On and Off the Ward

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“Inpatient treatment may be the first opportunity some individuals have experienced in their lives to interact safely with their peers without fear or prejudice.”

Source: Angela Sergeant, via rcpsych.ac.uk. Read more here

Life on the Ward and Connections with Home



Whether it’s through religion, or supporting a football club, or simply knowing the neighbours, being part of a particular community (or culture, and that may mean a culture within a culture) is important for everyone. Having a strong connection with life outside the ward brings hope and fosters recovery, whilst wider social networks can create a sense of belonging. Keeping a connection to these caring circles is crucial and aids resilience. While an inpatient admission can play a key part in a young person’s recovery, wards must have an outward-looking treatment ethos and be continually mindful that a stay on a ward is a means to an end. Young people moving forward and reintegrating back into their home community is the main focus of inpatient care, and helping to keep their external connections alive plays a huge part in this. Staff can remind the young person about this throughout their admission, and highlight and review the accumulating recovery steps they’ve taken while being on the ward.
Of course, the ward itself also offers community, companionship and peer support. This theme emphasises the feel-good factors of community spirit, generosity, kindness and respect. It’s about experiencing positive emotions with others, including fun, openness, understanding and giving and getting support.

Wards provide a rare opportunity for young people to learn about relationships and intimacy. They have the chance, perhaps for the first time, to interact honestly with others who will help them, and provide them with helpful feedback and validation. In this sense, the ward can provide a safe space for a young person to continue ‘testing out’ and forming their identity. You can support this by being a good role model and promoting empathy, patience and respect for others, which in turn fosters peer support.

This is the sort of thing:
“The other patients talking to me would have made me feel more welcome.”

Source: a young person via YoungMind's Where Next 2. Read more
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Having a strong connection with life outside the ward brings hope and fosters recovery, whilst wider social networks can create a sense of belonging. The ward can provide a safe space in which peer support is promoted.

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"We bring everyone together, sometimes to identify and solve particular problems, sometimes just to check in with each other, sometimes just to have fun. Over time, a collective sense of being part of a larger whole develops in the children."

Jon Kabat-Zinn

A Space to Safely Learn, Share and Explore



Just as every family has to establish its own rules and draw its own boundaries, the ward community (a big ‘family’ of sorts), has to actively work out how best to live, learn, share and explore together. As we all know, being part of a group of people who are experiencing similar difficulties, or who have a similar focus, can be reassuring in itself, refreshing and hugely restorative. Although it takes place amidst turmoil, an admission to a CAMHS ward can be an ideal opportunity for accelerated emotional development. You can clarify where and how it is culturally acceptable to express (sometimes disproportionately strong) feelings, by containing and encouraging emotional expression, through group work and one-to-one time, for example. Ward groups, such as community meetings and social skills groups, provide a space to safely learn, share and explore emotional states together. One of the wonderful things about community meetings is that they give newcomers a chance to get to know others and bring in even more talents and ideas, making the ward community a rich and diverse one.
Hearing about the successes of peers (especially those peers young people admire) is both motivating and educational - it’s an opportunity to absorb others’ skills, knowledge and attitude. The closer their role-models are to them in age, gender, life or career direction, the more chances they have to base their confidence on peers’ achievements. Learning is a social experience.

Hearing about the struggles of others stimulates appreciation, and has the power to break destructive impulses. Appreciation is a foundation of the social and emotional skills that help the ward community (and the community at large) to treat each other well.

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Researchers have found that having newcomers does more than introduce fresh ideas, it actually nurtures more thinking and better results, especially when the newcomer agrees with some - but not all - existing group members. Having people who don't think the same way is good. It also makes shared problem-solving even better, which is perfect in the ward context. (From Personality and Social Psychology Bulletin. Research by Northwestern University)
In his best selling book ‘How To Behave So Your Children Will Too, school psychologist Dr Sal Severe (2004) describes a ‘pleasant family climate’. We’ve given his description a bit of a ward community remix below:

  • A pleasant community climate motivates young people.

