The demand for CYP mental health during Covid “a crisis on a pre-existing crisis” – Honorary Professor Dr. Bernadka Dubicka

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In this podcast, we talk to our CAMH Editor in Chief, Honorary Professor Dr. Bernadka Dubicka.

Bernadka discusses her achievements at the Child and Adolescent Faculty at the Royal College of Psychiatrists, from which she has recently departed, together with the recent Honorary Professor role from the University of Manchester.

Bernadka explains what can be done to translate research into practice, and what mental health professionals can do to influence policy. She details the key points of evidence she put across to the Health and Social Care Select Committee on Children and Young People’s Mental Health, including integrated care as being essential. She also elaborates on describing the increasing demand for children and young people’s mental health during the Covid pandemic as “a crisis on a pre-existing crisis”.

You can listen to this podcast directly on our website or on the following platforms; SoundCloudApple PodcastsSpotifyCastBox, DeezerGoogle Podcasts and Radio.com (not available in the EU).

Honorary Professor Dr. Bernadka Dubicka
Honorary Professor Dr. Bernadka Dubicka

Dr. Bernadka Dubicka qualified in medicine and psychology at University College London and completed her training in child psychiatry in Manchester, alongside her MD on adolescent depression. She has been a consultant for an adolescent unit for over a decade, and recently moved to a new post in Greater Manchester where she is helping develop intensive community and crisis services for young people and is also a research lead. In 2015 she was elected vice-chair of the RCPsych Child and Adolescent faculty, and became chair in June 2017. She has campaigned actively for improved CAMHS since taking up this post. In August 2021 she became an Honorary Professor at the University of Manchester.

She has a research interest in mood disorders, with expertise in clinical trials and evidence based practice. Most recently she has been an investigator on one of the largest international psychological treatment trials in adolescent depression (IMPACT). Dr Dubicka is a member of the National Institute of Health Research, and a clinical advisor for the North West Strategic Clinical Network, where she has led on a project examining self-harm in young people. She is an editor of the Child and Adolescent Mental Health Journal, has published regularly, contributed to NICE guidance, and speaks regularly at national and international meetings, as well as in the media.

Interviewer: Hello and welcome to the In-Conversation podcast series for the Association for Child and Adolescent Mental Health or ACAMH for short. I’m Jo Carlowe, a freelance journalist with a specialism in psychology. Today, I’m interviewing Consultant Psychiatrist Dr Bernadka Dubicka. Bernadka recently finished her term as Chair of the Child and Adolescent Faculty at the Royal College of Psychiatrists, and she is editor in chief of the Child and Adolescent Mental Health Journal, CAMH. She has also recently been appointed Honorary Professor at the University of Manchester, starting from August the 1st.

If you’re a fan of our In-Conversation series, please subscribe on iTunes or your preferred streaming platform. Let us know how we did with a rating or review and do share with friends and colleagues. Bernadka, thank you for joining me. I haven’t included all your titles in the intro, so can you give an overview of your various roles?

Honorary Professor Dr. Bernadka Dubicka: Hello, Jo. Thanks for speaking to me today. I’ll start with my editor-in-chief role first of all because that’s my closest affiliation with ACAMH. So I started as an editor on the Journal of Child and Adolescent Mental Health quite a few years ago now and then I became deputy editor. Now when Dennis Ougrin left last September I took over as editor in chief, and I’ve been an academic with an honorary position at the University of Manchester for many years now, first starting as a research fellow when I was in child psychiatry, and then very recently I was very pleased to be appointed as an Honorary Professor.

And then lastly, I’m a working clinical consultant and I work for Pennine Care Foundation Trust, which is in Greater Manchester, and I’ve been there for several years now. I guess I should also say that over the past four years I was the Chair of Child and Adolescent Faculty at the Royal College of Psychiatrists, which was a great privilege to be in that post and it kept me very, very busy for the past four years.

Interviewer: I want to focus on that post. The term ended in June of this year. What did you set out to achieve in that time?

