Fear Can Put Us in Chains

Fear can put us in chains:

This photo was taken in Asia in January 2020. #Tourists paying to #touch this #tiger supports this industry that has taken away #rights of #animals including tigers. The tiger’s eyes say quite a lot.

Fear is one of the emotions that can save our lives and keep us safe, it is therefore important to listen to what the emotion is saying, but it can also lead to losing lives and increasing risk and harm.

We need to listen to fear, question it, be curious, look at the evidence, weigh evidence-based risks and benefits, finalise a risk management plan or strategy, and act accordingly to reduce risk and prevent harm. This often means running towards a building on fire or meeting with the child in prison classed as ‘very dangerous’, when a team advised that the child not be seen, to positively affect morbidity or mortality.

Risk assessment and management should be completed by individuals, eg clinicians or doctors or Police Officers or social workers, with extensive training and experience in systemic risk assessment and management.

Assessment and management in Medicine are associated with risk – risk is divided in immediate, short term or longterm, and low, high and very high.

We have worked in high risk fields from a bio-psycho-social point of view for at least 25 years and we know from experience that when one tries to avoid risk, one usually causes more harm and increased risk. This is very relevant in when working with hard to reach children, child protection work or working with personality difficulties.

In most medical or mental health domains it is impossible to avoid risk – but clinicians or doctors with extensive and appropriate training and experience in risk assessment and management (which includes assessment of protective factors) can balance risks and benefits, and provide a systemic risk management plan where risk is reduced effectively from a biological, psychological and social view.

Decisions should never be based in fear, if a good outcome is the goal.

Decisions should be based on information, good clinical, medical or scientific evidence and strategy; systemic risk assessments and a risk management plan.

Decisions should be made with a calm mind. Liaison with colleagues or seniors, collaborative working and good communication are evidence-based strategies of risk assessment and management, leading to good clinical outcomes.

Quotations:

May your choices reflect your hopes, not your fears. Nelson Mandela

I have learned over the years that when one’s mind is made up, this diminishes fear; knowing what must be done does away with fear. #RosaParks

We owe our children, the most vulnerable citizens in any society, a life free from violence and fear. Nelson Mandela

I learned that courage was not the absence of fear, but the triumph over it. The brave man is not he who does not feel afraid, but he who conquers that fear. #NelsonMandela

Courage is not the absence of fear, it’s #inspiring others to move beyond it. Nelson Mandela

We can easily forgive a child who is afraid of the dark; the real tragedy of life is when men are afraid of the light. Plato

Fear is mastered through love. Hate is rooted in fear, and the only cure for fear-hate is love. #MartinLutherKingJr

Fear is the path to the dark side. Fear leads to anger, anger leads to hate, hate leads to suffering. Yoda, Star Wars

The enemy is fear. We think it is hate; but, it is fear. #Gandhi

In time we hate that which we often fear. #WilliamShakespeare

Nothing in life is to be feared, it is only to be understood. Now is the time to understand more so that we may fear less. #MarieCurie

Fear defeats more people than any other one thing in the world. #RalphWaldoEmerson

No power so effectually robs the mind of all its powers of acting and reasoning as fear. #EdmundBurke

#Ignorance is the parent of fear. #HermanMelville

A man that flies from his fear may find that he has only taken a short cut to meet it. #JRRTolkien

He who has overcome his fears will truly be free. Aristotle

#fear #chains #safe #prison #child #children #harm #risk #medicine #mentalhealth #training #experience #balance #decisions #calm #mind #communication #yoda #starwars #hope #courage #free #love #quotations

An Achievable, Sustainable, New Normal

An Achievable, Sustainable, New Normal:

In efforts to prepare volunteers and prepare for service development projects we have remained up to date with infectious diseases, including tropical diseases, and relevant management or preventative options ,including vaccines, in various countries.

It is important that we focus on longstanding well-established evidence-based strategies to reduce risk of infection or disease (morbidity and mortality). This might be the first step in #creating #positive and #lasting #change.

1. Give all individuals #tools to practice good hygiene – this relates to alcohol gel on tables, wash rooms with running water and soap, and allow #homeless people access to tools too (more than 50% returning #veterans who risked their lives for the nation’s freedom, needing and wanting access to water and soap, in some states and nations. Please know that more or less 40,056 veterans are homeless on any given night). http://nchv.org/index.php/news/media/background_and_statistics/

Please see the ABCDEFG rules that we employ during our travels, previous post.

Food and drinking water, as well as appropriate shelter, might be relevant here too.

Water quality, which affects children, adults and communities, is relevant here too. Please see previous comments relating to Bangkok, Thailand and the river. Sewerage drains leaking eg into beaches or rivers need to be addressed as a matter of urgency. Numerous infectious diseases including coronavirus can be found in urine/faeces.

Let’s start with the basics, with simple measures, let’s get it right, before we make it more complicated. What affects one of us, affects all of us – this is relevant in most contexts, but especially in infectious diseases and general health.

2. Be at home and stay at home, if you feel sick, have symptoms or have been in recent contact with a confirmed case – and contact health services for advice. Too many individuals attend work or flights or travel when they are not well. We often offer emergency services during flights and most often the person felt unwell whilst still at home. Employers should support employees in this system approach.

3. Cover your nose and mouth if you cough or sneeze whether you wear a mask or not, and no spitting. These behaviours reduce risk.

4. Do not share food, drinks, cigarettes or #hookah / #shisha or anything relevant in this same context if you are not confident the person is healthy – think mouths, noses, eyes and hands.

5. Ventilation – open windows and doors to facilitate ventilation or improve ventilation in any way appropriate – this is especially relevant for schools and GP practices, and any area where large groups of individuals gather.

6. Positive Space – create and maintain space outside, in shade, with seating where individuals can rest and relax. Theme parks such as #Disney or #SeaWorld are wonderful places for #children to #enjoy, #develop and #learn, however, when there are limited seating, groups gather in small areas to rest in the same shade or keep an eye on the same seats hoping they would be available.

7. Limit numbers to avoid #chaos and #crowding. It is the #culture to encourage and be proud of long lines and crowds – it provides messages of popularity, demand and ‘not to be missed’, however, these same factors lead to increased risk in terms of health and safety. We usually aim to avoid these contexts.

8. Education regarding evidence-based protective factors for the immune system, general health, mental health and social risk. More or less 3/10 individuals could provide us with more than 3 evidence-based protective factors for health or mental health or social risk. Evidence-based protective factors significantly improve prognosis, morbidity and mortality, in terms of mental health, general health and social risk. Please see previous comments on evidence-based protective factors, children’s development, normative activities and the immune system. 

