I have been thinking a lot about the ripple effects of a war in Europe, on the psychological safety of us all. Children and Young People perhaps more than others will be vulnerable to feeling anxious, confused and upset. Graphic and disturbing updates are only a click away online.
I asked some colleagues about resources available in this regard. Particular thanks goes to Ryan Lowe, Clinical Director of “The Therapeutic Consultants” who has compiled a list.
There are some generic links to begin with, then some specific to the current Ukraine conflict.
Information produced previously about war and international violence
How and when to talk to children about war, according to a parenting expert (Independent):
How to cope with traumatic news – an illustrated guide (ABC News, Australia):
Talking with Children About War and Violence in the World (Family Education, US):
Tips for parents and caregivers on media coverage of traumatic events (The National Child Traumatic Stress Network, US):
An article in the Independent on talking to children about Ukraine:
We should not hide from children what is happening in Ukraine (Schools Week/Children’s Commissioner):
How to talk to children about what’s happening in Ukraine and World War Three anxiety (Metro):
Help for families to talk to pupils about Russia’s invasion of Ukraine and how to help them avoid misinformation (Department for Education)
Sadly, the numbers of Children and Young People presenting with a picture of severe, restrictive intake has increased exponentially in the last 2 years. This is undoubtedly a consequence of the pandemic. Young people have had to tolerate a high degree of uncertainty, a lack of structure, a loss of normal support functions. They have been without many normal peer interactions. Some have been increasing exposed to emotionally damaging home environments.
In seeking ‘control’/containment/certainty, a small subgroup of young people have turned to managing their intake in a way which has become pathological. Many of these would not meet criteria for a “typical” Eating Disorder (anorexia nervosa). Rather than body dysmorphia and a fear of fatness, per se, they have become obsessional about the need regulate their bodies. Many have had unhelpful relationships with social media accounts promoting weight loss or dieting. A smaller subgroup speak of the “need” to be, or appear, unwell.
A clinical challenge for CAMHS and paediatrics has been the management of the physical health risks of these young people. Some become so compromised (bradycardia, hypotension, weakness) that they need inpatient care. We know from the evidence that specific “Eating Disorder” unit admissions tend to be very lengthy and involve being a long way from home. The evidence that such admissions are beneficial is poor. Most young people are best managed close to home, with short, planned admissions to paediatrics, supported by a close collaborative network of mental and physical health professionals.
Inevitably, some of these young people are so unwell that they may need feeding against their own wishes – via nasogastric tube. In a smaller number of cases, the resistance to this intervention may be so high as to necessitate clinical holding or even restraint, to protect the life of the child. Such an intervention is not entered into lightly. There are significant ethical and practical considerations to be made. Not least, what legal frameworks can and should be used to facilitate feeding.
Published today, a good paper by Sarah Fuller and colleagues sets out some of the challenges:
Most acute trusts are finding that their paediatric wards are increasingly having to manage these complex situations. All hospitals should have a lead for Young People’s Mental Health (as per NCEPOD and RCHCH guidance). There is a drive to skill up paediatric staff across the board.
In Summary: The pandemic has brought a wave of distress for many young people, some of whom require intensive and at times restrictive care for their recovery. We appear to be encountering a novel clinical presentation, in some. NHS England recognises the urgency to adapt clinical environments to attend to these often rather desperate young people.
It is hoped that the ‘resolution’ of the pandemic may help us return to pre-COVID levels of referrals, but many of us on the frontline are not so sure. The ripples of the pandemic will be felt for some time.
The Anna Freud Centre have made a range of free to access Podcasts about Child and Adolescent Mental Health. Top Experts Interviewed about Core Clinical subject. Fantastic resource. Available here: https://www.annafreud.org/parents-and-carers/child-in-mind/
Read here about the incredible new specialist childrens’ hospital being established in Cambridge. This is the Gold Standard that all paediatric settings should be aspiring to – full integration of body and mind.
“Tradition has always kept mental and physical care separate. Siloed off by specialisms, disconnected across wards, split between hospitals miles apart. There is an urgent need for a new type of care. Care which researches the links between the mind and the body. Which remove silos. Which pioneers integration across mental and physical health.”
“We’re going to turn healthcare as we know it on its head”
“Rather than moving the child to get the help they require, we’re going to bring the support they need to them. It will make their experience smoother and ensure they can access both mental and physical support from one place, without travelling between buildings and, quite often, hospitals. For conditions like epilepsy, where sudden anxiety can easily trigger a seizure, this streamlined approach can have a massive impact, letting young people focus on how to move forward instead of where to go next.”
The Association for Young People’s Health produces Key Data on Young People. The 2021 edition is the first to be published as an online resource, in a new “Youth Health Data Hub”. It provides a wealth of data on different aspects of young people’s health and lives over recent years.
This ‘Overview and policy implications’ report accompanies the
Youth Health Data Hub and highlights the main themes and ‘take home’ messages.
KEY FINDINGS (from my persepctive):
- Big fall in the number of Young People smoking cigarettes.
- Big fall in the number of Young People regularly drinking alcohol.
- Increasing inequalities in obesity.
- Serious concerns about increase in mental health difficulties.
- Increase in admissions for self harm.
- Increasing suicide rate.
- Teenage pregnancy rates continuing to fall.
- Reduction in investment in Youth Services.
You can see the whole report summary here: