Opportunity and expression

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“The best services are ones that place children, young people and their families at the centre of their care, offering a choice of evidence based treatments to help children and young people achieve their goals… By sharing best practice and improving systems we help to change our patients’ experience. The earlier we can intervene and treat young people the better.”

Dr Martin McShane, NHS England’s Director for Long Term Conditions

From here

Having a Say, Doing Things Their Way

Mentally, young people are at a sensitive stage where they are developing the capacity to reflect introspectively, and are starting to be able to consider their own way of thinking. 15 and 16 year olds especially, are often feeling the relief of less self-consciousness and shyness, and instead are becoming more sociable, helping to reinforce their unique expression. What is most important here is that they’ll be able to craft their own voices and their own discernment and resiliency, at a pace that’s right for them.

For this reason, it’s a time when opportunity and expression have particular importance, and wards can offer an excellent chance for young people to benefit from them. Young people usually have different views from adults about what matters in their care; so it’s important they’re able to speak freely and openly in a safe and nurturing environment.
Everyone can benefit from tapping into a creative outlet (creative in the widest sense of the word, that doesn’t have to mean artistic). Young people tend to be naturally imaginative and can reap wonderful rewards when they have the space and encouragement to express themselves through creative means.
So this theme is about involvement, influence and promoting self-expression: the creative communication of one’s personality, feelings, thoughts and ideas. It’s about treating young people as competent individuals who deserve attention and understanding, and who should be continually encouraged to make choices. Encouraging young people to make decisions about what’s important to them and supporting them to get a fuller sense of self are crucial. Ultimately, any therapeutic work is restricted unless the young person is engaged in it. Likewise, options shouldn’t represent (subtly or overtly) one choice as a punishment.
“When we try to see life from our teenagers' viewpoint, negotiate the boundaries with them, appear reasonable, remain flexible, have conversations rather than give lectures and keep a sense of humour, they will increasingly see us as advisers who are on their side. And, when they feel listened to rather than criticised and disapproved of, they may even begin to ask our advice.”

Lee N and Lee S. 2009

The Parenting Book


It’s about treating young people as competent individuals who deserve attention and understanding, and who should be continually encouraged to make choices.

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"Participation and involvement must take place on two levels: individual involvement, with people making their own healthcare choices and being confident in their interaction with health professionals; and group involvement, either as a service user or member of the public."

Source: rcpch.ac.uk

Decisions, decisions, decisions

CAMHS staff are highly skilled at promoting emotional and behavioural development, through encouraging the young people on the ward to take the lead as far as possible. As mentioned in the Understanding theme, ‘shared decision making’ is the exchange that takes place between young people and ward staff, which aims to reach a collaborative decision. It’s about having a constant focus on boosting the development of personal responsibility and self-direction.

Some young people might be used to making choices that they think others (especially parents) will approve of, rather than those that feel most congruent for them. This can feel really disorienting and can create varying degrees of identity crises and low self-esteem. Parents want to protect their children from making a ‘wrong choice’ and to safeguard them against painful outcomes. While this is perfectly natural, it denies their child opportunities to learn. Making choices for young people may give them the message they’re incapable of making their own decisions (Dr Sal Severe, 2004)

“Children learn to make decisions by predicting the consequences of their actions. Children learn self-discipline by predicting the outcome of their behaviour. They must be able to see the cause-and-effect relationship between how they behave and what happens to them: ‘If I choose this behaviour, then this consequence will happen.’”

Severe, 2004
Part of growing up includes learning how to make decisions, how to compromise, how to negotiate and how to work as part of a team. They need others (especially parents and staff) to listen to their point of view, and they need to know that their opinions area valued. These and other essential life skills are learned when young people sense that their feelings are taken seriously, that there is an effort made to understand their opinions, that adults around them are genuinely compassionate, open-minded, and curious about them.

A great way to help teach young people these life skills is by getting them involved in ward decisions. They’re much more likely to cooperate with decisions if they've had a hand in making them, especially if they can understand why they’ve been made. Asking a young person what they think your intentions are is very different from questioning their intentions! Also, when adults talk over and under and around a young person - when they talk too much - there’s less space for their thoughts, for what they have to say (Payne & Ross 2009).
Young people like to chat about things that might affect them or their friends. “They need to be consulted on decisions that affect them, just as you’d expect to be…” says bestselling author Richard Templar. “As kids get older they need to practise making decisions, to be consulted, and to be treated more like adults.” Likewise, there are also times when they definitely need to be related to as young people. A ward stay can support young people in beginning to think independently (and interdependently) and make their own decisions.

Although we sometimes wish we could, it’s not merely about fixing all young people’s problems for them, as that might constrain their ability to develop true resilience. Sometimes it’s about planting in them the notion ‘The quality of my life depends on the decisions I make.’ When a young person is encouraged, through exploring likely consequences, to make considered choices and constructive decisions, a positive self-image can flower. So they need opportunities to make choices where, if things end up going crappy (in the young person’s eyes), it’s still okay, it’s safe. Living with the impact of their own decisions can inspire them to be responsible for the choices they make. Shared decision-making encourages young people to continue to behave responsibly and make healthy choices, while boosting their confidence and building their confidence in others.
Some examples of how staff successfully achieve this include giving young people a choice of treatment, a say in their care plan or the opportunity to help shape a service with new, innovative ideas. For young people to become mindful, confident, caring adults, they need to know they can effect change, and that they can have a positive influence on other people’s lives, as well as their own (Susan Stiffelman 2015 - see Parenting with Presence: Practices for Raising Conscious, Confident, Caring Kids).

