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Mental Health

Has Children’s Mental Health Become Political Fodder in the United Kingdom

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Politicians in the United Kingdom have just announced plans to improve mental health services for children and young people. Leader Ed Milband accused the government of “stripping back preventive services”, and he stated his party is “committed to improving access to services and support”. If Economic austerity is set to continue after the General Election in May, then the current announcements by major politicians will be seen to be just more empty rhetoric with young people set to pay a heavy price.

stat-pageOfficial statistics show the volume and complexity of child and adolescent mental health problems have increased rapidly during the past five years of austerity. Public health enquiries and other research has highlighted the need for a response to meet the overwhelming demand which has stretched existing provision beyond its capacity to cope adequately.

Government policy directives encourage multi-disciplinary and more interprofessional working methods as part of the strategic response yet they do not provide any more finance to increase service provision. Demand has outstripped supply meaning that in nearly every part of the country waiting times for assessment are in excess of 8 weeks while it can take up to 6 months for treatment to begin. This is a long time to leave a child and family without any interventions in place.

The traditional model of service delivery in community Child and Adolescent Mental Health Services (CAMHS) in Britain began formally over fifty years ago. The first child guidance clinic opened in East London in 1948 after earlier limited developments to help children with emotional and behavioural difficulties.  After pressure from Education and Health officials since the beginning of the twentieth century, there were concerned about the abilities and behavioural problems of children brought into the new state compulsory education system. The clinics were comprised of an interprofessional team composed of various professionals with Health, Education and Social Work backgrounds who all brought their separate training, theoretical understandings, and working practices under one clinical umbrella.

Their aims were to intervene with children and families referred for help in a variety of ways where there were concerns about a child’s mental health, behaviour, or emotional development Each team member had distinctive skills and worked with the child, parents, or whole family. In the next twenty five years child guidance clinics grew in number and became accessible to more and more children and families. However, their success in offering support to parents resulted in increasing demand, creation of long waiting lists, delays in treatment, and pressure to prioritise the most urgent and worrying cases. These would invariably include children with severe and longstanding mental health problems, aggressive disturbed behaviour, physical, sexual or emotional abuse, depression, acute anxiety, and suicidal behaviour.

One of the difficulties highlighted in a seminal piece of research 20 years ago was the gap which had been steadily growing for decades between the primary care sector and the specialist child guidance service. A four-tier structure was designed to streamline the referral process for children who could be helped with minor emotional and behavioural problems at Tier 1 by their doctors (GP’s), teachers, social workers and health visitors. This system progressed from Tier 1 through to Tier 4 where very disturbed young people who were at risk of harming themselves or others could be supported by highly specialist staff in forensic work or eating disorders. The idea was based around the simple notion that early intervention could prevent problems from getting worse and thus harder to resolve. However, many believe the constant changes to Primary Care, National Health Service (NHS) re-organisation, and the introduction of private providers has destabilised the system, demoralised staff, and undermined good practice.

Child Guidance clinics were also incorporated in changes brought forward in the end of the last Century, and they were health-led bodies often designed as out- patient clinics in office buildings. When children and young people were consulted, feedback revealed consumers found these services lacked accessibility and were not designed around their needs. Additionally, the services were perceived as unhelpful, stigmatising and unfriendly. The milieu of young people’s mental health does not stick to 9-5 office hours which is often wrapped up with substance mis-use, drugs, alcohol and family breakdown.

Poverty, unemployment and poor housing are also implicated in developing and/or exacerbating mental health problems. What young people required were accessible services open at week-ends and evenings where they could drop-in, with staff who were qualified to work in a variety of therapeutic ways and who were trained in ways that enabled them to empathise and understand young people.

In 2008, the last national report from the NHS demanded increased training for all staff working with young people, more specialist resources, and extra investment in early intervention services to prevent problems arising in the first place. Seven years later the situation appears to be getting worse. Staff vacancies are high, moral is rock bottom, budgets are slashed and demand for help and support is increasing. Early intervention services have been cut back in a classic example of a false economy. The United Kingdom has the unhappiest children in the European Union, according to the World Health Organisation and the Children’s Society charity research.