Education regarding evidence-based risk reducing initiatives should also be prioritised eg relating to respiratory diseases and also mosquito born diseases. We often ask individuals about the country they have travelled to or are travelling to and less than 3/10 of adults were aware of local health risks or relevant vaccines. These topics reduce risk and harm.

9. A commitment to follow only good clinical evidence during clinical or medical emergencies, urgent medical matters and routine medical matters – to weigh evidence-based risk and protective factors, and to first do no harm, ensuring that child protection statistics improve, not worsen.

10. A commitment to transparency and collaborative work within nations and amongst nations during clinical or medical emergencies – a global health plan for global health emergencies.

We would strongly advised that face masks not be #normalised in any way. Face masks have a specific clinical indication where they are likely to be useful for certain individuals. We have liaised with the relevant Health Commissions and Health Ministries regarding these concerns. We can provide more details if requested.

Please see previous statements on #normal #normalcy and #normative activities.

We are confident, based on more than 15 years of training and more than 20 years of clinical experience, that these 10 items would improve morbidity and mortality statistics for every child and every adult markedly.

#NewNormal #education #children #space #medical #doctors #psychiatrists #travel #health #mentalhealth #socialrisk #flight #symptoms #achievable #sustainable

Evidence-Based Recommendations to Remain Healthy During Travel and Outreach Work

Our evidence-based recommendations to staff, schools, health or mental health services include:

A – Alcohol gel (wash or disinfect hands before eating or touching your face).  

At least 7/10 individuals confirm that they neglect this behaviour, due to “everything to remember, it is too much” and “I wear the face mask, I follow the rules and stay home”.

It is also important to wash or disinfect your hands before handling your mask, WHO guidelines, to prevent increased risk.

Most individuals report that they do not engage in the above behaviour when handling a mask.

B – Be at home and stay at home, if you feel sick, have symptoms or have been in recent contact with a confirmed case – and contact health services immediately for advice.  

At least 7/10 individuals confirm that they do not follow rule B – many report that the mask will protect others and that they “carry on as usual”. Many report “face masks are enough”.

C – Cover your nose and mouth if you cough or sneeze whether you wear a mask or not (and no spitting). 

We observe 9/10 individuals with face masks coughing and sneezing without covering their mouths or noses. Many report “face masks are enough”. Some countries now give fines for spitting.

D – Do not share food, drinks, cigarettes or #hookah / #shisha or anything relevant in this same context – think mouths, noses, eyes and hands.

We observe these behaviours on a daily basis in more than one country.

E -#Environment – the 3 important factors:  Avoid #restaurants, #shops, #musicperformances, #artperformances, #sportsevents or any other context or situation, if possible, where good ventilation and social distancing are not facilitated and maintained, and where recent contact with a confirmed case, temperature and symptom screens are not in daily use, before entry is allowed. Many schools in countries in Asia ask for these screens to be completed by staff and pupils at home, before leaving home, with good results.  

If you absolutely have to be in these contexts, for work for example, follow WHO and ECDC guidance and wear a mask safely.    

Restaurants, shops and #schools must be encouraged to open #windows and #doors to facilitate #ventilation or improve ventilation in any way appropriate. We have observed, firsthand, that good ventilation and social distancing are possible in most context including #airports and #airplanes during the pandemic through our #travels.

We personally usually aim to avoid indiscriminate mandatory face mask settings where possible and allowed by government rules or policies, we opt for environments and contexts where social distancing and good ventilation are maintained.

As mentioned before, we have never presented with #symptoms, a raised #temperature or a positive test for SARS-CoV -2 after the pandemic was reported in January 2020, despite our #travel through more or less 20 countries. Simple evidence-based (based on good clinical #evidence – longstanding well established good clinical #research) risk reducing and protective factors are effective. If good clinical evidence is not followed risk often increases; #risk from a #medical point of view, as well as #developmental, mental health and #social point of view.

Unfortunately we have observed indiscriminate mandatory mask wearing initiatives indoors and outdoors, whilst hundreds of people sit at restaurants or coffee shops, close together, for hours at a time, often more than once per day. This makes no clinical sense, is not based on clinical indications or good clinical evidence, and will significantly increase risk and harm. Restaurants, shops, #hairdressers, #liveperformances etc should be open – but with the advice worded in a different manner. In our opinion – it is important to word it in this way – good ventilation and social distancing is a MUST – the first priority – and where it is absolutely impossible to facilitate, and individuals MUST be in this context, such as doctors responding to emergencies, a mask must be worn safely.

Many individuals report “we don’t have to do social distancing, because we wear masks”, even in restaurants – evidence does not support this theory.

Clinical indications and good clinical research are essential to reduce risk and harm, and protect the public, high and low risk individuals equally.

F – Focus on evidence-based protective factors to #protect mental health and general #health – such as remaining #calm, #positive and #hopeful, spending positive time with loved ones, outside and in #nature, #eating healthy and #exercising, #enjoyment and #normalcy.  Evidence-based protective factors significantly improve #prognosis, #morbidity and #mortality #statistics, in terms of mental health, general health and social risk. Please see previous comments on evidence-based protective factors, children’s development, normative activities and the immune system. 

G – Good Food Hygiene: We prefer that food for sale in public is covered, especially when you are not going to wash or cook it, such as #pastries or #breads at #buffets or #bakeries or #farmstalls (people often cough and sneeze whilst walking around planning their meals). We prefer contexts where children are supervised (children sometimes touch food, put food back, of course adults also do the same sometimes). We will provide thoughts on general tips to remain healthy when travelling or visiting high risk areas or countries, which includes items re food.

Sharp mind – soft hands, as the #Jamaican #Bobsledders in #CoolRunnings suggested. 

As mentioned before, we have followed these recommendations in at least 20 countries during the pandemic and have never presented with symptoms, a raised temperature or tested positive for SARS-CoV-2. We usually prefer environments where face masks are not indiscriminately mandatory, and where social distancing and ventilation are facilitated and maintained.

HOWEVER, WE ALWAYS ADVISE EVERYONE TO FIRST FOLLOW THE LOCAL GOVERNMENT’S LAWS, RULES AND POLICIES, WHICH MAY SOMETIMES DIFFER SLIGHTLY. 

We will provide further details in future blogs, including of our go-bag and medical kits, along with practical recommendations and information.

CURRENT EVIDENCE REGARDING FACE MASKS December 2020 and January 2021

Let’s follow only good clinical evidence to protect children and communities.

