Case Studies

IceBreak is an early intervention mental health support service based in Plymouth. IceBreak is located at The Zone, a street based voluntary sector agency incorporating holistic provision to 13-25 year-olds through a range of services.

IceBreak works with young adults, 16-25, who are experiencing severe emotional distress, which is impacting negatively upon their day to day life and mental wellbeing.Young adults accessing the service are usually experiencing difficulties such as, forming or maintaining relationships; managing their own behavior; exhibiting self- harm or suicidal behavior; or experiencing a sense of not belonging. Through the work of six dedicated Care Co-ordinators, the IceBreak service offers young adults practical and emotional support, designed to empower them to make the positive steps needed to move forward in their life.

The team primarily support young adults through one-to-one work using a Care Programme approach. The Care Programme sets out achievable aims and goals that are continuously reviewed. The service can work with individuals for up to two years. The level and intensity of support is based on need. For some young adults this means seeing their care co- ordinator every 2-3 weeks, for others this may be two appointments a week.

IceBreak comprises a multi-disciplinary team, with a wide range of experience and relevant skills from health, social care and youth work disciplines, including those with teaching and criminal justice backgrounds. In addition to the core team, a GP with special interest in mental health, a clinical lead and two therapists are also linked to the team and are available to those using the service.

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IceBreak evolved as part of the Department of Health’s national programme to develop services for people with a personality disorder and was originally funded for 18 months. The project’s model was originally developed from the success of Insight – an early intervention service for 14-35 year-olds experiencing early psychosis, also being delivered at The Zone.

It was felt that these young adults were largely not receiving a service as they were too old for CAMHS (Child and Adolescent Mental Health Service) and yet did not qualify for adult mental health services. A key part of Icebreak’s role in working with this age group is to span this gap in provision.

The success of the project saw the funding extended and is now contracted by Plymouth teaching Primary Care Trust.

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There are six Care Co-ordinators in the IceBreak team, each with a caseload of approximately 15 young people. There are approximately 30 young adults at any one time awaiting results of initial assessment before joining the IceBreak caseload.

Referrals mainly come via the local Primary Care Liaison Service, GPs and also through young adults self referring through simply walking into The Zone. Other referral routes include probation, supported housing projects and the local A&E department.

Each new referral is discussed at a weekly clinical meeting where, if deemed appropriate, an initial assessment will be carried out by a team member. This is to establish whether Icebeak is the most appropriate service to support the individual, and to enable the young adult to make an informed choice about whether they are willing to engage with the service.

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Though services are available for people experiencing emotional distress post-18, the intensity and level of support starts to drop off, and subsequently so does a young adult’s engagement with that service. For young people with mental health issues, this can have devastating effects on their later life. IceBreak recognise the importance of working with young adults in a holistic way in order to help them make the transition to more successful adults. Below are some other innovative ways that IceBreak innovatively works with young adults.

Dedicating adequate amounts of time:

Adult services often have limits on the time and capacity that they are able to work with a person. IceBreak, however, considers time to be one of the most important things they can offer.

“I worked with a young lady who was in the leaving care team, and I did an initial assessment with her leaving care social worker... [the social worker] said her responsibility as a leaving care worker was just four contacts a year. We have contact with most of our clients on a weekly basis, and sometimes it’s twice a week. I’ve had somebody walk through the front door and I spent the next three days working with her.” (Care Co-ordinator)

Flexible working:

One of IceBreak’s most important assets is in understanding that young adults are going through a significant period of transition in their lives, as they move into early adulthood. This is a challenging time for any young adult, but set on a backdrop of early childhood trauma, unstable family background and poor attachments, the result is often complex and chaotic. IceBreak builds flexibility into their working to ensure that no young person misses out on help because of other challenges and difficulties in their lives.

“I skipped three or four sessions and I got a letter to say they were gonna delete me off the case-load.... I rang them up and I said sorry, that I just needed to be away, but then we met up, and got a little bit done, but he was really supportive about it.” (David, 24)

Empowering young adults:

Care Co- ordinators always work with the young adult in a ways that empowers them. It is very much about what the young adult wants to do, what they want to talk about and how they want to move forward.

“Every time something is changed, like when I was seeing [J] one week and [L] the next, when it went down to just [J] it was discussed first and then explained why, then it went to every other week, then it was, ‘do you think you can manage three weeks?’. It was discussed every time.” (Matilda, 23)

Linking young adults in with other important services:

IceBreak has a dedicated benefit worker at The Zone, and an associated GP. They also research and then signpost young adults to other services that might better meet their wider needs.

Building self-esteem and confidence:

Underpinning all their work, the IceBreak Care Co-ordinators aim to build self-esteem and confidence in the young adults they work with. This is often the first step in helping them forge the pathway to independence.

“If something goes wrong in my flat, I completely melt down and don’t know what to do or how to deal with it. [IceBreak] has helped me get confidence in dealing with it, helping me speak to people on the phone, ‘cause otherwise I’d just ignore it and hopeitgoesaway.” (Claire,23)

Helping focus their interests towards positive futures: Care Co-ordinators will also try and help young adults achieve their education, training and employment goals. This might be through helping them fill out applications, researching college/ university places with them or just helping them to think through what they might like to do with their lives.

Accompanying young adults to other appointments:

Where needed, Care Co- ordinators will also accompany young adults to appointments with professionals dealing with other areas of their lives, for example Job Centre Plus, GP or psychiatrist, or housing and benefits appointments.

Act as an advocate:

On occasions, the Care Co-ordinators will also act as representatives for the young adults they work with, and speak on their behalf. For example:

“[S] actually went to court with me. And he put in a report, helping me. He put across that [S]’s known me for a whole year, and I was on his case load”. (David, 24)

Link in with families:

Where necessary, and where the young adult wants this course of action, IceBreak will also link in with the young adult’s family to help build support networks.

“A while back I was having major issues with my family in general, and [S] said if I wanted to see him with them there he would organise it. I didn’t want him to, but it was there, which wasgoodtoknow.” (Claire,23)

“When I wasn’t very well last summer, there were huge rifts between both my parents, and my mum especially, so if my mum came round they would talk to her, obviously not just stuff that I’d been saying, but then they would also discuss it with me and say, ‘well maybe you should try this’. So they’d look at the family relationships as well. It was whatever came up for me.” (Matilda, 23)

Finding innovative ways to engage young adults: IceBreak recognises that young adults, particularly those who are most vulnerable, need encouragement and effort to build trusted relationships. This might be about taking them out on trips with other young adults, taking them in to town or meeting them on their ‘own turf’. In some instances, Care Co-ordinators have also worked with a young adult whilst they have been in custody.

“We do anything we can to engage them. That could be seeing them at home, taking them out and doing any activity they want to do, taking them out for coffee. I’ve taken them out to breakfast four weeks on the trot just to get them to turn up.” (Care Co-ordinator)

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