Abstract
Background:
Currently, a deficit model of mental health shapes children and young people’s experiences. Most UK interventions designed to improve mental health for this age group are adult led and dominated by a Western-driven medical model in which the emphasis is on individuals receiving mental health diagnoses. The voice of children and young people can be muted in this process.
Methods:
Research was completed using ethnographic-based participatory observation and longitudinal interventions designed in collaboration with pupils aged 11–16, in a secondary school over a 5-year period. By meeting once a week and later every 3 weeks, children and young people began to trust each other and feel safe to share their ideas about the direction that the therapeutic group work should take.
Findings:
Fieldwork highlighted ways in which receiving support as part of a group created positive shifts in individuals perceptions of themselves and each other. It also examined the contributions children and young people made to their group and raises broader questions about the role of participatory research when working in this way.
Conclusion:
Findings support the idea that child participation should be considered a special category of participation. They demonstrates that children and young people respond positively to working together. By the end of the 5-year period, individuals were talking differently about their emotions, felt less isolated, and were more empathetic. Some also felt liberated from thinking about their mental health as a singular diagnostic experience and had begun to develop a greater sense of positive self-worth.
Introduction
Children take a position in society not as humans but as future humans (Van der Geest in Bush, 1996: 40).
The focus of this paper is on children and young people’s mental health and the study it describes took place in a semi-rural secondary school in the South-East of England over a 5-year period. I was originally invited into the school as a result of supporting a post-graduate student with their studies in the same setting. By the end of 2014 the head teacher, knowing about my background in social work, had invited me to establish creative ways of addressing mental health issues among ‘difficult to reach’ students. Following ethical approval, 1 a child-centred group work project was established in December 2016 with the purpose of creating student led coping strategies to develop emotional resilience.
The central research question focused on whether being part of a therapeutic group could create an environment in which students would act together to develop positive understanding of their own and each other’s emotional needs. It was hoped that members of each group would become less isolated through the process. It was also anticipated that a group setting might create space for teenagers to be less focused on the presence of the researcher, and more attuned to each other and their thoughts and feelings. A group setting was utilised so that students could develop an appreciation that other people also experience challenging emotions. The long-term objective of the work was for individuals to develop resilience-based tactics for use in their everyday lives. Meetings were student led, and individuals were invited to participate in deciding the direction of each session.
During the fieldwork process, three questions arose from the experience. First, to what extent is it possible to be genuinely participatory during the research process? Second, how has past research with children and teenagers shaped contemporary understanding of child-centred research? Third, how does our cultural understanding of children and teenagers inform the research encounter and societal ideas about childhood and youth?
Background to child participation
Just as childhood is a social construction, the research process is also a cultural construct, shaped by expectations and academic traditions (Wyness, 2019). Today, it is standard for social scientists working with children to engage in child participatory research. This desire for children to actively participate in decision-making (and by extension, research) took off in the 1990s partly in response to the human rights objectives laid out in the UN Convention on the Rights of the Child, and the emphasis present within the Convention on child participation. (Wells, 2021)
Around this time period three British sociologists, Allison James, Chris Jenks and Alan Prout instigated a paradigm shift in the social study of childhood in which children were repositioned as competent social actors within the research process (Gallacher and Gallagher, 2008: 500; James and Prout, 1990). With this shift came a hoped-for expectation that children could be treated as fully fledged and autonomous citizens, thus hopefully consigning to the past the anthropologist Charlotte Hardman’s 1970s observation that children’s voices are muted within society (Hardman, 1973). Yet, as shown in this paper, achieving equal partnerships between children and adult researchers is far from straightforward and is complicated by wider structural influences.
Spyrou (2011, 2016) has questioned whether genuine participation is ever possible given the unbalanced nature of power that exists between adults and young people. Saether et al. (2024) have pointed out that participatory processes can sometimes be exploitative. In this paper, it is suggested that our current approach to children’s mental health continues to mute and inhibit children and young people, treating them as the passive recipients of care. We should, as a society, spend far more time working to create inclusive child-centred interactions between families, professionals and the young people we provide support to.
