Impact News

Responding to Violence, Suicide, Psychosis and Trauma

Young People who Die in Custody

An important report from the Prison Reform Trust:

Click to access Fatally%20Flawed.pdf

Filed under: Impact Training, Other Mental Health, self-harm, Suicide, trauma, Violence, , , , , ,

Self-harm still not understood by GPs

Self-harm is a major concern for young people, friends, family, teachers and mental health professionals and yet still GPs – the first point of contact admit that they struggle to understand it.

Filed under: Other Mental Health, self-harm, Suicide, , , ,

Divergent Drinking Habits in Young People

Alcohol misuse and violence are consistent bed fellows and in Western societies there is a great deal of alarm about the prevalence of binge drinking among young people. This interesting article suggests “Polarized drinking habits are a likely explanation for the recent divergence between per capita alcohol consumption, which has decreased, and alcohol-related hospitalizations, which have increased sharply among Swedish youth in recent years. We suggest that ongoing social changes could be affecting young people in the form of greater disparities, which are associated with a higher incidence of social problems generally, including heavy drinking.”

Read more …

Filed under: Violence, , , , ,

Increase in Violence in Young Offenders Institutions

With the biggest rise being at a private YOI, Ashfield, a suggestion is made that profit is being placed before safety. See the Children & Young People article …

Filed under: Impact Training, Violence, , , , ,

Bullying linked to child suicides

Nearly half of suicides among 10 to 14-year-olds are due to bullying, according to research.

Charity Beatbullying said of 59 cases of child suicide reported in the national media between 2000 and 2008, 26 were definitely connected to bullying.

But research suggested up to 78 out of the 176 official total of suicides in the age range were actually victims of bullying.

Official data also recorded 1,769 suicides of 15 to 19-year-olds between 2000 and 2008, Beatbullying said, which indicated that the total number of bullying-related adolescent suicides could be in the hundreds. The charity found that that every child suicide case related to bullying cited school as the main place of persecution.

Of these, four cases also cited cyber bullying – where bullying takes place online, by email and on social networking sites – as a contributory factor. Beatbullying’s report was published to mark the second anniversary of the death of 13-year-old Sam Leeson, who hanged himself after being bullied physically and over the internet.

Chief executive Emma-Jane Cross said: “The connection between bullying and child suicide is undeniably clear and the lack of clarity and research in this area is unacceptable – we need action and we need it now. Government need to take a long, hard look at the issue to understand why children as young as ten are taking their own lives.

“It’s a distressing subject but one which must be investigated as a matter of urgency if we’re to help our young people and prevent them taking such desperate action – suicide should never feel like the only option for any child or young person.”

Sam Leeson’s mother, Sally Cope said: “Two years ago my 13-year-old son Sam took the tragic decision to take his own life as a result of bullying, so I know from personal experience just how devastating the consequences of bullying can be, and the void Sam’s death has left in my family.

“I urge the government to take action to fund anti bullying work in schools and make the information regarding child suicides available so that organisations such as Beatbullying can work alongside them to prevent further deaths.”

Beatbullying’s research indicated a higher tendency of bully-related suicide among girls aged between 10 and 14, with 65% of such deaths coming girls. Its research was independently verified by Dr Benjamin Richardson at Warwick University.

Filed under: Suicide, , ,

A new scheme trains adults in ‘first aid’ for young people who turn to them in a time of crisis

Emotional rescue

Lucy is explaining why she didn’t go to school today. “I just couldn’t get up. I wasn’t being lazy. I just felt as if every bit of me has been filled with weighted blocks of sadness.” She is at a point of crisis and has singled you out to tell about her mounting depression. What do you do?

This scenario is one of a number of filmed true accounts of young people’s struggles with emotional distress, their sadness, fear, shame and anger – which are a key ingredient in a training scheme being pioneered in Southampton. The idea is to make sure young people get support from the first person they confide in about their troubles.

In most cases, such people will not have specialist medical knowledge. Those who have taken the first Emotional First Aid (EFA) training have included teachers and teaching assistants, youth workers and student support officers.

“The course’s aim is not to create experts in adolescent mental health but to help people recognise that they have an invaluable role in assisting young people in need,” explains family therapist Dave Smith, one of EFA’s designers. “Sometimes their involvement will be enough, getting the young person back on track, but even if more specialist services have to be mobilised, then there’s a part for an EFA-trained adult to play in supporting the young person through the process.”

