Sunday Soundtrack: Warpaint

For this week’s Sunday Soundtrack, here’s an offering by a all-girl band I’ve been listening to a lot recently.

I was lucky enough to catch them live at Glastonbury this year, and they were excellent.

Speaking of girl stuff (how’s this for a tenuous link?), I’ve been amused this week by the kerfuffle on various feminist blogs about a lawsuit by a guy named Tom Martin. He signed up for a masters in gender studies with the London School of Economics, but left after 6 weeks. Now he’s suing the LSE because….wait for it…he thinks there’s too much feminism in gender studies. He’s arguing that the course is sexist because it doesn’t talk enough about men.

Funny, I always thought that academics were supposed to love neglected areas of study or gaps in research, because that means they can write about it themselves and make their reputation. I might be missing the point though, as various people have pointed out that his action has more than a whiff of a publicity stunt about it.

Mr Martin is currently in fundraising mode if anyone fancies donating to his campaign. Personally though, I’d suggest to him that the money might be better spent on some tuition fees for a new masters course. If he thinks his arguments are so robust, then actually writing them down and publishing them in academic journals would be more productive (and a hell of a lot cheaper) than filing a frivolous lawsuit.

CAMHS in a Time of Austerity

Mind Uncut (no relation to the charity Mind) asked me to comment on the effect of the public sector cuts on CAMHS, so here goes.

As I mentioned last week, the most vulnerable jobs for the chop are those that are seen as highly specialist. Say, a systemic and family psychotherapist or an eating disorders nurse specialist. It’s more attractive to hire a jack-of-all-trades generalist – say, a CPN or a clinical psychologist. Patients can still be seen by those clinicians, but obviously there’s a drop in the level of expertise available. Remember, that’s not just expertise in terms of what can be offered to patients and their families, but also of who the generalists can turn to for advice if they get stuck.

When people leave their jobs, there’s a nervous wait to see whether the post will be re-advertised, or just disappear into the ether. If it is re-advertised, sometimes it will be at a lower pay band – say, band 6 instead of band 7. Sometimes this can result in the post not being filled because those with the skills to apply for the job have no incentive to do so. Why take on more responsibility if they’re not going to pay you any more?

As the cuts bite deeper, there’s more pressure to stick to a narrower definition of who CAMHS can offer a service to, and to do more signposting to other services. A child has a mentally ill mother – could they be seen by a young carers service instead? Somebody just wants talking therapies – why not point them to a school counsellor? Which is fine until you remember that all those other services are also dealing with shrinking budgets.

With increasing pressure to do more signposting, there’s more risk of services playing pass-the-parcel with their clients. This tends to happen regularly between CAMHS and social services. CAMHS insist it’s a child-in-need issue. Social services say no it’s not, it’s a mental health issue. The two services argue, letters go back and forth, and the child is left waiting for somebody to provide an actual service.

Occasionally we hear that we’re supposed to do more with less. I suspect in reality we may well just wind up doing less.

Sunday Soundtrack: Ghostpoet

I was tempted to have a PJ Harvey track as this week’s Sunday Soundtrack. Certainly I think she was a well-deserved winner of the Mercury Prize this week. Let England Shake was one of my favourite albums of the year so far.

However, given the acres of media coverage she’s received as a result of winning, I thought I’d instead give a shout-out to one of the more obscure Mercury nominees.

Ghostpoet intrigues me. There’s a thoughtfulness to his work that I find quite alluring.

Speaking of highlighting the non-obvious, I’ve also been reading this article on the other, forgotten 9/11 tragedy. The one that happened in Chile in 1973. I can’t say I’m a fan of Atrocity Top Trumps, but it did make me think about how, horrific as 9/11 was, it certainly wasn’t the unique event it’s sometimes portrayed as.

Also this week I’ve been reading the blog of Laurie Penny, a feminist writer who both intrigues and infuriates me in equal measure. Just recently she turned down an offer to appear on Celebrity Big Brother. Just yesterday she announced she’s on board a ship heading to the Arctic Circle.

Sounds like a wise choice. I think I’d rather be trapped on an ice floe with a rampaging polar bear than stuck in a house with Jedward and Kerry Katona.

Retreat into the Medical Model

Like just about everywhere else in the public sector, we’re feeling the effects of the cuts. Jobs are having a nasty habit of not getting re-advertised when people leave.

Particularly vulnerable to the cuts are the psychotherapists – psychodynamic therapists, family therapists, art therapists, play therapists. There aren’t many of them employed in CAMHS, but their influence extends beyond their numbers. I’ve had some fascinating conversations with our psychodynamic therapist who keeps “accidentally” leaving papers on attachment theory on my desk. The opportunity to co-work with systemic and family therapists has genuinely transformed the way I conduct my clinical practice. They don’t just change kids and families. They change their colleagues too.

We get a complex mix of cases coming through our doors. Kids with neurological disorders such as ADHD and autism. Kids who have been abused, neglected or traumatised. Young carers to physically or mentally ill parents. Families under enormous strain, or with tortuous family dynamics. Educational issues. Child in need/child protection issues. It can be a bewildering variety of problems. To navigate it requires an eclectic mix of clinical models in your toolbox – medical, psychosocial, cognitive-behavioural, systemic, psychodynamic.

