NEST (mental health and wellbeing): summary report

The 'Together for children and young people (2) early help and enhanced support (EHES) workstream' is focused on facilitating a ‘step-change’ in how we support babies, children, young people, parents, carers and their wider families with their mental health and wellbeing.

It aims to broaden the conversation away from just thinking that help is the domain of specialist services. These services are important, but there is much more that can be done to provide support. 

The purpose is to make expertise and advice quicker to access; and to give the grown-ups closest to children of all ages the skills and confidence to understand what they can do to help. 

When extra help is needed, it aims to take a ‘no wrong door’ approach so that families get the right help at the right time and in a way that is right for them.

We have listened to young people, parents, carers and staff who work in schools and children’s services all across Wales. These have included teachers, social workers, The National Youth Stakeholder Group (facilitated by Children in Wales) and Parents Voices in Wales have been especially helpful in making sure we keep focused on what is most important to children, young people, parents and carers.

It has also been important to link with services for adults too, and with housing,
police, ambulance, sports and leisure services. Families, schools and communities are so important in preventing mental health difficulties, but also in helping when children and young people struggle most.

That is why we talk about early help and enhanced support. This is not just about prevention; it is also about intervention including for those of greatest concern.

The more people we talked to, the more we realised how much interest there was in doing things differently. Lots of people across many services wanted to get involved which has been very exciting.

We have learnt so much from listening to everyone’s views.

We also talked to policy makers in Welsh Government, Partnership Boards and Health Boards across Wales.

It is especially positive that ministers across education, health and social care are taking an equal interest in this work as this leads to joined up planning. We refer to this as a whole system approach.

The aim is to bring everyone together across all agencies, services and departments to focus on the same goal – helping children of all ages in ways that support their mental health and wellbeing at every opportunity.

Through talking and listening and understanding what is needed we have developed a framework called NEST. This was chosen for the following reasons:

• The importance of a safe and nurturing base or NEST for everyone’s mental health and wellbeing.
• That all babies, children and young people get the support they need growing up to help them ‘aim high’ and ‘fly the NEST’ when they are ready - but they can return to it if they need to.
• That everyone’s NEST is different, filled with the people, places and activities that are most important to them.
• That many of us, and at different points in our life, will need extra support with our NEST, additional layers working together to help our mental health and wellbeing.

It is these layers of support, coming from the people in our day to day lives that often help us the most. 

There is research to support this and we have chosen the term ‘everyday magic’ to describe the power it has to make a difference. The acronym Nurturing, Empowering, Safe and Trusted were the preferred core qualities our NESTs need to have, chosen by stakeholders during our co-production sessions.

Nurturing (taken care of and cherished)

Empowering (feeling strong and listened to)

Safe (protected and able to be yourself)

Trusted (reliable and there for you)

The NEST Framework is a planning tool for Regional Partnership Boards. It aims to ensure a whole system approach for developing mental health, well-being and support services for babies, children, young people, parents, carers and their wider families across Wales. 

The framework is made up of several sections. The digital version can be developed to link to documents and practice examples as policy and services evolve.

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Here is a brief description of each section and why they are important. But the most important thing is that they all work together to create a whole system approach. All of these things are vital to our mental health and wellbeing, and we can’t focus on one thing without taking the others into account.

The NEST framework helps us keep an overview on how everything and everyone works together to achieve the best outcome.

Rights based approach

A rights based approach is fundamental to all our mental health and wellbeing. Every professional, childcare setting and service needs to understand the importance of this, demonstrating how they put it into practice. Are the children and young people in their care aware of their rights? How does this get enacted day to day?

Equity, diversity and inclusion

To feel included and that you belong and have the same chances as everyone else is also fundamental to our mental health and wellbeing. So many difficulties start with feeling left out, or different, or invisible, or like you don’t count as much as someone else. It is why some issues like race, ethnicity, culture, religion, gender identity, sexual orientation, physical health and disability, neurodiversity, additional learning needs, learning disability, adversity and poverty can put you more at risk of struggling with your mental health. This has to change if we are serious about addressing mental health difficulties. The NEST framework has this as an important priority for all professionals and services to actively address. It balances this with the importance of not defining anyone by these characteristics, but seeing the whole unique person, and focusing on what is most important to them.

Values led

All organisations work in different ways and are designed to do different things. This can lead to differences about what to prioritise and focus on. The NEST framework asks everyone to stop and think about what matters most, and what they should all focus on together to support children of all ages with their mental health and wellbeing. When we did this exercise with a large group of stakeholders from across Wales, these were the values they felt were most important.

Child development

All babies, children and young people are unique and develop in different ways. This includes their physical and emotional development as well as how they learn. The NEST framework asks that this is given more attention than the current approach that often has age as its main focus.

