Music to your ears, eyes and brain: scoring gold standards in mental health

The Health Quality Mark scheme helps youth workers promote better health

A group of teenagers meet regularly to learn and play music in Dublin as part of a mental health strategy within the youth service. The Swan Youth Service is based in Dublin's North Inner City. Video: Bryan O'Brien

 

Mental health wasn’t on the agenda when the Swan Youth Service started a weekly music group in the basement of its main centre in Dublin’s northeast inner city.

However, “it became apparent quite early on that the music was bringing up a lot of issues young people were experiencing”, says project leader Eibhlin Harrington.

Especially among those who write their own lyrics.

As she and her youth work colleagues heard themes of heartbreak, poverty, drugs and loneliness being explored through songs, they realised just how cathartic music-making could be for the youngsters – individually, within informal groups and performing for others.

“It helps them express themselves,” she says. “They feel they are being heard and they feel a connection with people with whom their music resonates.”

For Melvin Jamming, music is a way of coping with life. “It helps make sense of the emotions you are feeling,” he says.

He fell in love with the guitar as soon as he saw one at the Swan centre, which he started attending as a 15-year-old after arriving in Ireland from Mauritius a year earlier. Now aged 24, he’s a singer-songwriter who sometimes gigs in pubs but still drops in here most days, to play himself, jam with others or, as a young leader with the project, to help teach some of the younger ones.

From left, John White, Aaron Connolly, Conor McDonnell and Tamzin Brogan. Photograph: Nick Bradshaw for the Irish Times
From left, John White, Aaron Connolly, Conor McDonnell and Tamzin Brogan. Photograph: Nick Bradshaw for the Irish Times

Music has “kept me going, kept me alive and kept me out of trouble”, he says. “When friends were out selling drugs, I would be in here writing.”

Tamzin Brogan (17), who has just done her Leaving Certificate, also drops in here – St Agatha’s Hall on Dunne Street – most days. She plays the guitar and is learning to play the piano.

“I struggle a lot with anxiety,” she says. If there’s trouble at home, “it’s a place I come to play music and get away from stuff”.

Aaron Connolly (19), who started playing bass last January after three years of learning the acoustic guitar, finds it good for clearing the head. “It takes my mind off everything.”

Like the other two, he comes almost daily from his home in Phibsborough. “I am not one of those fellas who hang around the street – I used to.”

Music lessons

They’ve all been taught to play by the centre’s gentle mannered music tutor, John White, a lifetime musician. On a recent Thursday afternoon, he’s giving Conor McDonnell (16) from Darndale his weekly keyboard lesson in an almost-completed recording studio off the main recreation room.

“I only got into music after I got hit by a car,” says Conor. He suffered post-traumatic stress disorder after the accident when he was 13 and discovered that listening to music helped. Now he wants to play it too.

John White, a lifetime musician, teachers at the Swan Youth Service in St Agatha’s Hall, Dunne Street, North Strand, Dublin. Photograph: Nick Bradshaw
John White, a lifetime musician, teachers at the Swan Youth Service in St Agatha’s Hall, Dunne Street, North Strand, Dublin. Photograph: Nick Bradshaw

“It relaxes me,” he says. “It’s what I strive to do every day.” And Conor particularly likes how the more you practise the better you get: “You never get worse at it,” he smiles.

Last year Harrington completed a course in health promotion in youth work, certified by NUI Galway, which is an integral part of a Health Quality Mark (HQM) scheme that was developed by the National Youth Council of Ireland (NYCI). “It really opened my eyes to how broad health is,” she says.

Training

The 15 days of training are run every two years and the idea is that youth workers go back to their respective services to lead colleagues in looking at how they can promote better health for young people, staff and volunteers alike. The HQM, which is awarded at bronze, silver and gold levels, covers 12 criteria that are based on World Health Organisation best practice for health promotion.

Some 19 organisations have the HQM, while two are working towards it and another six are due to start next year. It has to be re-applied for every three years.

