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How do we understand the underrepresentation of black children and families accessing Child and Adolescent Mental Health Services (CAMHS)? A mixed methods qualitative research with professionals and service users
Get PDFThis research explores how professionals and service users make sense of the underrepresentation of Black children and families engaging with mental health services. A recent audit of referrals received in an inner London Children and Adolescent Mental Health Services (CAMHS) confirmed the underrepresentation. Using a Qualitative, Reflexive Thematic Analysis, audio recorded and transcribed, semi-structured interviews in focus groups explored the lived experiences of four Black mothers of African-Caribbean descent who accessed CAMHS; and four professionals who shared their experiences of working with Black families in need of mental health support. The findings revealed that difference, mistrust, fear, and disjointed thinking within the professional network affected access and engagement. Families described feeling isolated in their attempts to navigate the service and access support, and service satisfaction was variable depending on the stage of access. However, the children progressed when a good therapeutic alliance developed between service users and professionals. The findings were analysed, and the implications for the Black community, the practice of Child and Adolescent Psychotherapy and the NHS were considered using psychoanalytic concepts
Just like his dad? Understanding the impact of childhood experiences of domestic violence on adolescents and young men who present with difficulties later
No full textThis article is based on the author's clinical experience in working with both perpetrators and victims. It uses clinical examples to explore the various ways domestic violence impacts on the development of young boys who later present with a variety of psychopathologies. It shows how, in the aftermath of domestic violence, young boys can be thrusted into the vacancies left by their violent fathers, trapped within an identity best described as being "just like his dad". Without environmental changes that restore safety, benign experiences of aggression, boundaries, and intimacy, the boys who do not develop into being violent themselves do so by deploying various psychological solutions such as depression, perversion and becoming carers. This article discusses these different trajectories in the context of the trauma of domestic violence and then considers the implications for treatment
The cost of poverty for child development: The adverse impact on maltreatment, education and mental health outcomes cannot be ignored
No full textThe Cost of Poverty for Child Development: Recent reports highlight the growing issue of child poverty in the UK, with over 4 million children affected, and 1 million in Northern England alone. The Joseph Rowntree Foundation reveals that 600,000 more people, half of them children, have fallen into absolute poverty. Poverty has significant impacts on children’s well-being and increasing the risk of neglect and abuse. Data shows that many children referred to authorities for neglect and abuse are under five, and in areas like Blackpool, 1 in 52 children is in care. Poverty also severely affects children’s mental health. A report from the Children’s Commissioner links poverty to higher levels of stress, anxiety, and depression in children. NHS data shows that children in households with reduced income are more likely to experience mental health issues, with 1 in 4 affected children showing probable mental disorders. Educationally, children in poverty face serious challenges. They leave school significantly behind their peers, and only 4 in 10 disadvantaged children meet basic academic standards. This disadvantage extends into poor health and job prospects. Addressing these issues requires poverty-aware practices among professionals working with children. Mental health and social care services should integrate support for financial difficulties, including poverty screenings and financial counselling. Research is needed to evaluate the effectiveness of combined financial and psychological interventions to break the cycle of poverty. By focusing on poverty-informed practices, professionals can help improve outcomes for children in education, mental health, and overall well-being, emphasising that tackling child poverty is a necessary investment for society's future
Comparing the symptom presentation similarities and differences of complex posttraumatic stress disorder and borderline personality disorder: A systematic review
No full textComplex posttraumatic stress disorder (CPTSD) is characterized in the International Classification of Diseases-11 by affect dysregulation, negative self-concept, and relationship impairments, symptoms also presented in borderline personality disorder (BPD). Some research shows CPTSD as a distinct disorder, others as a subgroup or a replacement for BPD. No review currently amalgamates the findings on whether CPTSD presents too similarly to BPD to be a standalone disorder. This article systematically reviewed similarities and differences in symptom presentations of the two disorders. Six databases were searched (PsycINFO, EMBASE, PubMed, Web of Science, PsycEXTRA, and Open Access Theses and Dissertations) and identified papers were summarized narratively. The majority of studies found distinct profiles for CPTSD and BPD. One study found no differences between the constructs; however, this used a population without severe trauma. CPTSD and BPD can present comorbidly, these individuals will have likely experienced earlier and more frequent interpersonal trauma and display greater functional impairment
Introducing psychoanalytic observation through work discussion: the relationship between experiential learning and theory
No full textThis short paper will look at the way in which taking part in organised, carefully led workplace discussions can introduce workers in education, health and social care to the value of their observations and the value of reflecting on the thoughts and feelings they struggle to understand and manage in their working lives. How much can be achieved in supporting observation in practice, without direct teaching of psychoanalytic theory? Examples are drawn from a course for perinatal workers which is not explicitly linked to psychoanalytic approaches
A psychoanalytic exploration of CAMHS clinicians’ experiences with children and young people who do not feed. An Interpretive Phenomenological Analysis
