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Monday 28 July 2014

NEW YEAR'S RESOLUTION USE THE PRACTICAL PROTOCOL TO SAFEGUARD KIDS - Simple and Effective Process for Psychologists to Professionally Challenge Medical Practitioners when they have Concerns about the possible Over-prescription of Psychotropic Drugs to Control Behaviour in the Children with whom they work by Dave Traxson, Chartered Educational Psychologist.

Dave Traxson, Chartered E P, has collated these simple 'duty of care' guidelines to help colleagues challenge practice that 'causes them sleepless nights.'
 “There can be no keener revelation of a society's soul than the way in which it treats its children.”

Practical Protocol for Psychologists to Professionally  Challenge Medical Practice when they have Concerns about the Over-prescribing of Psychotropic Drugs to Control Behaviour in School-aged Children.

In all countries there will be ethical and professional guidelines that support a psychologist or any mental health worker's ability to professionally challenge practice that they have major concerns about in order to better safeguard the children with whom they jointly work. 
In the U.K. psychologists and many mental health workers have as members of the Health Care Professions Council have the ' Ethical Legitimacy ' to challenge medics when there is a real concern about the mental health and wellbeing of a young person with whom we jointly work.

This security  is provided by the HCPC’s  ‘Standards  of Conduct’ guidelines document which states, "You must not do anything, or allow someone else to do anything, that you have good reason to believe will put the health and safety of a service user in danger. This includes your own actions and those of other people. You should take appropriate action to protect the rights of children and vulnerable adults if you believe they are at risk."  (Page 8 of the HCPC's 'Standards of Conduct. Performance and Ethics - your duties as a registrant.') Check your own equivalent in other countries for a similar statement about the paramount duty of professionals to Safeguard Children.

The way that many concerned Educational and Child Psychologists are doing this in many services in the U.K. is, after taking supervision, to ring up or write to the medic who was involved in issuing the original prescription, which is usually a Child Psychiatrist or Community Paediatrician (GPs can only issue repeat prescriptions in the U.K.) this may be different in other countries, so check accordingly. They then give them some feedback about the level and nature of their concern, which may fall into one or more of the following:

- prescribing psychotropic drugs to under five year olds is totally against NICE guidelines and condemned by the Royal College of Psychiatry spokesperson Professor Tim Kendall on BBC Radio 4’s Womans’ Hour in 2011 (he also co-ordinated the National Institute of health and Clinical Effectiveness guidelines on ADHD)  Sadly this practice is still relatively commonplace in the U.K. (150+ such cases alone have been identified in the West Midlands from an informal survey of Educational Psychologists and I personally had one case where a child of well educated parents was first given a significant dose of Ritalin at the age of two and a half years old.) Tim Kendall described the use of anti-psychotics such as Resperidone at an age below five years as a potential national scandal on Channel 4 News in 2012.

- the behaviour pattern for which the child is being given these mind altering drugs is not normally evident in school to staff or to the EP (so there can be no triangulation of data as NICE recommends)

- no 'Drug Holiday' has been given after an extended period (more than two years) of time on psychotropic medication, to reduce risks of adverse side effects, addiction etc., which is another clear breach of NICE guidelines.

- severe side effects  resulting from the drug regimen which are causing concern to staff in school and their EP e.g. tremors, tardive dyskenesia,  over-stimulation of the heart, reported sleep difficulties, an agitated nervous system, loss of appetite or lethargy.

- there are concerns about the 'drug cocktail' (commonly three to four drugs) a child is on i.e. the combination of drugs may be cumulative and may be 'life threatening.' (Pharmacists can intervene in these cases and have done in a reported number of cases) A common drug cocktail that this has happened for is  high levels of Ritalin and Resperidone ( a strong anti-psychotic drug also known as Resperdal) and then an SSRI anti-depressant for their low mood and possibly Melatonin to promote better sleep which has been harmed by the psychostimulant.

