Children's Mental Health: Listen Up! - A nature-based conversation with Dr Katherine Kennet

In this final part of our joint CAP and GAP conference specials which follows on from a session on climate change, nature, and sustainability in mental health; Dr Matthew Leahy discusses nature-based approaches for children’s mental health with Dr Katherine Kennet, who is a consultant child and adolescent psychiatrist with a keen interest in social prescribing.

Transcript

Asilay Seker: Hello, welcome to another episode of the Children's Mental Health Listen Up, the Royal College of Psychiatrists, Child and Adolescent and Psychiatry Faculty Podcast, and I'm Asilay, one of the co-hosts, along with Dr Elaine Lockhart. This episode is a final part of our joint  CAP and GAP conference specials and follows on from a session on the important topic of how understanding climate change, nature and sustainability can enhance the care we offer in mental health.

One of our former trainer representatives, Dr Matthew Leahy, was with us for this episode, to discuss nature-based approaches for children's mental health, with Dr Katherine Kennet, who is a consultant, child and adolescent psychiatrist, with a keen interest in social prescribing. Without further ado, let's hear from Matthew and Katherine.

Matthew Leahy: So, hello, my name is Dr Matthew Leahy. I am the child and adolescent higher trainee rep for RCPsych and I'm here at the joint child adolescence and adults spring conference, uh, and today's conference is based on the transition from adults to from child to adult. And we've just been in the session on sustainability and ecology, and I'm here with Dr Katherine Kennet, consultant child and adolescent psychiatrist with North London NHS Trusts So Katherine is an active member of the College Sustainability Committee, and has spoken wildly on social prescribing and the link between mental health and sustainability.

Katherine was the lead author on the College Position Statement on social prescribing, and she believes passionately that climate change and access to green spaces are social determinants of mental health and should be treated as such. So we just had the session titled 'A Breath of Fresh Air, how understanding climate change, nature, and sustainability can enhance the care we offer'. So I suppose my first question is, how did you get involved with the sustainability committee?

Katherine Kennet:  So thank you so much for having me. Um, Oh, that is a long question, which I'll quite try and keep brief. So I've been involved in thinking about ecology and thinking about green aspects of, I guess, all of life through family connections. I've brought up in a household that was very eco-aware, very politically minded, very involved in the green party, and that was just a natural part of thinking for me. Um, and then when I was a CT1 in North London, um, I was putting together a conference, um, for an NGO that I was involved in, looking at green economics and I'd never put mental health and uh, sustainability together. They were just two different parts of my life. And I saw a speaker at an RSM conference on the history of medicine, was looking at a future of medicine and mental health. And he happened to be, he was Damien Warren, who was uh, my predecessor in my role as, Associate Registrar for sustainability at the College, and I thought his speech was amazing and really brought those two strands together of mental health and sustainability.

I invited him to speak at this conference I was helping organising. And it went from there really. He invited me to be part of a committee who was setting up at the Royal College of Psychiatrists, on mental health and sustainability, and so I was one of the inaugural members of that committee, and that's been going for about nine years. I've been very, very involved and that's led to lots of opportunities that I've been very lucky to be part of. And I'm now one of the co-chairs leading it. But it's been a very empowering and refreshing space to be in, really thinking about all aspects of planetary health, sustainability and mental health. Um, and and it's just been a real joy actually. It's very uplifting thinking about, I guess, hope and empowering and being part of these projects. Um, some of which we talked about in the session today.

ML: That's really exciting. So how has it changed over the last nine years working at the College?

KK: Well, at the beginning, we were this sort of outside group led by the passion of Daniel and several of his colleagues. And he led in a very holistic way. As a consultant now, was a junior trainee then, I've tried, I think about in most days actually, and how he kind of really empowered by, but led by empowering those around him, and he always said the College is everyone. It's all of its members. It's nothing scary. So get involved and whatever you're interested in. And he always said, bring good people with you. So, that's what I guess we try and do.

