A Year Like No Other; reflections on my journey so far as Chair of the Early Help and Enhanced Support Workstream for T4CYP (2).

I realise I am leaving myself wide open here – but April Fools Day has been a very significant date throughout my career for one reason or another. The 1st of April was when myself and my job share partner Rachel Williams first came into post as Joint Heads of Child Psychology for Gwent in 2002. Twelve months ago, exactly 18 years later, I took up the role of chairing the Early Help and Enhanced Support Workstream of the Together for Children and Young People Programme for one day a week. Just about every other year in between ‘month 12’ has been marked by the frenetic transition from the end of the last financial year to the start of a new one and all the angst/relief/hope/fear wrapped up in that.  Unusually this year it falls during the Easter holidays and so I find myself in a reflective space, looking back on what has been an extraordinary 12 months in so many ways.

Unlike just about every other aspect of life Covid has not hindered, and may even have helped this particular role. Firstly, we were already knee deep in a pandemic when I started so any plans had to be made with that in mind. Believe me it is much easier working out how to do a new job virtually than trying to work out how to do an old job – especially one that is dependent on relationships and connection. Suddenly I had access to people from all across Wales – youth groups, parents, carers, and front line professionals working in every sector – and all from my ( and often their) kitchen worktop. I could drop into established meetings and present for 15 mins or set up our own meetings and talk for hours! We could hold focus groups that teachers could join from their caravans in August and parents could join in their lunch breaks from work. We could film video logs on phones to explain the journey we were on, and narrate power point presentations that anyone could watch at their leisure. As a psychologist I am the first to say there is no substitute for human connection, and it would have been fantastic to meet up in person. However what we lost in depth of relationship we gained in spread of view and that is so important for a Framework that aims to include everyone.

The Early Help and Enhanced Support Work Stream’s task is to develop a planning tool to help Regional Partnership Boards to address the ‘missing middle’ – the gaps in knowledge, services and structures to support the mental health and well-being of babies, children, young people, parents, carers and their wider families across our communities. Co production is one of the five pillars of the T4CYP Programme, alongside Evidence Informed, Values Driven, Digitally Enhanced and Needs Led. Over the course of the journey so far towards developing the framework more than 220 hours of co-production have taken place; and the process is ongoing with continuous improvement built in. Every person we have spoken to has helped shape the direction; and the gems of insight, reflections, ideas and challenges from across such a broad range of stakeholders has been, and continues to be, inspirational.

We started with the views of our National Youth Stakeholder Group, a diverse forum made up of young people from across Wales, all of whom have experience of  mental health services. Building on the Hafal Report ‘Making Sense’, the landmark document ‘Mind Over Matter’ and a stakeholder event focused on the ‘Missing Middle’ in June 2019 we weren’t starting from scratch. The guiding principles were ‘don’t medicalise growing up’ and ‘help those who are closest to us, like our teachers to understand how to support us with our mental health’. The ideas from the group about how to operationalise this were phenomenal, and a penny drop moment came when one young person said ‘its a bit like Maslow’s hierarchy of need, we need to focus on the basics first’. Here is one of the early the vlogs we shared to start the conversations:

https://t.co/BBYPaKbzIg?amp=1

It was absolutely brilliant, and more than a little nerve wracking, to return to the Youth Stake Holder Group recently and share how far we have come since that first meeting nearly a year ago. There is now a finished Framework, and accompanying documentation about to be translated into Welsh; and the early concept for a digitalised and interactive tool due to be launched in a few weeks time. I won’t give away too many spoilers but we were delighted with the feedback the young people gave on how it looks so far, and their hopes for what it will achieve in practice.  They were especially pleased with the co-production journey, and hearing the very tangible differences their ideas have made. The concept of the ‘full circle of co-production’ has been really important to them. It seem obvious of course, that they should want to know the impact they have had but unfortunately it doesn’t always happen in reality.

Indeed, the energy and enthusiasm for this piece of work from across all stakeholders is really exciting to be a part of. It has been an absolute privilege too, especially at a time when hope and a vision for the future feels difficult to focus on. In addition to the Youth Stakeholder Group, there are so many people to thank for the contributions they have made, starting with the very proactive Parents Voices in Wales who have been alongside the developments every step of the way. Teachers, Youth Workers, GPs, School Health Nurses, Youth Justice, Police, Ambulance, Therapists, Social Workers, Housing, Third Sector Organisations – if they had an interest in mental health and well-being they were invited to share their views. We have been careful not to reinvent the wheel, drawing heavily on the inspiring work of leaders in the field – from the amazing Karen Treisman who has helped us significantly with her insights, to Kim Golding, Bruce Perry, and the work of the Anna Freud Centre to name but a few. Having lived and breathed it for 12 months it feels very strange to be pressing pause whilst the finishing touches are pulled together by people with a very different skill set to my own. But I will leave you with a taster…..

The framework is called NEST (NYTH in Welsh) because everyone needs a NEST to support us to grow strong, aim high and be the best that we can be. A NEST is there to come back to if we need to as well. Our NESTS are unique, made up of layers and layers of connections and experiences with the people who are closest to us, the things that we enjoy and the places we go. If our NESTs are to support our mental health and well being they need to be filled with experiences that are Nurturing, Empowering, Safe and Trusted. These happen in our day to day interactions at home and in our schools and work places, with our friends and in our communities. They create a sense of belonging and provide the ‘every day magic’ that give us hope, help us feel valued and taken care of, and lift and encourage us when life gets hard. Every baby, child, young person, parent and carer needs access to these experiences across their lives, and those going through the most difficult times need it most of all. The framework aims to build it into every environment and every context, supporting front line professionals to understand why it is so important, and why it can sometimes feel difficult to provide. When people are really struggling they may even reject it, leaving us feeling like we are failing and someone else would know what to do. Indeed, these are often the times it is needed more than ever, and persevering can make the difference. Quick and easy access to expertise to support this, alongside ‘no wrong door’ if and when extra help is needed is essential if we are to create NESTs that are truly Nurturing, Empowering, Safe and Trusted for everyone.

The NEST/NYTH logo above was co-produced  to capture the concept of the Framework.  Young people were clear they wanted something that was inclusive regardless of age, gender identity, sexual orientation, race, culture, disability, neurodiversity or indeed any other difference. I love how everyone sees something different in it – from the layers of support we all have a responsibility to provide to help everyone be the best that we can be, to the sun rising above the rolling hills of Wales! I am really excited about sharing this work in more detail at the launch in a few weeks but in the meantime we would love to hear your thoughts on the journey so far.

See Saw Margery Daw does mental health need a new master?

I’ve just written a blog aimed at new parents in the context of Covid. It has plunged me right back to when my children were babies and to my own childhood too. That is the thing about lockdown – you have time for your thoughts to wander – for good and for bad. I was remembering nursery rhymes and See Saw Margery Daw came to mind. Then it dawned on me that I rarely notice seesaws these days. They were always the first thing we would run to in the park – the thrill of the bounce at the top, and the glide down to the bottom being the draw. But in reality it was so hard to achieve, so dependent on who you were with, their relative weight to yours, and how serious they were about ‘getting it right’. The realisation that it wasn’t going to work, and being stuck either at the bottom or at the top was so disappointing we would run off to find something else. Occasionally I would brave it on my own by standing in the middle – desperate to find that ‘sweet spot’ where you hover between one side and the other. It was scary, and rare to achieve but thrilling too. We would always go through the same ritual every time; never quite ready to let go of the possibilities that the seesaw held.

In true lockdown mind wandering style this whole scenario made me think about all too familiar struggles we have in mental health services; and how achieving that balance, the ‘sweet spot’, can be so hard without tipping one way or the other. It was very present in my blog for new parents. On the one hand, Covid has resulted in devastating losses – from partners not being able to attend scans and even limited access around the birth, to restrictions on just about every aspect of life with a new baby. On the other hand, and this is the ‘sweet spot’, it has provided more opportunities to just ‘be’ with your baby, and from the babies perspective this is all to the good. By focusing too much on how wonderful this opportunity is would deny altogether the reality of the costs; but by over focusing on the negatives risks leaving people feeling hopeless and stuck in their grief about what should have been. Feedback from the blog suggests it hit the ‘right spot’ for some, but I am less likely to hear from the ones for whom I got it wrong, and there will be many I’m sure. Of course, it mostly depends on the moment it ‘catches’ you. Interestingly some of the most positive feedback came from parents to be and those who went through lockdown with a baby first time around; and are relieved to see the experience through a hopeful lens. Also from professionals, grandparents and friends as it gives them ‘something’ to offer new parents at a time that has left them feeling utterly helpless. I have heard little from parents going through it right now, and of course they are less likely to have the headspace to even read it. Here it is if you are interested:

https://weneedtotalkaboutchildrensmentalhealth.wordpress.com/2021/01/16/3-and-getting-through-lockdown-with-a-baby/

Achieving that balance of truly understanding someone’s pain whilst at the same time offering hope is at the crux of what mental health services are all about, and is the ‘sweet spot’ we all strive towards. Sadly though, for many we are still getting it wrong. The raging ‘diagnosis debate’ immediately springs to mind when I think about this dichotomy. On the one hand to have your difficulties described as a disorder can be very validating. It means they have been taken seriously and elevated from the ordinary to the extraordinary. It also offers hope that people have been on this path before and the experts know what to do to help. On the other hand, it unhelpfully implies that there is a clear and absolute line that people are on one side or the other of – you either ‘have a disorder’ or you ‘don’t’. It also risks losing sight of the individual, and the many contextual factors that may have contributed to how they are feeling and what they might need. The ‘problem’ becomes located within the person and seen as their ‘disorder’ rather than a complex interaction of many things over many years; often external and beyond their control. This can be very disempowering, as though they are some how at ‘fault’ or ‘disordered’ and need to be ‘fixed’. It also focuses the solutions on them rather than the root causes of the difficulties.  For example, is it helpful to tell a child they have an anxiety disorder when they are terrified of school because they have been bullied every day? One family might think “yes! it shows how serious it is and helps us know what to do!” Another family might think “Why should my child be labelled as having the problem when it is because of how they have been treated? School needs to sort the bullying problem out and take steps to make my child feel safe’. The children themselves will also have a view, and that may be different altogether.

