01 February 2022
The Chair of the Faculty of Child and Adolescent Psychiatry, Dr Elaine
Lockhart, and her colleagues Dr Guy Northover, Dr Alka Ahuja and Dr Louise Theodosiou reflect on a written piece from a young man who went through the CAHMS system. They also discuss their childhoods and the changes they would like to see for young
people in mental health support.
This podcast contains a first-hand account of self-harm.
Dr Elaine Lockhart: So, welcome to our podcast for Children's Mental Health Week and I'm delighted to be joined by other colleagues from our faculty executive Guy Northover, Alka Ahuja and Louise Theodosiou.
But first I'm going to start with a piece that has been prepared for us by Nathan Randles. A young person with lived experience of CAMHs, who has written a very powerful piece for us to first reflect on when we're thinking about children's mental health and growing together.
“It has been a decade since I first self-harmed. I was 12 years old and struggling with finding a voice of my own and attempting to come to terms with the person I wanted to be. It would take four years of apathy, resignation, and self-hatred for me to begin to reach out for help. During those years, I struggled to develop the social skills needed to maintain friendships with other young people my age, I experienced bouts of bullying, and grew to lows the world in which I lived.
In school, I had a desire to learn. I had my passions, the sciences, music and history. Unfortunately, I could not translate these passions into academic results. At age 15, and with the mounting pressure of my impending GCSE exams now looming, I finally broke. My self-harm had gotten to the point where ignoring it was no longer an option. I left classes with blood running down my fingertips, I wrapped myself in tissue paper to prevent my shirts from being stained. With the support of a patient friend, I finally reached out and told a teacher about how I was feeling. It felt like one of the first times I could be listened to and find a sense of self within it. This action is what changed the course of my life forever. I was then isolated from my fellow pupils, given counselling and eventually taken to a&e for an emergency mental health health assessment.
Two weeks later, I was in CAMHs. I was prescribed medications and therapies. I found myself in an environment where the most important thing was my voice and my ability to articulate myself with it. Gradually I began to improve. The occasions I self-harmed had slowed and finally stopped. I felt myself gaining a sense of optimism about the world and the people in it. Despite this, I still struggled when stepping back into my daily life. I did not do well on my GCSE exams. However, I no longer felt my scope to achieve was bound to grades on a slip of paper. The summer of my 16th year saw me participate in the National Citizen Service Programme. I felt it was a fresh start. I could put into practice all that CAMHs taught me. And so I did. The greatest thing about it was that it worked. I made strong friendships. I learned how to engage others my age besides a psychotherapist. If CAMHs is where I realised I had a voice, The National Citizen Service is where I learned how to use it. I shadowed at the CAMHs service for an apprenticeship. During this time I had the opportunity to sit on interview panels within the service, I began to see the genuine impact my words and thoughts could have on the ongoing development of the service.
Eventually, an apprenticeship was available. I applied, interviewed, and a week after my 18th birthday, I had a job. As a social media apprentice, I focused on the digital and networking of the service. The exact gift of voice that CAMHs had given me became the tool needed for me to do my job as well as possible. Jumping forward for more years, I'm now 22, I still struggled with many areas of my life, and I still have many places to improve myself. Yet, looking back at the person I once was and how that young boy felt every day.
The path I wish to walk down to the future could not be more evident. I have begun studying medicine with the aspiration of becoming a psychiatrist one day. I hope that far fewer young people find their voice under the same circumstances. I found mine in the future. I hope that young people won't feel forced to wait until the breaking point before reaching out in the future. Furthermore, I hope that young people live in a society that intends to nurture them and they're tomorrow's with cared for institutions available to help serve them whenever needed. I feel endless gratitude towards individuals and organisations who have helped push me to where I am today, without them, I wouldn't be where I am today. My final hope is that more young people receive access to the same opportunities I have been lucky enough to have had.”
