Teach your Child How to Fight Anxiety

Natasha Daniels is a child therapist  and has worked with young children and their families for over 15 years. Her book, How to Parent Your Anxious Toddler, covers everything parents of an anxious toddler need to know, to help them tackle everyday difficulties and build up their child’s resilience, independence, and coping mechanisms. In this post she shares some advice on helping your child to fight anxious feelings.  

Teach your Child How to Fight Anxiety….and be a Super Hero!
Teaching your child how to fight anxiety can start at a very young age. I have worked with children as young as two and three that were able to learn skills on how to face their fears. So, roll up your sleeves and start arming your child with skills to overcome their anxiety. It is never too early to turn your little one into a superhero!

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EPISODE 1: DEVELOP YOUR LITTLE SUPERHERO

Set the Battle Ground
Have your child name their worries. Sometimes this will just be Mr. Worry, but you can pick something more specific based on your child’s fears (Mr. Bossy, Mr. Bugs, Mr. Scared, Mr. Sick etc.). Tell them that Mr. Scared likes to boss kids around and make them fearful. Have them create a worthy superhero to fight off Mr. Scared. I like to use the child’s name with Super in front of it (Super John, Super Amber, etc.). Have them draw a picture of Mr. Scared and of their superhero. Prompt them to make the superhero look like them in some way.

Dress the Superhero
Children love dress up and there is something transforming when one is dressed as a superhero. Have your child pick out a superhero costume that they can wear when they are a fighting Mr. Scared. A cape and a mask are always good places to start. If they have a particular superhero that they love – have them dress up as that instead.

Give them the back story
Set the stage for your child by giving them their superhero story. Incorporate your child’s fears into the story. Their story might go something like:

There once was a mean, bossy guy named Mr. Scared. Mr. Scared liked to go around bullying kids and making them feel scared. Every time Mr. Scared was able to make a kid feel scared, he would grow bigger. Super John wasn’t going to let Mr. Scared grow any bigger! When Mr. Scared started telling him to be scared of the dark, Super John didn’t listen to him! He knew he could turn on the lights.

Put on Your Game Face
In my house we have a “Brave Face” pose. Whenever anyone is scared to do something – we say, “Brave face!” and we all put our heads up high and proud. Sometimes duck lips are included. Sometimes it is a full superhero pose – arms on hips, chest pushed out. It is a nice way to empower each other and it encourages us to fight through our fears. At the very least, it lightens the mood and makes us all laugh.

EPISODE 2: SEND YOUR SUPERHERO OUT TO BATTLE

Verbally encourage your superhero
Having your child dressed and feeling empowered is only half the battle. Now they will need actual experiences to challenge and fight Mr. Scared. You want to encourage your child’s independence by giving them the least amount of assistance they need during these challenges. First start by giving them verbal support. You can say things like, “Don’t let Mr. Scared win this battle! Where is Super John? Do you need to get your cape on? Show me the Brave face!!”

Give suggestions to your superhero
Give your superhero some suggestions. You can say, “I know it seems dark upstairs, but there is a light switch right there you can turn on.” Or another suggestion might be something like, “We can sing together as you go upstairs so you know I am still right here.”

Offer limited support to your superhero
When your superhero is lacking some any superpowers – it may be time to call in for back up. The main goal is for your child to feel success, so if you have come to the conclusion that Mr. Scared is definitely going to win the battle, get your kiddo’s back! Offer the least amount of intervention as possible. This might be turning the light on for them or walking half way up the stairs with them. Always premise your assistance with something like, “Okay Super John I will make you a deal. I will turn on the light for you if you do the rest” or “I will go up the first flight of stairs, if you go up the rest.” Getting your child to agree on a plan makes it more likely that they will stick with it…sometimes. If that doesn’t work – pleading helps – “Don’t let Mr. Scared win! I know you can beat him!”

Okay, if all else fails, bribe your superhero!
I know that if someone told me to jump off a high dive there would very little that anyone could say to get me to do it. However, if the price was right – I might be encouraged to face my fears and try to do it. When all else fails offer a “challenge prize.” I will often have families set up a “challenge treasure box” that is filled with dollar store toys and prizes. When your child is faced with a particularly hard challenge, you can offer a challenge prize if they try to do it. You want your child to push themselves just slightly out of their comfort zone. If they are able to do this, but don’t fully complete the challenge you can say, “You were amazing! I know that was scary for you, but you went ahead anyway and tried to do it! You get a challenge prize for being so brave!”

Children don’t turn into superheroes overnight, but if you don’t give your child the skills to fight their fears, they have lost the battle before it has even begun.

This post was originally published on Natasha’s blog: http://www.anxioustoddlers.com/ 

Find out about Natasha’s book How to Parent Your Anxious Toddler, read reviews or order your copy here 

 

Designing The Princess and the Fog

What better way to explain depression to children than with a relatable and enjoyable storybook full of vibrant illustrations? The author of The Princess and the Fog, Lloyd Jones, reveals the motivation behind designing this book and its characters in his distinctive and colourful style. This content was originally posted on Lloyd’s blog.

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The Princess

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I chose a princess as the protagonist of my book because it is an archetypical character in children’s fiction. If you know that a picture book is about a princess, you can infer a lot about what the story, setting and characters are likely to be based on the countless princess stories you’re already familiar with. I was then able to turn that on its head by introducing new elements to surprise the reader and make the main character of the story much more relatable.