This is an aspect of the training that Paul Jetten particularly appreciates as an outreach worker with the national charity Fairbridge in Solent, his focus being young people whose lives are often already seriously troubled. “I have already seen the EFA training come good in my work with a teenager with anger-management problems. I was honest and explained that I didn’t have all the answers, but I was happy to work together with her trying to get them. She has really responded.”

Barbara Inkson, children and adolescent mental health manager for Southampton’s city primary care trust, says: “EFA needs to be seen in the context of a broader policy of trying to ‘roll-back’ help for young people so that they get the early interventions they often need to stop their problems developing into severe kinds of illness.”

The trust has championed a multi-agency scheme offering young people a short burst of specialist counselling – often all they need to turn their lives around. For seasoned campaigners such as Dr Andrew McCulloch, head of the Mental Health Foundation, the scheme is an exemplary means of alleviating some of the “referrals congestion” that besets most children and adolescent mental health services nationwide. Young people are saved the agony of long waits for appointments – crucial time lost, during which their mental health often deteriorates.

McCulloch is also impressed by EFA: “It is essential to help young people before they get stuck, and equipping those adults that young people might turn to first for help is a sensible step.”

His use of the word “stuck” is significant. “Among the most important lessons we teach,” says Stuart Gemmel, strategic lead for primary mental health in the town and one of the creators of the approach, “is that young people’s behaviour, however distressing, is often their solution to their problems. We also emphasise the notion of ‘stuckness’ – the fact that self-harm, not eating or drug-taking may offer temporary relief, and there is a danger that they come to dominate a young person’s life.”

For Linda Tanner, the special education needs co-ordinator at St George Catholic voluntary aided college in Southampton, this aspect of the EFA training has already borne fruit. “Thanks to that simple word ‘stuck’, I have been able to move a huge distance with a young boy who is very withdrawn,” she says. “The concept seemed to click with him and he started to open up to me. I don’t think I would have had the confidence to address this with him had I not had the EFA experience.”

Gemmel says there is a responsibility for institutions, too, to offer staff the kind of support workers in health services receive in the form of proper “supervision” – the chance to discuss their case load. “Without the proper structures in place, there’s a real danger people can be left exposed when it comes to the kinds of powerful two-way transference that can go on in any human interaction, but particularly so in a counselling situation.”

The EFA training devotes one of its six two-and-a-half hour sessions to addressing the importance of the adults looking after themselves.

“Among our next moves,” says Gemmel, “is to provide the EFA training to new audiences such as carers or those working with certain minorities.”

NHS Innovations South East is working to develop EFA into a national brand. Karen Underwood, a spokeswoman for the organisation, says a recent posting advertising the next round of EFA training brought 300 applicants in just a few hours: “We don’t see that level of enthusiasm for something new in the NHS every day.”

Filed under: Other Mental Health, , , , ,

Adolescents At Risk Of Developing Psychosis Benefit From Early And Network-Oriented Care

Date: 15 May 2009 – 3:00

Family and network oriented, stress-reducing care improves level of overall functioning and mental health in adolescents at risk of developing psychosis, suggests a recent Finnish study. Jorvi Early psychosis Recognition and Intervention (JERI) project at Helsinki University Central Hospital (HUCH), Jorvi Hospital, Finland, is a project with an early intervention team for adolescents at risk of developing first-episode psychosis. As developing psychosis has been suggested to be a result of a combination of acute life stressors and trait-like vulnerability to psychosis, the intervention is based on the idea of multiprofessional, need-adapted, community-, family- and network-oriented, stress-reducing, overall functioning supporting and low-threshold care. The JERI team meets with adolescents at ages 12-20 in their natural surroundings, e.g. at school or at home, together with their parents and community co-worker, who has originally contacted the JERI team because of unclear mental health problems. The aim of the team is to recognize potential risk cases and reduce the stress level by family and network intervention. A follow-up study was performed to test how presented intervention will help adolescents at risk. Data was collected between January 2007 and May 2008. During the intervention, mean scores rose statistically significantly on overall functioning and scores on quality of life, depression, anxiety and pre-psychotic symptoms decreased statistically significantly, showing an improvement in overall functioning and mental health in adolescents at risk of developing first-episode psychosis. Adolescents did not receive other therapy or any antipsychotic medication. “JERI- intervention seems to improve level of overall functioning and support mental health in adolescents at risk of developing first-episode psychosis, even though further study with larger number of subjects, with a proper control group and with a longer follow-up time is needed”, says Dr. Niklas Granö, the leader of the research.