Of course it is rarely so black and white, and a ‘both/and’ approach where the child and family have access to support and strategies if they want them, at the same time as the wider issues being recognised and addressed proactively is ideal. Currently, however, most mental health services are set up to work with the individual child, and often require that they meet the criteria for ‘disorder’ before they can even access help in the first place. Going back to our seesaw, this heavily weights the balance in one direction, the individual, and despite the best efforts of most practitioners who do formulate more broadly, the wider work is hard to achieve. Pressure on services, waiting time targets, increasing rates of urgent presentations all keep the focus on the individual with the wider work seen as ‘a useful addition’ rather than core. Covid helps to shine a light on this bias with the increased concern about mental health that it raises. It begs the question: are we going to go down the road of declaring that the pandemic has created many more children and young people with ‘disorders’? Or do we need to acknowledge as a society that it has impacted distress levels significantly for very obvious and understandable reasons? And if we do choose this then will we also choose to pay more attention to the other contextual factors that impact mental health like poverty, discrimination and adversity, all of which existed long before COVID, and have only served to exacerbate its impact?

Back to the seesaw. At the ‘acknowledging distress vs offering hope’ level clinicians very much put children and families at the centre of helping to find the ‘sweet spot’ that is unique to them. We are open to listening really hard to feedback; and changing our approach accordingly (or at least we certainly should be!) What we are less good at is putting this voice at the centre of service design. We are getting better at co-production, but I’m not sure that it is at the level that asks the big questions. For example,  what should the balance of focus be between the ‘individualised approaches vs wider determinants’ and the ‘disorder led vs needs led’ debate? These are unsettling questions – both for service providers and service users alike because they challenge the status quo. However, a bit like standing on top of the seesaw, the ‘sweet spot’ that we can potentially find when we ask them together is well worth the risk.

Barry Mason, a renowned Family Therapist, referred to such a leap of faith as moving towards ‘safe uncertainty’ in his classic paper from 1993. I heard the sad news that he died today and so I am dedicating this blog to his legacy.

Mason B (1993) ‘Towards Positions of Safe Uncertainty’. Human Systems 4 (3-4) 189-
200.

3…..And getting through lockdown with a baby

During the first lockdown I wrote two blogs – one focused on supporting families with young children, and one focused on families with teenagers. They spilled out of me on that first weekend when we were still adjusting to the shock – my desperate attempt to ‘do’ something when actually my overriding feelings were of helplessness and inadequacy. They turned out to be more useful than ever I imagined, clocking up nearly 25,000 views between them. That is why I have decided to write another that focuses on supporting new families. There is already lots of brilliant people producing lots of brilliant information about this which has stopped me until now; but if just one new parent (or parent to be) finds it helpful or reassuring then it has been time well spent. And as it turns out I have quite a lot of time at the moment!

My previous blogs centred around acronyms – C.A.L.M for younger children, C.R.A.P for teenagers with O.A.K for their parents. You can read them here if you are interested. https://weneedtotalkaboutchildrensmentalhealth.wordpress.com/2020/03/27/tips-to-share-with-children-to-help-them-cope-with-the-new-normal/

https://weneedtotalkaboutchildrensmentalhealth.wordpress.com/2020/03/29/2and-getting-through-lockdown-together-with-teenagers/

The acronym I have gone for when it comes to babies is T.R.U.S.T. Firstly because the letters help me to describe the key ingredients that thankfully are available in abundance during lockdown. Most importantly, though, because it sums up perfectly the message I want to give to all new parents about their own abilities to get through this in a way that causes their baby no harm or disadvantage and actually provides opportunities to make those early weeks and months even more enriching.

T.R.U.S.T

T – Time

The one thing this pandemic has given many of us is time with our children – whether they are babies, toddlers, school aged, teenagers or young adults. They are at home with us or we are at home with them in ways we never could have predicted. The amazing thing about babies is this is what they want/crave/need/love more than anything else. That is not to say it isn’t also one of the toughest things about this pandemic for parents. It is often exhausting, stressful, boring and relentless. All of that can be true AND our babies can be benefiting from it as well. Lots of parents worry that their babies aren’t getting out and meeting a range of people and doing a range of activities. Of course, there are huge disadvantages and losses to this, but mainly for the grown-ups. Babies can get most of what they need just by having you near.

How you spend that time doesn’t really matter either to babies so long as you are together. They are fascinated by the most mundane of tasks – whether it is putting the bins out or sorting out the sock drawer. That is the wonderful thing about babies – so long as you are interacting with them they will be benefiting, regardless of what the focus is. Talking them through the boring jobs provides so many opportunities  for relationship and language development – from colours to shapes to patterns to numbers to letters to textures to smells to tastes to feelings. You name it, if you provide a running commentary of your day your baby will be taking it in. Even better if these are regular activities that happen throughout the day or week. Repetition, explanation and demonstration are all the tools you need to give your baby the best possible start in their development.  They especially love your face so look at them as often as you can. They will be enthralled by the stories you tell regardless of how dull they seem to you. When it comes to parenting, this adoration for all that you do slips out of childhood like sand in an hour glass – make the most of it!

R – Rhythm

Babies also love rhythm – whether it is swaying, rocking, patting, singing, dancing, clapping, bouncing or walking back and forth. Century old lullabies and nursery rhymes embody this and are loved by babies all over the world; passed down through generations. Indeed, the idea for this blog came when I saw a nursery rhyme on twitter that I used to sing to my own babies but had forgotten all about – and never actually seen written down before! Some parents feel self conscious about singing but babies don’t care how in tune you are; and to them you are the best singer in the world. They also don’t care if you get the words wrong. Again this tolerance reduces dramatically as they get older so make the most of it! I do occasionally try and sing this one to my now 16 and 19 year old if they are having a tough time. It can go either way, but mostly it helps me!

Ally Bally, Ally Bally Bee

Sitting on her daddy’s knee

Greetin’ for a wee penny

To buy some Coulter’s cand – y

One of the most powerful demonstrations of the impact singing like this can have on babies came when I volunteered for Roots of Empathy. This is a school based programme where a parent and baby comes into the classroom (now adapted to happen virtually), and helps the children learn about their own feelings by trying to understand the world from the point of view of the baby. I have written about it here if you want more information as it is so much more than this.

https://weneedtotalkaboutchildrensmentalhealth.wordpress.com/2017/11/07/why-roots-of-empathy-in-our-schools-might-just-save-the-day/

Singing is a key part and every session starts and ends with the hello and goodbye song; with nine sessions over the course of the school year. At the end of the programme there is a baby celebration for all the families who have taken part locally, and the one I attended had over one hundred babies, all about a year old by then. You can imagine the noise with babies crawling and toddling, and laughing and crying and parents trying to talk to each other whilst managing the chaos. Then, Mary Gordon, the founder of Roots of Empathy, started to sing the Hello song. Silence descended and you could hear a pin drop as every baby in the room stopped what they were doing and turned in wonder at a song they knew so well. It was fascinating and delightful to behold. It wasn’t long before chaos descended once more but that moment was magic! Familiar songs learnt during times of fun can be very powerful at calming an upset or worried baby too.

U – Understanding

This is a global pandemic. It is incredibly tough on everyone and especially tough on new parents. Momentous, one off land marks like sharing news, scans, preparing for the birth and the birth itself will have been impacted very significantly, and completely different to all your hopes and expectations. Be gentle on yourself, and give time to understanding the torrent of conflicting emotions you are likely to be feeling. By their very nature these are isolating times and to feel isolated and alone with a new baby is very tough indeed. Try to get out as often as you can, whatever the weather, even if it is the last thing you feel like doing. Try to have a regular routine – getting up, eating meals and going to bed at a similar time each day. Try setting small, achievable goals to provide a sense of predictability, progress and control.  Most importantly, be kind to yourself and to each other if you have a partner or a support bubble.

This is a moment in history, and it is very significant to have a baby at this time. Maybe keep a diary so that you can share it with your child as they grow up. It doesn’t have to be detailed or particularly interesting but it will provide a record of this strange and unique time. Ordinarily family visits, day trips and holidays provide an opportunity for taking photos so remember to create those opportunities locally, or around the house and garden. Have a Saturday dress up day where you set up a sense of occasion to capture precious moments. The wonderful thing about babies is that they will grow and change every day. It is hard to notice this but capturing them will help mark the passing of time.

