Our Trauma Informed Practise & Community Mental Health Approach

Bristol Deprivation

Statistics from 2019 show that 15% of Bristol’s population lived in the most deprived 10% of areas in England. 14% of the total population of Bristol were found to suffer from income deprivation, and the percentage of people who are struggling financially has continuously increased over the past three years. Within this, around 17,200 children and young people (21% of children and young people) in Bristol lived in income deprived households. Employment deprivation similarly has increased, and the statistics showed that around 10% of working age people (29,600) are employment deprived. There is also significant disparity between the deprivation levels across Bristol. Bristol continues to have deprivation ‘hotspots’ that are amongst some of the most deprived areas in the country, yet are adjacent to some of the least deprived areas in the country. This means that the inequality gap is substantial, with access to opportunities, experiences and services greatly unequal between adjacent areas. Birch aims to address this gap, by operating in those areas that are most vulnerable to deprivation. By holding our core programmes in these locations, we increase the accessibility of our services to young people who live within them.

Wider Context

On a national level, research suggests that, regardless of individuals histories and backgrounds, the years between mid-teens and mid-20s are significantly more vulnerable to developing mental health concerns, with around half of all lifetime mental health problems found to have started by the mid-teens, and three-quarters by the mid-20s. A survey of the mental health of children and young people in England found that 12.5% of 5 to 19 year olds had at least one mental health disorder when assessed, and 5% met the criteria for 2 or more mental health disorders. We aim to address this at Birch through targeting our programmes and services specifically for those between the ages of 16-25.

Research also suggests that 16-25 year olds are particularly vulnerable to experiencing feelings of loneliness and isolation, and that this in itself can prompt and heighten mental health and wellbeing concerns for this age range.

The Covid-19 pandemic has significantly contributed to and exasperated feelings of loneliness and isolation amongst young people. A survey from the Autumn 2020 cohort of 16yr olds (now 19-20 yr olds) - found that most participants experienced sudden and complete loss of social contact with peers. Those impacted most severely were young people with pre-existing mental health conditions; young people who receive additional support with learning; those living in households where there is violence and abuse; young carers; those living in a family where someone had developed long Covid, and members of some minority groups, such as LGBT+

Nearly all participants surveyed felt there had not been enough support in terms of mental health and well-being for young people. Negative mental health impacts of the pandemic may be experienced more severely by those young people already isolated, and more vulnerable to risk. A commitment to see all behaviour as communication, combined with recognition of the value of the insights to be gained from listening to young people themselves, is necessary, and is something which we prioritise at Birch.

In addition to this, 16-25 year olds are also particularly vulnerable to mental health and wellbeing concerns due to the transitional period to adulthood which they are experiencing. Once again, transition periods are even more likely to prove challenging for those young people that already accessed traditional mental health services in their childhood or adolescence. The point of transition from child and adolescent support services for mental health, to adult services, is potentially a time of upheaval for young people. Young people may find it difficult to navigate new service settings or to manage their mental health and wellbeing following discharge from child and adolescent services, especially as the availability and type of support can change dramatically.

There are also significant risks of young people disengaging or being lost in the transition process. This can result in young adults presenting again in crisis or with a greater severity of need later in life. Transitions for vulnerable groups, such as those within the criminal justice system, can be particularly problematic. They require close engagement with the young person and, where appropriate, their families/carers.

You can read more about the current wellbeing context for children and young people here:

Isolation can also be exasperated through educational and employment exclusion. Once again, those already most disadvantaged are more likely to experience educational and employment exclusion, and therefore experience more adverse impacts of isolation. Boys and young people from disadvantaged backgrounds (i.e. low socio-economic status, deprived neighbourhoods, etc), and Black Caribbean and students with special educational needs status are significantly more likely to be excluded from school, and permanently excluded students are more likely to experience worse health and well-being outcomes. A recent national study found that permanently excluded pupils reported higher levels of life dissatisfaction and had a higher reporting of lifestyle behaviours that negatively impact on health. As well as this, school exclusion increased the risk of becoming NEET at the age of 19/20, and then remaining economically inactive at the age of 25/26, as well as experiencing higher unemployment risk and earning lower wages also at the age of 25/26. In 2023, the percentage of the population of 16-24 year olds defined as ‘not in education, employment or training’ (NEET) was estimated to be 41.6% , an increase from previous years.

