2.1 Introduction

Within the field of children and young people’s mental health, consulting children and young people in what it is that they want and need within their healthcare is a growing area (Royal College of Nursing 2014: 6). In more recent years, it has gained increasing momentum. The field is progressively moving towards collaborative practice with not just children and young people, but also with their families and carers. Perhaps sometimes as adults, we can lose sight of what it is that children and young people want and need in healthcare settings. Often, this is not done on purpose; we just grow older and further away from childhood. At times we can make assumptions based on what we think it is that children and young people want and need. Sometimes, these are correct, sometimes not, and when they are not it is often not due to bad intent. Of course, the only true way of knowing what children and young people want and need from nurses and therapists is to ask them. Those with lived experience often know what went well and what did not go so well in their care and this should be used to invoke change in practice and within services. Additionally, it is important to consult a broad range of children and young people and hold in mind those that are hard or harder to engage, as they can offer valuable insights (Claveirole 2004: 258). Certainly it is essential to remember that what one child or young person might want or need, another might not. Likewise, what works well in one area of the country might not in another (Care Quality Commission 2018a: 5). Cultures, of course, differ.

2.2 Lived Experience

It goes without saying, within and outside of healthcare, we are all distinct individuals with varying needs (Royal College of Nursing 2003: 2). Although we can look at experiences and collate themes, it is important that we never lose sight of this individuality. This chapter will use lived experience supported by academia, policies and reports to explore what it is that children and young people want and need from nurses and therapists. However, as previously implied, individuality suggests there can never be a ‘routine’ approach as what works for one person may not work for another (Sellman 2011: 20) and this should be kept in mind throughout. Firstly, I shall look upon my own lived experience within Child and Adolescent Mental Health Services (CAMHS), before moving on to other lived experience. Having accessed CAMHS as a teenager, I have my own opinions around what it is that children and young people want and need from nurses and therapists. Of course, I am just one person and this is only my own singular experience. I had my first appointment at CAMHS at age 15, prior to this, I didn’t even know CAMHS existed. I didn’t stay in the service long, but shortly was re-referred and then I didn’t leave the service as a service user until after my 19th birthday. To put it simply, my first experience of the service was bad (and short lived fortunately) but I didn’t know it was poor at the time, as I had nothing to compare it with. I didn’t know it was supposed to be, or even could be any different. To me, the worker I saw felt patronising, showed little empathy and I was made to feel as if my problems were minimal in comparison to others. Ultimately, I became disengaged and left feeling unheard and frustrated. During the time period that I accessed CAMHS, I worked with a range of professionals within a range of settings including 1 to 1 and group. At 15, as a young person sat in front of a mental health professional (any professional for that matter), I didn’t know what it was that I wanted or needed from these individuals. I took whatever I was given to be what I thought I needed. I assumed whatever I was told to be the truth or the right way of doing something, because after all, they were the experts. That is the way I saw it then. It was only after I’d been in the service for a while and seen a few different professionals that I could begin to see what I not only wanted but needed from the people I was working with. It was only in hindsight after leaving the service and reflecting on my experiences as a whole, that I was able to draw out the fundamental elements that I needed in order to move forward and progress within my life.

I doubt that any of the themes in this chapter will come as a surprise. I hope to cement some of the key qualities of nurses and therapists. These can, in an ever-changing environment at CAMHS, be overlooked or overshadowed by other matters. For me, most of what I needed evolved around the individual worker’s personality and attitude. Being able to connect with the person I was working with was the single most important factor. In my own experience, genuine connection equalled progress, with no exception. Establishing a good working relationship came alongside other key components—time and space. I needed the worker to give me enough time, in order to build a relationship, to then feel able to share all the difficult things I was struggling with. I shall discuss these components and more, in further detail later on in the chapter. Next are some thoughts from Danni around her own lived experience.

2.3 Reflections from Lived Experience

2.4 What Is It That Children and Young People Want and Need? Key Themes

Although the nursing field is one that has changed and does change over time, it appears certain elements remain the same, such as the need to be caring and having passion for the role (Peate 2012). When it comes to what children and young people want, Collins et al. (2017: 163) found personal attributes are favoured over information and skill sets. If there was a choice, for example, between the qualities of a physical CAMHS building and individuals qualities, from the above experiences already and from my experiences of others, children and young people care less about environmental issues such as room design, and more about things such as ‘Can I open up to this person?’, ‘Is this person nice?’, etc.

This chapter now turns to the key themes drawn out from collective experience, my own, experiences of fellow young people who became friends, family, work colleagues, acquaintances, children and young people from a range of mental health settings including inpatient and community. They have been collated into the following headings: Consistency, Being Given Time, Working Relationship, Communication, Interpersonal Skills, Participation, Flexibility and Continuance of Care/Good Transitions. In no order of importance, they shall now be discussed in more depth, using examples to illustrate.

2.5 Consistency

Whether this is in regard to community CAMHS or inpatient, consistency is a very important aspect to children and young people and a lot of the time is highly valued. This usually relates to consistency in terms of having a single named worker, as opposed (or preferably) to say having appointments in the same place, at the same time every week (although some consistency in this way can be important too). Of course, it is inevitable that people are off work from time to time and as a whole this is generally accepted. It is common knowledge that we all get ill or need to take a holiday. It’s when children or young people see a different worker time and time again with little or no explanation that it becomes an issue. Perhaps this highlights transparency as important also, in terms of offering a simple explanation if this is to be the case such as ‘there is a lot of staff illness at the moment…’. There can be a frustration in not having an explanation.

2.6 Being Given Time

The themes discussed so far, consistency and time, go hand in hand with the third to be discussed here, developing a working relationship.

2.7 Working Relationship

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