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Ah! Just seen there are a couple of questions I haven't been able to answer. I will pop back on Tuesday. Sorry to have to go now.

Thanks for the questions all! I'll pop back on on Tuesday for half an hour at 10Am (GMT) in case there are any more.

Wishing you all well over this festive bit and into the new year.

I’d love your thoughts on CPTSD. I suffer from this and for some reason it’s still very taboo to speak about it generally.

What are some helpful tips to help overcome this issue? If there are any.

Hi Dr Maddox! I found out very recently I have been dissociating for large spells of my life as a defence mechanism from when I used to get in trouble at school. Have you read or heard anything about future improvements to the assessment of mental health for children/young adults?

I feel I’ve missed out on lots of my life and that my memories aren’t my own because I was left to create negative coping mechanisms. It would be great to hear of any plans to prevent this happening as much for people because it can have major impacts on their adult relationships & career.

Wowser this is a big'un!

Main changes I would like to see in the mental health field relate to adequate funding. There has been so much talk of "parity of esteem" between mental and physical healthcare but I would like to see "parity of funding" and also proper investment in social care and third sector services. I'd also love our knowledge of staff wellbeing and the impact on compassionate care to advance so that we can more effectively help both patients and staff.

That's an amazing image of it rolling down the hill. The pressures being passed on feels very true. I think there's also the bit about how people who have been traumatised respond to a system around them and how the trauma influences the system too. It's so complex. Important to recognise anyone could be involved in this as a dilemma though, as you say.

There was an article in The Psychologist magazine this week (the British Psychological Society mag) which summarised a book called Hospitals in Trouble by John Martin. I haven't read the book but the authors said certain quite practical aspects of ward location and culture influenced whether care became poor. The factors included ward location, personal and professional isolation of staff and lack of training opportunities. Obviously this is no excuse for abusive practice but I did think it was interesting to think about what factors could act as roadblocks to make abuse less likely.

Thank for your perspective on intervention efficiency - that's a very helpful thing for me to think about.

That's great to hear! I personally feel that the lack of compassion starts at Whitehall and rolls down the hill, ending with a HCA on a 12hr shift, getting yelled at, who then passes the hurt onto the patient.

I'll always remember how one of the Winterbourne view HCAs who was convicted, was voted "most caring" at school, had lots of St John's ambulance experience, wanted to go into nursing. She probably didn't start out abusive, but got there in stages.

What might those stages be? ( Maybe lack of service direction / exhaustion /boredom / suggestiblity?)

It would seem more efficient to start as close to thr top of the pyramid as you can reach (less NHSE /ICB senior leaders to reach, than front line staff).

Whoops! Thought this had disappeared so answered it twice!

Wow that's a tricky one! It's a lovely question actually because it makes me realise that there are so many very special moments. It's always great to feel like therapy has made a difference to someone's life, but even the moments when things are not going so well can feel important, especially if the person is able to tell you that they feel bored or like things aren't helping. It feels like there is a genuine connection and then you can try to do something differently. Many special moments happened when I worked on an adolescent ward in London where I also felt very connected to the team and to my supervisor, as well as to the young people I was working with.

Worst moments... I once got sent home from work because my clinical registration had lapsed without me knowing due to an admin error. It was awful! I had to be escorted from the building and I felt like a criminal! It's obviously very important to make sure that professionals are properly registered so it was absolutely the right thing to do, but it was horrible!

Ooh fab question.

I would say that things vary for individuals - there's no one thing, but things that tend to help daily are (obvious but still helpful): trying to move your body, eating well and sleeping enough (if possible!), trying to treat yourself with kindness like you would a good friend, trying to spot things you enjoy and things you feel proud of throughout the day.

Things that are usually unhelpful: too much of any one thing - e.g. too much isolation or too much busyness, not enough rest (even if it's tiny micro rests in the day), beating yourself up about things, ruminating on things that have already happened or worrying too much about things that are out of your control.

It's obviously easier said than done to make changes to these things, but they are worth considering in my opinion! There are more ideas in my most recent book which is only 99p on kindle for a few days: https://www.amazon.co.uk/Year-Change-Your-Mind-Therapy-ebook/dp/B0B4BTF8RH/ref=tmm_kin_swatch_0?_encoding=UTF8&qid=&sr=

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I couldn't agree more! I've got increasingly interested in organisational and systemic elements of compassion fatigue and compassionate care in general. I did a masters in organisational psychology recently and I'm hoping to be able to pull together knowledge about individual level interventions for staff with more organisational level interventional components which tackle work conditions. It's a bit of a tall ask but that's the plan!

