Addressing the social determinants of youth mental health in Newham and Northern Devon: reflections on co-design and systems change

Despite increasing efforts to provide support for children and young people’s mental health and wellbeing, rates of poor wellbeing and probable mental health disorders continue to rise. This underscores the need for approaches that target the root causes and social determinants underlying these issues. This paper offers reflections on efforts to address these determinants at the local level, drawing on learning from the co-design phase of Kailo, a research and design initiative that works with young people and communities to shift the underlying conditions sustaining poor mental health and wellbeing, including resources, policies, relationships, and mindsets. Across two pilot sites, Northern Devon and Newham, the Kailo programme used a community-based co-design methodology and a structured process for reflective, iterative learning. Participants included young people, community partner organisations, local professionals, academics, researchers, and designers. The co-design process was integrated with research synthesis and systems mapping to ensure that emerging strategies were informed by lived experience, empirical evidence, and a systemic lens. Four co-design strategies were developed through this process, involving over 300 young people and community members across the two pilot sites. While the intention was to support upstream prevention and systems-level transformation, most strategies ultimately focused on individual-level interventions. Nonetheless, the process generated important learning about the barriers and enablers to developing systems change approaches targeting social determinants and preventative action. Systemic co-design offers potential for developing youth-centred, locally situated policy and practice interventions. However, careful attention must be paid to the composition of co-design teams and in relation to who is included, who is more broadly engaged, and who is kept informed. This is particularly crucial when exploring system-wide solutions, rather than focusing solely on the immediate experiences of participants. While the significance of addressing social determinants was acknowledged and explored during the initial phases of problem identification and understanding, effective action in this area requires sustained collaboration, not only with young people, but also with other community members who hold valuable knowledge and experience regarding the use of, and opportunities within, systemic levers necessary to support transformative change.