Warmest Regards

Dr Sharon Pimenta, Paediatric Consultant for King's College Hospital NHS Foundation Trust, blogs about how children’s worries or difficult feelings might present physically, and how parents with mental health needs might find it difficult to engage with professionals and treatment regimes.

Sharon Pimenta"Warmest Regards" this is the email sign off of Anto Ingrassia, Consultant Psychiatrist with the Children & Young People’s Health Partnership (CYPHP). No matter how small the exchange, it’s always typed by Anto each time.

To me it conveys a willingness to be receptive, to encourage, and to connect beyond the usual formality of ‘Kind Regards.’

I came to know Anto and CYPHP over this last year. I’d heard Ingrid Wolfe, CYPHP Director, and Claire Lemer, CYPHP Transformation Lead, talk many times about their vision for child health, and for cross boundary and partnership working. All these concepts made perfect sense, but what I struggled with was binding physical health with emotional health in a practical sense. I was tasked with supporting the development of the CYPHP Health Support Packs, our attempt to produce family friendly health information on common or chronic health conditions.  “Come on,” I remember thinking, “really Anto? Why does a health information pack on asthma, constipation, eczema, and epilepsy need to have a section on emotional and behavioural health? Surely that bit can be given out separately by those who have time to listen, and deal with those issues. Surely most families just want to know about the medical treatment.”

Every paediatrician, like me, understands that to treat a child you must engage the family. But, before I came to CYPHP I was not used to being the one who necessarily did this every time. I did not use each clinical encounter with a family to convey my warmest regards and to start a dialogue. As a hospital doctor, I was just too busy being busy with addressing physical health needs.

Consider what you might have missed

I started noticing a few children being re-referred to my In-reach clinics, the joint clinical sessions I run with local GPs. “Oh dear,” I remember thinking, “what did I miss?” Well actually nothing physical, I don’t think, but everything emotional. For example, the little girl with recurrent symptoms of a urine infection, but with repeatedly negative urine cultures, whose symptoms were actually caused by her being constipated. Her parents at first couldn’t see the relevance of the laxative treatment I offered, because I initially didn’t note that they were struggling with their own mental health needs and behavioural issues in their other children. Once colleagues in the CYPHP health team engaged with the family and offered help to address those other needs, the little girl stopped needing to come to my clinic.

Another child repeatedly presented with multiple symptoms including back pain, chest pain, and leg pain. She looked healthy and I provided reassurance. Physiotherapy helped, but I kept finding her back in my clinic. I eventually had a separate conversation with her family to better understand their everyday struggles. Their flat is small and the child’s three siblings had severe largely unmet learning difficulties. I consulted with our mental health team who explained this is a child who is lacking her own space both physically and emotionally. Once her family, GP and I started to try and see her physical complaints in this context, we were better able to support and she stopped re-attending clinics. 

A personal experience

Perhaps the starkest illustration I can give about the importance of thinking about mental health as actively as we consider physical health, is a personal one.

One of my own family members recently presented herself to A&E because she was worried about her knee. Although her knee examined normally, she was tachycardic and hypertensive. “Her bloods are normal, she can go home” said the A&E doctor. “I don’t think there’s anything to do here. Her heart rate does come down and she can remember all the medications she’s taking.”

I felt uneasy about this decision, so I let slip that I was a doctor (I don’t often do this unless I really feel pushed). “Well ok,” said the A&E doctor eventually, “if you say it’s her behaviour that’s worrying you, I’ll refer to psych but they won’t do anything, you know that.” My relative and I spent the next 12 hours in A&E.  After a review by the psychiatric team, she was admitted to hospital under section; my relative was seriously mentally ill and had been for months. 

I talked to Anto about my experience. ‘’Yes it’s as if time stands still’’, just waiting, praying, someone will see what you see. I wondered how many times I may have overlooked mental illness when I worked under the pressures of A&E.

Our future

I recently discovered that the aims of King's College London GKT School of Medical Education are to train doctors that are:

  • critical scientific thinkers
  • champions for mental health
  • leaders in service quality improvements
  • equipped to transform healthcare on a local and global scale.

Similarly, the south east London Sustainability and Transformation Partnership (STP) set their goals as working together to:

  • improve health
  • join up community-based care
  • treat mental and physical health equally.

From the start of medical training to the commissioning of models of care, it appears that we all now agree that there is a right path to follow. Mental health is now recognised as an absolute priority, but what we need to change is our personal mindset. Do we genuinely care enough to go beyond the physical, and develop the local resources to help fill the chasm of mental health need?

Working within CYPHP has been the first step in my journey towards this.

Let’s hope that ‘people with mental illness and professionals work to co-deliver the future. This means better outcomes, more transparency and better personalisation of the service for the individuals.’ (Five Year Forward for Mental Health, Feb 2016).

Warmest regards,

Sharon Pimenta.

Are you a child healthcare professional, with an interest in integrating mind and body care? King’s Health Partners Mind & Body programme and CYPHP will be co-hosting an afternoon focus group on the 28 November (17:30 – 19:00), where Mind & Body Champions can share their existing best practice, as well as develop ideas and resources to improve knowledge and services.

If you would like to register for the focus group, or are interested in becoming a Mind & Body Champion, please email mindandbody@slam.nhs.uk.

 

 

 

 

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