Results are published in the journal Early Intervention in Psychiatry. Reference: Niklas Granö, Marjaana Karjalainen, Jukka Anto, Arja Itkonen,Virve Edlund and Mikko Roine: An intervention to improve level of overall functioning and mental condition of adolescents at high risk of developing first-episode psychosis in Finland. Early Intervention in Psychiatry (2009; 3: 94-98) Source: Niklas Grano, Ph.D. University of Helsinki

Filed under: Other Mental Health, psychosis, , , , ,

7 Year-Old Boy Is Youngest Case Of Suicide Attempt

A new medical report calls for caution following the recent case of a boy who tried to hang himself after watching a hanging depicted in a fictional film. This seems to be the first case of attempted copycat suicide in a child under 10 years old. Exposure to suicidal behaviour in the media has been strongly linked to copycat suicide attempts but never in someone so young. This case warns of the potential danger to young people who are exposed to suicide even when it is fictional, and exposes the previously ignored role of attention deficit and impulsive behavioural traits on suicide.

The case report, published in Cases Journal, describes how a seven year-old Iranian boy was found by his mother, semi-conscious, lying down with a torn band around his neck. It was apparent that the boy had hanged himself after watching a scene in a fictional film in which four soldiers were hanged before being rescued and escaping. The boy was taken to hospital and treated effectively.

There was no history of depression or anxiety in the boy and his medical record was insignificant. The boy’s family history also displayed no suicidal tendencies. However, the boy was diagnosed with attention deficit disorder (“ADHD”) and had a tendency for impulsive behaviour. Although the roles of anxiety and depression in suicide have been well documented, there has been no research into the role of ADHD and impulsivity in such cases, and these should be considered by doctors in future.

Cases Journal publishes case reports from medical professionals from all over the world. As an online journal, it does not have the space constraints of traditional medical journals, and allows the publication of a very broad range of cases. Typically, an important case such as this might never have achieved public exposure due to the high barriers to publication in major journals.

More information about Cases Journal can be found on the website: Cases Journal is a peer-reviewed, open access journal. The editor-in-chief is Richard Smith, previously known for his role as editor of the British Medical Journal, and he is supported by an international editorial board. Unlike traditional medical journals, Cases Journal publishes any case report that is understandable, ethical and complete – the perceived interest level, or rarity of the case is not important. The journal’s ethos is that every case is important, just as every patient is important, and we can learn something from every case report.

All case reports published in the journal will be included in the forthcoming Cases Database, which will allow doctors to search all case reports to find those relevant to their practice. As an open access journal, all case reports are free for anyone to download without subscription.

Cases Journal

Filed under: Suicide, , , ,

Training Curbs Anger And Aggression In Adolescents With Tourette Syndrome

Article Date: 24 Apr 2009
In the first study to gauge the benefits of anger control training in adolescents with Tourette syndrome (TS), researchers at the Yale Child Study Center have found that cognitive behavioral therapy is helpful for short-term improvement in anger and aggression. The study is reported in the April issue of the Journal of the American Academy of Child and Adolescent Psychiatry. Children and adolescents with TS, a disorder characterized by tics-involuntary, rapid, sudden movements and vocalizations occurring repeatedly in the same way-should also be evaluated for the presence of disruptive behavior problems, according to lead author Denis Sukhodolsky, associate research scientist in the Yale Child Study Center. “In some cases, these disruptive behavior problems can cause more impairment than tics,” he said. “If disruptive behavior is present, cognitive behavioral interventions such as anger control training could be recommended to reduce the levels of aggression.” Sukhodolsky and his team studied 26 children and adolescents with TS (24 boys and two girls between the ages and 11 and 15) with moderate to severe levels of oppositional and defiant behavior. They were randomly assigned to a group that received 10 sessions of anger management or to a control group that received their usual treatment for 10 weeks. When faced with frustrating situations during anger control training, the children role-played appropriate behavior. They were asked to identify and evaluate the consequences of various actions for themselves and others who were involved in hypothetical conflicts. The children were also asked to recall frustrating situations and to problem-solve and role play behavior that would have diffused the problem. They also completed homework to practice “anger coping” skills and share their experiences at the next session. At the end of treatment, parents reported that disruptive behavior decreased by 52 percent in the anger management group, compared with a decrease of 11 percent in the control group. Clinicians who were unaware of the treatment rated 69 percent of the children who completed anger management training as improved compared with 15 percent in the control group. Sukhodolsky said this improvement was well maintained at a three-month follow-up. He and colleagues plan to conduct larger clinical trials to confirm their results. The study is part of a clinical research program directed by Professor Lawrence Scahill to develop and test interventions for children and adolescents. Other authors on the study were Lawrence Vitulano, Deidre H. Carroll, Joseph McGuire, and James Leckman, M.D. Citation: J. Am, Acad. Child Adolesc. Psychiatry, 48: 4 (April, 2009) Links: Denis Sukhodolsky Lawrence Scahill Source YALE