In terms of how it's changed, we've become, I think, quite a well-respected group, we've got an awful lot done in nine years in terms of Position Statements, but also just changing in terms of internally in the College. And we touched on this in the session, but the Royal College of Psychiatrists is really leading the way in terms of sustainability among all of the Royal Colleges. We're a member of the UKHACC the UK health alliance on climate change, which is doing some amazing work on a kind of policy level, but also in terms of just day-to-day, things like what's stocked in the canteen, committing to net zero by 2040. There are so many things, divesting from fossil fuels at, every single level. Within the College at a practical level a lot is being done. As a full-time sustainability officer, that's new. He's doing amazing work. really pushing quite a lot of boundaries, um, in terms of the day stay running at the College, but in terms of how it affects the members, really sustainability is now being brought onto nearly every aspect of College work.

It's always, we're always invited to be part of discussions, which is a real shift to nine years ago when it was seen as a kind of quirky outside, 'let's just plant more trees and turn the lights off' approach, whereas now I think we're really seen as a social determinant of health, right? Sustainability, access to green spaces, um, empowering patients and staff, to be to be, connecting with nature, but also thinking sustainably in all ways. That's prevention, that's empowerment.

ML: So you were involved with writing the paper on social subscribing. How does social prescribing link to all of this?

KK: Oh, so social prescribing is part of the solution. It's not the whole solution, but it's part of the solution. So when we think about sustainability, we think about climate change, we think about ecological crisis, both of which are two sides of the same coin. And we think about the direct and indirect impacts on mental health, so I'm going backwards a little bit from your questions and then I'll go and answer it. So we think about the direct impacts. If we think about hurricanes, droughts, floods. When we think about all of these things that massively impact people day to day when they happen. We think about the direct impacts on their mental health, and we also think about the indirect impacts. So what happens if you have to leave your home or change your livelihood or have forced migration locally or internationally because of these impacts?

And we also think about intersectional challenges that come with that. So those who are already at risk, those who are in low socio-economic groups, with less resource to move or to manage these challenges, but also those with the severe and enduring mental illness. Now, all of these things affect mental health. Um, So we really have to think when we think sustainably, we're thinking about various things. One is prevention, prevention, prevention. That's the most important thing, but we also think about what else we can offer.

So social prescribing is an addition to the current gold standard of care. Green and sustainable healthcare is not a less than gold standard care. It's a better than gold standard, we call it a green standard sometimes. It's even better. It's providing the medication-based interventions we would normally be offering. The psychological interventions, the social interventions, but also there's other aspects, there's ecological or this green space.

So social prescribing is about, is about meeting that need, the social and the eco aspect. So what we're doing with social prescribing is when meeting individuals, usually it be a link worker, so someone who's embedded in a local community, really knows what's happening in that local community, and has a meaningful one off conversation with an individual and says, what actually matters to you? You know, whether you have mild illness, moderate or severe and enduring mental illness. What really matters to you? And if that's exercise-based or craft-based or nature-based, then what can we do? What can we provide in the local community that meets that need for you?

And it's what people talk about is it's hugely empowering. There's so much of what we do that's hopefully not coercive, but not fully, you know, service users that aren't necessarily fully on board of everything we're doing. We're kind of often having to nudge them and to take a medication, see how you feel about it, attend this group, see how you feel. And actually, what do you actually want to do? You want to spend time in nature? Great. How can we work with you to get there between your care coordinator or a family member to help you get to this group?

So social prescribing is about adding this extra level, really empowering aspect of people's care. And if you're in the mild end of the mental illness kind of spectrum or if your quite far down your recovery, that might be all you need actually. And if you're at the more severe end, say you're an inpatient or bring up an forensic services. Actually, we can still provide that. We can provide green spaces, we can provide craft or nature-based experiences. It just takes a bit more thinking and a bit more kind of planning and there's been there's a lot of evidence to show these are beneficial, but just to be clear, this isn't a low cost alternative at which some politicians see it as. There was a big move in the last government to see it as something that's being added...no, okay, I'm not going to say that, joke. Sorry, there was a big move. Okay, what should I say instead?

AS:  Anyways, we'll cut it. Don't worry. Just don't, don't go into politics.

KK: Sorry, didn't get political. So I guess just to be clear, it's not a local alternative to good care. It's an addition to good care to make it even better.

ML: So how would psychiatrists get involved because in my head, I might have thought of social prescribing as something you get through the GP. How would a psychiatrist find a link worker or find a programme to refer people to?

