On and Off the Ward

“The other patients talking to me would have made me feel more welcome.”

Source: a young person via YoungMind's Where Next 2. Read more

Having a strong connection with life outside the ward brings hope and fosters recovery, whilst wider social networks can create a sense of belonging. The ward can provide a safe space in which peer support is promoted.

"We bring everyone together, sometimes to identify and solve particular problems, sometimes just to check in with each other, sometimes just to have fun. Over time, a collective sense of being part of a larger whole develops in the children."

Jon Kabat-Zinn

In his best selling book ‘How To Behave So Your Children Will Too’, school psychologist Dr Sal Severe (2004) describes a ‘pleasant family climate’. We’ve given his description a bit of a ward community remix below:

• A pleasant community climate motivates young people.


• A pleasant community climate allows members to speak politely to each other, and rules, expectations and boundaries are positive.


• Everyone feels a sense of togetherness and co-operation.


• Structure is balanced with flexibility.


• Everyone is encouraged to pursue their own interests.


• The community has fun together.


• When the climate is warm and accepting, young people learn new values and goals.


• Young people are willing to accept guidance, rules, expectations and boundaries; because they can see the community is acting out of care and concern. If a problem occurs, they will bounce back more quickly.

The key role of climate

In 'Creative Teaching and Learning Toolkit' by Brin Best and Will Thomas (2007), it's suggested that learning will be maximised if due consideration is given to the following three domains: Physiology, Psychology and Appropriate teaching and learning strategies. We've listed the factors included in the Psychology domain below. They're all are concerned with learners’ feelings but they can be adapted while thinking about the ward climate, and therefore, young inpatients.

Best and Thomas suggest that learners need to be in an "appropriate emotional state to learn, which can be characterized as being 'intellectually challenged and motivated, without being negatively stressed." This will help them to enter what's called the ’alpha state’ of relaxed alertness, which is most conducive to effective learning.' The following factors should be considered:

• Stress: high levels of stress can prevent learning.


• Challenge: high challenge or expectations are important, but if challenge is too high it can cause negative stress.


• Motivation: highly motivated learners are those who are engaged with their learning and see its personal benefits.


• Self-image and esteem: learners who have a positive self-image are more likely to have high self-esteem, which will help them to engage in effective learning.


• Inspiration: learners can be inspired by teachers, stimulus materials and teaching and learning methods.


• Support: learners who feel supported as they learn (by the teachers, teaching assistants and other learners) are more likely to take risks and achieve their potential.


• Justice: learning is most effective in an environment which is seen as fair and just.


• Respect: it's important for learners to feel respected as they learn, which helps them to feel valued.


• Contentment: learners who are feeling happy and fulfilled are more likely be successful learners; they're likely to feel happier if they achieve success.


• Alertness/attention span: learners need to be fully alert to learn, and lack of sleep or too much day-dreaming can interfere with the learning process, meaning they can concentrate for shorter periods of time.

Hearing about the successes of peers is both motivating and educational - it’s an opportunity to absorb others’ skills, knowledge and attitude. Hearing about the struggles of others stimulates appreciation, and has the power to break destructive impulses.

Supporting social, emotional, behavioural and moral development

• Make sure you are approachable and give children and young people your time.


• Give fair but firm boundaries and explain the reasons for these.


• Ensure children and young people feel valued and are given praise and encouragement.


• Give children the chance to develop their independence.


• Be aware of each child's overall development and sensitive to their needs.


• Encourage them to think about the needs of others.


• Act as a good role model.

(Source: Burnham & Baker, 2011)

Happy communities share skills, time and resources in creative ways. They offer a warm and attractive space for people to share, learn and look out for each other.

Repairing Conversations

Below are ideas for making conversations more effective, even when they begin with difficulty. We refer to staff-young person interactions, but these tips can apply to everyone.

1. Stop the lecture. When noticing they’ve been lecturing the young person, the member of staff might pause, acknowledge it, change their tone, and invite the young person’s perspective on the event.
   
2. If it’s possible, take a break. When noticing that they, or the young person, are experiencing a strong emotion that is making the conversation difficult, the member of staff might acknowledge the emotion and say that they both need to take a timeout, and talk again when they are able to hear the other’s perspective.
   
