Supporting Children and Young People’s Mental Health – An insight for Parents, Caregivers and Teachers

In this ‘In Conversation’ podcast, Dr. Mei Simmons discusses some of the factors that affect children and young people’s mental health and wellbeing and provides an overview of her recently published book ‘A Guide to the Mental Health of Children and Young People: Q and A for Parents, Caregivers and Teachers’.

Discussion points include:

• The best, and some of the challenging, aspects of working in a CAMHS outreach service.
• The signs parents should look for and when they need to step in and seek support.
• Best ways of setting boundaries around use of technology.
• The impact of relationships on mental health and wellbeing.
• Advice to parents, teachers, and carers around spotting when a child is feeling lonely or isolated.
• What parents and teachers can do to help children build personal resilience.
• Recommendations to young people going through the system and struggling with their mental health.
• What needs to change at a policy level to improve service provision.

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Dr. Meinou Simmons is an experienced Consultant Child and Adolescent psychiatrist working in the NHS in Oxford, UK, is interviewed about her recently published book ‘A Guide to the Mental Health of Children and Young People: Q and A for Parents, Caregivers and Teachers’ available at https://www.amazon.co.uk/dp/1911623915. The aim of the book is to give supportive adults confidence in understanding the basics of children and young people’s mental health, including important factors which influence it, as well as giving an overview of common mental health difficulties and disorders with several case examples. It is designed to be dipped into rather than read cover to cover and provides signposts to a number of helpful resources including websites and books.

Dr Simmons studied to be a doctor at the University of Cambridge and then trained in postgraduate psychiatry in the East of England. After completing her training, Dr Simmons took up her first post as a Consultant Psychiatrist Oxford in 2015 and has worked in both the Oxford City CAMHS Team and then moved to be clinical lead in the Oxfordshire CAMHS Outreach Team in August 2021, where she currently works. Dr Simmons has a longstanding interest in medical education and is actively involved in training of medical students and junior doctors. She is Training Programme Director for Child and Adolescent Psychiatry trainees in the Thames Valley region. More recently, Dr Simmons has broadened her interest to include public education of mental health issues.

Transcript

[00:00:10.019] Mark Tebbs: Hello and welcome to the In Conversation series for the Association for Child and Adolescent Mental Health, or ACAMH for short. I’m Mark Tebbs. I’m a Mental Health Commissioner, Leadership Coach, and Freelance Consultant.

If you are a fan of our podcast series, please subscribe on the preferred streaming platform, let us know how we did, with a rating or review, and do share with friends and colleagues.

Today, I’m really pleased to be interviewing Dr Mei Simmons, Consultant Child and Adolescent Psychiatrist and Training Programme Director for Child and Adolescent Psychiatry at Thames Valley and who’s recently published a book entitled “A Guide to the Mental Health of Children and Young People: Questions and Answers for Parents, Caregivers and Teachers.”

Mei, thank you so much for joining me. Could we start with an introduction, maybe introduce yourself, what your current roles are and a little bit about your career history?

[00:00:55.350] Dr. Meinou Simmons: I’m a Consultant Child and Adolescent Psychiatrist, currently working in Oxfordshire CAMHS Outreach Service. So, I studied to be a Doctor in Cambridge and then I did my Psychiatry training, then I had a bit of time abroad, and then took up my first post as a Consultant in Oxford City CAMHS, and then around 18 months ago, I moved into the County Outreach Service. So, I now work as Clinical Lead, so that works with the, kind of, most severe end of the spectrum. Children and young people who are often really, really stuck with their mental health problems, for example, struggling to get out of the house, access education, often have really severe problems. So, that’s quite a lot of multiagency work with education, social care, as well as some community visits and clinical time, so it’s quite a mixed role.