Psychologically informed

We are learning all the time from psychology and related fields about what brings the best out in us as humans. The NEST framework anticipates all services should have access to expertise to enable them to keep up to date with the latest research. Examples like 'attachment theory' (how we learn about relationships as babies and children from the grown-ups around us) and trauma informed approaches (how we respond when we are exposed to traumatic experiences for prolonged periods of time), are new and emerging learning that we all need to know about and integrate into how we work.

Trusted adults

This is the most important section of the NEST framework. It is about the vital role that the proximal grown-ups have in helping babies, children, and young people, with their mental health and wellbeing. Having someone close by who they can turn to when feeling sad, or who understands that anger might be about something deeper that is worrying them is so important. Trusted adults  can help babies, children, and young people to learn to manage their feelings  by listening and empathising, by helping find words for difficult emotions, by showing ways of managing difficulties, and by helping to sort problems out.

Co-regulation, where strong emotions are contained by someone trusted, is fundamental to self regulation and is a vital building block in psychological development. Trusted adults who feel supported to provide this, alongside being able to focus on an individual’s strengths, encourage them to not give up, and celebrate their achievements, no matter how small, provide the ‘everyday magic’ that is so important to positive mental health and wellbeing.

We all need experiences of this; but children of all ages who don’t experience enough of it in their lives for all sorts of reasons, need it even more. Trusted adults help prevent mental health difficulties and they help to address them if they develop.

Wellbeing across education

From crèches, to nursery, to school, to sixth form and on to college, education settings are a big part of the lives of babies, children, and young people. It is vital that they have a good understanding of mental health and wellbeing and take every opportunity to support it in every way they can. Welsh Government really understands this and have developed a range of policies and initiatives to put mental health and wellbeing at the centre of education.

These developments also recognise that this is as important for teachers and support staff as it is for parents and carers too. The NEST framework emphasises the significance of this, and of all services working together to support it.

Co-produced innovation

The NEST framework has been co-produced which means taking on board everyone’s ideas, especially those of the young people and the families it is here to serve. There are so many different points of view that sometimes decisions have to be made about what stays and what gets left out, but the end result is better for having gone on that journey. The NEST framework values this in all services aimed at helping with mental health summed up by the phrase 'nothing about you without you'. It means services stay focused on what matters most to children, young people and their families, and keep on improving. Peer support, where people get help from others who have gone through similar things is also important; as well as using technology to keep things up to date and open to everyone.

Easy access to expertise

One of the biggest changes the NEST framework aims to achieve is to make expert help and advice more available. From helplines, to information, to a regular visit from a specialist to a school or youth service, to multi-agency teams with mental health professionals embedded in them, there are many ways of achieving this. The most important thing is that the grown-ups in children’s lives know where to go for help and can get it quickly if they need it. This makes them more likely to feel confident to work through difficulties with young people, instead of feeling out of their depth and passing them on to someone else for help. We call this ‘holding on’ instead of ‘referring on’ and the aim is to stop families being passed from service to service, and telling their story lots of times, and never quite feeling that they are in the ‘right’ place. Of course, sometimes specialists are needed to take a bigger role, but always with the aim of supporting those closest to children and young people first. This recognises that ‘everyday magic’ can be very powerful therapeutically.

Safe and supportive communities

Babies, children, young people, parents, carers and their wider families need safe places to live, to play, socialise and exercise, along with access to healthy food, sports, arts and leisure activities. Work is an important part of this, and access to jobs that pay well is crucial to well-functioning families. The NEST framework recognises that these things are very important to mental health and wellbeing, and when they are not available then children of all ages and their families are likely to struggle. These are problems that can’t be ‘fixed’ in clinics and their importance often gets under-estimated when we think about improving mental health services. The NEST framework aims to shift this balance, emphasising that these are often the most important things in keeping us well and achieving our full potential.

No wrong door

Sometimes, of course, extra help is needed. This is a really important part of the NEST framework and is all about families getting the right help at the right time and in a way that is right for them. All services that have a role in mental health and wellbeing need to come together to work out how best to meet the need. These services can be from health, education, social services or the third sector. All have something to offer depending on a family’s circumstances. The more services come together to listen to what families need, the more they can adapt how they work together to fill the gaps. Services offering extra help might focus on particular groups of children and young people, or on particular issues. No wrong door helps work out what is working well in an area and what new services are needed. It also stops the big frustration of waiting on a list to find it’s not the right service after all.

Working together

The aim of the NEST framework is to highlight the most important things that support the mental health and wellbeing of babies, children, young people, parents, carers and their wider families, ensuring that all services work together to make them a priority. It emphasises that every relationship and every service needs to be Nurturing, Empowering, Safe and Trusted if we are to build the foundations for positive mental health and wellbeing. These qualities are even more important for those who are struggling most, which is why it is about prevention and intervention. They are also as important for the professionals. We all need to take care of our mental health and wellbeing.

What is your NEST like? What would need to happen to make it more Nurturing, Empowering, Safe and Trusted?

These are the questions we need to be asking if we are to support the mental health and wellbeing of our communities together.

For further Information, contact: nest.mentalhealth@gov.wales