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Improving mental health services for adopted children: co-production

The story so far ….

In October 2015 feedback from adopters about CAMHS services was presented to a large meeting of professionals and government officials. The feedback was the result of an informal but substantial consultation with adopters and professionals and the suggestions we made to improve services were cohesive and well thought through.

In March 2017, again in consultation those proposals were boiled down to two core principles that most agreed should be part of a good quality service that would meet the needs of adopted children and their families.

That brings us to now. This week I submitted four detailed proposals to the expert group I belong to. I’ve tried to stick to things that are achievable and affordable.  These are:

Mandatory training (initial and continuing) for all mental health professionals who work with adoptive families in complex trauma and attachment, co-produced by adopted young people and their families.

Adopted young people and their families to be embedded in commissioning and governance of mental health services and in their design, delivery and evaluation. Again, co-production.

Establishment of regional centres of excellence that specialise in complex trauma and attachment, that act as a focus for creating excellence in services and improving skills, education and research. Involve users in the design, delivery and evaluation of services. Co-production.

Development of an app for adoptive parents that encourages and supports self-monitoring of mental wellbeing. acts as a prompt for self care and records data around what helps and hinders. (Not meant as an alternative to professional support). Not very well thought out, so could be a crap idea.

NB I refer to adoptive parents throughout because these are the people who have taken part in this work. I don’t mean to exclude others who parent care-experienced children and young people, although these proposals could work across the board, I’m just taking care not to speak outside my area of experience.

Services that listen to and learn from their users, work best for those users, and adoptive families are no different. Plus we are engaged, committed and well-trained. What’s not to like?

Improving mental health services for adopted children

Some weeks ago I asked for your help in submitting user-based ‘evidence’ to an expert group tasked with improving mental health and emotional wellbeing support for care-experienced children and young people. I asked you to tell me about the clear and achievable ways in which you thought mental health services could be radically improved for adoptive families.

Your responses were full of experience, good ideas and passion. Almost everything you suggested boiled down to two principles that you told me should underpin improvements to mental health services;

  • empower, respect and ‘tool up’ families in order to improve their ability to support their children, and
  • improve professional expertise particularly in trauma and early adversity.

Many of you continue to report that when you can access child and adolescent mental health services your child’s early life experiences are not explored or seen to be relevant and you feel blamed for your child’s difficulties and disbelieved. The more experience I gain and the more I learn, the stronger my view that adoptive families, as well as others who parent care-experienced children and young people are a valuable, knowledgeable and essential part of healing and growth. It makes no sense in health or economic terms to work against the willing, the able and the emotionally invested.

Thank you to everyone who responded, including members of Adoption UK and POTATO. Thank you also to the professionals who checked out our principles and who gave encouragement and advice. Please feel free to use and share this graphic if you’d like to.

Can you empathise too much?

Can you empathise too much?

For the sake of those who are time and attention poor I’ll jump to the answer to this question.

Yes. Yes you can.

Empathy has become a by-word for feeling someone else’s pain so intensely it automatically means you are a good and righteous person and people are miraculously improved by your very presence. It’s very public, very ‘social media’ and teamed with a ’tilted to one side’ head position and a slightly unhinged sing song voice tone it really is something to crow about. But that’s “empathy” (which makes me come out in acts of imagined violence) and not Empathy.

For some of us Empathy means not only casually knowing a person who is suffering and taking them out for a latte, but living with that person 24/7, through thick and thin and shit and stinky shit. Empathy, the real deal, is a much tougher call altogether. It can run dry and require replenishment with sunlight, happiness, good books and simple carbohydrates. (And when we run dry, we risk appearing ‘cold’ and ‘uncaring’ to the latte-drinking, empathy part-timers.)

Empathy, as Dr Brene Brown explains is about taking the perspective of another and rather like climbing into a dark cave with a person, not merely peering down at them from above and shouting down nonsense.

I like that analogy. Except, there are limits.