3. Say ‘I’, not ‘you’. When conversations regarding conflicts are difficult, the staff member might practice giving ‘l-messages’, focusing on behaviours and their own reasons for being concerned. By using ‘I-messages’, the staff member can begin the communication, by saying clearly what they’re thinking or feeling and the reason for it.
   
4. Practice curiosity. Recall the need to be curious without judgment. Be curious about the thoughts, feelings and behaviour of the young person, without judgment.
   
5. Rediscover the positive. When the staff member notices that most of their recent conversations with the young person involved conflicts and problems, they might focus on the young person’s interests and strengths, and initiate discussions related to those or other positive themes.
   

Source: adapted from Hughes, 2009
Highly recommended: Principles of Attachment-Focused Parenting: Effective Strategies to Care for Children

Repairing Things After Misinterpretation of Staff Body Language

If you pick up that this is happening, try to turn the misinterpretation into a fresh opportunity to talk. Here are some ideas for giving you and the young person a second chance:

• Ask the young person if you can try again and use a calm tone of voice.


• Ask the young person if you’ve come across as angry and reassure them that you’re not.


• ‘Did I upset you?’ is always a nonthreatening, non-blaming question.


• ‘Can we take a break and talk when you’re ready to?’


• ‘I’m really happy to talk to you. Sorry if I gave you the wrong impression.’


• ‘I may seem distracted, but I’m really not. I’m very interested in your opinions.’


• ‘Please forgive me if I seemed ……….. Talking with you is really important to me.’


• ‘You know that I sometimes come across as……….. when I’m actually………. Let’s keep talking.’


• ‘I didn’t mean to be judgmental if that’s what you thought. I’m just trying to listen to you without interrupting.’

 

Adapted from Dr Greenberg and Dr Powell-Lunder, 2010

Stephen Covey in his book The Seven Habits of Highly Effective People (1989) champions interdependence. He connects three key elements to making this work:

1. Thinking win/win - ensure that both parties in an interaction benefit.
   
2. Seeking first to understand, then to be understood — find out the circumstances before acting.
   
3. Synergy - utilize the strengths of others to create a whole which is more than the sum of its parts.
   

Great wards establish and sustain a noticeable culture of positive interdependence, mutual support, and individual responsibility, which can feel empowering and confidence-boosting to young people.

Here’s how Enhancing the Healing Environment put it:

“The environments in which we live and work have a profound influence on our physical and psychological wellbeing. In health care settings the environment can support recovery and wellbeing and has a real effect on patients’ perception of the care they receive. This goes beyond the necessity for cleanliness, infection control and the preservation of an individual’s privacy and dignity, to creating spaces that are fit for purpose and comfortable. Research has repeatedly confirmed that a supportive and welcoming environment can have positive effects on both those who visit hospitals - whether as patients or visitors - and those who work in them”.

 

Read more here

Other influences could include the psychological effect of having views of fields and trees, rather than roads and buildings.
The Spanish researchers found that each degree of increase in surrounding greenness led to a 5% improvement in the development of short-term, or working, memory over a period of one year. It also improved the progress of ‘superior working memory’ - the ability to update memories with changing information - by 6%, and reduced inattentiveness.

Source: theguardian.com - read more

Being active and having quality family time are two things that help children and young people thrive. Getting out and about together on an exciting camping adventure or for a walk to the local park is positive mentally and physically. As well as health benefits, spending less time online could reduce the hidden dangers children are exposed to online.

Javed Khan, Barnardo’s Chief Executive

The ward environment has a profound influence on young people's physical and psychological wellbeing. It can support recovery and wellbeing and has a real effect on patients’ perception of the care they receive.

Not only does the ward have an internal sense of community, it also nurtures strong relationships with families, other caregivers and supporters, as well as with the wider community.

• Encourage the young person to use an internet chatroom that requires registration the first time you visit. These are also more likely to have ‘moderators’ - people who keep an eye on what’s going on and have the ability to exclude people who are breaking the rules.