Additionally, princesses are typically revered and looked up to by the children who read their stories. They are something that a lot of young girls in particular strive to be. If a princess can get depression, anyone can. I think it’s important that the children who read my story can relate to its protagonist in quite a personal way so that they know that they aren’t alone and that this thing that they’re struggling with that they can’t explain can happen to just about anyone else. Depression can make you feel very alone, so just knowing that there is someone out there – even a fictional princess – who is going through something similar can be a huge comfort.

 

The Setting

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The setting of The Princess and the Fog is a strange mix of traditional old-fashioned fairy tale and modern day. A huge purple castle sits at the heart of a bustling modern metropolis. The Princess rides horses, everyone else drives cars. Television and print media apparently exist but so do knights and adventurers with swords and shields. This, again, is designed to make the story relatable on a number of different levels. Children will find the fairy tale elements of the situations as familiar as the real life ones.

In my research into writing for children I learned of the importance of metaphor. Children do not tend to like stories with aggressive morals. While the book deals with real-life problems, I have managed to avoid “outing” the children who read it by disguising the issues that young readers may be facing behind metaphors. Readers may understand that the book is describing a situation similar to their own without feeling like it’s singling them out or trying to teach them a lesson. The story is designed to be enjoyed in its own right but with a hidden depth to it that should communicate with any young readers who are feeling the same way as The Princess.

 

The Fog

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In my early design ideas for the book I was toying with various ideas for how to represent depression visually. I had previously used the idea of a hole in one’s chest and an obscured, scribbled out face in an earlier independent project called There’s A Hole In My Chest and didn’t want to use it again as I thought it would be too grim for children. Early ideas included some kind of slow, lazy slime monster not unlike The Doldrums in The Phantom Tollbooth, a hat or helmet of some kind that couldn’t be taken off once it was put on, and a ball and chain, but none of these quite described the feeling adequately. I decided that whatever it was it needed to be opaquely black, thick, impossible to remove and in some way at least partially obscure the protagonist’s head and face to create a sense of loneliness and isolation from the outside world.

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The title The Princess and the Fog popped into my head one day and it just fit perfectly. It ticked all the boxes, I could illustrate it in a similar frustrated scribbly way as the obscured faces in There’s A Hole In My Chest, and I just couldn’t resist the pun. The exact depiction of The Fog developed considerably  over the course of making the book before I settled on how it looks in the final product, particularly after notes that it obscured too much of The Princess’s face and could be seen as scary for some readers.

 

The King and Queen

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It was important to me to have the King and Queen both appear very physically strong, in their own ways. The Queen is extremely tall with very large legs but she’s very thin and a little unbalanced, while The King is short and squat with diddy little legs but with a very large upper body. In this way, it shows that they each have their own strengths that make them a very well-balanced team, both as parents, supporters and as the co-rulers of the unnamed kingdom in which the story takes place. Most children will look to their parents as their first port of call in times of crisis and The Princess is no different. The King and Queen are the first two characters to offer help to The Princess in dealing with her affliction. Although they get it a bit wrong at first, they are an essential part of the large support network The Princess is eventually able to put together. I hope any parental figures reading this book will be inspired to be as strong and determined as The King and Queen.

 

The Supporting Cast

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The other characters in the story that The Princess eventually enlists for her support network all play important parts in aiding her gradual recovery. Most of them straddle that same weird line between fairy tale and reality by representing both a trustworthy adversary one might find in the battle against depressive illness and a friendly fantasy character. The Druid, for example, brews up some potions for The Princess to try to help her fight away the fog.

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With his lab coat and diplomas, The Druid is clearly a metaphor for a doctor offering to help medicate the problem. But not everybody responds to medication. Everybody experiences depression differently and no one cure exists that will work for everyone, so I felt it important that the story never explicitly states which of the many solutions The Princess uses to try to rid herself of The Fog actually ultimately works.


Lloyd Jones lives in the south of England. Lloyd has a first class honours degree in Illustration from the University of Portsmouth, an MA in Sequential Design and Illustration from the University of Brighton and he is currently working on a PGCE FE from the University of Southampton. He has learned to live with his fog, rather than suffer from it. Learn more about The Princess and the Fog

 

Exclusive look at The Princess and the Fog

Enjoy this sneak peek at The Princess and the Fog, JKP’s latest children’s book. Vibrantly illustrated, this book was designed to be read with children aged 5-7 who are suffering from depression. 

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Once upon a time there was a Princess. She had everything a little girl could ever want, and she was happy. That is, until the fog came…

 

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Lloyd Jones lives in the south of England. Lloyd has a first class honours degree in Illustration from the University of Portsmouth, an MA in Sequential Design and Illustration from the University of Brighton and he is currently working on a PGCE FE from the University of Southampton. He has learned to live with his fog, rather than suffer from it. Learn more about The Princess and the Fog

 

What it means to be a transitions social worker

Jill Hughes and Natalie Lackenby are part of a Young Adults Team in Worcestershire that has a dedicated focus on supporting young people with disabilities through the transition to adulthood. As the authors of Achieving Successful Transitions for Young People with Disabilities, Jill and Natalie briefly describe their experiences as transition social workers from their unique point of view.