It can be difficult to engage with young people to begin with, but presenting them with a selection of choices encourages them to take responsibility and influence their care. Young people who grow in responsibility also grow in self-worth. Each young person’s recovery journey is unique and deeply personal, and freedom is very, very important to young people. “Choice means doing something in accordance with one’s personal volition (rather than external control),” says Dr Ilona Boniwell, “aligning our actions with something we value... Once they feel that the responsibility is real... they are very likely to rise to the occasion.”
“One of the most important skills we can teach our kids is to make good decisions in high-emotion situations.”

Siegal & Bryson, 2012 (From The Whole-Brain Child: 12 Proven Strategies to Nurture Your Child’s Developing Mind)
​Enabling greater participation of children and young people in the design of services requires careful planning. The Royal College of Paediatrics and Child Health and the NHS Confederation, in association with the Office for Public Management, have produced a helpful publication to assist: Involving Children and Young People in Health Services.

Source: hqip.org.uk
"...all meaningful change occurs when individuals buy into the benefits of the change - and this can take some time. The more investment they have, the smoother and more effective the change is."

Best & Thomas, 2007 - read more here


Shared decision making focuses on the detail of interactions between individual staff members and the young people they work with. These interactions underpin young people’s capacity to take control and include five key stages:

  1. Young people and those working with them agree key problems and goals
  2. Those working with young people support them to understand the options available to them.
  3. Young people and those working with them agree which options for help they will try.
  4. Young people and those working with them review progress.
  5. Young people and those working with them discuss options and make any changes as necessary.

Source: 'Closing the Gap through Changing Relationships' from The Health Foundation. Read more here

Young people who grow in responsibility also grow in self-worth. Each young person’s recovery journey is unique and deeply personal, and freedom is very, very important to young people.

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Young People Friendly Services

There needs to be sufficient provision to help young people in dire circumstances. Children, young people and families frequently say that well-timed, accessible and non-stigmatising support is one of the fundamental features of an effective CAMHS service.

YoungMinds have compiled the following list of the characteristics of an ideal service based on young people’s views:

  • Being accessible and available.

  • Providing support in a timely fashion.

  • Privacy and confidentiality - but with the option to have someone accompany you

  • Clear communications.

  • Working with the same professional each time.

  • Being listened to and believed, having key information available.

  • The opportunity for an informal first meeting with professionals to get to know people.

Source: YoungMinds, 2015. Read more here


Well-timed, accessible and non-stigmatising support is one of the fundamental features of an effective CAMHS service.

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“When I was 15 I went into hospital. On my CAMHS ward there was a lovely art psychotherapist who ran an art therapy group every Thursday with the help of the consultant... [Over time] it was a highlight of my week - I’d purposely rearrange any other appointments/commitments in order to attend! Around the same time I disclosed some things that I had never previously spoken about, and art gave me a chance to process it almost. It became the tool I turned to the most in order to communicate with staff, both about how I was feeling and about things that had happened. It also gave me the ability to say things without really saying anything. I could put things down on paper that to me were monumental, but would not have meant anything to others from glancing at it. It served in giving me some control….”

@corstejo corstejo's blog

Express It

Preliminary research in Canada reveals how parenting interventions strengthen their value by paying more attention to children’s choices, initiative taking and sense of autonomy. A team of Montreal-based psychologists note how ‘autonomy support’ is a crucial dimension which is often overlooked (Read more).

An autonomy-supportive, motivating style involves staff being willing to embrace the young person’s perspective during interventions, including their needs, interests and preferences, and to deeply value, understand and appreciate that perspective. When doing so, staff focus on identifying, nurturing and building young people’s inner motivational resources.

We have loads of admiration for those who are committed to empowering young people to speak their minds and hearts and to trust their feelings and instincts. Of course, structure and boundaries must first be made cystal clear. Young people should be encouraged (but not forced!) to express themselves through creativity - for example, through art, dance, music, drama, gardening etc. Wards can help young people to express themselves, verbally, non-verbally or symbolically, through games and creativity, as well as through advocacy, and offer emotional security so young people can progress emotionally, socially and educationally. Your perceived availability is a major factor that predicts how likely young people are to express what’s going on for them. If they think you’re too busy to spend time with them or just unavailable in some way, it’ll probably feel hard for them to reach out to you (Greenberg & Powell-Lunder, 2010).