  • A pleasant community climate allows members to speak politely to each other, and rules, expectations and boundaries are positive.

  • Everyone feels a sense of togetherness and co-operation.

  • Structure is balanced with flexibility.

  • Everyone is encouraged to pursue their own interests.

  • The community has fun together.

  • When the climate is warm and accepting, young people learn new values and goals.

  • Young people are willing to accept guidance, rules, expectations and boundaries; because they can see the community is acting out of care and concern. If a problem occurs, they will bounce back more quickly.

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“The goal here is to create a structured and predictable home environment and it’s important to acknowledge this is an interactive process. When teens are fully involved in the process of creating the rules they feel empowered; they are more likely to comply with the rules because to some degree they will feel like they own them. This heads off such protests as: ‘I don’t have to follow those rules. I didn’t agree to them, those are your rules.’ Your teens should also be encouraged to discuss and develop guidelines for you if necessary.”

Dr Greenberg and Dr Powell-Lunder, 2010
The key role of climate

In 'Creative Teaching and Learning Toolkit' by Brin Best and Will Thomas (2007), it's suggested that learning will be maximised if due consideration is given to the following three domains: Physiology, Psychology and Appropriate teaching and learning strategies. We've listed the factors included in the Psychology domain below. They're all are concerned with learners’ feelings but they can be adapted while thinking about the ward climate, and therefore, young inpatients.

Best and Thomas suggest that learners need to be in an "appropriate emotional state to learn, which can be characterized as being 'intellectually challenged and motivated, without being negatively stressed." This will help them to enter what's called the ’alpha state’ of relaxed alertness, which is most conducive to effective learning.' The following factors should be considered:

  • Stress: high levels of stress can prevent learning.

  • Challenge: high challenge or expectations are important, but if challenge is too high it can cause negative stress.

  • Motivation: highly motivated learners are those who are engaged with their learning and see its personal benefits.

  • Self-image and esteem: learners who have a positive self-image are more likely to have high self-esteem, which will help them to engage in effective learning.

  • Inspiration: learners can be inspired by teachers, stimulus materials and teaching and learning methods.

  • Support: learners who feel supported as they learn (by the teachers, teaching assistants and other learners) are more likely to take risks and achieve their potential.

  • Justice: learning is most effective in an environment which is seen as fair and just.

  • Respect: it's important for learners to feel respected as they learn, which helps them to feel valued.

  • Contentment: learners who are feeling happy and fulfilled are more likely be successful learners; they're likely to feel happier if they achieve success.

  • Alertness/attention span: learners need to be fully alert to learn, and lack of sleep or too much day-dreaming can interfere with the learning process, meaning they can concentrate for shorter periods of time.

Hearing about the successes of peers is both motivating and educational - it’s an opportunity to absorb others’ skills, knowledge and attitude. Hearing about the struggles of others stimulates appreciation, and has the power to break destructive impulses.

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“Connection is a need to relate. It involves building strong relationships with others and feeling that you belong. While younger children are more prone to establishing relationships with family members, adolescents are far more likely to give priority to others their own age.”

Dr Ilona Boniwella

Getting Comfortably Connected



Caring connections and relationships are essential for happiness, and the environment they take place in is equally important. Young people can be encouraged to connect more deeply with those around them - on and off the ward. Research shows that relational connection not only makes us feel better psychologically but physiologically too - increasing our immunity to infection and decreasing the risk of heart disease! It also shows that people with secure and wide-ranging social relationships are happier, healthier and may even live longer. (Dickerson S et al 2009)

Happy communities share skills, time and resources in creative ways. They offer a warm (both in temperature and in atmosphere!) and attractive space for people to share, learn and look out for each other. Naturally, there are sometimes compromises to be made and personality clashes may erupt, but a foundation of connection can ground everyone.
Think of your favourite place; a place where you feel soothed, safe, and snug, a place where good relationships begin and blossom, where you can be your most authentic self. Now think of the characteristics of that special place. They’re probably not too dissimilar to those we’ve listed below (with a bit of adaption and imagination).

