Children, families, colleagues and friends of all ages, cultural, educational, religious and social backgrounds usually say that they enjoy Christmas, because “it is a happy time, where people come together, they relax, they enjoy and they have Hope”, 80 year old.
“I like Christmas because there are lights and people smile”, 8 year old child.
“I live alone, I spend Christmas alone, but for me it is still a time of Peace and Hope, because Christmas is of something bigger than ourselves, it is not about people, it is about Love and Faith.” 92 year old. Many pubs in the UK offer free Christmas lunch to anyone who is alone on Christmas. No c-pass necessary in the UK.
Many report “the same terror that happened now before Christmas, where we are all terrorised again, now for 2 years with crescendo before Christmas and late summer every year, happened last year when we were not allowed to buy books or decorations, now we can’t have fireworks or get together again, and it is not about a virus or health or protection, any doctor with half an education and some experience know this, it is about human decisions to profit, to stay in the spotlight and to control, ghost stories continue, half truths that maintain drama, chaos and fear”, medical specialist, 30 years experience.
Our referrals of experts in the field, academics and medical doctors increased markedly last year before Christmas time, and the same is observed this year. Most report “it is about being unable to swallow lies and exchange freedom and autonomy and good evidence for lies, we all live in terror with our mouths shut or covered, we are told not to get involved, it is symbolic, we live in a prison with a false story that makes it ok”, GP. “It is true that there is a viral threat, a biological threat, but it is a serious threat to much less than 25% of the global population, more likely 5-10%, even before vaccines, now, due to vaccines AND ALSO due to the virus mutating as most will do, spreading easier, BUT ALSO having lost most of the power, the ‘danger’ (the usual pattern), it is now a small sniffle for most – it is so interesting how (the media, or leaders or even) doctors report half of it, they leave the most important part out – it was time long ago to stop all the tests, passes, lockdowns, self-isolations – and masks never had good evidence backing it and hurt more people than help.” Medical specialist, decades of experience
Let’s not allow our Love, Hope, Faith, Joy or Peace to be affected this year – then our Freedom is affected. We need Strength, Courage and Wisdom for this path – it is within our reach – for everyone. We see children who have experienced 10 lifetimes of losses and trauma, with enormous strength, courage and wisdom every day, who refuse to give up on Hope, Faith, Joy and Peace; who don’t give up on Love (not the romantic kind, but Love, the kind that changes the world, changes anger into forgiveness). These items, above in bold, are all connected, you don’t have the one without the other. Start with one, the rest will follow.
“Everything can be taken from a man but one thing: the last of the human freedoms; to choose one’s attitude in any given set of circumstances, to choose one’s own way.” V Frankl
“The mind is its own place, and in itself can make a heaven of hell, a hell of heaven”. Milton
“Faith is the bird that feels the light and sings when the dawn is still dark.” Tagore
“All the great things are simple, and many can be expressed in a single word: Freedom, justice, honour, duty, mercy, Hope.” Winston Churchill
“Love recognises no barriers. It jumps hurdles, leaps fences, penetrates walls to arrive at its destination full of Hope.” Maya Angelou
Corinthians, “Love is patient and kind; love does not envy or boast; it is not arrogant or rude. It does not insist on its own way; it is not irritable or resentful; it does not rejoice at wrongdoing, but rejoices with the Truth. Love bears all things, believes all things, Hopes all things, endures all things. Love never ends.”
“Let no man pull you so low as to hate him.” Martin Luther King Jr
“Courage is like Love; it must have Hope for nourishment.” Napoleon Bonaparte
“Peace is Liberty in tranquility.” Marcus Tullius Cicero
“Do not let the behaviour of others destroy your inner Peace.” Dalai Lama
“Never be in a hurry; do everything quietly and in a calm spirit. Do not lose your inner Peace for anything whatsoever, even if your whole world seems upset.” Saint Francis de Sales
“ Peace cannot be kept by force. It can only be achieved by understanding.” Albert Einstein
“It isn’t enough to talk about Peace. One must believe in it. And it isn’t enough to believe in it. One must work at it.” E Roosevelt
“Joy lies in the fight, in the attempt, in the suffering involved, not in the victory itself.” Mahatma Gandhi
“Do your little bit of good where you are; it’s those little bits of good put together that overwhelm the world.” Desmond Tutu
“The weak can never forgive. Forgiveness is the attribute of the strong.” Mahatma Gandhi
“An eye for an eye only ends up making the whole world blind.” Mahatma Gandhi
“Courage isn’t having the strength to go on, it is going on when you don’t have strength.” Napoléon Bonaparte
“Never, never, never give in!” Winston S. Churchill
“The measure of intelligence is the ability to change.” Albert Einstein
“Knowing others is intelligence; knowing yourself is true Wisdom. Mastering others is Strength; mastering yourself is true power.” Lao Tzu
“Whenever you find yourself on the side of the majority, it is time to reform (or pause and reflect).” Mark Twain
“Any fool can know. The point is to understand.” Albert Einstein
“Children often understand and follow truth, more than adults will, because children are more fearless than adults, they have faith.” GP
“The children in my school brought this quote to me last year, when this virus was still a serious threat to more people, then to about 20% of the population, now the virus is no more than allergy symptoms for most, 95% most say, but yet, deprivation of liberty is now a thing of the past”, teacher. Benjamin Franklin “Those who would give up essential Liberty, to purchase a little temporary Safety, deserve neither Liberty nor Safety.”
“Rather than love, than money, than fame, give me Truth“. Henry David Thoreau
“The man who fears no Truth has nothing to fear from lies.” Jefferson
“I know not with what weapons World War III will be fought, but World War IV will be fought with sticks and stones.” Albert Einstein
We decide, who we are today, and every day. This is how we change tomorrow.
We will write about travel or holiday opportunities for 2022 when matters settle. Our previous two posts provided some thoughts regarding current opportunities.
We currently provide opportunities to join us with pro bono outreach and service development work or visit us on site. Everyone can contribute in some way – even playing football with children. Please see http://www.mentalhealthbus.co.uk for more details. The current locations include:
We thank the nearly 20 individuals who have signed up as volunteers in the last few months, however, due to so many GPs and psychiatrists taking early retirement or extended sick leave or moving countries, we would ask that you please confirm your interest at this time. No contracts are required at this time and a ‘maybe’ is more than enough.
We also currently provide opportunities to join our organisation and provide services, mostly remote work, to children and families in the UK:
• Private assessment, treatment, consultation for children and families
• Consultation to carers, support workers and professionals – advice regarding service provision or development
• Educational sessions, training, teaching or presentations to schools, universities, support groups, groups of families, Social Care, Youth Offending Teams, GP surgeries or professionals in hospital settings
• Children’s mental health services to the NHS
• Children’s mental health services to private organisations in the UK
• Children’s mental health services to charity organisations in the UK
Our offices are in Cambridge and London, however, we offer services throughout the UK in the context of home visits, school visits or consultation in GP or Social Care offices. We were informed recently that we are the oldest Child Psychiatry or Child Mental Health private organisation in the UK.
We see children and young people up to age 25 if in part time or full time education; many of our referrals are from universities or mental health teams in universities. On some occasions we also accept referrals of adults over 25, for instance academics at universities, medical doctors, police officers, social workers or teachers. Referrals frequently relate to PTSD, other anxiety disorders, anger or depression. All consultant child psychiatrists (with CCTs in Child Psychiatry) are trained and registered to work in Adult Psychiatry due to 3 years training as specialists in Adult Psychiatry, before 3 years training as specialists in Child Psychiatry.
Our referrals have increased with more than 1000% in the last few months, more or less 50% of our work is offered pro bono. We have offered 2000h pro bono in the last 2 years. We do not require pro bono work from everyone who joins us, however, opportunities are available.
We accept private referrals from adults, children, families, carers, schools, universities, social workers, Police and other professionals.
Most of our private referrals are for families where parents are academics, medical doctors or solicitors. We usually have a short waiting list, however, due to after hour, bank holiday and weekend clinics, we now offer a waiting list of 1-3 weeks. Referrals can be sent to firstname.lastname@example.org and our website www.cinaps.co.uk has information regarding the referral process, which is relatively simple. We usually offer a discounted rate for individuals working with high risk children such as certain teachers, doctors, Police or social workers.
We thank everyone in our team for their support and assistance during the years. Your input moves us forward. We also thanks our colleagues who have referred trusted professionals to join our team, individuals they have worked with and trust from a professional point of view. We cannot move forward without you. All professionals currently affiliated or working with CINAPS and MHB IP have worked with us, usually in NHS settings, or have worked with our trusted colleagues and are considered to be professionals with extensive clinical training and experience, and committed to the best care for children.
Please contact us at email@example.com for more information if you are interested in joining our team.
We have crossed more than 30 borders during the pandemic, since January 2020. We have observed different nation’s clinical and political approaches along with clinical outcomes and public responses. We have observed when and how these patterns have changed. We have shared observations with relevant authorities; many have asked us to continue to share observations and concerns.
We were recently asked to report which countries followed good clinical evidence during border crossings, such as;
• requesting that travellers report current, relevant serious symptoms or raised core temperature,
• requesting that travellers report a recent positive test or
• requesting that travellers report a recent contact with confirmed positive case,
however, much has changed in the EU and the UK in the last few days or weeks, astoundingly so, and most agree not due to any clinical reasoning and that no good clinical evidence is now followed in most contexts before, during or after border crossings in the UK, EU and otherwise (if not now, then starting tomorrow or soon). “It is clear that this is political and not clinical, but a lot of people, most people, are being harmed seriously by these rules, when will the courts stop this, because it seems the doctors can’t stop this, we are told our opinions don’t matter and are not relevant, and that the emergency law supports this”. Medical specialist.
“There is not a doctor or professional or expert in the world with good clinical training and good clinical experience and who can identify good clinical evidence who will agree that boosters are needed for everyone, not for this viral agent, not with this clinical picture and pattern, or that after you have been ‘fully vaccinated’, you still need tests to enter anywhere or do anything, even after confirmed contact, or to self-isolate for any reason, even after confirmed contact. Don’t get me started on masks. An African nation used to say certain fruit cures HIV, which is not true, the same qualify of evidence supports face masks, it doesn’t work in these settings, it hurts a lot of people. Vaccines mean – you now continue with normal life (after a week or so) – 100% normal, 100% free, 100% autonomy. This is the purpose of vaccines. This is why we risk with vaccines – so we can enjoy benefits. You still do common sense things like wash your hands, eat healthy. You need tests if you present with serious symptoms, where your health or life is at risk – clinical indications. To be continued next paragraph.
Don’t authorities know they are doing the exact thing to make people’s immune responses weaker, and to give this virus an ‘up’ and a longer shelf life, so that this virus does not beat us. Hiding does not work for a virus, it makes the virus stronger. Assault by testing (or fear) does not work for a virus, it makes people weaker. Many viral infections, especially flu viruses, mutate, develop, become more infectious, but much less dangerous. This is predictable, everyone said this in September. This helps people, because they build a healthy and normal immune response. People who make the decisions do not understand viruses, coronaviruses, immunity, immune systems, vaccines or Health (Medicine). Medical doctors, clinicians, professionals expert in these fields – they need to lead the decision making processes – otherwise the public will suffer incredible harm. Is it not enough that harm has been illustrated as increased by 1000% by these decisions (not the virus)? These have become games and protection is not the aim, and this is no time for games.” Medical specialist, lead position in crisis management, several decades.
We have been asked to give details regarding the current state of affairs, as it stands now, however, hopefully clinical thinking will lead and it will change tomorrow or before the New Year:
Portugal – All passengers arriving by air need PCR or AG (antigen or lateral flow) tests, or EU COVID pass. Arrivals from South Africa need to self-isolate for 14 days and PCR or AG on arrival (no mention whether individuals who have had vaccines are exempt). All passengers arriving by land – EU citizens and residents – need a COVID pass. Face masks mandatory indoors (no mention whether individuals who have had vaccines are exempt) and outdoors when unable to maintain a social distance. COVID pass for restaurants, tourist attractions or gyms. Negative AG test for bars, clubs, hospitals, large events. 2-9 January 2022 all bars and clubs closed.
