We've been listening to young people for 45 years. Is the system finally ready to hear them?
We've been listening to young people for 45 years. Is the system finally ready to hear them?
A response to The Independent Review into Prevalence and support for mental health conditions, autism and ADHD, by Simone Spray Chief Executive at 42nd Street
On Friday 9th October we saw the much anticipated release of the findings of the independent review led by the brilliant and inspiring Professor Peter Fonagy with vice-chairs Professor Sir Simon Wessely and Professor Gillian Baird. This feels like a landmark moment in our nation's response to the mental health and wellbeing needs of our amazing young people.
At the heart of the review is a recommendation that seems startlingly obvious to those of us who have spent our lives in this field listening to young people but could represent a seismic shift if more people actually get behind it.
Support for young people needs to be needs-based, not diagnosis dependant.
The review challenges an over-reliance on clinical diagnosis, assessment and thresholds as gateways to support. Importantly, it’s findings challenge the deeply unhelpful and frankly disrespectful narrative that we are dealing with a 'snowflake generation' who have somehow become less resilient than those before them.
The findings are clear. Young people's distress is real. Their lives are complex, often overwhelming and shaped by financial insecurity, discrimination, cynical social media, unique threats from A.I., uncertainty about the future and reduced feelings of connection and belonging. These experiences rarely fit neatly into one diagnostic category.
And yet we have spent decades building systems that expect young people to do just that.
At 42nd Street, we have been taking a needs-led approach for over 45 years. Listening to the changing and diverse needs of young people across Greater Manchester and beyond and developing our responses with a choice of personalised, young-person informed approaches which include one-to-one therapeutic and psychosocial support, group, peer support, identity- based support, access to nature, self-expression through creativity, digital innovation, residentials and social action.
Everything we offer is underpinned by decision-making and mutual respect. Every day at 42nd Street we see young people who are capable, compassionate, curious, creative, critical thinkers and when their rights, expertise and ideas are unlocked they see and feel their enormous potential.
Last year alone, we worked with 4588 young people and because no one should have to wait to be helped, groups like our Peer 42 waiting room and the creative drop-in at the Horsfall are available to access immediately with no diagnosis required.
Our own Change Ambassadors made this crystal clear in their 2025 Manifesto where they articulated four clear priorities:
- Young people should know their rights and have autonomy over their care.
- Background and circumstances should never determine access to help and support.
- Disadvantaged and disabled young people deserve genuinely personalised, tailored support.
- Young people deserve help to find careers with purpose.
And underpinning all four was an even more fundamental principle; young people should have decision-making power over mental health support including shaping how it is funded in the UK. Not just a voice. Not just a seat at the table. Actual influence over the decisions that shape their lives.
What strikes me is just how closely these priorities align with the findings of Peter Fonagy’s review. That is not surprising, as the review brings an extraordinary depth of research and evidence including a refreshing approach to listening to young people that is, sadly, not always evident across the system
Our health, education and social care systems have become increasingly stagnant. We expect young people to behave like grown-ups while simultaneously controlling and restricting their behaviour, too often dressing up our own adult prejudices in the language of safeguarding and protection.
Don't get me wrong. I am all too aware of how young people can be exploited, how their vulnerabilities can be preyed upon and how essential skilled safeguarding is. However, I firmly believe, and more importantly have witnessed throughout my career, that we strengthen young people's ability to cope and protect themselves by supporting them to explore options, think critically, weigh up risks, make decisions about their own lives and develop a genuine sense of agency and self-efficacy. Not by taking their choices away or limiting them within restrictive clinical boundaries that make personalisation hard and improvements limited.
Young people tell us consistently that they need people that they can trust, who will listen, challenge, guide and stand alongside them. It isn’t just about more services, it’s about how we meet young people – as whole people, not as a diagnosis or as a threshold. That's what relational rights-based, trauma-responsive, creative practice looks like. Which is why I am genuinely excited by the tone and ambition of this review and the anticipated Government response and Mental Health Strategy.
The commitment to prevention, earlier intervention, de-escalation and support based on need rather than diagnosis could mean that young people finally get relevant, timely help in places and ways that make sense to them.
Of course, we will always need access to timely diagnosis and specialist clinical treatment. For many young people, including neurodivergent young people, diagnosis can be hugely important in understanding themselves, securing adjustments, medications and appropriate evidence-based support. Yet many neurodivergent young people wait years for an assessment and they need access to relevant support before, during and after it.
However, reliance on a diagnosis should never be the price of being listened to or helped.