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Supporting social, emotional, behavioural and moral development

  • Make sure you are approachable and give children and young people your time.

  • Give fair but firm boundaries and explain the reasons for these.

  • Ensure children and young people feel valued and are given praise and encouragement.

  • Give children the chance to develop their independence.

  • Be aware of each child's overall development and sensitive to their needs.

  • Encourage them to think about the needs of others.

  • Act as a good role model.


(Source: Burnham & Baker, 2011)

Happy communities share skills, time and resources in creative ways. They offer a warm and attractive space for people to share, learn and look out for each other.

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Working It Out Interdependently



We humans are extremely social beings, designed for collaboration and teamwork. Young people instinctively want to help their peers, and even while on a CAMHS ward they find ways to do so. Great wards establish and sustain a noticeable culture of positive interdependence, mutual support, and individual responsibility, which can feel empowering and confidence-boosting to young people.
“As we help our children get to know people outside their immediate circle, they more naturally begin to understand how interdependent we are with our fellow human beings, both those down the street and on the other side of the globe.”

Susan Stiffelman, family therapist in Parenting with Presence: Practices for Raising Conscious, Confident, Caring Kids (Eckhart Tolle Edition)
“It’s really quite empowering to learn how to help others. It’s a natural inclination most of us have, to reach out to someone in need, yet the art form of helping others is rarely taught as a social and relationship skill.”

David A. Levine, author of Teaching Empathy in Teaching Empathy: A Blueprint for Caring, Compassion, and Community

Repairing Conversations


Below are ideas for making conversations more effective, even when they begin with difficulty. We refer to staff-young person interactions, but these tips can apply to everyone.

  1. Stop the lecture. When noticing they’ve been lecturing the young person, the member of staff might pause, acknowledge it, change their tone, and invite the young person’s perspective on the event.

  2. If it’s possible, take a break. When noticing that they, or the young person, are experiencing a strong emotion that is making the conversation difficult, the member of staff might acknowledge the emotion and say that they both need to take a timeout, and talk again when they are able to hear the other’s perspective.

  3. Say ‘I’, not ‘you’. When conversations regarding conflicts are difficult, the staff member might practice giving ‘l-messages’, focusing on behaviours and their own reasons for being concerned. By using ‘I-messages’, the staff member can begin the communication, by saying clearly what they’re thinking or feeling and the reason for it.

  4. Practice curiosity. Recall the need to be curious without judgment. Be curious about the thoughts, feelings and behaviour of the young person, without judgment.

  5. Rediscover the positive. When the staff member notices that most of their recent conversations with the young person involved conflicts and problems, they might focus on the young person’s interests and strengths, and initiate discussions related to those or other positive themes.


Source: adapted from Hughes, 2009
Highly recommended: Principles of Attachment-Focused Parenting: Effective Strategies to Care for Children

Repairing Things After Misinterpretation of Staff Body Language


If you pick up that this is happening, try to turn the misinterpretation into a fresh opportunity to talk. Here are some ideas for giving you and the young person a second chance:

  • Ask the young person if you can try again and use a calm tone of voice.

  • Ask the young person if you’ve come across as angry and reassure them that you’re not.

  • ‘Did I upset you?’ is always a nonthreatening, non-blaming question.

  • Can we take a break and talk when you’re ready to?’

  • ‘I’m really happy to talk to you. Sorry if I gave you the wrong impression.’

  • ‘I may seem distracted, but I’m really not. I’m very interested in your opinions.’

  • ‘Please forgive me if I seemed ……….. Talking with you is really important to me.’

  • ‘You know that I sometimes come across as……….. when I’m actually………. Let’s keep talking.’

  • I didn’t mean to be judgmental if that’s what you thought. I’m just trying to listen to you without interrupting.’