Get PDFThis research project explores the experiences of four Child and Adolescent Mental Health (CAMHS) clinicians who have worked with children and young people who restrict or refuse food. The participants were identified through purposeful sampling and the data was collected through semi-structured interviews. The interviews were transcribed and coded using Interpretive Phenomenological Analysis. The findings are arranged in 4 Group Experiential Themes that reflect the experiential themes the participants described in undertaking this work: their internal experiences, their experiences of the patient, their experiences of the patient’s parents and their experience of the network and their professional context. The analysis of the findings indicates that clinicians need to feel meaningful connections and have supportive relationships. The success of the work is connected to the clinician supporting the patient to build a new type of relationship that is more realistic and allows for vulnerability and dependence. To do so the clinician has to manage painful feelings in both the patient and in themselves. Clinicians are in contact with projections of extreme anxiety and aggression from both the patient and the patient’s parents and therefore the patient’s parents’ history influences the trajectory of the work. The professional context of “not feeling alone” is highly influential in clinicians’ decision to keep working in this area. Physical recovery is important, but not the main focus
“A transformative journey”: How Child and Adolescent Psychotherapists experience their work with adolescents with depression. An Interpretative Phenomenological Analysis
Get PDFThis study explores the lived experiences of child and adolescent psychotherapists working
with adolescents with depression. In this study, the age group of the adolescents discussed is
13-18 years. In this context, the definition of depression is not limited within psychiatric
terms, but includes a variety of presentations, such as long-standing feelings of low mood,
hopelessness, lack of motivation, self-harm, and/or suicidal thoughts. Data was collected
through semi-structured interviews. Five child and adolescent psychotherapists were
interviewed, the experience of whom varied from ten to more than thirty years. Data was
analysed using interpretative phenomenological analysis (IPA). Five group experiential
themes emerged from the data analysis across five interviews: Losing internal compass; Risk
changes it all; Reaching the adolescent; Therapeutic relationship is a personal matter; Another
mind to think with. The main findings of the study show that the work with adolescents with
depression has a significant impact on the therapist, who experiences feelings of
hopelessness, incompetency, guilt, rejection and sadness among other feelings. The results
strongly indicate that countertransference is a helpful tool in understanding the young
person’s internal and external reality. Most therapists talked about needing to adapt their
psychoanalytic approach, such as transference interpretations, something that raised
dilemmas in some therapists. Links between personal and professional life were also made.
Finally, risk was discussed as one of the most impactful factors for the therapist which led to
findings about the importance of network in managing risk and supporting the therapist
(Un)timely care: findings from the Waiting Times project
Get PDFThere is a historic crisis in waiting times in the UK’s National Health Service. Crisis brings both a call for judgement – a response to the question ‘what has gone wrong?’ – and a call to action, such as better management, more resources, strategies to mitigate staff burnout, or even a shift in access commitments to reduce demand. However, not all forms of waiting are a sign of service inefficiency or failure, or a form of abandonment or lack of care. Instead, we argue that all healthcare entails waiting, and other forms of elongated time such as pausing to observe, staying alongside patients at end of life, enduring or even encouraging the repeated presentations of those with medically unexplained symptoms, delaying treatment to see what time will bring the situation, or stopping treatment as an ethical intervention. In this paper, we offer three examples of care practices that require waiting and that take place ‘fugitively’, in the ‘seams’ of the NHS, demanding considerable patience on the part of patients and healthcare workers: care for the chronically unwell in general practice; care of young people in mental health crisis; and care for trans and gender-questioning young people. Cutting across the ideological processes of marketisation and provision rationalisation and the linear models of time that have dominated health policy in the past forty years, we argue that understanding ‘timely’ care as relational, interdependent, and paradoxically ‘untimely’ enables a vital recasting of what it means to wait in and for care in the NHS
A systematic review of literature on homicide followed by suicide and mental state of perpetrators
Get PDFBackground - Homicide followed by suicide is rare, devastating and perpetrated worldwide. It is commonly assumed that the perpetrator had a mental disorder, raising concomitant questions about prevention. Though events have been reported, there has been no previous systematic review of the mental health of perpetrators.
Aims - Our aims were twofold. First, to identify whether there are recognisable subgroups of homicide–suicides in published literature and, secondly, to investigate the relationship between perpetrator mental state and aspects of the incident.
Methods - We conducted a systematic review of published literature on studies of homicide followed within 24 h by suicide or serious suicide attempt that included measures of perpetrator mental state.
Results - Sixty studies were identified, most from North America or Europe. Methodologically, studies were too heterogeneous for meta-analysis. They fell into three main groups: family, mass shooter, and terrorist with an additional small mixed group. There was evidence of mental illness in a minority of perpetrators; its absence in the remainder was only partially evidenced. There was no clear association between any specific mental illness and homicide–suicide type, although depression was most cited. Social role disjunction, motive, substance misuse and relevant risk or threat behaviours were themes identified across all groups. Pre-established ideology was relevant in the mass shooter and terrorism groups. Prior trauma history was notable in the terrorist group.
Conclusion - Research data were necessarily collected post-incident and in most cases without a standardised approach, so findings must be interpreted cautiously. Nevertheless, they suggest at least some preventive role for mental health professionals. Those presenting to services with depression, suicidal ideation, relationship difficulties and actual, or perceived, changes in social position or role would merit detailed, supportive assessment over time
How do we teach systemic leadership management and consultation? Reflections on delivering such a course
No full textWe are three women, different in many ways, some of which can be described via our cultural, past professional lives, current work, our ages, geography, colour and race. We are now two black women and one white, Jewish woman who have joined in co-creating and delivering on this systemic leadership and management course which has had several iterations and course leads in its long life at the Tavistock Clinic. Feedback from delegates on the course consistently shows us just how important it is to have aspects of difference represented in who is teaching and facilitating the conversations and learning. One idea might be that if delegates do not see someone chat looks like them their ability to fully acclimatise to new ideas may be compromised