"Complex lives aren't rare, but tailored support for them is. Personalised care is crucial."
That is a challenge to all of us. To recognise the whole young person, their strengths, identities, circumstances, relationships and aspirations, rather than simply the difficulties they present with.
I am hoping (and manifesting) that we won’t take this extraordinary opportunity and simply rebrand the old ways of working.
We absolutely need better mental health support in schools, to transform SEND services, to tackle youth unemployment and expand access to specialist professionals and strengthen clinical provision. Absolutely. However, what we need alongside this – and in equal measure- are different approaches that produce different solutions. I am delighted that the eminent clinicians involved in the review professionally recognise the importance of youth work, creativity, community connection, green spaces and the voluntary, community, faith and social enterprise (VCFSE) sector.
There are a plethora of amazing, tried and tested models and approaches that have been co-developed and evidenced over decades- so let’s find them, celebrate them, scale them and mainstream them as core practice and sustained delivery.
I am interested to explore how the future national policy will endorse and translate the findings into a validated, sustained, impactful eco-system where psychosocial support, social action, arts and creativity, sports, leisure, nature, youth-centred approaches and trusted community spaces are finally recognised as essential parts of our mental health infrastructure. These approaches support clinical and personal outcomes and provide essential life-enduring, protective factors; they are not just nice to have “extras”.
We cannot deliver a genuinely needs-based system without investing in these approaches and the people who make them possible.
However, we cannot keep expecting charities and community organisations to innovate around the edges of systems that remain fundamentally unchanged. This review gives us an opportunity to do something much bigger.
To move beyond treating distress as an individual problem to be assessed and managed, and start recognising the relationships, environments, inequalities and opportunities that shape young people's wellbeing.
To stop measuring success simply by referrals, diagnoses and clinical activity, and start asking whether young people feel connected, hopeful, respected, safe, able to make decisions and excited about their futures.
We need to move beyond a financial system incentivised by escalation; where prevention and de-escalation is only supported when there is “money left over,” or a particularly enlightened commissioner, a supportive and well researched Trust or Foundation or an insightful evidence-enthused philanthropist.
The review itself calls for longer-term, sustainable funding for voluntary and community organisations are core partners.
I am also encouraged that the review recognises that different communities understand and experience emotional distress differently, and that stigma, shame, racism, discrimination and cultural expectations can profoundly shape whether a young person feels able to seek support. This is compounded by poverty, inequality and the structural injustices that make young people's lives even harder. Indeed, young people at 42nd Street often tell us that the current system actually actively makes things worse more often than it helps. This has got to change
The Manifesto written by young people at 42nd Street says “Background and circumstances should never determine access to help and support”
At 42nd Street we have taken this seriously. Not only do some young people experience additional difficulties causing increases in poor mental health, they often then find the services offered difficult to access or identify with and sometimes culturally insensitive when they do. Inequality compounded by structural inequity. Our peer research where we have paid and listened to care leavers, estranged young people, young people aged 16-25 years, young black young men, GEM young women, Muslim young women, Orthodox Jewish young people, LGBTQ+ young people has revealed such insights into how we should understand support and changed our approach to our pathways, workforce, partnerships and programme of support. We have a long, LONG way to go…but we are trying…
The review – like the Milburn Review has a focus on understanding the issues around supporting young people into education and employment, and is careful not to just use unhelpful phrases like “economic inactivity”?
Our Change Ambassadors didn't just ask for jobs. They asked for "careers with purpose."
I think that distinction really matters. Young people want meaningful opportunities, financial security, to enjoy and identify with their work with a sense of belonging and the chance to contribute to the world around them. They want to imagine a future worth looking forward to. We need to recognise how much the world of work has shifted – and continues to shift- and we need to find new ways to ensure young people are welcomed into and can sustain work. Our Careers42 pilot in partnership with the People’s Health Trust and DWP is in the early stages of understanding this and we look forward to supporting the innovation of the DWP and the recommendations of the Milburn Review.
I cannot write any piece on young people’s mental health without finishing on how important it is that we recognise that young people themselves are the most important part of the solution.
Not just as people to consult. Not even as lived-experienced examples in a strategy document or at the top of a Board meeting. But by genuinely sharing power and seeing young people in paid positions as peer practitioners, peer trainers, researchers, artists, campaigners, community leaders and experts- they have the knowledge, ability and tenacity to shape the services and systems around them.