Okay, that is such a powerful piece. And it gives me great cause for hope. And also I found it emotionally, really, really challenging to listen to, because I think Nathan has expressed how much suffering he was going through, and how alone he felt. And I just wanted to start with you Guy and, and ask you to reflect on that and share your thoughts.
Dr Guy Northover: What a powerful statement and I know you've already said it Elaine, but I think it's worth repeating. And what strength from Nathan to be able to put that down and to let us know his experiences. And I tell you what, I can't wait for Nathan to be a psychiatrist, because he's undoubtedly going to be an absolutely fantastic psychiatrist. And I think can see that from everything, that he's been able to achieve everything he's been able to change already, and his desire to make services better for everybody. And from his statement, I mean, Elaine like you said, the emotional impact, I think is huge. And I'm not trying to move a little bit beyond the emotional impact. And one of the things that I've really taken out of this is that phrase that it takes a village to raise a child, I probably misquoted. But I think you know what I'm probably trying to say there. Because when I listened to what Nathan was saying, the impact of school was crucial, both positive and negative.
Having a teacher who Nathan was able to confide in him to say, look, actually, there's something here that I need some help with the ability to access the right services, but then for it all to be crystallised around the National Citizenship Service. And that it's not just about a mental health professional giving you some CBT, it's about how that fits into everything that's going on. And then finally at the end of it, which is just fantastic, as well to see as Nathan's consideration of his friendships that he's built up and developed as well. And how all of that together, allowed Nathan to develop into what we all know to be a fantastic young man with such incredible potential in the future.
EL: Thank you absolutely. And I, I really like the point you've raised, which is how schools can be a place causing such stress and difficulty for young people. And at the same time can be exactly where they find the support and the nurturing that they need. And that just creates all sorts of challenges. But also, as you say, it's not just one person, it is the village, it is going to be friends, family, school communities, as well as specialist services that can really make a difference. Yes, no, thank you very much, Louise, what are your thoughts and feelings after hearing that?
Dr Louise Theodosiou: I would agree with both of you that it's a very impactful piece to listen to. And it really felt very powerful. What I also was left with was a sense of hope, because this is a young person who has travelled this very difficult road, but who, at the end of it is resilient and hopeful and is going to be sharing his experiences. And we all know how valuable it is to be able to bring empathy and lived experience into your work. I think for me, the other thing that really stands out is how important it is that we listen to children and that we give children the tools to support one another because you know, that lovely phrase, a patient friend. You know, the idea that his friend understood what he was experiencing, and was there to offer that peer support. You know, it's so wonderful that we've got the initiatives we have in terms of skilling up children and young people to support one another. And to understand that it's okay not to be okay. And to me, this just beautifully illustrated that.
EL: Young people at the moment seem to be much more open to thinking about mental health and about struggling with mental health can often be the most empathic and supportive. Yeah. Thank you, Alka, coming to you and great to hear your thoughts.
Dr Alka Ahuja: No, and I totally agree with what has been said. Because for me, after reading that piece, it almost got me quite emotional. I'm actually quite angry in the fact that, you know, this is a young person who was crying for help, but obviously wasn't getting it. But then on the other hand, when I read the last bit, it made me think that, you know, sometimes it's things like this that get the best in you, although he had to go through all that traumatic journey of trying desperately access health. But I agree, we sort of underestimate the role schools play in the child and young person's life, because they do spend a significant amount of time and I know, sometimes it's the most unqualified and non-professional people who can be most helpful. Everybody doesn't need that specialist help. And it may be just the receptionist in school or a dinner lady who gives you that time and the phrase weights that patient friend, in the way he described a friend for somebody just was willing to listen to him and give him the time that he needed. And I think it's just being mindful that those small things matter so much when one is vulnerable.
EL: Completely, and it was so good to hear how not only did he receive the help he needed within CAMHs, but also that people recognised the value of bringing him in to help the service to develop further. And that then led to him coming to work with us on the Royal College of Psychiatrists executive committee. And that gives me great hope. Because other people reached out to him and he was able to take up that opportunity and that challenge, and we're, we're very much the better for it. Thank you, can you can we move on to thinking a little bit about what life was like for us? And Alka? Thinking back, he talked about difficulty starting quite a young age, and really coming to a head when he was about 15. Can you tell us a bit about what life was like for you at that age.