 

Adapted from Dr Greenberg and Dr Powell-Lunder, 2010
Stephen Covey in his book The Seven Habits of Highly Effective People (1989) champions interdependence. He connects three key elements to making this work:

  1. Thinking win/win - ensure that both parties in an interaction benefit.

  2. Seeking first to understand, then to be understood — find out the circumstances before acting.

  3. Synergy - utilize the strengths of others to create a whole which is more than the sum of its parts.

Great wards establish and sustain a noticeable culture of positive interdependence, mutual support, and individual responsibility, which can feel empowering and confidence-boosting to young people.

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Therapeutic Buildings


From Wardipedia.org (CAMHeleon's big sister):

Some of the best practice we’ve seen has been in some of the worst designed environments we’ve seen. But, the staff have to put vast effort into counteracting the safety, social and therapeutic impact of inappropriate environments. Nevertheless, hospitals burdened by old buildings (even the 1970s produced what are now recognised as hopeless environments) can make wards look much lovelier and operate more effectively with some relatively inexpensive changes. Happily, the new generation of hospitals have individual ensuite bedrooms, layouts which help rather than hinder staff being connected to patients, style, delightful artwork and the strong sense that patients are cared about and for. Harrison House in Grimsby exemplifies the 21st century approach to mental health hospital design.
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So, what would the ideal CAMHS ward be like?

  • Spacious, with access to outside space, private space and areas to see visitors.

  • Age-appropriate.

  • Have a range of activities and facilities to cater for different ages, allowing young people some choice over the daily programme.

  • Have gender-segregated areas.

  • Non-institutional, in terms of having clear links to the community, and the potential for young people to take part in activities off the unit.

  • Young-person friendly. Many young people spoke of the need for ‘homely’ services: colourful, warm and comfortable. Young people’s involvement in service design would be invaluable in providing services that met their expectations.

  • Offer clear information on different aspects of mental health, and services.


 

Source: YoungMind's Where Next 2 - take a look here.
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Here’s how Enhancing the Healing Environment put it:

“The environments in which we live and work have a profound influence on our physical and psychological wellbeing. In health care settings the environment can support recovery and wellbeing and has a real effect on patients’ perception of the care they receive. This goes beyond the necessity for cleanliness, infection control and the preservation of an individual’s privacy and dignity, to creating spaces that are fit for purpose and comfortable. Research has repeatedly confirmed that a supportive and welcoming environment can have positive effects on both those who visit hospitals - whether as patients or visitors - and those who work in them”.

 

Read more here
It’s often possible to detect, before being informed, if a hospital has been blessed with an Enhancing the Healing Environment (EHE) makeover. The distinctive features are style, boldness, visual pleasure and artwork. Whether it’s an entrance, a waiting area, a ward or a garden, it will be attractive, welcoming and above all convey the strong impression that people using the space are valued.

This is the sort of thing…
“The modern, spacious centre has a bright and funky feel, with vibrant colours scattered across the unit.  It has been designed to meet the needs of the young people we care for and has a ‘home-like’ feel.  All of our facilities are suitable for people with special needs and wheelchair users.”

Source: tewv.nhs.uk - read more here

 

“This new space has plenty to offer, it is light and the facilities have been significantly upgraded. There is room for the children to run about safely. The new campus boasts a beautiful garden with vegetable patches and soft play areas. The building is wheelchair-friendly, state-of-the-art alarms ensure safety and, of course, there is the latest therapeutic equipment.”

Source: swlstg-tr.nhs.uk - read more here

 

“The thing that many people comment on when they first visit the unit, is that it doesn’t look like a typical hospital ward because it’s so homely and friendly.”

Staff Member
⇦ Sounds lovely, hey?

