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We Know What Needs to Change – So why is it still so hard?
by Rachel Stephen, Organisational Consultant for i-THRIVE
15/12/2025
Reflections from the King’s Fund “Building the Healthiest Generation” Conference
The recent King’s Fund conference brought together policymakers, practitioners, researchers, voluntary sector partners and — crucially — young ambassadors. It was one of the first times the room truly felt multi-generational, with young people not simply present but shaping the conversation.
Throughout the day, a striking truth emerged:
The issues young people raised are the same themes the sector has been grappling with for years.
So if we know what needs to change, why is progress so elusive?
Familiar Themes, Renewed Urgency
Across panels and conversations, several consistent messages were repeated:
- the need for cross-system and cross-sector collaboration
- shared accountability across health, education, social care and the VCSE sector
- designing services for children and young people, not adapted from adult models
- genuine co-production and lived experience leadership
- recognising the creativity and trust held by the voluntary sector
- measures that reflect nuance and young people’s preferences
- personalised approaches that respond to who a young person is, not generic protocol
Young people reminded us that many of the challenges they face are unintended consequences of system design, not individual failings.
Two issues, in particular, deserve deeper reflection.
- Technology, Social Media and Young People: A “Dual Truths Dilemma”
Debates about smartphones often fall into two camps:
phones = harm or phones = connection.
Young people made clear that both truths coexist.
They described loneliness, scrutiny, complex online relationships, and the pressure to “get it right.”
Yet they also spoke of connection, belonging, and safety that only online spaces provided — especially during Covid.
As one young person said:
“Adults blame phones, but mine kept me going through Covid.”
The task is not to pick one truth — but to hold both, and design responses with young people that recognise technology as both a risk and a resource.
- Saying “Child First”… Until Risk Appears
This second theme goes to the heart of system change: risk and organisational anxiety.
Many organisations espouse “child first” values. But when risk rises, different forces take over:
- service boundaries
- fear of liability
- organisational protection
- defensive practice
Risk becomes a hot potato, passed between agencies until it lands somewhere unintended.
Two examples illustrate this painfully:
Example 1: A child with anxiety and a trusted practitioner
A young person builds a containing, supportive relationship with a school nurse or MHST practitioner.
When a friendship breakdown escalates into self-harm or eating concerns, their “risk level” increases — and suddenly they no longer fit the service remit.
The case is closed.
They are referred on.
They wait.
At the moment they most need continuity, they lose the adult they trust to help them.
Example 2: A neurodivergent 14-year-old child drawn into a legal process
A child known to multiple services becomes involved in a first-time online offence.
Professionals privately believe this should have been treated as safeguarding, not criminalisation — but feel unable to challenge due to organisational boundaries and fear of repercussions.
The values of “child first” evaporate in the face of system anxiety.
These examples show how risk can override relationship, even when everyone agrees that relationship is what holds children steady.
If we want to build the healthiest generation, this contradiction must be addressed head-on.
What Needs to Shift?
To move from knowing to doing, change must be anchored in the i-THRIVE principles of equity, partnership, accessibility, shared decision-making, co-production, flexibility and person-centred practice.
- Commit to equity and accessibility
Support must be early, flexible and fair — without thresholds that shut young people out.
Every child, in every community, should be able to access the help they need.
- Strengthen shared decision-making with children and young people
Young people want to be partners, not passive recipients.
Shared decision-making creates care that reflects their identity, preferences and lived experience.
- Embed co-production throughout the system
Co-production means sharing power — in design, governance, delivery and evaluation.
Young people must be central to shaping the system, not adjacent to it.
- Protect and prioritise relationships
Relationships are therapeutic.
Systems must ensure they are preserved, especially when risk rises — not disrupted because of service criteria.
- Offer personalised, flexible, needs-led care
Support should bend around the young person — not force the young person to bend around the system.
- Foster partnership and cross-system working
Children’s lives cross boundaries every day.
Effective care requires shared responsibility and shared purpose across health, education, social care and the voluntary sector. Shared responsibility and decision making can encourage systems to remain “child first” in the face of risk – more able to make brave decisions in the interests of children and young people.
Build cultures that can reflect, tolerate complexity and learn
Systems need reflective spaces to think under pressure — otherwise risk triggers reactivity rather than thoughtful response.