AA: I was born and brought up in Bombay in India, and 15 years was when I was preparing for my GCSE is as well, we tend to do them in Year 10. And I went to a convent school. And one thing, you know, that struck me was the amount of support on that social network that I had because GCSEs were very stressful, there's a lot of academic pressure to do well, and achieve and achievement is almost identified as either you get into medicine or engineering, there wasn't any third career. So, everybody sort of went down those two paths.
You've got to get the grades, you've got to go to the best university and excel. And I think the very fact that we had almost an open door policy, and I still remember times when we just found Oh, my God, maths was getting too much. And we could walk into the head teacher's office and say, Well, this is really getting too much. And she would say, Do you want to have a bit of a chat? Or do you want to have an extended break? And we used to have a little canteen downstairs, and we could go there and talk to the lady in the canteen the librarian she was, you know, our best friend. And now in hindsight, I think it was often those little conversations just went in venting and often gossiping about teachers and sort of saying, oh, you know, this one's really horrible because she gets too much work - was so much helpful because it destressed us and unfortunately, coming up to a GCSE, yes, I lost a very close friend of mine in a road accident. And I still remember that it was hard because the whole school atmosphere had changed. But the very fact that everybody was grieving at the same time, yet supporting each other. And we managed to go through it, it had an impact, because I still remember the time when we went for the funeral. But having people to talk to knowing that people were there for you. It didn't seem that bad for some reason.
EL: I know it's funny, because at the other end of the world, I was in a small town in Ireland at a convent school, which in some ways was quite limiting. It was an all girls school. There wasn't a whole lot of variety in terms of people's background and cultures. But strong friendships were really key. And we just went on, we talked a lot, people might be surprised to know that about me. I was surrounded by quite strong-minded other young women. But we were encouraged to talk and to have opinions and to think about our place in the world and to move on and be ambitious for ourselves. But when you're saying that, I think some of the best chats and support I ever got was from my piano teacher, where there wasn't a whole lot of piano playing because we would just talk about stuff. And it was about big ideas or what was going on and maybe a bit of gossip. But it was a great relationship as well. Just shows how you find that support and strength from lots of different people. So yeah, thank you for that. Guy, how was life for you as a young teenager?
GN: I wasn't the best behaved of teenagers I have to say, but fortunately not so bad that I couldn't get myself into medical school. But I grew up in Devon on a small farm which felt like it was in the middle of nowhere. And you know, in the fact that I couldn't get anywhere, even though it wasn't in the middle of nowhere it made it it distant enough to to get to school every morning I had to be dropped off at the station in the nearest town and then catch the train into school and then walk from the station to the school. So, the whole process getting into school would take me around about an hour and 15 minutes to an hour and a half.
I would always walk rather than catch the bus at the other end, and then I'll save up the money to buy cigarettes, which probably not the best thing to do. But then there we go. And then in addition to that, it was a private school where work was really prioritised over everything else. So, being in a slightly isolated place in a school which prioritise work, it made friendships a little bit more difficult than perhaps I would have liked it to have been. And then on top of that, I did an awful lot of sailing. So, my most of my leisure time was sailing, and doing that quite competitively. And I think that throughout my childhood, I probably missed some very close friendships. I did, of course, have friendships and quite a lot of the people who would go to school on the train with me, but it just led to the situation in a school where I probably wasn't alone in not recognising or knowing other people who might be going through emotional distress. And that was quite, it was quite a surprise to me actually, to find out when I applied for my first consultant job that the CAMHs team was on the same site as the school I went to. And I hadn't realised that. I think that sort of shows a shift in some ways of the understanding around mental health and the importance of our emotional wellbeing to how it was when I went to school.