Honorary Professor Dr. Bernadka Dubicka: I think the main thing that I wanted to achieve was to get Challis mental health much more on the agenda. I think that’s been happening for a number of years now. Of course, the pandemic has accentuated the interest and the concern about mental health amongst our young people, and I certainly think that we managed to achieve that as a faculty and certainly the number of communications we’ve had around our concerns about health and wellbeing, children and young people have gone up significantly over these past few years, and that’s been accompanied by similar interest in terms of policy making as well.

So, for example, just within the past six months I was invited to sit on three different parliamentary select committees to give evidence on the mental health of children and young people. So there have been lots of really important opportunities to try and move this agenda forward. Of course child and adolescent  mental health been underfunded and neglected for many years, but I hope that Covid will give policymakers the further impetus and incentive to try and push this agenda forward further for the sake of our children’s futures.

Interviewer: Were there any particular issues at the college that feel important to highlight?

Honorary Professor Dr. Bernadka Dubicka: One of the most pressing recent issues that’s come to the fore more and more, of course it’s been important for a long time as the ecological crisis and we know that young people have really taken a lead on this issue and it started with Greta Thunberg who’s done incredible work, but we also know it comes up as a concern time and time again for our young people. So it’s something that I felt it was really important that the College of Child Psychiatrists that we support young people with this because it not only affects their lives, it affects our lives, it affects the future of the planet.

And, of course, it affects mental health globally and right now we’d have a crisis not only nationally, but globally in terms of trying to meet the mental health needs of children and young people, but if the ecological crisis continues at the pace that it’s going, that’s only going to become worse. So it’s very, very relevant to practicing. Well not just child psychiatry of course to CAMHs and to everybody really. So over the past year we were able to highlight that issue quite significantly.

So we were very involved with the recent college position statement on the ecological crisis and our culture has declared a climate emergency. So it’s taken a lead in that. Also we had a special conference earlier this year, Winter Institute, and invited key speakers and that event was run by young people as well and they really gave it the impetus that it needed. So I hope that we very much try to raise the profile and one of our key speakers during our events was somebody called Dr Lise Van Susteren from the United States, and she is a forensic psychiatrist and gave evidence for young people when they took the US government to court on the climate emergency, and I guess that’s work that I’m really keen to continue to highlight in the journal, and in fact we’ve commissioned a special issue to be published in February next year specifically on this particular issue.

Interviewer: Relating to your time at the college, are there any particular achievements that you’d like to highlight?

Honorary Professor Dr. Bernadka Dubicka: There’s probably many things that I’d like to discuss, but I guess one of the things that I was particularly proud of with the people I work with, particularly Louise Theodosiou  who was very instrumental, collaborative in this particular project, was around the paper that we produced on the impact of technology on children and young people’s mental health. The reason this paper developed at the college is because we were constantly being asked in the media to comment on social media. It’s the number one topic that journalists were interested in and I thought it was really important that we try and do this from an evidence based perspective.

So we did do a relatively thorough scoping review around the topic and that was published in January 2020. Though what we reported really in that paper was that the evidence around this is still very much behind the times of social media and technology is developing far more quickly than the research and evidence can keep up with it, but certainly there’s some evidence of potential emerging harms.

Of course, lots of benefits to those during the pandemic, particularly in terms of interconnectivity for young people. It’s just been so, so important and service delivery, but certainly in some areas, particularly thinking around contagion effect that I spoke about clinically, on clinical units regarding self-harm and eating disorders. That’s something that is of huge concern in terms of online communities and it’s certainly a space, an area that we do need to make sure that we advance the research as soon as possible.

And I guess something that I want to say around this area, I mean, the topic has become quite difficult to discuss. It’s become quite reductionist and quite polar. So it isn’t the question of is social media technology good or bad for children and young people? The question is much, much more complex than that. Personally, I see the development of technology along the lines of the climate crisis, the two huge things that for the most important developments for in young people’s lives and affects them on a daily basis.