If one stays down in that cave perspective-taking for too long it can become more a feat of endurance than a virtuous trip down Cheddar Caves. You start to forget there is any kind of life outside the cave, you develop rickets, poor eye-sight and trench foot. You might even start to own the perspective, like it’s yours. One day you may wake up on that cave floor, after a damp and disturbed night’s sleep and realise you are both trapped down there, weighed down by misery (and the rope ladder is rotting away).

I expect Brene would say this herself (in my head she drops round to my house for wine Friday from time to time and we chat and connect on a really deep level): the cave has to be reserved for short trips only and not gap years or longer stays. There are times when a trip down Empathy Caves is not even possible and not even helpful. Sometimes chucking down a head torch and a Bounty and saying ‘it’s sunny up here, why not come and join me when you’re ready’ (in a non-sing song voice) is the best we can do.

Things I learned in 2016

Most Decembers I write a light and reflective round up of the year. As I’ve been as yet unable to digest the events of 2016 and am still bouncing from despair to mild optimism and back again, sometimes within a matter of moments, I’m going to stick to something far simpler. Here’s a list of shit I’ve learned about this year.

  1. Turns out cutting down carbs does in fact help you lose weight and feel better.
  2. Carbs are lovely.
  3. Feeding the birds is really satisfying. I like woodpeckers.
  4. I need to get better at arguing with racists (there are way more around than I’d thought).
  5. There’s zero point arguing with those who have rigid belief systems and racists as it just leaves you feeling terrible and post-factual.
  6. Most people are generous and thoughtful and kind.
  7. Things are better than they were, and we must hang on to that.
  8. Things are way worse and getting scary.
  9. No one is an expert, so we must engage with a wide variety of people and listen and learn.
  10. Of course we need experts, idiot. Who’s going to fix you when you get a tumour or something? An amateur? A newspaper columnist?
  11. Democracy is imperfect but the best we have.
  12. Democracy is rubbish because people read and believe any old shit.
  13. People have valid concerns and no one is listening to them.
  14. It’s ok to vote for a maniac if you feel ignored and ‘little’.
  15. We’re all fckd.
  16. Mental health services are properly bust.
  17. Mental health professionals should trust people more and enable them to help themselves and each other: it’s the democratisation of health.
  18. People read and believe any old shit.
  19. Walk or self-combust.
  20. A nice pair of shoes makes the journey more bearable.
  21. Books are much nicer in paper form. Sorry I ever doubted you, books.
  22. Getting angry makes things worse. Everyone’s so angry with each other.
  23. Watching Question Time makes me want to hurt people.
  24. It’s best to avoid Question Time, most news, Andrew Marr being annoying on a Sunday, most twitter scraps, for reasons of mental wellbeing.
  25. It’s important not to hide from current affairs and challenging debate. Don’t you know anything about the rise of Nazism?
  26. I really like owls.

Comedy and the Art of Therapeutic Parenting

Parenting children traumatised by their early experiences has taken me to some of the most bleak, incredible, lonely and wonderful places: places I had never imagined existed before I became a parent. At the same time the experience has been one of the most comic: not in a flippant way, but in the way that comedy and tragedy collide and for a moment the tragedy it forgotten and perhaps longer term becomes more bearable.

And thank goodness for that, because without the moments of comedy accompanying us through the times of drudgery and drama, where would we be?

Comedy is about making sense of things, its pain relief, an unsticking, its sharing something silly and profound with someone. Laughter, even in the bleakest of times humanises, ourselves and each other. It magics us away from rage and despondency and tips us off our high horses and out of our despair. Laughing along with someone, a child, a partner is pure connection.

And it is one way of trying to marry up the mainstream lives we may have imagined for ourselves, with the bizarre lives we end up with (and perhaps not just because of the kind of parenting we do). It’s a bridging material. Comedy is found in dissonance and there’s never been a greater need for that.

trumpfarageIf you were at the Adoption UK conference last weekend then you may have noticed the sound of laughter everywhere; around the coffee tables, the stands, the dining room, the toilet queue. It’s what happens when isolated people come together and find things in common. It’s the sheer relief of realising you are not alone in say happening upon a poo in a strange place or a digestive biscuit in your wash bag. These events experienced alone can be a long way from funny, but sharing them takes some of the the sting away. And the next time something similar happens, we may be able to experience it with a comic disbelief, rather than the hopeless kind.