Indiscriminate Mandatory Face Mask Initiatives:  Evidence and Recommendations

“”At present there is only limited and inconsistent scientific evidence to support the effectiveness of masking healthy people in the community to prevent infection with respiratory viruses, including SARS-CoV-2”  WHO

The WHO says when it MAY be helpful to wear a face mask – December 2020:

https://apps.who.int/iris/rest/bitstreams/1319378/retrieve.  

“Wear a mask if you cannot maintain a physical distance from others”. 

“In areas where the virus is circulating, masks should be worn when you are in crowded settings, where you can’t be at least one metre from others, and in rooms with poor or unknown ventilation.” 

“Individuals/people with higher risk of severe complications from COVID-19 (individuals > 60 years old and those with underlying conditions such as cardio-vascular disease or diabetes mellitus, chronic lung disease, cancer, cerebrovascular disease or immunosuppression) should wear a mask when physical distancing of at least one metre CANNOT be maintained.” 

“Caregivers or those sharing living space with people with suspected or confirmed COVID-19, regardless of symptoms, should wear a medical mask when in the SAME room”.

https://apps.who.int/iris/rest/bitstreams/1319378/retrieve

https://www.who.int/news-room/q-a-detail/coronavirus-disease-covid-19-masks

https://www.ecdc.europa.eu/en/covid-19/questions-answers/questions-answers-prevention

https://www.ecdc.europa.eu/en/covid-19/prevention-and-control/protect-yourself

The ECDC (European Centre for Disease Prevention and Control) says when it may be helpful to wear a mask – January 2021: 

“If you are infected, the use of medical face masks (generally pale blue in colour and available from pharmacies) MAY reduce the risk of you infecting others.”  

“Consider using a face mask when visiting busy, enclosed spaced, such as grocery stores and shopping centres, or when using public transport, where it is NOT possible to maintain a social distance from others.” 

“We strongly recommend the use of medical face masks for individuals with risk factors for severe COVID-19, for all people in airports, and for all passengers during flights.”

“Wear a face mask indoors and outdoor whenever physical distancing with other people CANNOT be guaranteed.”  

The ECDC have updated their advice. No good or strong clinical evidence or research supports the wearing of face masks for healthy individuals in the community.

https://www.ecdc.europa.eu/en/publications-data/using-face-masks-community-reducing-covid-19-transmission

Recommendations as published in newspapers in Singapore, February 2020, a country with experience and relative success in managing previous and current outbreaks of coronavirus:

“Do Not Wear a Mask” unless at higher risk: “Do Not Wear A Mask If You Are Well.” 

“Who Needs To Wear A Mask?  IF you have a Fever, Cough or Runny nose and IF you are Recovering from an Illness.”

Conclusion

The WHO and the ECDC therefore do not recommend indiscriminate mandatory face mask wearing as an initiative for the general public indoors or outdoors; it is clear that the WHO and ECDC specify specific contexts where this initiative will likely reduce risk on balance (balancing evidence-based risk and protective factors), which cannot be ignored, generalised or misinterpreted.  

These recommendations also make sense from a clinical point of view based on clinical training and clinical experience, along with research and statistics that risk is increased and harm is caused by these initiatives if not applied as clinically indicated.  

WE ALWAYS ADVISE EVERYONE TO FIRST FOLLOW THE LOCAL GOVERNMENT’S LAWS, RULES AND POLICIES. 

#evidence #recommendations #healthy #travel #outreachwork #children #schools #smoking #drinks

Liberty linked to Peace

Liberty is a longstanding, well established, evidence-based protective factor for children’s development, well-being, general health, mental health, social risk, safety and security.  

The same is true for adults with different cultural and psycho-social backgrounds.

Nations protect liberty, advocate for liberty and prioritise liberty for these reasons.  Many prioritise liberty over safety or health, because liberty has significant effects on, is an evidence-based predisposing, precipitating and maintaining factor for, safety, mental health, general health and well-being.  Liberty also facilitates and maintains peace in communities, in nations and between nations.

Nations define their identity with liberty and many have sacrificed their lives for liberty.  “Remove a person’s liberty, you remove a person’s voice, rights, hope and life, you take control of him or her”, as reported by a medical colleague. 

Many children’s emotional, language, cognitive, social and physical development, as well as mental health, general health (morbidity and mortality), well-being and safety are significantly affected by ongoing measures depriving liberty intended to protect, not based in good clinical evidence.  Please see statistics regarding risk and harm previously mentioned.

There can be no further delay in weighing evidence-based risk and protective factors for children by medical specialists with training and experience in this regard, and acting accordingly.  

Medical emergencies require a systemic approach with clear clinical leadership; assessment of clinical presentations and relevant bio-psycho-social risk and protective factors by doctors with clinical experience.

First do no harm is a prevailing principle that leads clinicians in high risk and complex contexts, and this is a principle that must be employed with no further delay. 

#liberty #children #development #safety #wellbeing #health #mentalhealth #evidence #ProtectiveFactor #peace #identity #doctor #medicine #medical #psychiatrist

Paint the walls of your mind with many beautiful pictures – William Phelps

#LatinAmerica – more beauty – thank you for your lessons.

We can change our day or our year or the outcome when we change our thoughts.

Many therapies are based on this principle, as most medical doctors would agree.

The body and the brain listen to thought and usually complies.

We have spoken to many children, families and communities, along with medical colleagues, who have serious concerns (“dark thoughts” as reported by a medical doctor) about ongoing indiscriminate mandatory mask wearing, lockdown, stay at home, quarantine and curfews.

Many professionals are working hard to liaise with appropriate health and governmental organisations to raise concerns regarding risk and harm in the context of ongoing indiscriminate mandatory initiatives, and many leaders share these concerns. Your thoughts are heard and will be taken seriously.

What can you do now?

Focus on today – focus on now – what can you do – to lighten the load – to have a good day today or a good moment or few hours today?

We will share thoughts on this matter in the next few posts.

For today – think about your thoughts.

Thoughts drive our mental health and our health (blood pressure, heart rate, breathing rate, immune system), and thoughts also drive our safety and security, our well-being, our development and success with our goals.

It is important to accept and acknowledge thoughts relating to anxiety, depression, anger or risk – and to share them with someone you trust (with an adult if you are under 18). Think about whether there is something that needs to be done right now – such as getting help in an emergency to keep someone safe or healthy.

If there is no urgency or emergency – think about future plans and strategies to improve things. Thoughts give us information – the body and the brain often give us messages – we need to listen and act accordingly (after we have made a plan with a calm mind).

