Change the Story: Nina’s Story

Change the Story: Nina’s Story

Change the Story: Nina’s Chapter

Our CAMHS inpatient ward – The Maudsley Adolescent Unit (MAU) is an open unit offering mental health care for young people with serious mental illness such as psychosis or problems relating to their mood and require hospital admission. We have developed a national and international reputation for innovation and pioneered the introduction of a comprehensive, all-hours emergency admission service.

Within this unit, individuals such Nina, are the driving force behind our efforts to support and nurture the mental health of the next generation. Their commitment forms the very core of our Partnership. In this spotlight, Nina tells her story on how her team went above and beyond to support a young person to attend college from an inpatient CAMHS ward.

Nina

Nina

Ward Manager, CAMHS PICU

Young people admitted to inpatient CAMHS wards usually attend the on-site hospital school. The school is independent of the hospital and is run by Southwark council and staffed by an incredible group of teachers and support staff. They work with young people at various ability levels and support young people who are just starting secondary education, right up to young people who sit GCSE and A-Level exams whilst in hospital. However, fantastic as the school is, sometimes they aren’t able to provide the exact course a young person wants to do. Previously in these instances we may have encouraged a young person to look at alternative courses; ones which the hospital school could support them with. Or suggest doing different courses for a year and applying to the one they really wanted next year. However, over the summer we spoke with one particular young person on the ward and realised that this approach didn’t really work for them and wouldn’t be supporting them to achieve what they could.

This young person had been an inpatient with us for a number of months. Due to this she sat her GCSE exams at the hospital school at the Maudsley. During this period, she was also able to meet with a careers advisor at school to begin thinking about what she wanted to do post-16, as well as more long term. As a nursing and education team, we also began thinking about how we could support her with achieving her goals. She told us that her ultimate goal was to train as a nurse and work in healthcare; so, we started looking at what she would need to do to start on that path. After lots of conversations she decided that a college course in health and social care would be the best next step.

During evenings and weekends (when not revising for her GCSEs!) she began looking up different colleges and the courses they offered. Staff on the ward gave her advice on her applications and her parents were able to take her to some open days to meet with college staff. After a lot of work she found a college in South London that felt like the best fit for her and applied. Then following her fantastic GCSE results she officially enrolled in August!

Despite all the incredible work she had done towards getting her college place, the young person wasn’t able to be discharged before it started; and so, we began thinking about how best to support her to attend. Everyone was agreed that we wanted her to start college and that doing a course she was passionate about was so important. We were also conscious of not making too many big changes at the same time, so we all agreed that starting to attend college from the ward first made the most sense. We were really keen (as was she!) to make this as ‘normal’ as possible whilst ensuring she had all the support she needed.

We suggested doing some practice journeys between the ward and her college before her first day. Ray, an activity support worker on the ward, met with her to look up the route on public transport and plan the journey. The two of them the caught the bus there together to get familiar with the journey and where to go once she was at the college campus. Since then, she’s been attending all of her classes at college, and has begun making her own way there and back each day.

It was a tricky journey to get there at times, and the easiest solution all those months ago would have been to say the young person needed to be discharged before going to college full time. However, we all knew this wasn’t the best solution for her at the time; and we wanted to make sure we were thinking of what was important to her and doing whatever we could to support her in safely achieving those goals.

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Change the Story: Lauren’s Chapter

Change the Story: Lauren’s Chapter

Change the Story: Lauren’s Chapter

In the tapestry of any organisation, there are threads woven with extraordinary dedication and tireless effort. These threads belong to individuals who go above and beyond, turning ordinary tasks into extraordinary achievements. Their commitment, often behind-the-scenes, is the bedrock upon which success is built.

In this spotlight, we shine a well-deserved light on those who exemplify the spirit of hard work and dedication. These individuals are the driving force, the unsung heroes, and the heartbeat of our organisation and our shared vision to transform mental health for young people.

Their stories inspire us all to reach for greater heights, reminding us that with perseverance and determination, remarkable accomplishments are within our grasp.

Lauren

Lauren

Nurse, CAMHS PICU

Within inpatients CAMHS services we do out upmost to support the human rights and well-being of our service users while also maintaining safety. This can take many forms from supporting someone to bake a cake to gradually building up periods of leave back to their family home.

 One of our service users was struggling to find meaningful goals to work towards to help motivate them to remain safe while on the ward. As they had been in hospital for a considerable period there was a feeling that they felt hopeless in the idea that any meaningful progression could be made.

Across the ward multidisciplinary team (community teams’ input, family and social care), we wanted to do something to uplift their mood and positivity. A goal was set for the service user to be supported to attend their first ever concert. Due to the young person’s love and passion for music this felt like a meaningful activity for them as well as being something that was age appropriate and a ‘normal’ yet exciting milestone of adolescence. I’m sure most people can still remember their first gig, concert or festival as a teenager.