“No one who understands what is going on from a clinical point of view will continue with the red or green list countries or that certain countries can or cannot enter, it just doesn’t make clinical sense.” GP
Italy – State of emergency extended until 31-3-21. All arrivals including from EU must have a negative PCR or AG test (no mention whether individuals who have had vaccines are exempt) and must quarantine if not vaccinated. COVID pass necessary to enter restaurants or cinemas. No one can enter from South Africa. “COVID free travel corridors” include Maldives, Mauritius, Seychelles, Aruba, Dominican Republic, parts of Egypt. Masks mandatory indoors and if not possible to socially distance, outdoors.
“I know no medical doctors who agree that COVID passes necessary to enter anywhere, not cross borders, not go into shops or restaurants. This is not clinically indicated for this virus in this context, it borders on assault.” Medical specialist. “I do not want to live if I have to show a sign to enter and eat, shop or live”. 80 year old. “I have to show a sign to go into the shop to buy food, I can’t breathe, because I am afraid all the time.” 14 year old.
Greece – arrivals must have a negative PCR or AG test and proof of vaccines. Border control has the right to test anyone on arrival and if positive (even if no symptoms), the person/s will be placed in hotel quarantine. Closed for travellers from South Africa. Masks mandatory indoors and outdoors if crowded. COVID pass needed for all shops and restaurants. Over 60s must have 3 vaccines for COVID pass (many EU countries now include this rule).
France – From UK – only essential travel allowed or can enter if EU resident. Negative PCR or AG test required. Self-isolate for 48h, then PCR/AG. Masks mandatory indoors and outdoors in areas like Var (except natural areas, beaches and forests) until 7-1-22 and Alpes Maritimes (except natural areas, ‘urban green spaces’ and ‘edges of water’ such as lakes and beaches).
The border crossing (Eurotunnel) between the UK and France has never been more busy (days before the above ruling came into place). We have never seen more GB cars on the road driving to the south of France. However, many decided to go to Spain further to realising that they have to wear face masks outdoors, even when no one is around.
Spain – All arrivals need a COVID pass or negative PCR or AG test. From ‘High Risk Countries’ all must have a COVID pass and negative PCR or AG test. Face masks mandatory indoors, outdoors where can’t maintain a social distance. Some regions require a COVID pass for restaurants.
Most prefer Spain as a holiday destination now. Scandinavia is also a very popular destination.
UK – All arrivals need a negative AG and have to take a PCR in the UK on day 2. Many are concerned due to the NHS’s policy to test human DNA along with viral RNA/DNA without patient consent. Private laboratories in the UK have confirmed that they do no patient DNA testing without patient consent (in writing). No masks are required outdoors or indoors in restaurants, hotels or other spaces (except in shops, health related settings and public transport such as the underground trains). It must be said that the UK allows the general public to not wear face masks if face masks cause “severe distress” and that no medical or GP letter is required. Some individuals wear a ‘exempt from wearing a face mask’ sign around their necks. We have observed that more or less 50% of individuals do not wear face masks indoors in many settings such as shops (London, Cambridge etc). People who do not wear face masks are treated with respect (November, December); no hostility or rudeness has been identified. Some contexts do however require a negative AG test, such as shows or musicals in London, even if fully vaccinated, which most agree makes little clinical sense and only causes fear and frustration.
In general the “atmosphere of fear” is much less in countries like France and South Africa, compared to the UK, because “it is clear that in the UK the pandemic is government lead, rather than clinically (medical doctors with clinical experience) lead (ideally you want health crises to be lead by both working collaboratively like in Singapore), so you are not in the hands of doctors, and this causes a lot of people a lot of panic” (Medical specialist), however, the UK currently offers more liberty and normalcy in the context of face masks. Face masks were not mandatory in any context, except perhaps health contexts, from the early summer to December 2021 in the UK, with very good clinical results.
USA – Arrivals need proof of vaccines, as well as a negative AG test. Many states such as Florida have no mandatory initiatives not based on good evidence in place, and follow only good clinical evidence. This includes no mandatory face masks, no mandatory vaccines, no need to show evidence of vaccines to enter into shops, restaurants etc. Disney is the only theme park, we are informed, that still has mandatory face mask policies. Colleagues and patients now inform us that they will return to Disney after they have the same policies as the other theme parks in terms of face masks. Most people respond that the USA offers wonderful and evidence-based experiences in many states, and recommends the USA as a travel destination.
Some colleagues in Asian countries now report that “things have changed, we are following the EU and UK’s approaches, which do not work”. Examples include individuals who have had 3 vaccines, not high risk for severe COVID-19, are asked, further to positive contacts in establishments, to remain at home and report for 3 PCR tests, nasopharyngeal samples taken. Individuals report that they “stand for hours outside in the cold and rain” to wait for these tests, which increase risk for any infectious disease. Many Asian countries followed only good clinical evidence from day 1, and we were inspired by their consistent and congruent (Health, Government and General Public) evidence-based approaches, prioritising education, autonomy, liberty and normalcy, however, many now report “pressure from the old world”, despite excellent clinical outcomes due to their initial approaches.
South Africa – Arrivals need proof of negative PCR tests. We have identified no statements regarding proof of vaccines. Face masks are mandatory indoors and outdoors. Many medical colleagues avoid South Africa, due to face mask rules and because they avoid PCR tests if no clinical indications, because PCR tests can remain positive for several months (and many countries then enforce self-isolation or quarantine for extended periods without clinical indications). Most medical colleagues report that they do not believe that South Africa is high risk in the context of COVID, quite the contrary. We have written extensively about South Africa’s risks and strengths. https://www.gov.uk/foreign-travel-advice/south-africa/entry-requirements
We recommend that you consider the government website above, relevant for most countries, as well as the government advice of the host country (where you are travelling to) for up to date advice, as advice or rules often change without much notice.
It is important to note that many countries and many leaders have the best interests of the general public at heart. Medical emergencies or crises or challenges are not easy to understand without good clinical training and extensive clinical experience. Let’s rely on good clinical evidence and liaison with the appropriate clinical professionals.
We have taken note of nations who followed good clinical evidence at the time of our crossing (however, approaches now appear to vary due to “pressure from the old world” we are told) such as;
• India – symptoms and temperature screens in place mere days after the announcement of the outbreak
• Sri Lanka – as above
• Maldives – as above
• Singapore – as above
• Malaysia – as above
• France – focus on the 3 items above (until recently)
• South Africa – focus on the 3 items above (unfortunately face masks are not evidence-based initiatives i.e. based on good clinical evidence, this deters many people from visiting)
and who offered friendly, helpful and supportive input to tourists or travellers such as;
• North America (Hawaii and California – unfortunately masks were mandatory in California at the time)
• France – as above, a welcoming and lack of fear atmosphere is presented, which is appreciated by many
• South Africa – as above
• Italy and the rest of the EU before recent changes where free movement has been discontinued before Christmas
Some countries made it very difficult to cross borders due to rudeness, shouting or increasing risk by encouraging hoarding. Details will not be shared. Some countries stated that it was their aim to make it difficult or “near impossible” to travel, which does not respect the ‘first do no harm’ rule most medical doctors adhere to.
Most colleagues agree that no good clinical evidence or clinical reasoning supports these changes relating to travel or border crossings, and that these changes, associated with deprivation of liberty, autonomy, normalcy and chronic anxiety or frustration increase risk and harm markedly from bio-psycho-social point of view.
It is our understanding that the UK plans to reverse all initiatives put in place mere weeks ago due to this new variant, which most agree, does not pose an increased clinical risk (please see statements previous post). South Africa was asked what their opinion was of the UK’s approach to this variant and the word “hysterical” was used. Many medical doctors and professionals or experts in this field agree that face masks can also be summarised under this heading. South Africa has taken an approach relatively similar to many countries in Asia in many ways, an evidence-based clinical approach, except for the mandatory face mask initiative which has continued to concern most.
Much have changed in the EU and the UK since the following information, below, was provided in October 2021:
Most professionals agree that there is no good clinical evidence that supports routine testing or requesting evidence of vaccines when crossing borders.
• Tests required to cross borders have been discontinued in at least 27 countries such as relating to the EU (this has now changed, as mentioned above).
• Statistics relating to serious cases identified or mortality do not increase further to discontinued testing.
• Most now agree that PCR tests are not reliable routine screening tools, due to the possibility of the tests remaining positive for several months, and have recommended that all routine tests now discontinue for those without signs or symptoms indicating an active infection. https://apps.who.int/iris/rest/bitstreams/1322776/retrieve
• Professionals have raised concerns regarding increased harm and risk secondary to special investigations / medical tests required without clinical indication (direct eg due to nasopharyngeal testing and indirect consequences).
• Most medical doctors agree that medical testing requires clinical indications for the specific person in accordance with good practice guidelines to be lawful and ethical, and that nasopharyngeal testing is not clinically preferable to anterior nasal, oral or oropharyngeal samples, and associated with unnecessary increased risk.
• Many medical colleagues report that they have avoided nasopharyngeal testing or any test not self-administered in the context of COVID-19, and that they now avoid settings where testing is required without clinical indications of an infection.
• Most agree that the gathering of genetic, biometric or personal data through COVID testing, or when sharing evidence of vaccines, should not be allowed, this includes personal photographs, personal videos, date of birth and personal addresses (date of birth and personal address can be shared as part of medical information on medical documents to be kept secure and confidential as medical records by medical/health services), considering some individuals work in high risk fields, and considering that some governments have collected human DNA samples without patient consent during COVID tests.
• “The roadmap, proposed by three members of Singapore’s Covid-19 task force, would scrap lockdowns and mass contact tracing and allow for a return to quarantine-free travel and the resumption of large gatherings. It would even stop counting the daily Covid cases … The good news is that it is possible to live normally with it in our midst,” said Singapore’s Trade Minister Gan Kim Yong, Finance Minister Lawrence Wong and Health Minister Ong Ye Kung. https://apple.news/AJeB9WpBMRm6wyAEE4KrNTg
• “The Western Cape will argue for an end to the National State of Disaster. National Government cannot use this extreme tool indefinitely, especially if we are to grow the economy, create jobs & recover …The hard truth is that we cannot be in this state of disaster forever, and we need to have a frank discussion on how we will continue to manage Covid-19 in the future without relying on this extreme instrument”… “It is simply not justifiable to impose restrictions on the economy, especially at a time when we are facing a terrifying unemployment crisis, and when the data clearly demonstrates that our healthcare platform has more than adequate capacity to respond.” Mr Alan Winde, Premier of South Africa’s Western Cape province
Most agree that it is essential, considering longstanding risk management, for cruise ships to ensure adequate ventilation and space to avoid crowding, especially during boarding, disembarkation, initial emergency and safety drills, “where hundreds or thousands stand together right next to each other in terrible heat often listening to emergency drill announcements in 5 languages, whilst sharing all available germs amongst each other”, Medical specialist. Some ships offer these safety measures in a context of air conditioning, seating and adequate spacing, which benefits the public, especially individuals with certain health conditions. Concerns have been raised regarding dining or food etiquette and supervising children at all times, especially at buffets. Concerns have also been raised regarding mosquito infested public transport in tropical areas where serious mosquito-born illnesses are common. Simple measures can reduce risk significantly.
According to IATA, studies regarding flights indicate the “actual safety of airplane cabins in terms of pathogen transmission”. These include a recent study where Airbus used computational fluid dynamics (CFD) research to create a “highly accurate simulation of the air in an A320 cabin, to see how droplets resulting from a cough move within the cabin airflow”. The simulation calculated parameters such as air speed, direction and temperature at 50 million points in the cabin, up to 1,000 times per second. The same tools were used to model a non-aircraft environment, with several individuals keeping six feet (1.8 meters) distance between them. The result was that potential exposure was lower when seated side by side on a plane than when staying six feet apart in an environment such as an office, classroom or grocery store.