Suicide is now the second-most common cause of death in young men and women in Britain, yet stigma and shame continue to blight those trying to cope. Three young people commit suicide every day while tens of thousands self-harm or suffer serious depression and anxiety preventing them studying or in some cases even attending school. Working class children feature disproportionately in the numbers affected. School teachers, practitioners, and parents are crying out for resources to tackle these problems.

Steven Walker earned his MSc in Social Policy and Social Work from the London School of Economics leading him into a career in social work and eventually finishing his career as a Principal Lecturer with a dozen academic textbooks published and over 50 peer-reviewed scholarly papers. Steven is also a Co-Author: Safeguarding Children, Young People and Families: A Guide to Integrated Practice. Russell House Publishers.

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Education

Discussing Current Events with Students and Children: If, When, and How?

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Photo Credit: @Reuters

The unfortunate reality for children growing up right now is the prevalence of senseless tragedies. I myself, even as a grown adult, struggle time and time again to make sense of the catastrophic violence that pervades our day-to-day. For my students, I cannot fathom the panicked bewilderment and anxious uncertainties that events such as the Las Vegas attack bring to their frightened, yet curious, minds.

During these formative years, how can we mediate the thin line between informing and frightening our students and children? If we decide that information is power, how do we present such heart-rending topics to young people in a way that equips them to do better for the world? Conversely, if we instead choose to shelter our innocent young people by preserving their naïveté, how can we expect to bring up the next generation to be culturally responsive and informed citizens?

When considering conversations with young people involving tragic current events, such as this week’s Las Vegas mass shooting, adults must be extremely cautious. From the educator’s perspective, I am personally conflicted about my exact role as the adult in the classroom when it comes to conversations of a sensitive nature. Even as a middle school teacher, where my students assert themselves as “informed” or “aware” community members, I find it irresponsible of me to take on the role of informant for other people’s children.

Yes, our students are privy to infinite amounts of and avenues for any and all information, thanks in great part to the 1:1 ratio of school-aged children to smartphones. However, I firmly believe that the family (parents and guardians) know that child best. Therefore, as a teacher, my obligation begins and ends with parental consent. I can, and have, encouraged curious students to speak specifically with their parents about current events and the questions they have regarding those events.

Additionally, as an English teacher, I have provided students with criteria for credible sources, smart searches, and strategies to detect bias and objectivity. But that is where my responsibility ends. This is not because I don’t want to hear their opinions or thoughts on the world’s happenings, but rather because it is not my place to open such an emotional or sensitive topic up to discussion.

Suggestions for parents regarding if, when, and how to broach these types of discussions with your children vary from family to family. Obviously, you know your children better than anyone else. Parents are also in control of the extent of info to which children are exposed. Parents are the gatekeepers of information, charged with filtering, limiting, and explaining the events that you deem appropriate for your children.

If families decide to discuss emotionally-charged current events, such as terrorism or mass acts of violence with their school-aged children, parents should consider multiple factors, including age, social and emotional maturity, and peer influence. Let your children do the talking first. Take the temperature of their background knowledge on the topic before you begin.

Ask if they have heard or seen anything about the specific news story. It is likely that, if your child has a smartphone, she has some level of prior knowledge. Between social media and other communicative platforms, preteens and teenagers are presented with a deluge of news stories, photos, and videos.

Once you’ve gauged their level of prior knowledge, plan to direct the conversation with the goal to inform on a broad scope—do not necessarily delve into specific details, as details rarely serve to comfort or answer questions. A curious teen will inevitably stumble upon more details, but remind your teen to check the validity of the source before forming opinions or drawing conclusions.

Furthermore, be prepared to some answer questions, while leaving other questions unanswered. Especially with unanswerable questions like “how?” it is more than okay to respond with “I don’t know” or “we may never know.” Find some security in the fact that a senseless act will never make sense—and share that important realization with your teen.