And we haven’t kept up with those developments in technology as quickly as we can, and the call that we had with this paper was that technology companies should be held to account. They should be paying more tax, and that tax should be used for more research, and also thinking how we can use social media for the benefit of children and young people, and also that social media companies should be providing independent data for academics to look at in terms of examining these facts, because right now there is zero accountability. They collect all this data from children and particularly our worries about most vulnerable children and young people, those who are already disadvantaged or struggling with mental health problems, and young people have no control over their digital footprints.

So all sorts of stuff might be happening. For example, exchange of pornography, naked images but young people have no control over what happens to those images and their data, and young people are telling us they want to have more control. They want to be able to control their privacy settings, but at the moment there is none of that. So I’m really pleased that since we published that paper there has been much more discussion around accountability for social media companies globally and in terms of… And not just their accountability for safety, security and data privacy, but also thinking about the profits they make and how those are used, and our paper did make a huge international splash.

So we had more than half a billion hits globally. So we had coverage across the world in the United States, New York Times, Washington Post, Times of India and down in New Zealand. So it had huge national international interest. So I was proud that we did manage to achieve that, but of course this is a highly topical issue and the debate is only really just started, but I really hope the debate moves on from sort of  a simplistic, narrow view-point, just thinking about screen time and effects on mental health well-being in general population. To thinking much more about the really complex interactions about how young people use social media, how they use screens, which young people under what circumstances, because certainly clinically, you know, so for example, I have young people attending the clinic when they’re feeling good.

Then they can use social media to help support their friends. However, if they’re feeling depressed and suicidal they will find that social media can then trigger some of those self-harm thoughts and feelings and escalate some of those feelings. So there are very, very complex interactions that we need to understand, but the bottom line is social media companies need to be much more transparent and accountable and this is an issue for society and it’s an international issue, of course, as well.

Just staying with the college for a moment, what more still needs to be done?

I guess where do I start? Our work is probably never done, is it? So yes, children and young people are on the agenda, and of course I’m talking to an international CAMH audience to talk about the UK here. Then one of the big things that happened policy wise in the National Health Service ten year plan fairly recently, the government has made a commitment that within the next ten years that they will aim to meet the needs of all children and young people aged zero to 25 who have got mental health difficulties.

And of course, you can’t argue with that aspiration, but in order to meet that it’s going to take an awful lot of thought, planning, investment and of course work-force. So the biggest thing still needs to change and needs to happen, and the talk is going in the right direction, but of course that has to be accompanied by policy and investment is that specialist service in themselves are never going to meet the needs of children and people with health problems, and we need to be looking at systems as a whole. By that, I mean anybody who’s involved with children and you people needs to have awareness around mental health and wellbeing.

So much can be done at so many different levels. I mean, this country has got something called a Thrive Model and that basically is terminology for thinking about how children can thrive in their environment and what support they need at different stages of their lives and development. That support for mental health issues doesn’t necessarily have to be specialist professionals. So that might be within schools. It might be within families, within their communities. It might be charities providing support. There’s all sorts of professionals and networks who can help in supporting children and young people.

And of course that has to start really early on. So we know that the majority of mental health disorders in adults begin before the age of 18. 75% in fact, and we know that the sooner you can help children and young people and prevent them falling into crisis, the better the outcomes. So, of course, that needs to happen. You know, even during pregnancy and from birth. So it’s important that we can support families very early on and particularly young children, toddlers who are struggling perhaps with neurodevelopmental problems, behavioural issues, parents that are struggling.

If they can be given that support early on we can prevent mental health problems developing. That’s the sort of position I’d like to see us being in. Of course internationally, you know, we live in a relatively well-off country but of course we’ve got significant social economical disparities within this country, but there are countries around the world and people might be listening where provision is even less than we have here. So, for example, we commissioned debate around covid last September in CAMH and one of our colleagues was writing from India where the population, children and young people was double what it is in the UK, services, you know, are very piecemeal compared to what even we have here.

Interviewer: I want to focus on the impact of policy and as you mentioned earlier, you’ve given evidence to a number of parliamentary select committees. In May, you gave evidence to the Health and Social Care Select Committee on Children and Young People’s Mental Health. What were the key points that you put across?