S – Support

This is the most important gap to focus on trying to fill because when new parents feel well supported everything else falls into place. It is, of course, the hardest gap to fill given the impact of lockdown and what that means for connecting with others. Take any and every opportunity to reach out to people – whether it’s through social media, virtual groups, family Zooms or interacting on walks (safely of course). Accept all offers of help, and be brave about asking for more even if you don’t feel in desperate need. If none are forthcoming then talk with your health visitor about what options may be available. Services are more prepared now than they were in the first lockdown and lots more creative solutions are coming to the fore – as well as a greater understanding of the impact on the pandemic on new families.

If you are in a relationship try to support each other. It is a fraught period for couples at the best of times as you are thrown into a whole new way of life and with very little sleep. It is even tougher at the moment; especially if there are work or money or housing or health or relationship worries thrown into the mix, as there are for so many. Give each other space and breaks whenever you can and rest or sleep rather than feeling you have to do jobs when the baby is napping. Indeed any pressure you may have felt to keep on top of housework can relax a bit knowing people can’t just pop over uninvited. If you do feel worried that you are not coping then do let someone know – your partner, a relative, a friend, a professional or a help line. Prepare a list of people and in advance whether you think you will need them or not – just in case. Strong feelings can take you by surprise, especially when hormones and sleep deprivation are thrown into the mix. Sharing your worries is often enough, but there is help out there if you need it so don’t be put off reaching out.

T – Tuning in

One of the most important things you can do for your baby is to notice and tune into their mood. This is called ‘attunement’ and it refers to the ‘dance’ parents and babies can get into when everything else in the world disappears and it just just ‘them’. You may have seen some of the lovely Youtube videos capturing when this happens in big ways; they are often shared on social media because they lift our spirits. It happens in small ways every day moment by moment. This is at the heart of bonding, and helps babies to learn about themselves and the world around them by showing them that a safe adult ‘understands’ their needs and will be there for them. The easiest way to think of it is like being a mirror for your baby to look into; and by seeing themselves in you it helps them to develop a sense of who they are and what they need.

Often we do this ‘dance’ automatically as  it is something humans are hardwired to do  – but when it is day in and day out it can drop off or feel laborious. TRUSTing that this is actually the key ingredient for happy, healthy developing babies is one way of recognising the golden opportunity lockdown has provided. It frees us from many of the distractions that can get in the way of providing this. With your baby taking the lead, smile when they smile, gurgle when they gurgle, blink when they blink, frown when they frown, yawn when they yawn, clap when they clap, wave when they wave…..and so on and so on and so on. This really is the ‘magic’ ingredient and one of very few things the pandemic has provided even more opportunities for.

So T.R.U.S.T yourself that, regardless of the frustrations, pain and losses of lockdown, it has not hampered and it may even have enhanced opportunities to provide these little things that new borns need to grow and develop into happy, healthy babies and toddlers. Indeed, the more of these opportunities they have the more safe and secure they will feel. It is precisely this sense of safety and security that equips them to venture out into the world when we eventually get our freedoms back. In fact it is likely to make them MORE not LESS confident and sociable.

Top 10 things no-one tells you about going to Uni in a Global Pandemic…..

 

It has been such a privilege to meet up with Elle (virtually!), a member of National Youth Stakeholder Group helping to shape Mental Health Services for children and young people in Wales. Elle is a Masters student and really wanted to use her experience to think about the particular hardships facing Freshers this year. Going to University is a huge step anyway…add COVID into the mix and the need to focus in on mental health and well-being is even more important. Here are Elle’s top tips in time for World Mental Health Day:

1. Home sickness is a real thing……

The chances of feeling homesick are actually very high – and yet, unlike Covid, no one ever really talks about it. When it hits it can hit hard, and often when you are least expecting it – a day in, a week in or even a couple of months in. Suddenly you miss your mum, your brother, your grandad, your bedroom, home cooking, your school friends, your pets. Just anticipating that it is going to happen, that it is normal and that it doesn’t mean you are doing anything wrong will help! Unlike most years you might not be able to just pop home so prepare ahead. What can you do to keep in touch and build in things to look forward to that will help you through?

2. Sleep is precious and takes more effort to get right in halls……

A good nights sleep can make a huge difference to how you are feeling and equally, poor sleep can make everything seem worse. Find what works for you and recognise that your routines at home that helped you get to sleep may need to be different in a new environment. Is it earplugs? Is it headphones? Is it black out blinds at the window? Is it the signature student fairy lights? (Although check beforehand as many halls have rules about them!) Is it a regular bedtime? Is it no coffee after 2pm? All the disruption before going to University may mean you’ve not had a regular sleep routine for a very long time and you may need to work even harder to put one in place. It’s worth persevering as more than anything sleep helps you feel like yourself.

3. Routines make a big difference to your mental health well-being…..

One of the great things about going to Uni is that no one is there telling you what to do and when to do it. The trouble with that freedom comes a loss of routine; and with that a loss of predictability. Routines can really help at times of uncertainty – and what could be more uncertain than a global pandemic? Politicians, parents, lecturers – the people we turn to for reassurance about what is happening are facing uncertainty too which all adds to the anxiety students are facing. That is why it is important to focus on the things we can control, and our own routines help things feel more certain while the big things are getting sorted out. Whether its starting your day in the same way, a regular time to go outside for a walk, a lunchtime catch up with a flat mate, ‘attending’ virtual lectures at a set times or with a friend, or having a warm shower before bed, doing set things at set times can really help things feel predictable at an unpredictable time. The prospect of possible lockdowns in halls means this is even more important as your world may need to shrink for a period of time.

4. Find your tribe……

This is really important as who we surround ourselves can make a huge difference to how we feel about ourselves. It may not be immediately obvious at first but universities are so big, and so full of different people from different backgrounds that your people are out there somewhere. You may get lucky and find them in your flat, but if not don’t give up! Courses and societies are more likely to have like minded people, shared interests and just space for connection without the pressure of trying to share a tiny fridge space. Covid, of course, makes this much much harder as we lose many of the incidental moments that grow into familiar faces and eventually friendships. All the more reason to work even harder at this – don’t be put off that many societies are operating virtually to begin with – they are a start and a familiar online face is better than no connection at all. And don’t forget – Uni lasts at least three years. It’s not all about the here and now – your tribe may not have joined yet!

5. Be careful about your news and social media consumption…..

The headlines at the moment are pretty grim – whether it’s on official channels or on your feed as you scroll the various platforms filled with what your family or friends are sharing. You don’t need to be tuned in 24/7 to be informed. It is important to switch off and relax too. Students and young people generally have had a particularly tough time in the media in recent months – from the abrupt end to schooling, cancelled exams having been building up to them for years, the results debacle, uncertainty regarding University places, and now the Covid outbreaks in halls. Try to focus on yourself and your own experience – we are all individuals going through this in our own way. You deserve a break but more than that you deserve acknowledgment that this has been a particularly tough time to start out on what should have been an exciting next step on your life journey.

6. But be aware and plan ahead……

We can’t avoid the realities of Covid either. Lots of people coming together from all parts of the UK and abroad, and living in small spaces means some outbreaks are inevitable (even big spaces like 10 Downing Street and the White House have had their share!). Do what you can to minimise the risks but plan ahead in case you face a local lockdown or quarantine. Get yourself a box of foods ready in case you can’t get to the shops and someone else needs to go on your behalf. Bookmark a favourite series on Netflix. Make sure you have one or two of your favourite treats in stock (within budget!). Organise your room so that it feels as ‘homely’ and comfortable as possible. Put photos of good times on your pin board. Arrange regular virtual catch up slots with friends and family so you keep connected. No one ever thought we would have to think about Uni in this way but we can get through it one step at a time.

7. Change is stressful and starting Uni brings monumental change…..

Leaving home, fending for yourself, moving town, meeting new people, studying a new subject, learning in a new way…..you name it, becoming a student changes just about every aspect of your life. Give yourself credit – these are majors challenges that take everyone a bit of time to settle into. Add in Covid, and we need to be even more gentle on ourselves. Be kind and go easy on yourself and on each other too. Emotions are running high, tempers will be frayed, especially with broken sleep, and someone using up the last milk in the fridge might feel overwhelming. Take a breath, count to ten, listen to your favourite tune, watch your favourite episode on Netflix, go for a walk. Remember to try to do whatever it takes give yourself space to face the next challenge.

8. It’s okay to not be okay…..

And its okay to feel overwhelmed by it all too. There is so much pressure at Uni to have a good time. In some ways COVID may have taken a bit of the pressure to be constantly out socialising away as that can be a source of stress for some people. For others it may feel like totally missing out on the student experience, and that is a very real loss too. It has heightened the risk of loneliness and feeling like everyone else must be doing better than you are. Take one day at a time, and trust that it is a marathon not a sprint. Remember this is a global pandemic after all. Most importantly try not to judge yourself.

9. Don’t suffer in silence…….

Whether it is someone in your flat, someone at home, someone on your course, a lecturer, a personal tutor, the student welfare service or a helpline there is ALWAYS somebody to listen and help you make a plan to get through whatever you are feeling. NOTHING is too difficult to sort out. Use the time when you are in a good place to make sure you have a go to list of people and numbers, local and national, just in case you need them.

10. Reach out to others…….

Is their someone in your flat or on your course or in your society or friendship group who you think might be struggling? Reach out and check in with them. A kind word, a cup of tea, a game of FIFA, an offer of a walk to the shop – whatever it is, it is often the little things that make the biggest difference. That act of kindness can help you too – there is no better feeling than knowing you have made a difference. It will take time for Uni to feel like a community where you belong, and Covid means it might take even longer than usual. It is these little connections that all add up and will get us all through.

