al found that among 18-24 year olds living in temporary accommodation 84% also reported problems to do with, employment, debt/ money and welfare benefits75. It has also been found that young people with mental health problems are more likely to experience difficulties in maintaining a home in the future76.

Young

people

with

health

problems

are

mental more

likely to experience difficulties in maintaining a home in the future

9


4. Young people’s information, advice, counselling and support services (YIACS) Youth Access77 has argued that there is an ‘extensive and robust evidence base’ for the effectiveness of young people’s information, advice, counselling and support services in relation to helping vulnerable young people and adults, including those with mental health problems . This has been supported in recent government policy78 . In particular, YIACS have been shown to achieve good outcomes for young people. For example, the data from Youth Access’s Youth Advice Outcomes Toolkit to which YASP contributed, shows that 62% of young people with complex and often multiple needs felt better able to deal with their problems as a consequence of receiving advice; 57% had improved confidence and control over their lives; and 35% had higher involvement with education, training or employment simply as a consequence of receiving advice on social welfare problems (housing, benefits, debt etc), before the effect of any additional intervention cuts in. Outcomes were particularly good for the most socially excluded young people.79

What YASP service users say:

It’s about lack of friends, lack of confidence, feeling singled out, paranoia about people, don’t know what people are thinking

or thinking you are weird

see p.22

You can have problems going out and negative thoughts like being frightened that people are thinking negatively towards you and a fear of rejection from society. Young people are scared

to tell people about their mental health so they close up.

see p.22

It’s hard enough for a young person to go to one place for the first time – being able to access everything at one place is really good.

see p.23

10


5. YASP : an evidence-based service There is now a well established research evidence base regarding effective ways of meeting the needs of vulnerable 15-25 year-olds with mental health needs, together with reviews of practice that is likely to lead to positive outcomes. Working practices at YASP are based on this evidence, which is summarized below and supported by the views of YASP service users who participated in a recent service user evaluation.

a) Mental health promotion, emotional wellbeing and early intervention The CAMHS Review emphasised the importance of emotional wellbeing and mental health promotion with vulnerable young adults, advocating early intervention before mental health issues become entrenched problems. YIACS such as YASP are recognised as having an important role to play in this and can contribute to a range of local authority ‘prevention and wellbeing’ agendas80. Importantly a young person interviewed at YASP as part of a recent service user evaluation commented: ‘I wish I had come to YASP earlier. I don’t feel so alone now and it really helps knowing that other people also have similar mental health problems but are OK.’

b) Holistic approaches that ensure that the young adults’ wider needs are met The Social Exclusion Unit 81 has made the point that very few disadvantaged young people only have one ‘issue’ and that to deal with multiple and complex needs requires services that see them holistically as individual people rather than a cluster of separate problems, and that this demands client and personcentred approaches which address the full range of a young person’s needs. This may include advocating on their behalf, providing practical support, advice or information, signposting to other services 82 and emotional or therapeutic support83 It has also been found that the ‘one-stop-shop’ or ‘no wrong door’ approaches such as that adopted at YASP have positive outcomes. One of the young adults interviewed, as part of a YASP service user evaluation, told the interviewer: ‘When I arrived at YASP I didn’t realize the extent of the service offered. The café was really nice and the people were very friendly. The on-going advice and support was essential alongside the coun-

Just having someone to help with practical things that people with mental health problems can’t always cope with is important,.

selling and kept me going between sessions. The also helped me to get a temporary place in a hostel, where I have been for approximately two months.’ The need for practical support alongside therapeutic help was also emphasised by YASP service users who participated in the service user poll: ‘Just having someone to help with practical things that people with mental health problems cant always cope with is important, like filling in forms and help with letters and benefits and other practical things. I wouldn’t understand if I didn’t have help.’

c) Meeting basic needs Research has also shown the importance of addressing young adult’s basic needs alongside other interventions.84 For example, a number of studies have found that physical safety and stable accommodation are prerequisites for young adults engaging with services. Additionally, the integration into projects of access to good quality food, as found at YASP, has also been identified as being important and is confirmed by YASP service users reported experiences: ‘I was given food vouchers so I could eat at the café every day which was great because I had no money.’

d) Advice and information needs A review of the literature on advice and information services 85 demonstrates the financial gains for young people who seek advice regarding benefits and money management. Several research studies86 87 have also focused on whether social welfare law advice can assist in improvements in mental health and wellbeing. For example, a study by Borland and Owens88 found that 88% of over 1000 young adults said that they ‘felt better after seeing the advice worker’. In addition, 84per cent said that receiving an advice intervention made them feel that someone cared and had reduced feelings of 11


hopelessness. 69per cent said that it had increased feelings of effectiveness and self-esteem and 77per cent said it had helped to improve the quality of their lives. This is clearly mirrored in the reported outcomes from YASP service users presented in the next section of this paper and in the case studies in Appendix 1 which have been based on interviews with YASP service users.

e) The availability of counselling and therapeutic interventions for young adults The Social Exclusion Unit89 noted that there was a wide consensus amongst service providers that psychological therapies or counselling for young people and young adults on issues like depression, anxiety, substance misuse, eating disorders, or bereavement, could be beneficial, and that those with complex and multiple needs can also benefit. More recently, the Children’s Workforce Development Council reported that young people experience counselling as a positive process that can help them gain in confidence, develop problem solving skills which help them understand things differently; improve the practical things in life (e.g. going to college, finding a job), and prevent an over-reliance on family and friends. However, it has also been reported that capacity issues within services offering psychological therapies and counselling mean that many young

Volunteering in the cafe helped me learn skills which have helped me living on my own’.

adults are on waiting lists and critical windows of opportunity are often missed. In 2007 the previous Government introduced the ‘Improving Access to Psychological Therapies’90 initiative, but initially this did not specifically address the particular needs of young adults or those with complex needs, and was primarily focused on the introduction of brief and relatively inexpensive Cognitive Behavioural Therapy Interventions for which there was a clear cut evidence base of efficacy with some groups of people. However, several IAPT pathfinders have subsequently identified the continued need for counselling as well as CBT particularly in relation to work on psychological issues such as depression in the context of relationship problems, trauma, refugee and dislocation issues, postnatal depression, work-related stress and health anxiety. 91 They have also emphasised that partnerships with voluntary sector agencies mean that they can signpost to counselling, support and advocacy services which are particularly valuable in addressing the gaps in mental health provision for BME and other ‘harder to reach’ groups. This is clearly confirmed by the experience of YASP service users with one commenting: ‘I didn’t find the (CBT) sessions offered at the GPs very helpful. How on earth could I be ‘cured’ in 6 weeks? But she did refer me onto YASP for counselling where I have had time to learn how to cope with all sorts of things.’

f) Promoting independence and life skills Recent government policies92 93 have emphasized the need for services that work with vulnerable young adults to provide opportunities to equip young people with life skills and suggest that helping young adults with activities such as cooking, budgeting, form filling or advising on finding accommodation or obtaining child care are critical in ensuring their ability to survive independently and make healthier choices and decisions about their lifestyles.94

12


The YASP volunteers who were interviewed as part of a service user evaluation reiterate this point: ‘Volunteering in the cafe helped me learn skills which have helped me living on my own’ and ‘Being able to use the computers was great because they don’t have them in the hostel and I could help myself more and find out and make decisions for myself.’

g) Personalised tailored support and the quality of relationships Tailoring support to individual service users, as happens at YASP, is now widely recognised as increasing the effectiveness of interventions, and many organisations have published recommendations to this effect95 96 97 98 99 100. Indeed interviews with YASP service users clearly illustrate the value of a tailored approach. For example, ‘My worker has given me support and confidence in addressing my own particular problems. I was very withdrawn and couldn’t talk to people, but now I can look people in the eye and talk to them’ and ‘My Advice Worker is very helpful and has supported and guided me through the process of applying to stay in UK, which is my particular issue.’

h) Quality of relationships Research based on consultations with young people has consistently identified that the quality of relationships with workers is a key factor in determining whether they continue to engage with the service101 102. This is especially the case where young adults have previously had negative experiences of services. Young people have emphasized that it is important that they are treated with respect, listened to, and their views taken seriously, but have particularly stressed the need to have a ‘trusted adult’ who they feel cares for them and will work with them consistently in addressing their needs. The ‘trusted adult’ can be a mentor, personal adviser, advice and information worker, a support worker or counsellor103 104. YASP service users confirm the critical importance of this role. One young person told the interviewer: ‘My Advice Worker was great. She visited me at home at first and spent a great deal of time helping me to find ways in which I could gradually go out alone. It’s much better now and I can take my little girl to school. She was very kind and patient’ and another said: ‘I have had an amazing amount of help from my YASP worker, I don’t trust many people but I can really trust her.’

I was very withdrawn and couldn’t talk to people, but now I can look people in the eye and talk to them.

i) Continuity and longer-term support Research on socially excluded young people has found that sustained support over time, is essential for vulnerable young people whose needs last beyond the upper age limit of many children’s services.105 106 Amongst the sample of young people interviewed as part of the most recent YASP service user evaluation, a quarter of the young adults had been engaged with YASP for under a year with another third having been engaged for between a year and eighteen months. Just under a half had been engaged for two years or more. The fact that there were no fixed time limits on interventions offered was universally appreciated by these young people.

j) Flexibility It is widely accepted that vulnerable young people often dip in and out of services, and that a flexible response is needed so that they are not discharged prematurely107. For example, young adults may need more time to engage with a service and require a greater level of understanding when they fail to engage or keep appointments. Made to Measure emphasizes that flexible ‘time’ is one of the most important things that can be offered to vulnerable young adults. The Young Minds ‘SOS’ report108 also emphasizes the importance of services that are flexible enough to be able to respond to young people in a crisis. One of the young people who participated in a recent service user poll suggested: ‘It is really important I have someone I can ring up knowing that there will always be someone at the end of the phone I can contact and can meet up with – I don’t have to wait for an appointment in a month.’ Another young service user told the interviewer: ‘I came to YASP first when I was pregnant and kept in touch for a bit now I’m back to get help with my divorce. The important thing is I know I can always come back.’

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I now feel motivated to look for

k) Linking in with the young adult’s wider support networks Made to Measure 109and the RDA Report110 both stress the importance and value of linking in with the young adult’s own support networks or helping them to develop them wherever possible –in order to give them the greatest chance of recovery/ rehabilitation/ future success. This is an important element of YASPs work with young people. One of the YASP café volunteers told the interviewer: ‘my worker helped me to talk to my father about what I wanted to do with my life. He understands a lot better now and has accepted me and supports my decisions more.’

l) Encouraging high aspirations The Social Exclusion Task Force noted that ‘Young people are more likely to achieve positive outcomes when they develop ambitious, achievable aspirations, combined with the self-esteem, self-efficacy, information and inspiration they need to persevere towards their goals’111. Made to Measure 112 also suggests that building self-esteem and confidence, promoting positive futures and encouraging high aspirations should underpin all work with vulnerable young adults, and that this is often the first step in a pathway to independence. RDA research participants welcomed projects which offered activities which stretched their abilities and were aiming to improve their skills and confidence.113 One of the YASP interviewees noted: ‘I now feel motivated to look for work again’ and another noted: ‘YASP helps to build up confidence and helps you to reach your goals in life.’

work again

m) Young adult’s involvement in services

Research emphasizes the benefits for organisations in involving service users114 including the development of a more responsive service to meet the range of needs of existing and potential users, increased accountability to funders and more informed staff.115 116 RDA research117 suggests that service user involvement in volunteering, offers opportunities for constructive activity and helps young people to gain useful experience and improve their skills.

n) Service location A number of research projects that have consulted young adults about the development of effective services have reported that the location of the service is important. For example, Young Minds118 found that young people were reluctant to be seen to be attending a ‘mental health service’ and thought that a ‘drop in’ type approach where a range of services for young people was available was much more likely to be attractive than a specialist single focus service. Young Minds suggested that voluntary sector services provided in non-stigmatising environments were often more acceptable to young people than statutory services in more formal settings. One young person who completed a questionnaire as part of a service user evaluation stated: ‘Listening to advice in an informal atmosphere makes a big difference.’

