Arc tries fresh solution to youth mental health crisis

Walking through the doors of the Arc mental health day centre, there is a noticeable absence. Teens slump on large bean bags, while parents work with children to prepare food at the other end of a bright common room. But there is no looming reception desk asking patients to justify why they are there. What would seem normal to an adult was intimidating to the teenagers who gave feedback on the design of the centre.

Arc is part of the Best for You project at London’s Chelsea and Westminster hospital. Every inch of it has been tailored to the experience of teenagers with mental health problems. From renovating the physical space, to training all the staff they encounter, and creating a library of YouTube videos filled with advice, everything is designed to help stop problems developing into crises.

The project is trying to spread its model for mental healthcare across the UK and around the world, hoping to provide an alternative to long waits for care in the community, which often culminate in crises in which teenagers can become stuck for long periods on inappropriate hospital wards.  

Kasim Kutay, the chief executive of investment group Novo Holdings, was a founding force behind the project and helped to fund it, after his own experience when he and his wife turned up in Accident and Emergency with a teenager in crisis. “We were deer in headlights,” he says.   

Kutay recognises that A&E is not the right place for a young person struggling with their mental health. James Ross, clinical director of general paediatrics at Chelsea and Westminster, says it can be “extremely difficult” to manage this group of adolescents. “To be honest, getting through our front doors is some degree of a failure. The aim is not to have got to this point,” he adds. 

Kutay also saw that his family was far from alone: young people’s mental health took a huge hit during the pandemic and has yet to completely recover. One in five children or young people under 25 in the UK are thought to be suffering with a mental health condition, according to the NHS. 

The picture is similar around the world. According to the World Health Organization, one in seven 10-19 year olds globally is affected, with depression and anxiety among the leading causes of illness and disability for the age group.

“From the outset, what we wanted to do was to be innovative enough to deal with what appears to be a somewhat out of control crisis,” says Kutay. “We want to really create a blueprint so that if what we do works, we have really created an innovative approach that others can copy.” 

Young people with mental health problems come to the centre five days a week for four weeks, accompanied by a family member, for therapy and other activities designed to help before a child goes into crisis. 

Tom Lankester, a mental health nurse who helps manage the centre, says it is an environment where they are able to move beyond “firefighting”. Importantly, it is also a space where people are not sectioned under the Mental Health Act, detained without their choice. “This is a voluntary space, you can see even within the four weeks, when certain people really want to use the space and they’re ready to recover,” he says.

An adolescent is not seen for two weeks, maybe three, four, five . . . and then they go from having a mental health issue to a crisis

Kutay believes the day centre is “really important” for preventing crises. “The reason why a lot of adolescents go into mental health crises is they try to get an appointment,” he says. “And of course, the NHS is very stretched. An adolescent is not seen for two weeks, maybe three, four, five . . . and then they go from having a mental health issue to a crisis.”

Best for You is also trying to rethink the entire journey of a young mental health patient. With funding raised by CW+, the charity linked with the NHS trust, they are ensuring rooms in hospitals are better set up for mental, rather than physical, health problems.

This includes safety measures, such as making sure doors cannot be barricaded, making sure there is room for patients to walk about, and training paediatric nurses on how to treat mental health patients. 

The measures are being studied by a team at Imperial College London to judge their efficacy, with the first results expected later this year. 

The model is already being used in Denmark, where it is known as Best for Us. The Novo Nordisk Foundation, which receives its funds from Kutay’s investment company, decided to fund a pilot in northern Jutland. 

But Chris Chaney, chief executive of CW+, admits there are challenges spreading the idea across the cash-strapped NHS. The charity and the NHS raised £8mn to launch Best for You, and while it would cost less to replicate, it would still be an investment. 

“If we turned it up to sister healthcare institutions around the UK and went, the first thing you’re going to need to do is put X million pounds aside to pay for all of this, we’d be laughed out of the room,” he says. “Even if the NHS says we want to adopt this, how fast and how much will be an issue.”