5 minute tips for anxiety in children and young people

This post allows you to give brief advice if it send that a child has problems with anxiety. It should be read after you have gone through our introductory post, and is intended for non specialists working in health services.

When to think of anxiety
Excessive anxiety is common in childhood, but is particularly common in chronic or recurrent pain (up to 80%) and in developmental conditions, especially autistic spectrum disorders.

What are the key questions to ask
Worries: in quiet moments, does the child worry about going to school, harm coming to their family or themselves, any imaginary creatures or anticipated events
Avoidance: anything that the child doesn’t do, or doesn’t want to do
Sleep: difficulty settling, frequent waking, nightmares
Eating: restrictive patterns, poor appetite

Safety checks: (seek advice if these are happening)
Is the child harming themselves, or consider doing so?
Does the child feel worthless?

What advice can you give?

There are two main forms that therapy takes, both of which can be applied in a ‘low-voltage’ fashion in non-specialist settings.

Firstly, it is helpful to draw out the thoughts and beliefs that underlie the anxiety.  This is not so that the adult can dismiss them as silly or mistaken, but so the child can be helped to compare the harmful cognitions with their other beliefs and feelings (e.g. monsters aren’t real) which can then be used to challenge the anxiety. Equally, it’s important when a child is worried about a particular event to talk through what consequences may result, and again check that the child really thinks these consequences are likely, and plausible. In some cases, especially involving social situations, it may that the child’s fears are justified, in  which case negotiation with third parties (teachers, family) would be useful.

Secondly, some kind of graduated exposure is often helpful. Say the child is scared of going to the toilet alone. Going with a parent, but with the parent then standing in the doorway would be a good start, which the child could be rewarded for. Next time, they would need to tolerate the parent being in the hallway in order to earn a reward, and so on.

These techniques are explained further in resources

Resources

This fact sheet can be a useful start for parents . Simple-ways-to-help-children-with-fears-and-anxieties

Cathy cresswell’s article in the Archives of Disease in Childhood is very good, as is her book for parents

The Mind Ed portal has a lot of information on anxiety. It’s designed for professionals, but there is really no reason why a motivated parent can’t access it, especially

The worried child

Anxiety disorders

The session on school avoidance is excellent, and there are loads of generalisable tips in it

Troubled teens – recognising and responding to the health needs of looked after young people | British Association for Adoption and Fostering

‘ Negotiating adolescence is a challenge for any young person but it is particularly difficult for looked after and adopted young people and care leavers, including those on remand. Although these vulnerable young people experience a wide range of health inequalities, and high levels of mental and emotional health difficulties, professionals may find it difficult to engage with them to address difficulties with school, relationships, sexual health, bullying, including through cyber-space, self-harming and other challenging behaviours, and to safeguard them from child sexual exploitation.
 
This fascinating conference will consider the evidence base and assist health, social care and education professionals to understand these issues and risks, and how to approach them. The themes of engagement, health promotion, building resilience and developing skills for the adult world, all of which are required to promote health in the broadest sense, are considered throughout the conference’

Couldn’t have put it better myself!
http://www.baaf.org.uk/node/7444

Building resilience in children and young people: talk by Alys Cole-King

Important to build resilience in yourselves before you can do so in others. This can decrease stigma in others if you do it openly.

Resilience is the ability to cope with adversity. Not toughness, stiff upper lip. It’s good mental well-being and resourcefulness.
Analogy of a tree in a hurricane is useful, bends not breaks.

Resilience is not a dichotomy, have it or not. Small degrees of improvement, slowly build.

Personal resilience built by respect, care

Suicidal thoughts quite common, but no-one talks about it. Taking about it will not make someone want to do it, but particular methods may be copied.

Identification of suicide risk currently very poor.

Self harm connected to suicide, although not invariably. Often an expression of distress which is temporarily relieved.

Adolescents are vulnerable to taking ‘small things’ as massive issues.

Resilience associated with optimism, self-esteem, gratitude, emotional awareness, flexibility, problem solving ability, self regulation.

One thing better is worth doing. External motivators e.g. pledges, social pressures, can help.
Gadget free time.
Mindfulness application in families needs to include self compassion. Your inner voice needs to be kind as much as possible.

Suicide prevention requires: awareness, compassion, skills, governance.
Professionals need to lose their fear of suicidal people. Need consistent assessment framework applied across professions.For pediatricians, awareness, triage, co- create, effectively refer,  common language are key.
Human factor errors important.  E.g. good assessment leads to poor documentation.
Suicidal thoughts can be classified into passive, active, dangerous and dangerous and imminent.
Talking through scenario can be beneficial.

Connecting with People is a not-for-profit organisation formed to develop and deliver training packages for a range of sectors, including healthcare, social care, statutory bodies and communities.Our modular training includes bite-size suicide awareness and prevention courses and we have also developed resources and training for young people, professionals and the wider community

http://www.connectingwithpeople.org/healthcare-front

 

Substance using adolescents: Dickon Bevington talk

Hard to work with people who don’t want to work with you. Stressful and worrying

Recommended Michael Ungar and John Weisz

Quality of service more important than number of services. Vulnerable young people can feel overwhelmed by numbers of contacts

Alternative model of multi modal worker supported by others. This support needs strong structure

Team structure helped by aggregation of marginal gains.