Within the team a week-by-week plan roughly spanning eight weeks was put in place to attempt to support the young person to achieve their overall goal. This was then reviewed each week and decided if the young person as ready to progress onto the next stage and if not, what things could be put in place to support each stage to be completed to help facilitate the overall aim. As the young person progressed further through the stages other challenges did arise such as who was going to take them? How would we transport them? and logistics around what time would they take their prescribed medication etc. This took a lot of coordination within the team and with the family, but each hurdle was overcome, and the day of the concert arrived.

This was a particularly unique experience as although within other services day trips are slightly more commonplace within a PICU setting they are often far from the norm. However, it was felt that for this young person this would be an important step in helping reintegrate them back into the community and so the team all worked together to ensure it took place. Being part of the team that accompanied them to this concert was a special experience as the young person could not quite believe they had managed to keep themselves safe enough for the trip to take place as well as having all the same excitement any person would have of seeing one of their favourite artists perform.

A new outfit from Primark, make-up applied, and McDonald’s consumed en-route made it feel all the more like an adolescent night out. Seeing anyone enjoy a new experience for the first time is exciting but when you have been part of the challenging journey with a young person of them keeping themselves safe enough to achieve their goals, it is a special experience.

Although one also full of anxiety as you imagine all the possible dangers and things that can go wrong. (We had tried to mitigate and plan for some of these by making sure the young person was aware we could leave if it all felt overwhelming) That aside when it all goes to plan to take a positive risk and seeing the joy it can bring to an individual is without a doubt the best part of the job.  

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‘Onwards and Upwards Parenting workshops’

‘Onwards and Upwards Parenting workshops’

‘Onwards and Upwards Parenting workshops’

Our Helping Families Team provides a comprehensive and supportive service for parents facing complex mental health issues as well as other stresses that my include poor housing, financial instability and chronic ill health. Multiple challenges can impact on their ability to look after themselves and their children and prevents them from parenting in the way they would like to. The team supports parents to reconnect with their children, feel more confident as a parent and to navigate the relationships they have with professional networks supporting their family.

Funded by Maudsley Charity’s Change Maker scheme, their latest programme promotes peer-led parenting workshops facilitated after parents have completed the Helping Families Programme and they have been discharged from the service. The events support parents to feel equipped with the necessary tools and support they need to overcome the challenges they face, without the need of another referral to specialist services.

How do the Helping Families Team support parents?

 We work with parents to identify their strengths and empower them so that they can communicate, manage their emotions, and hold the needs of their children in mind in ways which may feel more helpful, containing, and safe.  We have the privilege of witnessing their progress whilst they work with us. In these very difficult times it can be hard for parents to hold hope and continue to attend to their own needs in addition to the needs of their families.  The team explain how this peer- led programme is bringing together parents to create opportunities for social support and connection, and empower parents to create lasting, positive changes in their lives.

 What is the Change Maker Scheme?

 Change Makers exists to enable staff to complete small projects that could have a big impact on the quality of life for patients.  The scheme is a joint initiative between Maudsley Charity and the South London and Maudsley Trust’s Listening into Action (LiA) team. Maudsley Charity invests £100k into the scheme each year and the Listening into Action team will support staff to make applications, deliver the grants, and work with grant recipients to share the impact funding has had.

 The scheme is open exclusively to staff from the South London and Maudsley. Departments can apply of grants between £200 and £2,000 to get small projects off the ground in wards and services to improve access, outcomes or experience of people with mental illness. 

 How did the ‘Onwards and Upwards’ programme start?

 We consulted with parents that have used our service and responded to parents’ requests that they would really value the opportunity to connect with other parents with similar lived experiences and to also revisit specific parts of  the parenting programme that they had found helpful. With our Change Maker award we were able to hire space and provide food and refreshments for the parents in a beautiful historic local community venue which is easily accessible and offers a quiet, calm space. 

 We have facilitated three Onwards and Upwards events and we are planning to hold another in the Autumn. So far, 14 parents have attended, and the group is growing in strength and numbers.

 Has there been any feedback from the parents?

 The parents who attended expressed how important it was that they felt heard and seen during these events.  They valued the opportunity to share their experience of parenting before, during and after their time working with the Helping Families Team and felt able to speak freely and share their stories and experiences in ways which felt helpful and important for them.  Parents often lack confidence to connect with others but all who attended have created connections with each other outside the events.

 We kept events light and balanced. We had laughter along with tears. These events were designed to be empowering and validating for parents, delivered via a safe, nurturing environment where they could speak freely and share experiences and advice with other parents. Many of the parents that we work with are economically disadvantaged, so they really valued being cared for and feeling valued.

What do you hope for future events?