- there are apparent adverse drug effects of sleep disturbance and major weight loss which are having an adverse psychological and/or physical impact on the child. Resperidone has just been the subject of the largest ever class action for criminal injury in the U.S. due to it producing fully formed female breasts in pubescent boys and massive associated weight gain, which the drug companies knew was a likely consequence from their own studies. One can only imagine the psychological distress this causes to a boy at this critical stage of development and family alike.

- there has been a sudden physical collapse in school which results in hospitalisation (not as rare as might be thought - two occurred in one small area of the West Midlands in a 12 month period)

- there is concern amongst professionals that parents may be reporting behaviours to deliberately access Disabled Living Allowance at medium or high rate.(£300 or £600 per month respectively) An Amazon best seller by a medic promotes this course of action and gives procedures to follow step by step for worried parents. One family, I am aware of, had two children on the higher level and attempted to get a third which would have led to a large monthly income. Some parents are known to add to this by selling the Ritalin on the black market at a price of at least £5 per tablet. (Potentially another £300 per month.)

- the child regularly displays acute anxiety which is a contra-indicator to a doctor prescribing psycho-stimulants, as we all know anxiety is very common in children who present with behavioural difficulties. Also if the psycho-stimulants do the job they are designed to do the child will have an poor night’s sleep and certainly be jumpy and anxious the next day, as all parents know, which continues the vicious cycle. We believe this response is very common in the U.K. with doctors not taking into account the obvious presenting anxiety pattern.The youngest in my area was a two and a half year old who had been anxious from birth and well educated parents pressurised a psychiatrist to put him on psychostimulants - surprise - surprise the child became increasingly agitated at school until the ritalin was removed and then he settled again.

So what do we do in these cases?

-Simply ring or write a letter to share your professional concerns and any evidence with the medical colleague who issued the original prescription. This is a basic 'duty of care' protocol to Safeguard Children from the potential harm due to toxic harm from psychotropic drugs. This is our individual and collective Paramount Duty as many Directors of Childrens’ Services regularly remind their staff..

What is the result?

-The medical colleague invariably thanks the psychologist or mental health worker for taking the time to ring them to share their professional concerns and for the information which they were often unaware of, from their own invetigations and formulations. They often consequently review the medication very soon afterwards with consequent benefits to the child  involved.
This is a simple and effective procedure which better safeguards the child from “overzealous prescribing by some psychiatrists.” (Sir Simon Wesseley - President of the Royal College of Psychiatrists on the BBC News Channel 2014) He went on to describe the developing situation as ‘a perfect storm’ of the over-prescribing of psychotropics particularly psychostimulants for normal behaviour patterns and the under-diagnosis of real mental health difficulties for which less resources are being made available nationally.

PLEASE CIRCULATE -  to teams and help continue the great progress being achieved collectively, nationally and even internationally with such appropriate and effective ways of reporting concerns to a health colleague.

These guidelines were collated by Dave Traxson, Chartered Educational Psychologist and Committee Member of the Division of Child and Educational Psychologists' (DECP)  a national committee of the British Psychological Society.(BPS)

Sunday 20 July 2014

The Cultural Amelioration of Negative Social Constructs of Difference – in the Context of Holistic Psychological Formulation - a new Opinion Piece by Dave Traxson


The Cultural Amelioration of Negative Social Constructs of Difference –
in the Context of Holistic Psychological Formulation.

“A negative focus on difference damages an individual human being’s ability to make relative progress in a range of important skill areas.”

Reframing negative constructs of difference to being more positive manifestations of a human being's right to individuality, creativity, and potentiality is a process that is well under way in society but there is still along way to go. Aprocryphal tales abound of young people whose special talents were missed by the adults around them including educators and then suddenly when unleashed led to a transformational levels of progress. One of my own, is a young woman who was two days away from permanent exclusion as a fifteen year old, when I asked an obvious question about what she could see herself doing in her mid-twenties. Without hesitation she said, “ I am going to be a semi-professional footballer and a car mechanic.” No one in the circle of professionals and parents, including the careers guidance officer, knew that, but when the necessary curriculum adjustments were made to achieve this, she thrived and even stayed on to the sixth form to improve her chances further. We also noted profoundly that she was co-operating previously in all subjects that, she could see, related to her ambition and was not co-operating in subjects that she could not see the relevance of , in achieving her clear goals.

