Britain’s Bounce

Britain’s Bounce

“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

For more information https://www.cambridgedancers.org

Christmas Dance Event 10 December 2021 https://www.eventbrite.co.uk/e/xmas-special-festive-ballroom-social-dances-tickets-217436176457

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 admin@cinaps.co.uk 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:

https://www.mirror.co.uk/news/politics/face-masks-instil-fear-division-25571052.amp

https://apple.news/Alfm8VfZ5TU-tCAeX4U_zaw

World Health Organisation:  “At present there is only limited and inconsistent scientific evidence to support the effectiveness of masking healthy people in the community to prevent infection with respiratory viruses, including SARS-CoV-2”  More details at https://apps.who.int/iris/rest/bitstreams/1319378/retrieve and https://www.who.int/news-room/q-a-detail/coronavirus-disease-covid-19-masks and https://www.who.int/publications/i/item/advice-on-the-use-of-masks-in-the-community-during-home-care-and-in-healthcare-settings-in-the-context-of-the-novel-coronavirus-(2019-ncov)-outbreak

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.

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