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Transitions Social Work

We are part of a Young Adults Team in Worcestershire that has a dedicated focus on supporting young people with disabilities through the transition to adulthood. We are fortunate to work as a team that has a co-ordinated approach to transition, but recognise that not all workers are so fortunate and some have to navigate these complex issues alone. Having been in this position previously, we know how lonely and bewildering transition can be and we looked for a comprehensive text that would support our practice in this area without success!

Transitions has traditionally been a service area which has been overlooked and under-resourced, and often seen as an add-on to the work of adult teams.  However, in these times of financial austerity there is a growing realisation that resourcing these complex pieces of work in a timely and efficient manner is actually cost effective.

The implementation of the Care Act 2014 has placed a framework of duties on Local Authorities for social work with young people in transition. This has brought the whole area of transitions into focus with clear roles and responsibilities.

In Achieving Successful Transitions for Young People with Disabilities we included practical case studies so as to highlight some of the challenges faced by workers, and offer suggestions of how to overcome such challenges. The importance of empowering young people to be more informed about the transitions process is essential, but equally we need to ensure that practitioners are equipped with the knowledge to successfully support young people to navigate the transition process and make their own decisions about their future.

Natalie’s Background

Social work is generally considered to be a tough job and as a newly qualified social worker in a learning disabilities team I felt ready for the challenge ahead. When I applied for the job, I remember thinking what a vital role this was and I was sure that there would be a wealth of information and resources to draw on. I was fortunate to be in a supportive and friendly team when I started my career almost 12 years ago, but what I soon found to be the most challenging part of my job surprised me somewhat.

I was different; I was the transition social worker. Unlike the other social workers in the team, my role focused on supporting young people from 14+ to think about adulthood and support them through a transition from children’s to adult services. It became evident that the issues faced by the young people I worked with differed from those faced by clients other team members worked with. Similarly, the challenges faced by my colleagues in their roles, were significantly different to the challenges I experienced in mine. I looked for guidance and found lots of information aimed at parents and carers but limited practical information for professionals about navigating the transition process.

I often found myself as a lone voice in a large school review trying to explain a number of systems, processes and policies to anxious parents and young people. In fact it was pretty lonely as a transitions worker.

My colleagues remained supportive, offering and advice and information where they could, however, I always felt that my role was unique, combining traditional social work, with a strategic approach that identified a need for future service provision. In 2012, the council recognised the need to have a strategic approach to transition and developed a county wide transition team to which I was transferred, the Young Adults Team.

Jill’s Background

I moved to the Young Adults Team in 2012, as it was being set up.  My background was primarily older people, but I had also worked with younger people with a physical disability. Prior to social work training I had also worked as an advocate and support worker to adults and children with a learning disability.

I was very apprehensive initially about a move into team where I was unfamiliar with the specific work, in an area that is often complex, with the added complication of it being a brand new team.  When looking for textbooks or practice guidance to support me with the move, I was surprised that there was nothing available to guide practitioners, and this left me further in the dark about what transitions actually meant, both to the workers and the young people experiencing it.

As a newly set up team, we all grappled with the challenge of transitions, but luckily we were in the position of learning from each other, and sharing experiences both positive and negative.

Jill Hughes is an Advanced Social Work Professional in the Young Adults Team in Worcestershire, UK, which manages transitions for young people with disabilities and complex health needs between Children’s Services and Adult Services. She has led on Practice Development Groups, facilitated reflective and interactive supervision in both one-to-one and group sessions, and she has a particular interest in personalisation and person-centred planning. Jill also provides sessional lectures to students completing access courses, BA and MA studies at the University of Worcester and Heart of Worcestershire College.

Natalie Lackenby is a social worker in the Young Adults Team in Worcestershire, supporting young people with physical and learning disabilities through the transition to adulthood. Natalie has worked as a Transitions Social worker since 2003, and prior to joining the Young Adults Team, she worked as part of the community learning disability team. Natalie has a BA in vulnerable adults and community care, and she has given lectures around learning disability, legislation and policy and the transitions process to undergraduate and postgraduate students at the University of Worcester and Heart of Worcestershire College.

To learn more about Achieving Successful Transitions for Young People with Disabilities click here.

What about parents who aren’t able to emotionally connect with their child?

Jane Evans, trauma parenting specialist and author of Kit Kitten and the Topsy-Turvy Feelings and How Are You Feeling Today Baby Bear?, writes about the importance of giving children the best chance to catch up on their emotional awareness and build their emotional vocabulary.

Evans-KitKitten-C2WThere are many reasons why a parent or carer might not be able to be emotionally connected and available to a child. It might be that they did not have that kind of childhood so they aren’t aware of the benefits of talking with a child about their own and others’ feelings. Or, it could be that they are preoccupied with their own unmet emotional needs, living with domestic abuse, addiction, an eating disorder, high levels of stress and anxiety or other physical or mental illness, any of which could create a distance between them and the child they are raising.

What it doesn’t mean is that they don’t love their child as that’s a different matter altogether, it’s often more that they are not able to tune into and regulate their child’s emotional needs and state. This can have a lasting impact on all areas of a child’s development as they may struggle to express and cope with their daily emotions and this can then get in the way of their learning, being able to make friends, have fun and enjoy a carefree childhood.