Thank You Elle!

The Recipe for a Whole School Approach

It is such a privilege to be asked by Parent’s Voices in Wales to share one parent’s story about what got her and her son through the crippling anxiety that every school day would start with. It feels really timely as the consultation on the Whole School Approach closes, the review of Mind Over Matter is published and the Youth Parliament share their report, all in time for World Mental Health Day. It highlights the power of relationships and that it is the little things that make the biggest difference. As a psychologist there is so much in this I could link with the evidence around school culture – from belonging, agency, efficacy, empathy and care….but it speaks for itself so I have just highlighted the key ‘ingredients’ that stood out for me. These ingredients apply to all children, young people, parents and carers and of course, teachers too. Those who are struggling most need precisely these ingredients in even greater quantities. Huge thanks to this mum for taking the time to put it into words; and showing how it is teamwork between school, home and the young person themselves that gets the best results.

“What I wouldn’t give for a magic wand to end the tension and stress of a morning journey to school. Watching my son listless and incapable of articulating his feelings because he was overwhelmed with anticipation of the worst scenario looming in the 15 min journey – form time.  There was a consolation in this whole sorry mess though – at least we had the 15 minute car journey. If we lived within walking distance to the school then I have no idea how I would even entice him out of the house.

At least when he was younger I could stop at the Spar en route and bribe him with chocolate – he always succumbed to a treat and ate the bar with a dramatic reluctance. He knew I found it difficult to buy sweet foods (especially in the morning!) so he appreciated the gesture. We both knew he was conflicted about accepting the treat because it meant he had lost the battle after that first bite. He had committed himself to attend school that day. I would try and hide my sense of triumph but after a deliberate pause give him a side smile, and he’d turn his head and grimace out of the window.

As the years passed chocolate alone wasn’t cutting it anymore and I had to think of a new distraction. It seemed obvious once we realised. The family dog. A medium sized, docile, fluffy and affectionate King Charles Cavalier who our son felt was an animal version of himself. They both had curls, both small but stocky, had gaps in their teeth and a mole in the same place on their right cheek. I couldn’t see the resemblance myself but agreed with him daily in the car, as the dog sat illegally on his lap in the front seat. On bad days the dog was surplus to requirements and was more of a nuisance than comfort as his ever increasing weight pressed on our son’s cramped stomach whilst trying to steal the chocolate. Mostly though it was a blessing to have Rio in our car especially if it meant that we could reconnect him with the Teacher who met us at school.

The Teacher was becoming a regular acquaintance of our family when our son was in the lower years of high school. He’d first met us when he visited our home and spoke to our son who was hiding under his bed in distress and refusing school. He managed to bring our son downstairs and reassure him he would support him going forward. No pressure. Just reassurance. On another occasion he drove to our house and collected our son and took him to school himself. The visit to the house was a clear message to us all: he wanted to help our child and cared very passionately that he should attend school for an education. Our boy wasn’t in trouble for struggling, but he needed support and the Teacher made it clear that he was going to get that in school. There was no doubt that this demonstration of strength and commitment to our son changed the outcomes for us all.

Some days when our son couldn’t leave the car independently and walk through the gates I would park in the corner of the school yard. I would blast through the school doors and arrive breathless with urgency at the reception desk. I’d share too much needless information about the morning while they listened, their phones ringing in the background. I would tell them where I was parked in the yard and ask if Mr X could come and get our son from the car.  I would immediately feel ridiculous for arriving in such  a panic, but the thought of him missing his education and falling even further behind sent me into a spin and I’d forget myself. It wasn’t until later I realised that it didn’t matter if we were late – what was important was that I modeled calm – a hard but essential skill to learn for any worried parent.

Mr X would arrive composed and smiling while I twittered on again with intensity about the morning. The same story as the previous time. He would nod and smile but his concerned eyes would flick towards my son in the footwell of the car. He’d open the door, ask about the chocolate around his mouth or the dog now sitting regally in the seat above and talking whilst patiently waiting for some interaction. He’d tell my son about the day ahead, and how they would now go to a quiet room and have a drink, read a book, calm down and then walk him to next lesson when he was ready.

My son, looking exhausted, would slowly and reluctantly move from the footwell, coat zipped, hood up, head down to hide the red eyes, making whimpering sounds in agreement. I would hug him tightly and say he was brave, amazing and that I loved him lots, and tell him to have a good day. In my peripheral vision I always noticed Mr X shifting uncomfortably when I did this. I wondered if I was doing something wrong, making the situation worse perhaps? Or maybe it was because he had never been shown the same level of affection himself?  He had once told me that he remembered the footwell of the car as a child. Perhaps his level of empathy came from his own experience?

As my son progressed through school we muddled through and we occasionally bumped into Mr X. He felt like a distant family member to us, a relative that you see once in a while. I’m never quite sure if he knew how much we appreciated him through those early years of high school, and quite how much he did for both my son and I? I do know he ended up getting a dog himself so maybe we nudged that idea along. We also never needed to stop off to buy morning chocolate anymore!”

Recipe for a Whole School Approach:  (Quantities vary but double up for those who need it the most)

Smiles

Distraction

Affection

Reassurance

Wanting to help

Care

Concern

Patience

Commitment

Calm

Listening

Quiet

Hugs

Love

Empathy

Appreciation

Bake in warm environment for as long as it takes….

My Cheesecake take on the ‘A’ level Eton Mess

I’ve kept relatively quiet on the blog front during this pandemic. Primarily because work has taken up most of my thinking brain; but also because the dilemmas and compromises, and work loads and pressures I see across all sectors of society leave me feeling overwhelmed and with a profound sense of gratitude and forgiveness for those who suddenly find themselves having to make difficult decisions with life impacting implications in the context of COVID. I won’t apologise for saying it. These are unprecedented times. Occasionally though, my fury and upset at how our children are being treated in all of this has leaked out – the odd tweet here and there, and one ranty thread that garnered lots of support but disappeared into the Twittersphere; as ranty threads do.  On Thursday, ‘A’ level results day, my distress didn’t just leak, it poured out of me in a way that I thought might never stop. That it happened in a restaurant on a rare night out with my husband was a minor inconvenience. The combination of social distancing and dogs meant we were tucked away pretty much in a room of our own. He went to pay and requested my dessert, which hadn’t yet arrived, as a take out instead.

Many of the days headlines culminated in my outpouring of tears – ‘algorithm’, ‘downgrading’, ‘inflated’, ‘deprived areas hit hardest’ ‘teachers too generous’ to name but a few; as well as individual stories of students and teachers left devastated by the shock results, and dashed hopes. This is our young people we are talking about. The exam cohort who have spent nearly six months in their bedrooms with no structured input from education what so ever. As the first in my family to do ‘A’ levels and go to university, and with an academic and professional career haunted by inferiority complexes, imposter syndrome, guilt at getting paid to do a job I love, guilt at being paid more than a paramedic who attends car crashes and brings people back to life……guilt also that my own son had done fine and got the grades he needed……it all hit a very personal nerve. And just before my cheesecake had arrived. ‘How dare anyone get ideas above their station?’ is how I interpreted the grade adjustment process. And what chance do disadvantaged kids have if that is the prevailing attitude? If I were my own psychologist I would ask me:  ‘What word would be written inside that first tear as it rolled down your cheek?’ Injustice. It is just not bloody fair.

The entire system that judges a child’s worth by a piece of paper on a Thursday in August when they are 18 or 16 is so riddled with unfairness; and I have written about this many times before. Indeed, in lots of countries that do absolutely fine on the education front there are no such external exams; no such days in summer when journalists hover at school gates waiting for the best and worst news story; the highest leap of joy, and the biggest pool of tears; winners and losers paraded for all to see. No such parenting obsessions with school catchments judged by league tables and resultant extortionate house prices exacerbating and perpetuating the class disparities. Really! These are just not a thing! Here is my blog about my own personal experience as a parent in Canada where none of this exists. Why Education in the UK isn’t helping the mental health of children or parents. Kids go to school, the teachers support them to do the best they can based on their strengths, they are assessed on the basis of school work and internal exams, and they leave to go on to their next chosen pathway. It is as straightforward as that.

Kids and teachers in Canada will not be in this sorry mess despite facing the same Covid catastrophe. They can focus on getting back to educating and supporting  children through a global pandemic instead of pouring hours of time into creating a false way of assessing children that tries to replicate a system that isn’t even fair in the first place. The question should be as simple as the one that gets asked in Canada; and as simple to answer because it is based on trust – how do you, a group of teachers who know these students best, think this individual young person was going to do had a global pandemic not come along and interrupted everything? Graduate? or Graduate with honours? or could do with another year as struggling to achieve the required level and likely to be even more set back by months of nothing? Easy. Not perfect, of course. But the alternative seems to have been reduced to a ‘computer says no’ approach.

