This is a superb video about how Mental Illness in a parent or carer (considered to be an “Adverse Childhood Experience”) can impact on the emotional wellbeing of a child or adolescent. Also how early intervention and support for the whole family is crucial. Made in Collaboration with Devon Partnership Trust, and in particular Dr Jo Black, consultant perinatal psychiatrist.

Produced by ForMed Films CIC

Incredibly grateful for two of our expert patients, Astro and Malcolm, who have generously shared their stories here about being helped by CAMHS. They are both instrumental in supporting our services now – sitting on interview panels, and helping shape our services. They also give sessions for our medical students to educate the next generation of junior doctors. Please take a look at their videos:

The Royal College of Psychiatrists have run a successful campaign overseen by Dr Kate Lovett, to promote psychiatry as a career to medical students and junior doctors. It’s had a major impact, improving application rates significantly. Here is the latest recruitment video:

https://www.rcpsych.ac.uk/become-a-psychiatrist/choose-psychiatry

On Good Morning Britain in August of this year, there were some extraordinary claims made. The mental health charity STEM4 had published results of an online “survey” which appeared to suggest that as many as 37% of 12-18 year olds were taking / had been prescribed antidepressants.

This story was run by GMB in rather sensational fashion:

An exclusive GMB survey with charity Stem4 has found that 4 in 10 young people between 12 & 21 have been prescribed antidepressants for their mental health difficulties.@drniharakrause tells @kategarraway & @richardm56 that the 'prevalence of mental ill health has been rising.' pic.twitter.com/jTmOPfV2Oa

— Good Morning Britain (@GMB) August 3, 2022

I, and other child psychiatrists raised immediate concerns about this data. I approached STEM4 to understand how this survey had been conducted, and found the explanations wanting. This was not credible research. NHS data shows that rates of prescribing of antidepressants in young people sits somewhere in the low single figures – perhaps 10x less common than was being suggested.

The problem here was that a single study (with no robust scientific planning that I could be shown) was being used as an eye catching news story, hugely distorting the realities of the clinical situation. It’s findings went against the evidence from a number of large and credible data sets.

I was pleased to liaise with BBC “More or Less” show, who looked into this in greater depth. Their findings are available in today’s excellent show, “debunking” the claims – please have a listen:

https://www.bbc.co.uk/sounds/play/m001cq31

Why does this matter so much? Many young people are particularly vulnerable at present. We know the prevalence of all mental disorders in young people is on the rise. There is no doubt, for example, that rates of anxiety are increasing. However, it is essential that normal human experience is not pathologised. The pandemic has caused huge disruption and uncertainty. Many young people are feeling unsettled. This is compounded perhaps by the war in Ukraine, financial instability, and the climate crisis, to name just a few subjects which are at the fore of many young people’s minds.

A distressed teenager might read such a headline and think: “Am I ill, too?” or “Why is it that I can’t have medication, when others are?”. Parents may press GPs and CAMHS services to prescribe, even when the evidence for doing so is not there. The rates of private prescriptions of drugs like Fluoxetine might (ironically) rise as a result of this sensationalisation.

The key lessons here: 1) We need more research in the area of child and adolescent mental health 2) We need those advocating for young people to do so on the basis of sound evidence 3) We need journalists to exercise caution, and question the reliability of such claims.

Increasing numbers of children and young people are requiring admission to paediatric wards with restrictive eating, and physical compromise.

This is a FICTIONAL account of a multiprofessional discussion regarding Nasogastric feeding, and the potential for restrictive practices and restraint, with consideration of legal frameworks.

Those involved in this teaching are clinicians involved in this work regularly. The video itself forms part of a teaching day run by the Royal College of Paediatrics.

https://charliewaller.org/mental-health-resources/managing-difficult-feelings/help-for-young-people-worried-about-self-harm

The Charlie Waller Trust, Young Minds & Royal College of Psychiatrists produced a range of mental health resources around Self Harm in 2016, including some fantastic videos to raise awareness and bring hope to those suffering. These resources were under the banner of “No Harm Done: Things Can Change”. We are now looking to update the information alongside these videos. Please take a moment to view the pages and send any feedback here, particularly if you are a young person or carer for whom this is directly relevant.

Thank you.

“The aftermath of the pandemic provides an opportunity for the Government to reshape its approach to supporting young people’s mental health. The last two years have shone a much-needed spotlight on the shortcomings of current provision and a broad consensus exists to put young people’s wellbeing at the heart of the pandemic recovery.”

The Report makes 10 key recommendations which are well worth reading.

The Royal College of Psychiatrists have produced a new resource of information, guidance and professional support regarding the mental health of asylum seekers and refugees:

https://www.rcpsych.ac.uk/international/humanitarian-resources/asylum-seeker-and-refugee-mental-health

The advice is endorsed by the Academy of Medical Royal Colleges and will be of most use to those working in primary care, and schools.

It’s been upsetting this week to have been accused on Twitter of “gaslighting” children and families.

I’m keen to clarify my position on Medically Unexplained Symptoms (MUS), an area in which I have clinical interest.

A thread follows.