These findings were replicated through an independent study by Boeing, which similarly concluded that, based on the airborne particle count, passengers sitting next to one another on an airplane is the same as standing more than seven feet (or two meters) apart in a typical building environment. https://www.iata.org/en/youandiata/travelers/health/low-risk-transmission/ A United Sates Transportation Command (USTRANSCOM) study demonstrated that released aerosol (and pathogens) was rapidly diluted by the high air exchange rates observed in the airframes. The time the aerosol tracer particles remained detectable within the cabin averaged less than six minutes. For comparison, a typical American home takes around 90 minutes to clear these types of particles from the air. The high air exchange coupled with high efficiency particulate air (HEPA) filtration of all recirculated air, means a commercial aircraft’s air supply system provides protection greater than the design standards for a patient isolation room or a hospital operating room. https://www.ustranscom.mil/cmd/panewsreader.cfm?ID=C0EC1D60-CB57-C6ED-90DEDA305CE7459D
Vaccine Certificates or Vaccine Passports:
Most professionals and medical doctors agree that there is no good clinical evidence that supports vaccine certificates as a requirement to enter shops, restaurants or cross borders for the general public.
The WHO agrees that travel should not be refused for those without vaccines.
There is no current recommendations from the WHO, ECDC or CDC regarding vaccine passports required for shops or restaurants.
We have travelled in countries where vaccine certificates are required to enter shops or restaurants and where none are required; significant anxiety, anger, frustration and expressed low mood are evident in areas where certificates are required. The following is relevant:
• Vaccine certificates required in restaurants and shops have been discontinued after a short period in several countries such as Denmark, and was never introduced in many countries such as the UK.
• Statistics relating to serious cases identified or mortality do not increase or decrease further to these policies and most agree that no good clinical evidence supports these strategies.
• Professionals are concerned that this initiative will contribute to increased mental health morbidity (and eventually mortality) and social risk.
• 40-50% of restaurants or shops do not ask for evidence of vaccines where this is required as per national policy, as per our observation.
• 25-50% vaccines apps are reported to malfunction, especially when required in short succession, as reported.
• Business owners usually allow patrons to enter establishments when the app does not work.
• Vaccine certificate requirements are often associated with no requirement for face masks in establishments, however, most businesses decide to ignore this advice and continue with mandatory face mask policies.
• Most shops or restaurants are not concerned by patrons (or staff) who present with symptoms of respiratory infections.
• Most medical doctors agree that paper copies of vaccine evidence are the most reliable tool and should be used/sufficient for travel (“medical documents have been used in this format for official matters for decades”).
• Most agree that the gathering of genetic, biometric or personal data through COVID testing, or when sharing evidence of vaccines, should not be allowed, this includes personal photographs, personal videos, date of birth and personal addresses (date of birth and personal address can be shared as part of medical information on medical documents to be kept secure and confidential as medical records by medical/health services), considering that some governments have collected human DNA samples (not only viral genetic data) without patient consent during COVID tests (many doctors are concerned that this has prevented the public from getting tested if symptoms or concerns) https://www.gov.uk/government/publications/coronavirus-covid-19-testing-privacy-information/testing-for-coronavirus-privacy-information-quick-read–2 and considering some individuals work in high risk fields such as Police or individuals working in child protection contexts.
It is relevant to consider data relating to violence at work, March 2019, https://www.hse.gov.uk/statistics/causinj/violence/work-related-violence-report-19.pdf, and to consider that this research was not focused on individuals working in high risk fields, where stalking behaviour, threats, aggression and violence can be common. It is relevant to consider the recent increase in violent behaviour, as reported earlier. Violence (or threats) at work in CAMHS or Social Care settings has increased markedly, as reported by colleagues. We have previously written extensively regarding these concerns.
Further to recent liaison with a colleague in Asia we are informed that the focus remains on good clinical evidence; identifying a raised temperature and enquiring about symptoms. The focus is placed on clinical evidence of a clinical infection and associated risk. The responsibility is however given to the specific person or patient. No sworn statements, completion of forms or evidence of vaccines are required. Tests are encouraged only further to clinical indications of a clinical infection; symptoms or signs such as a raised temperature. This is however now changing in some countries, as mentioned above.
“I am asked to get 3 vaccines, but for what, even with 3 vaccines I am still forced to wear a face mask, no good evidence, to get tested when I do this or that even if no symptoms, to go into quarantine hotels even if no symptoms, so that they can make more profits, where are the lawyers in all of this, this is not just cruel, it is not just psychological warfare or assault, it is far worse than that, this virus does not necessitate any of this, this is sadly about profit and power and a long game we perhaps don’t see, but it will hurt most people irreversibly”, Medical Specialist, expert in the field for several decades.
Let’s listen to professionals, experts, medical doctors, the general public, to adults and to children, because they are telling us what they are angry, anxious and sad about. Let’s address their concerns. This will increase education, compliance, calm and positive outcomes.
Many are saying that they will get vaccines “if it means no masks, no tests, no quarantine, bring back normal and freedom, but no, we are coerced and forced and lied to, and we still need to be the parrot in the cage with the muzzle, now I am asked to trust”, 75 year old.
“The routes open to travel are most interesting, it speaks of political agenda and not clinical. Clinical thinking has patterns easy to see, because most doctors understand viruses or infectious diseases and vaccines, and political patterns are also now predictable to see after nearly two years, who stands together and who stands with good evidence is clear” GP with law degree.
“Every medical doctor I spoke to said they will bring darkness before Christmas, because how better do you make a statement, cause fear and bring control, and we knew this new variant had to be sold as if it was a big risk, how else would this be justified, and more testing and more vaccines justified, it is very bad, my spirits of hope have been broken”, Medical Specialist working with children.
Let’s be honest. Let’s follow good clinical evidence. Let’s listen to professionals and experts in the field. Let’s listen to medical doctors.
To protect the future we need to focus on preventing harm and risk for our children.
Please see previous post for information relating to protecting children with statistics illustrating increased risk and harm by 1000% in some cases.
“It is super interesting how the climate is a perfect distraction, and another story of fear, so that we don’t focus on current mental health problems and child abuse, on the lies, corruption, profit and gain in terms of power, making millions off the backs of vulnerable children in CAMHS or social care, look at what the (NHS) leaders (or managers) take home every year, look at what the children get in terms of services, everything on the cheap, not much hope to get better – look at what is going on right now – who worries about the future if your children are not safe right now (see current child abuse statistics and relating to mental health) – look at animals – they protect their children – first and always – when their house is in order and their children are safe and healthy – then they plan for tomorrow. Most animals don’t prioritise profit and power above their children, perhaps this is why children are suffering. We fall for the distractions and the ghost stories like 3 year old children, we should be adults and ask the right questions”, Psychologist, 20 years of experience in CAMHS
“Have we learnt nothing from World War II – statements such as ‘we were just following orders, obeying the law’, what about natural law, what about previous laws put in place to safeguard. Have we learnt nothing. Have we forgotten. Are we so busy with electronics that we don’t look up and see freedom is missing. People say they don’t get off their machines or electronics, because they cannot face the world, life, reality. So no one asks questions. Everyone is mute. No one says anything. Everyone says they feel or are terrorised like never before, and doctors say there is a war against them, because emergency laws have made all their opinions invalid. My friends tell me to watch the documentaries about how people are making billions during the pandemic. This is worse than anything, because so many players are involved and it is sold as ‘safe’ when it is the opposite.” Veteran, medical background
Let’s work together – good evidence in relation to health, mental health and social protection is step 1, education is step 2, maintaining calm and positive mental states step 3.
We recommend vaccines for most adults, especially adults who are high risk for severe COVID-19. We recommend that patients talk to their doctors about risks and benefits for themselves as individuals. This is a clinical decision and a clinical approach is required. Most doctors continue to report that they prefer the Astra Zeneca vaccine, however, most report it is difficult to find this vaccine or the booster in the UK. Many prefer this vaccine due to the organisation’s vow to not make a profit during the pandemic, which is an ethical step to take during a global health crisis. Many report that “Astra is penalised because of their vow or sabotaged, because other organisations want to profit during the pandemic”.
We, like most of our medical colleagues, do however not agree that vaccines for COVID-19 should be mandatory. It is our understanding that the WHO also agreed with this sentiment in October (we have not reviewed their guidelines on this matter since October). Coercion is not a clinically appropriate, medico-legal or ethical approach. We would however recommend education and making it clear that vaccines are associated with bio-psycho-social benefits (bio – protection against this virus to avoid serious symptoms or hospitalisation, psycho – less anxiety regarding ‘getting sick’ and social – more doors will open in terms of joining social events or busy markets). This suggestion has been posed to us – that individuals are informed that further to vaccines, they would enjoy certain benefits such as ‘never hearing the word face mask again in any public settings’ – most of our patients and colleagues report that this would improve compliance with 1000% or more.
We recommend following good clinical evidence and the advice of medical doctors with good clinical training and clinical experience. We recommend that individuals with a raised temperature or symptoms relating to a cold or flu remain home and get tested. We recommend that you wash your hands before eating or touching your face. These are examples of evidence-based approaches.
As mentioned before, we always recommend following government guidelines, recommendations and rules. If you have concerns, raise concerns and ask questions in appropriate and respectful ways. You will be surprised to find how may share your concerns and want to hear from you. However remember Newton’s 3d law – if you push hard, you will often receive the same response, so be gentle, do your homework, have the right priorities in mind, but don’t give up. “It always seems impossible until it’s done.” Nelson Mandela
Lao Tzu “A leader is best when people barely know he exists, when his work is done, his aim fulfilled, they will say: we did it ourselves.”
“The best leaders are people who don’t want to be leaders or who don’t want to have a spotlight on them”. 16 year old child
Current Statistics – deaths/million:
Singapore 139, South Korea 83, Malaysia 966, Thailand 304, Maldives 687, Sweden 1476, Finland 257, Norway 212, Denmark 515, South Africa 1539, UK 2184, France 1707, Italy 2236, Spain 1877, Portugal 1816, Greece 1796, Belgium 2394, Netherlands 1134
Let’s report accurately and look at the numbers. Let’s learn from countries who have managed previous Coronavirus outbreaks successfully.
We were interested to see that some countries such as the UK state that positive tests are referred to government officials (Test and Trace – we were informed that they are two separate organisations), no medical doctor’s opinion or recommendation will be considered. This approach is very different compared to South Korea, Singapore, Sweden (we understand Scandinavia too) or South Africa, where medical opinions and recommendations are prioritised. Public Health England shares these concerns.
We were in Asia for the first few months of the pandemic. We were inspired by their calm, positive, evidence-based, congruent and consistent approach. No mandatory face mask initiatives were present during these times in Asia where we travelled, including on airplanes. No face masks are currently mandatory in Sweden, Finland, Norway and Denmark. We have previously provided information on clinical outcomes.
Following good clinical evidence is a simple, yet effective approach, and the first step to protecting children’s well-being, development, mental health and physical health.
A medical colleague in Cambridge recently reported “I want to find normalcy for Christmas, my health needs this to carry on, it is urgent”. Many share his wishes. Concerns relating to serious medical problems, not related to COVID-19, have increased markedly for many (many relating to the immune system or chronic ‘stress’). Referrals for serious mental health concerns have also increased markedly, 500% or more, based on reports, including relating to professionals with no predisposing factors. Co-morbid concerns include increase in aggression and violence, often at home (at least 300%, many report 10x this figure), child abuse (nearly 100%, many report at least 20x this figure), drug and alcohol use (400%, many report 10-20x this figure). Many report “I used to have a few glasses of wine on a Saturday (1-4), now I drink every day, starting in the morning, and I mostly drink vodka (up to 9 units per day)”, 50 year old professional. We have not liaised with one person who have not reported a marked increase in alcohol consumption “due to rules, not fear of the virus”, as reported by most.
Colleagues including medical doctors are asking where they can travel during Christmas to find;
• autonomy (“where I am allowed to educate myself and follow good clinical evidence”, GP)
• a focus on good clinical evidence (eg no mandatory face masks in the general public indoors or outdoors or in flights, no mandatory tests when no clinical indication, no mandatory vaccines and boosters, and “no showing the dreaded sign on your phone that proves you have been vaccinated, so that you can enter or eat or shop or buy food i.e. live”, medical specialist).
“Crossing the Eurotunnel I am usually asked – has your dog been vaccinated – this time I was asked only one question – have you been vaccinated. It is time to follow clinical thinking for this infectious disease and this virus – it is not hard.” GP
Many are concerned that no flights offer the above 4 protective factors, “which means we are all stuck in dark prisons, because many doctors want to avoid rules not based on good evidence”, GP. Hong Kong’s Cathay Pacific has an option, however, very expensive.