That’s not to say I’ve laughed my way through parenthood. I haven’t. I’m not insane. The moment itself, in that moment can be too painful for words but what plays out after that moment, given a bit of context, can be comic, in the full Shakespearean sense of the word. And like they say, if you don’t laugh, you cry, or you get angry, or withdrawn.

The ability and the opportunity to see the comedy gives us back some power and it reminds us we are all doing the best we can. And the best kind of comedy, my favourite kind isn’t mean, it’s full of heart. And you need tonnes of that to be a therapeutic parent.

Thank you to everyone who came to the Adoption UK conference in Birmingham. I hope you came away feeling encouraged and connected. I certainly did. It was a joy to meet so many people, so thank you! And for those who couldn’t make it, here’s something I shared from my own catalogue of self care strategies, filed under ‘funny youtube videos”.

Arvon Experimental Fiction Week Learnings

As a break from Experimental Living, I spent last week Experimental Writing at the Arvon centre in Devon, with tutors Adam Foulds and Toby Litt and a fabulous and kindly group of writers and experimenters. The Trump Triumph and his Farage Menage were a world away. It couldn’t have been better timed. 

Don’t pack a spare towel, you won’t need it. Likewise teabags. Bring more clothes.

Download more podcasts for palate cleansing at the end of a day of rich brain food.

Expect to feel odd and dislocated for a day or two. You will come back to yourself. You will make friends.

Physical isolation, plus no wifi is a GOOD THING. You will experience panicky feelings over an inability to instantly fact check. Get over yourself. Leave a gap and go back later. Be less of a dopamine reward junky.

It doesn’t matter if you haven’t read all of the things, but you should read better. TLS. LRB. That sine wave storyline thing though, that came straight out of Ramsay Street.

Remember a plot doesn’t need to be bland to be believeable (POTUS afterall) however if it feels wrong, it probably is. Wrong. Trust your instincts.

Work in the wifi-free, well-heated town library more often. Drink the coffee. Pity the old men.

Continue to get up early and work before the crazy grabs the day. Two hours early is worth four later.

Say ‘no’ to a lot more stuff, especially if that stuff involves complicated travel arrangements.

Create space to ….

write, write, write.

Write the scene, not the summary.

Nurture brainy friendships; Malteser Rachel and University Kirstie.

Go to the pub, but this time order a pint. Otter. Stop crapping on about Poldark.

Do it again next year.

Big Thank Yous to the Arvon Experimental Writing class of 2016; Adam, Toby, Mary, Louise, Luke, Natasha, G, H, S, M, S, J, L, L, E, C, P. 

Things that were broken

The outbreak of peace in our house continues. It’s brilliant. That’s the thing, when life has been so relentlessly crap for so long, it just needs to be less crap for a few weeks and everything is a complete joy.

I went to the Yorkshire and Humber Adoption Consortium annual conference this week – had a ball (I so enjoyed meeting everyone). I caught up with old friends in the pouring rain – brilliant. I spent two hours selling raffle rickets in a field yesterday, and even that was a blast.

Living in a state of near hysterical joy (for one never knows when it will end) means that things get done as there is at last time and head space to tackle Mount Must Do. On the Must Do list for this week was:

RING PLUMBER: heating has been malfunctioning for … two years, radiator has been leaking for …. five years.

RING OIL TANK SUPPLIER: oil tank is old and has cracks in it, which means it cannot be refiled. Current oil level = empty.

RING TREE SURGEON: massive tree has needed cutting down for … at least three years, but at last I have a certificate saying it is allowed to go.

FIX LAWNMOWER: broken for six months, state of lawn = dire.

On a separate Must Do list has been, lose some weight. Living in Trauma Central is bloody terrible for the BMI. That’s been done too.

In other news, Mr D has been building a summer house in our garden. He took some unpaid ‘I take it or I go insane’ leave from work last year and spent weeks in a happy bubble of woodmanship drowning out the crap with power tools. It’s almost finished, and it looks fabulous. I bought some cane furniture for fifteen quid in a charity shop  and have sprayed it green (apple green, if you will). I won’t mention how much I’ve spent on the paint.