Acknowledgement isn’t necessarily about agreeing with or condoning young people’s behaviours; it’s about validating the feelings behind them. It’s a straightforward, yet effective way to reflect a young person’s experience and inner world, including their thoughts, feelings, desires and motivations, and show them that they’re acceptable. Acknowledgement is about giving the young person the space and time to express painful feelings, without trying to censor or even make them feel better with a solution. Acknowledging, instead of judging or ‘fixing’, nurtures trust and encourages young people to keep sharing their feelings and to gain clarity (Lansbury, 2014 - see Elevating Child Care: A Guide to Respectful Parenting). For example, acknowledging what you’re picking up from them by saying something like: “You’re feeling overwhelmed right now” or “I recognise that your relationship with your mum is difficult”. Acknowledging their difficulty might be all the encouragement a young person needs to move forward a few more steps.
In 2007, a University of California, Los Angeles (UCLA) brain-imaging study revealed that verbalising feelings makes sadness, anger and pain less intense and has a therapeutic effect. Naming it to tame it, if you like. When staff acknowledge a young person’s feelings with words, not only does it help alleviate distress, it also helps the young person to build their confidence and a language with which to describe and think about how they feel. Fostering empowerment instead of powerlessness. One example is displaying emotional vocabulary posters on the ward, which everyone can refer to, and using this language in groups and individual sessions. A shared vocabulary is one facet of fruitful communication.

It’s also useful for staff to have an understanding of what kinds of feelings and emotions young people are able to express at different developmental stages, and of how boys and girls differ in how they experience and express their internal worlds (Weissbourd, 2010 - see The Parents We Mean to Be: How Well-Intentioned Adults Undermine Children's Moral and Emotional Development).


Young people between the ages of 11 and 14 often have a strong sense of justice, but tend to see issues in black and white and from their own point of view. 15 and 16 year olds are less suggestible and less eager to conform compared to younger children, which can be tricky for staff and parents but highly liberating for young people! However, they are,more able to tell good choices apart from not so good choices. But, they may still find it hard to describe their worries about their symptoms, past traumas, school and relationships. By giving them a new language, they’re more able to express their concerns and views, perhaps for the first time, and also to see things from different perspectives.


Using or finding words isn’t always easy. Many young people have difficulty using words to describe how they feel. So they might want to try expressing themselves with drawings or pointing to images. This helps young people get started. Once they have a picture, you can ask about events, thoughts and feelings. Some may benefit from using a diary to help reflect on emotions such as anger. You can teach them to write down what happened, how they got angry (or whatever feeling they’re experiencing) and what they did after they got angry. This helps young people see patterns to triggers and reactions (Severe 2004).


Feelings pre-teens and teenagers typically experience (and sometimes express)

  • 'Nobody likes me.'

  • ‘I feel ugly.’

  • 'Nobody understands me or cares about me.'

  • 'Any place would be better than here.’

  • 'I feel like running away from home.’

  • 'I just wish everyone would leave me alone.'

  • `My parents treat me like such a baby.'

  • 'I feel like crying all the time.'

  • 'Sometimes I feel like I’m going crazy.'

  • 'Everyone is looking at me.'

(Lee N and Lee S. 2009)
To be taken seriously is very satisfying to a young person. Advocacy helps, and it plays an important role in making services accessible and meaningful. Advocates help young people to navigate what’s on offer. They do this by speaking up for them, and empowering them to make sure that their rights are respected and their views and wishes heard at all times. Young people need to feel that their take on things has been given full consideration, before they feel willing and able to consider alternative suggestions presented to them.

An autonomy-supportive, motivating style involves embracing the young person’s perspective during interventions, including their needs, interests and preferences, and to deeply value, understand and appreciate that perspective.

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“Find some common ground - it’s no good approaching this child from your own point of view, you need to approach them from a place that they can communicate from, something that they understand, be it music, popular culture, TV, whatever it is, find some common ground.”

Newton, 2012 - see The Teen Years - Don't Get Mad - Get Through It

Creative Common ground

Here’s what bestselling author Richard Templar says: “…take an interest in the things that they enjoy. They may not show it, but actually they’ll think that’s pretty cool… You don’t have to pretend to be a huge fan of their music or clothes style, but you don’t have to put it down either. And actually, you might even discover all sorts of new things to enjoy. [They’re] close enough to adulthood to have some pretty sophisticated interests, and you can learn a lot from them if you’re broad-minded enough.”
Psychotherapist Susan Stiffelman (2012) suggests another way of creating an unshakeable connection with young people is to ask them their view on something (for example, a celebrity story or news headline), and then invite them to elaborate. “Stop and reflect on what they’ve said, demonstrating your sincere desire to understand life from their vantage point. Show them you really want to know what they think about a piece of music or an issue in the news, or why they think chocolate ice cream is better than vanilla. Be hungry to discover more of who they are, and let them know what a delight it is to get to know them as they blossom into their true selves.” - see Parenting Without Power Struggles: Raising Joyful, Resilient Kids While Staying Cool, Calm and Collected

Young people need to be helped to pursue whatever they love, whatever makes them feel good. They must learn through their own exploration where their passions will take them. By supporting this dynamic exploration staff can help them uncover the value of their uniqueness. Mindfulness is the key (as with all the COLOURFUL themes). Mindful therapeutic relationships help foster a deeper openness and awareness, allowing communication to flow successfully.
Here’s a creative, mindful approach to encouraging the expression of a young person’s unique view of their inner life, again from the fabulous Susan Stiffelman:
“One of the ways I help children connect to their emotions is to ask them to imagine feelings as having colours. I might suggest we use red for anger, blue for calm, yellow for worried, black for sad, orange for excited, green for happy, and purple for ‘perfect!’ If a child is telling me something upsetting, I’ll say, “What colours are swirling around in you now?” If they say there are a lot of red (anger) and black (sad) feelings, I encourage them to point to the part of the body where those feelings are happening. “Is it mostly black, or mostly red? Is there any green in there?” This is an excellent way to help some children stay in their bodies and move through their emotions, rather than disconnect and intellectualise when they’re distressed."