 In the future, we plan to invite their families along to a family-friendly event to celebrate their progress. We hope that the Onwards and Upwards events remind parents of the importance of continuing to prioritise their own needs alongside those of their families.  We know that parents who feel able to do this create very positive outcomes for their families.

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How clinical and research teams are working together to reduce stress in sixth form students

How clinical and research teams are working together to reduce stress in sixth form students

How clinical and research teams are working together to reduce stress in sixth form students
Over the last few years, rates of mental health disorders among young people have been rising. The latest data from the NHS found that in children aged seven to 16 years, rates rose from one in nine in 2017 to one in six in 2022. Adolescents aged 17 to 19 saw an even greater increase in mental health difficulties, rising from one in 10 in 2017 to one in four in 2022 – this means a quarter of young people in this age group were experiencing a probable mental health disorder.

Dr Stephen Lisk

Trial Manager for BESST at the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King's College London

Adolescence is a key period for the prevention and treatment of depression and anxiety, as half of lifetime mental health problems start by age 14. We know that accessible and effective interventions are crucial to combatting these conditions, especially in the lives of adolescents where there are many barriers to help seeking, such as long waiting lists, inconvenient locations, competing time commitments, and fear of stigma. Researchers at the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s College London and clinicians at South London and Maudsley NHS Foundation Trust have been working together to develop and test a school-based group workshop programme called DISCOVER to help reduce stress in young people aged 16-18 years.

 

The DISCOVER programme, led by Dr Irene Sclare from South London and Maudsley NHS Trust, uses psychoeducation and cognitive behavioural therapy (CBT) methods to equip sixth form students with tools to better manage their stress. Researchers in four areas of the UK, led by Dr June Brown, Reader in Clinical Psychology at King’s IoPPN, are running a large clinical trial, called the Brief Educational Workshops in Secondary Schools Trial (BESST), to investigate the effectiveness of DISCOVER.

So, what is my role in this project? I am trial manager for BESST, acting as a central coordinator to ensure all the clinical and research elements of this large research project come together as planned. You could therefore say I am a link between all the different teams – so let me explain how this collaboration works!

How did BESST and DISCOVER come together?

Based on an adult workshop model developed by Dr June Brown, Dr Irene Sclare started developing the DISCOVER stress workshops for adolescents. In 2014, they collaborated to run the first pilot study of the workshops in schools in South London. Their teams subsequently ran a slightly larger study in 2019 which showed the DISCOVER workshops were accessible and likely to be effective. However, a larger study was needed to rigorously investigate the effectiveness of the workshops – hence BESST was born.

Understanding the structure of BESST

BESST is a nationwide randomised controlled trial (RCT), funded by the National Institute of Health and Care Research (NIHR), with multiple institutions contributing to the project. There are two sides of BESST – research and clinical. The research side is led by King’s College London, with the IoPPN acting as the trial’s core research institution. However, we also collaborate with other research institutions across England to make this possible, including the Anna Freud Centre in London and Manchester, University of Bath, University of Northampton, and Middlesex University. Our research teams are responsible for all organisation of the trial, recruitment of schools, participants and workshop delivery teams, data collection and management, and data analysis and reporting findings.

On the clinical side of the trial, we continue a long-standing collaboration with the DISCOVER workshop team at South London and Maudsley NHS Foundation Trust, with the DISCOVER team leader, Dr Irene Sclare, as the clinical lead for BESST. The DISCOVER team have provided valuable input into workshop delivery within the trial and have been responsible for ensuring staff are fully trained to deliver the workshop programme. As trial manager, I have been working closely with members of the DISCOVER team to ensure the research and clinical aspects of the trial work together effectively.

What does the trial actually look like?

BESST is a cluster randomised control trial. This means that we recruit a number of students within several ‘clusters’ (in this case, school sixth forms) to participate in the trial. We then randomly allocate half of the sixth forms (and all participating students within them) to receive the DISCOVER programme delivered by a workshop delivery team (intervention arm), and half to receive their usual school care but no workshop (control arm). Our six research workers conduct assessments with all students at the start of the trial, and at three- and six-months after the workshop so we can understand what effect the workshop has on the students.

Working with clinical teams to run DISCOVER in schools

We’ve had a lot of interest and enthusiasm from students and staff to take part in BESST. We recruited 57 sixth forms across Greater London, Southwest England, Midlands, and Northwest England, with a total of 900 students taking part in the trial. With this trial being nationwide, it was far too large in scope for all workshops to be delivered by the core DISCOVER team at the Trust. We therefore recruited 16 Mental Health Support Teams (MHSTs) from 11 NHS Trusts across England to deliver DISCOVER in the sixth forms allocated to receive it. MHSTs are teams of mental health professionals that are already embedded within schools in England, making them ideal to be trained to deliver the workshop programme. The DISCOVER team ran a series of two-day training sessions with all MHSTs to ensure all staff were ready to deliver the workshops, as well as providing ongoing supervision sessions throughout BESST. It was then my role to ensure the schools were ready to receive the workshops being delivered by these MHSTs.

