Agency in Youth Mental Health (4): Michael Larkin

This post is the fourth 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 Michael Larkin's turn to answer.

Michael Larkin

Michael is a Reader in Psychology at Aston University. He is interested in related and connectedness and is an expert in the co-production and co-design of psychosocial services. In 2019, he was awarded the Mid-Career Research Prize by the Qualitative Methods Section of the British Psychological Society.

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

Over the years I’ve been involved in lots of studies about people’s experiences of mental health services, and of course, read a lot of other’s people’s work in this area too. It’s really striking how frequently certain key themes recur when people are unhappy with services. Off the top of my head, I’d summarise these as: not being listened to, not being understood, not being helped, and a lack of continuity even after some help is provided. There are some more coercive themes too, unfortunately. Generally these are themes are like overarching patterns, but this project presents a really exciting opportunity to ‘zoom in’ at the micro level, and to do that at the point where people are seeking help.

 

Services which are really attuned to not losing out on the opportunity to build a relationship with someone would see these clinical encounters as critical, make-or-break points. But many mental health services are not in that position. They are underfunded, and so they have more requests for help than they can deal with. They are also structured to provide a different kind of support (assess, intervene, discharge) to the kind that many service-users want (continuity of care; and permeable, ongoing access to that care). Instead of working hard to start everyone’s journey well, the organisational pressures may well be about identifying who they absolutely have to take on, so that everyone else can be re-directed elsewhere.

Why is the focus of agency important in this context?

 

It’s a horribly familiar case of an interaction arising from two completely different sets of expectations. The person seeking help wants to be heard, understood, and supported in improving their situation. They want to be told that they have done the right thing, come to the right place, and that now something helpful will happen. This is a reasonable expectation. But to be heard and understood, you need an audience willing and able to deal with complexity, ambiguity and contradiction – the grey areas of human experience.

 

Unfortunately, the person assessing them may well have been directed to decide that things are either one thing (acutely serious and immediately risky) or the other (currently under control or somebody else’s problem). If so, the young person’s agency gets overwritten– their nuanced account is recategorised firmly as either a Problem for this Service, or Not a Problem for this Service.

 

Experienced users of services come to understand that the way to reliably access the little support that is available is by learning the magic words – the things that have to be said to a gatekeeper for them to judge that the problem in front of them is a Problem for this Service. In our project we are seeing young people’s agency quashed, partly because they do not yet know the magic words.

 

We can add to this an unpleasant Catch-22. Young people seeking help are exercising some agency, and this can be turned against them, if someone has a suspicion that what they have brought is Not a Problem for this Service. ‘Too much’ agency can be read as too much functionality, an indicator that a person does not need help. This is especially true if the only help available is urgent help, I think.

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

 

I’m writing this in Mental Health Awareness Week. Like a lot of people with a stake in mental health, I find it difficult: awareness is not really what’s lacking. What I’ve been feeling very aware of is a trail of dead family members, friends, colleagues, and friend’s family members. Something came on the radio which prompted this, so I began counting them, naming them. It was overwhelming - I had to stop. These people that I knew, who came to mind, are now dead. I was surprised how many there were. They died prematurely - largely because, as a society we have not been able to organise ourselves, and especially our workplaces and education systems, in ways which accommodate – and do not pass judgement – on the complexities of how life is lived when people experience mental health difficulties. I don’t think that it ought to be so difficult to do this, and I feel very angry about it. So that’s my experience, right now, at the time of writing: I feel angry.

 

One of the few advantages of not being a young person myself anymore (Kurt Vonnegut was right about the knees) is that I could stop there. It would be allowed. But I will try to say something about my disciplinary perspective too. As a psychologist, sometimes it is tempting to overstate the complexity of psychological matters – to say that of course a more concrete problem would be easier to deal with. Unfortunately, if anything, seeing the response to Covid has made me feel even more angry about the situation with mental health. Even with an immediate, universal problem with clear parameters, it has been striking how difficult it is for many of our institutions to imagine organising themselves differently. It’s tempting to throw your hands in the air. But … 

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

The point about our topic is that agency – and mental health – are much more complex. The parameters are less clear. There’s a lot less ‘either/or’ and a lot more ‘both/and’. Young people may, for example provide care to others, and still need care from others too. This shouldn’t be rocket science, but if we build systems which sort helpseekers into two streams (yes, you do or no, you don’t), then researchers need to illuminate this complexity, and to show some different ways of working with it, and responding to it, which are human, and which are helpful. I would hope that this is where a convergence of phenomenological and psychological perspectives can help.

 

The young people working with us on this project – as advisors, co-analysts and co-authors – are a tremendous antidote to the feelings of anger and hopelessness that I associate with the topic generally, and with some of the video recordings we have watched, specifically. It is tremendously valuable to work with collaborators who not only remind you why change is important, but also show you how it is possible. So what I hope is that we can do some work together that will allow others to see that too. One of the things we will do is identify what it looks like when someone is listened to, is understood, and help is provided. I think that can be a positive step, even if it is one component of a systemic problem.