In the UK we have a system that is so invested in it’s own hype it has missed the entire point of its one strength. An independent assessment of a child’s ability based on their individual performance on a specific day is exactly that. And only that. If they don’t sit the exam, then you can’t award a grade as though they did. You need to do something else. Unprecedented I know. But these are unprecedented times after all. So what can, and should we do instead? Ask the teachers; trust the teachers; assume that a young person’s chosen next path isn’t wildly out of synch with what they are realistically capable of and should therefore be supported to pursue. Acknowledge this is a global pandemic and everything is different this year. Tell them they are the Covid cohort and have had it tougher than any generation you know. Say you will err on the side of giving them the best possible chance in life. Acknowledge they will need it more than most as the impact of this pandemic on their futures is already a major concern……And, most importantly, use this debacle as an opportunity to draw a line in the sand and review the whole system. It could even be an interesting, if unintended experiment. Does this revised approach really result in a radically different outcome at the next stage given all the hurdles our children have already had to cross beforehand? And the many more they have ahead of them.

A couple of hours after we left the restaurant and I had cried it all out of my system I felt ready for my cheesecake. And it was as delicious as it looks.  A reminder to all our young people that intense feelings pass, things will feel different with a bit of perspective, and that their time will come. But first those in charge have to take control. Enough is enough. This cohort deserve an apology and a plan that undoes the harm that has been caused. And future generations deserve a long hard look at a system that really does seem to be based on a bizarre conviction that your future worth is dictated by your A level and GCSE results, even when they have been generated by an algorithm that you had no control over what so ever.

*postscript

Hooray. Centre Assessed Grades will now be awarded. Let’s hope important lessons have been learnt.

Conversations in the time of COVID and how we continue to connect, collaborate and co-produce……perspectives from a Parent Representative and a Clinical Psychologist.

 

“It’s an ill wind that blows no good” is a saying I was brought up with, and probably influenced my choice of career. An ability to spot the light in the dark is an essential quality for a psychologist. It’s important to acknowledge, however, that COVID has seriously challenged this, especially as connecting with people, being alongside them and forming relationships is my primary professional tool. I am trying to let myself off the hook though; it is a global pandemic after all.

Having said that, as we settle into the new normal there are some consistent messages emerging about creative solutions that we must hold on to as we plough through this – digital technology and virtual reaching out being the most obvious one. A clear example of this is in my new role as Chair of the Early Help and Enhanced Support strand of T4CYP (2). Co-production is one of our core values and as I started in this role on the 1st of April it faced an immediate and unprecedented challenge. How can we get together if getting together is the one thing we cannot do?

Ceri, who is our Parent Representative for the programme, and I wanted to share our early ‘virtual’ conversations to show just how much can be achieved through this route. She leads Parent’s Voices in Wales, a support group for parents of children experiencing mental health difficulties, additional learning needs and neurodiversity. Our paths have crossed in various ways, most notably on twitter. We recently struck up an e-mail exchange that tried to get to the heart of what matters most from our respective vantage points. I am not sure we would have learnt so much so quickly through more traditional meeting forums. We are sharing our exchange during Mental Health Awareness Week because we took a guess that if we were interested in each other’s answers you might be too. But first a word from Ceri:

Normally as a parent, if a Consultant Psychologist asks you to undertake a joint blog the first reaction may be to look over your shoulder and question if they were speaking to you or someone else.  But this isn’t any Consultant Psychologist.  This is an all parties welcoming professional who is jointly leading a Gwent service based on active listening and who holds a clear vision of unity involving families and services supporting our children and young people.  Who wouldn’t jump at the chance to have this platform with Liz to share our parental views on the mental health of our children and young people?

That’s very kind Ceri but I feel equally privileged to have this opportunity. There is something about the slowing down that formulating a response to e-mails has allowed that has been so powerful.

Clinical Psychologist to Parent Group:

What have been the most helpful experiences of services that you hear described?

This is relevant to all public services at any stage of a child’s life, so I will speak as if all services are one – as if a whole systems approach were already embedded and each service were an ambassador for the other. I love this question from Liz because it evokes a memory of the only positive moment in a child/young person’s troubled journey.  It takes you to the moment that every parent/carer remembers – the day they were truly heard by a professional.

Parents/carers never forget finding that one person in a service they can trust, the person who takes time to really listen and understand.  It’s that moment when a parent/carer’s expert knowledge of their child/young person is respected over and above the expertise of the professional – the most stress relieving moment, an instantaneous release. When the child/young person also connects with this practitioner, we are almost euphoric because we know this is good and we know this is going to work!   This great moment is not fully appreciated unless a family has firstly attended several meetings, appointments, programmes and read a hundred leaflets.  What makes this professional different to others, is their genuine concern, their active listening, their display of knowledge and understanding.  Be warned however, families can detect pretence, one wrong move and you have lost us. No pressure of course!

We usually witness active listening during an assessment stage, when the professional is gathering information and piecing together the jigsaw of a child/young person’s life so to formulate a plan.  The enthusiasm of the assessor suggests a deep understanding of our child/young person’s trauma and provides hope for an answer.  Parents/carers cling to the hope that this person will continue throughout the whole process until our child/young person has recovered, but this is sadly not always the case.  Changes in staff mean a lack of continuity in therapy, often reported as the most unhelpful experience and thus the moment of euphoria is short lived.

Despite setbacks in continuity, we cannot detract from the power of empathy, active listening and trust between a parent, child and a professional.  Knowing that one person wants to stay with the family throughout a process, remain engaged and put the child/young person in the centre of the focus/therapy, may not be commonplace, but it has been reported as the most important and helpful of experiences.

What do you think would make the biggest difference to children’s lives from a mental health perspective?

When I posted this question in the Parents Voices in Wales support group, my phone buzzed immediately from response. It’s an answer I had already predicted.  Prevention.  Sounds very simple as a three syllable word but the context is far more complex. It may be rude to answer a question with a question but I am a fan of scrutiny, it is part of the territory of having a child with additional needs!  So, how can anyone prevent a child having mental health issues?  The answer that nobody wants to hear is – we can’t.  I don’t think we can ever totally prevent poor mental health but the biggest difference that can be made is ‘early help’ – quite simply, a prevention of later crisis.  We should talk about the impact of crisis though in order that the biggest difference to be understood.

Not all parents/carers readily know what mental health support their child/young person needs and certainly not if a deterioration in their mental health is insidious. When a child does hit crisis it is the most frightening experience for everyone.  Parents/carers feel utterly helpless and panic stricken.  It is shocking to realise you are not equipped to help your child, that you didn’t know they could be so poorly and that you don’t know if this is the worst of it or, God forbid, not. You are a candle in the wind, trying to grasp at any hope of solution. Where once you perhaps chose not to discuss your child’s issues with other parents, now you reach out to everyone.  There is no pride in desperation.  You’ll take any advice, recommendation or resource from any person willing to listen or help, because your child’s pain is your pain, its overwhelming and there is no time to lose.

Time changes in crisis, it stands still for the child like they are frozen in time, not developing nor really functioning.  For the parent/carer, an hour feels like a week and a week feels like a year.  An appointment with the GP to obtain an appointment with CAMHS, which may offer a 28 week waiting time, feels too long to bear and yet there is no other option.  So we read up on EMDR, CBT, DBT and become fluent in acronyms, calming apps, nutritional supplements, mindfulness, breathing techniques, alternative therapies and realise when all websites are exhausted that we are still not equipped nor skilled to decide on an intervention and will still have to wait for the appointment.  A long painful wait which impacts on the well-being of the whole family.

There is a saying that a parent is only as happy as their least happy child – it’s true.  Poor mental health of a child/young person seems as contagious as COVID.  Parent/carer mental health deteriorates alongside their child, which is not helpful when you need to think clearly and be on the ball to spot another change in behaviour.  You cannot surrender to the strain because there are other family members to care for, there is work to be done and someone you love deeply is desperately sad, possibly harming themselves, talking about wanting to die, or not talking at all. 100% of parents in our group reported that their mental health deteriorated as a result of their child’s poor mental health.

Who knew that when your child reached crisis, the ripple effect could be so damaging?  You had no idea your own mental health was so delicate, that the impact on siblings would be so enormous, that your child/young person’s trust of the school and possibly every adult had diminished because they had been brave and patient for far too long, that they may refuse to leave the house/attend school/speak to anyone, that you may have to reduce your working hours or give up employment to look after them because they cannot be left alone.  Many of our parents have had a drop in income because they are caring for a child with poor mental health.  Is anyone adding the possible ACE’s for this child/young person already in crisis yet?

It is commonly reported that parents had repeatedly raised concerns with education or other services but that no intervention was required because the issues were not considered severe enough ie the child wasn’t failing in school enough, their BMI wasn’t low enough, they hadn’t been violent enough or their mental health just was not bad enough. Some report that professionals stated it was an outside school/other service issue and told parents/carers it did not warrant further investigation/intervention.  This is where an early help needs led approach would make the biggest difference to so many children and young people.

It is wonderful that we have specialist services available should children/young people hit crisis, but with early help programmes/interventions, suffering from extreme emotional distress (and possible further ACE’s) could be avoided for the majority.  If education, health and social services really talked to parents, worked as a team with other agencies, without hierarchy or barriers, and understood that parental concerns and behaviours of their child was merely a language to be understood, this would make the biggest difference.

If you knew then what you know now about how services work what difference would it have made?

This is a poignant but important question to answer because it’s based on that old tool of torture that parents/carers frequently torment themselves with, hindsight.