"I’ve created a visualisation for this, asking an angry (red) child to imagine pouring a bucket of blue (calm) into the angry feelings (red) to create purple (perfect). Some children love this approach to proactively creating emotional shifts toward greater wellbeing.”
‘Creative Teaching and Learning Toolkit’ by Brin Best and Will Thomas (2007) is an awesome spiral-bound gift. The book aims to help teachers become more effective through a new teaching and learning framework which centres on the key role of creativity. What follows is a list of key principles of this framework. Whether you’re a teacher, Occupational Therapist or part of the nursing team, we’re sure these principles will inspire and challenge you:

  • Change is essential for us to grow, but that change needs to come from within by making appropriate choices.

  • Positive changes can be challenging and will require high levels of commitment and much determination.

  • Values and vision underpin everything we do, but they're frequently not articulated.

  • We possess within us the resources to find solutions to many of the questions or problems that we set ourselves — but we sometimes need an external influence to help us to see a situation differently and to find an alternative preferred future.

  • One of the keys to making positive change is the ability and willingness to pose yourself challenging and thought-provoking questions.

  • Effective learning is fun — for both teachers and students. Effective learning happens when teachers and learners work together in partnership (not when teachers ’deliver’ a curriculum to learners).

  • Be the change you want to see in your classroom — when we model the behaviours we want in our students we get them more of the time.

  • Taking calculated risks leads to invention and growth — encourage this whenever you can.


Read more here

Young people need to be helped to pursue whatever they love, whatever makes them feel good. Mindful therapeutic relationships help foster a deeper openness and awareness, allowing communication to flow successfully.

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Two Ears One Mouth and Loads of Mindfulness

As you’ll know, the crucial ingredient when spending time with young people is listening; not only hearing what they say but also how they say it, how they express themselves. Listening to young people makes them feel that what they have to say counts, and that you're doing your best to see things from their viewpoint and appreciate whatever they’re going through.
“The brain works four times faster than the mouth, so the good listener will use this time delay to ask questions of themselves about what is being presented.”

Phil Beadle, Secondary Teacher of the Year 2004

Could Do Better!: Help Your Kid Shine At School
“The best time to… gather information… is when they offer direct self-disclosure; when they feel free to open up to you on their own you’ll have an effective way of learning just who they are and how they spend their time.”

Greenberg & Powell-Lunder, 2010
No one wants to see a young person feel bad. But when painful experiences are unavoidable, the next best thing is to be fully there with them, helping them through the process by letting them feel their unhappiness and distress, or whatever difficulty they’re facing. Showing real appreciation for their world is huge. Sometimes the best help we can give is our clarity and accepting presence, our inherent empathy. For so many young people, being sincerely listened to is such an unusual thing. As we said in the Caring Relationships theme, to be heard by a tuned-in and committed person is in itself a therapeutic experience.
Provide stability amidst a young person’s chaos by being fully present throughout their crisis, to help them be fully present too. Your immediacy and patience say more than words ever could. A mindful ward staff member has the capacity to be fully focused on what’s being experienced in the moment. This allows you to listen, comprehend, accept and creatively interact with the young person while appreciating their unique character. Be as ‘awake’ as you can with them and give them your profound listening; listen with all your senses, your whole being. Their despair most likely needs no lectures or wise words; only a compassionate presence in which it can gradually unravel and dissolve.
“You may be familiar with the frustration of a one-word response to a seemingly harmless question. It is ironic that at a time when you want nothing more than for your teenagers to feel comfortable talking to you, they are most likely to shut down. Teenagers withdraw because they are attempting to develop their personal identities and separate from their parents. They fear that if they open up to you they will be criticised, judged, or possibly embarrassed.”

Greenberg & Powell-Lunder, 2010
“Everyone has heard a teenager complain sulkily "no one listens to me!" But it’s because they sometimes feel helpless and pissed off, and are likely to find far less tolerable ways of making their feelings known than easily approach you about them. So I always make time to sit down and listen to what’s bothering them.”

Healthcare Assistant
Lots of one-to-one time helps young people manage their very intense feelings. It helps them to ‘sublimate’ - to direct and express their rage, and other primitive impulses, into activities that are healthier, more constructive and socially acceptable. As young people struggle to work out who they are, staff can provide a supportive framework that they can bounce off. Finding a good balance requires staff to provide appropriate limits while not being too rigid and restrictive. Choices and consequences activate young people’s thinking brain and provide opportunities to form their identity, instead of triggering fear and rage in their lower brain, which can be destructive. Young people can also learn to extend the gap between having an impulse to say or do something and acting on that impulse. From coping with impulsivity to taming emotional regulation, modelling how to slow down and reconnect to the here-and-now (through mindfulness practice, for example) gives them a massive boost in terms of leading a happier life as they develop.