Conclusion: Complexity Is Not the Enemy — It Is the Reality
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The NHS 10-Year Plan: Prevention, Mental Health & Our Children’s Future
by Rachel Stephen, Organisational Consultant for i-THRIVE
07/08/2025
The Situation
The newly announced 10-Year Health Plan for England presents a much-needed focus on prevention, signalling a move away from a predominantly reactive, hospital-centric approach towards a community-based, proactive model of health and care. The ambition is not only to treat illness but to create the conditions that help people remain well in the first place.
Among its priorities is a significant commitment to children and young people, aiming to improve long-term outcomes and reduce health inequalities. The National i-THRIVE programme welcomes this shift, especially the emphasis on early support and prevention, with the vision to create the healthiest generation of children ever, very much aligned with our own goals.
The THRIVE Framework for system change places the idea of “THRIVING” at the centre of its approach – that is children and young people who are currently managing the typical ups and downs of life and don’t require specialised mental health support. Approximately 80% of children and young people are thriving at any given time (Wolpert et al 2019), and supporting this majority to stay well must be a priority. Prevention is not only cost-effective but critical to the emotional and psychological wellbeing of future generations. We are seeing a rapid rise in both the numbers and complexity of children and young people facing mental health challenges. To act preventatively, we must first understand the root causes contributing to this rise, and the picture is a complex one.
What We’re Seeing: Understanding the Complexity
There is no single cause, but a wide network of societal, psychological, and structural factors influencing young people’s mental health today. A few of the most urgent drivers include:
- Poverty
This month, the Children’s Commissioner published a report highlighting the scale of childhood poverty in the UK. She describes it as reaching “almost-Dickensian” levels. Children spoke candidly of the shame and exclusion they feel when they can’t afford what others can. These lived experiences underscore the emotional toll poverty takes on mental health.
- Neurodivergence
While neurodivergence itself is not a mental health condition, neurodivergent children are more likely to experience emotional distress due to a lack of understanding, appropriate support, and the challenges of navigating systems not designed for their needs. There is a significant association between neurodivergence and higher Adverse Childhood Experiences (ACEs) (Wilson et al 2024). Studies show that 3 in 10 neurodivergent individuals have four or more ACEs, compared to 1 in 10 neurotypical individuals. In addition emotional burden at school, difficulties with emotional regulation and sensory processing issues all play a role (Lukito et al 2025). - Lack of Belonging
The #BeeWell programme found a clear link between a sense of belonging and emotional wellbeing in young people. Pupils from minoritised ethnic backgrounds, LGBTQ+ groups, and those with SEND report feeling less connected to their school communities, which impacts their overall wellbeing (BeeWell 2024) - Impact of COVID-19
The Royal Society of Medicine recently brought together clinicians to discuss COVID-19’s lingering effects on neurodivergent young people. Their findings suggest that neurodivergent CYP may have experienced more lasting disruption, including challenges in returning to school, increased burnout, and reduced overall functionality (Doyle 2025). - Contextual and Societal Factors
Young people today are facing a very different social environment.
They are:
- Less likely to play outdoors or build community informally (Dodd 2024)
- More reliant on smartphones and social media (NIHR Maudsley Biomedical Research Centre2024)
- More exposed to online harassment and harmful content (NIHR Maudsley Biomedical Research Centre2024)
These broader social shifts all influence their emotional and psychological development.
Our Approach: Supporting Change at Every Level
The National i-THRIVE programme has worked with over 70 organisations across the UK to co-design systems that put children and young people’s mental health at the centre of prevention and service planning.
We support areas to:
- Build collaborative, cross-sector systems of care
- Develop neighbourhood-based early intervention services
- Focus on what helps young people to thrive, not just what treats illness
We know this work is complex. But we also know that working together at local system level is the only way to build sustainable, effective mental health systems for children and young people.
We have learned a huge amount from our national work. One key insight is that change is only possible when everyone in the system is working toward a shared vision of wellbeing, inclusion, and equity.
Get Involved
The problems facing children and young people won’t be solved overnight. But we can make change, by working in partnership, sharing what works, and building from the ground up in order to deliver on the 10 year plan’s aspirations together.
If you’re working to improve neighbourhood services, or want to bring a systems lens to your approach, we would love to work with you. Get in touch so that we can think about how we can collaborate together.