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The story of Kit Kitten shows how Kit becomes withdrawn, watchful and is often overwhelmed by not being able to put feelings into words and from not having a close adult to help unpack all of them in a safe and manageable way. This is something I have repeatedly seen in the parents, children and young people I have been working with for over two decades now. It causes such emotional distress and anxiety, and often leads to mental and physical illness from the stress of feeling emotionally invisible, stuck, overwhelmed and isolated.

Kit Kitten and the Topsy-Turvy Feelings aims to address this missing emotional connection early on to offer children the best chance to catch up on their emotional awareness and build their emotional vocabulary by encouraging adults to begin this vital work with them in a gentle way. Emotional intelligence is the key to good mental health, to being free to access learning and to building healthy long-term relationships for life.

 

‘If your emotional abilities aren’t in hand, if you don’t have self-awareness, if you are not able to manage your distressing emotions, if you can’t have empathy and have effective relationships, then no matter how smart you are, you are not going to get very far.’

– Daniel Goleman

 

You can find out more about Jane’s work, upcoming events and read more of her blog posts on her website: http://www.parentingposttrauma.co.uk/ You can also follow her on twitter: @janeparenting2

Preparing a child with ASD for a move to another country

Jones_Talk-to-Me-Conv_978-1-84905-428-7_colourjpg-printHeather Jones is the author of Talk to Me: Conversation Strategies for Parents of Children on the Autism Spectrum or Speech and Language Impairments – in this new blog she talks about what it has been like to relocate to the UK with her son Jamie, who has an autism spectrum condition.

Since moving to Australia 30 years ago I hadn’t given any thought to returning to England, but when my father was diagnosed with Alzheimer’s and it became apparent that he would need my help I started making the arrangements. In August of 2014 I moved to the UK with my son Jamie, who has high-functioning autism. He was then 19 and it was a huge decision for us to make this move.

Jamie’s main problems are his severe speech and language impairments. The work that I have done with him to help improve his communication I ended up turning into a book (Talk to Me: Conversation Strategies for Parents of Children on the Autism Spectrum or Speech and Language Impairments), he has long since passed his driving test, got his own car, held down a part-time job at a nursery and become far more comfortable socialising. I had my concerns about how he’d adjust to life in England, but I also had a huge amount of faith that all the work we had done would pay off and he would continue on as the independent person I’d worked with him to be.

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I wanted Jamie to come with me because I would simply have missed him too much had he stayed in Australia, but I was faced with the prospect of removing him from the friends, hobbies and habitual living that had been a huge part of improving his communication and this was a problem.

I made my arrangements very clear in my head, I knew how long we were going back to the UK for, where we would be living and what Jamie would be doing. I wrote down all my plans and then told Jamie as if it were a fait accompli.

“Jamie, we’re going to England.”

“Oh… Right.”

(Then, as is Jamie’s way, came the questions over a period of hours and days).

“Where will we live? …. What will we do? …. Will I still drive? …. Will I work?”

We were lucky in two instances – my sister Ellie and her children (now in their 20s) all lived in the same town and she had just taken over a pub. This meant that Jamie had a ready made group of friends (or cousins) and that my sister could offer him a job there and my responses to Jamie’s questions could be reassuring:

“We’ll live in Malvern near your cousins… And you’ll get a job in the kitchen at Ellie’s pub.”

 

pubWherever possible, I answered honestly and clearly. I got Google maps and photos out and we looked at the place we would be living. I took out photos of the cousins and we Skyped them to get Jamie familiar with their voices and homes and as a result I found that Jamie, while not wholly embracing the idea of moving away from all the things he knew, was more accepting of the prospect of moving.

When it finally came to getting our flight to the UK I tried to give Jamie as much responsibility for our situation as I could. I asked him what information we needed and guided him to the screens or gateways to find out the answers. In fact, we took two other flights during our stay in Britain – one to Paris and the other to India – and during both I tried to involve Jamie. But he finally said to me, “Mum I can’t do it. Can you, please?”

I realised that this type of organisation was too far beyond him at this stage of his communication development. However I still thought the process was rewarding for him and I will certainly take up the practice again when we next travel by plane.

Settling Jamie into a routine he was happy with in England was a serious challenge and one that I know other parents have faced in the past and will in the future.

Firstly he needed steady work, a routine built around establishing an income. Jamie could work at the pub and although he had never done anything like that before (and this would undoubtedly increase his anxiety levels) his cousin (David) was a very calming influence in the kitchen and before long Jamie was accustomed to loading and unloading the dishwasher, labeling foodstuffs in the fridge, peeling the vegetables and developing an instinct for what needed to be done.

That kind of initiative has taken a great deal of time to develop in Jamie and I am sure that the work we have done together has contributed to this. I’ve made sure that he has been able to continue with activities he has grown accustomed to at home, playing on the Xbox, going to the gym and going to see live music in some of the local pubs. With the help of family and friends Jamie has settled down surprisingly quickly and expanded his skills in ways I had never previously thought possible.