Honorary Professor Dr. Bernadka Dubicka: That particular select committee was focussing on inpatient services. I was really pleased to be invited because before my current clinical post I did work in an in-patient service for 11 years, and very recently we published a debate on the use of in-patient services and Challis and mental health. So it’s a very topical issue. So the key point that I wanted to get across, which I’ve been trying to get across ever since I started my post at the college, was that in-patient beds are incredibly expensive.

For some young people in some circumstances they might not actually be very helpful. It could be positively harmful. For example, if you have a young person that’s  struggling with self-harm that may be very early with their difficulties in that area, they may have come onto a ward where there are other young people who have got very severe problems and eating disorders is another example. So during my time work working in research you could see that what we call contagion affects, so young people being very much affected by what’s going on around them and then deteriorating even further.

But of course, it’s really important to say for some young people absolutely is life-saving. So we have to make sure that we use a very scarce, expensive resource carefully for the right young people at the right time, but of course we want to be in a position where young people, we reduce the number of young people falling into crisis and they don’t need to be admitted because we could produce hundreds and thousands more beds, they’ll all be filled if we don’t have the right support in the community to prevent crises.

So that was the key message that I wanted to get across. The other key message just as important is the workforce. So we know that there are issues with the workforce in this country in terms of recruitment retention in child mental health, but that problem is particularly acute in in-patient services. It’s quite a stressful job for professionals to take on and unless we can address the wellbeing of staff and make sure they’re properly supported we can’t hope to provide the sorts of services that we would like to provide.

And of course, we know if there’s high turnover of staff then that can impact on the outcomes of children and young people. What we need is well-trained staff who are well-supported, who aren’t burnt out and who are there for long periods of time.

Interviewer: Recruitment and retention issues have long plagued child and young people’s mental health services. What’s the situation currently?

Honorary Professor Dr. Bernadka Dubicka: There is some good news in terms of child psychiatry in the UK. So in terms of trainee placements, what we call core trainees or relatively junior psychiatrists, all those places have been filled 100% in the past year, which is really good news. So obviously we would hope to persuade as many of those junior psychiatrists as much as possible to come and work in child mental health, and we also increased recruitment into four specialist child and adolescent psychiatry posts in terms of the trainee post, which is really good news.

So that’s certainly improving. So that’s very positive. On the other hand, you know, a few years ago we were promised an additional 100 consultant posts, and of course we haven’t increased those posts at all. We’ve actually reduce those posts, but it’s not just child psychiatry posts that are an issue, the recruitment is an issue across the board in terms of Challis and mental health services. So it’s an absolutely urgent issue, and when I was in my position at the college we were calling for an urgent ten year workforce plan to accompany the aspiration that the government have in terms of addressing all mental health needs for zero to 25.

It’s so important that we have a workforce plan around how we’re going to address that in the short, medium and longer term and also thinking about it in a systemic way. As I previously said, how can lots of different sorts of services be working together to try and provide those for those needs? And of course in England we’ve got a big schools programme and mental health support teams are developing within schools, but again that’s a ten year plan and at this point in time referrals are greater than they ever have been last November and partly due to the pandemic.

So it’s important that we speed up that process and speed up what we’re trying to deliver on the ground to children and young people, but there’s been a recent call from various charities calling for early hubs for young people in the community that can provide early intervention services. So I’d very much like to see that happening together with the same sorts of hubs for very young children, for the under-fives as well.

Interviewer: In the evidence to the committee you did describe systemic integrated care as essential. Can you say a little more about the barriers that have been to this?

Honorary Professor Dr. Bernadka Dubicka: So one of the biggest barriers, the cuts in social care services, and that’s something that’s been a huge issue in in-patient services for quite a few years now and it’s becoming more and more acute, and there’s been too much polarisation around young people’s needs. It’s not either social care or specialist mental health. You need teams of professionals in different disciplines working together to achieve the right outcomes for young people, but of course, for example, if you have a child that’s looked after, who’s been moved to multiple placements, who’s at risk of significant mental health issues, it’s so important that they have stable placement and the right care and community to prevent crisis.