Good clinical evidence is recognised not only by professionals in the field, by medical doctors with extensive clinical training and clinical experience, but also by the general public and children.
We have never been approached by more individuals in Cambridge sharing thoughts or concerns – all congruent with this summary. Various fields are represented including International Travel leads for County Councils, Criminal Justice, Health, Law, Social Care, Education, Optometrists, Dentists, Driving Instructors, Hair Stylists, Bakers and Business leaders.
Children report “I want normal to come back for Christmas, I don’t want to show a sign to be allowed to go into a shop or restaurant, and I don’t want to be forced to wear masks, I am tired of being forced every day, a mask is a symbol of submission, control and being a prisoner without a voice, I am tired of it, my friends all say it will never end”, 14 year old planning to study Law.
Referrals of CAMHS have increased by at least 1000% as reported. Waiting lists were usually 100 children, sometimes 300 for certain teams, however, teams are now reporting waiting lists of at least 1200 children.
Children are informed that they have to wait 3-5 years for an assessment (no longer 2 years).
Children are also informed that they will likely not be assessed by a Child Psychiatrist (the only medical specialist with specialist training in child mental health and neurodevelopmental problems such as ADHD or ASD). Child Psychiatrists are now informed that CAMHS (Child and Adolescent Mental Health Services) prefer to use psychologists or other doctors without specialist training such as paediatricians or adult psychiatrists, because they see “up to 10x more children per day”. Child Psychiatrists have raised concerns regarding inaccurate diagnoses, prescribing and over prescribing in this context. More at the end of this posting.
Paediatricians, nurses, social workers, psychologists, therapists, adult psychiatrists or doctors without specialist training (staff grades) and other mental health professionals, such as occupational therapist or speech therapists, are exceptionally valuable team members with valuable and unique skills required for CAMHS teams to provide families with a multi-disciplinary treatment plan to improve prognosis (short term and long term outcomes). Children cannot function well if their parents present with serious and untreated mental health problems. A systemic approach is required.
Every professional has a different perspective based on training and experience (and sometimes interest). We learn from these professionals on a daily basis and they continue to expire us. For example – We have a family therapist colleague in Cambridge, always insightful and measured, able to assist families and change a poor prognosis into a good prognosis with a few sessions. We have psychology colleagues with exceptional skills in CBT to assist children with severe OCD (Obsessional Compulsive Disorder) and various phobias, where most therapists or doctors will struggle to change a poor prognosis into a good prognosis. Psychology colleagues also provide excellent insights in terms of children’s learning profiles (different learning strengths and weaknesses); treatment plans usually require insight into learning profiles.
Paediatric colleagues offer helpful insights in relation to children presenting with head injuries, Migraine or Epilepsy, or general health concern such as cardiac problems. Medical nursing colleagues are incredibly valuable during medical emergencies due to their consistent level heads and medical or nursing contributions. Psychiatric nurses are incredibly valuable during psycho-social emergencies, many have backgrounds working as Police Officers, which makes for incredibly valuable team members due to their ability to think systemically and manage risk successfully (deescalate rather than escalate).
Benefits of working with colleagues in multi-disciplinary areas such as nurses, psychologists, different therapists, paediatricians are too numerous to describe.
Most Child Psychiatrists have extensive training and experience in assessing and managing high risk and complex presentations relating to neurodevelopment (eg ADHD or ASD) and children’s mental health, and training and experience in at least 5-6 psychotherapies, along with social interventions (knowing which child and which presentation will likely benefit from which psycho-social approach), which means medication can often be avoided or kept to a minimum, and children’s needs can be identified and met without delay.
Differential diagnoses (different diagnoses that present as similar) and comorbidities (eg children with ADHD often present with many comorbidities such as difficulties relating to depression and anxiety) are frequent in CAMHS. The word ‘CAMHS’ usually refers to Tier 3 CAMHS – children’s specialist services, and most children, at least 90%, are usually referred with complex (possibly more than one difficulty, challenge or diagnosis) and high risk presentations. This varies from team to team for example children in Cambridge often present with a lower risk compared to children in Chester. CAMHS also should have a Tier 1 (before referral is made to the GP – focussed on prevention) and a Tier 2 (Primary Care or GP level input required), also often aimed at prevention. Serious mental health problems in children such as relating to possible depression or anxiety disorders are usually referred to Tier 3. Tier 4 refers to inpatient care, which is usually avoided where possible with children (only in high risk contexts are children admitted where clinically indicated – many high risk children are not admitted). Problems such as school refusal (without concerns relating to mental health) or night terrors can often be managed within Tier 1 or Tier 2 and no specialist mental health care is usually needed.
Child Psychiatrists are now (2021) informed by medical directors or IT departments of some NHS Trusts that they continue to prefer that they work remotely, which most are happy with (many CAMHS teams have limited office space, some specialists are asked to work in kitchens or storage rooms and often no admin or computers available), however, that they need to remain in the UK during this time at all times, which means many teams are now without any Child Psychiatrist or doctor with AC status to support children under the Mental Health Act. Many, including professionals in leadership positions in the NHS for 30 years, report “this is personal and due to Brexit”, which makes little sense. Specialist children’s mental health teams are now losing specialists or have no specialists/consultants in Child Psychiatry due to these decisions, not based on national or international policies or laws. Most medical doctors or specialists are happy to be in the UK within 24-48 hours if clinically indicated for any patient including for NHS work, however, in at least 10 years, this has never been clinically indicated, required or asked of us (we have provided online assessments and consultation, remote work, including attendance of Court and Tribunals for charity and private organisations, as well as for the NHS, since 2009).
Child psychiatrists usually work in a context where social workers, emergency department doctors, nurses and other professionals work with them (with the ongoing support and consultation from child psychiatrists). In person attendance is not often required, even in emergencies. Exceptions relate to for instance hard to reach children who initially refuse to engage. In person assessments are then essential, however, in the last 10 years we know of no NHS Trusts who have offered services to hard to reach children, children who refuse to engage. Many children and families or carers report that they prefer it if child psychiatrists work remotely, because then “we can stay at home, it is easier and more practical” and many report “it is less scary”. We, as an organisation, complete regular surveys and audits in this context.
We have offered NHS Trusts remote work, online work, and we have engaged in online consultation to assess and treat children in the UK since 2009 with good clinical outcomes. Our work will not be continue with this new change in place. No national or international policy supports this change. This timing, during this pandemic, could not be worse, or more curious. There are 1500 Child Psychiatrists in the UK, 0.4% of the medical workforce. Child Psychiatrists are now on long term sick leave stating “the system is broken, children’s care is not prioritised, I can’t work like this”, taking early retirement or are leaving the UK. Many of our colleagues now work abroad.
Please see more information relating to increased risk and harm for children during the pandemic at the end of the page.
We liaised with groups of American tourists in Italy, all reported that they prioritised the above 4 items and that “this is the best time to travel”, as reported by medical doctors. None wore face masks (this was allowed in this context – being outside).
We must add that this was in October/November, before the dramatic change in the EU recently which now means no freedom of movement in the EU.
We liaised with a group of American tourists in London recently (November/beginning December), most were aged 75 to 85. Most presented with more than one serious chronic medical problem including various malignancies (many were high risk for severe COVID). Many showed their wheelchairs, prostheses, wigs and reported hair loss due to various treatments, “but nothing will stop us to live our lives, I have had two different cancers, do you think I have time to waste and I can’t think for myself”, as reported by a 75 year old. Many reported “life is for living, no day must be wasted, I have no days to waste for agendas that are not mine, when someone tries to scare you – always be suspicious, that is how wars are started, good evidence should be in charge, always, we’ve been through war in our life times, we recognise human problems when we see it, and we are doctors – we know what is virus and what is not virus.” None wore face masks (this was allowed in this context – in a hotel, pub, restaurant or outside).
Most report that they aim to avoid contexts where masks are mandatory. In the UK at the time face masks were not mandatory in any indoor establishments such as hotels or restaurants, however masks were mandatory for shops and public transport (not all taxis). Masks were not mandatory in any context in the general public, except for health settings (however masks were handed to patients with unwashed hands in hospitals) until a few days prior to our meeting.
More or less 50% of the general public wore a sign around their necks stating that ‘I am exempt’ and that they do not need to wear a face mask in any context, based on our observation in London and Cambridge, as well as surrounding areas such as Milton Keynes. Tests were required before engaging in general life such as watching a show in London, which many were unhappy with, and many in the general public reported that their friends now insist on a negative test before they visit, which is unfortunate. More or less 50% of individuals we liaised with reported that close friendships had “broken up because of imposed rules”. “Great dramas about boosters and timing and why Astra Zeneca is not available are very sad and not clinically sensible, it is clear this is political not clinical”, GP. “The little test centres set up saying ‘so you tested negative today, have another test’ is also very far from clinically reasonable or appropriate, and motives are apparent”, GP.
“Most people, at least 90%, from observation, wear masks in ways that will increase biological risk (relating to infectious diseases). There is no good evidence to support masks in the public, but if you do want to wear a mask, wear a mask safely, otherwise you increase biological risk for infection, different infections, significantly. I see people put them open on tables in restaurants, others walk by and cough on them. I see people in hospitals hand patients masks with their dirty hands, masks that have been open all day, as people walked next to them coughing and sneezing. You make a mask a little petri dish for infections and then you breathe into it all day.” GP. The WHO provides information on safe mask wearing. We have previously provided links.
Many now report “I am keeping a good eye to see which countries make their rules more strict or cruel before Christmas, because it says everything, especially when not based on good evidence, because almost all good doctors and professionals said in the Summer that this virus has no where left to go to become more dangerous (following the pattern of previous viral outbreaks in this context), now presenting with much more mild symptoms like hay fever sniffles mostly – political patterns during these days are predictable, we knew people would turn off more lights before Christmas, and I will plan where my family moves to next year by what a country prioritises – my vote is good evidence, freedom, equality, autonomy, the right to have a normal life and be educated and make your own decisions, with other words, to live in the light, not the dark ages – my vote is Florida” (medical specialist, 20 years experience). Many colleagues report that they plan to move to Florida. https://www.flgov.com/2021/11/18/governor-ron-desantis-signs-legislation-to-protect-florida-jobs/
We certainly recommend sharing concerns with authorities, however, in curious and respectful ways with the aim to learn, to educate yourself and your loved ones along with the general public, to protect and work together with all parties and all nations. Education is the first step to liberty, autonomy and collaboration.
Liberty, autonomy, education, normalcy, following good clinical (medical or scientific) evidence are very significant protective factors for general health (strong immune system), mental health and social well-being (eg peace, safety); this is based on consistent and longstanding good clinical evidence. Most medical doctors always adhere to these principles starting with first do no harm.
Many is concerned that risk is increased and harm is caused by initiatives not based on good clinical evidence, that continue and escalate, now, 2 years after the onset of this viral outbreak.
“They force you to have 3 vaccines, which is not clinically necessary or recommended for most, then they force you to still wear a face mask, never good evidence and harms many or most, then they force you to still be tested like a guinea pig for no clinical reason, and be quarantined, also no clinical reason – there is no clinical evidence for any of this, and if medical doctors did any of this, even one thing, without good clinical evidence and patient consent, it would be considered assault, this we all know”, medical specialist with law degree.
Many colleagues report that they have cancelled their holidays to countries such as South Africa, not due to the traffic light system, which most agree is not based on clinical evidence and not appropriate during this pandemic in most contexts, but due to mandatory face masks and “rules depriving liberty, autonomy and normal”, GP.
Countries offering the above protective factors at the moment (this often varies from time to time):
• States in the USA such as Florida
These countries present with much better statistics compared to many others. Countries who followed good clinical evidence from the start, such as Singapore or South Korea, continue to present with good statistics, however, many report “pressure from the old world” to follow their lead.
We want to thank the countries and leaders who follow good clinical evidence and prioritise protective factors, especially when a consistent approach is applied. You are saving lives, especially lives of children.