Finally, encourage your teen to focus on the heroic deeds of bystanders, first responders, survivors, etc. Tragedies cannot be explained or reconciled, but the focus of the aftermath should always center on taking measures to lift up, help out, and affect change for the better. Always!

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Mental Health

APA Offers Resources for Coping with Mass Shootings, Understanding Gun Violence

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Constant news reports about the shooting in Las Vegas can cause stress and anxiety for people, leaving them with questions about the causes of and solutions to gun violence. Resources on the American Psychological Association’s website can help people with both issues.

One APA resource offers tips for managing feelings of distress in the aftermath of a shooting. “You may be struggling to understand how a shooting could occur and why such a terrible thing would happen. There may never be satisfactory answers to these questions,” it says. “Meanwhile, you may wonder how to go on living your daily life. You can strengthen your resilience – the ability to adapt well in the face of adversity – in the days and weeks ahead.”

Talking to children about the shooting isn’t easy but parents or teachers shouldn’t completely shield them from violence or tragedies. APA offers a series of tips to parents and other caregivers on how to guide the conversation in a proactive and supportive way. “The conversation may not seem easy, but taking a proactive stance, discussing difficult events in age-appropriate language can help a child feel safer and more secure,” according to the resource available in the APA Help Center.

Parents should also watch for signs of stress, fear or anxiety.

For those who feel too overwhelmed to use the tips provided, APA suggests consulting a psychologist or other mental health professional.

“Turning to someone for guidance may help you strengthen your resilience and persevere through difficult times,” it says.

There is no single personality profile that can reliably predict who will use a gun in a violent act, according to a report issued by the APA in December 2013 entitled Gun Violence: Prediction, Prevention, and Policy. There is, however, psychological research that has helped develop evidence-based programs that can prevent violence through primary and secondary interventions.

Written by a task force composed of psychologists and other researchers, the report synthesized the available science on the complex underpinnings of gun violence, from gender and culture to gun policies and prevention strategies.

“The skills and knowledge of psychologists are needed to develop and evaluate programs and settings in schools, workplaces, prisons, neighborhoods, clinics, and other relevant contexts that aim to change gendered expectations for males that emphasize self-sufficiency, toughness and violence, including gun violence,” according to the report.

Gun violence is estimated to cost hundreds of billions of dollars a year in medical, legal and other expenses, not to mention the psychological toll. That is why the government needs to approach it as a public health problem, according to APA acting Executive Director for Public Interest Clinton Anderson, PhD, writing in a blog post entitled No Silver Bullet: Why We Need Research on Gun Violence Prevention.

“Some have argued that we need to focus on policies that prosecute criminals and prevent those individuals who have been found to be a danger to themselves or others from obtaining a firearm,” wrote Anderson. “While these policies have merit, they are clearly not fully effective, and do not address the roots of violence in our society.”

No one policy will prevent gun violence, writes Anderson. “It will take a multi-faceted approach. Funding research that explores these horrific, impulsive acts can help us all inform and adapt our policy approach.”

In another blog post, clinical psychologist Joel Dvoskin, PhD, warned against unfairly stigmatizing the mentally ill by immediately jumping to the conclusion that most shooters have a mental illness.

“Too often, even the most well-intentioned among us believe that most mass shootings are carried out by those with untreated mental illness,” he wrote. “What the perpetrators seem to have in common is the experience of extreme situational crisis.”

Additional resources:

Talking to Kids When They Need Help

7 Ways to Talk to Children and Youth about the Shootings in Orlando

Helping Children Manage Distress in the Aftermath of a Shooting

How Much News Coverage is OK for Children?

Gun Violence Prevention

APA Initiatives to Prevent Gun Violence

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Emergency Management

Rescue to Recovery Stages in a Red Cross Disaster Deployment

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Roy was my partner for most of our deployment with Red Cross on the Disaster Mental Health Team in Texas. We spent many hours on the road mostly on our own, with the exception of “ride to the office” or “back to the shelter” caravans, which could be quite crowded as there were few available cars to ferry us all from the staff shelter to Headquarters for the day.