“You notice people who have gone through this process are not thinking about health in terms of a range of individual topics; they are taking a whole organisational approach to the issue and they are embedding health across everything the organisation is involved in,” says Louise Monaghan, health promotion consultant and trainer with the NYCI.

When the council is looking for grassroots information to feed back to policy-makers within, say, the HSE or the Department of Children and Youth Affairs, it is the HQM organisations it is most likely to consult.

“We know the work that they do is so good, we’re confident to be able to stand over it,” says Monaghan. 

Mental health issues

Mairead Mahon, director of the Swan Youth Service, which has a gold HQM, says that now they have health promotion ingrained within their organisation, they are looking to contribute nationally. For instance, they brought a group into the Children and Young People’s Policy Consortium, which is chaired by senior civil servants, to discuss mental health matters.

Mental health is the big issue they’re working with at Swan, she says. Due to a lot of shootings in the area in recent times, they are seeing trauma, secondary trauma and community-based trauma.

“Young people witness a lot; there’s surveillance and a general level of tension,” she says. This is on top of problems generic to disadvantaged communities, such as poverty, addiction and low expectations.

“A lot of kids get sucked into things at a very young age; there is intimidation. They all lead to levels of anxiety and depressive episodes,” Mahon adds.

While other HQM youth services may be working in very different settings from Swan, mental health is the top issue for them too. Being neither the young people’s parents nor their teachers, youth workers can develop a rapport that gives them a particular insight into the upcoming generation. Here’s a sample of what they’re seeing and doing:

Co Kerry

Training in “mental health first aid” has been invaluable for staff and volunteers working with Kerry Diocesan Youth Service.

With five youth centres throughout the county and four satellite centres, it sees a high level of mental health issues, says health promotion co-ordinator Rena Powell. Up to 4,000 youngsters, aged mainly 12-20, engage with its youth clubs, while about 700 more are referred for targeted services, such as crime diversion or a drug project.

Anxiety and very poor self-esteem are evident and this is affecting everything the young people do, she reports. Some struggle with suicidal thoughts.

The “first aid” training, completed as part of the service’s programme to retain a gold standard HQM at the end of last year, helps youth workers to recognise early signs of mental health issues and to know “how to support that individual until you get them to the more specialised service they require”, she explains.

Availability of professional help all depends on location. Tralee, for instance, is fairly well served, she says, with a Jigsaw early intervention service and the Kerry Child and Adolescent Mental Health Service.

A lot of our young people would have very adverse situations growing up

Powell has seen big changes during the 25 years she has worked with the youth service – the “major increase in young people seriously struggling around their mental wellbeing” being the main one. She and her colleagues have theories, if no proof, about the root causes.

“We can blame things like life experiences. A lot of our young people would have very adverse situations growing up.”

Others are affected by school experiences, such as bullying or a feeling of not belonging. “They definitely bring that with them into later teenage years.”

Then there’s alcohol and substance abuse. “More substance abuse than alcohol if I am honest; we would have high levels of young people using daily, whether it is prescribed drugs or something else. They become paranoid and dependent on it.”

Social media

Social isolation in rural areas used to be a huge challenge and while it has been alleviated by the widespread use of the internet, that has created new problems.

Social media is very positive in lots of ways but some young people suffer when it’s not used in the right way. What’s more, she points out, its instant nature creates constant expectation.

Powell has no doubt that anxiety issues are on the rise and it is not just a matter of people being more willing to talk about them. To a certain extent, she sees it as a peer-led phenomenon.

If you are daily encountering people with high anxiety and poor coping skills, “you kind of become part of that – it’s like ‘this is how we act’ almost. They certainly pick it up from each other a little bit.”

In saying that, she is not suggesting that they aren’t experiencing genuine difficulties but rather that they are, perhaps, buying into a way of behaviour which is not helpful.

Co Tipperary

After the same-sex marriage referendum in May 2015, the floodgates opened for LGBT questioning by young people, says Pauline Strappe, health promotion officer with Youth Work Ireland Tipperary.

As a result, focusing on LGBT health, wellbeing and identity was the biggest change for the service as it worked to retain its gold standard HQM, which was awarded in June. Operating six youth centres in the mid-Tipperary area, the organisation caters for ages eight to 24.