And then, in terms of my educational role, so I’ve always had a really strong interest in medical education, and I did a master’s while I was training, and I’ve been quite heavily involved in education throughout, teaching and training of Junior Doctors and medical students. In the last couple of years, I took up the post of the Training Programme Director, so that’s the senior trainees who are just coming towards applying to become a Consultant, like myself, I’m supporting them through their rotation. Partly due to my interest in education, I’ve also become interest in public education and hence, that’s a bit of a background to me writing the book.

[00:02:25.769] Mark Tebbs: Can you recall what originally brought you into the field?

[00:02:29.550] Dr. Meinou Simmons: I got really interested in psychiatry, mental health when I was a medical student, and while most of my contemporaries were much keener on spending all their times in theatres and becoming Surgeons, actually doing psychiatry is a really unpopular choice. But I really got fascinated with following the stories, people with mental health problems, and just seeing what a huge impact mental health problems have on every aspect of their life, so relationships, work, just being able to function. And then, in terms of children and young people’s mental health, as a Junior Doctor, when I’d already decided to do psychiatry, I did a placement on a adolescent unit.

Even though a lot of these young people are often really unwell and in hospital for a while, I just really loved the energy and the creativity of young people. And the main thing was also the ability to effect change in young people. So, as opposed to working in adult services when often people are much more stuck and there’s less ability to do that, sometimes if you are able to work with a team around you to effect change in a child or young persons like that, can be really life changing and really help to get them back on track to functioning again. So that’s what really led me into – to this particular field.

[00:03:46.540] Mark Tebbs: Yeah, it must be really challenging at times, kind of, especially working at that severe end. I’m just curious what are the best aspects of work and maybe some of what’s most challenging?

[00:03:59.069] Dr. Meinou Simmons: So the best aspects is when you see a change in a child’s life, it can really, really be massive for the whole family. It can get the whole family back on track in terms of their lives, ‘cause often when children and young people have got mental health problems, the whole family’s life is put on hold. And I also really like the joint working. So, in my field, what’s really nice is you very rarely do something alone. You’re often working quite closely with colleagues who are really specialist in their areas like Occupational Therapists and Psychologists and I don’t in any way think that, because I’m medically trained, I’m above them, and we work very closely together. And often now, in my current role, not only am I working with the experts within my team and other CAMHS teams, but also across agencies.

But then, in terms of what is really challenging, I guess seeing a child or young person really suffering is very challenging emotionally to deal with. What I’ve seen quite a lot of, they’re so distressed that they’re self-harming quite severely, they’re suicidal, that’s very hard, and also seeing their lives completely being put on hold when they’re struggling. Luckily, in our team, we have got quite a lot of shared spaces for supervision, support and really discussing the impact of cases. I think that’s really important having that ability to reflect with colleagues, but also, having your own ways that you’ve developed over the years to decompress.

So me, myself, I’m quite an active person, I just love being outdoors, being able to run when I can, also, kind of, reading and connecting with others. Sometimes, it just takes a while to learn how to switch off when things are emotionally challenging and it’s not always very easy, so it’s, kind of, work in progress, I guess.

[00:05:43.569] Mark Tebbs: I think that brings us really nicely onto to the book, a question-and-answer book for parents, caregivers and Teachers on mental health in children and young people, would be of real interest to our listeners. It’s a really amazing, comprehensive, kind of, evidence-based resource. Could you give us a little bit of a overview of the book?

[00:06:02.690] Dr. Meinou Simmons: I wanted to write a book that was as user friendly as possible ‘cause I know it’s quite a daunting subject. So I wanted to give people a overview of children and young people’s mental health and I wanted it to be something that you could just dip into and reference, as needed, so you don’t necessarily need to, kind of, read it cover-to-cover.

First part looks at this huge range of possible factors that can impact on children and young people’s mental health, and I’ve just picked out some of the main ones and explained those in more detail. Then the second part of the book looks at strengthening relationships and giving support. So it’s a fairly short section, but it looks at things like how to connect and communicate with children and young people, ‘cause obviously the skills that you need to do that will change as children grow and develop, and also ensuring they have networks of support around them.