Filed under: Other Mental Health, Violence, , , , ,

Step-fathers who Kill

Lurking in the shadows

Posted: 09 April 2009 | Community Care Magazine

Maria Colwell. Jasmine Beckford. Heidi Koseda. Kimberley Carlile. Leanne White. Lauren Creed. Baby P. These names don’t resonate only with social workers; as some of the UK’s most notorious child deaths they conjure up grim details that are etched on the nation’s collective memory.

And they have something else in common: they all died at their stepfather’s hands. In many cases their mothers received prison sentences for offences ranging from neglect to assault or manslaughter.

Sadly, these are just a few names on the deathly roll call that stretches back to 1973 of young children killed by their stepfather or their mother’s boyfriend.

No matter how good our protective or preventive measures, there will always be parents who will harm or even kill their children. Whether the killer is their biological father or their stepfather may not seem that relevant when it comes to informing preventive policies, but research suggests otherwise.

In 1988, US data showed that children aged up to two are at about 100 times greater risk of being killed by their stepfather than their biological father. Psychologists call this the Cinderella effect. The research went on to look at British data, concluding that it indicated “considerable excess risk at the hands of stepfathers”.

With the rates of remarriage, divorce and cohabitation steadily increasing, giving rise to more stepfamilies, this is a disturbing thought. According to the Office of National Statistics, in 2006 84% of stepfamilies consisted of a stepfather and biological mother living with children from her previous relationship.

Research suggests that whereas genetic fathers often kill their children “more in sorrow than in anger”, out of perceived necessity and/or as part of a suicide, homicides committed by stepfathers tend to be more rage driven, impulsive acts motivated by hostility towards the child and characterised by violently beating or shaking them.

Despite this evidence, some researchers believe that minimal attention has been given to stepfathers – or mothers’ boyfriends – as the perpetrators of these crimes and the reasons behind them.

David Finkelhor, director of the Crimes Against Children Research Center in the US, says: “Sociobiologists point out that these are men who have no genetic stake in this child and see them as competition for attention and time, and their own offspring. Among other primates it’s not unknown for a new alpha male to kill the children of the dominant male when he comes into a group.”

But Finkelhor believes the reasons are simpler than that. “That has some reality to it, but I think it operates through more familiar psychological mechanisms; that these aren’t men who feel a natural affinity or protectiveness about the children of the women they are involved with. These are not men who are nurturing.”

Anger management

This squares with the fact that a child’s inconsolable crying is one of the main triggers for these homicides. “Frequently the dynamics of these cases are common,” says Finkelhor. “The woman leaves the child with the boyfriend or stepfather and when the child starts crying, he doesn’t have the nurturing skills to handle this in a calm way and then hits, throws, or smothers them because he wants them to shut up.

“They are not all of one sort, but a high proportion [in these cases] are violent, abuse their partners, and tend to have an anger management problem.”

Gathering any deeper psychological profile of these men is hampered by the fact that we know so little about them, and what we do know is usually learned after a child has been killed – which isn’t helped by serious case reviews that mostly focus on the pathology of the mother.

This reflects the continuing failure of agencies to engage properly with men, says David Derbyshire, Action for Children’s head of performance improvement and consultancy, and author of several serious case reviews.

“We probably don’t know a lot because too many times we come across cases where there is no involvement with men. Then there is an incident where the child is injured or dies, the serious case review takes place and we see the intervention is often only all with the woman and the man is not known about, or if he is, there’s no contact.

“If you don’t engage with the man but he is there everyday then the work we are doing is going to have a limited impact.”

Before we can even reach a position where men are properly involved, social workers need to recognise their importance to the whole familial picture and approach them with an open mind, which appears to happen too infrequently.

Research for a book he was writing on gender and child protection led says Jonathan Scourfield, senior lecturer at Cardiff University’s school of social sciences, to interview social workers about how they worked, or didn’t work, with men. He found primarily pejorative views.

“Men were seen as a threat, as no use, as irrelevant and absent – and there was a whole host of reasons given for not engaging with them.”