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6. YASP monitoring information a) Service users at YASP In total 235 YASP service users received case work during 2009/2010. ɲɲ A breakdown of gender of these young people revealed that over half (53%) were male and 47% were female. ɲɲ A breakdown of ethnicity of YASP service users during 09/10 revealed that 48% were from BME communities and were from 34 different ethnic origins, much higher than most comparable services. ɲɲ An age breakdown of YASP service users revealed that the highest proportion were aged between 20 and 23 years old (49%) Those aged 15- 19 years represented a third of all service users However the highest proportion were aged between 20 and 23 years old (49%) Those aged over 23 represented 16%. ɲɲ Altogether 63% of YASP service users had a diagnosed mental health problem and 44% were care programme registered.

b) Referrals YASP recorded referral sources for 225 young people during 09/10 (in 8 cases referral source were not recorded) Fig 1: Referral Sources

108 (48%) referrals were self referrals, this represented by far the greatest number of referrals. These included young people who had heard about the service from family members and by word of mouth from other young people.

Of the professional referrals, 85 (38%) came from mental health services. These included referrals from The Assertive Outreach Team (3), Community Mental Health Teams (9), The Crisis Intervention Team (5), The Early Intervention and Psychosis Team (61), The CAMHS 16/17 Team (2), The Royal Infirmary (1), The Pearl Assessment Unit (1) and Crisis Point (3). Of the other referrals: ɲɲ 11 (5%) were from Primary care, of which only one was from a GP. ɲɲ 6 (3%) were from social services including referrals from Area (3), Safeguarding (1) and Aftercare (1) Teams and one from a residential Children’s Home ɲɲ 6 (3%) were from Education, Employment and Training Services including Connexions (4), college(1), and Job Centre(1) ɲɲ 4 (2%) were from YASP groups or HARP (YASP’s mother project) ɲɲ 3 (1.5%) were from housing organizations including Manchester Housing Department(1), Manchester Methodist Housing Association(1), and Women’s Direct Access(1)

108 (48%) referrals were self referrals and as shown in Fig 1 this represented by far the greatest number of referrals (48%) These included young people who had heard about the service from family members and by word of mouth from other young people.

ɲɲ 2 (1%) were from advocacy organizations: one from MIND and one from a Mental Health Advocate. ɲɲ 1 (0.5%) was from Eclyspe, Manchester’s Young Person’s Substance Misuse Service

15


c) The nature of problems experienced by YASP service users receiving case work during 2009/10 An analysis of problems routinely recorded by the service on its database revealed that financial problems and in particular the difficulty in claiming appropriate benefits, were the most frequently reported by the young adults. Of the 1,852 initial enquiries from young people, over half (56%) were in relation to benefits and a further 156 related to debt. 43% had queries relating to their mental health problems and 33% had housing problems and 6% were homeless. Other significant problems included general health problems (11%), drug and alcohol issues (7%) and issues relating to being an asylum seeker (6%)

In 2009/10, the total financial gains for young people were calculated as £239,110.

Fig 3: YASP Internet cafe activities

Fig 2: The nature of problems experienced by the young people

e) An analysis of outcomes for the 235 YASP service users who received case work during 2009/10

d) An analysis of activity in the cafe An analysis of activity in the cafe showed that it served a number of important functions which contribute towards a holistic response to young people’s needs. For example in2009/10: ɲɲ Young people undertook 11,472 sessions on the internet ɲɲ 1,946 meals were sold in the Café ɲɲ 3,424 condoms were distributed ɲɲ 212 places were used by young people attending 32 group activity sessions

Despite their mental health difficulties, since coming to YASP five of the young people had started a course and five had gained a qualification. A further three had now taken up work and five had taken up volunteering opportunities elsewhere. Outcomes relating to help with accommodation show that for sixteen individuals homelessness had been prevented, with housing secured for sixteen young people, and housing sustained for eight young people who were in danger of losing their accommodation. There were a number of other outcomes which indicated significant improvements in the quality of life for the young people. For example, twenty-five individuals successfully reported harassment which had taken place on sixty-one different occasions. In three cases young carers’ reviews were undertaken and eight young people reported that they were more satisfied living in the area.

ɲɲ Young people undertook a total of 956 volunteering sessions.

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Fig 4: An analysis of outcomes routinely recorded by the service

The

YASP

Volunteering

Programme has clearly been of significant benefit to the young people who participated last year. It was also evident that the experience of working in the café had helped to develop young people’s confidence.

f) The YASP Volunteering Programme An analysis of young people’s financial gains as a result of YASP interventions shows that young people had secured 262 benefits to which they were entitled, a smaller number had received a lump sum, an award from a charitable organisation or additional weekly benefits. In seven cases young people’s debt has been removed and in a further seven cases they had been substantially reduced. In 2009/10, the total financial gains for young people were calculated as £239,110. Fig 5: An analysis of financial gains as a result of YASP interventions

In total eight young women and nine young men aged between 16 and 25 years old participated in the YASP Volunteering Programme between 2009 and 2010. Of those who have volunteered, fourteen had a diagnosable mental health problem with eight being on regular medication at the time that they volunteered. In addition, six of the young people had a learning disability or difficulty and twelve had some sort of physical disability or long term illness. It should also be noted that the young people who volunteered included some of the most vulnerable YASP service users, for example, ten of the young people had previously self-harmed; ten had attempted suicide at some time of their life and two were homeless. The YASP Volunteering Programme has clearly been of significant benefit to the young people who participated last year. All seventeen young people learned basic skills in food preparation including gaining knowledge of basic food hygiene. It was also evident that the experience of working in the café had helped to develop young people’s confidence, which in a number of cases led to them access other parts of YASP. For example, twelve also participated in activity sessions, six accessed case work and one took up the counselling that had been offered. Of the seventeen volunteers, eleven have subsequently gained a qualification, entered employment or taken up other opportunities for volunteering.

17


7.1 Service User Evaluation : Key findings The YASP service user evaluation involved interviewing 20 young service users aged between 17 years and 25 years old. In addition, 53 young people completed a brief questionnaire as part of a service user poll. The findings from both of these activities are summarised below

a) Service user interviews In-depth interviews were conducted with twelve young men and eight young women. Twelve of the young adults were born in the UK of which, nine were white British and three were Black British. (Of those who were Black British: one was of African Caribbean heritage, one was of Pakistani heritage; one was of Indian heritage, and two were of African Caribbean mixed heritage). Of the eight young people born outside the UK, countries of origin were Pakistan, Sweden, Afghanistan, Libya and Angola and three were asylum seekers and one had refugee status. Four of the young people in the sample were parents and one woman was pregnant with a second child. (Of the seven children of service users, three were living with their mothers, and in one case with both mother and father; two were adopted and one was in foster care.) Nearly all of these young adults (90%) had diagnosed mental health issues, ranging from common mental health conditions through to severe and enduring conditions. Eight of the young people had been diagnosed and received medication for depression; one was specifically being treated for anxiety, although a number spoke about social anxiety. Two of the young adults had been diagnosed as having agrophobia; one had a bi-polar disorder and one had an obsessive/ compulsive disorder. In addition, three of those who were asylum seekers/ refugees had been diagnosed with Post Traumatic Stress Disorder. Three of the young adults had been diagnosed with schizophrenia and all had been referred to YASP through the agency’s role In Manchester’s Early Intervention into Psychosis Service. It should also be noted that one young person had a history of self-harming and three said that at some time in their lives they had attempted suicide. Seven of the young adults also had a diagnosed physical disability or illness and three had a diagnosed learning difficulty or disability. The analysis of the interview responses revealed that young people had heard about YASP via a num-

It also became evident that just under a half of the young people had no educational qualifications when they left school and over a third had a history of truancy or school exclusion ... with YASP’s encouragement, eight young adults were, or wanted to, continue with their education or undertake training.

ber of sources. Five had been referred by professionals in other young people’s services, five had been referred from other mental health services and three had been referred via GP’s or Counsellors attached to GP surgeries – often because the short term interventions offered by them had been insufficient. However, it was notable that many of the young people had not been in contact with other services and had referred themselves. Of the six who selfreferred, several had heard about YASP via the internet, 2 had heard about it from friends; one from a family member and two from ex-service users who recommended it to them.

b) The young people’s experiences The young people who were interviewed were asked a series of semi-structured questions , one of which invited them to tell their ‘stories’. These have been anonymised and replicated, with the young people’s permission as a series of short case studies (See Appendix 1). However in summary the qualitative data revealed a number of key features in the experience of the young adults. In particular, the analysis revealed that many of the young people had experienced difficulties and trauma in their early lives and had long histories of stressful events and circumstances. Just over a quarter had been separated from parents who brought 18


them up from birth and a fifth had no current contact with their birth parents. In nearly a third of cases the young adults spoke of their parents’ separation or divorce as being a significant and stressful event in their lives. It was also clear that many had been the subject of abuse and violence at some time in their lives. Half of the young adults said that they had been a victim of physical violence and approximately a fifth said they had been exposed to domestic violence at home. Just under a third said that they had been physically or emotionally bullied at school or in the family. It also became evident that just under a half of the young people had no educational qualifications when they left school and over a third had a history of truancy or school exclusion. Just two young people were currently working, with fourteen of the nineteen young adults unemployed (the others were registered as disabled) and two thirds said that they had never worked. Only 3 had undertaken further education courses or E2E training since leaving school, although with YASP’s encouragement, eight young adults were, or wanted to continue with their education or undertake training. Of the four young people who had gained a place at University, three had, had their course interrupted as a result of poor mental health. Many had experienced (or were experiencing) periods of poverty and debt; and the majority of the young people interviewed were, or had, lived in insecure or temporary accommodation

Apart from advice, information and practical assistance, nearly all the young people (89%) said that they needed emotional support on personal issues with 80% saying that they were socially isolated.

with over a third having experienced at least one period of homelessness necessitating crisis accommodation. Four of the young adults were now living in supported housing. Many of the factors and issues the young people had contended with in their lives were inter-related and overlapped creating a multiplicity of needs. In the majority of cases mental health ill health could be seen to have caused, contributed to and compounded these needs, not least of all because of the stigma associated with poor mental health.

c) Key issues identified by the young people in interviews Between them the twenty young people identified a total of 106 issues representing an average of 5.3 issues for each young adult. However, nearly 90% of the young people had 4 or more issues. Of these, just under a half said that they needed help developing independent living skills, two fifths said they needed advice and information about employment or training opportunities and over a third needed help in managing money. Two thirds said they had needed help in applying for benefits; in particular Disability Living Allowance (a third). Additionally, two thirds needed help finding accommodation or completing Housing Application forms. Apart from advice, information and practical assistance, nearly all the young people (89%) said that they needed emotional support on personal issues with 80% saying that they were socially isolated.

d) Interventions received Over a third of the young adults interviewed had already accepted and engaged with counselling at YASP (two others were receiving counselling else19


where). In addition, over two fifths had received advice on training and employment; over a third had received advice and help in relation to debt; nearly two thirds had received advice and help in claiming benefits; and two thirds had received advice and help with housing problems. All of the young people said they had received emotional support alongside the practical support, advice and information. The young adults also cited specific examples of the help and support they had received. These included helping a young man trace his parents; help with accessing a pregnancy test and on-going support through pregnancy; advice on the Asylum Support Service and on-going support on immigration issues; advice and support on relationships problems and divorce; support and advice on dealing with the school attended by a service user’s child; facilitating access to other therapies offered by another service; support in legal matters and dealings with court and support for young carers.