I talk a bit about some positive parenting strategies, managing school and how to build resilience, which is the ability to bounce back. And then the final part of the book just looks at a whole range of common mental health difficulties and disorders. So I’m looking at the whole spectrum from just struggling a bit to having a disorder and how we would pick up if someone has got a disorder like difficulties with eating, mood, and anxiety, for example, how a mental health professional would then diagnose that as a disorder and what you, as a parent or caregiver, can do about it, so some strategies and tips. And then, at the end of each of those sections, I’ve got a case study. And then, I’ve got a few short sections in the back of – about mental health first aid and also who’s who is mental health teams. So, that’s roughly how it’s structured.

[00:07:42.789] Mark Tebbs: You’ve described the layout of the book and part one’s focussed on the factors that affect children and young people’s mental health and wellbeing. Could you just give us a quick run through of what some of those factors are?

[00:07:54.060] Dr. Meinou Simmons: First of all, looking at the biological factors. So, I go through these in more detail in the book, but we know, for example, the attachment relationship is hugely important and we know that secure attachment to a caregiver and parent has a really lasting and protective impact on children’s development, so I describe that in some detail.

Then I talk a bit about genetics, ‘cause we know that although most mental health problems have got a mixed genetic and environmental component, genetics is very important for lots of mental health problems, especially with neurodevelopmental disorders like autism, they’re very highly genetic. But what’s also interesting is we know that the environment can impact on genetic changes too. I discuss the developing brain and really discuss how the brain develops from babyhood to our early 20s. It goes through these massive leaps of development and understanding which parts of the brain are developing more rapidly, at different rates, can really help us understand behaviour.

And then I touch upon puberty as well, so we know that this huge transformation from children’s to adult bodies, which is kickstarted by these huge hormonal cascades, that has an inevitable knock-on impact on mental health. So, I discuss how those physical and hormonal changes can interact.

Then the next section talks about lifestyle factors, which is quite interesting and has been generating lots of research, in recent years, because obviously this is something that people can do quite a lot about. Things like sleep, we know how hugely important sleep is, not only to physical health, but mental health too, and it’s a real active process and understanding the different sleep cycles and stages through the night can really help you understand that. And I talk about tips for really helping to maximise sleep, important things from recent research like getting lots of natural daylight exposure, as early as possible in the day, and also increasing dark signals at night, but it’s also getting that consistent routine. So, all of these tips have got quite a lot of biological underpinnings.

Then diet, so we know that there’s been an explosion in research in nutritional psychiatry in recent years. I talk a little bit about what advice is in order to get as balanced a diet as possible, what key nutrients are as well for children and young people’s development. And then exercise, we know that that’s got a huge impact on mental health, it’s not just the endorphins, there’s lots of other chemicals in your brain, and I give lots of ideas about how to matchmake around exercise too.

A really big influence is technology, and that’s probably been the biggest single change in the last generation is how ubiquitous, kind of, technology is and how it’s got into everyone’s pockets and bedrooms and everything. And really understanding a little bit about that, I’ve started to unpick the pros and the cons and how to really keep on top about the quality of the technology that children and young people are consuming, as well as the quantity, but also safety. So, I talk quite a bit about safety online and give lots of signposts to really helpful resources for parents because often, it can feel as though the children know more than the parents ‘cause they’re the digital natives, but it’s about, well, how can you maintain that sense of control before it starts to control you?

And then alcohol and drugs, so there’s also quite a lot of research about the impact of these substances on the developing brain, especially for people with particular vulnerabilities. And we know that adolescence is a time of lots of experimentation, so I talk about being aware of the impact and how to look after others and really trying to keep safe.

And then moving onto the impact of relationships, so we know that relationships are just a core part of us as how we’ve evolved to be social animals, but really understanding and unpicking the different types of relationships is really, really important. So, starting with family relationships, which are often our longest-lasting, and then peer and social relationships. We know as parents they often take centre stage as our children start to develop independence. Similarly, romantic relationships and sex also are really often a key part of a lot of young people’s development.