You can read more about the impact of exclusion on long-term outcomes here:

It is widely acknowledged that the foundations for wellbeing include:

• Having basic needs met such as food, a home, rest, feeling safe
• Experiencing positive social relationships with friends and family and a sense of community
• Having the opportunity for a good education, including continued learning through life and to engage in meaningful, quality employment
• Being able to make a positive contribution to wider social and community life

You can read more about the foundations for wellbeing here:

Our approach to wellbeing, centred around a community building strengths based-approach, aims to address these foundations, through our core and fundamental mission to deepen participants' sense of belonging, purpose and resilience. We do this through an early intervention model that provides preventative solutions and a passion for lifelong learning to enable people to reach their potential. We are not Therapists, but offer a therapeutic approach to interventions. We prioritise inclusive practices, where everyone feels safe and welcomed. As well as this, the programmes and services that we offer are designed specifically to facilitate long-term support, so that even past the age of 26, participants can continue to engage with a variety of opportunities.

Early intervention can take many forms. The support that someone needs won’t always be ‘clinical’, and it’s important that we don’t over-medicalise people’s experience of distress. The ‘right’ support will depend on someone’s individual needs, how those needs affect them, the severity of their symptoms, their individual strengths, and their wider circumstances. In some cases, interventions which encourage people to access activities which improve mood and wellbeing such as the arts, physical activity, or nature, may be most effective.

For us at Birch, our early intervention model provides preventative solutions and a passion for lifelong learning to enable people to reach their potential. There is a lack of transition services between adolescent and adult mental health provision. This age group has specific needs and our community mental health model lacks the appearance of a service, removing barriers to engagement. With the Green Social Prescribing trial, a different approach to mental health provision is developing and services such ours are pioneering a nature-based approach, tailored to young adults.

Whilst our programmes are suitable for anyone seeking to spend more time outdoors and meet new people, our programmes are specifically suitable for those struggling with family and relationship issues, struggling to engage with study, socially and emotionally isolated, those not in education, employment or training and those experiencing mental health concerns. Participants are able to self-refer for attendance, however we do have some key referral pathways through organisations in the city, such as 16-25 Independent People, . As such, many of our participants may come to us through referrals which include significant detail around the participants background, which often includes any mental health, special educational need, and family circumstance labels and diagnoses. Whilst to provide inclusive practices and accessibility we do take into account any required adjustments participants may need, however we also take great care to ensure that we see beyond any labels assigned to them throughout their experiences with other services and instead see all of our participants as empowered, unique individuals with ownership and authority over how they wish to present themselves to us.

We actively target people who are under-represented in nature-based groups to access our services, beyond those that live in the vicinity. We ensure inclusivity through all our offers being free at point of contact. With trusted referral pathways with a range of youth services across the city, statutory and non-stat, we reach many who would not ordinarily access either green spaces or MH services. Our community MH model is activity focussed, eroding stigma.

The groups we run are fully inclusive of all types of needs. Our team is experienced at working with a wide range of presentations. In conversation with participants and their support network, we ascertain if what we offer is the right path for them.

We find a culture of tolerance and celebration of difference adds richness to our groups. We openly discuss the edges of this during sessions and encourage consideration of how one anothers difficulties affect us and how one might respond, with compassion for self and others.

Our referral pathways, our Therapeutic Forest School sessions with the ESOL department and partner work with OTR ensure that we reach minority ethnic groups. Consequently we access many who face socio-economic and cultural barriers to engagement. Our work with OTR and Bristol College particularly focuses on young refugees and asylum seekers. These bespoke courses, alongside the individual therapeutic benefit, promote a realisation that they are welcome at our other programmes and we actively encourage longer term engagement to our year-round programs. We provide both reimbursement of travel expenses and food to further facilitate and encourage engagement.

With advice from our steering group, we are altering our marketing materials to actively state that we welcome specific groups with protected characteristics.

Our ambition is to be a truly anti-racist organisation, where we acknowledge and challenge racism where needed, educate ourselves and others about the impact this has on our communities and seek representation at all levels of our organisation.

Another key element of our approach to mental health and wellbeing support for participants is our commitment to providing long-term support. We value community, and the strengths that come from the relationships we form within communities. To feel a deep sense of belonging to a community takes time. Relationships are built on safety and trust, and form a key part of our sense of belonging. Building these relationships takes time, and therefore so does our sense of belonging within a community.