Great facilities include:



  • Lounge

  • Dining room

  • Arts and craft room

  • Games room

  • Group rooms

  • A lovely garden

  • Ensuite bedrooms designed to meet the needs of the young person throughout their stay

  • Intensive care en-suite bedrooms with their own lounge areas

  • Pool room

  • Parent/carer overnight accommodation

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  • Sensory room

  • Visitors’ room

  • Therapy rooms

  • Kitchen where young people can prepare their own meals and learn to cook

  • Laundry room

  • Gym and sports hall

  • Family rooms with homely furnishings, televisions and activities to improve family contact

  • A communal lounge with TV, games consoles

  • Classroom

  • Outdoor play area

  • Garden room for quiet relaxation

Unique facilities include:

  • Flat to help families establish night time routine prior to discharge

  • Garden

  • ‘Safe’ space

  • Sensory courtyard

  • ‘Snoezelen’ – controlled multisensory environment

  • Music room

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Study: Green spaces improve schoolchildren's mental development

Green spaces within and around city schools improve the mental development of young children, a study has found. The findings may partly be explained by reduced exposure to traffic pollution, experts believe.


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Other influences could include the psychological effect of having views of fields and trees, rather than roads and buildings.
The Spanish researchers found that each degree of increase in surrounding greenness led to a 5% improvement in the development of short-term, or working, memory over a period of one year. It also improved the progress of ‘superior working memory’ - the ability to update memories with changing information - by 6%, and reduced inattentiveness.


Source: theguardian.com - read more

Being active and having quality family time are two things that help children and young people thrive. Getting out and about together on an exciting camping adventure or for a walk to the local park is positive mentally and physically. As well as health benefits, spending less time online could reduce the hidden dangers children are exposed to online.

Javed Khan, Barnardo’s Chief Executive

The ward environment has a profound influence on young people's physical and psychological wellbeing. It can support recovery and wellbeing and has a real effect on patients’ perception of the care they receive.

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Strong Caring Relationships Aid Resilience



Not only does the ward have an internal sense of community, it also nurtures strong relationships with families, other caregivers and supporters, as well as with the wider community. A psychosocial model of care involves supporting young people to develop and maintain social networks and relationships. While on the ward, young people can be helped to retain and build on their community ties. This involves recognising that young people are inseparable from their home communities, which play a part in conserving (or destabilising) their wellbeing. We enthusiastically urge ward staff to be aware that there are certain people and places that are especially dear to young people, whether they’re on or offline.

Good relationships with family and friends endow love, meaning and support, and can increase feelings of self-esteem. While wider social networks can create a sense of belonging. Families especially, can be very involved and effective partners in the care and recovery of young people, but community resources are also important: local facilities, schools and colleges, places of worship, shops, sports interests, entertainment and leisure activities, and so on. Keeping a connection to these and other community circles is crucial and aids resilience.

Dealing with Separation



Being on a ward and away from a parent or primary carer can feel incredibly scary for young people. In fact, fear of abandonment is a huge childhood anxiety, and the young person will no doubt imagine all sorts of ways it may happen during this difficult time. Too rapid a separation might lead to a young person transferring their anxious adhesive attachment to a member of staff, rather than developing their tolerance of being away from their primary attachment figure in a more positive and sustainable way (Holmes et al 2011). See Creating Change for Complex Children and Their Families: A Multi-Disciplinary Approach to Multi-Family Work

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Below are some ideas that wards use to support a young person in dealing with separation from their attachment figures:

  1. Provide age-appropriate information regarding the circumstances of their CAMHS admission or session, including its length, purpose and where their parent/carer will be (i.e. at work/home).

  2. Convey acceptance of any expressed emotions as a result of the separation. Show corresponding affect, empathy and curiosity.

  3. Be very clear about when the separation will end.

  4. Facilitate regular telephone or Skype check-ins, in which the young person can share what they’ve been doing with their parent/carer, and it’s obvious to the young person how important they are to them.

  5. Provide the young person with explicit reminders of their parent/carer throughout the admission. These may be tangible objects or remembered shared interests.

  6. Have the parent/carer lend the young person something of his or hers to keep close to them until their return. Likewise, have the young person lend the parent something.

  7. Have an activity associated with mutual fun planned for when they come together.

  8. Invite the young person to sleep with an item of their parent’s/carer’s clothing that smells like him/her.

  9. The parent/carer should express to their child that they miss them equally.

  10. Make clear to the young person that their parent/carer is looking for ways to reduce the duration or frequency of separation when possible.