It seems that there may have always been a part of the human condition that fears and often demonises difference in others compared to ourselves. This may have had a Social Darwinistic function for protection, to ensure that ideas and values of our own particular closed subgroup survive and even thrive.

The problem and question for us all is, can this be challenged and can tolerance of social variation 'genes' be woven intentionally into our collective values DNA?

I am optimistic that they can be and already the 'radiation' of ideas from the recent inclusion agenda, that have been emerging for the last thirty years, indicates that a dramatic evolution of societal values can occur e.g. the Tsunami of change occuring in front of our eyes with the massively improved tolerance and understanding of same sex relationships and the consequent legislative changes.

So what if we learn from this journey and apply the same 'selective pressure' to wider areas of intolerance to difference such as mental health or as 'medical modellers' would prefer, mental illness. If we can choose and promote a more socially and psychologically inclusive perspective on the normal range of human behaviours, that we mainly work with, then just imagine the long term benefits to us all:

  • less stigmatisation of children and subsequently adults.
  • many more people feeling a gteeater sense of belonging.
  • a massive reduction in the pathologisation of normality.
  • subsequent reduction to the costs of labelling for society.
  • a massive gain in individual and collective self-esteem.
  • empowerment of people with 'ups and downs' to succeed.
  • and a huge improvement in our collective Wellbeing.
  • And last but not least massive savings in NHS costs.

The acronym below tries to convey some of the key principles of ameliorating difference as a discriminatory construct:

D-ifference is beneficial to the community in which we live
I-ndividuality should be highly valued in schools and society
V-alidate childrens’ unique contributions to empower inner creativity
E-xpect relative progress by caring target setting and feedback
R-eview the progress achieved regularly and reinforce creativity
S-afety and security are fundamental to mobilising creativity
I-nclusive ethos promotes the value and benefits of diversity
T-reat all childrens’ strengths and abilities as being equal in status
'Y-ou are important and deserve personalised planning and outcomes.'

Schools as institutions are driven by uniformity and not creativity based on the wonderfully different skill sets individuals. Sir Ken Robinson in one of his seminal TED TALKS entitled “Schools kill creativity,”(2006 on Youtube) takes this argument to a logical conclusion. To progress successfully into a twenty first century of rapid change and challenge we need to discover the ‘Gold Nuggets’ of creativity that exist in everyone and maximise their abilty to follow their heart and soul in becoming a dancer, artist, sculptor, poet sportsperson or entrepreneur all of which are not as highly valued in our Education System as Maths, Science and English skills.

Cultural amelioration of difference is the systemically valued driver of wanting a school that you work in to collectively promote the importance of the unique human contributions that all children can make to any aspect of a hugely broad menu of curricular pursuits.

It is based on a triad of Ethos/Beliefs driving change in Actions/ Behaviour which in turn promotes collective Emotional Wellbeing/Mental Health.

The 5 Ms of Cultural Amelioration of Difference are :

  1. Moderate the use of labels of disability/disorder based on ‘Medical Model’ thinking.
  2. Modify educational programmes to allow a ‘Punctuation of the Day’ with creative activities that a young person demonstrably enjoys and engages fully in as a healthy learning process that promotes coping and resilience.
  3. Manage the individual’s needs /wants and the necessary resources to release their inner creative energies.
  4. Make appropriate adjustments to achieve success.
  5. Mollify conflict and prejudice against certain creative activities.

“Deliberately demoting difference effects can maximise the normalisation of childrens’ responses, as strengths and not difficulties.”

The ‘Medical Model” promotes ‘within child’ explanations of difficulty whereas the ‘Social Model’ promotes a holistic understanding of causation and possibilities for positive change. We as professionals are duty bound to see and recognise the rich palette of colourful skills as capacities, strengths and contributions which can enrich the sometimes apparent dullness of our communities and society as a whole.

