Huge changes to welfare reform came into force last month, with serious implications for many charities and the people they help. We’ve been discussing these changes in the office, and one theme that keeps coming back is the idea that it is getting harder for people to get the help they need—to know what help is available, to find it and engage with it.

In most cases, services, whether state or charity, can only help those who choose to go looking for them, and then to get involved with them. This is particularly true in an area like mental health, where someone almost has to self-diagnose before they seek any kind of support or advice.

How can you seek help for a mental health problem if you don’t know you have one?

One in three young offenders have unmet mental health needs at the time of their offence. But for many, even the concept of mental health is alien. Often, disadvantaged young people’s resilience is through the roof because they’ve had to cope with difficulties all their lives. Stepping back and recognising that how you are feeling, what you are thinking or going through, is not just ‘what life is like’ but is actually something you can change, knowing that the way you think or behave is not inevitable—it isn’t just who you are—is the first step to identifying and getting help for a mental health problem.

A couple of weeks ago, a colleague and I visited the impressive MAC-UK (which Eibhlin blogged about yesterday), a London mental health charity which has developed a unique model to engage some of the UK’s most excluded and deprived young people—those most in need of support, but least likely to access it. At the core of the charity’s approach is street therapy, which takes mental health into young people’s territories on their terms. Teams of mental health practitioners adapt and apply psychological practice to make it accessible. As the charity puts it, ‘Street therapy can take place on buses, benches, in stairwells—anywhere a young person feels comfortable.’

The bar for accessing many services is set pretty high to begin with. So reaching out to the most excluded members of society can seem almost impossible. People who don’t engage with government services, or with charity activity in their communities, don’t get the help they might desperately need, that could turn their lives around. This is where the innovation and creativity of the charity sector, and organisations like MAC-UK, really is essential.

MAC-UK targets young people who otherwise wouldn’t get the help they need, and brings them into existing services. It breaks down the barriers to accessing support; it lowers that bar to engagement. The results are pretty inspiring: of the original group of young people helped by the charity, 75% are in education, training or employment, and 25% are receiving NHS medical care. And in a model like this, success with a few individuals ripples out through a community that is traditionally hard to reach, as they act as ambassadors for the charity’s work to their peers.

The latest round of welfare reforms has raised the bar even higher for people to engage with government services and get the help they need—not just those with mental health needs, but those in poor housing, families with disabled children, young people caring for a sick relative, people out of work who need to gain skills to get back into a job, those living with an abusive partner who need support to escape their situation. It’s the already hard-to-reach who suffer most, as the bar to access help inches higher and higher. Charities have their work cut out to lower that bar and make sure help is still there for those who need it most.

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