Of the 20 young people approximately a third said that they had taken up opportunities to volunteer and just under a half said that they used the café regularly. Over half used the computers on a regular basis.

e) Self-reported Outcomes The young adults who were interviewed were asked what they thought were the outcomes of their engagement with YASP and how the service had helped them. The young adults’ responses from both the interviews are reported below. Wherever possible, young people’s own words have been used. i) Improvements in mental health and wellbeing A number of the young people reported considerable improvements in their mental health as evidenced by accessing appropriate medical help or less reliance on medical services. For example, one young person said: ‘YASP encouraged me to get medical help with the depression. When a GP diagnosed it and prescribed me pills, YASP helped me successfully apply for Disability Living Allowance, which has really helped too.’ Another said: ‘I used to see his GP every three weeks, but now I only need to see him every three months’ and ‘My GP knows I come to YASP. I see him every 4-6 weeks for him to check my medication. This is good progress because I used

Coming to YASP has given me the confidence to talk to people. I can pick up the telephone and ask for help now.

to see him every week.’ Others spoke about developing strategies to cope with particular symptoms and conditions. For example, one young person said: ‘I can now go to the shop on my own, which I couldn’t do a year ago.’ All reported improvements in their general sense of wellbeing. ii) Increased confidence and support Increased confidence was a critical factor for most of the young adults. One young person told the interviewer: ‘Since coming to YASP I have got my confidence back. People are so nice and make you feel really comfortable. I have become bubbly again.’ Many of the interviewees cited examples of how increased confidence had resulted in them participating in activities that they would not previously have been able to do: ‘With encouragement and support from YASP I have joined a Karate Club and entered two competitions in the last year.’ The young people also emphasised how increases in confidence had helped them to interact with other people, make friends and tackle problems and tasks: ‘Coming to YASP has given me the confidence to talk to people. I can pick up the telephone and ask for help now.’ iii) Improved life skills A number of the interviewees also told the interviewer that they had gained a number of life skills since coming to YASP and that these were helping them to live more independently. For example: ‘I have learnt a lot about cooking and now I can see that’s it really important to eat healthily’ and ’I am learning to manage money better now.’ iv) Reduced social isolation The interviews illustrated how engaging with YASP had helped to reduce young people’s social isolation. ‘I got to know more people through going to YASP and the things they put on like, ten pin bowling rock climbing, canoeing, horse-riding and iceskating’ and ‘I feel much better and am not so lonely anymore.’ 20


v) Engagement in constructive activity For many of the interviewees, key problems arising from the inability to work, had been boredom and a lack of purpose in their lives which exacerbated mental health difficulties and a sense of worthlessness. For example the interviewer was told: ‘If I didn’t come into YASP at all, I would be bored at home and get depressed.’ The YASP Volunteering Programme was identified as having provided a positive opportunity to overcome such feelings. Another said: ‘I volunteered in the café because I needed something to occupy me and keep my mind going... I like working with the people in the cafe kitchen and on the gardening project and I join in with various social activities, trips and outings.’ vi) More ability to deal with difficult issues It was clear that the counselling and on-going support provided at YASP had helped young people to deal with very difficult issues that they had not previously come to terms with. For example, one young person told the interviewer: ‘I hadn’t told my GP all of my problems, but I told my counsellor. I was able to talk about her mother’s heavy drinking when we were growing up and how this meant that I didn’t have normal friends ‘cos I had to look after her a lot.’ Another said: ‘I have got a girlfriend now and we had some problems at the start, but I was able to talk to my worker about it and now it’s much better and very

I have had no contact with my family in Angola and at first I was terribly homesick, and I still think a lot about things that happened to me in the past, but with the support and friendships at YASP I am now learning to live with this.

supportive.’ In some cases, the support at YASP was helping young people come to terms with extremely traumatic events in their lives: ‘I have had no contact with my family in Angola and at first I was terribly homesick, and I still think a lot about things that happened to me in the past, but with the support and friendships at YASP I am now learning to live with this.’ vii) Increased security in accommodation A large number of those interviewed had, had problems with housing and insecure accommodation. In nearly all these cases, the lack of a secure roof over their heads was a key barrier to being able to address other issues in their lives. One young person described her experience of this: ‘‘YASP helped to get me into a hostel. I didn’t like the place because there were lots of people taking drugs and getting drunk – but with my worker’s help I kept my head down and after three months I was offered a flat in Ardwick. I moved in last year and I’m much happier. Having a settled home has helped me to get my life back on track.’ viii) Overcoming practical obstacles Receiving practical help was cited as a critical feature of many of the young people’s experience of YASP. In some cases this took the form of helping young people tackle administrative tasks or filling in application forms for benefits, grants or housing. ‘I got help with my financial problems and they (YASP) helped me get a Debt Relief Order to find a way of repaying my debts from University’ and ‘My worker at YASP helped me with benefits and I now get Employment Support Allowance and Disability Living Allowance.’ In other cases it was about receiv21


ing food vouchers: ‘I eat at the project which is very helpful as the meals are subsidised.’ In a number of cases it involved workers physically accompanying young people to appointments with other agencies and helping them understand what was being said to them: ‘ It’s not always easy going on your own and getting confused about what they are saying to you. Going with my worker helped a lot.’ ix) Higher aspirations and ambition Several interviewees specifically spoke about the ways in which increased sense of self-worth had led

to them re-kindling aspirations or developing new ambitions. In some cases these were personal ambitions related to a change in lifestyle. For example: ‘Dave and I have realized that smoking weed was too much money and not good for the children so we decided to stop smoking and stopped using cannabis 4 weeks ago.’ In other cases these related to future work ambitions: ‘When I have completed the course I am currently undertaking I want to take a course in social work and eventually I would like to run a project like YASP in another area of the country which doesn’t have such a service.’

7.2. The service user poll The service user poll asked a sample of 53 service users for their views and thoughts regarding: ɲɲ Whether young people with mental health problems were isolated ɲɲ Whether and in what ways YASP had been helpful to young people ɲɲ Whether it was a good idea to offer a mix of services together (for example, advice, counselling, volunteering) ɲɲ Whether volunteering somewhere like YASP could help to improve young people’s confidence and if so how.

a) Young peoples’ experience and views about social isolation Overall 83% of the young people said that they thought they were likely to be socially isolated. Others said it depended on the illness. The young people interpreted and described ‘social isolation’ in a number of ways. Some described a sense of internal isolation in their heads. For example, a young white British woman with depression stated: ‘People often don’t know how to cope with their depression, they feel lonely and have no-one to help them. They feel like no-one understands them- they don’t want to do anything and might feel suicidal’. A young African woman with PSTD and depression wrote: ‘Yes because they might be depressed and stressed and think they don’t have a life. They feel that they cannot deal with things. They can’t study, they can’t go out. They can’t concentrate’

and a Sri Lankan young man, who had just experienced a first episode of psychosis, suggested: ‘Mental health problems can be due to highly personal problems or unique and personal experiences in the past. People keep on thinking about these all the time and it makes it difficult relating to others. This instils fear in them in a social sense, and make such people keep things to themselves and be isolated.’ Others described the specific problem of not being able to leave the house. An Asian young woman with chronic anxiety explained: ‘It is really hard to interact with people because I don’t like going outdoors due to anxiety. The symptoms can stop you going out and meeting people.’ Another young person with depression and psychosis wrote: ‘Before I received help from YASP and the Early Intervention Team, I wouldn’t go out anywhere due to my paranoia. I feel much better now knowing that I have help.’ Many of the comments related to individuals’ lack of confidence, insecurity and mistrustfulness of other people. In particular, many of the young people who responded to the questionnaire said that before coming to YASP they had no friends or people to whom they felt close enough to trust. For example, a young white British man with psychosis and anxiety said: ‘It’s about lack of friends, lack of confidence, feeling singled out, paranoia about people, don’t know what people are thinking or thinking you are weird’ and a young white British woman described how: ‘You can have problems going out and negative thoughts like being frightened that people are thinking negatively towards you and a fear of rejection from society. Young people are scared to tell people 22


about their mental health so they close up.’ Similarly a young Pakistani man with psychosis stated: ‘Sometimes young people may feel they can’t express themselves or they are misunderstood. Past experience may also be why they can’t bring themselves to say certain things until they feel comfortable. When you are ill – it is hard to trust other people.’ A young British Asian woman summed up these feelings as follows: ‘There is nobody to talk to – nobody to understand you - so you feel completely alone’ Of the young people who completed questionnaires 29% cited the lack of appropriate services to help young people deal with social isolation and how this lack of help actually increased their social isolation. A young Black African man stated quite simply: ‘There just isn’t much help out there.’ A young Asian man who had just experienced a first episode of psychosis emphasised the particular importance of services for young people who had no other social supports: ‘There are not enough services for young people with mental health problems especially if they have no-one else to help them.’ A young white British woman also emphasised the importance of being able to meet other young people who have had similar experiences: ‘There are not many places where young people can meet up and meet people in the same situation.’ Others suggested that another key problem was the lack of knowledge about those services that do exist: ‘People sometimes don’t know where to go for help... It may be hard to know where

There is nobody to talk to – nobody to understand you - so you feel completely alone.

help is, unless they get leaflets or hear from a friend.’ One young person commented: ‘YASP needs to be advertised well enough so people who need it can get to know about it.’ A number of the young people also highlighted the difficulties and nervousness that young people faced in approaching services. One young white woman suggested: ‘I think young people can find it hard to talk to people about their mental health – they keep stuff to themselves and don’t feel able to approach most services.’ This was reiterated by a young man from Afghanistan ‘Young people may feel shy and embarrassed about going to places for help.’ The young people demonstrated a clear awareness of the way in which people with mental health are stigmatised and how this impacts on mental health. ‘It’s hard for young people to talk about health problems in case people judge them. I have been alone not knowing what to do.’ A young black British man with Aspergers syndrome drew on his own experience to explain: ‘There is a lot of stigma so therefore the issues are not addressed. I , for example, can be interpreted as being very funny, rude or awkward , but in actual fact I just ask questions to find out what people mean when I misunderstand them.’ A young black African man suggested that the stigma surrounding mental health affected people’s willingness to approach services. ‘There is a stigma – people are worried about speaking even to their GP.’ Several young people suggested that this stigma arose from a lack of accurate information about mental ill health and the kind of society that turns its back on ‘difference’ or things that are not understood. One said: ‘The society we live in causes the isolation – people are too busy and the bad weather doesn’t help – people just look out for themselves.’ Another commented: ‘Because people with mental health problems get pushed out of society – people don’t know how to deal with them,’ and a third suggested: ‘Nobody likes helping people with mental health problems and people judge them the wrong way’ It was evident that YASP offered an important way of reducing social isolation. In particular it helped 23


to increase confidence, encouraged young people to engage in constructive activities, helped to reduce stigma and provided opportunities to meet new people. The interviewer was told: ‘I was not allowed to work but I wanted to keep myself busy and so I started volunteering in the YASP café, where I quickly made friends.’

b) Young peoples’ experience and views about the importance of a holistic service All 53 young adults who returned questionnaires (100%) said that they thought that it was a good idea to offer a mix of services under one roof. Respondents cited a number of advantages to the provision of a holistic service offering a range of help.

It was evident that YASP offered an important way of reducing social isolation. In particular it helped to increase confidence, encouraged young people to engage in constructive activities, helped to reduce stigma and provided opportunities to meet new people

i) Reducing stigma It was clear that many of the young people thought that having a holistic service with an internet cafe shop front was very important in reducing the perceived stigma associated with attending a mental health service. One young person commented: ‘It’s great because it doesn’t look like a mental health project as people use the building for different reasons.’ ii) Inspires confidence It was suggested that having a holistic service under one roof was especially important for people who lacked confidence: ‘It’s hard enough for a young person to go to one place for the first time – being able to access everything at one place is really good.’ iii) Difficulty and confusion in dealing with more than one service A number of young people identified the difficulties of having to attend different services to get different needs met. It was suggested that this could be confusing: ‘You don’t have to go to lots of different places which can be confusing’ In particular it was suggested that knowing which service was the best option to meet which needs was difficult: ‘I think having to go to lots of different places and having to repeat things makes me confused as to the best place to go.’ Another respondent stated: ‘It is easier to access everything you need in one building as you know where you are.’ Two young people specifically said that they would not go to a range of other services: ‘It would put me off going to different places – I

just wouldn’t go’ and ‘It makes you feel more comfortable knowing one place. I would find it difficult to go to different services. I wouldn’t have the motivation because I would feel too anxious / nervous.’ Young people repeatedly referred to the fact that they felt comfortable in a more holistic service: ‘I think people like us feel more comfortable having all the services in one building’ and ‘If people have mental health problems its better for them to have one place to go to access everything, instead of having to go to different places. Its really good also having the internet café where people can grab a sandwich and use the internet at the same time as getting help or advice. I may not feel comfortable in different places.’ iv) Convenience factors: The convenience of having a number of services under one roof was emphasised by a large number of those who returned the questionnaires. It was suggested that it could save time and money travelling from one service to another; ‘When people travel across the city like I do, it is really helpful to get all the services together’ and ‘You don’t have to go to lots of different places which is expensive. There is all the help you need in one place.... It gives you something to do and someone to talk to at the same time.’ v) Helps to overcome barriers Several young people identified the fact that holistic services could help to remove or reduce the barriers to access to services that they experienced. In one 24


case a young man with a physical difficulty stated: ‘People with mobility problems or language difficulties find it easier to go to one place’. A young woman commented: ‘It is more convenient – especially for people with children.’ vi) Having services available when young people are ready to use them Two young people said that it was really important to know that services were there when a person was ready to access them. ‘I think the counselling service is good and the drop in being there helps in getting to be aware of what help there is for when you need it’ and ‘It helps having everything under one roof and being able to access things when you are ready to.’

The service user poll asked young people if they thought that volunteering somewhere like YASP could help to improve young

people’s

confidence.