EL: Yes, and I would have been at school before you and mental health wasn't talked about as such. But also, my understanding was probably because my mum worked in a psychiatric hospital was mental illness was for people who were really, really unwell. And there wasn't a conversation about people like us as teenagers who had our ups and downs emotionally, and could feel really upset at times, that wasn't really connecting up with that. And I really don't think that we're mental health services for children, young people going around at the time. So, it does show how, whatever the challenge is, now we have come a quite a long way in understanding and recognising that and developing services. But, it is hard to think about you ever being badly behaved Guy. So yeah, that's quite interesting to hear. Louise, I know that you were in another part of the world growing up. So, tell us a little bit of your experience, then.
LT: Yeah. It's wonderful to be part of this conversation. And I think what's interesting is that I too, went to a girls school in Zimbabwe. And Zimbabwe is unfortunately not a country that, I suppose, fully embraces LGBTQ rights. So, for me, as a young person, who was already very aware that I was gay, it was quite a complex environment. And I think that sense of isolation that Nathan spoke about, that really resonated with me, I was very lucky to have good close friends at the school, but I didn't feel able, and that was my choice, to discuss my sexuality with anyone and it I think it made me feel lonely and made me feel different.
I think that sense of, of being different, and being Other is something that that I feel I encounter a lot in my work now. And it's something that I find very valuable, having that experience within myself to get in touch with and, you know, I love working in environments now where you know, there are LGBTQ friendly, and diversity friendly spaces everywhere I look. And to me, you know, one of the most important things that we can do for young people is to make it clear that whatever your differences, whether you hold that difference inside or whether it's a difference that you think other people are looking at, we are a service for everyone, all different, all welcome. And to me that is is what is so important about wellbeing income services is that we need them to be for everyone and everyone needs to feel welcome right at the door, and right through to when they're actually talking to people in the building.
EL: Completely. And recently, a young man said to me how important the pride flag flying over a hospital, and the badge I was wearing was to him because his family aren't very supportive of his sexuality. And he was finding that it was validating to see services. Absolutely saying you're welcome here. And this is a safe space to come in and talk about how you're feeling and what your struggles might be. So, it does show that it's not just lip service or ticking a box when we have these symbols and thinking about now Louise, what would you wish for teenagers growing up in 2022 that how things should be in terms of supporting them with their mental health, particularly if they're struggling or feeling different and other and maybe not sure where to go with that?
LT: I think for me, what is incredibly important is that we are advocates for a whole young person. I know that what we're not focusing on here today are themes of hunger and poverty and lack of opportunities. But I feel that, you know, we have a really powerful platform that we stand on as psychiatrists. And it's important that that's kept in mind, because we all have those basic needs for warmth and protectiveness and safety. And I think, you know, hoping that those opportunities become available to every young child is something that I think we all share. But I think in addition to that, it's about making sure that there are as many different spaces possible. Just to echo Alka’s point from before, what is really important is that different services and different types of services will work for different people. The pandemic has been a real challenge to us all. But it has opened up so many more platforms, digital platforms, phone platforms, text platforms, it's really important that as many different people and as many different services are available for young people. And yes, in all of those, I think we should make sure that people recognise that whatever your diversity is, we should have those symbols there, because I look for the moment for pride flags myself, and which people should know that they'll feel safe and welcome.
EL: Thank you. And it does seem helpful that with the rollout of digital technology, everybody was very conscious that not all families could access that and could afford access to data or devices, that seemed to be in the front of people's minds very quickly, which I think is is encouraging, isn't it? Because it's the same way for some families, getting to clinics can actually be quite exclusionary, if that's a word, but it can be very difficult financially, to work that out. Absolutely. Thanks, Alka, what would your hopes be for young teenagers growing up now, and the support that they might need for their mental health?