Then the next section, I won’t go into too much detail now, but it’s all about stress factors, and we know that stress is one of the most significant factors impacting on both mental and physical health, but we also know that not all stress is bad.

The final part of the chapter is really looking at the increased mental health risk of particular vulnerable groups. We know that certain people in vulnerable groups are much more likely to experience mental health problems. So, for example, those with intellectual or learning disabilities have a much higher risk of certain mental health problems, but they also really struggle with their communication. Also we know that children with other physical – long‑term physical health conditions, for all sorts of reasons, like they’re managing the symptoms of their condition, the isolation, the time off school, that can have a big impact on their mental health, and that is increasingly being studied as well.

Young carers, so being a young carer where children have to grow up really quickly can take a huge emotional toll due to the stress. And also we know that those in the LGBTQ+ community, we know there’s lots of studies to show they’re at increased risk too.

[00:13:28.030] Mark Tebbs: And you’ve given a really good overview of the different risk factors for different groups and also different stages of development. I was really interested in how you picked out puberty as a particular time of enormous biological change, and it can be quite a difficult time for parents and carers to understand the threshold for seeking support. So, I was just wondering, from your experience, are there signs that parents should look for about when they need to step in?

[00:13:54.670] Dr. Meinou Simmons: I guess the main things that you really need to start worrying about is when you see a significant change in functioning in the young person. So when you really spot that they’re really struggling in a certain area, for example, they really seem to be struggling with managing school or becoming much more isolative at home, much more than you would expect, or what you see around you from their peers, stopping activities or losing the ability to enjoy things that they used to, or starting to worry a lot more. So, it’s any of these really significant change in functioning, I think, that you need to look out for, but also just keeping in close touch with schools, ‘cause schools are usually really good barometers.

[00:14:35.670] Mark Tebbs: You mentioned technology, and I think our listeners would be really interested in your thoughts around best ways of setting boundaries around the use of technology.

[00:14:45.690] Dr. Meinou Simmons: I guess what to recognise is it’s not all bad and there’s recent research which indicates that there’s quite a lot of benefits there as well as, kind of, disadvantages. It’s really important to understand the quality of what they’re accessing rather than just focusing on quantity. And so, nowadays, most mental health professionals advocate balanced use, and not cutting off completely, but being able to access those benefits, for example, being able to access resources that we never were able to access when we were younger, all this encyclopaedic knowledge, networks can be really helpful, staying connected to friends and family, creative outlets.

But an important principle for parents is really to set clear boundaries early and then keep renegotiating them and really emphasising the importance of balancing that time outdoors and prioritising sleep, schoolwork is completed first and then time is then negotiated afterwards. And that varying control, because we know that a lot of tech companies now have really built in these really addictive-type mechanisms to keep people hooked, and often children and young people really struggle with disconnecting from those, and especially those with really vulnerable brains can really struggle with that. And monitoring the content and ensuring that they’re safe online. And we know how vulnerable children and young people are, so it’s really keeping quite a close eye, but I think it is an ongoing conversation that parents need to have.

It’s difficult, obviously, when children and young people are used to having their phones on them all the time. But we know that sleep is one of the biggest victims of modern technology, and we know how hugely important sleep is to developing brains. It’s such an active process as well, and it’s the brain’s own housekeeping, and if you start cutting off sleep cycles and things like that, then that’s going to have a huge impact on their ability to manage school, but also their emotions and processing. So, I think that’s something that families really need to continue to negotiate and bear in mind.

[00:16:50.610] Mark Tebbs: And in section two of the book, you start to discuss more about the impact of relationships on mental health and wellbeing, particularly, kind of, family relationships and peers and also, some of those romantic relationships. Could you describe a little bit more about the impact of relationships on mental health and wellbeing?