Heather Jones is the author of Talk to Me: Conversation Strategies for Parents of Children on the Autism Spectrum or Speech and Language Impairments which is available in paperback or e-Book from Jessica Kingsley Publishers

 

Autism Spectrum Disorder de-escalation strategies: Restrictive Physical Interventions

Brown9781849055031In this latest entry for the JKP blog author of  Autism Spectrum Disorder & De-Escalation StrategiesSteve Brown offers another short practical insight into how professionals working with children that have an autism spectrum disorder can create the most comfortable learning environment possible and de-escalate situations that can lead to volatile meltdowns. In this blog Steve covers what is appropriate physical intervention or restraint in the learning environment and what parents should be looking out for to make sure that the learning environment is the best for their son or daughter. 

 

Restrictive physical interventions

Physical interventions, positive handling, restraint and holding can conjure up negative images of mistreatment and punishment. Understandable because of historical practice in some organisations and settings.
downloadMy experience of working with children with ASD is that there is occasionally a need to prompt, guide, hold or restrain to keep the child and staff safe. Before I discuss this any further I would like to mention the importance of physical contact. Over the past 20 years of supporting children on the spectrum I have been told many times that children with ASD do not like to be touched. I initially believed this but now I beg to differ. I think that many children do like physical contact, usually assertive touch that can reassure and contingent touch such as handshakes, high fives and an arm around a shoulder. I have supported several children who have not liked positive touch but eventually through social stories and verbal reassurance have been able to experience hugs and cuddles from familiar people.
Sensory wise, many children can be hypo-sensitive to touch and seek out firmer touch that gives them a feeling of being comforted. If children only ever experience touch through restraint then the feelings they have toward touch are only going to be negative. If children experience positive appropriate touch from adults when receiving praise and encouragement physical interaction becomes less threatening.

 

To hold or not to hold? (That is the question)

When staff have to decide whether to hold a child it often becomes a stressful and pressurised situation. In the UK staff that work with children have a ‘Duty of Care’ to consider a child’s safety so any physical intervention has to be preceded with a risk assessment and evaluated afterwards. The following things need to be considered:

  • Is the adult acting reasonable?
  • Is the force applied proportionate?
  •  Is the action the adult has chosen necessary?
  •  Is the action chosen in the best interests of the child?

 

Adult_Child_handThe above checklist is essential to think through in order to make safe decisions and act in the best interest of the child or young person. The child’s welfare is the fundamental principle around which a teacher or carer should base their decisions and actions.
For parents or staff that are concerned about the use of physical touch or restraint my advice would be to check the school or care facilities policy on Care and Control. Find out if risk assessments are used and if staff can access training on De-escalation and Physical Intervention and investigate. And while you are making these inquiries find out how staff record and report an incident especially if a hold or restraint has been used. Parents need to be informed and this should be a part of a shared risk assessment.

 

For me it is a matter of staff confidence. Physical intervention can keep adults and children safe with equal importance. As long as risk assessments are used, training accessed and staff rely more on de-escalation, communication and behaviour management then physical intervention is a true last resort, but not an approach that should be feared or shunned when supporting children with ASD.

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Steve Brown is the author of Autism Spectrum Disorder & De-Escalation Strategies which is available in paperback from Jessica Kingsley Publishers

Mental health support made simple

Following the second edition release of Introducing Mental Health, authors Connor and Caroline Kinsella provide insight into taking a more global and simplified approach to mental health support in the fully revised and updated second edition.

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We wrote the original Introducing Mental Health: A Practical Guide to make the very complicated seem a little bit simpler and to help front-line workers do what often seems like the impossible. It’s not an easy role at the best of times, but much has happened in the nine years between editions to make the job of mental health care even more difficult than it was in 2006.

As thoroughly well behaved and professional writers (ahem) we chose not to fill the book with a long list of all that is wrong with UK mental health services. After all, most of our British readers need no reminders of the savage cuts, dwindling resources and disappearing in-patient beds that are now a feature of UK mental health.

But while it’s all very well to moan incessantly about our own back yard, we looked to the developing world for inspiration to update the simple, straightforward approach to mental health care embodied in the first edition. We’re lucky enough to have as a close friend one Vikram Patel, the Foreword writer of both editions, who is also the director of the Centre for Global Mental health, London. Vikram has spearheaded the global mental health movement which has helped make mental health a priority issue in those parts of the planet where malnutrition, malaria and HIV have traditionally demanded resources that truly put our own budget cuts and resource slashing into perspective. He is now on Time Magazine’s ‘World’s 100 Most Influential People’ list and we met up with him just as he had been interviewed for BBC Radio Four’s excellent The Life Scientific series.

It was a little strange sitting in a London pub with an old friend who is now the psychiatric equivalent of Kim Kardashian, albeit with a rather more worthwhile contribution to the world. While western psychiatry remains bound by an ever increasing list of obscure diagnoses, pharmacological treatments and reliance on highly trained professionals, the global mental health approach is a means of delivering care and support to communities without the need for complex resources, vast infrastructures or highly qualified personnel. Under this guise, mental health support is largely delivered by local people who, to put it quite simply, work with people not symptoms. In a word, it’s a very, very simple model of mental health care. And it works.

Psychiatry is, after all, a relatively straightforward science. It doesn’t take a master’s degree to recognise  when someone is severely depressed or saying bizarre things or taking an hour to leave their house because all the windows and doors need checking several dozen times. But supporting people through mental ill health can be anything but straightforward, and with qualified professionals and NHS facilities becoming ever more scarce, we now rely on police and prison officers, accident and emergency staff, housing support workers and (increasingly) friends and relatives to deal with our most needy and distressed people.