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There has been a theme around our family for a long time about Rock Bottom. Mr R (trusty therapist) had been saying to me for ages ‘we often only see a turnaround when our children and young people take things to rock bottom and you need to think about how far down you are willing to follow’. It took me ages to see it but he was on the money. Both he and our family therapist C were also on the money as they helped Mr D and I to work out when we needed to shout ‘enough’ and how to do that as therapeutically as we were able. This process has played a large part in our survival of Rock Bottom and current state of flourishing.

I sit here typing and I can hear our family outside, doing their things, having fun in the sunshine. I’m going out now to join them. Things that were broken are being mended and it’s a complete joy.

Spring has sprung …

Peace has broken out chez Donovan. The crisis generators have been set to ‘normal*’. No letters home. No interactions with anyone in uniform or a gown or white crocs.

Cover me in Lindt and roll me in mini eggs – it’s amazing. Who knew what real life felt like? I’d forgotten.

It’s incredible what can be achieved when parenting** doesn’t drain the batteries.

I’ve dug out the enormous stump of a dead shrub, dug out a tree and moved it, weeded like a demon and planted some new lovelies. I’ve sat in the sun and done some work. I’ve wallowed in the publication of Billy Bramble and in the early feedback (even my mum likes it). I’ve been catching up with old friends and bingeing on House of Cards (24 episodes in two weeks – go me).

I’ve been reminded that tough times are sometimes an indication that in the dark, wet soil, things are growing.

I’m aware that in even thinking any of this, let alone committing it to black and white I risk invoking the great jinx of the optimist, but without optimism I’d be in a much rougher place.

FacebookI wish you a happy and relaxing Easter. I know the holidays can be tough for some but at the very least, spring has arrived, the clocks will change and there will be hot cross buns.

* our kind

** crisis management

 

Billy Bramble and the Great Big Cook Off is published

In November 1997 (long story) I wrote this on a post-it note:

post it

This morning, the postman delivered a copy of my first children’s book, Billy Bramble and the Great Big Cook Off to our conservatory-less house.  It’s only taken me 18 years. I still don’t have groovy hair.

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I didn’t write Billy Bramble to meet some personally set milestone. I wrote it because I find the voices of young people like Billy incredibly strong and perceptive. Billy is 11 (nearly 12) years old and on the threshold of adolescence. Adolescents, particularly boys and particularly boys who struggle to engage with school for whatever reason are not amongst society’s most treasured groups. The ways in which they are depicted in popular media, if they are at all, are often negative. The terms ‘naughty boys’  or ‘naughty girls’ are openly used to describe children perhaps not unlike Billy.

We don’t know what has brought Billy to the point at which we meet him and his angry dog/sidekick Gobber but there are indications that like many children, his childhood might not have been straightforward. He describes himself as naughty and bad and picks up signals from the adults around him that his conclusions about himself are correct. Despite everything though, he wants to fit in, to do well and to be a success, he just needs some help to achieve it.

And that’s where Mrs Buttress comes in. Mrs Buttress is my fictional ‘thank you’ to teaching assistants and teachers across the land who value all children, who can see the best in them, who go that extra mile to enable them to grow their talents and who can at the same time find a way through rigid behaviour policies and league tables. My own family have benefitted greatly from the steady and patient hand of a number of Mrs Buttresses (some of whom carried out this great work on minimum wage) and the difference they have made is hard to put into words.

Billy Sits With Facebook

For all my theorising, Billy Bramble and the Great Big Cook Off is of course a novel for children. I’ve designed it to be choppy and fun, with some drama and some comedy. It gives more than a nod to those for whom reading might not be their number one choice of activity and for that reason it had to be strongly illustrated by someone who ‘got’ Billy and his chicken and his cat and his sense of humour. I am so fortunate that the illustrator Kara McHale was able to more than amazingly fulfil what was in my head and which I couldn’t always describe. She took the text and ran with it and I am thrilled with the result.

Egg Sequence