What happens next with BESST?

By the end of 2022, the last workshop had been delivered in the trial; in fact, every single workshop that was due to be delivered was completed according to plan, which is a fantastic achievement for everyone involved in the trial. We have now finished following up with students after the workshops, with the last students followed up in May 2023, and have been busy performing the analyses to understand how effective the workshop was. The results will be ready to publish soon – we hope they will inform our approach to early intervention and lead to wider roll-out to provide highly accessible support for as many young people as possible, giving them the resources they need to combat mental health difficulties during a highly vulnerable period.

Please do check out the BESST twitter account to follow along with our progress.

You can also read more about how DISCOVER was developed in Dr June Brown’s blog.

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Results Day: The Day After

Results Day: The Day After

Results Day: The Day After

It’s the day after results day and hopefully your young person has had some time to start processing things. Their attention may have turned to the next steps, all of which may bring new worries and challenges.

a young girl holding a leaf

Thinking Traps

Our minds can very quickly fall into what we call ‘negative thinking traps’, even about seemingly positive situations, like positive exam results.

We can all be hard on ourselves at times, especially in a situation like this. Here are three examples that you may notice in yourself or your young person.

  1. You might notice catastrophising, which means predicting worst-case scenarios about the future and underestimating one’s ability to cope (e.g. “I didn’t get the grades I needed so I’ll never get to do my dream job.”). Remind them that they have coped with lots of challenges before and that the future has many possibilities!
  2. Many of us find ourselves generalising from one scenario that the same will happen again in similar future scenarios (e.g. “If I found GCSE/A-Levels tough, there’s no way I’ll manage a degree/apprenticeship/job”). Instead, encourage them to ask themselves “am I jumping to conclusions?” Remind them of what they have achieved so far and the things they can achieve in the future.
  3. It’s also human nature to compare ourselves to others and see them as doing better than we are (e.g. “Everyone else seems to know exactly what they’re doing next and I don’t”). The truth is, we don’t know exactly what others are thinking, feeling, or dealing with 24/7, and everyone goes at their own pace.

We’re more likely to fall into these, and other negative thinking traps when we’re stressed.

Choosing kindness

At a potentially challenging time like this, our inner voice, or thoughts, can become more self-critical and we’re often our own worst enemy. You can remind them that, even though they can’t go back and change things, they can decide how to respond to themselves and the situation – with kindness rather than blame.

Ask your young person to consider what they’d say to you, or a friend, in the same situation. Encourage them to offer themselves the same kindness that they would offer their friend.

If you feel that a young person’s mental health is struggling with the impact of results day, it’s important to remind them that they are not alone. Although it’s not always easy from them to open up, it may be helpful to speak with a GP – they can support and guide them towards longer-term support.

Kooth and The Mix are also available as free, online, chat-based counselling platforms for young people.

We wish you and the young people in your lives all the best with whatever comes next.

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Results Day

Results Day

Results Day

Results day is finally here. It’s bound to be an emotional day, whatever the outcome. Many young people will experience a mixture of excitement, anxiety, and countless other emotions. GCSEs and A-Levels are important milestones in the UK education system, as they tend to determine what happens next for many students. We’re here to help you support the young people in your life.

a young girl holding a leaf

If things have gone well

Your young person may have met or even exceeded their targets – in which case, congratulations! Encourage them to enjoy the moment. It’s tempting for you or them to start worrying about what comes next and getting into planning mode. They may start comparing to others and downplaying their achievements.

Everyone has different goals and versions of success and remind them that theirs is every bit as worthy of celebrating!

Try and plan something exciting to celebrate, such as seeing family or friends, going out for their favourite meal or doing something that is special to them.

If things haven’t gone to plan

On the other hand, it’s possible that things didn’t go to plan. Your young person may be feeling disappointed, upset, or anxious, and may be trying to push these feelings away. Remind them that these emotions are completely natural.

Try talking to them about their feelings. They may not want to discuss immediately but reassure them you’re there if they want to talk, need advice or company.

If they start panicking, support them to take a mental pause. Not everything has to be decided at once. Try deeper, relaxed breathing – a proven way to relax your mind and body, allowing greater clarity of thought in the process.

Most importantly, whilst today is bound to be a significant one, these results don’t define them as person. Support them to remember that they have all sorts of interests, passions, and abilities that make them the person they are – their results won’t change that.

It may be that a new path suits them better than the one originally planned. Encourage them to be open to new opportunities and reassure them you’ll support them through this period.

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