I think that is a real risk which is important to try to guard against. My worry with waiting until there has been a complete overhaul though, as you say, is we may be waiting a while, and if there are some interventions which we know have value, both for staff individually, and at a more team focussed or wider system focussed level, then should we wait or is it good to offer what we can whilst still shouting about the problems in the wider system?

Yes! Couldn't agree more. I got very interested in the organisational aspects of compassion fatigue. I ended up doing a masters in organisational psychology and thinking about how some of these ideas about workplace conditions might influence staff ability to provide compassionate care. I'm in the very early stages now of a 5 year project but the aim is to develop a multi-level intervention, not something which is just for staff, but which also involves managers and possibly commissioners.

Thank you for the response! I will check these out

The picture here is very interesting and researcher Amy Orben has done some fab work in this area: https://www.amyorben.com

It depends on how we use social media. If we use it to compare ourselves negatively to others and to isolate ourselves then it's unhelpful. If we seek out accounts which are affirming and social links which help us feel connected then it can be helpful.

We need to be careful though, I think, as some dilemmas which occur online e.g. sharing personal photos with wide groups of people, can have devastating effects on young people

I use mindfulness, both myself in my personal life and professionally with other people. It's not for everyone but I find it very useful.

Such an important thing to think about. We spend a lot of time with ourselves and if we're having a go the whole time it can have a negative effect. One question I find useful is to ask yourself what you would say to a good friend. We're often much meaner to ourselves than to someone else we love.

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This book by Mary Welford is a good one too: https://www.amazon.co.uk/Compassionate-Mind-Approach-Building-Self-Confidence/dp/1780330324/ref=asc_df_1780330324/?tag=googshopuk-21&linkCode=df0&hvadid=310805565966&hvpos=&hvnetw=g&hvrand=18171044736043241899&hvpone=&hvptwo=&hvqmt=&hvdev=c&hvdvcmdl=&hvlocint=&hvlocphy=9045631&hvtargid=pla-537293131368&psc=1&th=1&psc=1

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And in the new book I just have out one of the chapters is all about speaking to ourselves more kindly (April's chapter). This is on sale at only 99p for a few days if you want the e-book. https://www.amazon.co.uk/Year-Change-Your-Mind-Therapy-ebook/dp/B0B4BTF8RH/ref=tmm_kin_swatch_0?_encoding=UTF8&qid=1671200145&sr=1-1

Similar situation going on in children's residential homes. We're often working with teens who have just left hospital or secure units but chronic underfunding and lack of appropriately trained/ competent staff combined with ludicrous red tape and unrealistic expectations means all to often they end up going back.

Therapeutically parenting traumatised children and teens is challenging and compassion fatigue is a very real issue that definitely needs greater awareness and intervention. It is, however, something that needs to take place alongside a complete overhaul of health and social care services. My fear is that what sounds like it has great potential would be used to allow complacency with the current standards which are seeing vulnerable people failed on an alarming scale.

ETA wrote this without seeing Dr Lucy had responded. It's great to hear you've acknowledged wider issues and the need for systematic change!

This sounds tricky... And christmas is a time when we often find ourselves stuck in repeating patterns in relationships with people we have known for a long time. One thing that can sometimes help is thinking about what you can do differently to shift the dynamic slightly. Can you make a conscious effort to talk more about your own stuff and not wait to be asked? The results might be surprising!

This is a very interesting new area of research. I don't know enough about it but good people to read/listen to include Suzi Gage who has a fab podcast on all things drugs: https://play.acast.com/s/saywhytodrugs and Val Curren who does really interesting research in this area: https://www.ucl.ac.uk/pals/people/valerie-curran

For more AMAs on this topic, subscribe to r/IAmA_Academic, and check out our other topic-specific AMA subreddits here.

Hopefully at some point but it isn't yet

I think of most psychological diagnoses as on a spectrum with more common experiences, and I suppose I feel fascinated by the relationships with the people who I see rather than thinking about an illness in particular. Having said that I’ve worked a lot in wards with teenagers, and worked with some young people who are experiencing psychosis, and I think that’s one areas which is open to misunderstanding, with people seeing it as something dangerous or totally “other”, when again it is actually a spectrum of experience that we all lie on somewhere. All of us can experience paranoia and lots of people have beliefs that others don’t necessarily share. The difference is when it affects someone’s life negatively.