Models and logics of care in youth mental health: a comparative case study of Early Support Hubs in England

Thesis

Early Support Hubs are community-based prevention services designed to support young people’s mental health and wellbeing. In England, policy interest in the model has grown rapidly, culminating in a government commitment to fund and scale a national version. Yet this expansion has outpaced conceptual clarity. Although the literature shows that hubs are accessible and valued by young people, it has not adequately explained how they organise care, what gives the model coherence across different settings, or what logics underpin their work. In this thesis, I ask what model of care Early Support Hubs enact in England, and what logics of care underpin that model?

I used comparative case study and focused ethnography to study three Early Support Hubs in England. Alongside this, I led a national evaluation to develop the co-designed Youth Access Quality Framework for hubs. The case studies provided the main empirical basis for theorising the enacted model of care, while the Quality Framework offered a sector-level account of how quality was defined and made usable for policy and practice.

I argue that Early Support Hubs have moved from a less clearly defined service category towards a more specified model of care. Across the three case studies, I identify shared logics of care: distress understood as social, relational, and material; care as unfolding over time; open access as an ethical principle; and youth voice as a defining feature of hubs. I also argue that trust is one of the mechanisms through which these logics become practice, sustained not only in relationships between workers and young people but through organisational culture, continuity, and institutional infrastructure. Finally, I argue that the politics of evidence in this field have been shaped by pressure to measure outcomes before the model expected to generate them was adequately developed and understood.

This thesis advances understanding of Early Support Hubs by clarifying the model of care they enact in England and the logics that underpin it. In doing so, it provides a foundation for service improvement, policy development, and future research aimed at improving mental health care for young people.

Authors: Hanson, I

• DOI: 10.5287/ora-1z1na1jmr
• Type of award: DPhil
• Level of award: Doctoral
• Awarding institution: University of Oxford
• Language: English
• Keywords: Early Support Hubs; co-design; comparative case study; integrated youth mental health services; ethics of care; youth mental health; quality framework; models of care; focused ethnography; early intervention; trust; youth voice; health services research
• Subjects: Youth; Primary health care; Qualitative research; Mental health care teams