Conversations stayed rooted mostly in the present, even with kids occasionally Face-timing us in the car when a signal would pop up. I know that he’s been a social worker since 1970 and that he has been married nearly as long. Getting to know each other on a disaster mental health deployment is a different way of knowing someone, but knowing them well regardless. Similar relationships are built with the people you sleep a couple of feet from in the staff shelter.

Roy: “Wasn’t there a band people used to like called the Dead Heads? People liked them but I think they’re dead.”

Roy, In response to a question about breakfast: “Right I’ll give you another rotten orange in the morning.

Kristie: “No thank you; that coffee was sufficient.”

Roy, just go ahead and get in the wrong lane again for this right turn.” (Texas “turnarounds” can be a nightmare).

There was the normalcy of the city center recovering, demonstrated through open shops and Home Depot’s parking lot was nearly at capacity. Starbucks opened, there was a carafe in HQ for one of the lucky teams.

Vulnerability and exploitation were visible not far from the city center. Compounding issues plague those who struggled prior to the disaster. Living paycheck to paycheck when there is suddenly no paycheck creates a domino effect of financial disaster. You can only call the companies to beg for mercy if your phone works, if there are enough bars available to connect you. The smell is rising in neighborhoods, and the question, “What is that smell?” was more frequent today. Mold grows rapidly, and you can smell it from the street.  Weeks have passed since the initial disaster, but it is just beginning to unfold for many people do not have flood insurance.

I ended up making a call to the Attorney General’s office regarding landlords who are refusing to remediate damage and demanding rent from those who cannot pay (or live in their home), with the threat of their things being sent to the dumpster. The police were empathetic but said that it’s a civil issue and in a disaster needs to go to the AGs office. So the wet carpet stays with children living inside, and they lack healthy food- maintaining on what looks like a vending machine diet.

There are contractor company scams that further exploit the exploited, and many workers are being brought in from surrounding areas without protective gear (notable lack of face masks) and clearly without reasonable hours or meal contracts.

On the other end of helplessness and anger, I felt in awe of all of the volunteers and what they do. They respond at the crack of dawn to Headquarters to work with a team using colored post it’s on the wall to map progress and hot spots for the day. Knowing that it’s likely that at the end of the day, they will have gotten sidetracked from the need that was directly in front of them, feeling regret for not making it back to the places they know are in desperate need but are now blocked by factors beyond their control.

Headquarters experienced an evacuation- someone screamed, “Get out! Get out of the building!” It turned out to be some off-gassing cones, but everyone went right back to work outside while standing outside the building waiting for clearance entirely unfazed.

Volunteers will talk it out with each other back at the shelter late at night, eating cold leftovers from the ERV (feeding) vehicles. Informal meetings run from their cots which will make a difference the next day in how resources are allocated because drivers are sleeping next to mental health, nurses, and those doing communications assessments. If you end up both eating and securing a space in line at the shower trailer behind the civic center before it’s too late, it’s something of a miracle. With a lot of contamination and illness going around, it’s best to just throw away the shoes on your way out.

As for the people we served, we realized the depth of desperation that is held for those in areas without good water. Your clothes were washed away or were contaminated, and even if you could wash them, you can’t because your washer and dryer is flooded (one family had some kind of snakes in theirs) as is the laundry mat down the road.

We brought restaurant workers wearing their last items of clothing and shoes serving people in the only community restaurant to open back up in Port Arthur in a certain radius, knowing that those clothes too, would soon be dirty. So what then? How long will this all take? While you may see signs of recovery in the city center, it’s clear that this is going to take so much longer for others, and the rural areas are barely touched by “helpers”.

The depth of this disaster isn’t something that we are used to covering, Katrina taught us a few things that are applicable, but each disaster is its own, and this scale is unimaginable. Puerto Rico is now unfolding as we watch on our screens, in some sort of mass denial of scale.

Most of us can sit comfortably behind our devices and all caps “GET TRUCK DRIVERS!” and while I can personally imagine the barriers that they have in distribution as we just experienced them in Harvey, you just can’t know unless you’re there and are using all of your five senses.

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