AA: I think going back to what everyone has said, it's not just mental health being provided by mental health specialists, but looking at the wider community. And it's how we have a role in supporting some of the work that happens in schools, in leisure centres, you know, with places where children and young people will have contact and just generating that awareness. And letting young people have the opportunity to have these conversations, and not waiting for the time when things get so severely damaged, that they need specialist help, or they need to come into hospital. The other thing I would flag up is, and this is part of when I was growing up, even when I started my medical training, I hadn't seen children and young people with ADHD, I hadn't seen older people with dementia. And I think it's something about culture and about people's acceptance and tolerance, because a lot of that was accepted. I'm not saying whether that was right or wrong, kids were treated as being naughty, but, the grandparents would step in, and they would provide support, and they would be helped available so that parents could have some time off, and have the kids on the weekend with grandparents.
The family system has evolved, and it's more nuclear families, parents working, but I do think there's something about the wider community participating in. You know when I came to this country, and I saw kids with ADHD was thinking, Oh, my God, where are they coming from? There's something in the water here, because I've never seen so many children and young people with ADHD. And again, things have changed in years, while they have more and more of this being recognised. But I do think that society has a huge role to play in promoting that. And in some ways, you know, having awareness about mental health and wellbeing in the curriculum, people understanding it. And going back to digital, you know, it's looking at different ways in which young people can be supported for some that may be the way they access health, because it ensures privacy, it ensures, you know, the fact that they can talk to somebody without parents knowing as long as you know, those conversations are happening safely. But for others, it may be the face to face work that's needed, and more of that. So, yeah, it's something that we should be thinking more widely, and being accessible.
EL: I was also thinking back to being a teenager and how a lot of what was on offer has been really good for supporting my mental health on a lifelong basis, because we were encouraged to be active, and to try lots of different sports and you didn't have to be fantastic and on the top team to be allowed to participate, and also to have access to music or art. And again, it was just about enjoying it. And these are all things that I think it's so important for children and young people to have access to. And I do feel particularly for children with ADHD, sometimes the educational setup and where they live can be really difficult in terms of lack of access to spaces for just running around and blowing off steam. So, it is about thinking as you say about the whole child and as Louise was saying, you know to start off being safe and secure and not worry about where the food is coming from and families not having to choose between eating or heating, which we're unfortunately hearing about that the moment. Guy, what would your hopes be for young people to be able to access now?
GN: Before we get into what I want to do, I just want to bring up one of my own stories just quickly, because we've been talking about ADHD and just how things have changed. I was assessed for ADHD when I was eight years old. And the child and adolescent psychiatrist, in his report said, I don't have ADHD, I was just a naughty child. And what I needed was more of a structured language. And I got prescribed Latin lessons. Believe it or not, I was terrible at Latin. So, if we're thinking about hope, and at that time, that was probably considered a good approach to the presentation that I had. One of my hopes for the future is that we continue to develop, we continue to improve, we continue to learn, and we continue to find new ways to help teenagers as they become young adults as they become adults and on throughout the whole of their lives. And the other thing that I really hope is hope itself.
I think at times we live in a world where hope can seem a little bit distant. I think if we look at the, the environmental crisis we seem to be going through on top of that, we've got COVID as well. And I would just like all young people to be able to hope and know that they can make a change to what to how we're moving into the future so they can see a future not just for themselves, but for everybody.
EL: Thank you. And yes, young people are also so much more connected with the bigger issues. I think sometimes we get a little bit blinkered as we focus down in our work and our families. And they are thinking about these big issues on say they are wondering about the state of their planets, and what type of world they will be going out into in terms of the working world and worrying about the effects of the pandemic and whether there might be more in the future. And I do feel that that's a burden they're carrying, that I wasn't aware of when I was growing up. I completely agree that I would like to think that they will feel hopeful about the future as well because they have so much going for them. That is part of the joy of our job, isn't it, we come in contact with young people all the time, who are just so impressive. So, thank you so much.
I think that's a really nice way to finish, isn't it, that we have great hope for children and young people and I hope that they will carry on their teaching of us and pushing us to develop better skills, resources and opportunities for them. Thank you very much for being part of our podcast, and I look forward to seeing you soon.