More nuts for the winter – more information to assist with education: Quotes, definition and helpful information (Oct and early Nov)
Indiscriminate mandatory face mask policies have been discontinued in several countries such as Denmark, Finland, Norway and the UK. Statistics relating to serious cases identified or mortality do not increase further to discontinued face mask wearing, the opposite is often observed. https://coronavirus.data.gov.uk/details/cases
Statistics and Definitions: Many agree that it is important to consider statistics relating to serious cases and mortalities, and are concerned that medical data is not accurately recorded.
Many families and medical colleagues report ongoing concerns regarding ’cause of death’ reported as COVID-19 when patients presented with longstanding health problems such as malignancies or recent trauma such as motor vehicle accidents. One major leading hospital in the UK recently reported to a family that they get a “financial grant” for every COVID-19 death. The hospital did however agree to change the ’cause of death’ for the family member.
Many professionals agree that COVID-19 deaths are recorded in such a way, due to definitions or guidelines, that mortalities due to COVID-19 is likely much lower than recorded in many countries; “people who die with positive tests a month ago, who never had symptoms of covid, but died in a car crash, are marked as covid deaths …” and “many countries mark the same person as ‘new case’ in their country, because they don’t bother to take a history or to record medical information at all or accurately, whatever happened to accountability and good medical practice”, Medical specialist.
Some nations, committed to accurate medical reporting, have audited statistics, as per good medical or clinical practice guidelines. “On re-evaluation by the National Institute of Health, only 12% of death certificates have shown a direct causality from coronavirus, while 88% of patients who have died have at least one pre-morbidity, many had two or three.” Prof W Ricciardi, Italy
The WHO international guidelines define deaths due to COVID-19 as “a death resulting from a clinically compatible illness, in a probable or confirmed COVID-19 case, unless there is a clear alternative cause of death that cannot be related to COVID disease (e.g. trauma). There should be no period of complete recovery from COVID-19 between illness and death.”
Public Health England defines a covid-related death as “a death in a person with a laboratory-confirmed positive COVID-19 test and died within (equal to or less than) 28 days of the first positive specimen date”. Many agree that this definition will result in “an enormous amount of false positives”.
Most professionals agree that these marked variations in definitions and guidelines will also help to explain the different mortality rates due to COVID-19 in different countries.
We have been asked to comment on COVID-19 in the context of other relatively common infectious diseases and mortality or infection or case fatality rates. We have, but will share details on this forum in later posts. However, in 2020, before vaccines were available, the following statements were published:
• “80% of the time COVID-19 is a mild disease that feels like a minor cold or cough.” Prof P Piot, Director for The London School of Hygiene and Tropical Medicine
• “95.5% of the general population will likely not require hospitalisation, only 4.5% of the global population will likely require hospitalisation if infected with SARS-CoV-2.” The London School of Hygiene and Tropical Medicine
• “Only 4% of those younger than 20 years could be at increased risk for severe COVID-19.” This is an important and relevant statistic to consider when making ethical and lawful decisions regarding children in the context of the pandemic. “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
• Most medical doctors agreed in early 2020, “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
• Organisations including the WHO have reported on previous flu (influenza and coronavirus) outbreaks and related mortality rates before the pandemic: The WHO reports “650 000 people worldwide die of respiratory diseases linked to seasonal influenza each year, up to 72 000 of these occur in the WHO European region”.
• A case fatality or mortality rate is estimated to be more or less 2% for COVID-19, some report 1-2%.
• The Imperial College, London, estimated an infection mortality rate for COVID-19 of more or less 1.15% in the UK and high income countries in October 2020.
Mortality and morbidity rates can vary depending on a multitude of risk and protective factors, and over time, as is often observed in various infectious diseases or outbreaks. These mortality rates are similar to, and sometimes lower than many other infectious diseases for many. Many medical doctors continue to manage biological risks, with a risk much higher than COVID-19, on a daily basis without face masks, but by following good clinical evidence.
We have expressed our concern regarding lack of education in the context of relatively common infectious diseases in the UK. Prevention cannot be achieved without education, especially in healthcare. Helpful information often available at https://travelhealthpro.org.uk.
Vaccines and Boosters:
Prof S Gilbert, lead scientist for the Oxford vaccine, Astra-Zeneca, reported, Sept 2021, that “immunity from the vaccine was holding up well, even against the delta variant. While the elderly and those who are immune-compromised may need boosters, the standard two-dose regimen is providing lasting protection for most people … I don’t think we need to boost everybody. Immunity is lasting well in the majority of people” and there is “nowhere left for Covid to go to mutate into a deadly or much deadlier variant … there is no reason to think we will have a more virulent version of Sars-CoV-2 …viruses tend to become less virulent over time as they spread through a population becoming more immune.” https://apple.news/AtJ4KMvbsSda6Od1APWlXtA and https://apple.news/Aqd2ODvgdRbKOdrAbWewudQ
WHO “Vaccines are effective for protecting people from COVID-19. Governments and/or institutional policy-makers should use arguments to encourage voluntary vaccination against COVID-19 before contemplating mandatory vaccination. Introducing booster doses should be firmly evidence-driven and targeted to the population groups in greatest need. The rationale for implementing booster doses should be guided by evidence on waning vaccine effectiveness, in particular a decline in protection against severe disease in the general population or in high risk populations, or due to a circulating VOC. To date, the evidence remains limited and inconclusive on any widespread need for booster doses following a primary vaccination series. More evidence is needed on the use of the different COVID-19 vaccines in children to be able to make general recommendations on vaccinating children against COVID-19. Vaccine trials for children are ongoing.” https://www.who.int/emergencies/diseases/novel-coronavirus-2019/covid-19-vaccines/advice and https://www.who.int/news/item/10-08-2021-interim-statement-on-covid-19-vaccine-booster-doses
Recommendations to safeguard children – most colleagues recommend ending indiscriminate mandatory initiatives, not based on good clinical evidence, where evidence exists that harm is caused and risk is increased without delay.
Most colleagues agree that face masks and vaccines should not be mandatory for children, unless specific indications, such as children presenting as high risk for severe COVID-19, then vaccines should be recommended, but still not mandatory.
Most children report significant distress and impairment secondary to mandatory mask wearing policies. Physical health, mental health and social risk is increased by initiatives not based on good evidence. Children with learning disabilities, ADHD, ASD or serious mental health problems have particular difficulties, however some children with significant anxiety report that “I will never stop wearing a mask, I can hide from the world and be safe from the world’s germs”, 16 year old. “It seems people with a premorbid personality of severe anxiety or insecurity are more comfortable with mask wearing”, GP.
Many children have not engaged in school for nearly 2 years due to school refusing to see children who had not been seen by CAMHS yet, and due to CAMHS long waiting lists. Children are harmed in many ways, considering a systemic view.
Please consider full guidance of every organisation on every topic.
Social risk has increased up to 4x (400%), some say more, for children due to indiscriminate mandatory initiatives not based on good clinical evidence, but with evidence that bio-psycho-social risk is increased and harm is caused. Initiatives include mandatory face mask wearing indoors/outdoors, routine testing without clinical indications, stay at home messages, curfews, lockdown, self-isolation or quarantine (including hotel quarantine). Statistics relating to increased risk published in 2020:
• 80-400% for children living with domestic abuse, parental drug/alcohol dependence and severe parental mental illness, England’s Children’s Commissioner. 18.6% of children in England (2.2 million) lived with domestic abuse, parental drug or alcohol dependency and/or severe parental mental illness before the pandemic. WHO. Ms Bhatia, deputy executive director, UN Women, reports “it provided institutional cover for people not being able to leave the house. And so it just was, if you will, the perfect set of circumstances for a perpetrator of abuse”.
• 300% in general violence. 80% in domestic violence, National Domestic Abuse Helpline. In the UK, calls, emails and website visits to Respect, national domestic violence charity, increased 97%, 185% and 581% respectively. “In the UK 14 women and 2 children were murdered in the first 3 weeks of lockdown, the highest figures in 11 years.” WHO
• 400% in alcohol abuse, Alcohol Change UK. The Royal College of Psychiatrists reported, Sept 2020, “8.5 million adults drinking at high risk (versus 4.8 million Feb 2020), while number of people addicted to opiates seeking help in April at highest level since 2015”. Bans on alcohol sales often increase use of illicit drugs.
• 30-65% in child abuse, 60% in online sexual abuse, NSPCC, 90% in child sexual exploitation, NCMEC. Baseline before pandemic: “50% of children aged 2-17 suffered violence and 75% of children aged 2-4 years regularly suffered physical or psychological violence. Globally it is estimated that nearly 50%, 1 billion out of 2.2 billion children worldwide, aged 2-17, experienced child abuse in the past year”. WHO
Mental health risk has increased up to 4-10x (400-1000%), some say more, for children due to indiscriminate mandatory initiatives not based on good clinical evidence, but with evidence that bio-psycho-social risk is increased and harm is caused. Initiatives include mandatory face mask wearing indoors or outdoors, testing without clinical indications, stay at home messages, curfews, lockdown, self-isolation or quarantine. Countries continue to report concerns such as “suicide rates soar”. We were informed of the following pattern in one example: >500 calls per day from individuals with suicidal ideation before the pandemic, 2x more during lockdown and 4x more currently (October 2021). Concerns appear to have doubled in CAMHS for children between October 2021 and December 2021, as per reports.
Children waiting for appointments at NHS CAMHS (Child and Adolescent Mental Health Services) in the UK has been described as record high (October 2021). One Child Psychiatry consultant usually sees 50 children per year, significantly less if complex or high risk cases. Many children are routinely informed that they have to wait at least 2 years for an assessment (more recently 3-5 years), which can relate to a significant increase in morbidity or complications and which can result in significantly poor prognoses.
A 33% year-on-year increase in CAMHS referrals has been reported in the UK (between 2020 and 2021). Public Health Scotland has reported that the number of children and young people waiting a year or more for specialist mental health care has increased by almost 115% in the last 12 months.
Many CAMHS teams don’t accept referrals of children who externalise, rather than internalise, or who refuse or are unable to attend clinic (due to eg social phobias, germ phobias, agoraphobias etc) which means statistics are much worse than presented.
Private organisations or doctors, often with little appropriate training or experience, are now contracted to manage CAMHS waiting lists. CAMHS teams are reporting “we are told we cannot ask questions about their training or experience, we have to work with them”. Families report that they have written to CEOs of NHS Trusts due to concerns regarding these matters, but that “CEOs often change, so by the time I wait for a response, it is a new person”, mother of 15 year old child, October 2021.
We have previously raised serious concerns regarding professionals with no training in Child Psychiatry (training or experience in identifying serious mental illness or neurodevelopmental problems such as ADHD or ASD) or Medicine (to rule our medical problems that can often present similar to mental health or neurodevelopmental problems) offering children assessments in CAMHS. It is not usual that some children wait 5 years before assessment by a child psychiatrist, referred due to treatment resistance when diagnosis was never accurate. In our experience, it is not unusual that 30-50% (sometimes 60%) of children in ADHD teams are not correctly diagnosed. It is also not unusual to identify 5 year olds on 3 different psychotropic medications (nearly always inappropriate) with serious side-effects (unacceptable).
Medical and legal colleagues, as well as senior government officials and business colleagues always insist that their children are seen by a Child Psychiatrist if presenting with concerns relating to neurodevelopment eg ADHD, ASD or mental health, why should the general public not get a specialist in a specialist service?
Comprehensive initial assessments in CAMHS, screening for serious mental illness, neurodevelopmental problems and medical problems, without delay, further to referral, providing a bio-psycho-social impression and recommendations, will improve short term and long term prognosis markedly, as well as outcomes in adult life and for the patient’s children and children’s children.
A comprehensive assessment, by an appropriate specialist, with appropriate training and experience, can often be achieved in one 90 minute session, however, sometimes 2-3 sessions are required (if complex or high risk). Let’s get this right from the start. Children often present to CAMHS with 10 lifetimes of losses, trauma and challenge, let’s not perpetuate the harm. Let’s be honest, let’s offer children services associated with integrity and honour. We teach by doing.
We are sometimes asked to allow doctors specialising in Paediatrics to attend our clinics as part of their training; it is not unusual that these doctors report that their 3 year specialist training in Paediatrics only includes 1 day of training relating to ADHD or ASD or mental health, which is the day they spend with us observing 1-3 cases (and often all 3 appointments cancel or do not arrive).