Without that there is just a horrible, vicious cycle of repeated crisis, repeated admissions, and that shouldn’t be happening. We need to ensure that those sorts of vulnerable young people are supported early on and have got stable placements in the community. Another example will be children and young people with intellectual disability and autism, and if we could have more service to support people with neurodevelopmental difficulties as well, hopefully there will be less risk of them falling into crisis too. So it’s about prevention, prevention for the most vulnerable children and young people and social care is certainly really, really important in that regard.

Interviewer: Unfortunately, as you mentioned earlier, demand for children and young people’s mental health services have increased during the Covid pandemic, and at the select committee you described this as a crisis on a pre-existing crisis. Can you elaborate on that?

Honorary Professor Dr. Bernadka Dubicka: So, I mean, going back many years, so 20 years ago, we had a report called Every Child Matters by the then Children’s Commissioner. Of course about 20 years has gone by since then and since then we’ve had multiple documents, Future and Mind and various numbers, and we had a big CQC review of Challis and mental health services in 2018. The recommendations and recommendations are the same. They’re very, very similar but it just seems we have one report after another.

But during that entire time the number of children and young people treated within services didn’t really change. So historically we’ve only treated one in four school aged children. That’s five to 16 with a mental health disorder. Therefore, 75% of children with a mental disorder have historically not received treatment, which is absolutely scandalous and you wouldn’t expect that to happen, for example, if a child had cancer. Those figures have increased recently to one in three in England, which is obviously a move in the right direction.

That’s only two thirds of children, and then what about children those who don’t meet threshold for mental health disorders? So we don’t even have data on that, and of course the pandemic has raised a lot of issues. We’re still waiting for the data to see exactly what the effects have been. We’ve had some preliminary data here in the UK from NHS Digital and our prevalence study and Professor Tamsin Ford was involved with that. That showed that from 2017 to the end of the first wave last summer mental health problems had increased from one in nine to one in six children and young people.

So that was an indication of problems continuing to increase. Of course, demand has increased significantly, the highest numbers ever in November last year, but of course demand doesn’t represent prevalence. It might just be that more people coming forward. We don’t know, and we clearly have to continue to collect data on that and this is where evidence and research is really important. So Challis mental health has historically always been the Cinderella of not only services, but also research, but we can’t plan for services.

We can’t plan for investment in evidence based interventions, unless we have detailed information around prevalence. So the last survey took 15 years to be repeated. So, of course, we can’t afford to be waiting that long again and it’s really important the government continue to invest in research to explore prevalence, and then we can map on what the services need to look like to address that prevalence, and also it’s important to map that onto the government’s aspiration of looking at zero to 25, because historically we’ve only looked at the prevalence amongst school children as well.

And I guess lastly, in terms of research evidence and be able to apply that policy the question I always get asked and many people get asked, why is it that emotional disorders, for example, seem to be rising, and it’s very difficult to answer that because we don’t have enough data around that. So if we could include data around risk protected factors, as well as the use of services within prevalence studies that would give us the data that we need and it wouldn’t cost that much money, but that’s so important in terms of mapping services, mapping these and trying to understand changes in needs as well.

Interviewer: Can you say anything more about how you go about translating research into practice?

Honorary Professor Dr. Bernadka Dubicka: And that’s a really good question, and again in CAMH we commissioned a debate series on evidence based practice and policy recently, and also there was an editorial perspective on implementation of evidence based, and that is hugely challenging, having been involved in various research studies myself, to actually see evidence base then translate it into practice. It’s quite difficult.

There seems to be a big gap there. What I think what needs to happen is there needs to be funding around that. So when you apply for research funding, you know, you put a bit of money in for dissemination, but there’s nothing for implementation. If you have a finding that is significant and appears to be robust and is peer reviewed and it’s thought it will be a good thing to bring that into practice there needs to be funding for implementation.