After you have considered the message your thoughts have given you – and have discussed it with someone – and have a provisional plan or strategy – now is the time to manage your thoughts – until you go back to the drawing board – and think about ‘life’ again and strategise further (perhaps once a week – make a dedicated time and keep boundaries to stick to the plan).

Needless to say – in an emergency or urgent situation – act now – get help and advice without delay. Our thoughts often save our lives or the lives of others. Your GP or the Emergency Department can give you contact details.

If there is no urgency or emergency – now to manage your thoughts – to manage the moment, to manage your morning or your day and to manage your life – to have a good life.

If we take care of the moments, the years will take care of themselves. Edgeworth

Real generosity towards the future consists in giving all to what is present. #Camus

Nothing is worth more than this day. #Goethe

The importance of thought and public messaging inspiring thoughts have been known for a very long time:

Do not think that what your thoughts dwell upon is of no matter, your thoughts are making you. B Steere

A man is but a product of his thoughts, what he thinks, he becomes. M #Gandhi

For as he thinks within himself, so is he. King Solomon

All a man achieves, all that he fails to achieve is the direct result of his own thoughts. James Allen

The belief in a thing makes it happen. Frank L Wright

Whether you believe you can do a thing or not, you are right. #HenryFord

The height of your accomplishments equals the depth of your conviction. #Scolavino

What a man thinks of himself determines and indicates his fate. H #Thoreau

The secret of living a life of excellence is a matter of thinking thoughts of excellence; a matter of programming our minds with information that will set us free. C Swindoll

Master your thoughts to master your life. A #Lincoln

Happiness does not depend on outward things, but on the way we see them. #Tolstoy

How do I start to do this?

1. Start by thinking about your happiest or calmest moments or times in your life – were you at the beach or planting a garden or walking in the woods or working with animals?

Dwell on those thoughts – take mental pictures – dwell on the feelings. Spend time in those moments – like visiting a friend.

2. Put pictures that remind you of these moments on your phone, in your home – little tokens to remember wherever you can. Look at the pictures and take time to enjoy the moment and the thoughts.

Many report that their blood pressure and heart rate go down as they think of enjoyable and relaxing memories or thoughts. This makes sense from a medical point of view – this benefits health – immediate and long term effects. Simple measures can affect health outcomes significantly.

3. Many children and adults find it helpful having a mantra – such as “I can do this” or “It’s in the bag” – children often have an action hero who has a certain saying – and repeating this mantra – reminds them of this person and their attitude and inspires thoughts of “can do” and feelings of excitement and enthusiasm. Quotations or narratives or images (pictures or thinking of this action hero can help).

4. Many children or young people find it helpful to have a bucket list of exciting plans (this must not be to-do or work items – it must bring you a smile when you think about it), this may include getting a dog, learning a language, taking a trip or going for a hike. Think about your exciting plans for this evening, for Friday or Saturday, or for long term – make a list – put some visual reminders to it. It is often a good idea to have something to look forward to at the end of the day, at the end of the week, month or a few months, one day. Carrots move us forward with positive thoughts.

Many people have bucket lists full of travel itineraries – pick a #destination and plan a day or weekend to celebrate it – find the right #books or blogs and read about it, find the right #music – find the right #food or learn the #dance of the destination eg #Cuban #salsa – there are lots of wonderful websites to learn the dance or to make the local dishes. These simple efforts built around thoughts – will likely transport you to another place – and provide you with a #positive #mentalstate.

5. Many find it helpful to have a gratitude list – a physical or mental list – every morning or evening, first thing or last thing, or both – think about what you are grateful for – it can be that nice cup of tea, your favourite tea mug, your garden, the blue sky and sun, your cat, your favourite blanket or music or song – don’t just list it – think about it and feel every single happy or relaxed feeling you can.

What you think about multiplies. If you constantly or often think ‘my knees are sore’ – your knees will likely feel worse. Go see a doctor and get advice and think about something else for a while. If you think about how kind your neighbour is – your neighbour often gets kinder. The mind is much more powerful than we think, but we will not go into this now.

Changing thoughts takes a bit of time – like any habit – but every day it gets easier if you stick to it.

If you find yourself thinking something negative such as “what is the point” – say “stop” to yourself and REPLACE it with – “there is a point – everything happens for a reason and I can do this and will do this until it is done” – an example of a medical colleague.

“It always seems impossible until it is done.” Mandela

It is important that you are KIND to yourself at all times when you learn or understand something new – hostile or negative environments do not facilitate learning, growth, development and well-being.

“Constant kindness can accomplish much. As the sun makes ice melt, kindness causes misunderstanding, mistrust, and hostility to evaporate.” Albert Schweitzer

Habits are often not ‘stopped’, but rather replaced by others – so choose your own replacement.

It is also important to remember that there are two steps forward, one step back – in every new venture – so expect difficult days where things don’t work out – but tomorrow – start anew. Animals often make excellent progress with learning in life because they live in today – their lives start anew every day – they don’t ponder yesterday’s failure. We can learn from them.

Have fun with this new #venture, it is a true #adventure, because you decide who you are and where your life takes you – and most often, it starts with thoughts …. start small and simple – your mind will take it from there and will ‘run with it’ – it will get easier and easier…. start with a beautiful picture you have had in your life and allow yourself a voyage to another frontier during this storm.

One example of a child who changed her life by changing her thoughts is of a 14 year old girl in Cambridge who left prostitution and stopped heroin, she was on methadone and was seen weekly in clinic. She had one #dream that consumed her life, she wanted a child and a family with her boyfriend “to feel a family’s love”. We spent some time thinking about what she wanted, what she hoped to gain from it, what her other wishes were (if she believed anything was #possible, which she didn’t initially). She eventually changed her thoughts from “I need a baby and a family to feel good and worth something” and “good things are not meant for me, I am not worthy” to “I can and will make myself happy”, “good things are meant for me if I show up to work for it and don’t give up” and “I am worthy, because I was born – there is a plan for each of us – our past only teaches us lessons, it doesn’t define us”. She decided a few months later, that she would rather wait with starting a family with her boyfriend (“my child deserves a happy mum with a job”), that she would rather get a dog and start College, which she did. She stopped methadone a few months later and she completed her degree with her dog by her side, as a single, confident and determined young person.

If children see you see something #positive in them, that you see that anything is possible for them, despite context, they start to #believe, and that is often the first step towards positive #lasting #change for children often referred to us with “no (or little) hope” as part of the referral.

#thoughts #crises #positive #calm #beauty #health #children #habit #health #mentalhealth #beauty #success #wellbeing #development #goals #happiness #safety #bloodpressure #heartrate #Mandela #quotations #habits #grateful #bucketlist #venture #travel

Latin America’s Treasures

#LatinAmerica has many treasures and many lessons to teach.

