An independent rigorous assessment of children’s mental health services is long overdue, wake up National Audit Office! Therapists are navigating children through a fog. Paula, not her real name, a 6 year old, had a traumatic incident at a fair and suffered separation anxiety disorder. She had 6 treatment sessions with CAMHS, she was discharged on the basis of ‘low chance suffering from post traumatic stress’ and recalling the event with ‘no distress’. But having seen her myself and assessing her using a standardised diagnostic interview she never did suffer from PTSD and the separation anxiety disorder has not been systematically addressed. Nevertheless the therapist calls for the whole family to attend ‘family systemic therapy’, notwithstanding that Dad does not live with them and sees mum as irresponsible for taking her to the fair. Mum sees this as just a further example of his being a ****** and is unphased by this!
The current zeitgeist is to ask for more resources for children’s mental health, putting mental health workers in school etc. The idea is that adult mental health problems could be prevented by such actions but the evidence base on this is at present weak. But even in the unlikely event of extra resources being delivered,(as opposed to promised), if we multiply very poor treatment you still get very poor treatment. It is crucially important to clarify the landmarks that child and adolescent therapists should use to assist children and their caregivers through the fog.
Charities often link up with formal bodies to provide services, but they are often a) desperate for funding and b) don’t have the training (or wish) to measure real world outcomes. Perhaps the best Christmas gift to children would be a truly independent and rigorous assessment of the psychological treatment they receive. This is not at all to marginalise the importance of support groups for children and adolescents with a wide range of problems.
Young people effected by the bombing are having to wait 7-8 months for CAMHS services. The most debilitated adults have sought private counselling or been placed on a CBT waiting list. These findings are from the Kerslake report on Services response to the Manchester bombing published last week. Worryingly there is no indication that evidence based CBT has yet been made available. This is not to say that most people have not been grateful for the assistance they have had to date, but this is not unexpected as only a significant minority of trauma victims suffer long term debility.
The following are the psychological abstracts from the report:
2.27. Feedback about the NHS Manchester Resilience Hub (established after the attack
to coordinate the care and support for children, young people and adults whose
mental health has been affected by the attack wherever they may live) was largely
positive, although many commented they would have liked something sooner.
Participants appreciated the three-monthly contacts from the Hub and felt
reassured that someone was there for them.
“I think the services set up to help those struggling with their mental health
following this event are great too and I feel happy knowing there is always
someone I can talk to if I need to.”
“I do however feel that there is a lack of counselling for young people.”
“The counselling support provided in the hospital did not appear to have the skill
level or approach for this type of situation. The counsellor was super-intrusive
coming into the room at 7am.”
“I contacted the Resilience Hub and both me and my daughter filled out the
questionnaire. Someone contacted us straight away and felt that my daughter
needed further support, which was arranged quickly. I felt there was lots of
support available. I also felt it helpful that the Hub were going to keep sending
questionnaires every three months to check how people are doing.”
“My son was referred for counselling through the Manchester Resilience Hub and
is on a waiting list for CBT as they feel he may have Post-Traumatic Stress
Disorder. The counsellors from Reflections in Oldham are brilliant.”
“My GP was extremely helpful and made a referral to CAMHS, however, there is a
seven-month waiting list.”
“My daughter has been referred to CAMHS for PTSD and low mood, however,
there is an eight month wait for this.”
“The counsellor at my daughter’s school is very good and offered to do some
sessions for me too. I went back multiple times and found it helpful.”
“The caller said she was told how she was feeling was normal and that they would
call her in three weeks. This wasn’t helpful as at the time she needed to speak to
somebody.”
“I feel as though the email received in October could have been sent earlier to
those who had been affected by the attack. I feel as though I have come a long
way since May. I’m less jumpy, having less nightmares and emailing my story was
nice to get it off my chest.”
“The attack has affected my mental health to the extent that I have been unable to
start my university course as planned. My mental health deteriorated, I had to
seek private psychotherapy after being diagnosed with PTSD and anxiety.”
“I have been in touch with the Survivors’ Network as well as the Manchester
Resilience Hub and they all provided great support. The Foundation for Peace
have written to the children’s school with tips on how to support them.”
“My place of work paid for private counselling sessions; I was a mess and did not
stop crying for the first three sessions. I have not been in work since the attack. I
spend most of my time talking to a war veteran who gives me support.”
4.39. The strategy was to communicate a ‘normalisation’ and support message not only
in Greater Manchester but via NHS national networks. The advice given was that
directing people into treatment at an early stage was potentially harmful and was
an inappropriate response to normal responses which people experience after
such an incident. If, after four weeks, people were experiencing difficulty e.g.
mood shifts, trouble sleeping, experiencing panic, then they should be pointed to
further mental health support. This advice relating to psychological reactions to
traumatic experiences was widely circulated within hours of the incident,
describing what were normal reactions, when to seek help, and from where to get
help. Efforts were made to circulate these messages through a range of media
platforms including digital and broadcast
Dr Mike Scott
NOTE: Victim Support provided the front door in the 1st 4 weeks after the bombing
Yesterday a Counsellor from the Children and Adolescents Mental Health Services (CAMHS) announced on the BBC News, that staff are going to go door to door asking whether the occupants want professional help. Is this really the best use of resources 6 months after the tragedy? The days news also contained an item on a parent averting the gaze of her children from the Grenfell Fire Tower Block as she took her children to school.
Without health staff having a clear understanding of what in effect constitutes the ‘bruising/ tissue damage’ from the Tragedy as opposed to that which constitutes ‘disorder’ scarce resources are likely to be squandered. There is clearly a role for a preventative/ 1st Aid input, information about not blocking intrusions, the normality of a period of increased irritability, anxiety about rehousing but there also has to be a reliable assessment of dysfuntion so that an evidence based treatment can be highlighted.