[00:17:11.220] Dr. Meinou Simmons: We know that relationships are crucial for most of us. We are all social beings and for most of us they do take centre stage in our lives and can have a huge impact on our mental health, but which relationships take centre stage varies as children develop. So, we know that a newborn baby is completely dependent on its parents and caregivers, and gradually, the salience of different relationships changes as children develop and have the ability to make their own friendships, sibling relationships, peer relationships, and then going on to negotiating romantic relationships. And even the most skilled probably do need a lot of support and modelling from their parents from the early stages about how to manage these.

And what’s really important is that secure attachment relationship between the child and their parents is probably the single biggest protective factor for their longer-term mental health, and investing in that and reinforcing that relationship will really help children and young people negotiate and learn how to manage other relationships. And we know that family relationships can be a significant risk factor for mental health problems.

We know that some children and young people really struggle with negotiating peer relationships, particularly those who are neurodiverse, people with autism, and they might need a lot more support in learning how to manage these than others, and so using roleplay and modelling. And schools can also help play a role in supporting children who are struggling with those relationships, because we know that isolation and loneliness in children who don’t feel connected really can be quite damaging too.

And then in terms of developing romantic relationships, that’s also a really core part of most of our emotional development as we grow older. But I think a lot of young people, they might need quite a lot of support in learning to negotiate those, what’s a safe relationship, what are helpful boundaries, particularly if one of the partners is struggling themselves with mental illness. But, as I say, the key thing is if you can get that early attachment relationship as good as you can and keep renegotiating it as your child’s developing, that’s is the blueprint for all future relationship and is really protective.

[00:19:26.289] Mark Tebbs: You mentioned loneliness as a, kind of, key predictor of poor mental and physical health, could you – is there any advice that you can give to parents or Teachers around, sort of, spotting when a child’s feeling particularly lonely or isolated?

[00:19:41.690] Dr. Meinou Simmons: A child who’s really lonely will often start to, kind of, retreat more into themselves and shut themselves off, communicate less, stop engaging with their family. We often hear about them just shutting their door of their bedroom and just staying there for long periods, taking part in less social activities.

One thing to really bear in mind, in our increasingly online world, is that people might feel that they are digitally connected to online networks. But really understanding what the quality and nature of those relationship, I think, is really important for families because it might be that they just talk to these big groups, international groups online, but there isn’t a reciprocal nature. So, getting them to really understand what a friendship is and the support and caring nature around that is helpful.

It’s much easier to spot loneliness if you build up really good communication with your child from a young age and really show them that you’re there, you’re walking alongside them, that you accept them, and you’re there to listen to them. And some children find it much harder to communicate in the standard way than others, but really being creative about giving them outlets to communicate if they’re struggling. And also just staying in touch with school because they can help really identify if there are concerns about a child being more isolated.

A good, kind of, mapping exercise that families can do, which I also outline, is the importance of building networks of support around their – the child. So having the child in the centre and then concentric circles around, identifying who is closest to the child, which will vary at different points of their development, but who’s in their extended networks as well, and how can you draw on those different people in terms of support, especially when things are more challenging, ‘cause children, especially teenagers, may not naturally always want to open up to their parents. But it might be some of those extended family or friends who are trusting relationships that you can really build on to help to support people in those situations.

[00:21:39.480] Mark Tebbs: You mentioned the importance of networks. I’m wondering what other things parents or carers or Teachers can do to help children and young people to, kind of, build that personal resilience.

[00:21:50.070] Dr. Meinou Simmons: So, the ability to bounce back really depends on a number of factors, some of them are more controllable than others. So, some of them will be genetic and personality factors. But I use this seesaw visual model in my book to help people to really understand that to build up on resilience and strength, you need to increase the side where you have coping strategies at the same time that you’re reducing risk factors, so then you swing the seesaw up towards coping. And a way to do that is really building on these protective factors, things like having a really close, confiding, always available adult, and then thinking about ways to reduce the impact of risk like trauma, so having really – building trauma-sensitive environments, having training around that.

