European cities supporting the mental well-being of children and young people

Along with 200 other cities, the City of Helsinki is involved in the Eurocities network, the members of which share know-how and knowledge and aim to influence decision-making in the European Union. A meeting of the Eurocities Social Affairs Forum’s working group on children and young people was held on 30 November 2022 in Nantes, France. The theme of the meeting was the mental health of children and young people.

The mental health of children and young people is a hot topic in Europe. For example, the 2022 Health at a Glance report states that nearly half of young European people find their local mental health services to be inadequate, and the proportion of young people with depression symptoms has more than doubled in several EU countries during the pandemic.

Working group representatives from France, Germany, Poland, Belgium, Italy, the Netherlands, Sweden, England, Spain, Latvia and Finland discussed the theme of mental health.

The meeting of the working group involved several visits to the services of the City of Nantes and local organisations. We also heard speeches and presentations on supporting the mental health of children and young people from different perspectives by the City of Nantes and several other cities attending the meeting.

At the start of the working group meeting, we visited Public Primary School Chataigniers in Nantes. As part of a broader national project aiming at overhauling the yard environments of schools in France, 1,000 m2 of vacant asphalt had been removed from the yard of the school. The new yard was built in accordance with the children’s wishes. The overhauled yard features plenty of vegetation and grass, as well as versatile facilities that encourage play and physical activity.

The children took part in the design work by means such as writing and illustrating stories of a schoolyard of their dreams. The urban planning gardeners utilised the children’s drawings and wishes in their work. The end result is a yard environment that invites children to play and learn and is entirely new not just to the people of Nantes, but to all French people. The teachers reported that they have already observed that the new yard environment has improved the children’s mental well-being and learning. For example, they have observed that interaction among the children has increased and become more diverse. Previously close-knit groups of girls and boys and other cliques have begun to mix. The children are more active and play more during breaks. This has resulted in more peaceful lessons and better concentration among the children. The school has also been able to promote the children’s relationship with nature through means such as holding lessons in the yard. The enthusiasm of the teachers and the principal who showcased the school tells us that the overhaul has had a positive impact on the well-being of the adults of the school as well.

Our second visit destination in Nantes was ‘la maison des adolescents.’ It is a low-threshold service centre for young people aged 11–21 and their families. The centre provides help and support to families with issues such as interaction problems between the parents and a young person, depression and anxiety symptoms, challenges with schooling and friendships or questions about a young person’s identity. The centre provides 1–5 tailored work sessions as private, family and group meetings. The work is anonymous. The centre does not monitor the effectiveness of the work afterwards or the service and support path potentially chosen by the young person and their family after the sessions.

The different cities’ presentations on the theme of the working group meeting were diverse and connected to the themes of the working group’s visit destinations. For example, Eurocities representative Emma Cortès from Barcelona talked about the connection that urban planning and different urban spaces have to mental well-being. She presented what is called the ‘Playable City’ perspective on playground design. The City had projects aiming, among other things, at preventing loneliness and providing people with visual impairments with experiences in parks.

Gothenburg representative Inger Jayakodda’s presentation touched upon themes familiar to us Helsinki representatives on the significance of different family centre operators in services for children and families. We were particularly interested in Inger’s presentation of a maternity and child health clinic operating model that includes measures such as intensive and systematic home visits with families with babies aged 0–15 months. The model has been found to have improved cooperation between immigrant families and social welfare and health care professionals. All families with children in Gothenburg are urged to read a lot to their children and are provided with book donations.

In her presentation, Marianne Labre from Ghent, Belgium, highlighted the significance and potential of service integration. Based on observations that she had made in her own work, she summarised the additional value that integration provides to children and families insightfully as follows: “1 + 1 = 3.” Street-level work was considered to be meaningful in work with young people.

The City of Glasgow’s presentation highlighted a systemic, communal approach to supporting the comprehensive well-being of children and young people. While listening to the presentation, we recognised certain aspects in the way of thinking, such as the principles of the ‘Collective Impact’ framework utilised by ITLA. Examples of good practices mentioned in the presentation included peer support groups introduced in everyday school operations. The Glaswegian presenters stressed that even one good adult is enough to change a young person’s life path in a good direction that supports their strengths.

