Young People presenting in Mental Health Crisis need practitioners who can sensitively disentangle the biopsychosocial aspects of their presenting puzzle, to make sense of the whole picture.

It's like detective work, done in collaboration with patient & family/carers.

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When admitted to the acute hospital, I ask paediatric colleagues (as the 1st officers on the scene) to make observations & begin the fact finding exercise.

They are the Assistant Detectives... (c/f Lewis & Morse)

Paediatric staff are not expected to complete the puzzle (and make a full formulation), but they can begin the process of sorting the the jigsaw on the table with the young person, so the pieces are visible and ready for CAMHS +/- social care.

Paediatric doctors and nurses hugely underestimate the value they can have in making a young person feel safe, listened too, and ready to talk.

Why do young people present to hospitals in crisis, having harmed themselves? this is often (unconsciously) a means of seeking refuge, from intolerable feelings or experiences elsewhere.

I encourage colleagues to be gently inquisitive, interested, unafraid of making 'mistakes'.

The use of silence needs practice.

Socratic Questioning is a helpful concept, helping the family dive deeper into their own understanding of how they have ended up 'here'.

"How can I help?" is a very simple, open question, which demonstrates, if nothing else, a willingness to try.

"What needs to change?" is a powerful question, I first saw this used in my training under @sebkraemer
It instills hope as well as challenges the "stuck" position that individuals and systems can find themselves in.

Some questions are easier to ask than others:
"What has helped before when you have felt like this?"
"What could we have done differently last time?"

Staff need support to learn how to ask more 'difficult' questions eg screening for abuse, domestic violence, asking about thoughts of suicide. This is a training need.

Hearing the young person's voice is paramount. This can be literal (is the environment too noisy for this conversation) or metaphorically (is there a dominant narrative which is excluding the child)

Validating Distress is an essential task "things must have got really bad for you to feel like that"

We need to think about communication differently. Speech language difficulties can be found in 50% of CAMHS patients.
"Could you possibly write down, or draw what has happened, or what you are feeling?"

The culture of the ward is important. We need to make spaces where young people do not feel alienated/dismissed in the way they are managed. It is possible to be welcoming & kind without "encouraging re-attendance" (a defense used to avoid becoming involved)

There's so much more to say here but I need to get it down into a PowerPoint for a presentation to paediatricians on Friday....

What have I missed?
@sebkraemer @DrJonGoldin @DrEstherSabel @DoverPsych @jmw3cat @MikeG_CAP @RcpsychCAP