Children and young people’s position in society
Across the Northern hemisphere, developmental psychology and life-stage theory lies at the core of much research on children. Within this paradigm, a link is made between chronological age and capacity. This creates a perception of both children and teenagers as still ‘becoming’ regardless of gender and ethnicity, and in turn shapes how we engage with and listen to individuals, particularly when they are experiencing challenges (Burman, 2021). Within such a framework children in advanced post-industrial societies are raised to focus on individualistic notions of self-hood and the autonomous self, in other words it is ‘I’ who has feelings, and it is the individual separate to their family and peers, who becomes the recipient of individually focused support (Burr, 2006).
This process of providing stand-alone diagnoses and interventions isolates children from each other and creates the impression that mental health challenges begin and end with the individual. In other words, the process over-focuses on the individual in isolation from external influences in their lives. Furthermore, the language used to discuss mental health prescribes deficit conditions onto the child or young person in line within the medical Diagnostic and Statistical Manual of Mental Disorders (DSM framework). Children and young people who appear troubled in some ways are most likely to be labelled as having attention-deficit/hyperactivity disorder (ADHD), a neurodiverse condition, or depression (Burr, 2022; Timimi and Leo, 2009).
Within this societal context, when children report that they are unhappy it is standard to turn to mental health practitioners for care and support (Burr, 2022). Yet as Maclean and Law (2022) have shown there are significant structural barriers to receiving care. In the UK, Children and Adolescent Mental Health Services (CAMHS) are overstretched, and individuals in need of specialist support are often placed on long waiting lists (Burr, 2022). Poon et al. (2022) have suggested, it would be preferable for children and young people’s mental health needs to be understood within the community and family context in which they have been raised. Understanding each person’s experiences in the wider societal context makes it possible to acknowledge prejudices and judgements that shape their lives, whether that be in a person’s day-to-day existence or, as is the focus here, as children within school settings (Burr, 2022).
Origins of child focused fieldwork and the influence of research on how children and young people are understood
The majority of researchers in the field of childhood and youth studies acknowledge the challenge of eliciting authentic views from members of this group and recognise the power differentials that shape their encounters with children (Alanen, 2016; Gallacher and Gallagher, 2008; James et al., 1998; Spyrou, 2011). In this paper, it is argued that we should include in the write up of our research how children and researchers respond to each other during fieldwork, and the extent to which they felt able to react to each other on an equal footing. The ideas developed by the anthropologist Christina Toren, when living among children in Fiji is of relevance here, when she argued that
to understand Fijians well (as opposed to superficially) I have to know their history and also by means of long participant observation and other research methods, find out what they take for granted. This is difficult because I cannot help but project onto them my own understandings- not because I am especially mired in my own ideas, but because this is the way that people make sense of the world. (Toren, 2011: 24)
Both Christina Toren and Allison James suggest that the lived history that the researcher brings with them to the field continues to manifest and transform itself in relationships and observations (James et al., 2010: 1). Because of this we need to be driven to be mindful of our identities and the childhood experiences that we have had, and which shape us and in turn influence the lens through which we work with, and understand, children and young people as subjects.
Ethnographic studies shed light on emerging social constructions of childhood
Value in examining the impact of the researcher within a fieldwork site is central to cultural anthropology. Childhood and youth focused researchers have undoubtedly been influenced by anthropology and many studies with children and young people now claim to use participatory-based research methods (Gallacher and Gallagher, 2008; Taguchi and Palmer, 2013). But unlike cultural anthropologists, most interdisciplinary childhood and youth researchers rarely reflect on the influence of their presence during the fieldwork process. Few stay continuously at the fieldwork site or visit children over an extended period of time. In short, anthropologists and interdisciplinary researchers understand participatory research quite differently.
The social construction of youth as a time of storm and stress
The seminal work of Margaret Mead (2001 [1928]) and Jean Briggs (1970) among others highlights how childhood is socially constructed, and show that the landscape of child development is not universally the same (Montgomery, 2008). In the case of Mead, her findings critically challenged Stanley G. Hall’s 1904 earlier study in which he created the term and concept of adolescence as a universally experienced separate life-stage falling between childhood and adulthood. Hall stated that during this life-stage individuals are destined to experience ‘storm and stress’ (Hall, 2013 [1904]). Mead’s ethnographic findings seriously undermined Hall’s claim that adolescence was a universally challenging time. Yet Hall’s influence still looms large in the global North and, as shown in fieldwork examples later in this paper, contributes to the enduring perception that the teenage years are difficult and that by extension teenagers are likely to experience mental health challenges. We can look to the media as another body perpetuating this expectation (Burr, 2022).