So, for example, you know, if there’s an intervention that seems to be working you can’t just disseminate that via a lecture series, a few articles here. Staff need to be trained. They need to be supervised. That supervision needs to be disseminated. There needs to be a sort of cascade effect and that cost time and money, and it can’t just be done with the odd few sessions here and there. So we do need to look at how we implement evidence base and we need to have much better structures for that.

Interviewer: Is there anything mental health professionals can do to influence policy?

Honorary Professor Dr. Bernadka Dubicka: I mean, that’s a very good question. Obviously, I hope, you know, CAMH is very much a clinically led journal, and I hope by reading journals such as ours that readers can become more alert to the emerging evidence that they can take to their places of work and disseminate that where they work. On an individual local level it’s really important to do that, and of course collect data as well. You know, collect outcome data on patients, young people, children, families that they see as well to see what’s helping and what’s working and feedback from families as well, because that’s something that historically is quite challenging to do. And, of course, getting involved in innovation, getting involved with your local R&D departments, getting involved with research, getting involved in quality improvement, all that’s really, really important in terms of trying to improve our practice.

Interviewer: What about the public? Can they do anything to assist?

Honorary Professor Dr. Bernadka Dubicka: That’s an excellent question, because certainly during my time as Chair I found that, you know, working with service users and young people in particular they’re usually a hugely important voice in terms of advocating for Challis and mental health, including for research, including for interventions. Often people, you know, clinicians often think that research is a huge burden with children and families, but certainly in my experience the people who do participate they’re really keen to participate and they want to do it for altruistic reasons.

They want to improve services. They want to improve the quality of evidence for other young people, and people are really keen to get involved. I think it’s incumbent on all professionals working in services to make sure that within their own organisation that there is a move to make sure that we involve service users and also to advocate for research and innovation within Trusts.

Interviewer: You recently gave evidence at the Education Committee that was in March 2021, with questions to Dr Alex George, the government’s newly appointed youth mental health ambassador. What were the main points you put across to the committee and for Alex George?

Honorary Professor Dr. Bernadka Dubicka: It’s brilliant to have ambassadors for the young people’s mental health. So I really respect, Alex, for doing the work that he’s doing. Also for his reasons for doing it because, you know, he at first hand has suffered a terrible tragedy with his own family and it’s so important that people like him can speak out and also try and affect policy in terms of ensuring that people like his brother get the help that they need early on. So I want to express my thanks to Alex for taking on this work.

I know that Alex is really keen in terms of making sure that young people get the support they need, and we know that’s been a very much neglected group, and particularly what we call this transition group. That we know not only the UK but around the world the so-called transition from child to adult mental health services is usually very, very poor for many young people for many reasons, and the cut-off is many people describe it like a cliff edge, instead of being a smooth transition.

So even if you are in child mental health it’s often very difficult to still be accepted by mental health services because the criteria is usually so different and the way that those services work that are so different. We have to rethink how we do that and how we deliver services. So I’m really pleased that the government policy has shifted towards zero to 25 and we need to really work and think about how we deliver services to one to 25s because we know young people keep developing and brains are developing to age 25.

And young people not only go through that transition services, but they’re going through huge transitions in their lives, and of course during the pandemic time and time again what’s coming through in the data is that it’s young adults, older teens and young adults that seem to be most affected by the pandemic in terms of the disruption in their lives, in terms of education, their training, their jobs and their futures as well. It’s so important that we make services that are accessible to those young people.

And the call for these early help hubs by children and young people’s mental health coalition and Young Minds recently a campaign around that. You know, they’ve been working with Alex George. I think that is so important that we think about making sure these sorts of early help hubs are accessible to young people, to teenagers and young adults, and they shouldn’t have to fall into crisis.

Interviewer: What about the role of local government? What should they be doing to improve young people’s mental health?