How to teach young people to talk it over:

  • Acknowledge the young person’s feelings, and give them time to talk through what worries them, rather than immediately offering solutions or opinions.

  • Be a good role model: always try to talk through issues to be sure you understand their point of view. This does not mean allowing yourself to be drawn into an argument.

  • Model how to listen, and to repeat back what someone else has said to be sure you've understood.

(Adapted from Palmer, S 2006)

Toxic Childhood: How The Modern World Is Damaging Our Children And What We Can Do About It
'"Just listening" is powerful medicine. If we can hold back from putting instant Band-Aids on every hurt, we can enter the deeper world of our children.'

Steve Biddulph, 1999 - read more here

When to put off or discontinue conversations with young people

This involves reading the young person accurately, so you know when they clearly do not want to talk. Cues might include:

  • Irritability

  • Sarcasm

  • Yelling

  • Lack of eye contact

  • Changing the subject

  • Leaving the room

  • Hanging up the phone

  • One-word answers

  • Requests to delay the conversation

  • Listening but saying nothing

  • Crying

  • Slamming doors

(Adapted from Greenberg  & Powell-Lunder, 2010)

Provide stability amidst a young person’s chaos by being fully present throughout their crisis, to help them be fully present too. Your immediacy and patience say more than words ever could.

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Fluid, Tricky, Sticky Labels

Identity formation is believed to be the most important developmental task of adolescence. It involves young people working out what chimes with their emerging sense of self, including their self-perception, abilities, self-image, values, religion and spirituality, gender, sense of belonging, interests, friendships, aspirations and sexuality.
“Achieving one’s own identity often involves serious pitfalls and may lead one to make false starts and turns. It is a process that requires one to retrace one’s steps, and it is also a path strewn with uncertainties as to which direction to follow.”

Bruno Bettelheim, 1988

A Good Enough Parent: A Book on Child-rearing
Younger adolescents start to experiment with things like dress, speech and manners in an attempt to find a separate identity of their own. 15 and 16 year olds invariably change these things frequently, as you’ll know if you have teenagers of your own! Parents may take alternating and often bizarre changes of image too seriously, and worry they may be permanent or a sign of something emerging that they should be concerned about. This age group typically wants to fit in as much as possible with their mates, by having the ‘right’ clothes, hairstyle or listening to the same music. Parents may be irritated by what they see as conformity and its associated financial demands on them. 17 to 18 year olds, on the other hand, usually try to find a social or political cause, and might explore religious or spiritual ideas and movements which light them up. This can also be terrifying (or even dangerous) for parents whose kids end up rejecting their own religion or beliefs.

Yep, opportunity and expression are massive for young people and wards can play a part in helping them safely explore themselves and the world around them.
In the following snippet, clinical psychologist Becky Albertallis discusses how labels can be both helpful and hindering, and the possibility of young people being OK with fluidity.

“There's something tricky about labels. They're simultaneously useful and inadequate, necessary and problematic. As a clinical psychologist with a special interest in working with lesbian, gay, bisexual, transgender, questioning, intersex and asexual teens [LGBTQlA+], I use labels regularly. They are inescapable.

For some people, the rush to label and categorise is stressful and confusing. We're often uncomfortable with ambiguity and we place a lot of pressures on teens to declare themselves, sometimes before they're ready. Even before they come out, LG BTQlA+ teens are primed to place themselves in particular categories. We leave little space for fluidity — even though this fluidity can be a huge part of a teen’s experience. Even more importantly, sometimes fluidity of gender and sexual orientation can be a core aspect of a person's identity.

Yet, labels can be lifesaving; they can help us integrate complicated aspects of our identities. For some, labels can be a point of access into the LGBTQlA+ community. They can be critical in helping these teens find and connect with each other.

There are no universal answers, which means it's important to empower teens to embrace or reject labels on a person-by-person basis. It's OK to find comfort in them. It's OK to find more comfort in fluidity. It's OK to change your mind, and it's OK not to know. I believe labels should be used if (and only if) they are useful for you.”

From Psychologies Magazine, June 2015
Here are some of the ways being on a CAMHS ward can help young people continue to develop and express their identity:

  • General interaction in the care setting.

  • Considering their own and others’ experiences and opinions.

  • Receiving feedback about themselves from others.

  • Making positive contributions to others.

  • Being acknowledged and thought about by others.

  • Making choices and negotiating with others.

  • Working through what they’ve experienced.

(Adapted from Tomlinson 2004, cited by Rymaszewska and Philpot, 2005 - see Reaching the Vulnerable Child: Therapy with Traumatized Children (Delivering Recovery))

Identity formation involves young people working out what chimes with their emerging sense of self. Wards can play a part in helping them safely explore themselves and the world around them.