And while the poorest parts of the world begin to develop simple low-tech support systems that make optimal use of professional expertise combined with common-sense and the local knowledge of communities, the global mental health approach starts to look a lot like the sort of system that in many ways we in the UK are adopting by default.

We’ve written Introducing Mental Health twice, in both editions reflecting the many different scenarios and types of worker with whom we have worked in both clinical practice and training. We haven’t ignored the huge advances in the science of genetic and biological origins of mental illness, and have tried to make the science accessible to all. After all, there aren’t many people who would guess how much their Chinese takeaway has in common with the latest explanation of psychotic illness*. But above all we’ve strived to learn from Professor Patel and global mental health how this is above all a social issue, and how all of us have a part to play in helping our community’s most distressed and vulnerable people. It’s really surprisingly simple.

* Sorry. You’ll have to read the book to find the answer.

 

Caroline Kinsella has been a registered nurse since 1980 and has specialised in working with offenders and individuals with severe mental health problems. She has a Master’s degree in Forensic Mental Health from St Georges Hospital Medical School and is currently working with the Dorset Inreach Team as a mental health nurse assessing and care co-ordinating the needs of offenders in several Dorset prisons. Both Connor and Caroline live in Dorset, UK.
Connor Kinsella trained as a mental health nurse and has considerable experience of working with mentally ill people in both in-patient and community environments. Since 1998 he has designed and facilitated training for a wide range of services in health and social care. He writes a well-regarded blog called The Stuff of Social Care and has contributed to The Guardian’s Social Care Network.

To learn more about Introducing Mental Health click here.

 

Music therapy and dementia care – it’s now time to win friends and influence people

Shibley Rahman completed his PhD in frontotemporal dementia at Cambridge University, commencing a lifelong interest in the timely diagnosis of dementia. In this article he argues for more high quality research into the possible benefits of music therapy for people living with dementia; as well as making the case for the development of dementia care strategies which include the vital insight of people trying to live well with dementia today, so we can improve the experience of care for the many people in future who will receive a diagnosis of dementia.
You can learn about Shibley’s book,
Living Better with Dementia, here

It won’t have escaped you, hopefully, that the five-year English dementia strategy is up for renewal at any time now. The last one ran from 2009 to 2014.

Probably the usual suspects will get to command the composition of the new one. “Dementia Friends” has been a great initiative which has taught at least a million people so far about some of the ‘basics’ about dementia, but this ‘raising awareness’ is only part of a very big story.

In my book Living Better with Dementia: Good Practice and Innovation for the Future, about to be published by Jessica Kingsley Publishers, I argue that it is the people currently trying to live better with dementia who should be the ‘champions’ for the future. I believe strongly they should drive policy, not ‘leading Doctors’ or senior members of big charities.

My reasoning is as follows.

The population at large can be thought of as consisting of many people, represented below as dots. Networks

In a ‘cohesive’ (close) network such as A, members in the network are connected in close proximity. This builds trust and mutual support, discourages opportunistic flow of information, facilitating communication but minimising interpersonal conflicts. A cohesive network might be the hierarchical network of medical professionals.

A ‘sparse’ network (C) is effectively opposite to cohesive networks; but let’s say for the purposes of my example C consists of people with an interest in non-pharmacological interventions in dementia, including unpaid family carers.

In bridging networks, the ‘bridge’ (B) acts between disparate individuals and groups, giving control over the quality and volume of information exchange. I think of politicians such as Debbie Abrahams MP and Tracey Crouch MP, and the All Party Parliamentary Group on dementia at large, as people who can act as the bridges. These people are pivotal for policy formation.

I devoted a whole chapter of my new book to promoting leadership by people aspiring to live better with dementia.

Having all these people involved will improve the thought diversity and relevance of the new strategy for people actually living with dementia

We are currently in the middle Music Therapy Week 2015, dedicated to raising awareness about how music therapy can improve the lives of people with more progressed dementia. It’s no accident I’ve devoted the bulk of one chapter in my book to explain the brain mechanisms behind why music has such a profound effect on people living with dementia.

We, as human beings, all react uniquely to different music – there’s every reason to believe that certain people living with dementia, whether in the community, at home, in residential home, or a hospice, in other words wherever in the “dementia friendly community”, can hugely benefit from the power of music.

According to NHS England;

“Over the next five years and beyond the NHS will increasingly need to dissolve these traditional boundaries. Long term conditions are now a central task of the NHS; caring for these needs requires a partnership with patients over the long term rather than providing single, unconnected ‘episodes’ of care.”

In Rotherham, GPs and community matrons work with advisors who know what voluntary services are available for patients with long term conditions. Apparently, this “social prescribing service” has cut the need for visits to accident and emergency, out-patient appointments and hospital admissions.

Today sees a wide-ranging, open discussion of music therapy and dementia in Portcullis House, in Westminster. Prof Helen Odell-Miller, Professor of Music Therapy, Director of The Music Therapy Research Centre and Head of Therapies at Anglia Ruskin University, presented significant research findings at the meeting.