In terms of, kind of, budling up those resilience or ability to cope, one way of doing that, we’re trying to, kind of, use increasingly in mental health services, is trying to build on this strength-based approach. So, previously, there was much more a problem-centred approach and then you would really go into problems each time, and sometimes that could be quite depressing for children. It would be, like, going over their problems again and again 22:59. So it’s really important instead to really focus on the positive, the strengths, what is going well and how can you build on these.

That might need a bit of creativity to really try and think more laterally about what are the child’s inner strengths and it’s not – nowadays, a lot of children and young people are so focused on this external locus of control of outward appearance or, you know, they’re getting lots of feedback about their academic performance. But we know that huge amounts of strengths come from internally, your own internal qualities like kindness and looking after other people and really building on those and giving people this sense of being able to change things for others, and making sure that school staff and families are really aware of what the child’s, kind of, individual profile is, so that you can really build up on those and reduce their risk factors.

[00:23:50.280] Mark Tebbs: Excellent, really interesting. In the last section, you, kind of, move onto describing mental health difficulties and disorders, again, could you just give us a brief overview?

[00:24:00.250] Dr. Meinou Simmons: As we know, all mental health difficulties and disorders are on a spectrum from being at the severe end of having a diagnosis, to having some traits and difficulties. So, kind of, understanding the full range of difficulties is helpful.

The, kind of, main, kind of, area topics that I cover are mood and emotion regulation difficulties, spotting when to worry more, is a child becoming depressed, difficulties with worries and anxiety, which is really, really common and universal and a big problem for a lot of young people, but understanding when does it become an anxiety disorder is helpful, I think.

And then difficulties with self-harm and suicidal thoughts which, unfortunately, is hugely common now and we see a lot of in mental health services, and that ties in with emotional regulation difficulties too.

And then what we know increasingly has a massive impact on mental health is trauma. So I spend a little bit of time thinking about trauma, and not just the traditional post-traumatic stress disorder, but all the different impacts that trauma can have on increasing the risk of mental health problems. Then difficulties like anger and behaviour.

And then attachment difficulties, so that ties in with the first section of the book where I talk about the importance of these attachment relationships. We know that children who do have attachment relationship difficulties, so often the children in care, you know, are at much greater risk, and I talk about some of those in terms of attachment disorders, etc.

Then a huge topic is all the neurodevelopmental difficulties and disorders. And I actually split into two chapters, the autism and ADHD in the next chapter. And we know that because these neurodevelopmental difficulties are being picked up much, much more in this generation than in previous generation, they actually seem to underpin a huge number of the – a huge proportion of the children and young people coming to CAMHS in all of the areas of CAMHS because we are just getting much better at picking these up. So, I talk about the signs of them and also what we can do to help support people ‘cause we know that huge numbers of people are unfortunately waiting a long, long time for diagnoses. But it’s really advocating well, what are their individual needs and profiles and rather than necessarily having to get a quick diagnosis there.

Then I talk about difficulties with alcohol and drugs, and that also ties in with the first section when I talk about that as having an impact on mental health.

Then eating difficulties and disorders. We know that the rates of eating disorders have exploded hugely in the last few years.

And then difficulties with body image and body dysmorphic disorder. I touch upon that as well as then perfectionism and OCD. We know a lot of children and young people struggle with obsessions and compulsions.

And then the final area is difficulties with losing touch with reality. I talk about hearing voices actually being quite common, but actually being out of touch with reality and having psychosis is much rarer. Even though it’s pretty rare, it’s really helpful if people are able to spot it and get in there early.

[00:27:11.820] Mark Tebbs: Yeah, I’m wondering whether you have any, kind of, words or recommendations to young people themselves who may be going through the system and having a particularly hard time.

