Two children playing.

Children's mental health

Rethinking the evidence we use to understand children’s mental health and behavioural difficulties

We’re working with a collective of design researchers and strategists to understand whether and how dominant theories around children's mental health serve families and practitioners.

Key information:

What we are doing together

We’re partnering with Hello Brave and a collective of freelancers to look at the different kinds of evidence used to explain, quantify, and ‘treat’ children diagnosed with mental health and behavioural issues.

One of the messages we have heard repeatedly from families and professionals in our boroughs is that the way mental health issues are talked about, especially in formal settings, can feel incredibly judgmental and blaming of both the child and the adults around them. We believe a lot of this stems from the dominant evidence base.

One of the main positions we take as a programme is that language around children’s mental health, and children’s behaviour especially, is a response to a medical and academic framing of behaviour. As a result, the interventions developed and evidenced as effective often place the blame within the child, rather than recognising behaviour as a communication of how they feel – sometimes distress or trauma. This neglects the social and environmental factors impacting on children and their families – things like unsafe housing, food poverty, and structural racism – and means that solutions are rarely focused on these root causes. This is something we have heard from families and partners repeatedly and was one of the strongest lessons learned from our ethnographic research into so called behavioural difficulties in 2021.

We think this works to pathologise children’s behaviour, particularly Black children and those forced into poverty, whose responses to distress are often perfectly valid and little to do with who they are inherently. Because some children experience these external stressors so much more than others we need to understand mental health as an issue of inequity and social injustice. We know that children forced into poverty are four times more likely to have a diagnosed mental health problem, but the evidence base often implies (or states explicitly) that this is about who they are, rather than what they are going through.

It’s important that this research project is flexible, explorative and iterative. We will learn and modify as we go. Hello Brave will start by carrying out a literature review to better understand the dominant evidence around this issue. Then they will hold interviews with practitioners that support families (like psychologists, GPs, social workers) to hear their perspectives on the evidence, how they engage with it and to what extent they think it serves them and the families they work with. Hello Brave will then develop ways to get the perspectives of children and parents directly.

A lot of the decisions made around children’s mental health are “evidence-based”. This evidence around children’s mental health and behaviour is impacting the trajectory of a lot of people’s lives in a huge way, and forms the basis of how we think about what’s ideal, healthy, helpful, supportive, what works for children and families. But the evidence isn’t faultless, and it hasn’t ever been considered or critiqued by the people it disproportionately impacts. There’s a real need to explore it with children, families, and those who are supporting them within the system of care.

Efun Toni Coker Freelance researcher and medical anthropologist collaborating with Hello Brave

We know that families voices are largely missing from the dominant evidence base around children’s mental health and so-called behavioural difficulties. This means there's often a disconnect between what the evidence says, and how families' experience their children's mental health. We want to invite families to critically engage with the evidence and center their voices and experiences in how we make decisions about the direction of our programme.

Stephanie Woodrow
Steph Woodrow Portfolio Manager

Aims of partnership

This work can be broken down into five key aims:

  1. Better understand the current evidence base and whether it is supporting children and families to be healthier and happier
  2. Find out how young people, families, and practitioners view the evidence base and in which ways they would call for change
  3. Think about how we can broaden and diversify the current evidence base around children’s mental health and behaviour
  4. Understand how existing evidence can be better understood and more thoughtfully applied
  5. Explore how children and families can contribute to and engage with evidence in more equitable and healing ways

Strategic fit

While developing our strategy, questions have emerged about the evidence base that sits behind our academic and cultural understanding of children’s mental health, and particularly children’s behaviour. Questions like the extent to which the evidence base has been built using white Western ‘norms’; the extent to which childhood behaviours are and should be pathologised; and the extent to which current classifications, thresholds and diagnostic labels help children and their families to feel cared about and able to access safe, trusted support.

We hope to answer, or at least begin to answer, these questions by the end of this research project, and use what we’ve learned to keep building on our emerging strategy. This work overlaps with one of our other strategic priorities – to center the experiences and expertise of those most impacted by inequity and oppression in our boroughs (and society more widely). That means thinking about the kinds of evidence we commission, diversifying the kinds of evidence we ‘trust’ and use to inform our decisions, and crucially involving children and families in the design and analysis of evidence from the outset.

Meet the Hello Brave team

Tayo Medupin (she/her), Project Lead.

First-generation Nigerian, aunty, flaneur, plant mum. Researcher, designer, trainer, speaker and facilitator with 12 years of experience. Formerly Innovation Director of Shift Tayo now operates under the name Hello Brave and focuses all of her work on mental health, early years and addressing structural inequalities in civil society.

Past clients include Wellcome Trust, Impact on Urban Health, National Lottery Community Fund, Mellon Foundation, NCT and Alphabet X.

Efun Coker (she/her).

British-Nigerian researcher, facilitator, children’s literature enthusiast. Background in medical anthropology, with 7 years of experience. Champions research design that prioritises participants’ wellbeing, and has delivered training on developing methods to be as inclusive, ethical and engaging as they are fruitful. Experienced with children, young people and parents, and sensitive topics including mental health, debt, gender identity, and parenting values.

Past ethnographic field sites include hospitals, homes, churches and medical schools. Clients and partners include , Cambridge Assessment, LEGO, BBC.

Nicky (she/her).

A Scot, teacher, medical anthropologist and traveller. Nicky is a secondary school teacher and senior leader with strategic school improvement experience who has taught in a range of educational settings. She has extensive knowledge and experience of multi-agency working for children and young people with special educational needs and disabilities (SEND). She has also carried out project work for local authorities (LAs) and a multi-academy trust (MAT) to develop and improve inclusive practice in schools.

Nicky also delivers training for an Autism Education Trust Hub and supports an orchestra to develop inclusive practice in schools.