Adapted from Daniel A. Hughes, 2009. See link above.

Not only does the ward have an internal sense of community, it also nurtures strong relationships with families, other caregivers and supporters, as well as with the wider community.


Keeping In Touch Online



The internet is now a major part of many young people’s lives, and a space where they make and connect with friends. Having a connection with others through a supportive community helps them feel understood. Providing access to an online community (for example, Skyping mum and dad or Auntie Emma in Australia) that they can feel a part of while an inpatient, can also reassure their family and friends, who frequently and understandably feel very detached and worried.
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Teenagers under the age of 16 could be banned from Facebook, Snapchat, Instagram and email if they don't have parental permission, under proposed changes to EU laws (source). Internet use is definitely not without real dangers, including cyber-bulling; around twice as many girls than boys reported being a victim of cyber-bullying in 2014, according to figures published by the Health and Social Care Information Centre (source). Furthermore, more than one out of every three 12 to 15-year-olds wakes in the night at least once a week just to use social media, one study suggests (source). However, when used appropriately, the internet has an extraordinary role to play in providing information and support to young people experiencing mental health problems. Nevertheless, it’s really important to balance the risks and the benefits of internet use.

Here are some fab internet safety tips:

  • Encourage the young person to use an internet chatroom that requires registration the first time you visit. These are also more likely to have ‘moderators’ - people who keep an eye on what’s going on and have the ability to exclude people who are breaking the rules.

  • Explain that even after they’ve registered, they should never give out their email address or phone number to somebody they don’t know. Encourage the young person to use a nickname and be careful not to give out their friends’ details. One expert put it like this: ‘Would you put a billboard around your neck with your name, age, mobile phone number and address on it and walk down the street?’

  • Some sites allow children to build up a list of ‘selected friends’. These are other users that they trust and are allowed to chat with. Talk with them about what they might want to be sure of, before they invite somebody to join their ‘selected friends’.

  • Warn the young person to be aware of somebody who wants to get too close too soon - for example, someone asking for personal details (such as an address or phone number), someone who wants them to send a photograph or use the webcam, or someone who sends photographs of themselves which might make them feel uncomfortable.

  • Sending photos is fine - to people they actually know. But remind them that they should never send their photograph to somebody who is just an ‘Internet friend’. In many ways these people are still strangers and may have been deceptive about themselves. Also remind them that when they send a photo via their mobile phone, they are sometimes sending their mobile phone number as well.

  • Tell them to always let you know if somebody has made them feel uneasy - perhaps by using inappropriate language or suggestions. Incidents can be reported to your service provider or to the Child Exploitation and Online Protection Centre (CEOP) at ceop.gov.uk

  • Remind the young person that they should only meet face to face with somebody they have ‘met’ online if they have an adult they trust present - and then only in a public place.

  • Warn them about chatting online with somebody who is obsessed with secrecy. They may insist you don’t tell anyone about their chats with you or ask you to keep details of a proposed meeting secret.

  • Remember that even though most teenagers would prefer to have a computer in their bedroom with internet access, this may not be wise. Having a computer in the living room or somewhere else where people are coming and going makes it a little harder to get into trouble.

  • Consider installing filtering software that prevents your teenager entering sites that you don't want them to.


Adapted from Parsons, 2007 See 'Teenagers!: What Every Parent Has to Know'
From The Guardian (abridged):

Fears about sexting, cyberbullying and access to inappropriate violent or pornographic images are being linked with other evidence pointing to communication disorders, spatial awareness issues, sleep disorders, stress and anxiety, eyesight damage and posture issues.

The blue light from screens has been linked to depression as well as insomnia. Rates of mental health issues experienced by schoolchildren are rocketing, with fingers being pointed at the pressures of social media or hours spent while online gaming.

Baroness Beeban Kidron, a film producer who was horrified by what she found while documenting young people’s online lives has started a campaign to support young people to access technology responsibly, calling for a charter of “iRights “ for children to be able to delete their online profiles.