Likewise, Elisabeth Young-Bruehl points out that because of Hall’s (2013 [1904]) study, teenagers are often treated as ‘obsessionally unwanted and to be feared and considered a threat to adult society’ (p. 254). As is shown with the case of Jack further into this paper, where there was an expectation that turbulent and disruptive behaviour and poor mental health are normal parts of the teenage experience, individuals can be catastrophically misunderstood and let down by the professionals who are supposed to be supporting them (Burr, 2022).
Elisabeth Young-Bruehl coined the term ‘childism’ to highlight the prejudice that society has towards children and teenagers (Young-Bruehl, 2013) and Galtung (1969) created the term structural violence to highlight the ways in which individuals are culturally positioned and often violently treated within social structures or social institutions. Hillevi Taguchi and Anna Palmer (2013) during their study of girls’ experience of wellbeing classes in a school setting found that the methods used offered as a means of preventing stress in reality put responsibility on individual girls to self-manage their feelings (p. 671). In other words, there was an institutional expectation that it was up to the individual to manage themselves and there was no acknowledgement of the influence that the school might be having on young people in its care (Burr, 2022).
The dominant societal expectation remains that adolescence is a generally difficult time, in which children and teenagers often receive or take on mental health diagnoses of their own volition, which they are individually expected to take ownership of (Burr, 2022). This focus on diagnoses within a medical model sidelines the development of strengths building preventive interventions and creates an unnecessary crisis, which the likes of John Wall, also writing more positively on the subject of childism, would also see as avoidable (Maclean and Hall, 2022).
Being protectively participatory
As highlighted at the outset, this paper examines experiences of a group of teenagers, most of whom were known to local social services. While it has already been established that it is not possible for children to be on an a completely equal footing with adult researchers, I would go further to suggest that rather than refer to the use of participatory research, we should instead talk of ‘protectively participatory’ research.
This is partly because child focused professionals in the UK are legally bound under the 2004 Children Act to report on child protection concerns. Reportable concerns do not exist in the opposite direction from child to adult. No matter how hard we work to establish open dialogue with children, if we are based in the global North, we do so in societies in which the dominant discourse is that childhood is a time of becoming, and that adults are in control. In addition, most research encounters take place in institutional settings, such as the school or the private domain of the home. Neither setting is neutral, and educational settings have very particular expectations of children, requiring them to follow rules and regulations designed to maintain control of large numbers of people at any one time (Taguchi and Palmer, 2013). Furthermore being ‘good children’ in school environments requires that they achieve a reasonable level of academic success. In this context, children are more likely to feel accepted if they show a willingness to behave in a conformist way, abiding by the rules and regulations of their institution, echoing Bourdieu’s work on institutional habitus. (Bourdieu, 2002: 27).
The central objective for the group work
One of the research questions in this study focused on whether children and young people working in groups could learn to look to themselves and each other to provide positive and empathetic support, and to take part in meditative practice without the need for adult led involvement. Meditative practice in the context of this group took the form of guided meditation (Burr, 2022). The plan was to see if it was possible to support individuals towards developing self-worth through indirect means, such as by sharing ideas and embarking upon meditative practice. This was an open-ended approach, very much in keeping with ethnographic fieldwork completed earlier in Vietnam (Burr, 2006; Gallacher and Gallagher, 2008).
One problem with any form of participatory engagement with children is that individuals need to have a certain amount of confidence in themselves if they are to voice their thoughts and openly share ideas. As the anthropologist Christina Toren has pointed out, ‘Children’s ideas do not come out of nowhere. They have everything to do with the child’s intersubjective engagement with the world’ (Toren, 2011: 39). It is with the most confident children that we are most likely to develop a more equal relationship, and even then, the social agency on offer to children continues to be negatively shaped by societal influences.