100% said that they thought it did.

vii) Ease of referral Several young people also talked about the importance of the YASP staff working closely together and being able to link with other services – all of which helped to ease referral to other services when needed: ‘ They all work together as a team.. you can go straight from one service to another’ and ‘I am happy to be referred to other services by YASP, as I trust them.’ One of the young people who was engaged with the Early Intervention Team as well as YASP commented: ‘All the workers are helpful in their own ways. I really like the fact that the workers from YASP, the Early Intervention Team and the psychiatrist all talk to each other and get things done between them.’

c) Young peoples’ views regarding the kinds of help received at YASP The service user poll asked young people if they had found YASP helpful, and if so, in which ways. All 53 respondents (100%) said that YASP had been ‘helpful ‘or ‘very helpful’ to them. The 12 key reasons why the young people said they found YASP helpful are listed below in order of priority (assessed by the number of respondents who mentioned each reason): ɲɲ Quality of staff ɲɲ Advice, help and information needs on a wide range of topics ɲɲ Support and practical help ɲɲ Holistic services under one roof service ɲɲ Receiving help with mental health difficulties ɲɲ Meeting other young people with similar problems ɲɲ Informal setting and a ‘ safe place’ ɲɲ Accessing other services ɲɲ Creating a sense of direction ɲɲ Counselling ɲɲ Activities ɲɲ Volunteering One of the young people commented: ‘It’s always busy and well used which shows that it is helpful’. Another stated: ‘YASP makes sure clients have got everything they need. They get clients involved and make them feel more part of the community.’ 25


d) Young people’s views regarding the role of volunteering in improving confidence The service user poll asked young people if they thought that volunteering somewhere like YASP could help to improve young people’s confidence. All 53 young people (100%) who returned questionnaires said that they thought it did, although a few individuals admitted that it could be challenging at first. ‘Yes it can boost confidence, but it can be daunting - but you eventually do develop skills.’ The young people suggested a number of reasons why this was the case. i) Developing work skills A large number of the respondents suggested that volunteering in the cafe could help young people develop and learn new work skills: ‘It definitely helps young people to gain experience and learn new skills.’ It was also thought that it could be a valuable first step back into employment: ‘It helps to get you back on the road to work.’ Another young person suggested: ‘When young people with mental health problems need to get back into work, it is a taster for them and it can help to open up their options.’ One young person specifically emphasised the way in which volunteering could help to get back into leading more structured days: ‘It gives you experience and helps you take steps towards work. It gets you into a routine. It means getting up and being useful during the day and it means you are more active.’ ii) Confidence in looking for work There was a general consensus that volunteering at the YASP cafe had helped young people to feel more confident in looking for other work. ‘It is a brilliant experience and makes you feel more confident to look for a job.’ A frequent comment was that it helped knowing that most of the other young people also lacked confidence. For example: ‘It helps that it is a small project. It helps that everyone has health problems and therefore understand what you are going through’ and ‘Young people feel more confident in this environment, where everyone is similar and have no confidence so you are all in the same boat.’ iii) Improving self-image Several young people highlighted the importance of volunteering in helping young people to improve their self-image and self-esteem. One person stated:

When young people with mental health problems need to get back into work, it is a taster for them and it can help to open up their options.

‘Seeing other young people like yourself who are engaged in voluntary work instils confidence to join in ....volunteering in a friendly and relaxed place like YASP definitely improves young people’s confidence.’ Another said: ‘You get a really good feeling from doing voluntary work.’ iv) Improving life and social skills Apart from developing work specific skills, a lot of the young people identified the importance of volunteering in helping to develop life and social skills. As one young person explained: ‘You don’t just cook, you get to speak to people and the more you do that, the more confident you become.’ Another suggested: ‘Seeing people come in and use the cafe, gives volunteers the chance to use and improve their social skills... it helps to get people back into socializing with other people and is a good way to get them back into society.’ v) Making new friends and meeting people A number of the young people who had been volunteers stated that it had been important in helping them to meet new people and make friends: ‘It gets people out of their homes and you meet new people of all ages and make friends.’ vi) Removes stigma Several of the young people thought that working in the cafe helped to remove the stigma of mental health difficulties: ‘You would never know that the people working in the café have mental health needs.’ vii) Inspiring hope for future Young people who had been volunteers stated that it had proved to be critical in helping them to think more positively about the future. One young woman stated: ‘It is inspiring to hear about volunteers in the café through the newsletter who have 26


got better and gone into employment. It helps seeing people moving on in their life and coping with their illness.’ Similarly a young man said: ‘Volunteering at YASP means eating healthily and learning new skills. You also get confidence speaking to people, customer service skills –and this can help you to go on to work or achieve other goals...It gives you hope and motivation and a focus on what you want to do in the future.’

Views regarding the importance and intrinsic value of volunteering were echoed in a number of the in-depth interviews, for example one young woman told the interviewer: ‘YASP helps to turn people’s lives around. People who come in for help often end up becoming volunteers. It’s brilliant –seeing people flourish’ and a young man commented: ‘YASP has given me a real support network for myself. Working in the café has really boosted my communication skills and confidence. I think it’s really helped to develop my character.’

7.2 Young people’s overall assessment of YASP It was clear from both the service user poll and the in-depth interviews that the young people who use YASP think highly of the organisation and value the help they have received. In many cases young people describe it as having been crucial to their survival: ‘YASP has been a lifeline to me’ and ‘YASP was a refuge when things were really difficult. I spent every day here.’ Others said it gave them the help they needed to make a fresh start or resume a more normal life again: ‘They just helped me to get the ball rolling again so I could get on with my life.’ The support offered alongside counselling and advice was also greatly valued and young people describe how this helped them to get through difficult times and remain positive and determined: ‘YASP has helped me with my case, but more than anything it has helped me to stay positive and enabled me to fill my time while I wait for a decision from the Home Office as to whether I can stay in England.’ The service users were eager to pass on positive messages to other young people with similar problems. One young woman told the interviewer: ‘I want to tell young people that YASP is a place you can trust if you are on your own. They are there to help you. I have so much more now: a home; more

confidence and a beautiful baby and I will definitely make sure she has a better life.’ Another young woman said that she wanted to tell people how, because of YASP she is ‘a lot happier and calmer than I used to be’ and a third said: ‘the best thing about YASP is that everyone is friendly, they don’t judge you, and the workers respect you- this place makes people happy.’ One of YASPs long-term volunteers told the interviewer: ‘Lots of the young people tend to come back. When they are on track it’s to say ‘thank you’ and if things don’t go so well, they come back because they know the door will always be open to them.’ There were two less positive comments from service users. The first related to the lack of space and the need for bigger premises. One young person stated: ‘I would certainly recommend YASP to other young adults, but they could meet more needs if they had larger premises. I think that it would be really helpful if the café could be expanded.’ The second was that YASP needed to be advertised well enough so that people who needed it, had more chance of finding out about it. Both criticisms reflect current capacity issues.

27


Recommendations It has been argued that young people will be one of the hardest groups hit by the recession and that high youth unemployment is likely to cause a major increase in young people’s needs for advice on housing, debt and benefits and for counselling and mental health services. 119

‘

YASP is a place you can trust if you are on your own. They are there to help you. I have so much more now: a home, more confidence

Additionally, evidence from past recessions suggests that this effect is likely to be sustained for a number of years.120

and a beautiful baby.

For this reason it is clear that there is a continued need for YASP to maintain and find ways of developing its current service. The following recommendations necessarily take full account of the difficulties faced by the organisation within the current financial climate.

Further increase Ser vice User Involvement

’

Figure 6 - Main Recommendations

Maintain a holistic approach

Develop befriending and support ser vice

Maintain current levels of ser vice provision

Maintain access to computers

Advertise more widely

Expand activity groups

Develop volunteering opportunities beyond YASP

Increase volunteering opportunities Increase cafe activities

28


Recommendations in detail 1. Maintain a holistic approach that offers information, advice and counselling under one roof 2. Maintain current levels of advice, information and counselling services at YASP 3. Access to computers is important and must be provided 4. YASP to be more widely advertised in a wider range of venues likely to be frequented by the most vulnerable young adults e.g. hostels, housing providers, criminal justice agencies, health and hospitals ( including A &E ), custody suites, asylum seeking and immigration services, substance misuse services, Sure Start Children’s Centres. 5. Increase opportunities for volunteering within YASP 6. Consider ways in which activity in the cafe can be increased to ensure that more subsidised meals are made available to those who need them 7. Develop further opportunities for volunteering beyond YASP, creating pathways from volunteering at YASP to other volunteering and work experience schemes in suitable external locations which offer an appropriate level of supervision and support

8. Expand opportunities for activity groups – including linking in with external recreational, leisure services and social media 9. Develop a service user led befriending and support service to complement existing services. This would involve training a small group of the most confident service users to provide peer support in order to:

i. Assist in the use of computers and accessing information;

ii. When appropriate accompanying

young people to appointments and on necessary visits and trips;

iii. Providing information on access-

ing new opportunities (e.g. college courses, volunteering, community activities etc).

iv. Accompanying young people on social outings.

10. A further increase in service user involvement would provide more opportunities for development for young people as well as using this excellent knowledge base to improve services for all.

29


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Appendix Case study 1: Dawar Dawar is a 20 year old young man who currently lives in South Manchester. He has been partially disabled from birth and has mental health needs. Dawar was born in Pakistan and trafficked into the UK when he was just 15 years old. He travelled with a family contact who abandoned him in a car where he remained alone, tired, hungry and frightened for many hours, until he was spotted by someone, who took him home and took him to Social Services the following morning. His fear was intensified because he could not speak any English and so had no idea what was happening to him. Dawar was immediately placed in foster care in North Manchester. However, shortly after he arrived with the foster care family he reported starting to hear voices and was subsequently moved to another foster family. After a few months he became ill again and was admitted to hospital where he was diagnosed with schizophrenia and Post Traumatic Stress Disorder (PTSD), stabilised on medication and discharged to a children’s residential unit, as he had not been happy at the second foster home. When Dawar reached 18 years of age he was moved to the supported accommodation where he currently lives (and can remain for another 18 months). He was still hearing voices and having hallucinations and was on medication seeing the GP every 3 weeks. Dawar reports finding independent living very hard at first, in particular it was difficult to go out alone. (However, there are 24-hour staff at the supported accommodation and he reports feeling safe there.) He has a social worker who visits every six weeks. At about the same time as Dawar left school, he was placed under the care of the Early Intervention and Psychosis Team. He attended College for three years and having completed this course went onto another college to undertake a BTech course in Engineering, but became unwell again 6 weeks into the course and had to leave. Dawar has been in contact with YASP for about a year. He heard about the project from a Leaving Care Worker who took him to YASP for advice regarding claiming benefits. He started working with one of the Caseworkers and saw her on a regular basis for approximately two months. She helped him to sort out successful claims for Employment and Support Allowance and Disability Living Allowance. Dawar was also offered and accepted counselling at YASP, but found the experience too traumatic and concluded that it was too soon for him to begin reflecting on what had happened to him. Knowing his difficulties in travelling, his Advice and Support worker brought him to the cafe for appointments. Within a short time he started volunteering in the YASP cafe and now visits YASP at least 3 times a week working in the cafe for about 9 hours a week. Dawar still finds difficulty making friends. He says that he finds that people he meets don’t keep in contact with him. He sometimes joins the activity groups at YASP. He particularly enjoyed going to the cinema and a New Year lunch. However, he does not socialise with people from YASP outside the project, although he would like to be more included in friendship groups there. Dawar admits that he feels very lonely at times and is still homesick for Dawar has no contact with his parents and doesn’t know if they know where he is. Dawar admits that he feels very lonely at times and is still homesick for his mother and family (he is an only child). He has been to the Red Cross on two separate occasions trying to trace them, but so far has met with no success and doesn’t know what has happened to them. He says he will keep trying to make contact with them. Dawar now hopes to get a job so he can save up some money which would enable him to return to college to complete the course in engineering. He is confident that YASP will help him find some work. He says that YASP has been very important to him, giving him support, help and confidence. He told the interviewer that at first he was very withdrawn and couldn’t talk to people, but ‘now he can look people in the eye and talk to them.’ He feels that volunteering in the cafe has helped him to learn valuable life skills which have helped him to adjust to independent living. 34


Dawar also says that he thinks being at YASP has helped his mental health. In particular he says that he used to see his GP every three weeks but now only needs to see him every three months.