Networking complexity
Family system, social ecology, local service ecology, political context

Negative feedback about professionals is a way of help seeking, but corrosive to local joint working.
Respect for local practice and expertise

Mentalising is a framework for bringing perspectives together. It’s a process of wondering, reflecting on what current needs are.

Csibra and Gergely: epistemic trust
There needs to be formation of a bond by understanding the particular situation of the person in front of you.  Then teaching, persuasion can occur.

Mentalising is born in attachment.
Therapeutically, you need to ‘get’ the person before you can make progress.
The job of a therapist is to show ‘I’m changing my mind about you not I’m trying to change you’

When contacting someone, important to mark the task. Mentalising had to start with us.
Never in a set balance, constant movement around tensions.

Consider levels of dis agreement, explanation, intervention, responsibility

If this summary tantalises you, Dickon’s slides are in our Member’s area

 

CAMHS: the health select committee speaks

The House of Commons Health Select committee has produced a report on CAMHS.

The  Press notice provides a neat summary.

Hilary Cass has responded on behalf of the RCPCH:

“For too long policy makers have failed to tackle the crisis in child and adolescent mental health– so much so that it is now becoming a hidden epidemic.

“If a child with a physical illness is forced to travel hundreds of miles for a bed, if funding for hospital services are severely cut or if there is huge variation in the provision of care for children with a physical condition – it is deemed a national scandal. And yet we continue to see budget cuts and increases in waiting times for CAMH services, and increasing numbers of children and young people being held on adult mental health wards and high numbers still held in police cells.

“Today’s report paints a picture of a service in crisis, but provides some real solutions to transform the landscape.

“We fully support the emphasis on early intervention; children and young people with mental health problems can become adults with mental health problems. All professionals working with children and young people need to be better equipped to recognise and act on the signs of mental ill health in children and young people , with more care delivered outside the hospital setting.

“It is absolutely crucial that the prevalence study of child and adolescent mental health is conducted regularly and extended to under 5’s with better evidence collected on the mental health of children and young people from ethnic minorities. The current variation in services for children and young people with mental health needs is unacceptable and far too few paediatric departments have sufficient and timely paediatric liaison services.

“Adolescence is considered a risk period for serious mental health disorders, substance misuse, and risk-taking behaviours. We welcome the report’s focus on transition to adult mental health services and plans to review progress in this crucial area again in 2015.

“There is a clear message to the next Government: get to grips with the CAMHs crisis or put the mental health of thousands of children, young people and adults at risk.”

Max Davie, PMHA convenor, gives his personal view here

We in the PMHA are committed to support RCPCH and other bodies to continue to campaign for change, as well as engaging with the DH CAMHS task force (which Max attended yesterday).

If you are reading this as a non-member, please consider joining to help our work to continue (and other benefits to you!)

PMHA at the party conferences

Max Davie, PMHA convenor, reflects on the party conferences:

IMG_3479

For the past few weeks, I’ve been roaming the country with the RCPCH public affairs team. We’ve been talking about children and young people’s mental health at fringe meetings at the three major party conferences, along with colleagues from the RC Psych and the charity Young Minds. I’ve been able to talk to people from around the country about the problems with CAMHS, and discuss some possible solutions. For the benefit of PMHA members, here are some thematic reflections on the problems:

  • There isn’t enough money in the system

While there had been no concerted attempt to cut CAMHS, the brute reality of NHS and local authority funding has led to unprecedented reductions in budgets, by up to 40% in 4 years. This is in part due a lack of clear tariffs and targets, because in the NHS “money follows targets”. An understandable retreat by local authorities into their ‘core business’ has compounded matters.

  • We think of CAMHS services, when we should be thinking about a local CAMHS system.

Services have, in response to cuts, raised the drawbridge to referrals, and shrunk their scope. Paradoxically, once children are in services, there are perverse incentives to pass then to ever more expensive echelons of the system. Meanwhile, other children and young people are lost between services as they don’t ‘fit’ anywhere. Only by re-imagining CAMHS as a comprehensive system, supported by specialists and incorporating education, health, social care and the charitable sector, can we maximise our resources.

  • Early intervention needs more priority

More lucrative specialist services have been prioritised by cash-strapped mental health trusts, but parenting programmes and universal mental health education for children are low cost, effective interventions which need political priority.

  •  Professional cultures need to be more collaborative and inclusive

There is a pervasive myth that mental health can only be done by specialist CAMHS. This is encouraged by lack of engagement by many CAMHS services with the wider system. This leads not only to poor integration, but also another lost opportunity for early intervention outside of specialist CAMHS.

  •  Parity of esteem needs to be more than just a phrase

Many of my first points can be encapsulated in this: parity was enshrined in the health and social care act, and yet mental health continues to be a poor relation of physical health. Recent policy announcements, especially by the liberal democrats, are welcome, but a robust plan is required to embed parity across the NHS.

  •  No CAMHS system will serve children and young people unless it listens to these young people

The best speech I heard at our meetings was by Lisa Murphy, from the RCPCH youth panel, who talked passionately about the need for a responsive system which listened and respected young people as individuals. How we achieve this while embedding robust commissioning and manage a continuing squeeze on finances is the challenge of the next five years.

 It was fascinating to visit the conferences, with their bustle, intrigue and hubbub of chat and speeches. Mental health had never been higher up the political agenda, and we hope that we have played a small part in keeping this vital issue somewhat at the forefront of politicians’ minds.