• Explain that even after they’ve registered, they should never give out their email address or phone number to somebody they don’t know. Encourage the young person to use a nickname and be careful not to give out their friends’ details. One expert put it like this: ‘Would you put a billboard around your neck with your name, age, mobile phone number and address on it and walk down the street?’


• Some sites allow children to build up a list of ‘selected friends’. These are other users that they trust and are allowed to chat with. Talk with them about what they might want to be sure of, before they invite somebody to join their ‘selected friends’.


• Warn the young person to be aware of somebody who wants to get too close too soon - for example, someone asking for personal details (such as an address or phone number), someone who wants them to send a photograph or use the webcam, or someone who sends photographs of themselves which might make them feel uncomfortable.


• Sending photos is fine - to people they actually know. But remind them that they should never send their photograph to somebody who is just an ‘Internet friend’. In many ways these people are still strangers and may have been deceptive about themselves. Also remind them that when they send a photo via their mobile phone, they are sometimes sending their mobile phone number as well.


• Tell them to always let you know if somebody has made them feel uneasy - perhaps by using inappropriate language or suggestions. Incidents can be reported to your service provider or to the Child Exploitation and Online Protection Centre (CEOP) at ceop.gov.uk


• Remind the young person that they should only meet face to face with somebody they have ‘met’ online if they have an adult they trust present - and then only in a public place.


• Warn them about chatting online with somebody who is obsessed with secrecy. They may insist you don’t tell anyone about their chats with you or ask you to keep details of a proposed meeting secret.


• Remember that even though most teenagers would prefer to have a computer in their bedroom with internet access, this may not be wise. Having a computer in the living room or somewhere else where people are coming and going makes it a little harder to get into trouble.


• Consider installing filtering software that prevents your teenager entering sites that you don't want them to.

Adapted from Parsons, 2007 See 'Teenagers!: What Every Parent Has to Know'

From The Guardian (abridged):

Fears about sexting, cyberbullying and access to inappropriate violent or pornographic images are being linked with other evidence pointing to communication disorders, spatial awareness issues, sleep disorders, stress and anxiety, eyesight damage and posture issues.

The blue light from screens has been linked to depression as well as insomnia. Rates of mental health issues experienced by schoolchildren are rocketing, with fingers being pointed at the pressures of social media or hours spent while online gaming.

Baroness Beeban Kidron, a film producer who was horrified by what she found while documenting young people’s online lives has started a campaign to support young people to access technology responsibly, calling for a charter of “iRights “ for children to be able to delete their online profiles.

Dr Kaska Porayska-Pomsta of the Institute of Education at University College London says that young people had an innate skill to deal with technology thanks to some kind of speeded up human evolution.

“We need to be looking at technology in a very different way. At how to use it as a means to support education,” she says. “These questions about how technology is impacting on young people are really only starting, they’re gathering momentum but there is a lot of work to be done yet."

"With their online lives following them wherever they go there are no longer the ‘safe spaces’ that I enjoyed, away from the pressures of school-life, friendships and preparing for adult life.

But young people have stressed to us that the online world shouldn’t just be seen as a threat. It’s increasingly where young people look for support too."

Sam Gyimah, Minister for Childcare and Education 2015

(source)

Research on parent’s perceptions of their child’s internet use

• More than half (51%) of parents admit they are ‘extremely’ or ‘quite’ worried about what their children are getting up to online.


• Parents are almost as concerned about the impact internet use is having on their children’s mental health (31%) as on their children’s social skills (36%).


• Almost a quarter (23%) also fear it’ll impact their physical health as kids prioritise internet surfing over the real thing.


• Around one in seven (15%) worry their offspring’s digital footprints could one day affect their career prospects with future employers.


• More than one in 10 (13%) parents of teenagers aged 13-17 believe their child has ‘overshared’ on social media, while 15% say their kids have used inappropriate language on the likes of Twitter and Facebook.


• More than one in 10 (13%) of parents of teenagers say their child’s internet use has damaged their social skills.

Source: techcitynews.com

When used appropriately, the internet has an extraordinary role to play in providing information and support to young people experiencing mental health problems.

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