This must be compared to Child Psychiatry training (CCTs in Child Psychiatry) where doctors specialising offer direct assessment and treatment to at least 100 children per year (including ADHD and ASD) under supervision; this includes therapeutic training in at least behavioural therapies, CBT (cognitive behavioural therapy), CAT (cognitive analytical therapy), psychodynamic therapy and systemic family therapy, as well as (sometimes) creative therapies such as play, drama or art therapy. It is essential that these therapies are available at all CAMHS clinics; children presenting with a significant history of trauma or loss (most children in CAMHS in most cases) often require CAT or psychodynamic therapy to move forward and achieve clinical goals.
Children with mental health problems often present very differently to adults with mental health problems. Mental health problems, neurodevelopmental problems (eg ADHD or ASD), medical problems and social risk (eg abuse or anxiety due to threat) can often present very similar in children (differential diagnosis), it is therefore essential that professionals who offer initial assessments, offer comprehensive assessments based on adequate training and experience to ensure diagnoses are accurate. “Child psychiatrists usually screen for everything including health problems during assessments, so assessments are very comprehensive usually”, GP.
The WHO reports that medical problems are often missed in mental health patients, leading to increased morbidity and mortality (life expectancy reduced by up to 20 years). Clinical goals should include accurate diagnoses for children.
Recently, the focus in Health is on financial or political matters, however, the focus needs to be on clinical matters if reduced morbidity, reduced mortality and good clinical outcomes are the goals.
Most child psychiatrists agree that the “NHS could have a good capacity to meet the children’s needs if there were fewer managers (routinely 5 per doctor or therapist in some clinics), especially with zero child psychiatry or medical experience, more or some admin support, more private offices with desks as well as general support for the professionals in the team, especially listening to the professionals when they identify problems, such as I need someone to post my clinic letters on time”, as reported by a child psychiatry consultant colleague.
Statistics relating to increased risk published by MIND, Young Minds and Samaritans in the UK, 2020:
• 75-80% in mental health concerns for individuals with a relevant mental health history
• 55% increase in mental health concerns for individuals without a relevant mental health history
• marked increase relating to self-harm and suicidal ideation or attempts
Baseline statistics prior to the pandemic indicate that in England more or less;
• “1 in 4 people will experience a mental health problem of some kind each year,
• 1 in 6 people report experiencing a common mental health problem in any week;
• 1 in 5 people have suicidal thoughts,
• 1 in 14 people self-harm,
• 1 in 15 people attempt suicide,
• 1 in 8 adults with a mental health problem are currently getting any kind of treatment.”
Many believe statistics are “better for children compared to adults”, however, this is not the case in most domains, and most children with social risk or serious mental health concerns are not identified. Many believe “mental health problems get better when you get older so longer term consequences will not be severe”, however, considering a global perspective, prior to this outbreak, in developed and developing countries, as reported by the WHO, “depression is one of the leading causes of disability. Suicide is the second leading cause of death among 15-29-year-olds. People with severe mental health conditions die prematurely – as much as two decades early – due to preventable physical conditions.” The WHO commented 20 plus years ago that “around 450 million people currently suffer from such conditions, placing mental disorders among the leading causes of ill-health and disability worldwide.”
Mental health problems can occur as once off presentations, as recurrent presentations or chronic presentations, much like many medical problems. Individuals who have presented with a mental health disorder once, such as depression or an anxiety disorder, are usually at risk for recurrence; prevention (or preventing escalation or deterioration) is therefore the key to effectively managing most mental health disorders. Prevention starts with evidence-based protective factors.
Evidence-based protective factors for general health, mental health and reducing social risk include, but is not limited to, normalcy, education, autonomy, liberty and maintaining a calm and positive mental state / environment. Confidentiality and consent are also important items to protect the general public in the context of Health.
Respecting Consent: Most agree that the gathering of genetic, biometric or personal data through COVID testing, or when sharing evidence of vaccines, should not be allowed, this includes personal photographs, personal videos, date of birth and personal addresses (date of birth and personal address can be shared as part of medical information on medical documents to be kept secure and confidential as medical records by medical/health services), considering that some governments have collected human DNA samples (not only viral genetic data) without patient consent during COVID tests (many doctors are concerned that this has prevented the public from getting tested if symptoms or concerns) https://www.gov.uk/government/publications/coronavirus-covid-19-testing-privacy-information/testing-for-coronavirus-privacy-information-quick-read–2 and considering some individuals work in high risk fields such as Police or individuals working in child protection contexts.
It is relevant to consider data relating to violence at work, March 2019, https://www.hse.gov.uk/statistics/causinj/violence/work-related-violence-report-19.pdf, and to consider that this research was not focused on individuals working in high risk fields, where stalking behaviour, threats, aggression and violence can be common. It is relevant to consider the recent increase in violent behaviour, as reported earlier. Violence (or threats) at work in CAMHS or Social Care settings has increased markedly, as reported by colleagues.
We thank you for your time.
Many of these observations and concerns have been shared with appropriate authorities in the UK, the EU and abroad. Many authorities, government officials and professionals including medical doctors share these concerns, and confirm this to us in writing. Most agree that a systemic bio-psycho-social approach, always considering bio-psycho-social risk and protective factors, and following only good clinical evidence are essential to achieve good clinical outcomes. National and international health organisations as well as organisations safeguarding children have requested to remain on our mailing list since March 2020.
A congruent and consistent approach is required and urgent – between government, health professionals and the general public, and also between nations – to achieve clinical goals. Clinical goals have to be defined as reducing general health, mental health and social risk (and harm) for children and adults, high and low risk, equally.
A global health plan is essential to move forward and to protect nations.
Children and young people often ask us for advice with achieving goals. Some goals relate to general health, mental health, education, social interaction, managing difficult individuals or high risk contexts, understanding certain behaviour / interaction or successfully applying for employment.
Children or young people in this context range from students at the University of Cambridge to young offenders. Most children have the same goals. Most children have the same fears or concerns. Many children’s goals relate to “making a difference” and “being free and independent”. Many fears relate to “being judged”, “being ridiculed” and “not being good enough”.
Assisting children with achieving their positive goals are important. We usually divide this session or lecture into sections ranging from understanding human behaviour, self-esteem or confidence to practical advice.
We recently asked children what their favourite parts of our ‘preparing to achieve goals’ lectures were.
Many responded with “Dress for December”. Life has seasons. We all have favourite months or seasons. Most individuals report that December is their favourite month, because “everyone makes an effort”, “you feel good when you look good” or “you feel good when everything around you is tidy, clean, beautiful”. “Dress for success”, “dress for the job you want”, “we tell people how to treat us with how we dress and behave ourselves” and “people will treat you the same way you treat yourself” are advice children often hear from adults.
We ask children or young people if they had to compile a team to manage important decisions or emergencies, to take the lead, who would they pick? What would they look for? What gives a message of ‘trust’ and ‘sensible’ or ‘reliable’? Are they mostly calm or anxious? Are they positive or negative? Do they put other’s first? What do they prioritise? Are they confident and how can you tell? What do they talk about? What don’t they talk about? What clothing do they wear? Do they wear revealing clothing? Do they wear a lot of bright make up and nail polish?
“It is nice to do certain stuff, but you have to ask yourself will it work and what is my message to the world?”, 17 year old. “People see you in town and everywhere, you can’t just act the right way when in school, it is a commitment”, 16 year old.
It is a different world now compared to 1990 or 1960, however, the definition of leadership have not change much and many children aim high, as they should, to achieve positions of leadership.
“The players change, but the game stays the same”, 65 year old GP
If your mayor, your doctor, your police officer, your solicitor or the CEO of a favourite company goes to town or the beach, what do you expect them to wear? What will make you think his or her priorities are not right in terms of decisions or behaviour?
Messages we give each other, including children and young people, by our choices, by what we wear, by our behaviour, how we express emotions or thoughts, matter. Messages can confuse children or increase risk and harm.
“My mum does this on the beach, then my girlfriend should do it too”, 12 year old boy referred to us as recommended by the Police.
“People shouldn’t judge based on appearance, choices or someone’s behaviour, but the reality or truth is that they do, and this will never change, might as well be smart and play the game to get to where you want to get to”, as reported by a 16 year old.
It is important to represent a true version of yourself to the world, a version you are comfortable with, but also a version that represents the best of you and your goals. Programming yourself and your life for success is a matter that involves practical, physical, behavioural, cognitive and emotional prep and planning, and it should be fun.
“Appearance matters. And remember to smile.” Mandela
Season’s Greetings and a Happy 2022.
We continue to offer pro bono lectures or sessions for children, families, carers and professionals twice a year, usually April and November. Our ‘ask us anything’ question and answer sessions are usually popular. Please email us at firstname.lastname@example.org for more details.
“When anxious, uneasy and bad thoughts come, I go to the sea, and the sea drowns them out with its great wide sounds, cleanses me with its noise, and imposes a rhythm upon everything in me that is bewildered and confused.” Rilke
Everyone has good days and difficult days. Every life has good intervals and difficult intervals. Most agree that 2020 and 2021 have been a “very difficult to breathe interval”, as reported by a 14 year old.
The secret to success for many lies in prevention and planning.
We will spend the next year to provide practical information for children. Professionals often use the same techniques with good outcomes.
During psycho-education or various psychotherapies children are advised to create and maintain a contingency plan for difficult days or times. It is important to create and practise the plan during good days or good times. Difficult times are not ideal for making plans and testing plans, however, it is not impossible.
Some children prefer a cupboard drawer or box they keep for this purpose. Some keep favourite items, music, movies, photos, mementos, books or poetry in this drawer or box. Children are advised to think about what they would buy for or take to their friend at the hospital to cheer them up perhaps, and create the same for themselves, for when they need it.
Many children prefer to have an activity, routine or rhythm for difficult times, or prefer a combination of both a box or drawer as well as a routine. Examples that many children prefer include spending time walking the dog, engaging with animals, spending time in nature, spending time next to water or on water, spending time listening to music or dancing or watching favourite movies. Many also prefer sports from swimming, surfing and canoeing to hiking and horse riding. We often recommend that children keep a picture or a list of these activities in their cupboard, so that they don’t forget what their ‘go to’ plan is in difficult times (often when “one’s mind goes blank”, as reported by an 11 year old).
This plan must have a ‘reliable’ element – it cannot be dependent on the weather or someone providing transport – it must be relatively easy to achieve success with this plan in the context of ‘a difficult time’.
This practice, having a contingency plan, is associated with and inspires emotional independence – to take care of one’s own emotional needs.
Children are however always advised to speak to responsible peers and responsible adults about difficult days. The same advice is given to adults. “Going it alone” is not recommended for difficult days or times – it is important to talk to people about worries and to spend time together not talking or thinking about worries. Balance is essential for general health and mental health; balance includes for instance normative activities (we have written much about this due to the significant effect on prognosis), enjoyment, excitement and calm moments or rest.
This practice also instills a ‘plan, practise and peace’ approach – preparedness. Putting in effort at the beginning often means you can relax and enjoy yourself, knowing you have a plan B and C in place for challenges. You can also apply this approach to practical activities, for example long road trips. What might you need?
It is important to keep a ‘sharp mind, soft hands’ approach. This practice should not increase anxiety, it should decrease anxiety in the short and longer term. Ask for help if you find this stressful.
Two contingency plans are usually advised; one for low grade difficult days, as above, which are not emergencies, and which requires trial runs and one for emergencies, which usually does not require trial runs, as professionals or authorities are usually or always involved from an early stage.
Emergency plans should always include talking to your doctor (GP or the doctor at Accident and Emergency) without any delay. Emergency plans can vary significantly from child to child depending on whether the likely potential emergency;
A- medical (biological) such as hypoglycaemia in the context of Diabetes Mellitus or a serious side effect to medication, or
B – psychological such as anxiety (not due to medical causes) or
C – social such as physical safety issues, aggression or violence.
We recommend that children compile emergency plans with their carers and families, as well as with professionals. It is important that everyone is aware and happy with the plan.
The important message is that simple measures can prevent crisis or can reduce risk and harm in a crisis.