1. Everyone is familiar with the idea that life stressors can cause physical signs/symptoms (for example, we feel nauseous when nervous, our heart races when we are scared, we cry when we are sad, we might even collapse when in shock…). These are normal daily physiological responses.
2. “MUS” is a rather outdated term. This field encompasses persistent physical symptoms for which there is no clear ‘biological’ cause (according to current medical understanding).
3. Some years ago I wrote some guidelines on MUS, intended to help doctors, in particular paediatricians and GPs, to navigate this field, which is poorly taught in medical training.
4. MUS are extremely common. There are a wide range of symptoms encompassed here, from persistent pain, functional weakness, non-epileptic attacks. Essentially any aspect of the body that can have a “functional” problem. Any clinician working with children, or adults for that matter, will be aware of these presentations.
5. The majority of such symptoms are actually time-limited and will pass. Watchful waiting can be entirely appropriate.
6. Some of the children with MUS – perhaps 4% – will go on to be diagnosed with physical pathology (where infection, inflammation etc are the causative factors).
7. Therefore, all children must have full holistic assessments, including thorough investigation of biological causes. Some but not all will need blood tests, brain imagining, even Lumbar Punctures or EEGs.
8. Also essential is an understanding of the psychosocial situation (school, home, peer relations). Is the child under particular stress? For example, exam pressures, parental separation, bullying.
9. We also need to assess the influence of parental anxiety. It is normal to feel anxious when your child has distressing symptoms. Sometimes however the anxiety can be a perpetuating factor.
10. Many children with persistent physical symptoms have sensory hypersensitivities, and consideration needs to be made for neurodevelopmental disorders such as Autism, which can be contributory factors. The concept of Interoception is little understood, but key.
11. I have never met a child I have considered to be fabricating (making up) symptoms. Symptoms like pain are very real and distressing for all.
12. It is very rare that a parent/carer will actively induce illness in a child, but it DOES happen and doctors need to be alert to this. RCPCH now favours the term “Perplexing Symptoms” as a framework to consider possible safeguarding issues. They have excellent clinical guidelines on investigating and managing these scenarios. Fabricated Induced Illness / Munchausens by Proxy are uncommon conclusions and tend to be overreported in the literature.
13. It is never the case that a child with MUS “simply” needs psychological therapy. In fact, few do. They need a sophisticated discussion with a paediatrician who understands the body/mind connection. Time is needed to understand the health beliefs and what will work best to help the child function best and enjoy life.
14. The majority of children and young people do not need referrals to CAMHS (which is a specific service set up to treat mental illness). Some children’s physical symptoms will cause persistent low mood or anxiety. It is important to offer treatment if these meet clinical significance, whether or not they are secondary, rather than primary phenomena.
15. CAMHS services are under huge strain. It is in no-one’s interest to attempt to categorise problems as being ‘psychiatric’ when they patently are not. I am not seeking additional work!
16. Turning to specific diagnoses, there are MANY biological conditions which can present with an array of physical symptoms, from mild to severe in nature. These include, but are not limited to: Hypermobility Syndromes, PANS/PANDAS, POTS, CFS/ME, Lyme Disease, LongCOVID. All of these disorders must be considered carefully as differential diagnoses.
17. There are consensus guidelines for the management of these conditions. Doctors must work to these or their practice can be called into question. Guidelines will evolve as we understand more about these illnesses. Patient groups are right to demand more trials and studies where we have a lack of evidence.
18. There are undoubtedly additional medical disorders which we currently have insufficient understanding of, and will come to light in the future.
19. Additional tests must be entered into with caution. Over-investigation happens and can be a cause of iatrogenic harm. Some children will go on to develop a belief that there is something wrong with the substance of their body.
20. I am not an expert in paediatrics. So I rely on paediatricians to tell me when physical investigations have come to an end. This is usually the point that I become involved, as a liaison psychiatrist.
21. I have treated many young people with MUS. Many recover swiftly with a sensitive approach which considers body and mind, simultaneously.
22. Many other terms used to describe MUS are clumsy – eg “Psychosomatic” which tends to be interpreted to mean that a psychological problem is the cause of the difficulty. My presence in the consulting room is not equivalent to my paediatric colleague thinking that symptoms are “in the child’s head” (whatever that might be thought to mean).
23. Even now, medical schools teach in a Descartian, dichotomous fashion which separates body and mind. We need better, more accepted language to describe these complexities, and we need a new societal dialogue.
24. We also need more research, which involves young people and carers at every stage. We need to work collaboratively.

I have just finished reading Dr Suzanne O’Sullivan’s excellent book “The Sleeping Beauties“, which I really recommend: https://www.waterstones.com/book/the-sleeping-beauties/suzanne-osullivan/9781529010572 . O’Sullivan is a neurologist with a particular interest in Functional Disorders (where the patients presentation isn’t objectively caused by biological disease eg. an infection, a lesion, or insult to the substance of the body). One of the phenomena she describes is children with the brilliantly named“uppgivenhetssyndrom“.

Enhancing this no-end is the short Netflix Documentary “Life Overtakes Me”:

Known in English as “Resignation Syndrome“, this is a profound and serious presentation in asylum seeking children in Sweden (very topical at present with Ukraine’s war against Russia and the horrendous trauma repercussions of this). They stop talking, eating, and even moving – as if they are in a deep state of sleep.

Finally, we can learn a lot more as clinicians by looking at the biological theories behind these withdrawn, catatonic-type states. Here is a very good paper by Kasia Koslowska et al – “Asylum-seeking children in shutdown: Neurobiological models“

https://journals.sagepub.com/doi/full/10.1177/25161032211036162

The Polyvagal Theory in particular is something we should be teaching medical students and trainees.