The Royal College of Psychiatrists, faculty of Child and Adolescent Psychiatry, get together every year at their conference. This year it was in Brighton. And I was invited.
Professor Jonathan Green (University of Manchester), John Simmonds OBE (CoramBAAF) and I presented a session entitled ‘What are the needs of Children and Families during and after adoption – and is CAMHS failing to meet them?’. We formed a kind of medical/charity sector/user triangle.
I’ve learnt, when amongst medical people, not to use words such as ‘trauma’ (particularly ‘developmental trauma’), ‘attachment’, ‘dysregulation’, ‘dissociation’, ‘cortisol’, ‘trigger’ and so on. I’ve been told many times either overtly, or by eye-rolling that there are no such things and that my children (and I) should be well over it by now. As a result of one memorable CAMHS consultation I can no longer drive past the building without my stress-levels rocketing.
I ventured into the venue for the conference dinner the night before, with some trepidation. (I was terrified). The first psychiatrist I spoke to, tentatively, talked about ongoing research into pre-natal stress and cortisol levels, someone else talked about how boys and girls might react differently to trauma, then I heard about psychological models for carrying out life story work, ways of working with dysregulated children, studies into identifying the psychological needs of adopted children pre-placement, how trauma can look like other conditions and the importance of broad, all-encompassing assessments.
In short, I heard my experience (and the experiences of countless other families) and the language that fits those experiences taken as read. Some areas of contention perhaps, but that’s to be expected and not to be avoided.
Our session the following day was well received and some themes emerged; the profound impacts upon children of multiple traumas and the education of practitioners around this, a reappraisal of thresholds, a reappraisal of the system which tends to ‘silo’ children into existing pathways, the need for families to be held throughout their journey rather than ‘six sessions and you’re out’.
The nub of it all of course is the gross mismatch between resources and demand. Many families no longer express demand, by either suffering in silence, or finding their own alternative therapeutic support. Some end up back in higher level psychiatric services and one must ask whether better, earlier intervention could go some way towards prevention.
For me, the biggest and potentially most effective untapped resource is families. As we know, the majority of all the good therapeutic work and healing takes place within families and yet many battle on unsupported and not respected. Not only that, parents educate themselves, they share information and feedback, they support each other and they fight systems some of which even to this day refuse to accept, despite all the evidence to the contrary, the profound impact upon children of trauma. And all this takes place whilst delivering high-octane parenting, day after day, 24/7.
As someone who is interested in not only parenting post trauma, but also economics, social systems and new models of delivering services I offer this:
- Giving families(users) the resources and information they need to do the best job they can has got be cost effective, we are key members of the ‘team around the child’. Please also give us access to the evidence. It isn’t easy to find and some if it is expensive (lots of us don’t have jobs).
- We would love to engage with you more, in a professional manner, not in a ranty, negative manner (although sometimes we may become emotional because this stuff is personal and cuts deep).
- We would like you to engage with our groups too. We can fill a conference room with 350 people if there is a chance we can come away with hope, information and strategies that work. We like the great American speakers, which some of you don’t like so much but we’d be just as happy to listen to you. Where are you?
- We come under criticism for lunging at non-evidenced-based interventions, and for being a bit loud and pushy. I think that’s partly because we stare into a giant CAMHS void – voids suck things into them, anything.
- Every practitioner I’ve met (quite a few) who is offering therapeutic support to adoptive families has at one time worked for CAMHS. It suits me, because I’ve found what I need, but is sole-trader, private sector provision really a long-term, structural solution?
I know that at least one delegate who came to our session was expecting me to deliver a dirge of negative criticism of mental health professionals and CAMHS. I didn’t, because it’s pointless and disrespectful. It also leads us nowhere. I remain profoundly optimistic about the healing and progress that can take place with the commitment of families and wider teams who travel alongside a child. It’s long, hard and sometimes painful work and there are hard battles to fight along the way, but it can be transformative. Re-imagining a better future is part of that.