We were reminded of the importance of #community, #nature, #freshfood, #relaxation, #enjoyment and #normalcy.

We had the best #RedSnapper ever – picture. The fish was caught by the same person who prepared the fish.

We asked the locals what their advice was to relax and be healthy:

1. Good music

2. Good food – “but it has to be fresh” – “nothing beats fresh fish”

3. Food that you “catch yourself, clean yourself, make yourself” – and ideally a lot of “coconut, chillies and lime”

4. Good people around you – the kind who “don’t take themselves too seriously”, who laugh, who listens, who thinks positive

5. Learning new things and trying new things

6. Looking at the sunrise “if you are a fisherman” or at the sunset “if you are the chef” – but taking time to sit still and be quiet “within yourself”

7. Nature gives gifts every day to be happy and to be calm

8. Playing games with children or dancing – “the whole family”

9. Beauty – “seeing it everywhere, because it is everywhere”

10. Being grateful and hopeful – “having the right attitude”

Thank you for all the #kindness and #laughter.

#music #nature #dancing #family #beauty #grateful #hopeful #calm #fish

It Takes a Village

Poverty is a problem in every nation. Implications are vast.

Many children cannot reach #health or #mentalhealth #clinics due to various reasons, often it is not allowed to cross #borders, often #transport is expensive, often travelling is associated with #risk; #outreach work is therefore essential.

#Ofcom estimated in 2020 that between 1.14m and 1.78m #children in total in the #UK have no home access to a #laptop, #desktop or #tablet (or #computer or similar), and “an estimated 60 000 11-18 year olds in the UK have no home #access to #internet at all”. This is true for many or most nations.

“Even in the world’s richest countries 1 in 7 #children still live in poverty. Today 1 in 4 children in the #EU are at risk of falling into poverty.” UNICEF

1 in 6 children lives in extreme #poverty, World Bank-UNICEF analysis, Oct 2020

More or less 50% of children “1 billion of the 2.2 billion children worldwide are multi-dimensionally poor – without access to #education, #health, #housing, #nutrition, #sanitation or #water”. More or less 40% of the world’s population will require adequate and affordable housing by 2030. UNICEF

Many challenges can be overcome and risk can be reduced markedly with simple measures. Please contact us at admin@cinaps.co.uk for more information or to attend our annual #presentation, Complex Problems, Simple Solutions.

“More or less 25% of the world’s urban population live in informal settlements.” United Nations

“Children make up less than one third of the global population, but were 50% of the world’s #refugees in 2018.” UNICEF

#Positive #change is more than #possible, but we need to work #together – it takes a village.

#LatinAmerica

Safe Face Mask Wearing

Firsthand observations and information reported for more than 6 months in more than one country in the context of face masks, lockdown, curfews, stay at home, self-isolation and quarantine: 

Please see WHO recommendations regarding mask wearing and safe mask wearing.  

A. Many (or most in some European countries) individuals wear masks in ways that increase risk for COVID-19, rather than decrease risk, such as wearing masks under noses, on chins, on arms or hands. We sometimes or often observe that most individuals, at least 75%, in our surroundings engage in this behaviour, and that not many individuals, more or less 10%, wear masks to cover noses.

B. Many or most individuals regularly touch mouths with unwashed on unclean hands, often underneath masks, which increases risk for COVID-19 markedly.  

Research indicates that most adults touch their faces more or less 16-23 times per hour, often without registering this behaviour.  In the context of youth, elevated emotion eg anxiety, mental health problems, learning problems and/or neurodevelopmental problems, these behaviours usually increase markedly. Please see earlier references to children and schools.

C. Most individuals, not living in poverty, report that they never replace masks even though they fall on wet floors, which increases risk markedly.  

Most individuals report that they have worn the same mask for at least 3-6 months.  Many report that they have extra masks, but will rather “save them for emergencies”.  

D. Not one person has admitted to cleaning his or her hands before and after using a mask, as per WHO guidelines, December 2020, which increases risk markedly.  

It is also important to consider where the mask is ‘kept’ if not worn; wearing or keeping masks on arms or wrists are not good practice.

Most doctors will agree that if a recommendation or behaviour cannot be engaged in safety, it could increase risk significantly, rather than decrease risk.  

E. Many individuals report that they drink alcohol, take over the counter or prescription medication (for other purposes) or illicit drugs to “cope” with lockdown, curfews, quarantine and mask wearing; many report these behaviours on a daily basis.  Many individuals in this context never used alcohol or illicit drugs before the pandemic.

Many individuals do not know that a medical certificate can be requested to avoid mask wearing.

It is important to seek advice and assistance without delay in these contexts – GPs will have helpful information, and in an emergency, contact emergency numbers. Many organisations will keep concerns confidential. Please see Helpful Links at http://www.cinaps.co.uk for more information.

F. Many individuals report, during quarantine at home, that they could not access necessary healthcare, medication or food to maintain health.

G. Many report markedly increased social risk in their homes or immediate environment due to indiscriminate mandatory initiatives such as relating to mask wearing, curfew, lockdown and quarantine.  Concerns include general violence, domestic violence, child abuse, alcohol abuse and illicit substance abuse.  

It is important to seek advice and assistance without delay in these contexts – GPs will have helpful information, and in an emergency, contact emergency numbers. Many organisations will keep concerns confidential. Please see Helpful Links at http://www.cinaps.co.uk for more information.

H. Many report “breaking rules” regarding safety and health to comply with curfew rules, such as driving too fast.

I. Many individuals, with and without a relevant mental health history, report significant mental health symptoms or morbidity due to indiscriminate mandatory mask wearing initiatives, stay at home, curfew, lockdown and quarantine. 

It is relevant to note that many individuals report that their concerns are not related to COVID-19, but due to initiatives depriving liberty and autonomy.  

It is important to seek advice and assistance without delay in these contexts – GPs will have helpful information, and in an emergency, contact emergency numbers. If you are not sure if it is an emergency, get immediate advice. Many organisations will keep concerns confidential. Please see Helpful Links at http://www.cinaps.co.uk for more information.

J. Many individuals report significant general health symptoms due to indiscriminate mandatory initiatives such as relating to mask wearing, curfews, lockdown, stay at home and quarantine.  We have referred to these concerns in Deprivation of Liberty. Medical doctors often report that they fall into this group.  

It is important to seek advice and assistance without delay in these contexts – GPs will have helpful information, and in an emergency, contact emergency numbers.