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The Same Boat

We’re delighted that Trusts are providing ways for patients and families to get involved and have their say on matters that affect them and their peers. As with all of the COLOURFUL theme pages, you’ll find some tried-and-tested ideas listed below, as well as some quotes by people who’ve had stays on wards. Within the staff-young person relationship, as in all relationships, it’s the mutual influence that each one has on the other that adds to the relationship’s success.
“Involving young people and family members in developing support plans increases co-operation and ownership of the plan.”

“Support for vulnerable young people is usually only effective if their parents/carers are willing to receive support themselves and to encourage the young people to strive towards better outcomes.”

Department for Education, 2011. Read more here

What young people say and why it matters

  • The views of young people must be sought and taken into account when planning, improving and evaluating services.

  • The available research on participation and involvement shows that young people, their parents and healthcare providers often have different views and expectations of services.

  • Young people want access to better information about services. This should be offered in a range of formats and help enable greater involvement in care and treatment decisions.

  • Young people want help from professionals who are non-judgemental, empathetic, respectful, open-minded, informed, competent and respecting of their privacy and confidentiality.

  • Young people in hospital want access to a range of individual and group-based activities alongside support with their education. They also want help with developing the skills they need to leave hospital and get on with their lives.

Adapted from Street in McDougall & Cotgrove, 2013 - see Specialist Mental Healthcare for Children and Adolescents: Hospital, Intensive Community and Home Based Services
When a ward team encourages a young person to have an input into the decisions that affect them, staff are more able to tune into what they need and want. This enables the intervention to be both valuable in the given circumstances, and advantageous to the developing relationship. The most fruitful therapy is young person-focused, which means that the young person leads (Rymaszewska & Philpot 2006).

It’s our view that the most therapeutic wards are those that nurture a culture of ‘interdependency’. This is a healthy dynamic where everyone (staff, patients and parents/carers) works together to benefit the ward as a community - it’s the whole ‘all in the same boat’ thing. Everyone works towards individual goals, but generously; also go the extra mile to help others do the same. In this sense, CAMHS wards have the potential to be egalitarian and participative, so that everyone is positively energised, engaged and finds a bit more happiness.

The Triangle of Care

The Triangle of Care has been written by the fabulous carer activist Alan Worthington.

It sets out a vision of, as the title suggests, a triangular partnership between staff, patient and carer. The six key elements it identifies are:

  1. Carers and the essential role they play are identified at first contact, or as soon as possible.
  2. Staff are ‘carer aware’ and trained in carer engagement strategies.
  3. Policy and practice protocols around confidentiality and sharing information are in place.
  4. Defined staff responsible for carers are in place.
  5. A carer introduction to the service and staff is available, with a relevant range of information across the acute care pathway.
  6. A range of carer support services is available.

Care to Help / Help to Care

Caring about other people, as staff or patients, is fundamental to our happiness. Action for Happiness has got it sussed. On their website you’ll find their brilliant ‘10 Keys for Happier Living’, which includes (way up the list) helping others: “Helping others is not only good for them and a good thing to do, it also makes us happier and healthier too. Giving also connects us to others, creating stronger communities and helping to build a happier society for everyone.” The ward culture (as with any culture) influences the way young people express themselves and how they express, talk about and manage their emotions. Furthermore, most young people believe the things they think and feel are unique to them, and so being able to relate to one another can be reassuring and normalising in itself.

The most therapeutic wards are those that nurture a healthy culture where everyone works together to benefit the ward as a community, so that everyone is positively energised, engaged and finds a bit more happiness.

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Featured Tools and Ideas

Click on the headings below to read more and add a selection of ideas and tools to you own "Palette"

Self-review tool for quality criteria for young people friendly health services

The Department of Health ‘Quality criteria for young people friendly health services’ has been designed to help commissioners and providers of health services to improve NHS and non-NHS health services. The quality criteria provide good practice guidance based on local practice and evidence of what will improve patient experience and health outcomes for young people. Use of the quality criteria also helps to encourage young people to share in decisions about their health, and to increase effective use of NHS and public health services.


Becoming young people friendly

“Services can still do more to become young people friendly, particularly by listening more to service users and parent/carers. Services also need to listen to young people’s views more, on an ongoing basis, to help ensure that services develop in a way that meet young people’s needs. There should also be more choice for young people about the level of involvement of their parent/carers in their care.”

HealthWatch Leeds. Read more here

The criteria cover 10 themes:

  1. Accessibility
  2. Publicity
  3. Confidentiality and consent
  4. Environment
  5. Staff training, skills, attitudes, values
  6. Joined-up working
  7. Involvement of young people in feedback, monitoring and evaluation
  8. Health issues for adolescents

There are two further themes focusing on specialist and targeted provision:

  • Sexual and reproductive health services
  • Specialist and targeted child and adolescent mental health services (CAMHS)

Get the kit here

There are a few excellent guides on how to provide a young person friendly service, including


Mental Health Foundation Right Here - How to…promote youth friendly mental health and wellbeing services

Department of Health Your Welcome standards

Children's and Young People Survey

In 2014 the Care Quality Commission (CQC) carried out their first national survey of children and young people. They asked young people aged 8-15 what they thought about their time in a general hospital. They also asked parents and carers of 0-15 year olds for their views. Nearly 19,000 people responded.