Psychiatry applies the Medical Model conceptualisations to mental distress and anxiety whereas the new field of Psychological Formulation expounds an optimistic approach that maps the ‘Ordnance Survey Map’ of a young human being’s multi-various attributes, potentials, personality variables, interests and strengths and plots them in a way can help them determine the exciting journey that they are keen to embark on.

What is important is not to focus on arbitrary and prejudicial labels that are proliferating currently but to understand the complex web of interactions that results in an individual's mental distress. Understanding the interactive nature of a person's difficulties is a more progressive and inclusive way of finding how we can help them to succeed fully in an evermore complex world.

Reducing the continuous focus on difference and threat,that we see daily in our chosen media, axiomatically helps us to realise how similar we are and by focussing more on our 'common ground' we will develop the humanistic potentials of all individuals in our improved societies.

In essence creativity at all levels is the vibrant solution to our current shared ills and appreciating uniqueness and difference is the shared vehicle for progress.

Saturday 12 July 2014

FIDDAMAN BLOG: Two Boys, Two Suicides, One Antidepressant.

FIDDAMAN BLOG: Two Boys, Two Suicides, One Antidepressant.: Two inquests looking into the deaths of two 14 year-old boys bear striking similarities that should be a stark warning to all parents......

Friday 11 July 2014

“Medicalisation of Normality”, the new leader of Britain’s psychiatrists has declared. COURTESY OF THE TIMES WEBSITE


Last updated at 12:01AM, June 21 2014

Middle-class parents and teachers are pressing doctors to label children as mentally ill in a worrying “medicalisation of normality”, the new leader of Britain’s psychiatrists has declared.

 Drugs such as Ritalin and Prozac have been massively abused because of the desire to label problems as medical disorders, said Professor Sir Simon Wessely, who takes over as president of the Royal College of Psychiatrists next week.

Huge rises in the use of antidepressants and drugs to treat attention deficit hyperactivity disorder (ADHD) show that they are being given too freely in response to social pressure and not to those who could really benefit, he said.
Professor Wessely also criticised the prejudice against mental health among other doctors, adding: “You could not have designed a health service less able to join up mind and body, physical and mental, than the health service that we’ve had in the past 20 or 30 years.”
The use of ADHD drugs has tripled in a decade and the use of antidepressants has doubled. Professor Wessely said that this was unlikely to be explained purely by more disease or better detection.
“Medicalisation is not often done by doctors. In areas that are more accessible to public debate it’s almost the other way around. Now we see a huge rise in support groups, we see pressure brought to bear to bring in labels,” he said.
“Certain behaviours carry stigma and there’s less stigma if it’s associated with a disorder. Often it’s about the avoidance of guilt. You get obvious pressure from parents: we’ve all been to middle-class dinner parties where so many parents seem to say their kids are mildly autistic and yet they’ve just got into Oxford. And you think, ‘I don’t really buy that one’ . . . It’s interesting that many of these disorders are more common in the private sector of education.”
He added: “When did you last hear a kid called bookish or shy? At what point do those normal traits become social phobia or Asperger’s, or when does a naughty kid become ADHD? Now those are socially defined, and where psychiatry sits on those is often not where the public think.
“We are the most conservative in those areas because we know how awful autism is, we’re the ones who don’t want to extend the boundaries to include every shy, bookish, odd child. It’s psychiatry which is against the medicalisation of normality.”
Arguing that there are “perverse incentives” in the system, he said: “The more children that are labelled ‘special needs’, the more resources a school gets. If you just have a difficult kid in your classroom, you’ve just got to cope. But if you have a kid with ADHD you might get a classroom assistant. So you get pressure from teachers.”
Justine Roberts, from Mumsnet, disagreed. “Getting a diagnosis or educational statement for your child is fantastically difficult and the stigma associated with behavioural disorders can be a powerful disincentive, so it seems unlikely that [parents] are driving any significant increase in diagnosis rates,” she said. “Disparaging parents and teachers who are seeking support for children in their care seems misplaced.”
Professor Wessely said that ADHD and other conditions were real disorders, for which drugs did work. “It’s likely that stimulants [such as Ritalin] have been massively abused, but we know for children who have ADHD the evidence that stimulants are good, effective treatments is overwhelming. Therefore what we’re trying to do is ensure that the right treatment goes to the right person,” he said.
“We should be concerned about it, just as we should be concerned with the rise of antidepressant prescribing for the same reason. We know that many people who should be on antidepressants aren’t, we also know that people are getting antidepressants because of the lack of any other available alternative.”
While some critics suggest that psychiatric drugs do more harm than good, Professor Wessely said it was nonsense to say that antidepressants did not work. “It’s the same with Ritalin. It’s probably over-prescribed, but it’s also under-prescribed because we don’t have good enough [child and adolescence mental health] services,” he said.
Professor Wessely also said other doctors looked down on psychiatry because “we don’t have very big machines that buzz”, but it could teach the rest of medicine about the importance of communication with patients.