K. Many individuals report that they are not engaging in protective behaviours such as washing hands before eating, covering faces when sneezing or coughing, or remaining home if sick or if symptoms and contacting health professionals, and comment on indiscriminate restrictive initiatives maintaining lethargy and nihilism (no hope for the future or that things will change).  

L. Many individuals report that they are not engaging in medical or mental health appointments to avoid face masks and due to stay at home messages, lockdown or quarantine.  

M. Many individuals report that they will not seek medical assistance or buy medication needed for themselves, their children or family due to mandatory mask wearing initiatives, or due to curfew, during lockdown, quarantine or stay at home messages.  Some report that messages such as ‘pretend you have the virus’ and ‘anyone can make you sick’ cause confusion and “fear”, “it is safest to stay at home”, as reported by a family. 

It is important to prioritise general health and mental health, along with a safe and calm environment in this time.

Most individuals report that their concerns, as above, are not secondary to the risk of the virus, but due to restrictive initiatives; indiscriminate mandatory face masks, travel related quarantine, curfews, lockdown and stay at home messages for individuals without symptoms and not at high risk for severe COVID-19.

Most families report that the “most helpful thing” is to know that they are not alone in presenting with these thoughts, feelings, behaviours or mental health or general health presentations, that many experience the same concerns. This is our reason for sharing these thoughts today.

We have shared observations and concerns with relevant organisations, updating observations since our initial correspondence in March 2020. Many organisations share these concerns.

Finally, it is always important to prioritise general health and mental health, along with a safe, calm and positive environment, but it is especially important in this time. Please see previous comments on evidence-based protective factors and the immune system.

Simple measures often affect outcome in very significant ways. We provide an example – take a daily or weekly walk – one parent or carer with one child – where the rule is to only talk about positive and fun topics – if this is difficult in the beginning – focus on what you see around you that you like. This one to one time with every combination of child and parent or carer provides opportunities to share enjoyment, relax, bond, learn and develop. The walk does not have to be long, 10 minutes might be sufficient, but take the time to experience life and the precious moments if you can. We often recommend this simple strategy to families, often with good outcomes.

Statistics and Research to Protect Children and Families

Statistics and Research to Protect Children and Families:  

A. More or less 80-83% of individuals with infections will present with symptoms of COVID-19.   “Earlier estimates that 80% of infections are asymptomatic were too high and have since been revised down to between 17% and 20% of people with infections.”  https://www.bmj.com/content/371/bmj.m4851  

Many medical doctors agree that consistent temperature and symptom screens in ports, airports, schools and the general public are essential to effectively reduce risk and prevent harm for the general public. 

B.  “80% of the time COVID-19 is a mild disease that feels like a minor cold or cough”, Prof Peter Piot, Director for The London School of Hygiene and Tropical Medicine.

C. “4.5% of the global population is likely to require hospitalisation if infected with SARS-CoV-2 and 95.5% of the general population will likely not require hospitalisation”, The London School of Hygiene and Tropical Medicine.   

D. A COVID-19 related infection mortality rate of more or less 0.14% has been reported, and a case mortality rate of 2.63% has been reported in the UK, 2.37% in France, 1.66% in the USA, 0.94% in Denmark, 0.88% in Norway and 0.05% in Singapore (January 2021).

E. “4% of those younger than 20 years could be at increased risk for severe COVID-19”, The London School of Hygiene and Tropical Medicine.  

“About 1 in 5 individuals worldwide could be at increased risk of severe COVID-19, should they become infected, due to underlying health conditions, but this risk varies considerably by age, for instance, the risk is 4% for those younger than 20 years and >66% for those 70 years and older”.  https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30264-3/fulltext  

It is important to consider these figures relating to risk of general hospital admissions (4.5%) for the global population and relating to children (4%) at risk for severe COVID-19 when considering figures relating to increased risk and harm to the general population and children (up to 400- 500% increase) due to indiscriminate mandatory initiatives.  

Risks and benefits must be weighed in all bio-psycho-social contexts to comply with ethics and medico-legal guidelines. 

F. The purpose of most vaccines is to reduce serious morbidity and mortality, not to reduce or avoid mild symptoms.  

Available SARS-CoV-2 vaccines present with a likely efficacy rate of more or less 70-90% (after two vaccine doses given 21-28 days apart for vaccines available in the UK), which loses efficacy over time and will likely require annual boosters.  

Doctors agree that immunity, after active infection, likely lasts more or less 4-5 months, and immunity from vaccines will likely last more or less 8 months.  

Doctors are concerned that instead of providing vaccines as per manufacturer’s guidelines, 21-28 days apart, it has been decided to extend this interval to 3 months in the UK, the British Medical Association has raised concerns regarding consequences.  We have been informed that some pharmaceutical companies now state that 3 month intervals are acceptable, however, doctors continue to be concerned and many agree that maximum protection, without the extra 2 months delay, for high risk individuals (for severe COVID-19) should be the clinical priority. 

It is our understanding that the first vaccine dose provides a likely efficacy of more or less 50% and the second vaccine dose provides a likely efficacy of more or less 70-90%.

Many agree individuals should be vaccinated first who are (and many countries follow these guidelines):

• high risk for severe covid-19 due to age or illness (category 1)

• health professionals and category 2/3 individuals with the above concerns fall into category 1

• individuals offering public services such as healthcare, education, social care or Police (category 2)

• and individuals not able to socially distance (category 3)

• with the rest of the general public (category 4)

Most doctors are happy to take or to have taken the #Oxford (#AstraZeneca) #vaccine, due to the pharmaceutical company’s longstanding reputation regarding safety and also because the organisation offered to make no profit during the pandemic (despite news of research likely soon to be published, which many medical doctors are not very concerned about).  Most doctors realise a vaccine is “one of the tools in the tool box to manage infections”.  

G. More or less 30-40% of the world’s population presents with chronic disease.  Some studies report that more or less 4.3% of the world’s population had no health problems in a 1 year period and that 30% of the world’s population experiences more than 5 ailments in a 1 year period. “Mortality, morbidity and disability attributed to the major chronic diseases currently account for almost 60% of all deaths and 43% of the global burden of disease.  By 2020 their contribution is expected to rise to 73% of global burden of disease.”  WHO.  

Some individuals in this group are at high risk for severe COVID-19 (group A) and some individuals are not at high risk for severe COVID-19 (group B).  Group B constitutes at least 50% of this group (chronic disease), but likely more, and can constitute up to 36% of the general population, which is significant (some doctors report this figure may be much higher).  Some individuals in group B have made an appeal and have advocated for normalcy, liberty and autonomy (many have concerns regarding reduced life expectancy).  Many of our medical colleagues in group A, due to age with associated underlying medical problems, agree with group B. 