The dominant theme was of men as a threat, not surprisingly given the kinds of problems that caused referrals to be made to the team. But what worried Scourfield was the number of men that social workers didn’t pick up on. “Often there’s a boyfriend, the mother doesn’t mention it, but he’s hovering in the background, half noticed.”

Even if he is seen or known about, it’s all too common for no real attempt to be made to engage him. “The social work culture is an important part of that, but there’s a huge issue with the actual behaviour of these men. We are talking about men who are very difficult to work with and that needs to be acknowledged,” Scourfield adds.

This leads to questions of how a social worker can confidently decide whether to engage with the individual, or whether they are so dangerous they should be removed from the child’s life. It’s a dilemma that troubles Brid Featherstone, professor of social work and social policy at Bradford University: “We haven’t equipped social workers to work with these men. We haven’t got skills in assessing men generally, so we don’t even get as far as deciding that this man shouldn’t be in the family home.

“There is a problematic absence of an evidence base in the UK about working with men – either those who are a resource for children or a risk. Half the time we don’t know who is in a family. We don’t even record birthfathers if they are not there so how are we going to find others floating around? We tend to rely on the mother but it can be hard to establish living arrangements, as we can see in the Baby P case.”

The need for evidence

Jack Kennedy understands these difficulties. As a consultant in clinical and forensic psychology he compiles psychological reports for courts and parole boards and has worked on some of the most well-known child death cases. “Social workers have a very difficult job because they need evidence to act,” he says. “But it’s very difficult to anticipate or intervene unless there are overt indicators of risk or harm. Society almost expects [social workers] to be a ministry of pre-crime and intervene before these events happen, but to go in and remove a child on a suspicion won’t hold up in court.”

Other than obvious danger signs such as known domestic violence or injuries on a child, Kennedy suggests that where social services are involved with a family they need to be aware of mothers developing new relationships and people visiting the home. “Not least because it can be destabilising for the child having different people coming into the home. And also because they can assist a mother in actively risk managing all the time. But there is a thin line between policing and social care.”

However, any information social workers pull together often comes from the mother and therefore relies on her being honest. This is unlikely to happen if she is witness to her partner abusing her child but feels powerless to do anything about it.

While most of us would find this thought process hard to fathom, the issues behind this “collusion” can be complicated. The personality of these women can form part of the equation. Research into these deaths shows that many women lived in fear of their partners and that violence and abuse against a partner and child often coexisted.

These women can be depressed, overwhelmed or so distracted by their own difficulties that they don’t feel capable of doing anything. Women who are desperate to keep a partner will placate them, or those who are so intimidated by a partner won’t stand up to them.

“These are usually highly vulnerable women who have a confused understanding of relationships,” says Kennedy. “Their backgrounds are characterised by abuse and they are highly dependent on being in a relationship even if it’s dysfunctional because that provides them with the security they are looking for. Many women prize the man they have highly because they believe themselves to be loved in some way. Love and affection become more important to them than the needs of the child.

“They are not resilient enough to say ‘that is wrong, this is over,’ because they think they will not get anyone else. This is not about excusing their behaviour, it’s about helping us understand more about what sort of situation an individual may be in.”

Featherstone goes further, saying there are women who are terrified, and other more complex women who don’t acknowledge their ambivalence to their child. “We are hamstrung by the assumption that all mothers love their children or, if they don’t, they can be helped to. But we have to acknowledge maternal ambivalence. Hate can become the more dominant feeling. I have worked with a small number of women who were sadistic themselves. While you are not going to get lots of these women, sometimes you have to think the unthinkable.”

In 2007-8 there were 45 homicides of children aged up to four, according to the Home Office. But these figures don’t include death by neglect or cases which, although were not classified as murder, were not accidents either. Some analysts in the US believe that, there, the actual figure for child homicides may be double the official one because they can resemble deaths resulting from accidents or other causes; for example, a child who has been thrown or intentionally dropped will have similar injuries to those of one who died after an accidental fall.

The so-called Cinderella effect has no fairytale solution. Evidence of the prevalence of deaths caused by stepfathers is there, though the connection is not always made. But we owe it to the memories of all those children from Maria Colwell to Baby P to make sure we know who is present in a child’s life and whether they are a resource or a risk, so we can prevent as many children as possible from ending up on the same list.


* Crimes Against Children Research Center

* Men who Murder Children Inside and Outside the Family, K Cavanagh, R Dobash.

Filed under: Violence, , , , , ,