All parents/carers like to pretend that we would have done things differently if we had our time again, that we would have been more patient, been more ‘Mary Poppins’ (sorry no male equivalent) and been the perfect home educator and then perhaps our children/young people wouldn’t have struggled with their mental health.  Even if they did struggle we would have shouted louder at services, demanded more and effectively wrapped this horrible mess up in a matter of weeks.  The truth, however, is we would do it the same way again.  Parent/carer guilt is the by product of hindsight.  It is very unhelpful to our own emotional health and a pointless exercise unless you were to use it, for example, to evaluate a process/service provision and being intent on making change.  This is exactly what the Mind over Matter report has done and changed the focus of our parent group from wanting to change mental health services to wanting early help for the emotional well-being of our children/young people based on a whole school approach that included the voices of parents.

Sadly, our children/young people were not able to experience early help, so parents/carers answered this question with some anger and from a variety of perspectives.  Some feel they would have requested to see a youth worker immediately had they known and understood their role, instead of waiting weeks for a CAMHS appointment and allowing their child/young person to suffer needlessly.  Why were they not told about youth workers in the school/community? Why did they not know that schools had mental health champions or programmes in-house? Why was this information not readily shared with parents on joining the school? Why wasn’t support or signposting to support advertised on the school/other services websites?

Parents/carers discovered that their child had to hit crisis first before anyone would listen.  After months of GP visits and mental health appointments they now realise all they needed was someone to know how to reach their child and connect.  Someone who could actively listen, empathise, understand and give support strategies to the child/young person and/or parents/carers.

Some parents feel that their child/young person’s experience of mental health services was more damaging than helpful, as they disagreed with the prescribing of medication or that the therapy was not neuro-diversity centred and talking therapies were not always the best pitch when a child/young person was not communicating at home let alone in a hospital setting to a stranger.

Parents/carers report feeling a disconnect between services with education in the centre, being unaware of support for children/young people outside of their own ELSA programme and who are reluctant to refer onto other services because of the complexity of the referral process and tell families to contact services themselves.  Relationship break down between families and schools is often reported because the parents are frustrated and angry at their child/young person being let down, when in reality the education framework is not equipped to help their child and meet all their needs.

So what do we know now?  That some children/young people do require specialist mental health services but these are in the minority. We know that services are currently disconnected, working in isolation but really need to join and collaborate.  We know that waiting for months on a waiting list is damaging, that in reality all our children/young people needed was to be heard early on, their needs understood and supported, to have someone who built a relationship, showed empathy, made a real connection and worked with families advising parents on support strategies.  This person could have be a youth worker, social worker, school nurse, teacher or TA but all trained in additional needs and mental health.  This is when we ditch the guilt and hindsight becomes a vision of hope.

If you had a magic wand what would you do on behalf of parent’s and children in your group?

Now this feels like asking a child to write their Christmas list! I intended to be shamelessly indulgent, pretend there were no monetary or political constraints and possibly run out of ink and paper talking about re-framing support, but that has essentially been done above. I have to be true to my first thought on reading this question and that wish would be to end suicide.

I would wish that all those beautiful children and young people lost to suicide were returned safely to their loving families and homes. I would wish that there had been an open door, accessible at all times so families had received support at beginning of their child’s struggle.  Knowing that real support was there would have brought hope for tomorrow, so their children would not even think about the need to leave.

Ending suicide would mean that even if a child were struggling with their mental health parents/carers and the child would be safe in their  circumstance knowing this would be the worst of it and they would have time when seeking help.

Ending suicide would be the ultimate wish because from that point of crisis, services and families could work backwards together and journey with the child/young person supporting them back to where they belong – at home and truly happy.

This may be a wish, but is it an impossibility?  I think not.

Parent’s group to Clinical Psychologist:

Why does the quality of mental health support differ between schools and services (Councils and Health Boards). Why are there discrepancies and what can be done to amend this?

I am delighted to start with this question as it get’s to the heart of my passion: the need to move towards a whole system approach to mental health and well-being. Historically whenever mental health services are in the spotlight the focus is usually on specialist services; and traditional clinic-based models of intervention. However, children’s mental health and well-being needs to be far broader than just this; and indeed demand on these specialist resources is very dependent on what else is available to families along the way. A whole system approach, as put forward so helpfully in Mind Over Matter, means recognising the mental health and well-being work that goes on across all settings and agencies from early years, to schools, to youth work, to social care, to sports and leisure; and supporting front line staff and volunteers to feel confident and competent; ensuring they have quick and easy access to expertise when they need it.

It also means offering children and families choices – what is going to work best for them at a particular point in time. This does mean a culture shift away from the expectation that specialist services hold all the answers towards a recognition that what happens day to day in the relationships with trusted adults is often the thing that makes the biggest difference to a young person. It is also important to say that there will always be some variation in how local services are organised and delivered. Having worked in Gwent for many years there are five boroughs served by one Health Board and they all have very different populations and communities. We need a national framework that grows local services according to local need; but is also guided by best practice, the available evidence, and an openness to innovation and learning from other areas; and of course, children, young people and parents themselves.

Can every school really connect with every child and provide bespoke support because isn’t awareness/empathy considered more of a personality trait than a learned skill?

Another great question and one I am really pleased to have an opportunity to share some thoughts on. Awareness is something that we can all benefit from and one of my hopes is to identify the core training needs that all front-line professionals who work with children and families would benefit from. An obvious starting point is a children’s rights-based approach; but core skills like an insight into child development, attachment and the impact of trauma and adversity feel equally important and I do believe these things will make a difference and help to shift the lens that childrens emotional worlds are viewed through. More vulnerable groups, for example neuro-diverse or from minority backgrounds, would also benefit from a special focus to empower all settings to feel equipped to support their unique and additional needs.

I also think you make a very important point about personality or temperament; and in particular in respect of teachers as this is something that rarely gets discussed. My position is that every teacher was a child once, and they entered into the profession for a variety of important and valid reasons. For some, it may be a passion to nurture and develop the potential of children, for others it may be the passion for their subject and for others it may be because a teacher had a profound impact on them when they were growing up. Children and young people spot a mile off when teachers are being ‘fake’ and a whole school approach is as much about supporting teachers to be themselves, as it is about supporting this for children and young people. Empathy is, of course, an important quality but some people find this much easier than others. When it comes to supporting mental health and well-being having someone who spots your potential, or who brings a subject alive, or who shares an interest, or who offers structure and clear expectations, or a shared sense of humour among many other things are all important ingredients. Schools are made up of individuals who between them need to provide all of these things collectively. Young people are brilliant at knowing who they need to go to for what.

How do I teach my child from a young age to look after his/her mental health? What do I tell him/her to look out for, how can parents/carers be proactive about CYP mental health? Shouldn’t we be trained too?

Brilliant question and I am not sure that I can do it justice in a couple of paragraphs!! The first thing to say is that I do believe the more information and open conversations about mental health there are the better. Sharing this blog during Mental Health Awareness Week is just one example and there is now so much more that is readily available. Again, digital technology has brought this to the fore, and Covid 19 has ratcheted it up another notch. The key message is to not underestimate the power of the little things, the building blocks of well-being like a safe and secure home, a healthy diet, sleep, opportunities to play and learn, friendships and a sense of belonging. Having said that, as someone who has been steeped in mental health for nearly 30 years it feels important to acknowledge that I still flounder when it comes to my own children. This is a complex business where what we know interacts with our own emotional responses and experiences, and our resources and resilience as it ebbs and flows! I often turn to my husband and say ‘what shall we do?’ He is an engineer and inhabits a very different world. Occasionally he dares to answer, ‘isn’t this your domain?’

That said, I do feel in a very privileged position to have gained some insight over the years about the most important things, even though I inevitably wobble. The first is to walk the talk. Children learn by what they see so if I don’t look after my own mental health, talk openly about how I am feeling, notice when I am stressed and need to slow down then no amount of telling my children will make a difference. I have also learnt the importance of being rather than doing. Sitting with children and experiencing their pain alongside them is far more powerful than trying to find a solution and ‘fix’ the problem – excruciatingly tempting as this may be. Finally, and most importantly, your relationship with your child is the key to mental health and well-being. This will breakdown and ‘rupture’ all the time – that is normal. It is the repair that makes the biggest difference – reaching out, saying sorry, letting things go so you can start again, being the bigger, wiser person are the things that really make a difference. That is why you have to look after your own mental health and well-being first. The aeroplane metaphor is so helpful at making this point – you have to put your own oxygen mask on first before you put your child’s on despite this feeling acutely counter-intuitive.

Why are there discrepancies in professional opinion/diagnosis between psychologists/mental health experts and why do schools not always accept these opinions and refuse to give help? Why do parents have to fight for support?

This is such a big and important question. My perspective is that there are so many contributing and interacting factors to a child’s mental health and well-being that we need services that take into account this complexity. Unfortunately, services tend to be arranged in what we call silos – seeing things from a particular or dominant perspective; and reinforcing this perspective as a result of the organisations they sit in. For example, mental health services tend to sit in health, and health inevitably organises things in a more medicalised way. The reality is that this is just one aspect of mental health; which is impacted by relationships, experiences and environments. Most importantly, the solutions to mental health are often found in these everyday relationships, experiences and environments; and an overly medically orientated service model risks underestimating this often untapped potential.