Because of this, the structure of our programmes intends to offer a long-term approach to participant engagement. Our core programme, Fresh, runs every week, and participants can attend from the age of 16 up until their 26th birthday, and are free to engage in the programme for as long as they choose within this. In addition to Fresh weekly sessions, participants can attend our annual Camp Birch, A safe and inclusive 5 day and 4 night camp for 18-25 year olds to try something new, build confidence and skills, and have a moment to pause and reflect on their transition into adulthood. Participants join a group of other young adults from all walks of life to be inspired, to meet new like-minded people and to live together in nature. Pre and post camp mentoring is offered to help participants get the most out of the experience and help them decide what to do next, including a 1:1 session post camp with one of our facilitators. Participants can then join Fresh sessions, as a place to build on friendships made during the camp, create new ones, and where skills and passions can be developed further outside of camp too. This model ensures that long-term, weekly support is available to participants, with Camp Birch annually to deepen relationships and further embed into the community.

Alongside this, we offer several opportunities for those seeking to step up into positions of responsibility that extend beyond the age of 26, for example through acting as a returning peer rep at Camp Birch, holding workshop space at Fresh sessions, or participating in our steering group or shadow board. These opportunities ensure that participants can retain their sense of belonging to the community if they wish to, whilst contributing to the delivery of our programmes as well as further developing their own skills.

Key principles of trauma-informed practice

There are 6 principles of trauma-informed practice that we incorporate in the ways we work with our participants:

• Safety: The physical, psychological and emotional safety of participants are prioritised
• Trustworthiness: Transparency exists in our policies and procedures, with the aim of building trust with our participants and the wider community
• Choice: Participants are supported in shared decision-making, choice and goal setting
• Collaboration: The value of participants' experience is recognised in overcoming challenges and improving the system as a whole
• Empowerment: Efforts are made to share power and give participants a strong voice in decision-making, at both individual and organisational level
• Cultural consideration: Move past cultural stereotypes and biases based on, for example, gender, sexual orientation, age, religion, disability, geography, race or ethnicity

How we do this at Birch

Safety

• The site emergency procedures are displayed, signposted and discussed
• Staff are trained in, and have access to: site emergency procedures, site risk assessments, emergency contact information for participants, emergency contact information for other staff
• Staff are trained in safeguarding policies and practices, and our policies are kept up to date and reviewed annually
• We prioritise psychological safety through our gentle therapeutic approaches to practise
• We prioritise emotional safety through a gentle use of emotion coaching techniques (modelling emotional regulation, naming emotions, exploring emotional responses through reflective practices etc.)

Trustworthiness

• We are transparent about our policies and practices with participants
• We are transparent about our policies and practices with the wider community
• We build trust through ensuring that our actions match our intention

Choice

• Choice of activities each session - there is a range of options offered that include practical tasks that may include both more gentle and physically demanding tasks, creative activities, cookery and food prep, collective reflection and individual reflection
• Participation in activities, social interactions, group reflection etc. is gently encouraged, but there is no pressure to participate - we are clear that participation is an individual choice
• Participants are included in discussions around planning and prepping for different aspects of developing the garden space, for example which seeds we will sow and where, on a short term and longer term scale

Collaboration

• Staff and participants work together on practical and creative tasks
• Participants are gently encouraged to work together on practical and creative tasks, especially when these require teamwork
• We seek feedback from participants from the steering group and the shadow board
• We also seek feedback from participants through surveys, and spoken testimonials
• … and we listen to and act on feedback

Empowerment

• Power and voice is encouraged and developed through our steering group, shadow board, and regular seeking of participant feedback
• Power and voice is valued through adapting our practices based on feedback
• Participants are encouraged to feel ownership over the physical space and activities which we do

Cultural consideration

• Staff are trained on diversity awareness; equality and diversity policies are available and accessible to all staff
• We remove financial barriers through offering a free weekly service, and securing funding to ensure Camp Birch is offered part-funded, on a pay-what-you-can scale
• We openly discuss cultural considerations during sessions and encourage consideration of how one anothers difficulties affect us and how one might respond, with compassion for self and others.
• Our referral pathways, our Therapeutic Forest School sessions with the ESOL department and partner work with OTR ensure that we reach minority ethnic groups.