It was a great privilege to be invited to speak at the Paediatric Mental Health Association winter meeting in January on the topic of communication with adolescents. Not only was it great to get the opportunity to share some key messages from young people who use CAMHS services – but it was also very interesting to hear from paediatricians who work with young people on the difficulties they may face when trying to communicate with adolescents.
A number of those present raised the issue of developing a rapport with young people, getting them to understand their mental health and the importance of maintaing it. Interestingly, these were similar to the issues which young people have raised during previous discussions on communication – they often raise the issues of rapport, and of not having a full understanding of what is going on with them and why their treatment is important.
The key messages which I feel most important to share following our discussion are:
Ask the young person how they would like to be addressed: don’t assume name on record. Asking them what they would like to be called shows a respect for their identity that will help establish trust and rapport.
Often first name terms is best for communication: doctors may be concerned that this will distort their relationship, or will seem unprofessional – but young people are more likely to respond to someone they view as on their own level. However, if this doesn’t feel natural to you don’t force it, as a young person will know if you’re pretending to be something you’re not!
Focus on the young persons needs/desires: ask what they want to get out of a treatment or a session, or even what they want in general – this may give a insight into what is troubling them. It can also give a positive place to start at, and allows the physician to work backwards from the young person’s goal.
Don’t assume that because a young person has dealt with a traumatic event or long term physical health problem that they are going to be able to deal with a new, smaller problem. Sometimes a young person is walking a fine line with their mental health, and something seemingly insignificant can tip them in the wrong direction.
It can be difficult to talk about yourself to a complete stranger: sometimes it might be best to ask a young person about their friends, ‘Do any of your friends take drugs/self harm/tell you they feel down?’ etc etc. The young person may then talk about their ‘friend’ as a method of talking about themselves.
Don’t try too hard to emulate youth language etc, as it can actually be more alienating to a young person. Acting like yourself and being relaxed in your role makes a young person more likely to open up and feel comfortable.
Know when to use the family: while parents being present can make a young person more limited in talking, they can also be a useful supportive aid in a consultation, especially with a professional they don’t know. It is important the young person gets a chance to speak to their doctor alone, but do ask if they’d like a relative or friend to be there, even for first session.
Ask about physical manifestations: a young person may not know what ‘anxiety’ feels like, so ask specifically ‘has your heart ever felt like it was going very fast and you didn’t know why?’ Or ‘have you ever found it hard to breathe all of a sudden’.
Always give them the last word – every single consultation needs to end with the questions: ‘Do you understand everything?’ and ‘Do you have anything you would like to ask?’
Once again I can’t thank Max Davie and the rest of the PMHA team enough for inviting me to come and join your meeting, and to all those in attendance for being so welcoming and engaged in all aspects of the discussion. I hope that you all found it as useful as I did, and that you continue to use and share these messages from young people in your practice every day.