Other themes recurring in the different presentations held over the course of the day on the mental health of children and young people included the importance of children and young people’s participation, the availability of services and the development of know-how.

On our trip to Nantes, we also attended the international ‘Colloque International Villes & Santé Mentale’ conference on 1–2 December 2022. The conference featured plenty of speeches on well-being and mental health from a wide variety of perspectives.

The speeches illustrated how significant an impact and how diverse possibilities urban policies have in supporting the mental well-being of a city’s residents and preventing ill-being. In other words, responsibility for mental health does not solely lie with social welfare and health care professionals. It must be on every sector’s agenda.

We learned from the presentations and panel discussions of the conference how aspects such as good urban planning, regional development, cooperation between different operators, the reorganisation of work and art and cultural activities can yield verifiable positive impacts on city residents’ mental well-being.

What would an ideal city that supports its residents’ well-being be like? Nature, park areas in cities, meeting places for people, art and culture and various flexible ways of working in different stages of life support people’s well-being and health.

Many of the presentations at the conference shared the observation that the pandemic has caused a significant increase in mental health problems among city residents and, perhaps, children and young people in particular. Correspondingly, the conference highlighted the significance of childhood and youth in terms of a person’s lifelong well-being and health. The pandemic has made experiences of loneliness a perhaps, more significant underlying reason for mental health problems than before, regardless of the person’s stage of life.

Unfortunately, Helsinki shares many elements with other cities in terms of both the population’s service needs and service system problems awaiting solutions. We heard plenty of examples of people having to wait for treatment for increasing amounts of time: for example, the municipal mental health services of Nantes currently have 3–4-year queues. Prolonged treatment queues were reported to be prevalent in other European cities as well. There were also recurring messages about how burdened professionals are, and there are broadly shared concerns about factors related to staff attraction and retention in public services in particular. There are significant recruitment challenges all over Europe – or across the globe, based on what was discussed at the conference – especially in social welfare and health care services.

Despite the problems highlighted, we were also given plenty of examples of promising, knowledge-based and even creative solutions. Art and culture are known to have effects that support mental well-being. Experiencing art decreases negative emotions, such as anxiety, depression and sadness. Art supports people’s coping with mental health challenges in everyday life and promotes their self-knowledge and self-esteem. Above all, art experiences create hope and trust, as they reduce social exclusion and support social participation. The conference featured a presentation on a museum therapy pilot carried out in Canada. The pilot aimed at and, according to the results, succeeded in achieving these proven positive effects on people’s well-being.

Another positive aspect was that the presentations and discussions highlighted the importance of improving the communality of cities. There is a need for cities to provide flexible and accessible opportunities to interact with other people. This is one way for us to tackle people’s experience of loneliness, which is a key underlying cause of mental health problems.

It was stated in many discussions that people who experience mental health challenges must be engaged comprehensively as members of society, and their agency must be reinforced. As professionals representing Helsinki, based on the picture painted by the presentations, expertise by experience and co-development with residents, clients and patients appears to not yet have become mainstream in many cities. There was not a single expert by experience among the presenters! Of course, city residents had been interviewed for video greetings shot in the participating cities.

It was highlighted at the conference that even though mental health related matters are discussed in an increasingly open manner, there continues to be a somewhat strong stigma attached to mental health issues in many countries and cultures. Challenges with mental health have become stigmatised, as the illnesses do not manifest themselves merely physically but are instead multifaceted and complex in different areas of behaviour, experience and emotions. In turn, an individual may feel shame and inferiority due to having mental health related symptoms. This can cause a self-reinforcing cycle of negative impacts at the level of communities and individuals alike.

The significance of population-level, research information based psychoeducation in efforts to reduce this stigmatisation was emphasised. Each target group must be provided with appropriate information, for example, in a manner identified as being suitable for children and young people of different ages. Professionals working in different sectors of city organisations play a key role in this. As such, the core message of the conference was aimed at all of us: Identifying and changing stigmatising attitudes and practices starts from each and every one of us!

Text:
Outi Forsström, Senior Planning Officer, Human Resources and Development Services
Marjo Alatalo, Project Manager, Family and Social Services
Sari Della Spina, Senior Social Worker, Family and Social Services

Photos: Sari Della Spina