For those experiencing challenging childhoods, as most of the children were in this study, positive social agency is something that needs working towards. There was value in creating a safe and kind space for those who took part. Sessions were initially held once a week and later moved to every three weeks with individuals being encouraged to practice meditative relaxation techniques in between meet-ups with the aim that they began to see their practice as something that they owned, rather than something that could take place only with the encouragement of an adult.
An organic and ethical approach
Initially, the students who took part in the sessions were chosen by the teachers. They were young people who were known to the local social services department or seemed unsettled in the school setting. As the weeks went by, and students started to talk among themselves about their sessions, the make-up of the groups became more varied. Students started to self-refer, and some of the original groups invited friends along who they thought might benefit from attending. Sessions were designed to offer a high level of flexibility, and students could drop in and out as they wished. A huge amount of energy was put into involving teenagers in the fieldwork process, so that the study could be as person-centred and protectively participatory as possible. Throughout the process, children and young people had the option of dropping in or out of the group. They also understood their ethical responsibilities towards each other and were expected to maintain confidence in the group.
Group work
From the start, there was a therapeutic element to the work that groups were doing. Students met with between 3-8 other students. It was agreed that students would maintain confidentiality within the group setting, not disclosing anything that was too personal, and if anyone shared a child protection issue then that information would be acted upon. Students took this rule seriously and seemed to thrive in response to the trust that it created. In hindsight, part of the appeal of attending the groups was based on students having the chance to speak to a trusted and peer-based audience. It is a rare opportunity for any of us to be heard in this way without interruption and in supportive silence. It was notable that students attending the sessions really enjoyed the predictable nature of the process. This meant that once a practice was introduced into the group session and became part of the established routine students were reluctant to make any changes (Burr, 2022).
On one occasion early on, while working with a group of five eleven-year-old boys who were talking over each other, the group came up with the technique of using a pebble. Each student could choose to pick a pebble up to indicate that they were ready to speak and be listened to (Burr, 2022). As the weeks rolled on, the ‘pebble greet’ became central to the sessions, and students would start their time together by taking it in turns to share three things that had happened since they had last met. We were all struck by how varied their experiences were, and how keen they were to listen to each other. As time went on, it was also agreed among themselves that they would only give advice if invited to do so. It seemed that the simple act of sharing was a powerful one.
There was an initial expectation that students would become bored with sticking to the same routine week on week, and yet whenever the question of changing to a different activity came up the suggestion was very firmly turned down. The students seemed to gain comfort from the predictable nature of the techniques they were developing. As the weeks went by this activity morphed into each student sharing three challenging and three positive experiences. It is impossible to pinpoint when the groups arrived at this technique, but it was an interesting direction for the students to have taken, because it neatly moved the group away from a deficit model of mental health and tapped into the field of positive psychology developed by Martin Seligman, in which individuals engage in thinking about activities and moments that also have positive elements to them (Seligman, 2004).
Over time, the work that students did in the groups seemed to have an effect on their wider school experiences. For example, one student, Jack, talked in his group about how difficult he found lunch times. The following week, one of the boys in the same group shared one of his positive experiences as one in which he had sought out Jack in the lunch queue and invited him to join his lunchtime group. This experience of kindness led to students then going from speaking about three challenging and three positive experiences to also sharing any acts of kindness they might have taken part in as part of their weekly reporting on their news.
By sharing in this way, and in a trusting environment, students also began to seem less preoccupied with their own feelings and experiences, and more empathetic and protective towards each other. This meant that as the only adult in the room the researcher was often able to stay silent and leave it to students to offer each other support, something that they increasingly did with real insight and sensitivity.
Amber’s experiences
Amber’s experience offers a good example of why it is so important that children are given space to look out for and provide support to each other. Amber joined the group in year 7 and stayed for the duration of the programme. She normally came across as being very outgoing and upbeat, was very well liked by other students, and was kind to everyone in her group, despite managing a complicated homelife which involved ongoing social work support. She never attended the group in a distressed state.