Case Study 2: Safa Safa is a 25 year old young woman of Pakistani heritage who was born in Manchester and lives in South Manchester with her mother and two sisters for 12 years. She still has some phone contact with her father. She has been in contact with YASP for 2-3 years. As a child, Safa went to a special needs school in Wythenshawe which she found difficult. She describes herself as being ‘slow’ and also as having ‘anger problems’. She found it hard to make friends, despite describing herself as ‘very chatty’. Following school, Safa went on to college which she found challenging but says she got a lot of support from her tutors. Safa undertook a GMVQ beauty therapy course, but when she finished, she says that she couldn’t afford the equipment necessary to practice, and so undertook an e2e scheme. She also undertook a City and Guilds Course in literacy and numeracy. Since finishing college, Safa has had a series of temporary and short lived jobs mostly as sales assistants in shops but none have lasted very long. She was originally referred to YASP by Connexions for help with her CV and claiming benefits. Two years ago Safa was raped when she was at a festival. She went to YASP for a pregnancy test and discovered it was positive. Safa described how worried she had been about her mother’s reaction and it was several months before she was able to tell her. Her YASP Advice and Support Worker supported her in this, and also helped her to decide upon whether she should have a termination or not, subsequently supporting her in her decision to do so. She received counselling at YASP which she says has helped her a lot. Safa has had a long history of friends exploiting and bullying her. In particular, she says that while she was working she had saved as much money as possible ‘for her future’ and that a number of friends, including a boyfriend, borrowed money from her but then refused to pay it back. On one occasion she says she was mugged by them and they stole money from her handbag. She now has another boyfriend but says she is still very wary and anxious about trusting people, and ‘prefers to keep herself to herself’. Safa comes into YASP two or three times a week spending time on the computer and talking to the staff and other young adults who help with the café. She says that apart from this she spends most of her time with her mother and sisters at home, especially at weekends when YASP is closed. A few months ago Safa was volunteering on a regular basis in the café but she says that she was not able to carry on with this, because now she ‘has too much else going on’, including helping with a bathroom renovation at home and applying for jobs at the job centre. Safa says she has got to know more people through attending YASP and has participated in various activities at YASP, including ten pin bowling, rock climbing, canoeing, horse-riding and ice- skating. She says that if she didn’t come into YASP at all, she would be bored at home and get depressed.

Case Study 3: Emma Emma is 20 years old. She first attended the YASP service when she was 16 years old. Her parents had suggested that she see her GP because she was experiencing deep depressions. The GP prescribed anti-depressants and referred her to YASPs partner agency, The Roby Counselling Service, which in turn referred her on to YASP. She received counselling for 6 months. Emma had not disclosed all of her problems to her GP, but did so during the counselling sessions. In particular, she was able to talk about her mother’s heavy drinking when she was growing up (her mother had eventually been admitted to hospital and when she was discharged she needed full time care which Emma provided, which meant that Emma did not have a normal social life or friends). Emma did not attend YASP again until she was 18 years old. This coincided with a further period in which she had been prescribed anti-depressants by her doctor and had also been diagnosed as having a bi-polar condition. By this stage Emma had moved out of her parents home into a flat with a boyfriend. She says that she started drinking heavily, threw wild parties and had serious problems with neighbours which culminated in her boyfriend being arrested for assault and her being evicted. Emma spent the next few years sofa surfing and drinking more and more heavily. Emma had no qualifications and had a series of jobs but could not sustain any of them. She was often in trouble because of losing her temper and becoming aggressive. At the time of the interview Emma was attending YASP for weekly counselling sessions. YASP has helped her 35


to get a flat. She is still with the same boyfriend and is waiting for him to be released from prison where he has been serving a sentence for a further assault. She says she wants them to ‘get straight now’, and is saving up so she can go to college. Emma would like to do a course in hairdressing. She has discussed these plans with her YASP worker who has given her advice on possible courses. Emma’s GP knows she is attending YASP. She sees him every 4-6 weeks for him to check her medication. Emma says that this demonstrates her progress as she used to see him every week.

Case Study 4: Tom Tom is 24 years old and has had health issues since he was 10 years old. He was diagnosed with Crohn’s disease and had an ileostomy at 16 years. His physical condition causes him ongoing pain and discomfort. Throughout his teen years Tom experienced feelings of despair and hopelessness. Tom describes his relationship with his parents as ‘very strained and difficult’. At 18 he left home and went to University in the South East of England to study media and film-making.. However he found living independently extremely difficult and accrued serious debt. Tom described how he also had a series of problematic friendships with people at University including a close relationship with a girlfriend. He describes the ending of this relationship as a ‘tipping point’ and he began self harming. Tom was not able to complete the course and returned to the North West where he went to live with his grandmother. Tom says he loves his grandmother but he is young and finds the age difference between them makes it difficult living with her. He would now prefer to live alone, but can’t afford to move out as he still on invalidity benefit. Tom eventually went to see his GP who diagnosed him with depression, prescribed anti-depressants and referred him to YASP. Tom says that he dislikes taking the anti-depressants and tries not to take them on a regular basis as he says they make everything ‘hazy’ and ‘neuter his mind’. He sees his GP every month but says he finds counselling more helpful than the medication. During the first few weeks of counselling, Tom says he disclosed all his problems to the counsellor. He says he felt really bad after each session but now realises that it was really helpful and says he is now ready to focus on the present and develop better coping strategies. At the time of the interview, Tom had been seeing the counsellor for approximately 3 months. During this time he has also received help with his financial problems and has been supported in trying to get a Debt Relief Order to find a way of repaying his debts from University. He says he has started to go out from time-to-time, but is still wary of making friends. With encouragement and support from YASP he has recently joined a Karate Club and entered two competitions in the last year. Tom is still interested in creative activities and is now making a short film with some new friends (he is writing the script.) He describes himself as still lacking motivation. Tom says he knows he is very stubborn and has never been able to tolerate being told what to do by anyone. However, he says that he finds the counsellor’s non-directive suggestions very helpful, although he doesn’t always follow them up. He says that he feels he now has confidence that he will be able to move on and live a more satisfactory life.

Case Study 5: Behnam Behnam is a young man of 21 years. He was born in Afghanistan, left home at 13 years old following disagreements with his parents, and travelled alone to Pakistan where he remained until he was 16 years when he came to England to learn English and look for work. Behnam said that he thoroughly enjoyed his first years in England and had been studying hard as well as making lots of new friends. However, eighteen months ago Behnam was attacked in the street by a gang of young men. He was stabbed in the head and neck and woke up in hospital where he remained for the next 9 months. The attack left Behnam paralysed for several months, but very gradually he has regained the use of his legs and body, although he has had to learn to write again with his left hand. Since the attack Behnam has also had a number of serious epileptic fits. Behnam was unable to finish his courses and was unfit for work which resulted in serious financial problems as he had some small debts before the attack. Behnam also says that after the attack he became very angry, aggressive and paranoid with everyone - on one occasion assaulting a friend. He says that this aggression led to him becoming very lonely and socially isolated. His allocated social worker referred him to YASP for help. 36


Behnam has been attending YASP for a year. He sees the counsellor once a week and is learning anger management techniques which are helpful. He has received help in claiming Invalidity Benefit and sorting out his financial problems. He has also received help in finding accommodation as he had lost his rented flat while he was in hospital. His YASP worker has encouraged him to carry on working on his English and helped him apply for a course – which he had just started at the time of the interview. Behnam has made a lot of friends at YASP and joins in various social activities, trips and outings. He has become a volunteer - working with young people in the cafe kitchen and on the gardening project and joins and helps out with various social activities, trips and outings. He would like to undertake more physical activity to try to build up his strength but it is proving difficult to enroll at the local gym or go swimming because of his epilepsy. Behnam eats at the project which is very helpful as the meals are subsidised. He says that he is feeling much better and does not feel isolated anymore. He watches football at the weekend with friends that he made at YASP. College is keeping him very busy and he says that ‘time is going fast’. Behnam was seeing his GP weekly, but since attending YASP this has become much less frequent.

Case Study 6: Kate Kate is 21 years old. She says she was seriously bullied as a child by her mother and subsequently by friends at school. She left school with few qualifications but managed to find work at Burger King, where she was happy for a while. At 17 Kate started a casual relationship with a young man from Pakistan. She did not expect it to last because he explained that his parents would be arranging a marriage for him with a girl from Pakistan. However, the young man’s visa was running out and he wanted to stay in England, so Kate offered to marry him. Within a short time of the marriage, Kate became pregnant. She says that she was surprised when her husband suggested a second Muslim marriage. He told her she could not tell anyone that they were already married and he took her to Pakistan to visit his family where she was presented as a ‘friend.’ When the baby was born Kate says she had to tell everyone that the baby was born prematurely as he did not want anyone to know that they had had sex before marriage. Kate originally visited her GP for help with depression. He initially arranged for her to see a health trainer who helped her with her diet and low self esteem. The health trainer then referred her to a mental health worker, who said that she didn’t have a diagnosable mental health problem and referred her onto YASP. Following the birth of the baby Kate says that her husband became very angry and abusive towards her. She says that she left him several times but always returned. Eventually the situation became intolerable and Kate asked her husband for a divorce. He agreed but insisted that her young son remain with his family. He stayed in the family home and Kate became homeless. She spent 10 days in a homeless unit before being moved on to a temporary accommodation placement. Looking for support and advice regarding how to arrange the divorce and find more permanent accommodation, Kate referred herself to YASP. Kate has been seeing the counsellor at YASP but she also has an allocated support worker at the project. YASP have helped her find a flat. She now sees her son once a week and sometimes attends a mother and baby group at the City Centre Project (a voluntary organisation in Manchester that works closely with YASP). Kate has once again tackled her issues regarding her low self esteem.

Case Study 7: Harry Harry is a 23 year old white young man who was born in the Midlands. Harry’s father had developed a successful business but drank heavily and was rarely around for the family. His mother had a history of mental health problems, although he says that the family (including his mother) never acknowledged this. Harry had a particularly difficult relationship with his mother who he says constantly demeaned him. As a child Harry displayed behaviour problems. Harry also has a sister who is an ex- drug user and a brother who is two years older and who he describes as ‘the normal one in the family.’ When Harry was 11 years old, his parents separated. He continued to live with his mother who was re- training as a health visitor, and he and his brother were pretty much left to their own devices. He attended a private school and for a while became very insular – just focusing on his school work. 37


Harry says he has suffered from depression since he was 12 years old. He says that his mother was deeply angry and resentful that he and his brother maintained contact with his father following their separation. Throughout Harry’s teen years his GP prescribed ant-depressants, although he recalls that these seemed to exacerbate his low mood. When Harry was 15 years old, his sister became pregnant and the two brothers moved into a house she shared with her boyfriend. Harry was still at school and experienced bullying from other children who found out that his parents had separated and his sister was a drug user. Subsequently, the brothers moved into a flat which was owned by his father and while his father helped financially (they were given Child Support Money), they were largely left to cope on their own. By the time he was 16, Harry was a regular cannabis user (he states that this helped him more than the prescribed medication). Despite a lack of support, Harry remained at school, leaving at 18 having achieved 5 high grade A-Levels. When he left school, Harry worked as a sales assistant. He says that a lot of his old friends from school had left to go to University and others were getting more involved in drug use. He says that he began to feel socially isolated and that his life became a cycle of ‘going to work; coming home smoking weed; sleeping and then back to work again’. He subsequently applied for a science course at the University in Manchester and moved to the North West. While Harry managed to get through his first year at University he says he gradually began to realize that his mental health problems were more serious than he had thought. He became increasingly depressed and began to experience a series of physical symptoms of stress. (He has subsequently developed carpeltunnel syndrome which affects his wrists creating a weakness in grasping things and causing him a great deal of pain.) Following two suicide attempts Harry saw a student counsellor at the University. It was clear that he needed to take a year or so out. Two years ago his GP referred him to a psychiatrist who diagnosed him as having bi-polar disorder and referred him onto statutory mental health services (The Crisis Resolution Team) in Manchester. Nine months ago the Team referred him to YASP for advice and support. He describes the help he received as ‘getting the ball rolling again.’ In particular he received help with benefits and started to claim Employment Support Allowance and Disability Living Allowance. He also discussed his return to University and with YASP’s help applied for a student loan for his third year. The service also helped him with accommodation and he is now living in a shared house with three students in Victoria Park. Harry was also offered counselling at YASP, but refused this as he is still receiving counselling at the University. As he gained in confidence he started eating, and then volunteering, in the YASP café. He says that he learnt a lot about cooking and has realised the importance of eating healthily. He has also joined in various activity groups and played football with the HARP / YASP Team until he sustained an ankle injury. Harry now has a girlfriend and despite early difficulties in the relationship (his YASP worker helped him talk through these problems) he says that it is now a very supportive relationship. Harry says that he wishes he had come to YASP earlier. Above all he says he doesn’t feel so socially isolated and emphasizes that it helps knowing that other people also have similar mental health problems but cope. When he has completed the course he is currently undertaking at University, he hopes to undertake a course in social work and says he eventually would like to run a project like YASP in another area of the country which doesn’t have such a service.