KK: Really good question. So, historically, when social prescribing first came in, 15 or so years ago, it was seen as a physical hug intervention. So a lot of it would be, for example, growing your own food and learning about how to prepare food for those who have diabetes, type 2 diabetes, for example.

We're now seeing that there's huge benefits for mental health. So link workers are often embedded in GPs and that's absolutely fine. We can contact them and say, are you interested in working more with mental health services? A lot of areas do have link workers working specifically in adult CMHTs. It's better, I'm a CAMH psychiatrist. It's very hit and miss, whether you have a local, so where I work, there is no link worker provision for CAMHs, but in other boroughs in London there are.

But I would say it's about thinking what is the local offer? There will be something available locally. It might not be dressed up as social prescribing that doesn't mean it's not social prescribing and that you as a psychiatrist can't put your young people, your patients in touch with what's locally available. So I would say, look and see what there is. Invite link workers if they exist locally into team meetings. That's a really common model. So that when referrals come in, that can be someone in the room going, actually, could this person benefit from social prescribing? Should we arrange to see them?

Care coordinators and adult services, and children's services if it's relevant, can be really good advocates for young people instead of, again, educating to what is available locally, would be really helpful. So embedding them in the local community. So there's lots of different models and lots of different routes in. The other thing you can do is just set up your own. So in a, in your own practice, so we've got a garden, in our clinic where we work and I'm trying really hard to create the garden into more of a, therapeutic space, there are lots of routes and lots of ways to do it.

There's a, can't remember the name of the nav, but there's a GP practice that was really pioneering in Kentish Town in London, where they basically just said, right, we want some more social prescribing, and they just had loads of things going on. They had craft stations in the waiting room. They had a garden, which they turned into a therapeutic space. And they just had loads of events that were happening throughout the day in the GP practice using their space, and that, that's social prescribing, knitting groups and craft groups and football groups happening with the GPs and the conditions working there, all taking turns to run them. So there's loads of different models.

ML: So in this, this will be the last question. In the session today, we spoke about the benefits of being outside of being more present, they're getting exposed to sunlight, the exercise, loads of real benefits from getting outside, getting connected with nature. If you're working with adolescents, if you're working with young people, how do you work with that resistance when someone's been stuck inside for long periods of time?

KK: I guess you work, you try and empower. So you work with, you look for their home group. What does the young person enjoy? It might be that they're particularly drawn to blue spaces to water. It might be their particularly drawn to, I don't know, gardening or nature-based spaces or it might actually be about literally just getting outside for five minutes a day and giving someone an achievable task to do that.

I think young people in so many ways are, more forward thinking and more aware of the climate situation and sustainability than the rest of the population. We talk about eco-anxiety, or ecodistress, as we prefer to call it, because we don't think it should be pathologised, but young people being really distressed at the state of the planet in the future.

Young people, in my experience, are really aware of the state of the planet, and I think tapping into that, asking those questions in our routine appointments, you know, asking how young people feel about it. Do they want to be in nature? And going down that route, I think is a really positive one. But I think this is all about empowerment and it's all about um, tapping into the sense that all of us as humans have. We've evolved to be in outside. This is evolutionary speaking, this is quite a recent thing to be inside all the time, and I think we all feel that.

There's a reason why we feel calmer when we're outside in green and blue spaces and those spaces are everywhere, even in central London where we are now, you know, there are lots of green spaces in blue spaces we can get to within five minutes of the College. And it's about, I guess, sharing that. There's lots of resources on the nature matters part of the RCPsych website if you want some more kind of specific tools and if you're interested in the evidence.

But that's what I would say, is just start with that bit that we all feel, which is when we're outside, we feel calmer.

ML: That's fantastic. Thank you so much for your time, Kat.

KK: My pleasure. Thank you for having me.

AS: Well, that was great. We're really thankful to Matthew, Katherine, and all colleagues, who were part of the joint conference's sustainability session. It was a really insightful discussion, and the amazing work being done in the College. We hope you enjoy this episode as much as we did, and we will be back with more interviews from our September faculty conference. Also, please stay tuned for our episode on psychosis with the new faculty chair, Dr Guy Northover. And that's it for now. Take care until next time.