Difficult moments, days or intervals are often not entirely predictable, and these measures do not guarantee smooth sailing, because challenge, loss and trauma can be tricky (we will talk about what affects outcome in later posts), and how people respond is not always entirely predictable, however, these simple measures often help to avoid a crisis or ensure risk, along with harm, is markedly reduced.
These measures aim to inspire thinking, planning, education, focusing on prevention, and it should inspire calm, a feeling of empowerment and be enjoyable.
“Britain’s got its bounce back” – is how we were invited by colleagues to join the Cambridge University Dance on Saturday 4 December 2021. Ballroom and Latin dance including tango and salsa are enjoyed by many during these events. No particular or expert skills are required.
“Any kind of is better than no dancing at all.” Barr
Many children, families and medical colleagues are concerned about lack of normalcy, autonomy and liberty, and prefer contexts where these protective factors are available. Most governments that we and colleagues have liaised with do not mandate masks for sports including dance.
Dance is a unique way to connect with and integrate into communities and cultures, to build and maintain trust and positive relationships, to learn skills, exercise the brain and body, enjoy good music, manage stress or anxiety, relax, maintain calm and have fun. Dance is a protective factor for general health, mental health, general development, social risk and well-being for children and adults.
Dance also relates to trust. Learning about trust is essential for children. Read the inspiring true story or watch the movie “Take the Lead” based on the story of Pierre Dulaine, a Manhattan dance teacher, who changed the outcomes for children through dance. Once again, simple measures often affect outcome in profound manners for children. Measures must however be associated with evidence-based principles (principles based on good clinical evidence).
Many of our patients, after significant or repeated loss, report “my body or my heart, something tells me I have to dance to survive this dark time”, as reported by a 17 year old after losing more than one loved one in two months. Many report the same “urgent need” in terms of swimming in this context.
We all experience and manage loss, trauma and challenge differently, presenting with different needs at the time. “It is important to listen to your body, brain, spirit, heart – every cell that is verbal about moving forward must be heard”, as the same 17 year old reported. It is also important to never go it alone in dark times, to regularly meet with positive and supportive adults and peers to talk about concerns, plans or just spend time together. Many report “I want to withdraw from the world, just for a few moments, or for a while, so I dive into dance and music, it is an escape, a safe or healthy escape, that gives you a space to communicate without words”, as reported by a 14 year old child.
“Dance is the hidden language of the soul.” Graham
Dance is indeed a “healthy escape”; you can be surrounded by a group of people, yet be in your own world for the moment, or you can connect with others in a positive and light way “without talking about the heaviness”, as a child recently commented.
Everyone dances for a different reason.
“Dance, when you’re broken open. Dance, if you’ve torn the bandage off. Dance in the middle of the fighting.… Dance when you’re perfectly free.” Rumi
Many remarked on positive change in Britain since July 2021 and reported “there are no more chains, I feel I can dance”, “we are free, life has returned”, “I can hear music again”, “Britain is one of the frontrunners for normalcy and good evidence, because in July we stopped making face masks mandatory and we can breathe again, fear has been removed from our hearts and minds” and “we can’t expect good results if we don’t follow good evidence, and at last we are not following poor or inconsistent evidence any more”, as reported by a medical specialist.
However, unfortunately, this changes tomorrow, as announced yesterday. Many medical colleagues and legal colleagues are concerned considering increased rates of child abuse, domestic violence, general violence, drug and alcohol use (up to 500% or more in some cases – please see previous statistics published by the NSPCC as mentioned earlier) due to initiatives not based on good clinical evidence causing significant and chronic anxiety, frustration, anger and low mood. Many medical colleagues and professionals in the relevant field agree that this variant does not warrant these measures; “risk should be managed appropriately, after risk is assessed appropriately – this would be the same as admitting every child to hospital whilst assessing a child, this would translate into (more) negative prognoses for children”, as reported by a medical colleague.
We must however continue to dance.
“Musicians don’t retire; they stop when there’s no more music in them.” L Armstrong
The BMJ (British Medical Journal) published an article regarding the amount of doctors who have taken early retirement during the pandemic which is very concerning. Medical doctors report that they are “losing hope that good evidence will lead”. We are now recruiting medical doctors who only want to see a limited amount of patients, and only low risk patients, per year, so that the music doesn’t stop unnecessarily for doctors willing, able and interested to continue to work. Please contact email@example.com for more information. Doctors in any field are welcome. We often work with vulnerable children presenting with a wide range of medical problems. Referrals to CAMHS (Child and Adolescent Mental Health Services) in the NHS in the UK have increased from 100 per team to up to 1200 per team or more in some teams. Now is not a time to lose willing, able and interested doctors.
We must continue to dance, and we continue to dance by many steps, for example, by standing up for those without a voice, by looking after our own health to maintain our work and by asking questions. We often inform parents that curiosity, asking questions, is a sign of intelligence in a child, when children can’t stop asking questions, which is not just a way doctors reassure parents, it is true.
We too must ask the right questions, in the right way, to the right individuals at the right time. Psychiatry can be summed up by this sentence.
We often work in very high risk contexts, where we have only 3-5 minutes to do a physical examination, mental state examination and/or risk assessment. Success in most contexts, but especially in these contexts, depends on asking the right question or questions, in the right way, at the right time. The difference between success and failure in these contexts are very significant, and can change the outcome for the child.
One example. Working in a children’s prison we were informed by our mental health team that we cannot see one particular child, because he threatened that he would “kill the psychiatrist he sees”. He was on the ‘most dangerous’ list for children’s prisons, more or less 10 children in the UK at the time. The prison governors wanted the child to be seen to rule out eg serious medical problems, ADHD and depression, and to consider medication. The child remained in isolation most of the time, with limited contact with one or two adults. We (the child psychiatrist) agreed to meet with the child the next day. The assessment was brief, but effective. It is essential that children ‘feel’ and ‘believe’ that they are valued, respected and that professionals are honest and have as first priority their health, well-being, learning more about their concerns and goals, and children are experts at knowing what is real and what is not.
Further to the assessment, moments later in the prison yard, the child walked up to the child psychiatrist, leaning against the wall, saying “what’s up doc?” In that moment, the child’s status changed from ‘high risk’ to ‘low risk’ (as assessed by the prison) and the child was perceived differently by the adults and authorities around him. A world of opportunities in terms of support and care opened up for the child in that moment. The child asked if he has to see us again, that he would be happy to do this. He didn’t need to be seen again. He was removed from the ‘most dangerous’ list and professionals started positive engagement in terms of addressing his concerns and his goals. This child’s prognosis changed in a positive manner, further to these steps, and it started with one brief assessment.
When not to dance – when to sit one out for now. Please know that training, experience and expertise are required to engage in high risk contexts such as in children’s prisons, and with high risk children and complex presentations, and if you are not confident, based on extensive training and experience, that you can help a child and be successful in this role, that it is not the right timing for you as a professional to proceed, that you should rather request another doctor for the role (and request that this doctor provides training and support to the team). Children often get once chance in this context mentioned. If professionals fail, children are often blamed. One experience of a positive interaction with a professional or person with authority for a child, often the first positive experience with a professional or person with authority, can change a child’s path. This child’s ‘story’ changed from a clinical outcome perspective; he was no longer seen as ‘dangerous’ by medical and mental health professionals, but as a child presenting with difficulties requiring support. This translated into the clinical and social risk he posed to others (now and in the future), he was initially assessed as ‘high clinical and social risk to others’, and after a few weeks and months, ‘no high risk to others’, which was maintained long term. Simple, rather than complex solutions often change clinical outcomes for high risk children and risk for children in general, the general public and the community.
We must continue to ask questions in every context, not in frustration, anger or anxiety, but to learn and find evidence-based answers (evidence-based means ‘based on good clinical evidence only’ for most medical doctors). This is how we grow. We ask questions. This is how we protect the most vulnerable, by asking the right questions, finding the right answer, by good clinical evidence.
Let’s continue to dance. Even when the music stops, let’s continue to dance.
This is a good example of continuing to dance. Medical colleagues in the UK, but also in other countries agree with Ms Lois Perry:
Let’s move forward following only good evidence. The dance is better this way, it’s easier to move forward and change the outcome in a positive manner. Let’s continue to dance as a team in one direction – forward (or anti-clockwise, as in many dances) – in one direction as a group, as nations, to avoid unnecessary stumbling blocks, delays, collisions or harm and increased bio-psycho-social risk for the general public.
“Gentleness is a divine trait; nothing as strong as gentleness, nothing so gentle as real strength.” R Sockman
A 14 year old boy sits down next to a 80 year old woman sitting alone on a park bench in the village. He asks her what she bought. She shows him her vegetables that she bought at the market. She tells him what she will cook tonight, that it will keep her strong, and that it tastes very good. He smiles. She asks about his skateboard. He shows her the wheels. Until today, they had never met. These are the experiences France offers every day, and in every corner, from what we have observed or from what has been reported to us. Powerful protective factors can be found in this brief example.
Individuals of all ages like to connect with individuals of all ages; eye contact is made, smiles are shared, brief enquiries regarding health, comments regarding the weather (usually pointing out how good it is), simple acts of respect and validation. Interactions are often brief, but always or usually meaningful. Individuals stop, make eye contact, and greet each other as they enter an establishment, or as they are handed their coffee. Strangers stop to greet you, wish you a good breakfast and comment on the good weather.
Calm, focussing on plenty and patience (and offering or receiving someone’s full attention) are part of the tradition in France from what we have observed over 20 years.
“From serenity comes gentleness, comes lasting strength.” P Brown
France has highlighted the importance of focussing on child protection concerns in recent months during the pandemic. France has considered good evidence in relation to practical, academic and theoretical challenges. Many charities in France look after those without a voice.
Most comment that they feel ‘home’ and ‘accepted’ in France, even after their initial arrival. France is a place where many feel welcome. Camaraderie (often working together with common goals eg protecting children), liberty and equality are evident in France.
Liberté, Egalité, Fraternité are not mere words in France, but experienced. Most people leave France with one main lesson, that everyone from every walk of life eats the same excellent quality of food, and that you can have the best meal of your life for 3 euros. Months or years can be spent discussing the bread and the butter. Simple things are treasured and expert skills are valued in these domains. Many report “airlines can learn from France’s approach to food”. Attention to detail, relating to all matters, including quality of bread or butter, makes all the difference and translates into quality of life, strength and success. People are inspired by skills, enjoyable food, beauty, by tidy parks and colourful gardens.
Many now report “France is a place where we can find normal, breathe, we can exhale, we can find calm”. Markets provide a world of experiences in every small village. Conversations started, treasures found, stories shared and moments made. Lives are sustained and made worth while by simple things and precious moments. Restaurants are open and Jazz live concerts continue. Spirits soar as the audience enjoys the talent. Communities come together to connect and enjoy together, with evidence-based safeguards, such as regularly washing hands and remaining calm and positive. Simple evidence-based initiatives, decisions and priorities relating to protective factors, promote and sustain immune systems, general health, mental health, development and well-being.
“In this world there is nothing softer or thinner than water. But to compel the hard and unyielding, it has no equal. That the weak overcomes the strong, that the hard gives way to the gentle, this everyone knows, but no one acts accordingly.” Lao-Tzu
Patients, children and families, medical and mental health colleagues often contact us to ask us “where do I find some normal to protect my (or our) health”. Normalcy, autonomy, liberty are evidence-based protective factors for health, mental health, development and well-being. Other examples of protective factors are provided above, such as being part of a community, support networks, friendly conversation, enjoyment and calm.
Medical doctors use the phrase ‘evidence-based’ when good or very good clinical evidence supports the statement or initiative.
We have been asked to write about bio-psycho-social protective factors for health, mental health, development, well-being and success. Health, mental health, appropriate development and well-being are some of the building blocks for success and victory with goals. We have liaised with several organisations, visited many places, and provided lists for several months. We know our colleagues are asked the same questions.
Simple evidence-based protective factors can change the course of individuals’ health, mental health and development. Let’s work together to focus on good clinical evidence.
Every country or area in a country has their own sounds, smells, tastes, traditions, colours, cultures, styles or narratives. Everyone perceives and enjoys these connections differently.
We usually wake up in Italy with the sound of roaring laughter. Children, young people as well as adults of all ages laughing together, often not long after sunrise.