Case Study 8: Antar Antar is 17 years of age. He has lived in Manchester all of his life. He lives with his mother (who is Indian), his father (who is English) and his maternal grandfather. When he was growing up the family spoke Hindi at home as his mother knew very little English, and then suddenly when he was about twelve, it was decided to speak English at home. Antar has hearing loss and found that as he got older this was limiting his social life and the opportunities open to him. Antar did not do very well at school and gained very low grades. He has a difficult relationship with his mother who he describes as a perfectionist and says that he has constant arguments with her. His older sister, who he gets on well with, is now at University. Antar used to spend most of his time at home and had a limited network of friends. He went to the Temple with his grandfather on a regular basis and sometimes helped out there. How38


ever, he spent most of his time with older people and rarely met young people of his own age. He says he felt very low and isolated at times. While Antar has very good computer skills and recently completed the National First Diploma ICT, he has great difficulty with writing. When he was young he had been assessed for dyslexia, but no problem had been identified. While he was at college, he was assessed again for dyslexia and this time the tests proved positive and he was provided with extra support. Antar says he wanted to improve his communication and life skills and decided to find somewhere where he could volunteer to help other young people. He has a growing passion for cooking and having found out about YASP on the internet was attracted to the project because of the opportunities to volunteer in the café. Antar has been in contact with YASP for approximately 2 months. He was undertaking three volunteering sessions a week. He decided that he wanted to start a catering course, but his father was not in agreement. He asked his YASP support worker for help and she contacted his father and helped him to understand that this would be helpful to Antar as he obviously had a talent in cooking. His father agreed and Antar is now attending a Catering Course at a local college. When he has completed the course he will have a Vocational Recognised Qualification and hopes to get a job in catering and eventually aspires to running his own restaurant. He says that he thoroughly enjoys the course which has also enabled him to broaden his social circle, which has been really good. Since attending YASP Antar has made new friends and apart from volunteering in the café, has joined in some of the activities (he particularly enjoys football). He says that coming to YASP has given him the confidence to talk to people, pick up the telephone and ask for help. He can currently only volunteer at YASP once a week because of attendance requirements at college. Antar still spends most of his time at home when not at college and YASP is closed. He says he passes time on the computer and cooks for the family when he is allowed to. He sometimes works in the garden and now has an interest in growing things. Antar says that he still likes his own company but would still like to spend more time with friends at weekends.

Case Study 9: Axel Axel is a 20 year old white young man who is currently living in hostel accommodation in Manchester. Axel was born in Scandanavia. He says that his parents treated him very badly since he was a small child, bullying him and treating him like a slave in the home. (He had two sisters who his parents treated differently). Axel did not do well at school. He was bullied by other children because of his small size and high pitched ‘bright’ voice. Axel says that since growing up he has been a constant victim of physical and mental bullying emphasizing that the mental bullying is worse. ‘Physical bullying heals after a while, but mental bullying stays stuck in your head.’ Over time Axel developed a deep anxiety about being around other people, which gradually turned into agoraphobia. Whenever he got depressed he talked to people in chat lines online. Axel ran away from home when he was 18 years old, going to Holland to live with a man with whom he had developed an internet friendship. The man who he describes as ‘his friend’ took care of him and looked after him financially so Axel did not have to work. Axel decided to come to England after meeting another new friend on the internet. He had known him for approximately one month but started living with him immediately upon his arrival in the UK. Axel said that this worked well until the man had financial worries and told him he couldn’t afford to keep him any longer. He heard about YASP from an older friend on-line and contacted the service. YASP immediately helped him obtain a hostel place and offered advice and support on a range of things including helping him to address his social anxiety and agoraphobia. Axel has been coming to YASP for approximately a year. He has had regular sessions with his Caseworker in which they have explored his social anxiety problem, but he has refused counselling and says he still prefers talking to people on line. He says that when he arrived at YASP, people were very friendly but says that he still hasn’t made many friends that he sees outside the drop in. However, he says he has gained enormously in confidence and is now able to go to the shop on his own, which he couldn’t do a year ago. YASP have also helped him with a number of practicalities. In particular, they have helped him fill in forms for Job Seekers Allowance and have talked to him about trying to find work. He is not interested in going to college 39


and is looking for work, but so far has been unsuccessful. He would like to work in a store selling computer games. Axel’s experience of the hostel is not good. He is not sleeping well and is being bullied by some of the other young people who are resident there. He says he has not told anyone about this as he fears reprisals, but will think about asking for help from his Support Worker. At the time of the interview he had recently met a new friend on the internet who is at University in London and says he hopes to live with him before long. He says he will look for another project like YASP if he goes to London.

Case Study 10: Marcos Marcos is a 22 year old young man who was born in Angola in South West Africa. At the time of the interview he had just moved into accommodation near YASP. Marcos came to England with a friend. He was seeking asylum. He didn’t speak any English and admits he was very scared when he first arrived (he was subsequently diagnosed with Post Traumatic Stress Disorder). He was allocated a social worker and moved into a shared house with several other people. Shortly after he arrived, a friend told him about YASP and that they would help him try to sort out putting together his case for staying in the UK (he did not have any money and so was not able to afford a solicitor.) He says that his Caseworker was very helpful and has supported and guided him through the process. He was also given food vouchers which allowed him to eat at the café every day. When Marcos turned 18 he was offered National Asylum Support which covered the cost of somewhere to live and money for clothes and food while his asylum claim was being decided. He says that living independently was a big challenge. He was not allowed to seek work but wanted ‘to keep himself busy’ and so he started volunteering in the YASP café, where he quickly made friends. He continued working in the café for approximately 9 months. He also joined in various activities organized at YASP including rock climbing and a trip to lazer quest. He has also joined in the football sessions. Marcos has now been coming to YASP for nearly three years. He says that more than anything YASP has helped him with his case, but has also helped him to stay positive and enabled him to fill his time while he awaits a decision from the Home Office as to whether he can remain in England. His application has been a very long process full of uncertainty and he still does not know if he will ultimately be able to stay or be sent back to Angola, where he fears for his physical safety. He has just submitted a fresh claim and is hoping for an answer in about a month. He says he still worries a lot about his situation. Marcos has had no contact with his family in Angola and says that at first he was terribly homesick, and still thinks a lot about things that happened to him in the past, although , with support and friendships at YASP he is now learning to live with this. Marcos has now learnt English and says that his contact with people at YASP has helped enormously with this. He has already undertaken and completed a course in Business Management at a Science and Technology college and if he is able to stay in England he would like to go to University to study International Politics. He has already applied and gained a place on a course at University, but because of his asylum-seeking status he is not entitled to a student loan and has had to apply for a support grant from a charity who have told him that he is on a waiting list for next year.

Case Study 11: Stephan Stephan is a 23 year old young man who was born in the Midlands but now lives in South Manchester. He had an abusive early childhood and spent his childhood years with foster carers. Stephan did not have an easy time at school; was excluded on several occasions and left early without taking any GCSEs. He left his foster carers when he was 17, travelled around the country for several years and then signed up for the army. After completing his basic training, he realized that the army was not for him and turned his hand to hairdressing. He worked as an apprentice at a number of salons, but says that he did not like the 40


atmosphere and found his colleagues to be ‘unkind and gossipy’. The last of these jobs led him to Manchester and he moved into a shared house. His experience in the house was not good – it was dirty, infested and he quickly discovered that the other young people who lived there were heavily into drugs. On several occasions he was physically threatened by them. Stephan says that by this time he was also drinking heavily. Despite having a job he was getting into serious financial difficulties and he became involved in sex work – primarily to pay the bills. He says he hated himself at this stage and that in retrospect he can see that he didn’t care about his physical or emotional health; had no confidence and didn’t trust anyone. He felt completely alone and detached. Eventually, Stephan started what he describes as ‘an honest and intimate relationship’ with a young person his own age who helped him to realize that he needed to change his life. When the relationship finished, he decided that the time had come to seek help in addressing his long-term issues. In the Spring of 2010, he approached the Gay and Lesbian Foundation and asked to see a counsellor. He has continued to see the counsellor since then and feels that, with their help, he is ‘finally coming through it and finding himself again’. In particular, he says that as the counselling progresses he has begun to realize that he has been running away from key issues in his past which need to be resolved and that his drinking was an attempt to block out painful feelings. The Foundation suggested that Stephan contact YASP for advice and addressing the practical issues in his life. He says that when he arrived at YASP he didn’t realize the extent of the service offered. His first impression was that the café was really nice and the people were very friendly, and he quickly realized that the on-going advice offered to him would be an essential compliment to the counselling and ‘keep him going between sessions’. Stephan sees his Caseworker on a regular basis. He says that he realized that he needed to get out of the shared house and that YASP helped him apply for supported accommodation and found him a temporary place in a hostel, where he has been for approximately two months He has also had help sorting out his financial problems (he is now on Job Seekers Allowance and has come to arrangements with his bank about the repayment of his debt). He receives regular food vouchers so he can eat healthily in the café. Stephan says he feels motivated to look for work again and feels that he would like to do something which might help other people. At the time of the interview he had an impending interview for a job as a Support Worker for patients in hospital. * At the end of the interview Stephan asked if we would include the following direct quote as advice for other young people who might use YASP: ‘YASP is like a helping hand reaching out to you. You can hold onto it when ever you need extra support. It gives you the courage to keep going.’ *Stephan was successful in his application and has now started work again.

Case Study 12: Livvy Livvy is a 25 year old white young woman. She was born in Manchester and grew up with her mother, a younger brother and an older sister. She now lives in private rented accommodation in South Manchester with her two daughters who are aged 7 years and 18 months. She has known her partner (also the father of the baby) for over ten years, and explains that he was her best friend before they started living together. She has long-standing agrophobia. As a child Livvy had a serious bowel complaint which meant that she frequently had ‘accidents’ that were beyond her control. This inevitably impacted on her confidence and she stopped going out with friends, frightened that she would be embarrassed. Livvy says that she increasingly disliked school and hated the journey on the crowded bus taking a lot of days off school to avoid this. Livvy says her feelings of inadequacy were compounded by teasing, name calling and bullying arising from the fact that she had red hair. She described herself as being extremely anxious, distressed and isolated as a child. Although her physical condition was reported to the GP, and her mother constantly sought help, it was not until she was 17 that she received a diagnosis and appropriate treatment, having been rushed into hospital in severe pain. However the impact on Livvy’s mental health proved more long-lasting. She remained anxious and frightened of going out alone. She had her first panic attack in a high street store, blacking out completely. Once her physical problems had been sorted out, Livvy found a boyfriend who was much older than her and 41


became pregnant. Livvy says that she was still living at home with her mother and was still very immature: ‘I was certainly not ready to be a mum!’ She says that her mother was ‘very disappointed in her when she became pregnant ’ and she was admitted to a mother and baby home where she gave birth to her first daughter. Livvy was determined to keep the baby and eventually her mother and sister came to take them home again. She stayed with them until she eventually moved out to a flat of her own. Livvy’s mother now has serious mental health problems and needs to be cared for. Livvy says that her relationship with her mother has improved. Her brother, who trained as a doctor, also has mental health problems and he stayed with Livvy for a long period of time after a breakdown.Livvy says that she continues to have a difficult relationship with her sister who became a regular heavy drug user and introduced her mother to drugs. Livvy blames her for her mother’s ill health. When Livvy was 21, her sister became pregnant and had a daughter. She was still taking drugs and the child was placed on a Child Protection Order. When Social Services said that the little girl would need to be taken into care, Livvy offered to look after her and became the child’s foster carer. She continued to care for her for two years as ‘her own child’ until her sister requested supervised access and Livvy refused. Social services subsequently removed the child stating that as the child’s mother, Livvy’s sister still had the right to see her. The removal of her niece left Livvy severely depressed. She was finally diagnosed with agoraphobia and depression. By this stage Livvy had started a relationship with her present partner and had become pregnant again. Her boyfriend, brother and her niece were all living with her and she was finding it difficult to cope in the overcrowded conditions. She was still finding it difficult to go out alone and had few social supports. Following the birth of her second baby Livvy’s GP had referred her to a counsellor attached to the surgery. A key problem was being able to take her daughter to school as she was still phobic about buses and could not afford taxis. She was offered 6 sessions, but she says she did not find the counselling helpful : ‘How on earth could I be cured in 6 weeks?’ The counsellor referred her onto YASP. Livvy says that YASP has been a lifeline to her. Her Caseworker visited her at home at first and spent a great deal of time helping to devise strategies in which she could gradually deal with going out alone. This led to considerable improvements. However, when Livvy suspected that her daughter, who is of mixed heritage, was being bullied and receiving racist comments at school, she kept her away from school on and off for nearly two years, despite various threats from the authorities . Eventually she was taken to court on two occasions and fined. Her YASP worker supported her in finding an alternative school for her daughter. Livvy’s YASP worker also suggested that she might benefit from CBT rather than counselling (following her previous experience, she has little faith in this at the moment). Her worker arranged for her to have CBT at a partner organization and accompanied her to sessions. She says that this helped her to improve her self-image further and gave her more confidence. Livvy also received help from her YASP worker in filling in forms, obtaining the benefits to which she is entitled and responding to letters from external sources – which she also finds difficult. Livvy’s niece is now four years old and she is still trying to get her back. Livvy’s worker has accompanied her to the court and provided on-going support for her in coping with the situation. Livvy is now living alone with her two children. Livvy’s partner also has mental health needs, and he has moved back into his mother’s house nearby and is currently cared for by her. He sees Livvy and the children at least once a week. Livvy says that at first this arrangement was welcome as she needed more space for herself, but increasingly she feels frustrated and feels that he needs to ‘sort himself out’ as she is carrying all the responsibility. Again she suggests that her YASP Caseworker has been invaluable. Livvy says that she has had ‘an amazing amount of help from YASP.’ She particularly values the fact that the workers are able to both respond to crisis situations immediately, but also provide on-going support which is not time limited.