Professor Sir Simon Wessely, the president-elect of the Royal College of Psychiatrists - shares concerns about over diagnosis of childhood behavioural conditions and describes it as a, "Perfect Storm." COURTESY OF THE TIMES WEBSITE

http://www.thetimes.co.uhood behavioural conditions.k/tto/opinion/leaders/article4125804.ece
updated at 12:01AM, June 21 2014

Professor Sir Simon Wessely, the president-elect of the Royal College of Psychiatrists, yesterday made a timely and measured contribution to the debate over two trends that have come together. The first is the growing tendency to attach medical labels to human behaviour previously regarded as outside the medical remit. The second issue is that, as a consequence of such-and-such a condition or syndrome or disorder being identified, doctors then prescribe drugs in an effort to treat it.
The rich western world has, Sir Simon argues, become too keen — even dependent on or addicted to — the business of categorising every last foible, every crease and crinkle of an individual personality. Once a thesis, diagnosis and prognosis are advanced, the pharmaceutical industry is only too willing to conjure up the plausible chemical corrective, a product that health professionals are then only too willing to supply. Such a “medicalisation of normality”, as Sir Simon terms it and rightly says, is not a healthy development.
Sir Simon is right to argue too that, while his profession must bear some responsibility for the situation he describes, and doctors have become too willing to prescribe, the wider public cannot escape all blame. Parents — middle-class parents especially — are complicit. Unwilling to accept their child’s normal deviation from the tightly-drawn parameters of the normal personality, many parents lobby the relevant agencies for a medical explanation instead. It does not help that pupils and schools attract extra resources once certain conditions have been diagnosed. The idea that even minor problems must all have a cause and therefore a solution has become dominant.
The current fashion to label and try to treat aspects of human behaviour is not only unsustainably expensive, it may also prove injurious to the health of society as a whole. Many people who make hugely significant contributions to mankind’s well-being in adult life endured unusual, troubled, even harrowing childhoods. At a minimum, the talented are, almost by definition, in some way different from their fellows. Some people, especially during their early years, can act in ways that others — teachers, parents, peers — find eccentric, irksome, embarrassing, regrettable or just plain irritating. Some children are shy, naughty, obsessive or peculiar. Some are, sadly and with no obvious cause, unhappy.
That is not to say that suffering should not be alleviated. Any victim of a quirk of character sufficient to cause distress must be treated with kindness and sympathy, as well as being offered whatever encouragement, discipline, stimulation or other help they need as is judged appropriate.
What such individuals should not be subject to, however, is a pseudo-diagnosis that does little more than stigmatise the particular personality trait they happen to possess and which a prevailing majority view happens to deem unacceptable. Many conditions are created in the naming and the diagnosis often does no good at all.
Nor, other than as a last resort, should a child suffering no apparent physical ailment be routinely placed on long-term medication, whatever difficulty that child’s actions may create for those adults charged with his or her care. A chemical response may well be convenient but convenience seldom makes for the correct or the civilised course of action. Anxious parents and overzealous doctors are making a problem worse.