Dr Kaska Porayska-Pomsta of the Institute of Education at University College London says that young people had an innate skill to deal with technology thanks to some kind of speeded up human evolution.

“We need to be looking at technology in a very different way. At how to use it as a means to support education,” she says. “These questions about how technology is impacting on young people are really only starting, they’re gathering momentum but there is a lot of work to be done yet."
"With their online lives following them wherever they go there are no longer the ‘safe spaces’ that I enjoyed, away from the pressures of school-life, friendships and preparing for adult life.

But young people have stressed to us that the online world shouldn’t just be seen as a threat. It’s increasingly where young people look for support too."

Sam Gyimah, Minister for Childcare and Education 2015

(source)
Research on parent’s perceptions of their child’s internet use

  • More than half (51%) of parents admit they are ‘extremely’ or ‘quite’ worried about what their children are getting up to online.

  • Parents are almost as concerned about the impact internet use is having on their children’s mental health (31%) as on their children’s social skills (36%).

  • Almost a quarter (23%) also fear it’ll impact their physical health as kids prioritise internet surfing over the real thing.

  • Around one in seven (15%) worry their offspring’s digital footprints could one day affect their career prospects with future employers.

  • More than one in 10 (13%) parents of teenagers aged 13-17 believe their child has ‘overshared’ on social media, while 15% say their kids have used inappropriate language on the likes of Twitter and Facebook.

  • More than one in 10 (13%) of parents of teenagers say their child’s internet use has damaged their social skills.


Source: techcitynews.com

When used appropriately, the internet has an extraordinary role to play in providing information and support to young people experiencing mental health problems.


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Featured Tools and Ideas


Click on the headings to read more and add a selection of ideas and tools to you own "Palette"

The Secure Base Model

A secure base is at the heart of any successful caregiving environment - whether within the birth family, in foster care, residential care or adoption. A secure base is provided through a relationship with one or more caregivers who offer a reliable base from which to explore and a safe haven for reassurance when there are difficulties. Thus a secure base promotes security, confidence, competence and resilience.

 

 

The Secure Base Model has been developed through a range of research and practice dissemination projects led by Gillian Schofield and Mary Beek in the Centre for Research on Children and Families at the University of East Anglia.

The Secure Base Model is drawn from attachment theory, and adapted to include an additional element, that of family membership, for children who are separated from their birth families. The model proposes five dimensions of caregiving, each of which is associated with a corresponding developmental benefit for the child. The dimensions overlap and combine with each other to create a secure base for the child, as represented below:

 

 

From: https://www.uea.ac.uk/providingasecurebase/home


“Never turn anyone away”

Young people, sometimes fresh from A&E, turn up on Dr Simon Newitt’s doorstep. He runs Off the Record, a youth mental health charity in Bristol.

Five years ago the charity saw around 150 young people a year, these days it's closer to 1,500, so there can be long waits for some kinds of support like counselling.

“There is so much unmet need - much of it is driven by wider social and economic inequalities - that those most in need of early help are also those least likely to seek it out,” says Newitt, who has worked in frontline mental health services for both the NHS and the voluntary and community sector for over ten years.

Off the Record is a self-referral service that offers counselling and therapy for children across Bristol and South Gloucestershire. Its ethos is: never turn anyone away.

Newitt says: “There is an increasingly large number of young people who need something more than light touch early intervention services like ours, but who don’t meet the criteria for more specialist services.

 “They bounce around in the gap between early intervention and specialist help, before maybe reaching a crisis point and ending up somewhere like A&E. They’ll get assessed at that point but they still won't get ongoing support unless they are assessed as having a mental illness of some kind.”

Off the Record recently teamed up with its local NHS provider to work on a pilot project to try and fill these gaps. Newitt says, “Really it shouldn’t take admission to hospital before the right kind of support is available.”

Source: from here


‘Street based’ mental health outreach services

“Help needs to be offered early to prevent problems escalating and that help needs to be holistic and flexible to the needs of individual young people.”