On one occasion 3 years into the project when it came to her turn to pick up the pebble, she quietly said that her mum and social worker were worried about her because it had been decided between them that she was showing signs of being anxious. Amber was clearly not only upset, but also scared of the diagnosis that her social worker had given her during a home visit. One of the other girls in the group asked her to provide some context. It transpired that during the previous week, Amber’s stepfather had left the family home, and her mum had broken down emotionally. Over the following week, Amber had taken charge of her family, looked after younger siblings, fed them, and got them ready for school, and sat up late into the evening comforting her mother. The social worker’s visit to the family home had been the first opportunity that Amber had had to process what was happening to her family, and because she trusted her social worker, she had used the visit as an opportunity to finally share how upset she was.
As a group, we listened to Amber sharing her experiences, and the girls in the group pointed out that it was Amber who had shown real strength in the face of her mother’s emotional collapse. They were as impressed as the researcher was by Amber’s resilience, and the way that she had taken control in the family home. Under the circumstances, it was difficult to pigeonhole Amber as ‘anxious’, and as her friends in the group sympathised with her and spoke of the strength that she was showing we watched Amber begin to dry her eyes and quietly absorb the words of her peers. One of the girls pointed out that anyone would feel sad and worried under the circumstances. The group’s take on her situation was both strengthening and supportive, and provided a broader context in which Amber could open up and process how she was feeling. To everyone’s delight it was Amber who then looked up and into the room and said, ‘maybe I’m not anxious then?’, and as she spoke those words other group members quietly nodded in agreement.
Without being part of a structured and supportive group, Amber would most likely have continued to view herself as anxious. The experience highlights how easy it is for adults to tell children who and what they are, and for children, because of their lack of social agency, to accept so readily what they are being told about themselves (Bourdieu, 2002). When Amber’s social worker visited her, she unfortunately drew upon her training in mental health not to offer thoughtful and context informed support, but to label Amber in a way that made her feel scared and inadequate (Burr, 2022: 20). The intervention was poorly executed and one-dimensional, and based on a deficit model of mental health that did not consider or acknowledge the caring responsibilities that Amber had taken on (Bronfenbrenner, 1979). If the social worker had spent good quality time with Amber, she might have seen things differently. The humanist psychologist Carl Rogers coined the term ‘unconditional positive regard’ in recognition of the importance of individuals being treated with non-judgemental compassion (Rogers, 1951). If the social worker had sat with and properly heard Amber, then Amber would not have left the encounter feeling scared and belittled but would instead have had opportunity to properly grieve her loss.
The value of longitudinal fieldwork
Amber’s experiences demonstrate how important it is that practitioners and researchers alike spend good quality time with children and work hard to treat them as protected equals. Her example also shows how valuable it is for individuals to becomes members of a peer group, because in this case it was Amber’s peers who very quickly reacted against the limited diagnosis of anxiety and offered a kinder and more humane interpretation of what Amber had experienced.
Genuine peer to peer support in which children take control and share insights is of real value and creates a level of participation of a different type to the one-on-one support which adult professionals can provide. In this case, Amber’s peers treated her with respect, and gave her space in which to talk about her loss and the sadness evoked by her stepfather moving out.
Pathologising normal emotions out of context
Amber’s experiences shed light on current attitudes towards childhood and by extension the role of mental health services, in which children are often treated at a highly individualised level, and as if they incapable of holding responsibilities or have capacity to provide insight about their situation. Childhood has become portrayed as a time of innocence, in which it is the child’s job to grow and learn without responsibilities (Burman, 2021). Within this discourse there is little expectation that children can care for themselves and others.
Amber’s experiences shed light on wider concerns about the treatment of young carers, in which they may go out of their way to hide what they do for their families because of the contradictory nature of how childhood is viewed, and fear that their family could be split up and they might be taken into care (Aldridge, 2017). Amber was not the only young person to be misunderstood, this was also the case for Jack, whose disruptive behaviour sometimes led to him being placed in school exclusion (Burr, 2022).