That is a complicated way of saying we need to move to a model that draws on a range of options and is much more bespoke to fit the unique needs of an individual child and their family – taking into account the strengths in their support networks and communities to bring about change. This shift is about moving from single agency or professionally led services to needs led services – the all important question being what would this child and family benefit most from now? One way of taking the ‘fight’ that you describe out of this is a single point of access. A one stop shop or no wrong door model where all services that offer mental health and well-being support sit in one place. For some families the next step will be the traditional clinic based model, for others this will never fit for them, and they would benefit more from a community based approach. Consistently we hear from children, young people and parents that it has less to do with the profession or even the approach but more about the relationship. This is the most important vehicle for change; and a service model that supports and recognises this has to be a priority. That is not to underestimate the value of professional expertise, but to ‘flip the script’, and use this expertise to support every day relationships, therefore maximising their therapeutic potential.

After all Ceri, as you so powerfully articulate in your answers to my questions it’s the little things that make the biggest difference regardless of where we are on a journey. This e-mail exchange has made a very big difference to mine.

2……and getting through lockdown together with teenagers

My first blog in this series of 2 is aimed at helping families think together about how they can get through the next few weeks of lock down from a well-being perspective Tips to share with children to help them cope with the new normal. I use the acronym C*A*L*M to talk about Creating new routines, Asking the grown-ups whenever kids have worries, Lovely things you can enjoy to help you through, and Making the most of the new opportunities this historic event provides; in spite of all the really hard things it also imposes. I share ideas about how to involve children in this process; offering them some control in a situation where we are all feeling pretty powerless.

Lots of people have asked me to write something similar for teenagers. All of the above applies, of course, as it does for every one of us. However, involving teenagers risks putting parents immediately into a double bind. It is really hard for us grown-ups to ‘get it right’ where teenagers are concerned; and their first response to an idea is often to reject it – regardless of how good the idea might be. Even introducing the idea of talking about their ideas is likely to be kicked into touch.

I picked my moment and asked my own teenagers if they would help me come up with ways to get around this trap. At first they said no, of course, or words to that effect. But bit by bit they have contributed lots to this blog. In fact, that is my main message – to offer opportunities, anticipate rejection, but keep the door open for them to join you in their own time. And be genuinely grateful when they do. But don’t go over the top with that gratitude or even mention it…….

An acronym to summarise this is O*A*K – which is really fitting actually as it requires us as grown-ups to stand steady throughout the storms, and be a calm presence when the sun does eventually come out.

O – offer opportunities often

A – anticipate rejection

K – keep the door open

I shared this acronym with my teenagers and they hated it, of course. They then spent a fun five minutes coming up with alternatives – you can imagine how that went. We settled on C*R*A*P because that pretty much sums up what lockdown feels like.

It is rubbish for everyone, of course, but out of every generation it could be argued that teenagers are uniquely disadvantaged during enforced house arrest. Developmentally, their main tasks are to separate from their families, connect with their peer group and form intimate relationships. This is all now rendered impossible. They have no escape, they have to be at home, and they cannot see their friends.

Some parents will be secretly delighted that this natural drive to escape has been curtailed and they are back in the nest; particularly at a time like this when everyone is feeling anxious. But the nest is the last place that most teenagers are likely to want to be.

This tension of going out/staying in has always been around in families – but now it is enforceable by law and there really is no choice. The one advantage of that, of course, is that it is no longer a battle between you and them. Deep down they do know that, but their anger and frustration is likely to be directed at you anyway – because where else can it go?

There are some exceptions of course, and lots of parents of children who are very anxious or have additional learning needs are sharing that life is actually easier for them in some ways. They are enjoying a bizarre honeymoon of not having to get their kids to places they find difficult to be in; take part in activities they find really hard to do; or engage with people they struggle to be with.

But mostly it is C*R*A*P, and for everyone there will be C*R*A*P bits. Here are some thoughts about what might help:

C – Crashing is understandable

Our teenagers have been hurtling towards major milestones since they first started school. They have never had a say in this; rather it is an unwritten rule embedded in our culture – one that has loomed larger and larger in recent years. I am talking about external exams; GCSEs and ‘A’ levels. The ‘business end’ of school, as they are often referred to. Suddenly they are gone, disappearing before our very eyes. No one in the history of the British education system could have predicted this, and our teenagers, who are most impacted by it, are having to face it….alone.

It is like speeding towards a final destination and then suddenly flying off the edge of a cliff. Even for those not sitting external exams it is a derailment. The mantra that their future depends on working towards these goals, a mantra that has been chanted throughout their lives like a humming motor, has been silenced. Gone.

My daughter’s GCSE art boards still lie on our kitchen table, shrouded in bin bags, like a corpse. It is a bereavement with no funeral. The prom dress hangs in the spare room like a (subtle and tasteful) bridal gown with no wedding. As adults we know these things will get sorted, and plans will be made to address the losses….but for our kids? Right now? It is carnage. They are in shock, and the overwhelming urge must be to crash…and sleep it off.

It is tempting to say reassuring things like ‘at least the pressure of exams is off’. That has certainly been on the tip of my tongue many times and may have even slipped out. For some young people that might help. I would be cautious though. It is a complicated bereavement, like the death of a relative you don’t really like. Only you know how you want to manage such a sensitive loss. Better to ask open questions.….’how are you feeling about not sitting your exams having been building up to it for so long?’ Take a guess that it is probably a mixture of emotions. Some will have wanted their chance to shine, others will feel guilty about not doing more during the year, pinning everything on the exams. Reassure them by saying everyone is in the same boat. It is their year group and sense of  a nationwide Coronavirus cohort that will mainly get them through this.

But what about routine? What about schoolwork that still needs completing? What about the learning and revision they are missing out on? I asked my kids:

“First of all, there are a lot of hours in the day and a lot of time to find a balance. We know what we need to do. Secondly, all the build-up is about eventually finding a job and settling down. None of that matters if you don’t have good mental health so it is important to prioritise that first. This is a really stressful time so not the best time to put pressure on us”.

R – Rooms are their sanctuary

Social media means that we are constantly bombarded with images of happy families enjoying holidays and meals out and fun times together. The reality is that these are moments in time in some peoples lives and mostly teenagers are either out or in their rooms. I anticipate that lockdown will show the equivalent images of family craft and baking, hilarious Tik Tok videos and board games. Again, these are moments in time, and mostly teenagers will be in their rooms.

As parents we often struggle with this. We want them with us, to know they are ok, to see what they are up to, and to join in our ‘fun’ plans. When I asked my kids about this they said ‘It is because we like it in our rooms’. It is as simple as that. This, of course, makes perfect sense when we think that their main task is to separate from us.

It is important, therefore, to respect their privacy, allow their room to be their domain over which they have some control, and knock before waiting to be invited in. If they share a room and want their own space is there a temporary arrangement you can come to? Even if it is just some time when each of them will not be disturbed? Connecting with friends on social media is likely to be a life line for them, and some privacy to do this is essential.

But what about mealtimes? What about the mess and washing and dishes? What about spending hours on line or gaming? What about exercise and fresh air? I asked my kids:

“A lot of the time kids stay in their rooms to avoid being nagged to do stuff. The important thing is to make sure that the atmosphere when they do come out is comfortable, and somewhere they want to be. Being asked to do the dishwasher might seem like a little thing for you, but for them it might be the last thing they need after a really bad day on line. That doesn’t mean they won’t do it, just let them decide when.”

A – Acknowledge how hard this is

Lockdown and Coronavirus is really hard for all of us. When things upset our kids the overriding desire for parents is to try and make it better. Often we do this by focusing on the positives, offering cheery platitudes and using humour. This can work really well and the great thing about teenagers is that they let you know immediately if it does. You will also get a clear message if it bombs. Jokes about having an excuse to sit in front of a screen all day or not having to revise can go down very badly…..

Try instead saying things like ‘this is tough’, or take a guess at how they may be feeling. You will get it wrong, of course, but they will clock your efforts at some level. Acknowledge your own feelings – Scared? Sad? Lonely? Bored? Angry? Disappointed? I have certainly felt all of these things in the past few days.

Don’t underestimate the power of listening and being around. It may not feel like you are doing anything to help, but actually these are the crucial qualities all parents can offer. It is a rare silver lining in this horrible mess that we are with our kids when they need us most – and when we need them most too. You will argue, of course, but the making up is critical – and reaching out with an O*A*K branch is more important than ever if you fall out.

But what if they blank me? What if they slam the door in my face? What if they are rude and take their anger out on me? I asked my kids:

“You never know what is going on in someone’s head, and you don’t know what has happened in their day, even just in their room. No one should tolerate abuse but if you try to understand where they are coming from, that there are things going on that you might not know about, you will make their lives so much easier even if they don’t show it.”

P – Persevere

The most important message of all is to persevere, and never give up. Preserving your relationship, or building your relationship if you struggled before lockdown, is the main priority. It is the key to getting through this. This is where O*A*K really comes into its own:

O – offer opportunities often

A – anticipate rejection

K – keep the door open

Nostalgia can be a temptation that is hard for even teenagers to resist. Favourite meals, old board games, photo albums, movies, and family stories…..now is the time to revisit them all. And when they don’t work, which they probably won’t, revisit them again, and enjoy them for yourself anyway. That little kid is still in there.

Talk in their presence about all the things you love about them; all the things you admire about them and all the things you hope for them even though they might ignore and reject it. Write a note and shove it under their bedroom door. Most importantly let them know how proud you are of how they are coping with a global pandemic that has stopped everyone and everything in its tracks. I know that I am super proud of mine.