Many children or families living in poverty, in informal settlements or in detention camps, where face masks are clinically indicated (due to social distancing not being possible or due to medical symptoms or problems), do not have access to face masks.  Individuals not living in poverty, not with symptoms or medical problems, where social distancing is possible, 1km from informal settlements, are however “threatened with fines and prison sentences if they do not wear masks”, without clinical indication or evidence to support this initiative. 

H. “Even in the world’s richest countries 1 in 7 children still live in poverty.  Today 1 in 4 children in the EU are at risk of falling into poverty.”  UNICEF.  1 in 6 children lives in extreme poverty, World Bank-UNICEF analysis, Oct 2020, and more or less 50% of children “1 billion of the 2.2 billion children worldwide are multi-dimensionally poor – without access to education, health, housing, nutrition, sanitation or water”.  More or less 40% of the world’s population will require adequate and affordable housing by 2030.  UNICEF.  These statistics were concerning before the pandemic and as many organisations report, the figures have increased significantly in the last year due to measures restricting liberty. 

I. More or less 25% of the world’s urban population live in informal settlements.  United Nations

J. Children make up less than one third of the global population, but were 50% of the world’s refugees in 2018.  UNICEF 

K. Children, 0-15 years, make up more or less 20% of the population in the UK.  Most doctors refer to children under age 18, when referring to children.  

Children have to be protected during the pandemic from a bio-psycho-social point of view.  

Schools play a protective role for most children, however risk reducing measures within schools such as temperature screens and symptom questionnaires (before school attendance) are essential to safeguard the general public, and are not in place in many countries.  

Important statistics to consider regarding children in schools are

Please see relevance https://mentalhealthbus.wordpress.com/2020/11/16/children-neurodevelopment-learning-mental-health-and-schools/

L. More or less 2.5% of children present with learning difficulties, more or less 15% of school aged children have special educational needs.  

M. More or less 3-4% of children present with ADHD and more than 50% of children with ADHD present with at least 2 co-morbidities.  

N. More or less 20% of adolescents are at risk of experiencing mental health problems in any given year, more or less 12.5% of 5-19 year olds had at least one mental health disorder and 10% of children 5-16 years have a clinically diagnosable mental health problem, yet 70% of children with mental health problems have not had appropriate interventions (diagnoses and treatment) at a sufficiently early age, as reported by The Children’s Society.  These figures were reported before the pandemic.

Mental health concerns have increased markedly over the past year, 55-80%, as reported by most mental health organisations.  Many individuals report that their main concern does not relate to the biological risk of the virus, but relates to restrictive initiatives depriving liberty, not based on good clinical evidence, weighing risks and benefits, such as indiscriminate mandatory mask wearing, stay at home, curfews, quarantine and lockdown initiatives.  

O. Prevalence of mental disorders in the WHO European region was more or less 15% before the pandemic and 50% if neurological disorders such as epilepsy, dementia and headaches are included, as reported by the WHO.  

“Mental disorders are one of the most significant public health challenges in the WHO European Region, being the leading cause of disability and the third leading cause of overall disease burden, following cardiovascular disease and cancers.”  WHO

“People with mental health disorders die 20 years younger than the general population.  The great majority of these deaths are not cause specific (in particular suicide) but rather from other co-morbidities associated with their mental conditions, notably noncommunicable diseases that have not been appropriately identified and managed.”  WHO  

We always recommend that children referred to child and adolescent mental health teams be seen by a Child Psychiatrist, with CCT’s (specialist qualifications) in Child Psychiatry, within the first 2 weeks for this reason, to screen for medical problems, and for the concerns raised by The Children’s Society, that 70% of children with mental health problems have not had appropriate interventions (diagnoses and treatment) at a sufficiently early age. Please contact us for more details.

P. It was reported by the WHO that 18.6% of children in England alone (2.2 million) lived with domestic abuse, parental drug or alcohol dependency and/or severe parental mental illness before the pandemic.  WHO.  

Risk to children has increased 80-400% during lockdown in this context, as reported by England’s Children’s Commissioner, and 581%, as reported by Respect, a national domestic violence charity. 

Q. More or less 50% of children aged 2-17 suffered violence and 75% of children aged 2-4 years regularly suffered physical or psychological violence before the pandemic.  Globally it is estimated that nearly 50%, 1 billion children out of 2.2 billion children worldwide, aged 2-17 years, experienced child abuse in the past year (before the pandemic).  WHO  

The NSPCC has reported that risk to children has increased 30-65% in this context, further to lockdown and many organisations including UNICEF have raised concerns regarding stay at home, curfew and/or quarantine initiatives for children in this context.  NCMEC has commented on a 90% increase in concerns relating to child sexual exploitation. 

Please know that statistics relating to child abuse, mental health and neurodevelopmental problems are likely much higher than reported. 

Indiscriminate Mandatory Stay at Home, Shelter in Place, Curfew, Quarantine, Mandatory Self-Isolation and Lockdown Initiatives:

Statistics indicating increased risks due to above indiscriminate mandatory initiatives (most research relates to the UK):

A. 30-65% increase in child abuse, NSPCC, with 60% increase in concerns regarding online sexual abuse, NSPCC, and 90% increase in concerns regarding child sexual exploitation, NCMEC.  

B. 300% increase in violence.  “In the UK 14 women and 2 children were murdered in the first 3 weeks of COVID-19 lockdown, the highest figures in 11 years.”  WHO

C. 400% increase in alcohol abuse, Alcohol Change UK, 2020.  The Royal College of Psychiatrists reported in September 2020 that “new analysis find nearly 8.5 million adults drinking at high risk (up from just 4.8 million in February 2020), while number of people addicted to opiates seeking help in April at highest level since 2015”.  Many individuals report that they  “drink to cope with masks”, lockdown, curfews, quarantine or stay at home initiatives.  It is important to note than when alcohol sales are banned, individuals usually find other, often more harmful, ways to “cope”.

D. 80% increase in domestic violence, National Domestic Abuse Helpline, 2020.  “In the UK, calls, emails and website visits to Respect, the national domestic violence charity, have increased 97%, 185% and 581% respectively.”  WHO

These figures are likely much higher than reported.  It is important to note that most children do not report abuse, and that most women and men do not report domestic violence, alcohol or drug abuse. 