We can learn from Italy’s laughter. Laughter, togetherness and enjoyment, as separate items, but also together, benefit general health and mental health to very a significant degree.
We can also learn from Italy’s focus on beauty, children, communities and food. Everyone, from the fisherman to the mega yacht owner eats the same quality food – excellent food (see recent tweet regarding fish market / shop in Genoa – wait to see fresh fish prepared in the old traditional way – worth a trip – but go early).
Much energy is spent on making the environment or setting beautiful, which gives powerful messages. Music is played, table cloths and candles are ready – “making things beautiful is how we look after yourselves and each other – it means we care”.
We are inspired by Italy’s and Genoa’s many outreach projects for vulnerable individuals – the focus is often on education, learning skills and being part of a healthy community. In Cape Town in the 1990’s – all mental health patients well enough, in one of the main mental health hospitals, were taught a trade or skill such as planting vegetables or basic farming skills, so that when they are discharged (often after months or years), they have opportunities of employment, which help to contribute to a sense of achievement, meaning and being part of a community, which help with confidence and relationships, general health and mental health. These factors, from education to employment, also lead to less poverty and less crime. Most things are connected and the solutions are seldom complicated; solutions often start with education and empowerment – sustainable solutions leading to independence. Giving is not giving unless the goal is sustainable independence.
Simple things often make the greatest difference for adults and children with health or without health difficulties.
We are frequently asked what our thoughts are regarding happiness, general health, mental health, mental state and children – for vulnerable children and adults – and also for privileged and healthy children and adults. The answers are not different.
We will share some thoughts regarding these topics and the effects of for instance music, food, the environment, cognitions, emotions, behaviours and physiological changes such as breathing in future postings. Medical doctors, surgeons, professional athletes and many others use these simple techniques to achieve goals and to inspire or maintain calm or a positive mood.
Many medical colleagues, professionals, patients and families report that they currently “find it challenging to be calm, positive or hopeful or go on with life during this time” and have asked for general thoughts. We recommend that you speak to your GP if you have concerns about yourself or anyone else without delay – getting a general check up or screen in terms of general health and mental health has never been a better idea than now during this time. If you have the ‘all clear’ from your GP – there are many options to consider to move forward – different approaches will work for different people.
Many children and colleagues report that there is nothing more important than having a dream, a goal, a plan – and moving towards it – slowly – whilst enjoying every step of the way.
Where to start – some thoughts:
Step 1 – Be inspired – find a topic or interest that moves or inspires you – that you are very enthusiastic about – it might be Italy, food, sailing, surfing, tango, salsa, working with animals, playing the saxophone, speaking French, horse riding, performance driving, motorcars, travelling, gardening, photography – anything. If at first you cannot think of anything go on an explore adventure phase – read books, magazines, visit forums or webpages, arrange experiences such as sailing or golfing or spending time in nature or with animals – enjoy the explore phase to find something that moves you… there is no rush and ‘pressure’ will sometimes prevent you from reaching this goal or delay the process. Think about what you enjoyed when younger or what you would like to remember as part of your life when you are older. Try to avoid ‘tick box’ items or ‘what looks good on paper or to friends’ – you have to be moved by it – you alone – for yourself. This might be the second most important stage. You can start step 1 at any age.
Life’s blows cannot break a person whose spirit is warmed at the fire of enthusiasm. Paele
Step 2 – Spend time reading or researching this topic – enjoy every moment. You do not have to leave your home for this stage. Do not rush this stage.
Step 3 – Surround yourself with items related to the topic – a theme – for instance if your topic is Italy find suitable music, food, clothing or images. Do not rush this stage.
I have overcome nightmares due to my dreams. Salk
Step 4 – Pause – ensure you are enjoying the previous stages. Dream. There is no rush. Take it slow. Life is a game of inches. Slow progress is often good and sustainable progress. These 4 stages are protective factors for general and mental health, and positives in a life and should be enjoyable and relaxing.
He who has a why to live can bear almost any how. Nietzsche
Step 5 – Prep – start the preparation phase. Think about what you would like to achieve, what you hope to gain from it, why, how it will look like, feel like, as much detail as possible, think about when you want to achieve the first phase or the goal and how. Take it slow – achievable is good. This stage, if completed effectively, will guide and aid the next stage, as the foundation for where the house (plan) will be developed and built.
Everything worthwhile in life takes hard work. Diamonds are only chunks of coal who stuck to their jobs. Smith
Step 6 – Plan – start drawing up a plan – on paper. Read and research thoroughly. Consider risks, weather patterns, training, tools and equipment required. Speak to people with similar interests, professionals and experts. You might meet interesting people. This is the most important stage. Ask for second or third opinions regarding your drawn up plan and goals, as well as thoughts on your progress. This stage is lengthy, as it often takes a long time to develop a good plan, based on information gathered, and to complete required training, learn skills and collect tools. Enjoy this stage. Don’t rush it – rushing this stage will mean a less likely chance of success or achieving your goals.
There is no shortcuts to any place worth going. Sills
Step 7 – Jump – believe in yourself knowing you have prepared and planned well, that you have people at hand to ask for advice if need be, a safety net, and that you will enjoy the ‘getting to the destination’ as much as you have enjoyed the first 6 steps and the destination itself. Don’t give up. Adapt and adjust your sails. Know you should and will never stop learning.
Hold on, hold fast, hold out, patience is genius. Comte de Buffon
There is never a rush – as long as you keep moving forward slowly. Remember good and sustainable progress is often 3 steps forward, 1-2 steps back – that is how we learn, that is how we grow and achieve our goals.
Nothing great is created suddenly. Epictetus
Every one of these 7 steps are protective factors for general health and mental health.
UNICEF reminded us, April 2020, “while our eyes are firmly focused on how to avoid or treat COVID-19, the serious consequences that will challenge us far beyond the current pandemic – the hidden impacts – are not yet front of mind. This must change. Not only are children and young people contracting COVID-19, they are also among its most severely impacted victims. Unless we act now to address the pandemic’s impacts on children, the echoes of COVID-19 will permanently damage our shared future. According to our analysis, 99 per cent of children and young people under 18 worldwide (2.34 billion) live in one of the 186 countries with some form of movement restrictions in place due to COVID-19. Sixty per cent of all children live in one of the 82 countries with a full (7%) or partial (53%) lockdown – accounting for 1.4 billion young lives. We know that, in any crisis, the young and the most vulnerable suffer disproportionately. This pandemic is no different. It is our responsibility to prevent suffering, save lives and protect the health of every child. We must also ensure that risk-informed decisions on COVID-19 control measures are made based on the best available evidence in order to minimise and prevent any collateral damage, and to provide mitigation measures so the damage is not lasting.” https://www.unicef.org/press-releases/dont-let-children-be-hidden-victims-covid-19-pandemic Most agree,18 months later, that we have not prioritised these goals.
Significant concerns have been raised in terms of increased statistics relating to child abuse, mental illness, developmental problems, general health and well-being for children due to indiscriminate mandatory initiatives not based on good clinical evidence.
Many agree that child abuse and mental health statistics need to decrease significantly; early detection, prevention and access to appropriate services are essential steps to achieve these goals. We offer assistance and training in this regard, often pro bono. We have extensive experience in teaching and training, for example teaching medical students at the University of Cambridge, teaching medical doctors specialising in Child Psychiatry on the MRCPsych course in Cambridge and offering training to GPs, Paediatricians, Psychologists, Social Care, Police, Prisons and Youth Offending teams. Most of our training currently offered relates to identifying child abuse or mental health problems in complex presentations such as children with neurodevelopmental problems or hard to reach children. Please contact us for further details.
Recommendations to safeguard children – many colleagues recommend;
• schools need to re-open and remain open, but with education (age appropriate and enjoyable approach) regarding evidence-based risk reduction and protective strategies for children and staff in the context of COVID-19 and general health; it is important that children’s anxiety levels remain low in the context of ‘germs’ or infections to prevent mental health morbidity, often common in certain age groups,
• daily healthy school meals with educational, enjoyable opportunities to learn skills to cultivate herbs, fruit and vegetables at home and prepare enjoyable, healthy meals,
• education in schools regarding important life skills such as managing finances, starting businesses, applying for work or conflict resolution,
• education in schools (staff and pupils) regarding general safety, child abuse and mental health (practical and age appropriate approach) – we offer pro bono question and answer sessions in schools where any individual can ask any question,
• normative activities for children – regular opportunities outside schools where children can engage in enjoyable, positive and meaningful activities, including group activities, in the community with responsible adults and peers with similar interests, where opportunities are offered to develop social support networks, learn new skills and experience a sense of achievement. Normative activities promote normal child development (physical, social, emotional, cognitive and language), general health, mental health, general well-being, and reduce risk. Good clinical outcomes and prognoses in general and mental health usually require a bio-psycho-social approach. Children described as ‘hopeless’ (never an accurate description) are often referred to us, and we have consistently observed that prognosis can change markedly with the introduction of a patient specific and appropriate bio-psycho-social treatment plan. It is our recommendation that electronic activities or tools be excluded during normative activities; electronic activities and tools can offer other benefits to children, but we recommend that this is considered separately, based on our experience.
• positive narratives; many children with a background of ongoing or past significant trauma often report the life event that precipitated sustained positive change in their lives eg “one message” by a teacher or other adult, “who believed I can do better and have better”, “I saw she saw me as good, so I thought ok I must have good in me”, or provided by a setting eg “Disney’s message that anything is possible if you work hard and believe changed my life”. We have written extensively regarding the importance of positive public messaging and narratives, and the direct effects on thoughts, beliefs, emotions, behaviour, physiology and clinical outcomes.
• access to general and mental health services and specialist consultation without delay for serious presentations, we have shared extensively details regarding our concerns relating to children waiting more than 5 years for consultant input or for comprehensive assessments to screen for medical, neurodevelopmental and serious mental health concerns,
• formal and urgent review of A – child mental health teams (by individuals with experience in managing bio-psycho-social risk in clinical settings), B – regulations under the Mental Health Act relating to clinicians with clinical responsibility for children and adults detained under the mental health act. We have shared comments regarding the urgency of identifying medical concerns in patients with mental health problems, early and accurate mental health diagnoses, safe and user-friendly practices in CAMHS teams and in general health clinics.
• formal and urgent review of current policies, processes and emergency legislation in the context of COVID-19 and the definition relating to ‘state of emergency’ and ‘covid deaths’ (definitions need to be consistent and need to make medical sense – medical and legal colleagues raised concerns that some nations finalised legislation in haste and omitted appeals processes to safeguard the public or allow for the inclusion of medical opinions),
• training regarding identifying mental health problems, risk or child abuse in complex and high risk clinical presentations – child abuse can sometimes present very similar to other mental health problems such as anxiety, or neurodevelopment disorders such as Attention Deficit Hyperactivity Disorder (ADHD) or Autism Spectrum Disorders (ASD),
• service development and training regarding engaging hard to reach children, such as children refusing to attend appointments or children in high risk contexts such as homeless children or young offenders,
• a greater emphasis on child protection by governments – child protection concerns and an awareness of child protection in general have been emphasised in many countries in 2020 and 2021 – for example questions have been asked about adult nudity on beaches or next to pools where children are present, or at homes when children are present or have peers visiting, which most agree is not acceptable and does not protect children or promote healthy child development. Concerns have also been raised regarding general settings or policies in communities or schools relating to various topics. We have extensive experience of working in child protection, looked after children, foster and adoption, unaccompanied minor, youth offending as well as children’s drug and alcohol teams. We know that the children’s views, or views of professionals with decades of experience in these fields, are not considered in many or most of these decisions, which will often increase risk to children and communities.
These recommendations include evidence-based protective factors relating to child development (physical, social, emotional, cognitive and language), general health, mental health, social risk and general well-being.
Many agree that we should ask ourselves whether our decisions in the last 21 months contributed to harm or to protection for children and adults, based on evidence available, and that we need to focus on investing in or preparing for the future, knowing that the most logical place to start is with children’s welfare.
We asked children and young people in various countries where they would suggest the world starts to invest in a better future. Most replied that we should start with reviewing the definition of leadership and good leadership; “some things are as simple as building sand castles, but the focus is not on the problem and solution, the focus is on what is to gain from it”, young person in EU country.