At 42nd Street, through our creative mental health work at The Horsfall, our identity-based peer groups, therapeutic and psychosocial support, digital innovation, youth-led research and campaigning, and our growing work around employment and opportunities, we see what becomes possible when young people have genuine roles, choice, opportunities and influence and to move beyond consultation and co-production as exercises in engagement, towards genuine, shared leadership and decision-making. Here, also, we have much, MUCH to learn.
Young people are not the problem we are trying to solve.
I hope this really is a turning point. I hope we have the courage to challenge the structures, professional hierarchies and assumptions that have shaped our responses for so long and I hope we don't lose the ambition of this moment in another round of strategies, restructures and renamed services.
Because our young people deserve better than that.
They deserve a system that respects their rights, celebrates their strengths, recognises the realities of their lives and genuinely believes in their potential.
Let's use this opportunity to really shake things up, invest in what we know works and, for once, put young people's expertise at the heart of the decisions we make.
And rather than ending with another quote from an eminent professional, I'd like to leave the final words to some of our own eminent young people.
George, 42nd Street Group support:
“42nd Street is really unique as a service, because they are absolutely insistent on young-person-centred care, and they have an unwavering commitment to listening and embedding lived experience voices and perspectives into practice. No other space quite encapsulates that ethos like the Horsfall; it was created in response to the needs and wishes of service users.
“I’m speaking from experience that the one-size-fits-all approach offered by most services just doesn’t cut it … When a person becomes an active participant in their own care, they’re more likely to engage with it rather than drop out.”
Chloe, Young Artist at The Horsfall:
“I’ve experienced many different types of support: more formal support, medication, talking therapies, input from mental health professionals. What comes from being able to create is agency and autonomy. Nobody’s telling me I have to do it this way, so I can take control of what it is I need to get out. Nobody’s prescribing that to me; in fact, I can prescribe it to myself.”
“If we think about what recovery actually means, it’s an ongoing, iterative process. It’s not black and white. The support you may need at the point of crisis does taper out, but creativity is something that stays with you, and nobody can take that away.”
Young Person, one-to-one support at 42nd Street:
'To describe the impact that 42nd Street's support has had on me in a word: fundamental.
I sought a referral for Cognitive Behavioural Therapy after the end of my first experience with mental health support at my university's counselling service, and after a couple months, I received weekly support throughout my third year of university.
Even beyond the compassionate, patient, and uplifting support I received by my therapist, my whole experience was exceptional. I felt a comfort from the moment I would go in, to a weight lifted off my shoulders when I would leave. The quality of the tools and methods varied, and in that adaptation, my therapist was able to provide support that was tailored well to bettering my mental wellbeing. The transparency around using different tools and methods demonstrated the collective culture of the teamwork and constant improvement and continued to inspire my hopes in finding the techniques that worked with me.
I wholeheartedly recommend 42nd Street to young people needing support, and I hope that their services continue to evolve, as I experienced, to ensure that others can benefit from the latest and best support available.'
Young Person, one-to-one support at 42nd Street:
"I've had the pleasure of working with Matt for the past few months (2026) and cannot begin to explain the help and support I was given. I have been to many mental health services before and have often felt disappointed in what I got out of them. This time, I was blown away by not only the sense of professionalism, but the personability of Matt. From the get-go there was a plan and practical aims which we both worked towards, and in all fairness, were lucky enough to achieve. It goes without saying that no one's journey is ever this black and white, but 42nd Street and Matt gave me the help and support I needed to get to the point where my understanding of my own struggles are to the extent that I feel much more in control of them, rather than the other way round. Thanks again to Matt and the team!"
Young person, Jet 42 Group:
“People can look at Jet42 as exclusionary because it’s just for young black men, but I look at it the opposite way. It’s an inclusive space for people who have the same shared and lived experiences.”
“We do check-ins, and they usually take 90% of the session, but for good reason. It gives you a sense of belonging, somewhere you can be unapologetically you and not be judged for it, with people who have your best interests at heart and genuinely care for you.”
Young person, Jet 42 Group:
“I’ve had a hell of a year, but one thing that’s always stayed consistent is that nearly every Wednesday I know there’s a place I can go and feel safe and open to talk. There are times I don’t want to leave my house, but I’ll always try to make it to Jet42 because it’s that important to me.
“We’ve worked with The Guardian and had a major part to play in the Youth Access report. As a young person you can feel quite inconsequential, so knowing that your voice holds weight, holds meaning and is valued makes you feel like you matter, even on days when you don’t feel like you do.”