Jack’s Experiences
One Monday morning, about a year and a half into our time together, Jack appeared in our session in an agitated and frenetic state, having just been released from the school exclusion unit. When it came to his turn to talk about three challenging and three good things that had happened since we had last met, he laughed and said that his weekend had been difficult because his dad had dragged him away from his PlayStation and shoved him up against a wall. The boys in the group really listened to Jack and picked up on his distress. Unusually, rather than moving to share their news, they stayed with Jack’s experience and offered him comfort. During the session Jack revealed that his father’s mistreatment of him occurred on a regular basis. It transpired that Jack had been living with the ongoing stress of living with an unpredictable father on a long-term basis. Because of the risk posed to Jack, it was necessary to share his experiences with his tutor (hence the earlier argument for protective participation) and it also became clear that there was a pattern to Jack’s mood and the likelihood of him being placed in the school isolation unit. In short, he was most likely to be disruptive in school on Mondays, after a difficult weekend, and on Fridays, because he was worried about going home and being around his father for an extended period of time. For Jack, school was a safe place in which he could vent his upset, but only up to a point, because until school staff were aware of the root course of his behaviour Jack was not treated with much empathy. Instead, he was locked up, and his behaviours were simply put down to him being on the autistic spectrum.
If Jack had not been in the student group sessions and given a considerable amount of time to develop trust to share what was happening at home, it is unlikely that the real cause of his upset would have come to light. From then on, whenever he became upset, he was given permission to go to the school library, and his form tutor would give him space in which to talk.
Concluding thoughts
This paper highlights the very varied approaches adopted by researchers who choose to study children. It puts forward an argument for researchers to be realistic about the power dynamics that shape children and young people’s lives and to acknowledge structural influences that dictate how children view themselves and by extension engage in the participatory research process.
While researchers cannot erase dominant influences in children and young people’s lives they can and should take such influences into account. The paper also includes an argument for all childhood focused researchers to draw upon the experience of anthropologists and include a reflection in their write ups on how they think their presence shapes fieldwork findings. It also explores some of the vulnerabilities felt by children and points out that it is often only the most confident individuals who feel comfortable to express themselves and talk openly about their lives. Jack and Amber’s experiences highlight that it takes significant time for children and young people to both trust researchers and one another, and that the process of doing fieldwork is at its most genuine when it happens organically over an extended period of time.
Brooke Jesperson argues that, whether children directly shape the research process, the fact that we are inviting them into it has a positive effect on their social capital (Jesperson et al., 2021). But the fieldwork findings outlined here show that children’s experience of social capital is highly varied and that those who have experienced abusive home lives find it hard to contribute to the direction of fieldwork and given the option will cleave to routine as part of that process (Burr, 2022). In short, it would be more realistic for all researchers to replace the term ‘child participation’ with the term a ‘protective participatory approach’.
Why group work is so important
More positively, this study highlights the benefit of children and young people working together through peer focused group work and shows that individuals can thrive in a collective environment. The case examples also show that children can take the lead in offering each other support and that when they do so it can be with compassion and kindness. Their acts of kindness in these instances also seem to create new meaning and purpose in their own lives. In short, the project outlined in this paper has shown that it is possible to think about mental health differently and shift the focus away from the individual in isolation by creating an opportunity for individuals to come together in therapeutic and restorative group settings (Burr, 2022).
Finally, as a society we need to redress and create balance when discussing mental health needs. It is positive that we are encouraging children to talk openly about their emotions, but at present this shift is coming at a cost, because the opportunities to do so are few and exist within a constraining and limited environment in which adults have control and children’s experiences are too often considered within a limited diagnostic medical framework. The result of this focus on medical diagnosis influences the language we use to express our emotions and also heightens the emotional landscape. Today’s young people no longer express feeling sad, but are instead anxious; they are no longer unhappy, but are depressed; and they are no longer having a challenging time, but are experiencing trauma (Burr, 2022). The experiences of the children drawn upon here challenge current attitudes and question why their experiences are so often muted and reduced to a few limited and pathologising terminologies, most of which are negative and deterministic, and do not create permission for children to feel comfortable with sometimes feeling sad and worried.
Greater balance could be created if all children were offered preventive group work opportunities from the moment they start school, so that they could learn early on how to express their emotional needs in a balanced way without having to turn to one-on-one adult led psychotherapeutic interventions. During the group work sessions described here children learned that other people also experience life challenges, that as children it is not their job to lead a carefree existence or conversely to be demonised, and that children just like adults thrive when given the opportunity to support one another to cope with life’s inevitable challenges.