Honorary Professor Dr. Bernadka Dubicka: I guess it comes back to the issues we were talking about previously, about the whole systemic approach, and it’s talked about in the arguments between professionals, because the pots of money are very separate here in this country. So people try and protect their own pot of money, but we need to be approaching this from a holistic approach. I know services have changed into integrated care systems here in the UK. In other words, systems are trying to become more integrated and those pots of money become more integrated, so we can think about the young person as a whole and what services they need as a whole and education is obviously really important in terms of that.

So your first question related about the Education Committee, and I think covid again is an opportune time to review how we are educating our young people, and of course, wellbeing needs to be at the heart of education as well. We know from lots of data that if young people are struggling with their mental health they are not going to perform academically. So the focus in schools has to be about well-being as well as academic performance and not just academic performance because, of course, many children and young people may not be particularly academic.

They might thrive in other areas like sports or creative arts, and they should be allowed to thrive in different areas and fulfil their potential in things that they’re good at and things that they enjoy.

Interviewer: Are you optimistic? I mean, you’ve painted quite a bleak picture in part in terms of workforce issues, increasing demand, higher threshold for care. You’ve also talked about there being, well going back 20 years, various reports which appear to offer hope and then sort of come to nothing. I’m just wondering how you feel about the future going forward.

Honorary Professor Dr. Bernadka Dubicka: I guess I’ve been in services for a long time. It’s sort of over three decades now. So, you know, so looking at things with a bird’s eye view. Yes. I mean, certain things. I can’t use the word frustrating because it’s far more than that. It’s devastating for the families involved and also the families that I see on a day to day basis have really struggled to get the right help. However, there are things that have changed a lot over those three decades and the move towards evidence base practice, I mean, that’s been really notable and really important.

So I think things are very, very different on that front, and of course, the whole move towards providing more psychological therapies. There’s been a huge move around that and I think that’s been really important in terms of delivering services. I guess the other thing that I’ve seen a lot more of, which has been really positive compared to a few years back when I started, I think there’s less tribalism and I think more agencies, more professionals are sort of working together for the same cause rather than, you know, maybe sort of being competitive with each other, and I think that’s really, really important. I think one of my predecessors at the Royal College, Professor Dame Sue Bailey, I think has been also really instrumental in terms of ensuring that my profession, child psychiatry works much more closely with charities and other professionals. She’s set up a children and young people’s mental health coalition, which is a whole group of different charities working together to meet mental health needs of children and young people.

So I think I’ve certainly seen far more working together, people speaking the same language a lot more, which is so important rather than working in opposition. I think that’s been a massive move. The other thing that I think has changed, it still needs to change a lot more, but it’s certainly going in the right direction is the youth, the service user’s voices, and I think from what I can see in many other countries that I’ve visited, well some of the countries I visited, we certainly have far more local participation here in the UK than services and ensuring that we work with young people very closely in terms of trying to improve services and in terms of research.

So I think that’s something that has changed a lot. We’ve still got a long way to go, but I think definitely on the right path there, and certainly there’s been a lot more interest in mental health in recent years. Of course, the Royal Foundation, they’ve also have promoted mental health a lot and any exposure, particularly from prominent people like that, is really, really important.

So those conversations have been happening a lot more, which I think is great, and then more recently there’s been a big move towards digital delivery and there’s lots of charities like Youth, for example, have been set up and can deliver services remotely. Of course that’s happening more and more in specialist services as well, but those sorts of services and of course this is where social media is helpful, have become much more accessible to young people.

So those are a few of the changes I’ve seen which have been really important and really positive that we need to keep building on, but unfortunately it’s not just here in the UK, children don’t have enough of a voice. So the organisation like the Youth Parliament, for example. I just cannot understand why our government and governments around the world don’t work much more with those sorts of organisations and give young people a voice. I think we should have young people at the heart of policy making.

Youth Parliament, for example, is calling for the voting age to be lowered to 16 in this country, and it’s only, you know, young people will get more of a voice and more power when they have a right to vote because votes count and votes mean something, and I think those sorts of changes could make a huge difference for young people. So, yes, there has been progress in many areas. Of course, there’s always much more that can be done and covid has been devastating for many reasons, but it also presents lots of opportunities and I guess, you know, digital working and looking at staff burnout is sort of some of the key areas that we can be looking at.

