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Insight

We Know What Needs to Change — So Why Is It Still So Hard?

10 December 2025

By Rachel Stephen

A Systems-Psychodynamic Reflection on the King’s Fund “Building the Healthiest Generation” Conference
Tavistock Consulting

The King’s Fund Conference Building the Healthiest Generation brought together policymakers, practitioners, researchers, voluntary sector partners and, notably, a strong youth presence. It was one of the first times such an event felt genuinely multi-generational. Young ambassadors did not simply “feature” — they shaped the tone, disrupted assumptions and held the room to account.

And yet, amidst this energy and clarity, a familiar question hung in the air.

As Professor Sir Michael Marmot named it he said:

“We are failing our children — but we know what to do.

The uncomfortable implication: if we know, why does change remain so elusive?

A systems-psychodynamic lens — which explores how anxiety, organisational defences and unconscious processes shape behaviour — can help us understand why progress is slower than rhetoric implies.

Familiar Themes, Persistent Stagnation

Across workshops and panel discussions, messages long recognised in children and young people’s mental health resurfaced:

These are not new ideas. They reflect a consensus built over decades. The challenge is not vision but enactment.

Systems-psychodynamics suggests that when a system repeatedly fails to act on widely shared knowledge, it is often because anxiety is being managed in ways that impede the primary task — in this case, supporting the wellbeing of children and young people.

Two tensions raised by young people at the conference sharply illustrate this dynamic.

1. Technology and Young People: Holding the “Dual Truths”

Young people described the complexity of their online worlds:

As one young ambassador reflected:

Adults blame phones, but mine kept me going through Covid.

Adults’ responses often split into binaries — phones are harmful or phones are beneficial. But the reality presented by young people contains both truths simultaneously.

A systems-psychodynamic interpretation

Isabel Menzies Lyth’s work on organisational defences helps explain why adults and institutions may default to simplification. When faced with overwhelming or uncertain material — such as the rapidly shifting digital terrain — systems often defend against anxiety by imposing order, rules and binaries.

This is not malicious; it is a way to manage the emotional turbulence evoked by complex risk.

But in doing so, the system loses contact with the lived experience of young people, who navigate these contradictions daily. Rigid policies or moral panics can feel reassuring to adults while inadvertently silencing the nuanced insights young people bring.

To work effectively with digital life, organisations need the capacity to tolerate paradox, hold multiple truths, and resist the pull towards premature certainty.

2. “Child First”… Until Risk Appears

A second tension raised by both practitioners and young people relates to what happens when “risk” enters the room.

Two examples were highlighted:

Loss of the trusted adult

A young person builds a meaningful relationship with a mental health school team practitioner.
But when their “risk level” increases, they fall outside service criteria. The case closes; they are re-referred; they wait. Right at the point where relationship is most protective, it is removed.

A neurodivergent 14-year-old drawn into a legal process

Multiple professionals believed the issue should have been treated as safeguarding rather than criminalisation, but organisational boundaries and fear of liability left them feeling unable to challenge the system.

A systems-psychodynamic interpretation

These stories illuminate what Bion termed a collapse of the “containing function.” In moments of heightened anxiety, organisations can lose their capacity to think. Instead, they revert to procedural responses that protect the organisation rather than the child.

Anxiety becomes projected into structures:

Obholzer and Roberts describe this as a drift from the primary task into defensive practice. The professed value — “child first” — is eclipsed by an unstated but powerful imperative: protect the organisation from risk.

Such defensive routines are understandable. They are also profoundly damaging to the young people experiencing them.

Why These Patterns Persist

Organisations working with children face an unusually intense emotional field. Practitioners encounter distress, trauma, perceived danger, and moral responsibility. Leaders hold societal expectations and public scrutiny. Systems feel the pressure of limited resources alongside heightened demand.

In such conditions, defensive behaviour becomes a predictable — albeit problematic — way of coping.

Common systemic defences include:

These defences are not failures of individuals; they are organisational responses to emotional overload. But unless recognised and worked with, they block the very change the sector seeks.

What Enables Systems to Move from Knowing to Doing?

For Tavistock Consulting, this is the central question:
How do systems develop the reflective capacity to stay connected to their purpose under pressure?

Several shifts are needed:

1. Reclaiming the containing function

Leaders and structures must create environments where practitioners can think, not just react. Containment enables thoughtful, relational decision-making even when risk is present.

2. Building cultures that tolerate uncertainty

Complexity is not a sign of dysfunction — it is the reality of children’s lives. Systems need to strengthen their ability to hold ambivalence and resist binary thinking.

3. Reflective practice as a core operational activity

Supervision, team reflection spaces and cross-boundary case discussions are not “nice extras” — they are mechanisms that keep the system in touch with its primary task.

4. Prioritising relationship continuity

Relationships hold young people steady. Systems must find ways to preserve them, especially at the point where risk rises.

5. Working with, not around, young people’s subjectivity

Young people are experts in the complexity of their lives. Co-production at its best is not consultation but shared meaning-making.

6. Strengthening cross-system collaboration

Defensive practice thrives in organisational silos. Shared responsibility dilutes anxiety and supports joint thinking.

Conclusion: The Challenge Is Psychological as Much as Structural

The conference demonstrated that we are not short of insight, evidence or will. What we are short of are systems that can:

Young people are not asking for perfect systems. They are asking for human ones — systems able to stay with them when things become messy, frightening or uncertain.

As Sir Michael Marmot said:

We know what to do.

A systems-psychodynamic perspective helps us see why doing it is so hard — and what might finally unlock the change children and young people deserve.

References

Bion, W.R. (1962). Learning from Experience.
Menzies Lyth, I. (1988). Containing Anxiety in Institutions.
Obholzer, A. & Roberts, V. (1994). The Unconscious at Work.
Hinshelwood, R. (2013). Systems psychodynamics and organisational anxiety.