Case Study 13: Charise Charise is 24 years old. She is from mixed heritage and was born in Manchester. She has twins who were adopted when they were 2 years old and a 1 year old baby who lives with her. As a child Charise lived with her mother, father, brother and sister. Charise described herself as a very quiet child who didn’t talk to people. She says that her mother was very easy-going and she didn’t attend school regularly and was able to do ‘pretty much what she wanted.’ She says that as a young girl she started staying out late, drinking and smoking. On one occasion she stayed out for three days. 42


When Charise was 13 years old both her father and her grandfather died. Shortly after her father died, his family from Nigeria arrived and having taken back many of the family possessions, tried to kidnap the children from school. Charise says that by this stage her mother couldn’t cope and had started drinking heavily. She says: ‘I suppose everyone was just doing their own thing.’ Charise went to live with an aunt for a while, but as her mother did not get any better, she was taken into foster care. Her siblings remained with her mother and Charise says she felt she was the odd one out who was ‘more trouble than the others’. While she liked her first foster family she says she still felt unloved and when she moved to another foster home, (where the parents were much stricter), she found it very difficult. She says that following being bullied by another foster child in the home, she ran back home and her mother agreed to take her back. Charise became pregnant with twins at 14 when she was still at school. She went into a Mother and Baby home run by nuns, but they were also very strict and she rebelled against the rules. Following this Charise moved back to live with her mother, but when her mother moved she ended up ‘living here, there and everywhere, finally becoming homeless’. The twins were adopted and Charise went through a period of deep depression during which she attempted an overdose. She says she was also drinking heavily and smoking a lot of cannabis. Trying to overcome the depression, she tried to move on and lived for a while with a boyfriend in a new area. However she continued to claim child benefit and was eventually convicted of fraud and initially was ordered to pay back the money. Charise decided she had to change her life, but she had left school without any qualifications and had never worked, so this proved challenging. She managed to obtain agency work selling merchandise, drinks and food in arenas and concert halls. This did not provide her with much money but she says she got by. She also decided to cut off from her old friends who she thought had been a ‘bad influence’ in the past. She still had periods of depression and was feeling very isolated. Recognising that she needed help she made contact with 42nd Street: a young people’s mental health project in Manchester. She was offered counselling and says that she found this helpful. However, when her counsellor left, she was allocated another key worker with whom she struggled to make a relationship and so left the project. By this stage she was homeless again. Charise heard about YASP from her mother who had picked up a leaflet on the service at the GP surgery. She made an appointment to come down and YASP helped to get her into a hostel. She says that she didn’t like the place because there were lots of people taking drugs and getting drunk - but she kept her head down and within 3 months she was offered a flat in Ardwick. She moved in last year and says she is now much happier and having a settled home helped her to get her life back on track. Charise also accepted the offer of counselling and was seeing a worker on a regular basis. She volunteered in the café because ‘she needed something to occupy her and keep her mind going’. Charise says that since coming to YASP she has regained a lot of confidence ‘People are so nice and make you feel really comfortable. I have become bubbly again.’ Two years ago Charise became pregnant again. She still has some contact with the baby’s father and says: ‘he helps out when he can.’ She has also become closer to her mother who is now disabled and in constant pain. (She says she has never really talked to her about the past and just feels ‘guilty for having been so bad and causing so much trouble.’) Since having the baby she finds it more difficult to get down to YASP regularly, but still tries as she knows it is important for her to get out of the house more and still needs to make more friends. She told the interviewer: ‘YASP is a place you can trust if you are on your own. They are there to help you. I have so much more now: a home; more confidence and a beautiful baby. I really want her to have a better life.’

Case Study 14: Tony Tony is a 24 year old young man of African Caribbean heritage. He was born in Manchester and is currently living in supported accommodation in South Manchester. Tony, his brother and sister were mainly brought up by their mother. He says that there were a lot of tensions between his mother and the children as she was very strict. As a child Tony attended school regularly, but found academic work difficult. He was diagnosed with Aspergers Syndrome. At 16 Tony went to college where he undertook a GNVQ IT course and completed two years of a Business Studies course. However, he says that did not enjoy his studies and so decided to leave and look for work. He participated in a YMCA scheme which found him a series of work placements, one of which turned into a more permanent job as a storeman. He stayed in the job for eighteen months and says he enjoyed it at first, but after a 43


while became frustrated and left because the pay was not good. At this stage he was nearly 22 years old and still living at home with his family. He found another job and moved out of his family home to live independently in a flat of his own. However, the new job involved ‘flexible hours’ and gradually he had fewer and fewer hours and less and less money coming in to support himself. Tony described how he gradually accrued debt at this time and how anxiety about this contributed to the onset of a serious eczema condition which meant that he couldn’t work. His debts increased further during the period he was claiming sickness benefit and he fell behind with rent as bank charges soared. He says that this was really the start of what he describes as ‘a downward spiral’. He says that the eczema caused him a great deal of pain. He was referred to a dermatologist and eventually received treatment, but by this stage he says he was suffering from very high levels of depression, stress and anxiety. He says that the constant pressure of people trying to get money and the relentless pressure from the bank just became too much and that eventually he couldn’t cope anymore and took an overdose. He was admitted to A& E and the hospital subsequently referred him to the Mental Health Crisis Intervention Team in Manchester. The GP attached to the Team prescribed anti-depressants and he was allocated a key worker. He says that the medication helped and that the key worker helped him to claim certain benefits and make initial arrangements regarding the repayment of his debts. He was also referred to Turning Point’s Crisis Point which provided intensive support in a residential setting for 10 days. He says that during this time his eczema improved enormously and he went back to his flat with ‘more peace of mind than he had for a long time.’ The Crisis Team suggested that he make contact with YASP for ongoing support and help with his money problems, particularly his constantly accruing bank charges. At YASP he was allocated a Caseworker who provided on-going help in trying to sort out his debts. His worker attended several appointments at the Citizens Advice Bureau, during which ways were found for him to repay money owing to the bank in a manageable way, while still paying his rent on time. Once in contact with YASP, Tony says he discovered that the agency could also meet other needs. He started attending the project most days as it gave him a focus and provided opportunities to meet other people. He joined in some of the activity sessions. While at YASP Tony also found out about Creative Support, and managed to obtain a place in their supported accommodation in Whalley Range, where he now lives. Tony says that he would certainly recommend YASP to other young adults, but he makes the point that the project could meet more needs if they had larger premises. He thinks that it would be really helpful if the café could be expanded.

Case Study 15: Ceri Ceri is a 22 year old young white woman. She lives in North East Manchester with her partner and their three year old son. They are expecting another baby in January. Ceri was born in Manchester. She was one of 12 children and had 7 brothers and 4 sisters. The family lived in a 6 bedroomed house on a large South Manchester council estate. Ceri says it was tough growing up in such a large family and as the one ‘right in the middle’ she says she often felt overlooked. She was also bullied by an older brother. Ceri liked school but admits to ‘wagging it’ from time to time. She left school at 16 with some GCSEs but has never worked. As soon as she had left school Ceri wanted to leave home and one of her other brothers who had used YASP before, told her about the agency and that it would help her. Ceri met her current partner at YASP. She says that her mother did not like him because her older brother had told her that he was a drug dealer, which wasn’t true. Ceri was forbidden to see him and so she ran away from home so they could be together. However, the young couple did not have anywhere to live. YASP helped to find them hostel places. (Ceri was in a girl’s hostel; he was in a men’s hostel) The first hostel Ceri stayed in was small, but Ceri did not get on with the manager who was very strict. Ceri says she was rebellious at this point in that she ‘had already had a battle with her mother and wasn’t prepared to be told what to do by the manager!’ She says that she became depressed and started smoking cannabis. When she moved out she was transferred to another hostel which was much bigger and at first she thought it was OK. However, after a while she started to be bullied by some of the other girls. When the girls stole her phone she reported it, but although one of the girls was asked to leave the hostel, the others continued to bully her – on one 44


occasion throwing a bucket of urine over her. Ceri says that she became increasingly scared. During this time, she maintained her relationship with her boyfriend who was in a nearby hostel and on occasions she sneaked in to his hostel to be with him overnight. Ceri was still in contact with her mother and gradually she came to accept that Ceri was not going to give up her relationship with her boyfriend. When Ceri was 18, she moved from the hostel into the Women’s Direct Access hostel. She had her own flatlet there and says that she decided to just keep herself to herself. At first this was better, but after a while the bullying started again. Ceri was still deeply depressed and says that at times she felt suicidal. She was still in contact with YASP and they encouraged her to get medical help. When a GP diagnosed the depression and prescribed medication, YASP helped Ceri successfully apply for Disability Living Allowance. While Ceri was in the Direct Access hostel, she became pregnant and was initially moved into another flat in a hostel. By this stage Ceri and her boyfriend had given up hope of being allocated suitable accommodation where they could be together and made a decision to look for privately rented accommodation for them and the baby. They moved into a flat in East Manchester and from there finally found a privately rented house in the same area. At the time of the interview Ceri, her partner and their child had been living in this house for a year and she is now pregnant again. The family has Joint Income Support. Ceri says she still has periods of deep depression but says that she doesn’t regret being with her partner and is very happy with her two children. She also says that both she and her partner had still been smoking cannabis heavily and they have realized that this is costly and not good for them or the children. At the time of the interview they had just decided to stop smoking and had stopped using cannabis for 4 weeks. Ceri has been in regular contact with YASP for the 6 years since she left home. She and her partner have spent a lot of time at the agency over that time, at some points spending every day there. Ceri describes it as a refuge. They found the access to computers especially useful as these were not available in hostels. When the baby was born, they brought him into YASP and Ceri says it was very helpful to meet other young parents who were having difficulties. Ceri says that the other thing which was special for them was the Caseworker was always happy to see Ceri and her partner together.

