Blog: What constitutes a good outcome in young people’s mental health?

by Karolin Krause and Rebecca Neale

Much of the work we do aims to encourage those supporting young people’s mental health to use outcome and feedback measurement. The rationale for this is that routine outcome measurement can help us recognise where support is working to improve young people’s outcomes, and identifies areas for potential development in services.

In thinking about what improvement in a young person’s mental health might look like, however, we have come upon the question of whether we are able to agree on what we mean by a ‘good outcome’? In young people’s mental health support, there can often be a number of views on this; the clinician, the parents or carer, the teacher, and of course the young person themselves. Each person might have a different idea of what a good outcome of treatment might be, and that’s before we start thinking about what might be considered a good outcome by service funders and policy makers. With this in mind, it seems that if we are going to talk about measuring a young person’s outcomes and using that information to develop services, we need to also have a conversation about what we mean when talking about it.

Last year, EBPU hosted a workshop to start thinking about some of these issues. Spurred on by an interest in this topic, Professor Miranda Wolpert, Director of the Evidence Based Practice Unit and Child Outcomes Research Consortium, and Edward Harcourt from the University of Oxford brought together philosophers, psychologists, sociologists, advocates of young people, psychometricians, and historians for a workshop. Each presented their view of ‘what constitutes a good outcome in child and adolescent mental health?’

The aim of the day was to take a step back and question some of the concepts that we readily apply in thinking about young people’s mental health. We wanted to start from a place where we didn’t take it for granted that we knew what a good outcome, or treatment, might look like.

What did we discover?

One of the key areas of discussion was a question about competency: when might we consider someone to be rational or able enough to comment on their wellbeing and mental health? In philosophical terms neither children nor mentally ill people have typically been considered sufficiently autonomous or rational to make decisions, so where does that view leave us? What concepts do we need to get to grips with to involve young people better in discussions about outcomes, and recognise them as experts by experience?

The workshop also emphasised the question of whose views we should be considering when talking about a young person’s mental health outcomes. A young person’s development is shaped by their interaction with others in their family, at school and wider communities. Should we be considering an outcome at individual, family, community or even theoretical level? And why do we not consider the views of others when supporting an adult’s mental health? It seems that we need to think about the viewpoint from which we are thinking about outcomes and reach a shared understanding that really speaks to the young people we are trying to help.

Some of the workshop discussion focused on what we mean when we talk about mental health and wellbeing. Where is the overlap between the two? Are they the same thing? Does better mental health automatically lead to better well-being and vice-versa? We also discussed the challenges in measuring outcomes using standardised scales when mental health and wellbeing are viewed differently by different groups of people, and considered how we can concentrate on the individual whilst also bearing in mind that social, political and economic definitions and priorities can affect the dominant view of what a good outcome might look like.

Next steps

These are all complex questions and as a group we are determined to keep exploring the different views on them. This workshop started an important discussion at the conceptual level, and our next steps are to take some of these ideas to the people involved in children and young people’s mental health. We will be engaging with children and young people on this debate, and invite those interested from across the mental health sector (and beyond!) to join us on 3rd July to really get to grips to how we should thinking about outcomes in young people’s mental health.

Further information on last year’s workshop has been captured in this illustration. For those of you keen to explore this topic further, we look forward to seeing you for an in-depth discussion on some of these issues and welcome your contribution to this fascinating debate.

Monday 3rd July: What Constitutes a Good Outcome in Child Mental Health?

Karolin Krause is a PhD Candidate at the Evidence Based Practice Unit (EBPU) where she works on approaches to conceptualising and measuring what constitutes a good outcome in child and adolescent mental health.

Rebecca Neale is Website and Communications Officer at CORC where she focuses on the engagement of individuals and organisations working to support children and young people's mental health.