“Mental health workers need to be able to go out into the community, to work creatively, and alongside other agencies, to meet the needs of people whose lives may be chaotic and who may be facing multiple difficulties. There are a number of organisations offering ‘street based’ mental health outreach services of this kind, who do some excellent work, but these are too few and chronically under-resourced.”

Sarah (not her real name) is a social worker for a London-based youth offending service.

Source: from here

 


Internet safety from Islington CAMHS

Islington CAMHS spoke to young people to help them learn about internet safety and to find out what works well for them to keep safe online. The young people they spoke to gave them lots of tips and ways to keep safe online. Here’s a taste:

The internet is great for lots of reasons including …

  • Communication – such as interacting and talking to people.
  • Information – good for schoolwork, finding out updated information quickly and also having access to the news and maps.
  • Entertainment – streaming entertainment on websites such as YouTube and BBC iPlayer and also playing games.
  • Safety – young people told us they have used their phones to help them get out of tricky situations.

Top tips include:

  • Use a ‘phone jar’ – give yourself a target of how many times you go on your phone and if you go over, you have to put money in the phone jar.
  • Tell friends about the consequences of sharing information online, such as employers or prospective employers seeing posts and photos etc.
  • Don’t post when you’re upset /overly happy/ angry or in a different mood than usual.

Read the full guide here




Big White Wall

A safe online community of people who are anxious, down or not coping who support and help each other by sharing what’s troubling them, guided by trained professionals.

Available 24/7, Big White Wall is completely anonymous so you can express yourself freely and openly.

Watch this quick 2 minute video to find out how Big White Wall works.

https://www.bigwhitewall.com/assets/Videos/HowBwwWorkUKV2.mp4

Big White Wall is available free in many areas of the UK via the NHS, employers, and universities. It is also free to all UK serving personnel, veterans, and their families.


Keeping in touch using the internet - safely using social media

This guide by Foundation for People with Learning Disabilities includes easy-to-grasp tips on how to use social media such as Skype, Facebook, Email and Twitter safely.

Download it here

 


Silent Secret App

From: silentsecret.com:
"Silent Secret is a social community for young people to share their thoughts, feelings, secrets, news and lifestyle by posting anonymously.

Your post can be a secret, a thought, a feeling, something humorous, aspirational or hopeful.

We believe in Silent Secret as a social community built by and for young people, to support young people to have less stress and anxiety by providing a safe place to share, and connect to expert support organisations in times of need."
And from Sam Gyimah, Minister for Childcare and Education:
"Silent Secret app that allows young people to safely share secrets whilst providing direct support from key organisations when a young person seems to need mental health support.

Silent Secret is just one of the increasing number of apps that provide young people with support from their peers - and this is an area that I am particularly interested in looking at more closely." (source)

Check it out here: www.silentsecret.com


Relationships with friends and a sense of belonging are central to health and wellbeing

Improving Young People’s Health and Wellbeing from Public Health England is a pioneering framework which we hope will welcome more integrated CAMHS. Its core message is that young people’s physical and mental health are interconnected, and that services should use a holistic approach. It also states that relationships with friends and a sense of belonging are central to young people’s health and wellbeing. The framework recommends the following key principals:

  • A positive focus on what makes young people feel well and able to cope (See Learning and Growth).
  • Reduce health inequalities for those most in need by providing targeted services.
  • Integrated services that meet needs holistically and are centred on young people.
  • Understanding young people's changing health needs as they develop.
  • Accessing young people-friendly services.

 

 


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A Random Idea:

Conduct assembly talks, workshops or camps in schools to teach young people how to tell stress and depression apart, cope with their emotions in a crisis and reach out to friends with mental health issues.





COLOURFUL Themes Menu

Caring Relationships
Opportunity and Expression
Leisure and Therapeutic Activity
On and Off the Ward
Understanding
Relational and Physical Safety
Family and Friends
Unique Recovery Journeys
Leisure and Growth