When I asked my kids about a final message they said:

“Teenagers can be horribly stubborn and relentlessly cruel. But in all cases, this is just a wall put up to hide insecurities, vulnerabilities and fears that they just don’t want you to see. Helping them isn’t about exposing those vulnerabilities, it’s about recognising they exist, and doing what you can to take the weight off their shoulders.”

Proud indeed.

1……Tips to share with children to help them cope with the new normal

We are used to life staying pretty much the same – doing the same things, going to the same places and seeing the same people. That has changed with Coronavirus; and we are all having to get used to life being very different – a ‘new normal’ for a few weeks at least.

It is the same for everyone; and so we are all getting used to it together.

Doing this in a C*A*L*M way will help everyone to get used to it more quickly, and also help everyone to feel less worried generally.

C*A*L*M

C – Create new routines

Routines help us feel safe. Usually we don’t even notice them, and we often take them for granted. But we really miss them when they are gone. Making new routines will be very important over the coming days and weeks as they will help us feel safe. They become the new normal surprisingly quickly – just think of a time when you have been on holiday or to stay with a relative. What are the new routines you are starting to notice?

Some celebrities are helping with exercise, stories or cookery lessons on-line at different times during the day – can you use these to help create a routine as well as seeing a familar face and trying something new?

Some teachers are sending work so that you can have school lessons at home – can you do these at the same time of day you used to do them at school?

Some friends and relatives are using facetime and other ways to be in touch so that you can still see and hear them – can you arrange a time to ‘meet up’ on a regular basis?

Mealtimes and bedtime are a really important part of everyone’s routine, especially at a time like this. It is tempting to say they matter less as we don’t have to be anywhere on time; but actually they are more important than ever. They make sure that we eat healthily and get enough sleep – the key to us felling happy and well.

Some families are using timers as a fun way to make sure they stick to their new routines and move to a different activity, room, or the garden at different times during the day. Have you got something you could use as a timer? Alexa is brilliant, or an alarm clock or a kitchen buzzer?

It helps us if we do set things at set times in the day because it gives us something to look forward to. It makes sure we do different types of things during the day instead of just doing the same thing. It helps us do the things we are less keen on but need to do, and it keeps us busy so we have less time to focus on our worries.

What does your new routine look like?

A – Ask a grown up

If you have any questions or worries it helps to share them with a grown-up or older brother or sister. They may not have all the answers but knowing someone cares and is listening is often the most important thing when we have something that is bothering us.

There is so much news about Coronavirus and it is always changing so it is really important that we try to switch off from it most of the time. If you want an update stick to places like Newsround for information you know that you can trust.

If worries are going around and around in your head, then sometimes writing them down or drawing them can help. Some children find making a ‘worry box’ really helpful so that you can keep them in one place and put a lid on them, and even give them to a grown-up to look after. If worries are taking over then use a timer to give yourself a ‘worry ten minutes’ in your routine to try and make sure they don’t take up the whole day. Some children find drawing their favourite super hero or a ‘worry monster’ to stick on their bedroom door can help protect them from worrying at night.

One of the most helpful ways of managing worries is to divide them into things you can do something about and things you can’t do anything about. With Coronavirus there is lots that we can’t control but you can wash your hands at the recommended times, you can cough into your elbow and you can keep a safe space away from people when you go outside.

Maybe you have learnt about mindfulness in school and can make time for it in your new routine. You can teach it to the grown-ups in your house too! If it is not something you know about maybe you can learn about it online. It is a good skill for helping you to relax and gets much easier to do the more you practice.

If you have a big worry and don’t feel you can tell the grown-ups you live with then can you telephone or message an adult you trust? All the people who cared about you before lockdown are still around and thinking about you. For big worries you can also contact a helpline like Childine.

L – Lovely activities and laughter

The best way to keep worries in their place is to fill your time with things you love! Now is the time to search through your cupboards to find games, books and activities you had forgotten about or didn’t get around to. Old activities you used to do when you were younger can be particularly comforting at a time like this. Make a list of new things you want to try – there are lots of brilliant art, craft, music and sport ideas online. It really is a chance to let your imagination take over and involve the whole family! Maybe use the alphabet to make a list of things you can all try! Cut them out and put them in a box so each day feels like a surprise.

A favourite film or a favourite book or  story is a great way to escape into another world for a bit, or looking through old photographs is a lovely way of remembering happy times. You can’t laugh and feel anxious at the same time – our bodies won’t let us!

Being kind to yourself by doing things you love, and treating others kindly is more important than ever. Doing kind things for people in your family will make them feel amazing; and it will make you feel amazing too!

M – Making the most of it

Everyone is missing out on lots of things because of Coronavirus. Feeling sad, angry, cross, fed up, frightened, and upset and just about every other emotion are all very understandable. Everyone will be feeling like this from time to time. Doing something physical like running, jumping or even punching a pillow can help.

We can also try to think about it another way – Coronavirus has given us all a chance do the things you don’t usually get around to.

Everybody in the country is in the same situation – and actually all across the world. This is an important time in history – how are you going to remember what you did to get through it so that you can tell people in the future, and maybe even your own children? Perhaps you could keep a special journal or vlog? Already ideas are spreading – like the rainbows in windows and the clap for the NHS. What else can we spread around the world?

Everybody Needs Somebody In Their Corner

I love this photograph. It is of my little brother and our dog Digger; and captures a thousand tales of our childhood. The one I am going to tell is how our dog was always there for us; just as he is here when my brother felt like the whole world was against him. He often felt that way when he was little; and with the benefit of hindsight I can see why. We moved from a tiny fishing town in the far North of Scotland to Cardiff. No two different places could there be from our perspective as kids. At the age of 4 he was plucked from the safety and security of our very small world and tight knit community, and sent to school in Ely where no one could understand a word he said. He would be peeled off my mother every morning; as hard for her as it was for him.

I found the transition much easier after I got over the shock that we weren’t living in grass huts on a beach. My father, who worked in shipping, was offered two postings – one to Cardiff and one to the Christmas Islands and I got them both confused in my head. I was 7, and I was a performer (or show off as my mother would say) and so I loved being paraded around the playground and asked to say words in my strange accent. For some kids that would have been a nightmare, of course. My older brother, aged 11 at the time and starting in a big comprehensive school, coped differently again, but that is another story.

Digger had come to live with us as a puppy when I was new born. We had been visiting relatives on a farm when my mum heard that he had failed the ‘working dog’ test as he wouldn’t go out in the rain. Without further ado she brought him home; not daring to ask what might have happened to him otherwise. I realise now that far from failing, he simply knew that his vocation lay else where. He often went out in the rain with us kids. He quickly became my older brother’s shadow and could not have arrived at a more important time. Aged four and with a tiny baby in the house he now had a playmate and constant companion, and I don’t think I can remember a photograph without them side by side. It was back in the day when children were free to roam and dogs were too. Hard to imagine now.

When I grew older my brother would often be asked to let me join him with his friends, which he did reluctantly but Digger kept an eye. By ten he rejected that idea altogether and so Digger and I were left to make our own fun. Again, in hindsight, I realise that the last thing my brother wanted was a little sister telling tales; and a dog whose fur smelt of cigarette smoke. Digger coped well with the change in arrangements and new adventures emerged that often involved fancy dress or playing house or schools. I remember the pride I felt when I taught him ‘ready steady go’ and he would rush to the start line in our pretend sports day game. A classic example of a kid re-imagining through play difficult experiences in their life!

By the time we moved to Wales Digger knew it was time to move on to my little brother, as he needed him most. Constant companions, they would lie side by side as Digger comforted him in his sadness. He used to suck his thumb, and would pluck lumps of loose fur from Digger and roll it with his finger tickling under his nose as he sucked. We knew if he was having a particularly bad time as there would be a black fur moustache stuck to the tears and snot. As he settled and made friends Digger became their play mate too, going out for hours on end and only coming home before dark. On days when friends called and he didn’t feel like going out, Digger would go anyway. It kept that connection and meant friends didn’t give up on him. When he was at school, Digger still had work to do. He befriended an elderly neighbour and would spend all day at his house, scratching the door at three so he could be let out to wait at the bus stop for my brother’s return. It does make me wonder what our dogs could contribute to the loneliness epidemic if they were free to do their own thing as Digger was. His intuition and ability to attune was extraordinary. It’s a shame we have medicalised even this with ‘therapy dogs’, hugely valuable as they are.

Digger died when we were both 16 years old. Tuned into our needs to the very end, he waited until we were all awake and able to say goodbye before he took his last breath. By this time my brother had discovered his passion in music – first as a trumpeter and then as a drummer. Never comfortable in more formal music arenas he gave up the trumpet when he was asked to play solo in a concert that required him to wear scratchy clothes. He now works as a very talented musician, composer and producer, together with his wife. They work from home and he rarely wears trousers – and definitely not scratchy ones. They have a dog, of course. There is still a painting of Digger on the landing above the spot where he slept. Even now, nearly 40 years later, if I rush down stairs at my parents house auto-pilot kicks in and I step over him.

I tell this tale firstly to honour the dog who gave our family so much; and secondly to recognise that my own children will have their own tales to tell about how our dogs have got them through tough times. Thirdly, and most importantly, I tell it because it makes me think about the qualities we all need in being there for children when they are struggling most. Let’s not make this more complicated than it is. Digger’s rule of thumb was that he kept an eye out for whoever was most vulnerable; and made sure he was always in their corner.

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