I feel music is not being given a fair ‘crack of the whip’ in the current policy. The first English strategy,  “Living well with dementia: a national dementia strategy” , was initially launched by the Department of Health, UK in order to improve ‘the quality of services provided to people with dementia . . . [and to] promote a greater understanding of the causes and consequences of dementia’ (Department of Health, 2009, p. 9).

We could have done, I feel, so much more on research into music by now. We could have done much more to increase the number of music therapists in England by now. Maybe some of this is due to ‘parity of esteem’, which has seen mental health play ‘second fiddle’ to physical health.

There are, however, glimmers of hope though, I feel. For example, it was last year reported in the Guardian:

“Overseen by Manchester University, it is part of a 10-week pilot project called Music in Mind, funded by Care UK, which runs 123 residential homes for elderly people. The aim is to find out if classical music can improve communication and interaction and reduce agitation for people in the UK living with dementia – estimated to number just over 800,000 and set to rise rapidly as the population ages.”

Accumulating evidence shows that persons with dementia enjoy music, and their ability to respond to music is potentially preserved even in the late or severe stages of dementia when verbal communication may have ceased.  Musical memory is considered to be partly independent from other memory systems. In Alzheimer’s disease and different types of dementia, musical memory is surprisingly robust, and likewise for brain lesions affecting other kinds of memory.

Given the observed overlap of musical memory regions with areas that are relatively spared in Alzheimer’s disease, recent findings may, actually, explain the surprising preservation of musical memory in this neurodegenerative disease. Jacobsen and colleagues (2015) found a crucial role for the caudal anterior cingulate and the ventral pre-supplementary motor area in the neural encoding of long-known as compared with recently known and unknown.

That’s why I believe we should support the British Association for Music Therapy (BAMT), the professional body for music therapists and a source of information, support and involvement for the general public.  The title music therapist can only be used by those registered with the Health and Care Professions Council. So there is regulatory capture, if not corporate capture.

This year’s campaign by the BAMT focuses on the instrumental role music therapy has to play in supporting people with dementia and those who care for them. Indeed, the current Dementia Strategy acknowledges that music therapy, as well as other arts therapies, ‘may have a useful role in enabling a good-quality social environment and the possibility for self- expression where the individuality of the residents is respected’ (Department of Health, 2009, p. 58).

Leading research has suggested that music therapy can significantly improve and support the mood, alertness and engagement of people with dementia, can reduce the use of medication, as well as helping to manage and reduce agitation, isolation, depression and anxiety, overall supporting a better quality of life. But very recently Petrovsky, Cacchione and George (2015) have found that there is “inconclusive evidence as to whether music interventions are effective in alleviating symptoms of anxiety and depression in older adults with mild dementia due to the poor methodological rigor”. This reinforces my view that service provision will only be markedly improved if we invest in high quality research, as well as the allied health professionals who can offer high quality (and regulated) music therapy as clinical service.

Living Better with DementiaAs I argue in my new book, “Dementia Friends” is great – but we’ve gone way beyond that now. The “Prime Minister Dementia Challenge“, I feel, showed great leadership in prioritising dementia as a social challenge, and the “Prime Minister Challenge on Dementia 2020” follows suit.

Being honest, we haven’t got a good description of what ‘post diagnostic support’ means, and therefore what it precisely looks like, for dementia. But one thing that is very clear to me that we need to invest in the infrastructure, including research and service provision, to implement living better with dementia as a reality in England. But I remain hopeful that my colleagues in the music therapy world will be able to win friends and influence the right people.

Find out more about Shibley’s book, Living Better with Dementia, read reviews or order your copy here.

The Adoption Checklist: Are You Ready?

L. Gianforte, co-author of Keeping Your Adoptive Family Strong: Strategies for Success, addresses the critical importance of reviewing whether or not you’re ready to adopt.

As difficult as it is to acknowledge and accept, not everyone is a good candidate for being an adoptive parent. Some folks have more patience, stamina, and resilience than others, and the presence or absence of these qualities must be factored in before proceeding with an adoption plan. At the very least, parents must be willing to face the full spectrum of negative possibilities—however distressing and depressing they may be—before they move forward. A willingness to look at the realities of taking in a bruised and broken child is a fundamental requirement if successful integration is going to take place.

A traumatized child, no matter how young, is not a tabula rasa just waiting for a new mommy and daddy to imprint him with positive experiences. Instead, he has already been marked by abuse and/or neglect that can cause a host of difficult-to-deal-with behaviors. This history must be acknowledged and addressed by prospective parents if there is to be any hope of building a functional family, and there is absolutely no room for denial.

To maximize their chances of success, adoptive parents must see themselves as agents of change. It’s perfectly fine to hold on to preconceived expectations of what parenthood will be like (as long as you don’t come crashing down if the fantasies fall apart), but you must also acknowledge and address the child’s negative experiences. While it might be difficult and seem nonsensical to keep the past in the present, it remains the most effective way to rise to the challenges that seem to suddenly pop up out of nowhere, again and again and again.

IS ADOPTION RIGHT FOR YOU?

So—who’s good at this and who’s not? Providing honest answers to the following questions is a good start toward finding out.

Do you take a child’s bad behavior or acting out as a personal affront?