Professor Edward Baker, the CQC's Deputy Chief Inspector of Hospitals, said: "There is much to celebrate in our first survey to ask children and young people about their care.

"Nationally, most young people and children said they were happy with their care, are able to understand the information given by staff following an operation or procedure, and that they have confidence staff are doing everything they can to manage their pain...

"What is particularly worrying is that children with physical, learning or mental health needs are telling us they have poorer experiences. This needs to be addressed straight away so that services meet the needs of all children, irrespective of any disability or specific need." (From here)

As part of the survey, children were encouraged to draw a picture of their care. The CQC have pinned some of those drawings onto their Pinterest board with the hashtag #KidsVoice.

A vision for children and young people’s mental health: Future in mind - Promoting, protecting and improving our children and young people’s mental health and wellbeing

Future in mind "sets out how to build a responsive, inclusive system that reaches out to children and young people at times and in ways that work for them, rather than the other way round...

The tools are available to revolutionise children’s mental health and tear down the barriers that hold so many young people back."

- Paul Burstow was Lib Dem MP for Sutton and Cheam until the last election and served as health minister (from here)

Working within child and adolescent mental health inpatient services - eLearning

Based on the key concepts from each section of 'Working within child and adolescent mental health inpatient services - A Practitioners’ Handbook' this online learning resource is designed to provide those working in generic inpatient child and adolescent mental health services with a unique and interactive learning experience. It recognises the complexity and demands of working in such environments and, having identified the unique skills and qualities required to work in inpatient care, it encourages the learner to interact with the ideas in the handbook, by questioning, evaluating and reflecting to enhance their learning experience. In this way, the resource adds an additional dimension to the existing handbook.

View it here

Hear by Right - Putting young people’s voice at the heart of service delivery

Hear by Right helps services follow best practice on the safe, sound and sustainable participation of children and young people in the services and activities they take part in. Developed by the National Youth Agency (NYA), Hear by Right can be used by any organisation working with young people.  It helps provide evidence of the participation that is already happening in your organisation and shows you how to plan for improvement where there are gaps.

NYA have developed products and services to support you in putting young people’s voices at the heart of your organisation and gain recognition for your achievements.

The seven Hear by Right standards are:

  1. Shared Values
  2. Strategies
  3. Structures
  4. Systems
  5. Staff
  6. Skills
  7. Style of leadership

Read more here

Patient involvement in quality improvement: is it time we let children, young people and families take the lead

A summary: It is vital to involve children, young people and families in the design, delivery and improvement of their care. Their involvement can range from individuals giving feedback, such as patient stories, to collaborative work including patient groups and communities helping to develop and commission services. The methods for involving individuals and families include questionnaires and innovative ideas such as feedback apps. Other methods include the 15 Steps Challenge, which helps an organisation to view the care it delivers through a patient’s eyes and includes a ‘walk around’ involving a patient, carer, staff member and board member. The Experience Based Design approach is another method of reviewing a service and involves assessing how staff and patients feel when delivering and receiving care. Involving patient groups can be facilitated by working with schools and children's centres. The type of involvement will vary, but if carefully designed, it can allow meaningful participation and improvement of services.

You can read the article in full here

Closing the Gap through Changing Relationships programme

Camden CAMHS and the Anna Freud Centre ran a project as part of their Closing the Gap through Changing Relationships programme. They wanted to use shared decision making to support young people with mental health problems and their families to make informed choices and become active partners in their treatment.

The project was very successful, proving that shared decision-making is not just a powerful tool for physical health issues. Clinicians reported that using shared decision making radically changed the way they interacted with service users, making relationships more open and transparent. Young people reported feeling more engaged and involved in their care, more able to take responsibility for their actions and more committed to following care plans they’d been involved in developing. The team found evidence of improved outcomes in individual cases and anecdotal evidence from nurses in an outpatient unit, suggested that shared decision making led to fewer incidences of aggressive behaviour. From here

Read more about the CAMHS project or watch a video interview with Kate Martin from Camden CAMHS.

Superb support from NSPCC - ChildLine

“No problem is too big or too small. Whatever your worry it's better out than in.”

Almost 100 children suffering from mental health problems caused by abuse contacted ChildLine every week in 2014-2015.

The NSPCC's free, 24-hour ChildLine service undertook 85,000 counselling sessions in 2014-2015 – that’s one every six minutes - for youngsters with mental health problems, it says in its annual review.

Read more here

Go here for ChildLine’s mental health webpage


This site has a range of info and resources for 11 to 19 year olds including:


    • Information and factsheets about mental health and wellbeing.
    • A safe blog where young people can ask and answer questions and see what issues other young people have.
    • A monthly debate on topics young people want to discuss with an expert.
    • A toolkit with easy-to-use guides for young people, to help them improve their emotional wellbeing.
    • A directory of local services.
    • The opportunity for young people to access a support worker or counsellor online.