In hard times, it seems to be the psychotherapists – with their specialist outlooks and long, arduous training – who are most likely to be for the chop. My worry is that as we retreat to a core of doctors, nurses, psychologists and social workers, we’ll also retreat into a more narrow view of what CAMHS is for and what it does. Possibly diminishing into simply a medication and CBT service.

Don’t get me wrong, I’m not anti-medical model. I’ve worked with plenty of kids who’ve genuinely benefited from a bit of methylphenidate or fluoxetine. I’m not anti-CBT either, though I don’t think it’s the panacea cure-all it’s sometimes touted as. But one of the reasons I chose to work in CAMHS is because of its wide mix of models. Seeing it become narrower before my eyes is something that worries me.

On Labelling Kids

I’ve sometimes heard it said that there’s too many diagnostic labels for kids these days – Attention Deficit Hyperactivity Disorder, Autistic Spectrum Disorder, Oppositional Defiant Disorder, Dyslexia, Dyspraxia, Dyscalculia and so forth. The argument is that there’s now a label for everything.

My own view of diagnostic labels is a fairly pragmatic one. If they describe something accurately and serve a useful purpose, then they’re all well and good. If not, then don’t use them.

Oppositional Defiant Disorder, sometimes jokingly referred to as “Naughty Child Syndrome” is a label that tends to raise a few eyebrows. A lot of child psychiatrists are reluctant to use it unless it’s diagnosed as co-morbid with something that has a more neurological flavour, such as ADHD or ASD.

With high-functioning autism, sometimes the decision about whether to diagnose can come down to what the child will get for it. There’s no psychiatric treatment as such for autism, but a diagnosis can sometimes unlock educational support. If the child is struggling to cope with school, and support is on offer, then there’s a case to make the diagnosis. If they’re coping okay, or if no extra support will be available, or if the kid doesn’t want the support, then often we simply don’t bother to diagnose. Why label them if there’s nothing in return?

Back in my own childhood, I actually acquired a label of my own – dyspraxia aka Developmental Coordination Disorder aka Clumsy Child Syndrome. My motor coordination wasn’t developing as quickly as it should, which meant that I struggled with handwriting, and if I kicked a ball it would go in every direction except where it was meant to go.

This was causing me problems in school. I’d get frustrated at trying to write stuff, so lose interest and start staring out of the window in a daydream. I managed to sail all the way through primary school without it being noticed. Went I went up to high school, to their credit they picked up on it in the first term. I was sent to the special educational needs teacher, and then to a paediatrician who made the diagnosis. Hence I got my label.

Then again, before I had that label, I was given other labels instead.

Thick.

Lazy.

Bone idle.

I think I preferred the dyspraxia label. At least it was a label I wasn’t made to stand on a chair and repeat in front of the entire classroom.

Telling People What they Don’t Want to Hear

While browsing my Twitter feed (hi to those of you who have joined in the past couple of days btw) I came across this radio interview with Dr Allen Frances, an American child psychiatrist talking about paediatric bipolar disorder.

He’s surprisingly frank about the reasons why large numbers of American kids suddenly started being diagnosed as bipolar – over-zealous clinicians, aggressive marketing by drug companies, widespread ignoring of the DSM-IV criteria for bipolar disorder. All of which led to a lot of kids being prescribed frightening doses of antipsychotics, with all the side effects that come as part of the package. The overwhelming majority of those kids almost certainly didn’t have bipolar disorder.

I’m happy to say it’s a trend (Frances calls it a “fad diagnosis”) that never really took off in Britain. Nor for that matter, anywhere else in the world. Since coming to CAMHS I’ve seen very few patients with a bipolar diagnosis, and nearly all of those were around the 16-17 age range.

Frances is also very frank about the dangers of looking for a simple, elegant solution to complex, multi-faceted problems. He cautions about the limitations of psychiatric knowledge, and points out that often psychotherapy, parent training or just plain old watchful waiting need to be tried before reaching for a prescription pad.

What also surprised me about this interview was the extent to which the host doesn’t seem to want to hear it. I get the impression she was expecting him to come on the show and wow the audience with the latest discoveries and wonder drugs for paediatric bipolar disorder. He tries to point out that it’s really not that simple, but he has to hammer his points home because at times it all just seems to be going over her head.

I guess not everybody wants to be told that some problems can’t be solved with a pill.

Sunday Soundtrack – Symphony of Science

I only started the blog yesterday, and I’ve been pleasantly surprised to be getting some positive feedback, particularly here and here. Thanks to those people.

I think I’ll use Sundays to take a break from talking about child and adolescent mental health, and to have a musical interlude.

For the inaugural Sunday Soundtrack (see what I did there?) I present to you the wonderful Symphony of Science. This artist uses autotune to set the words of scientists like Carl Sagan and Richard Feynman to music.

The result is….wow, kind of trippy.

Relax and enjoy.