“Don’t medicalise growing up” – words of wisdom from children and young people who are brilliantly ‘blind spot’ free.

It’s been a little while since I’ve written a blog. Mainly I’ve been too busy with the day job and family life; and partly because I was running out of rants that other people weren’t already doing a far better job of raving about. And then I found myself getting all ranty about children and young people being ‘prescribed surf therapy’. Here we go again, I said to myself, ‘othering’ the children who either can’t afford, or are unable to access, or who just hadn’t had the opportunity to try surfing as an interesting and fun thing to do; and only getting a chance when they are desperate for help. Oh and squeezing through a medicalised gateway to access things that make all kids feel better if only they had been encouraged by a kindly and supportive coach. It is why I get so frustrated with the whole concept of ‘social prescribing’. Let’s make these things part of everyone’s lives and cut out the ‘middle-medic’. Or at least let’s stop thinking we are being innovative when all we are doing is recognising and facilitating the things in every day life that keep us all mentally well. Nature, community, arts, sports, activity, healthy food…..encouragement, kindness, persistence, belonging, a sense of achievement……

Then I remembered our Biblio-therapy Scheme – ‘Books to help’. As a service we were so proud of this initiative over a decade ago. Inspired by the adult Book Prescription Scheme that had been the brainchild of Dr Neil Frude, we bid for some under-spend that gave us just 3 months to develop an entire scheme for parents from start to finish. The whole team pulled together; we employed two utterly brilliant psychology assistants for just twelve weeks (that’s how desperate these fantastic folk are for the experience and a foot in the door), along with a wonderful locum psychologist prepared to roll their sleeves up for an intensive burst of activity. Determined to stick to our values and use a relational, developmental and contextual understanding of children’s distress they chose the books and the language they used carefully. They set up a systematic reviewing system including parents, psychologists, and other professionals and settled on the books that evaluated the best by all three groups across a range of topics families wanted most help with. They developed a website and a range of publicity materials and ensured there were copies of all the books in every library. The art work was by a child, of course, and even if we said so ourselves, it was utterly brilliant and evaluated very well.

In hindsight, of course, although we purposefully avoided the word ‘prescription’ we were drawing on a medical model whereby parents turn to their GP or other service provider for help; and one whereby we all feel better when we can ‘give something’, whether it’s a pill, a referral, or a ‘recommendation slip’ to take to the library. We had fallen into precisely the medicalising trap I was ranting about.  I still think it’s a great scheme, although sadly we never had the money or time to keep it updated.  Good quality, accessible and evidence based information is essential. But if we were developing it today what would we do differently? I like to think we would have the courage to step outside the power of the medical model we were trying to influence and expand from within. I like to think we would ensure that books (and apps and films) are equally available in local shops, leisure centres, community centres alongside our health, education and social care settings. I like to think giving and receiving sound advice about bringing up children is something our communities take ownership of and we contribute to; and not the other way around. It reminds me of the brilliant booklet about attachment I picked up at Timpsons when I was getting a key cut. Just out there and ‘free’ for the taking.

It is why I was so inspired by the research Hafal did when they asked young people in 2016 what they wanted from children’s mental health services. “Don’t medicalise growing-up” they said, and “help the adults who are closest to us like teachers to know how to support us”. Their ability to cut through the barriers and unnecessary layers of professionalisation that has influenced how services are accessed is so refreshing. Indeed, this ‘starting from scratch’ view is so essential if we are to truly co-produce services. We thought we were doing our bit by involving parents so heavily in the design of our scheme but we were already ‘in too deep’ to notice our blind spots. We were letting the dominant model; and our desire to play it at it’s own game, dictate our approach and trick us into thinking we were being innovative. Without distracting from the hard work and value the scheme added, and how it has helped many families, the whole idea of basing a scheme about parenting on a model of prescribing is something the wisdom of young people has made me reflect upon…………..what other blind spots will they help us uncover?

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