There is a LGBT support group for the whole county and, with funding from Healthy Ireland, it conducted research into these young people’s needs locally for its new sexual health policy.

“Some are questioning, some are in the zone; there are a couple of transgender young people we are supporting through their journey – and in rural Tipperary that is extremely difficult because there are no services for same,” says Strappe.

The thing that is coming through very strongly in Tipperary is that we have no mental health services

She does mental health awareness work with young people. “They are not disadvantaged groups, and wellbeing would be big in their minds,” she says. But for a colleague who works with young people involved in crime, or at the risk of being involved in crime, there would be greater emphasis on social health.

“The thing that is coming through very strongly in Tipperary is that we have no mental health services – we have CAMHS but the waiting list can be up to two years if you are not in crisis. We have no Jigsaw project; we have been campaigning in Tipperary for 10 or 12 years at this stage for Jigsaw.”

Suicide

A high-profile suicide in Carrick on Suir earlier this year caused much upset – even those who didn’t know the girl were very affected by her death. Youth work can provide one-to-one mentoring and support groups, but “that on its own is not enough”, she says.

During the school holidays, youngsters drop into the centres more frequently, “just for a chat or for the summer programme”. The service has teamed up with the local Sports Partnership to encourage them to try new sports such as paddleboarding and horse-riding. In June, it organised its annual hike up the Galtee mountains.

An Activ8 programme aims to get teens – girls in particular – to do eight activities during the summer that they haven’t done before, “so they are not lounging around”. Some are physical exercise but they include other things such as learning to cook “proper food”. 

Asked if they are swamped or under-utilised, she replies: “I would say both.” Young people speak with their feet so, if they like the youth workers and are comfortable in the space, groups fill themselves.

“You can be swamped,” she says. “You see new faces during the summer because they come in with their mates.”

However, she believes they are under-utilised because parents outside the towns may not be aware the centres are there and also that old image of the youth service being only for young people in trouble persists.

“We’re for everybody,” she stresses, pointing out that life’s transitions, such as starting secondary school, relationship breakups and going to college, happen right across the socio-economic spectrum. “Every young person struggles with those things.”

Strappe sees the three-year cycle for the HQM as “hugely important” for keeping health promotion at the forefront of all strands of youth work. And, after their LGBT initiatives, she thinks “spiritual health” might be the next area to tackle.

It “kind of knits into everything”, she says. Young people may not go to Mass “but they believe there is something there”. She sees their need for a moral compass.

“A lot of young people in today’s world haven’t that moral compass or something to guide them and, the more disadvantaged they are,” she adds, “the less support they have to teach them right from wrong.”

Co Carlow

Significant success in lowering anxiety levels among young people is reported by the Carlow Regional Youth Service, which has been the first youth organisation in Europe to run the Australian “Friends” programme.

It’s the only mental health and resilience programme that is recognised by the World Health Organisation as being effective in reducing and preventing anxiety, explains youth worker Leanne Sweeney. Now she and her colleagues are training other youth workers around the country in how to use it.

Every single young person had a significant reduction in anxiety at the end of it

They piloted it with young people aged 16-25 not in employment, education or training, having identified that it was mindset, rather than lack of education, which was the biggest factor holding them back.

“It was hugely successful. Every single young person had a significant reduction in anxiety at the end of it.”

They run the programme regularly and have recently done it with the 100-plus volunteers involved in running their summer camps.

“As practitioners, when we are in a better place ourselves, it has such a positive impact on our young people,” she points out. “I learnt that when I was training for the Health Quality Mark.”

Having achieved gold in the past, the Carlow service is about to reapply for its HQM. “Oddly enough,” she remarks, the application process is “really enjoyable. It is not just beneficial on paper, it genuinely has a feel-good factor when you are working on the wellbeing of young people and staff.”

One thing it is aiming to do is to move from just having a dedicated group for young people with Autism Spectrum Disorder (ASD), to making all its activities within the eight projects ASD-inclusive.

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