The Mindset Revolution project is led by the University of Birmingham (Sonia Bussu) in partnership with Manchester Metropolitan University (James Duggan, Zarah Eve), Katy Rubin, Youth Focus North West, Platoniq Foundation, 42nd Street, Reform Radio, and GM-iThrive, with funding from Royal Society for the Arts and UKRI.

This Legislative Theatre event was led by four young people involved in the earlier Optimistic Minds project, who went on to participate in facilitation training with Katy Rubin throughout the winter of 2023. These youth facilitators have been working with a new cast of young people since March 2023 to create and perform Mask to Break, based on lived experiences of youth mental health support in health and education settings in Greater Manchester.

The following policy proposals were developed through the improvisations of scenes in this play by audience members. Policymakers in the audience, including stakeholders from the Greater Manchester Combined Authority (GMCA) and the NHS Greater Manchester Integrated Care Partnership, were asked to make commitments based on these policy proposals. The core theme of the play revolved around the concept of masking, in which young people feel forced to suppress aspects of their identities to fit into their communities, at the cost of their mental health. Scenes delved into the dismissiveness young

people experience relating to their symptoms and lack of respect for self-diagnosis, as well as the lack of ‘dual diagnosis’ support around autism, addiction and mental health issues. Scenes also explored classism, discrimination, and the intersectionality of racial and gender-based expectations in schools, and how those can impact mental health.

Policy Proposals

Policy Issue 1: Bring all the stakeholders in young people’s mental health services around the same table.

School staff members, medical and support service providers, parents, young people, and charities should be able to collaborate in a positive way to support young people seeking mental health support.

• Young people should get an art box to help them create their shared information care record, with an array of literary, digital and journaling options. They can then use this personalised record of their information in future encounters with mental health or medical professionals.
• Mental health professionals should be required to offer options for young people to record their sessions (in various ways) at every intake.
• There should be an option for young people to select to add this shared care record to their official records.
• There should be a joint annual review of notes / records, by young people, health professionals and advocates together.
• There is already work underway to develop a self-directed medical passport, but that will take time and resources to implement; this could be an intermediary step that’s applied across Greater Manchester. We could use tools that organisations such at 42nd St already have in place, as models. One model could be a timeline that young people can create at the beginning of their treatment to identify goals and mark progress. 

Policy Issue 2: Co-design a more collaborative pathway through mental health support for young people.

This requires sustainably resources and appropriately funded advocates to support and empower young people seeking mental health support to use their voice. Advocates should also be trained in co-production and encourage the co-design of mental healthcare provision.

• Advocate roles that support the young person and help bridge the gap between young people and professionals should be created and funded across the system. This should be supported by ensuring that the system works together, rather than expecting an advocate to navigate a fragmented and siloed system.
• Advocates should be trained in shared decision making, co-production and supporting young people to make and share their care record tool, referred to in Policy Issue 1.
• People with experience of the mental health system should be given priority to take these roles, as paid peer advocates.
• Young people should be involved in co-designing job descriptions for advocates; young people should also have choice in which advocates they work with: culturally appropriate, representative, etc. 
• The use of advocates in the mental health system should not then become another bureaucratic barrier to young people seeking support.

Policy Issue 3: Shift the focus of the education system to mental health and wellbeing.

The education system should be designed for positive mental health and wellbeing, rather than rigidity, rules, and standardised academic success. The system should reflect and respect the lived experience of people living with mental health issues.

• There should be a compulsory requirement for every member of staff in schools, universities etc to be trained in mental health awareness, in order to identify issues towards early intervention.
• Look to schools that are already actively training staff and students in mental health awareness; their work should be highlighted to make the case to other schools and share training materials. 
• Education, in general, should take a more holistic approach, especially in mental health education. People learn in different ways, via arts, PSHE, etc, and different learning styles should be supported and resourced.
• Cultural artefacts such as video booklets, or a legislative theatre play, could be used as a way of communicating to young people and educational staff how to recognise and articulate their own and others’ needs around mental health.
• Mental health awareness should be integrated across the curriculum, through tools co-designed with young people, to help young people navigate mental health issues throughout their life, family and community.
• Mental health awareness implementation must be measurable and actionable: GMCA could design a workshop with young people to be implemented in a certain number of schools, for example.  

Commitments:

Deborah Thomson (NHS Greater Manchester Integrated Care) will ensure that the design and delivery of their mental health training will be co-produced with young people with lived experience. She is currently planning an initial meeting with the NHS, GMCA and Violence Reduction team to develop this mental health, neurodivergence and trauma training, and will be sharing their budget review publicly.

Mari Saeki (National Autistic Society) will work with 42nd Street and Youth Focus North West to get advice on co-producing their training for educators (including senior leaders) with young people, and ensure that it overlaps with their neurodivergence and trauma work.

Sharon Weetman (GMCA) will be sharing these proposals with the Enriching Lives group, including headteachers and post-16 providers, and will suggest that mental health should be part of the narrative on pathways in education.

Anna Bergqvist (MMU) will be bringing the co-creation and young person-led work on mental health to the next meeting of the MMU executive group on mental health.

Mark Leith (Bolton At Home) will inquire with the team designing mental health training for staff, to co-produce their training program with young people. He will also ensure that youth mental health is a focus in the GM Healthy Homes Network.