In many cases, children who have been abandoned by their birth parents believe they are not worthy of being loved. This belief can be so firmly imprinted that a child will do everything he can to prove that it’s true. He will behave badly to reinforce the notion, testing the limits at every possibility. His goal is to generate parental anger, which is either equated with love or used to reinforce his belief that he is, in fact, unlovable.

When a child does something horrid and it appears to be intentional, it’s human nature to take such offenses personally. But keep in mind that treating people well is a learned behavior. When parents do it, their children mimic it. When they don’t do it, neither do their offspring. When a child who has not witnessed or experienced basic respect is uprooted and deposited in a nice home with kind parents, he will not automatically become a kind person. He will push and test and act out just because he can.

You will suffer needlessly if you take his acting out to heart, because the slaps in the face will be far too frequent and much too painful. It is therefore important to remove yourself from the equation—emotionally, at least—and be sensitive to what motivates the child. This is about him, not you.

Do you believe that love conquers all?

Real life is not a romance novel. It is not a fairy tale. The good guys don’t always win, and bad things happen to good people. When the sun sets on a particularly horrendous day, a hug from a loved one may feel pretty terrific, but it doesn’t necessarily ease all the pain. While love is an essential component of a healthy life, it isn’t an all-encompassing solution to every problem.

When prospective parents think about adopting a child, they often see variations of the same scenario. A sad, abused child sits alone—his eyes huge and pleading, his sweet little face etched with misery. His family has been mean to him, people who are supposed to love him have hurt him, and all he wishes for is a loving mommy and daddy to come along and save him from his wretched plight. Sigh. Won’t you come soon and save me? And so he waits.

In fact, the phrase “waiting child” is often used by foster and adoption agencies, because these two simple words tug at the heartstrings. But the truth is, the child isn’t waiting. Not for you, not for anyone. He’s more likely trying to figure out what he can do simply to make it through one more day.

Cameron’s birth mother was a practicing drug addict who frequently chose getting high over caring for her children. He vividly recalls watching her tie a piece of rubber tubing around her upper arm to prepare for an injection. He had witnessed this ritual enough times to know that once the needle hit the vein, he would lose his mother for hours—even days.

Does it appear that this child had even the remotest opportunity to fantasize about getting a new, loving family? Did he have the luxury of wandering off into a quiet corner to wish and wait? For Cameron and other children like him, it’s all about survival.

Are you anti-meds?

Some parents simply do not believe in medicating children. Citing instances of inaccurate diagnoses and physicians who are quick to overprescribe, they draw a definitive line in the sand. No drugs. Not for my kid. Ever.

While their accusations often have merit, they are not universally true. What about the 7-year-old boy who cannot focus long enough to complete a homework assignment or finish a meal? What about the 4-year-old girl whose rage is so out of control that she screams most of her waking hours?

Prescription drugs often provide solutions that make a world of difference. To be sure, it’s a tough choice to make, but it’s often the right choice.

At the suggestion of a therapist, Sally started her adopted daughter on medication. Eliza was born addicted to cocaine, and she was constantly restless, irritable, and filled with rage. From the moment she gave Eliza her first pill, Sally diligently watched her child for signs of change. Three days later, Eliza walked into Sally’s study with a beaming smile on her face. As she flung herself into her mother’s arms, the three words she uttered said it all: “I happy, Mommy.”

Have you thought about the effect adoption will have on all members of your family?

If there are no other children in your home, feel free to skip this section. But if you are planning to bring a hurt child into a family with children already in place, you might want to linger here awhile.

The addition of an adopted child affects everyone. It makes no difference if the other children in the family are birth kids or adoptees, if they’re healthy and adjusted or fragile and struggling. The new child does not discriminate, and he shares his pain and dysfunction with parents and with siblings, with the weak and with the strong.

If there are other children in your home, you must carefully consider the answers to these questions before adopting:

  • What, if anything, will they gain by the addition of a new child?
  • What might they lose?
  • How will they react to the anger directed at their parents by the newcomer?
  • What will their friends think, and how will they handle any criticism?
  • If the birth order is changed by adoption, how might the kids feel about losing their position in the family hierarchy?

It’s not just about you and the new kid. There are other lives to consider.

Really—what are your expectations?

It is important to carefully examine your intentions when you decide to adopt. If you are trying to fill some sort of personal void, you’re setting yourself up for disappointment. You should not adopt so your only son or daughter can have a playmate. You should not adopt because you have three girls and would love to add a little boy. Your expectations will likely go unmet, and it is not the adopted child’s role to meet your needs in the first place. He can barely be who he is, much less become the manifestation of a pre-conceived fantasy.

As critical as what you expect from your adopted child is what you expect from yourself. Do you assume you will parent him in the same way that you parented your birth children? Do you think he will respond to you just like they have? Do you believe you can spontaneously jump into parenting without taking into consideration how your behaviors and interactions will be received by the adopted child?

We cannot stress enough the importance of looking deep inside yourself and providing honest answers. Trust us when we say that any adopted child will be better served by parents who truly know what they’re getting into and are fully prepared to face the challenges.

If you’re not there now, it does not necessarily follow that adoption is out of the question for you. With some focused work, you may be able to make the personal and attitudinal changes that can better equip you for the undertaking. You can’t force it, but it just might happen. After all, the human spirit is powerful, and determination is a mighty dynamic.