Agency in Youth Mental Health (3): Rose McCabe

This post is the third in a series of posts on a project on agency and youth mental health funded by a MRC/AHRC/ESRC Adolescence, Mental Health and the Developing Mind: Engagement Award and led by Rose McCabe at City University. The research team members were asked the same four questions and today it is Rose McCabe's turn to answer.

Rose McCabe

Rose is a psychologist specialising in professional-patient communication in mental health care. She records professional-patient encounters and micro-analyses verbal and nonverbal communication. She also works on translating these findings into novel interventions to improve communication and patient outcomes in mental healthcare. 

What interests you about clinical encounters with young people in the mental health context?

I am fascinated by communication between people and how it has the potential to impact us in a good or bad way. In a mental health context, when someone is distressed and vulnerable, this becomes even more important. Young people who are distressed may be particularly vulnerable and struggling to understand what is happening and why it is happening to them. 

There is a lot of self-stigma and societal stigma around seeking help for mental health difficulties and young people are putting their trust in people in positions of power to support them. Often these conversations go well but unfortunately sometimes they do not go well. This can have a profound impact and sometimes means young people will not seek help in the future when they may really need it.

Why is the focus on agency important in this context?

As agency is to do with our sense of being in control of our lives and decisions that affect our lives, it is important to think about how this plays out with young people in distress in mental health encounters. When we feel depressed or anxious, hear voices or have intrusive thoughts, this can make us feel like we are not in control. Young people may also be treated as not having agency by adults who think they are immature and not yet able to reliably report on their experiences or make good decisions about their mental health.

What do your experience and disciplinary background bring to the project?

I bring experience of analysing communication and working closely with people with lived experience and professionals to the project. I video record clinical encounters and analyse verbal and non-verbal communication in-depth, looking for obvious and less things that go well and not so well. An example of something obvious might be a professional encouraging someone by saying something like “You have been going through a really difficult time, you did the right thing in coming to see us and we are here to support you”. 

A less obvious, but really important aspect, might be a professional’s tone of voice when they talk to a young person (e.g. a patronising tone) or when a young person disengages nonverbally in the encounter and you can see they are losing trust in the professional. I have worked on communication surrounding self-harm in primary care, sharing a diagnosis of dementia, training to improve communication with people with psychosis, and shared decision making.

What do you hope to see as an outcome of this project?

I have enjoyed working with an advisory group of young people so much on this project and I am hoping that their views, experiences and recommendations will be used in training health professionals (and other people who support young people like teachers) to have better mental health conversations. 

There are some very fundamental and important things that are often missing from these conversations, particularly really listening to understand the young person, acknowledging that they are distressed and validating their decision to seek help. I hope that young people can be directly involved in training people who support them when they have mental health difficulties.