[00:27:23.169] Dr. Meinou Simmons: One thing that I often hear is that how isolating it is to have a mental health problem, and it can often feel really lonely and feel as though you’re the only one when you don’t know other people around you. So, it’s really learning to reach out for support around you and, kind of, really thinking about friends and family who you can open up to and really asking for help. The stigma is much reduced now. Asking for help from your GP, School Nurse, School Counsellor and then being signposted onto specialist help if you need it, but being really aware of which online networks are helpful to plug into and which are less helpful, and that you might need support around that. Getting your feelings down on paper or through any other creative means is a really good way of helping to process some of those difficult emotions. And then learning about which activities can have an impact on your mood and emotions, and I often tell children and young people it’s really helpful to have a list on their bedroom wall of things that they know potentially can improve their mood that they can go to, but it needs to be really specific. So it can’t just stay “music,” you have to say a particular song ‘cause you know when you’re in a dark place just having, kind of, “music” on there isn’t – is less helpful.

Also remembering that lifestyle factors can be really impactful, you know, nutrition, paying attention to sleep, exercise and trying to keep things going even when it feels tough. So you know you’ll feel better if you get out the house, even though it feels really hard to do that. And it’s often easy to make unhealthy choices when you’re feeling really rough, but really pushing yourself so you get this sense of achievement. Those are the main things that I would say to children and young people, just reaching out for support if they can and just being aware of self-care as well.

[00:29:11.529] Mark Tebbs: Yeah, that message of hope is really, really important, and I think that advice is super helpful. I’m just wondering, your experience of, kind of, working in the sharp end of service delivery, whether there’s anything that you think needs to change at that, kind of, policy level to address the needs that we’re seeing coming through the system?

[00:29:32.690] Dr. Meinou Simmons: Unfortunately, as most people working in this field will tell you, we have really struggled with a long, long period of underinvestment of services. Services across the UK are really patchy and what people can access is often a bit of a postcode lottery. Even the different parts of services, there’s hugely different waits, depending on staffing and availability. So we need a real comprehensive overhaul because we know that this is our next generation’s future and we know that when a child or young person stops being able to function ‘cause of their mental health, it has all sorts of long-term impacts and they miss out on a huge amount. And we know how common this is as well, that around one in six children and young people have a probable mental disorder, and this has risen since the pandemic, and that even rises to around one in four in late teens, but, unfortunately, only around one in three are able to access services that they need to. So, we really need a comprehensive, kind of, cross-party initiative to really focus on this area.

I think small initiatives are not enough. We need a really big rethink about how to invest in a sustainable way, getting more services out to schools, out to communities, as well as preventative services, I think is really, really important. I think there’s been a lot of work done on the parity of esteem with mental and physical health, but we’ve still got a long way to go. There’s still a lot of shame, especially in certain communities, but I think we still need to keep addressing that. And, unfortunately, we know that waitlists for some services are unacceptably long, you know, some of the third sector has really stepped in and done a lot of helpful work as well, and there’s lots of useful, kind of, resources out there. But it – but we do need to really think about this comprehensive overhaul of services, I think.

[00:31:23.600] Mark Tebbs: Great. So, finally, what’s your take-home message for our listeners?

[00:31:28.269] Dr. Meinou Simmons: I just want to stress how hugely important mental health is. It’s everyone’s business and we can all play a part in supporting our children and young people, and you don’t need to be an expert to offer support. And really investing in those relationships is really key and really protective for anyone who’s got a supportive relationship with children and young people. And also another take-home message is just really look out for any significant change in functioning in a child and young person and then get support early if you can. Speak to a School Nurse or GP at an early point ‘cause you may be able to prevent things getting a lot worse.

[00:32:06.990] Mark Tebbs: Thank you so much, Mei, it’s been a real pleasure to speak with you today. For more details on Dr. Mei Simmons, please visit the ACAMH website at www.acamh.org and at Twitter @acamh. ACAMH is spelt A-C-A-M-H and don’t forget to follow us on your preferred streaming platform. Let us know if you’ve enjoyed the podcast, with a rating or review, and do share with friends and colleagues.