‘Making mental health accessible’ How MAC-UK co-produces mental health with young people

[Sarah Lyall]

I was pleased to attend a MAC-UK open day to see firsthand the impact of the innovative North London mental health charity about which I had heard so much. Beginning as ‘Music and Change’ in 2008, MAC-UK engages some of the UK’s most excluded and deprived young people in therapeutic relationships that transform their mental wellbeing and make them far less likely to offend. Their target audience for ‘streetherapy©’ are the ‘non-help-seekers’: 14 to 30 year olds living in highly challenging neighbourhoods, with complex multi-level needs that can make them a high risk to themselves and others. MAC-UK workers often quote the statistic that ‘one in three offenders have an unmet mental health need at the time of offence’ as it is this group of young people – those most likely to be on the road to prison given their mental health environment – that MAC-UK most hopes to influence.

One of my particular interests in meeting with the MAC -UK team and young people was to understand how the charity co-produces its work. At nef we define co-production as ‘delivering services in an equal and reciprocal relationship between professionals, people using services, their families and their neighbours’ and MAC-UK is a prime example with its youth-led, community psychology approach. For a start, a core principle of MAC-UK’s model (now called ‘Integrate’) is to support young people to choose and lead any activity. MAC-UK workers accept that activities will change regularly as a young person’s interests ebb, flow and develop. The young people presenting at the open day stressed how distinctive this is in comparison to other youth services. “MAC asks you what you want to do and things are possible, even if it is just you who has the interest,” reflected one young person. “It doesn’t have to be a group thing.” The name ‘Music and Change’ itself came out of the interests of the original group of MAC-UK young people in DJ-ing, MC-ing, lyric writing, music production and music performance.

MAC-UK workers are clinical psychologists who spend regular time on a Camden Estate. Their faces are known in the area and because MAC-UK is a trusted brand, young people come to talk with them – about money, their relationships, future plans and how to manage their anger. There is a strong emphasis on ‘hanging out’ because streetherapy (including forms of CBT and motivational interviewing) can be delivered whenever, wherever: from bench to bus to basketball court. Conversations are open-ended and flexible which is different from conventional therapy. This was an important distinctive for one young presenter at the open day who said, “I can speak in a lot more detail with MAC.”

The community psychology approach means that MAC-UK seeks to engage the estate holistically: from individual young people, to their peer group, the local community and up to the level of social policies which affect the estate. Therapy is personal and relational, but also collective.

MAC-UK workers ask young people and community members for their help, out of the recognition that there is a great deal that they do not know about the estate or how best to make mental health accessible to young people. They seem alert to the extra potential that is released when young people own projects themselves. MAC-UK has helped a group of young men from the founding project set up a social enterprise known as ‘Mini MAC’ which promotes mental health to vulnerable youngsters through music in schools and pupil referral units. The sessions are taught by young DJs and MCs who are employed as ‘Mini Mac Tutors’.

All of this demonstrates the practical outworking of the principles of co-production, albeit in a highly particular setting. I could see that young people are treated as equal partners in the design and delivery of projects and that their contributions are integral to MAC-UK’s successes. Their opinions are consistently sought and are given equal weight to the opinions of MAC-UK workers. In fact, at times the roles of MAC-UK workers and young people are blurred: mutual help is offered, and both staff and youth know that MAC-UK is their project. It is shared. To return to our definition of co-production, the MAC-UK mental health ‘service’ looks very different from typical programmes because it is delivered through equal and reciprocal relationships between professionals, people using services, their families and the neighbourhood more broadly.

The work is not without challenges. One MAC-UK worker stressed that they “get to see tremendous change, but over very long periods of time.” There are no shortcuts. It can be difficult to demonstrate the impact of their work to funders when there is diversity in the outcomes that matter most to individual young people. The ‘professionals’ do not get to call the shots and there is an inherent risk in relying on young people for the success of projects. On a day-to-day level young people might be unreliable. On a programme-wide level MAC-UK would probably not survive if local youth abruptly stopped engaging with them or refused to offer their vision and direction. This is the nature of MAC-UK’s co-production model and it is what makes the charity risky – yes – but also transformative. It is the reason why MAC-UK is held in such high regard by the people I met on the North London Estate and it is why the reoffending rate for the core group of MAC-UK young people is estimated to have fallen by 70 per cent over the last few years.

MAC-UK is able to be authentically co-produced - so that young people initiate, run, direct, deliver and evaluate - but still to achieve its overall, specific goal - to support the mental health of deprived young people. The charity shows that there does not have to be a trade-off between these two things because where co-production is really successful, as it is with MAC-UK, the project goal becomes everybody’s goal.