Case Study 16: Dave Dave is a 23 year old white man. He lives with his partner, (see above) and their 3 year old son. The couple are expecting another baby in January. His family moved to Manchester when he was aged 5 years old and he has lived in the city since then. Dave’s mother and father separated when he was 6 years old and for a while he lived with his father, and his brother and sister lived with his mother. For the first few months Dave visited his mother occasionally and then for a short period he moved in with her and his siblings. However, following an incident when he stole a toy from a shop, she sent him back to live with his father. Dave recalls that at this time his father had started drinking very heavily and he found it extremely difficult. He remembers that after school he frequently had to wait for his father to come home from the pub. Occasionally Dave stayed overnight with his grandmother who lived in a bedsit in an older people’s home. The situation deteriorated further when his father started living with a girlfriend who also drank heavily. By this time Dave’s mother had placed his brother and sister in foster care and he had no contact with her. (Dave does not have any contact with his siblings now, although he says he would like to make contact again with them.) When Dave was 11 he was also taken into care and placed in a foster home in South Manchester. He didn’t like the first home and asked to be moved. He stayed with his next foster family until he was 18 years old. He says he got on very well with the other children in the family and felt he was a part of the family. Dave describes himself as a ‘difficult child’. He didn’t like school and truanted regularly. Eventually when he was 16 he was placed in a special inclusion class at school where he spent two days a week in school; a day in college and an activity day. He says that he responded well to this and learnt a lot more in his last year, leaving with 3 GCSEs. Between the ages of 16-18 he undertook e2e training and worked part time learning computer maintenance. However, when his foster parents took another foster child that he didn’t get on with, things started to be difficult and because he was 18 years old, social services asked him to leave. He stayed with another ex-foster child of the family until he was able to get a hostel place. Dave says that the first hostel he stayed in was definitely the best. He found out about YASP and was frequenting 45


it on a regular basis for help, support and advice. It was at this time that he met his partner, who had just started visiting YASP. By this time, he was working in a warehouse and then in a super store stacking shelves. He also contacted his father again, and after a short time he moved back in with him and his partner. The arrangement did not work out well as both were still drinking and after a while he was asked to leave. He was able to stay with his old foster carers for a short time, but then left and was allocated a place in the Men’s Direct Access hostel in Manchester. He says this was grim, but after a week he was moved to another smaller hostel, where he stayed for a year. He was smoking cannabis heavily by this time. At this stage all of his friends smoked and it just became a regular feature of his life. He describes himself as having been in ‘survival mode.’ However throughout this period he kept in regular contact with YASP. He and Ceri joined in activities and their Caseworker and he says that she helped them to sort out their lives. For example, the worker helped them to get a Community Care Grant to help them set up their first home together. Dave says that he is ‘rubbish’ filling in forms and that the Caseworker has helped him with these and now he feels more able to do it for himself. When his girlfriend became pregnant he says he was very pleased. He feels that they have a strong relationship which has survived both of them being separate and living for a number of years in hostels. He says that he already loves being a father: ‘Being a dad is better than being a nobody.’ They are currently investigating a nursery place for their three year old. He is also looking forward to the birth of the next baby. Dave says he does not get depressed and finds it difficult when his partner is depressed, but knows that her low moods have improved since they have been in more settled accommodation. Dave says that he and his partner have just decided to stop smoking cannabis. Since their last move, they have deliberately not kept contact with old friends or dealers that they knew and Dave says that this will make it easier. They have also accrued debts and he knows that it is important to sort these out before the next baby arrives. He says he is going to start looking for work again now he is more settled. He knows this won’t be easy as he hasn’t worked for a while. He says that he will also be asking for help from YASP again to help them sort out the existing debts as they are beginning to spiral with bank charges.

Case Study 17: Martin Martin is a 22 year old white young man. He was born in Scotland, but the family moved to Manchester when he was a baby and have been here ever since. He currently lives with his mother, his mother’s boyfriend, three sisters and a little brother aged just 4 years old. Martin describes himself as having been a ‘naughty child’. He hadn’t liked school and admits to truanting a lot. He was excluded 3 times. He was also in trouble with the police a few times, although he says that he was lucky and most of the time when he was ‘up to no good’ he didn’t get caught. He says he often became extremely angry and would then completely black out and be unaware of what he was doing. He saw a child psychologist for 2 or 3 years, but stopped going when he was about 11 years old. Martin’s father was in prison until he was 7 years old and died before his release. His mother met another partner who she lived with for ten years and Martin’s younger brother was born. He says that his mother was very strict with him and ‘tried to take him down the right path but he didn’t listen.’ Martin describes himself as being very close to his mother and sisters. Martin left school at 16 with no qualifications. He worked for a while with a friend’s grandfather but started worrying that he had serious mental health problems. At 19 he found himself in very serious trouble (he prefers not to say what this was). The court referred him for psychiatric tests and he was diagnosed as having schizophrenia and obsessive/ compulsive disorder. Two weeks later he was referred to the Early Intervention and Psychosis Team of which YASP is a part. Martin says it was relief to have a diagnosis and an explanation for some of the things that have happened to him and ‘the way he is with people’. Martin has a key worker in the Early Intervention Team who he sees weekly for counselling sessions and he sees a Caseworker at YASP on a regular basis. He also sees a psychiatrist every month. Martin is now on medication and his condition has stabilised. However, he says that he doesn’t like relying on his medication and admits that he does not take it as regularly as he should- ‘just enough to control it.’ Martin has found it difficult to manage financially as he is not well enough to work. His YASP worker has helped him claim the appropriate allowances and he now lives on Employment Support Allowance and Disability Living 46


Allowance. He says he wants to move out of his family home, live independently and see if he can manage on his own. His YASP worker is advising him how to complete a Housing Application Form. Martin still does not like going out very much and spends most of his time at home. He has a girlfriend now and sometimes gets a taxi to visit her. He also has a small, but close, circle of friends, who he has known for a long time. They generally visit him at home. He says that he only comes into YASP if he needs help with something specific or has an appointment with his worker. However he says that the worker phones him a lot which is brilliant. Martin says he is not a ‘group’ person and doesn’t like joining in group activities. However, he admits that he gets bored and needs to find things to occupy himself. He says that his YASP worker is helping him develop strategies to cope with and manage his illness, which he is finding very useful. At the time of the interview, Martin had been in contact with YASP for over two years. He thinks that all the workers he has contact with are helpful in their own ways. He really appreciates that the workers from YASP, the Early Intervention Team and the psychiatrist all talk to each other and get things done between them. Martin says he is a lot happier and calmer than he used to be. He is not scared to talk to people now and has more confidence. He says the best things about YASP are that everyone is friendly and non-judgemental and that the workers respect the young people who use the service.

Case Study 18: Kadia Kadia is a 24 year old young woman of Libyan parents. She lives with her mother, father and sister. An older brother and sister have left home and live independently in the UK. Kadia is the youngest in the family. Kadia was born in Tripoli but moved to England with her family when her father started an academic job at a University. All the family are fluent in English as well as Arabic. Kadia describes her early life as difficult and ‘not peaceful’ Her parents argued a lot and her father (who is much older than her mother) was extremely strict with the children. Her mother was violent towards Kadia and she described being frequently very frightened walking home from school. However, she says that she was ‘a smart child’ and learnt different ways of avoiding confrontation such as smiling a lot and trying to find ways of pleasing her mother. She says that her home life was a secret and she never mentioned it to any of her friends at school. Kadia says that she was also an intelligent child and did well at school. At 18 years she left home to go to University in London to study Law. She completed two years but in her second year she started to have mental health problems. She says that she recalled having a dream when she was a girl about someone who was telling her how to cope with what was happening in her life and these dreams started again. She was finally compulsorily admitted to hospital having had a series of full blown psychotic episodes. She remained in hospital for 6 months, returning to live with her parents when she was discharged. She was referred to the Early Intervention and Psychosis Team in Manchester and she still sees them every 2 or three weeks, visiting with a doctor who checks her medication. She continues to have hallucinations and hears voices that guide her. Kadia was introduced to a Caseworker at YASP, which is part of the Early Intervention and Psychosis Team. She would like to move out of the family home as soon as she is able. She has considered applying for a council flat, but has also the possibility of moving in with her sister. Her worker at YASP has advised her about how to claim Employment support Allowance and Disability Living Allowance. Kadia would like to work, but says that no-one will take her on until she is well again. She says she undertakes 3 sessions of voluntary work at a local hospital and has just enrolled in a series of non-vocational classes in French, Spanish and Pottery at a local adult education college. She says that she is enjoying this very much as it helps to pass the time. Kadia does not have many friends. She had few childhood friends and she says that she has not kept contact with her friends in London as she now realises they were all ‘fake’ and ‘employed by the devil.’ She says that she is not lonely and spends her time listening to music, and shopping for clothes and makeup with her sisters. She has just started going to the gym and likes to cook a little. She has also joined in some of the activities at YASP, and has used the computers at YASP a few times. Kadia has not been re-admitted to hospital again. She says she has been taking her medication, but she really doesn’t think she needs it and this is mainly to please other people. 47


Kadia thinks that her contact with YASP has been helpful. She says that she feels that she understands a bit more about ways to stay well and very much likes the informality of the place. Most importantly she says that she can trust people there.

Case Study 19: Marciac Marciac is a 24 year old African man. He was born in Angola and now has refugee status. Marciac left Angola when he was 17 years old. He came to the UK on his own as an asylum seeker having experienced several horrific violent incidents, including a machete attack which left him badly injured and traumatized. He has been diagnosed as having Post Traumatic Stress Disorder. Marciac’s first language is Portuguese and when he first arrived he found it very difficult to communicate with people, which enhanced his sense of isolation. When he first arrived in the UK Marciac was housed in a flat in North Manchester where he experienced a great deal of harassment from local residents, some of whom he says threw stones and eggs at him and finally set fire to his flat. Mariac stayed for four years in this flat and this period spent there represented another very fearful and traumatic period in his life. He describes feeling ‘less than a human being.’ Eventually after the fire attack, the council re-housed Marciac in a homeless unit near the city centre. While Marciac was living in the homeless unit, he found out about YASP and started attending on a regular basis. He received help with claiming benefits and was helped by his Caseworker in relation to re-housing. He also started English classes at a College in North Manchester and after a while moved back to another part of the area, where he lives in another flat on his own. While he was at college he met an Afro-Caribbean woman who he says was his first ‘real friend’. She introduced him to her family and he spent a great deal of time at her house getting to know her, her husband and her children. He says that she encouraged him at college and helped him re-gain some confidence. Gradually he made contact with other people from Angola and said that he felt he had a lot more support and did not feel so isolated. However, last year Marciac had a serious accident in which he sustained serious facial injuries and needed to spend some time in hospital. Again this knocked his confidence and he says that he spent a great deal of time alone at home following this incident. However, he says that his new neighbours are Ok and he says he feels he can trust his new friends. He continues to visit YASP and feels that the people there are also people he can trust, although he is still reluctant to join in any group activities

Case Study 20: Sameera Sameera is a 23 year old young woman of mixed heritage. She was born in Manchester and was brought up by her mother who is disabled. Sameera says that she was a quiet child and lacked confidence. Her parents separated when she was a child and she says that her mother’s second husband was a violent man and home life was often very difficult. Sameera says that since then her mother has had several relationships. Sameera has always taken on a caring role. She says that she coped by focusing on her school work and she succeeded in obtaining A-Levels before she left. While Sameera was at school she took up an opportunity to undertake volunteering work on one afternoon a week and started looking for a placement. She found out about YASP through Connexions. At first she volunteered one day a week and also during the school holidays. When she left school she increased her time as a volunteer and joined in the activities on Thursday afternoon. She says that it became an important refuge. Sameera says that she thoroughly enjoyed the work and notes that on a personal level the staff tried to help her explore the possibilities of moving away from home – although she decided against this in the end. Sameera explained that she has a really close relationship with her mother and that she needs to support her. (Her mother’s latest husband doesn’t drive and taking her mother to appointments; to get shopping and undertake other tasks now often falls to her). Sameera also has a close relationship with her sister who has a small baby and is currently living on her own, and she helps out a lot with babysitting. Two years ago Sameera successfully completed a degree course in Law at the University. After she finished she 48


took a gap year and started looking for a temporary job with a view to saving to undertake further part time training as a barrister. However, she found out about the Vodaphone World of Difference competition at the local job centre. The prize was to work for a charity of the person’s choice for two months. Sameera entered and won the competition. She chose YASP as the place she wanted to work and returned to the agency as a full time paid worker. After this period finished, YASP was unable to keep her on due to lack of funding, so Sameera took on other paid work elsewhere, but carried on volunteering one day a week. A further opportunity to gain further experience at YASP presented itself when Sameera was asked to cover a member of staff’s paternity leave on a 3 day flexible basis. She is still undertaking this work and has just started her part time course. In the future she wants to use her legal training and specialize in the advocacy and advice work field. Sameera describes having found ‘a real support network for herself’ at YASP and says that working in the café really boosted her communication skills and confidence, and has helped to develop her character. ‘YASP helps to turn people’s lives around. People who come in for help often end up becoming volunteers. It’s brilliant –seeing people flourish. It makes you feel less sorry for yourself when you realize what hard lives other people have. Lots of the young people tend to come back. When they are on track it’s to say ‘thank you’ and if things don’t go so well, they come back because they know the door will always be open to them.’

49


Service address YASP, 832 Stockport Road Levenshulme, Manchester M19 3AW

Charity address HARP, Zion CHRC, 339 Stredford Road Hulme, Manchester M15 4ZY

Registered charity number 1102058

Registered company number 4738057

Report copyright HARP, Jan 2011

No Job, No Home, No Money, No Friends, No Hope. You'd be Mad Too  

Evaluation of YASP, a young peoplesmental health project and part of Manchester Mind.

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