Interviewer: How do we keep child and adolescent mental health issues in the public eye?

Honorary Professor Dr. Bernadka Dubicka: I think using those users’ voices, young people’s voices, parents’ voices. From my time at the college that’s what cuts through the most. I remember just before the pandemic struck I was fortunate to be invited to my parent’s home country Poland to give a talk on Challis mental health services and child psychiatrists very frustrated about the lack of listening for their government around Challis and mental health and they were protesting to the government, but what hadn’t occurred to my colleagues over there was to do that in partnership with young people and families.

If you can work in partnership with families that use services and have had experience of services, but good and bad, that’s what cuts through to politicians and politics and policy making and it’s so important we do that on many levels, but particularly policy level.

Interviewer: Bernadka, what are your plans for future research?

Honorary Professor Dr. Bernadka Dubicka: So my previous research has been focussed on depression interventions and my interest has been around brief interventions. Not that I think that brief interventions are the answer to all problems young people might have who are depressed. However, because, you know, we’ve discussed the workforce crisis, we need to use our workforce most effectively. So it’s really important that we use simple things first, and during my clinical practice and also during my experience with the depression trials that I’ve done, is that simple interventions can be just as effective as more complex interventions.

So the first line treatment, that’s certainly what the impact study showed as well. I completed a feasibility study looking at behaviour activation and I hope in the very near future to start a large study looking at behaviour and activation as a first line treatment for depression, because if we can deliver brief first-line, less complex treatments first at a mass level, then we can reserve more specialist workforce for those young people with more complex mental health problems who might need those more specialised interventions.

Interviewer: Bernadka, is there anything else in the pipeline that you would like to mention?

Honorary Professor Dr. Bernadka Dubicka: I guess, in terms of moving on, so I’m really excited to have taken over as editor and chief. Some of the work I started at the college I want to continue to promote in the journal that we do have a special issue coming out in February around ecological crisis, and that’s to coincide with COP 26, which people may know is taking place in Glasgow this year and I think that’s an area I want to continue to highlight.

We’re constantly developing the journals. So during my time as Deputy Editor, when Dennis Editor we introduced debate section. So that gives an opportunity to bring out very current topics. So, for example, recently we’ve had a debate around the very difficult issue of gender dysphoria, evidence base practice and policy, the impact of the Covid pandemic. So for people listening, please, do take a look at articles that are coming up. We’re also commissioning perspective pieces from people who are experts in their particular fields.

For example, we mentioned earlier around the implementation of evidence that was a piece published fairly recently on that. We’re developing a letter section that we’re going to start. So we want to be more interactive with our readers, and that’ll give an opportunity for readers to respond about some of the articles that they read, and we might hope to develop that further in the future. We also have a section called Narrative Matters, and that’s an opportunity to explore culture around mental health, and my colleague, Gordon Bates is doing a great job in terms of commissioning some very contemporary articles to do with culture and society in mental health as well. So please, so if people are listening please do look out and hopefully we’re going to ever developing, ever evolving journal.

Interviewer: It all sounds excellent. Finally, what is your takeaway message for those listening to our conversation?

Honorary Professor Dr. Bernadka Dubicka: So please do reach on us at mental health. Please also look out for any allied events that we’re hoping to develop because we’ve got an exciting opportunity to develop webinars. That’s another positive development from covid pandemic, which many people could access remotely related to articles and papers that we’ll be publishing. So please do listen. Please, please do listen. Please do read what’s coming up in the journal and also, please do take the message back to your organisations about articles that you read around evidence and please do disseminate that and let’s all try and improve evidence based practice collectively and internationally.

Interviewer: Brilliant. Thank you ever so much. For more details on Dr Bernadka Dubicka, please visit the ACAMH website www.acamh.org and Twitter at ACAMH. ACAMH is spelt ACAMH and don’t forget to follow us on iTunes or your preferred streaming platform. Let us know if you enjoyed the podcast with a rating or review, and do you share with friends and colleagues.

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