E. 75-80% increase in mental health morbidity in individuals with a relevant mental health history during lockdown and 55% increase in mental health morbidity in individuals without a relevant mental health history have been reported during lockdown. Concerns also increase in terms of self-harm and suicidal ideation or attempts.  These concerns relate to children and adults of all ages and cultural, educational, professional and bio-psycho-social backgrounds.  Please see MIND, Young Minds and Samaritans for more details. 

Significant numbers of individuals with mental health and general health concerns have not been identified and many do not seek help for various reasons. 

F. 93% increase in non-engagement in required hospital appointments, RCPCH.  50% of individuals with a worsening condition did not seek assistance, UK GOV.  40% of individuals with mental health problems did not seek assistance.  Young Minds.  Many report “protect the NHS” messages, mandatory mask wearing initiatives, quarantine, stay at home directives, lockdown and curfews prevented them from “seeking help”.   

G. Cabinet Office polling, UK, indicates that only 17% of individuals with symptoms of COVID-19 informed health staff or requested tests in the UK.  Many report “we live without freedom if we are healthy, why make it worse”, this increases risk. 

H. The increase in statistics relating to poverty and extreme poverty has been extensively documented by many organisations.  The Trussel Trust, UK, reported an 89% increase in need for emergency food parcels in the UK, April 2020.  Oxfam identified that border closures, curfews and travel restrictions caused breaks in food supply that threatened to cause 12 000 deaths a day worldwide, exceeding the 10 000 deaths a day recorded from COVID-19 in April 2020.

WE RECOMMEND THAT YOU ALWAYS FOLLOW GOVERNMENTAL LAWS, RULES AND POLICIES.

Quotations:

“Lockdowns have just one consequence that you must never ever belittle, and that is making poor people an awful lot poorer.”  Dr David Nabarro, Special Envoy on COVID-19, World Health Organisation 

The UN reports “we are just beginning to fully understand the damage done to children because of their increased exposure to violence during pandemic lockdowns, said Henrietta Fore, UNICEF Executive Director.”

UNICEF, October 2020, reports “Lockdowns and shelter in place measures come with a heightened risk of children witnessing or suffering violence and abuse and can also expose children to new protection risks. When it comes to violence, a number of factors related to confinement measures are likely to result in increased risk for children including heightened tensions in the household, added stressors placed on caregivers, economic uncertainty, job loss or disruption to livelihoods, and social isolation. Children may also increasingly witness intimate partner violence.”

“Children have fewer health risks from COVID-19 and yet they have suffered disproportionally from the nation’s efforts to contain this virus.”  Anne Longfield OBE Children’s Commissioner for England, Summer 2020 

“This war, and I think it is reasonable to call it a war, against this virus, which is going to go on for the foreseeable future, is not going to be won by creating tougher and tougher rules that attempt to control people’s behaviour. The only way we will come out ahead of this virus is if we are able to do the right thing in the right place at the right time, because we choose to do it.” Dr David Nabarro, Special Envoy on COVID-19, World Health Organisation

International Outreach Services

We are medical doctors and specialists in Child and Adolescent Psychiatry.  We have been based in Cambridge, England, since 2005.  We offer NHS, private and pro bono services.  

Our offices are in #Cambridge and #London, however, we offer services throughout the UK and #Ireland, as well as internationally where requested.  

Our interest relates to service development and service provision for hard to reach children; vulnerable children in need or at risk from a bio-psycho-social context in developing or developed countries. 

We consider a systemic approach in our assessment and management, considering general health and mental health, along with culture and social risk for families and communities.  

In preparation of service development work in developing countries we regularly review National Health Plans and relevant strategies to safeguard and promote children’s and families’ general health and mental health in different cultural and risk contexts.  We remain up to date with local and general knowledge regarding emergency medicine and general medicine, including infectious diseases and vaccines, to prepare volunteers and to meet patients’ needs who refuse to see another medical doctor.  

Our background includes working with children and adults with medical problems, including infectious diseases with secondary complications, in emergency, hospital based, community based and outreach settings in developing and developed countries.  

We left for Asia on 11 January 2020 and travelled through more or less 15 countries during the pandemic.  We returned 5 months later, further to cancelling our trip due to lockdown initiatives and closed borders.  One of the reasons for our trip was to meet with Health Ministries who had requested service development for children.  We plan to resume our trip when borders open.   

We have continued to travel for work between June 2020 and today, often travelling to and from different countries on a weekly basis. We have travelled through at least 20 countries during the pandemic to date. It is relevant to add that we have never presented with symptoms, a temperature or a positive test. We go to great lengths to protect our health and those around us (some details provided – see evidence-based risk reducing and protective factors, normalcy, the immune system) and we prefer contexts, even in airports and airplanes, where good ventilation and social distancing is facilitated, rather than where face masks are indiscriminately mandatory.

We observed various medical and/or governmental protocols with different public responses and statistical outcomes during our travels.  We were particularly interested in these observations, because we offer services to individuals in diverse settings and high risk in social (eg homeless), biological (eg infective diseases such as HIV, TB, HEP B) and psychological (eg high levels of threat) contexts; our consultation includes, but is not limited to, assessment and management of environment, social context, physical safety, mental health, neurodevelopment, general health, immunisations or vaccines, nutrition and access to clean water. 

Our South African background, working in various informal settlements, inspired our interest and commitment to contribute to positive change in diverse settings. 

We have shared observations with relevant Health Ministries, Public Health Departments and colleagues, along with organisations such as the WHO, UNICEF and the UN, and organisations safeguarding children such as the NSPCC and England’s Children’s Commissioner, since March 2020. We are grateful for many positive responses from the UK and various counties in Europe and abroad, and for sharing thoughts, concerns and questions. Common clinical goals, to protect, to reduce risk and to prevent harm, are essential during a global health crisis.

We are happy to share our observations and concerns with relevant educational, social care, criminal justice, legal, health, mental health, managerial or governmental parties, please contact us at admin@cinaps.co.uk to request a copy of this 45-60 page summary.

We continue to make ourselves available to assist in any medical or mental health context during the pandemic in any country. We have offered our services to the UK, countries in Europe such as France, the USA, Africa, Latin America and the Pacific during this pandemic. Please contact us at admin@cinaps.co.uk if you require our services or input. We offer virtual consultation to patients, families, medical colleagues and mental health teams. Most of our crisis related work during this time is pro bono.

We hope to return to previously requested service development and outreach projects in the near future. If you are interested in volunteering please contact us at admin@mentalhealthbus.co.uk – a background in mental health or Medicine is not required. More details at http://www.mentalhealthbus.co.uk and we provide annual seminars on volunteering.

We thank you for your support.