Stopping Stigma

Islington CAMHS held a young people’s workshop about the stigma of mental health. Young people said that the stigma attached to mental health comes from the fact that many people do not understand it, which ‘makes people think there is something wrong with the person’, ‘makes assumptions about them’ and makes people ‘nudge each other or point’. They also suggested that negative stereotypes shown in the media contribute to this stigma.

Read all about the project here, which includes some great pictures.

Takeover Day

“Takeover Day is an annual event which gives children and young people the opportunity to work alongside adults and take part in decision making. This year (2014) was the first year Islington CAMHS got involved together with young people in this event and some of the planned activities included a Q&A panel, young people designing their own CAMHS, young people creating art work to be displayed in the waiting room and young people contributing to the design of this website.” Islington CAMHS

Commitment statements


Here’s an example of a statement which young people developed alongside staff. It clearly sets out expectations so everyone can stay on the same page, including:

Compassion is feeling yourself in someone else’s shoes and thinking about how they feel.

Staff promise to show compassion every day.

Care is looking after yourself, loved ones and others.

Staff promise to take care of you and support you.

Commitment is working hard and finishing what you started.

Staff promise to stick by you every day and put you first.

From here

Directing Change Program

The Directing Change Program & Film Contest encourages and provides a platform for young people to speak out, openly and honestly about mental health. Studies show that although half of teens who are thinking about suicide tell a friend, fewer than 25 percent of those friends tell an adult. By directing change the young filmmakers encourage their peers to know the warning signs for suicide and give them the knowledge to connect a friend to a trusted adult or resource.

"Directing Change provides young people with an opportunity to use a creative medium like film to start important conversations about mental health among their peers and our future California leaders," said Dr. Wayne Clark, Executive Director, California Mental Health Services Authority.



Resources created through partnership - NHS England


"Working in partnership with children and young people and families is an essential element of our work. Our nationally commissioned participation partners are GIFT for young people, who have developed MyApt, and YoungMinds ‘Parent’s Say’ for parents and carers."

Source: england.nhs.uk

Young people encouraged to take active role in local mental health service

Islington CAMHS is encouraging young people in Islington to take an active role in local mental health services in the borough, by joining their youth board.

Lucy McGregor, lead for user participation, said: “The CAMHS youth board is an exciting opportunity for young people to have their say, make changes and influence decisions about their mental health service. Joining the CAMHS youth board is also an opportunity for young people to develop new skills that will look great on their CV.”

Young people over the age of 13 years who live in Islington are invited to join. Everyone is welcome including current service users, past service users and young people who haven’t used the service but would like to be involved.

The CAMHS youth board meets once a month after school between 4-6pm.

Young people are invited to come along to:

  • Find out more about the CAMHS youth board and developing their skills.
  • Receive training in recruitment.
  • Meet new people.

From here

Your Voice Our Voice forum

The Your Voice Our Voice forum is made up of six young people and is currently recruiting new members. They’ve already held discussions around waiting times, referral processes and the redesign of the With U In Mind CAMHS website (www.withuinmind.nhs.uk).

CAMHS Participation Worker Anne Drury said: “The young people involved in the forum have already raised important issues and shared ideas on how they would like the services to develop in the future. We’re committed to empowering young people to have a voice in how their services are run and to make positive changes based on their suggestions.”

It’s also hoped that involvement in the forum will become an accredited process that will lead to a qualification for young people. From here

Young People's Council

“This group is run fortnightly and is optional as it runs outside the unit's therapeutic programme. The aim of the group is to facilitate direct action, through increased user involvement in all aspects of their care, treatment, issues relating to their environment and the resources we provide.

The group provides a forum for comments and complaints to take place, enabling the young people to be part of the process of change. Representatives of the young people, via the Young People’s Council, are invited to attend the monthly Simmons House Management Group meetings.

There is also a Food Steering Group which young people attend to discuss the quality and range of food available.” Read more here.

Involving children and young people for quality improvement

This is a case study from the NHS Youth Forum, who work in partnership with NHS England, Public Health England and the Department of Health to involve children and young people in healthcare quality improvement. It demonstrates the importance of using the views of young people, the results of partnership with young people, and the use of social media to reach young people.

View it here

Teenagers in Stockport shape future of mental health services

Teenagers in Stockport are helping to shape the future of mental health services with a new user forum. It’s hoped the group will influence the future commissioning of young people’s services in the borough. The forum has already shared suggestions including running more group activities and making the consulting rooms more friendly and less clinical. They’ll have their say on all aspects of the service - from the decoration of the waiting area to interviewing potential new staff. In the future, the young people hope to link in with other local organisations, including the Youth Council.

Sally Trowse, ADHD Clinical Specialist Nurse with CAMHS who works closely with the forum, described it as a valuable tool to help young people have a voice in how the service evolves. She said: “The young people involved in the forum have already raised important issues and shared ideas on how they would like services to develop in the future.” To find out more about Stockport CAMHS visit http://www.withuinmind.nhs.uk -


A Random Idea:

Tell young people that if they start talking about a small problem with someone, they can stop it from becoming a big problem.


Caring Relationships
Opportunity and Expression
Leisure and Therapeutic Activity
On and Off the Ward
Relational and Physical Safety
Family and Friends
Unique Recovery Journeys
Leisure and Growth