Simple strategies

Many children continue to live and work on the streets.

Estimates, several years ago, were that more or less 250 000 children lived on the streets in South Africa.

Homeless children need to be protected as a priority in every nation.

Homeless children need to be supported from a systemic point of view.

How to eradicate poverty? How to end homelessness for children?

It is important to understand the ABC’s of outcomes or events or behaviour. What happened before the event or occurrence to predispose or precipitate the event, what happened during the event, who suffered, who gained, details are important, how were systems affected, what maintained the event or occurrence or behaviour, what happened after the event, the consequences, how was the system affected afterwards, who gained.

For example, most individuals understand that if you provide money to individuals or parties in debt, they are often in worse debt within a very short period of time. Systemic thinking, clinical thinking, based on bio-psycho-social risk and protective factors, are required when understanding behaviour, thoughts, emotions or events, and when making decisions.

Simple and systemic solutions are often the most effective.

Homeless children can have different lives if bio-psycho-social systemic thinking is applied, beyond housing or finance, to maintain the positive outcome.

Sustainability should be an important goal.

A safe and stimulating environment is key.

Education is key.

A place to ‘belong’ is key. This can be a team or a place of work, if need be.

Responsible carers are key.

Responsible peers and seniors are key.

Close, healthy, positive relationships with warmth and caring are key. Animals can be sufficient, if no other alternatives are available. Many adults report that their lives changed or were saved due to an animal.

Engagement in regular, positive, normative activities, where a child is interested and enthusiastic, such as playing a sport or musical instrument, is key.

Accessible, user-friendly, effective, evidence-based (good clinical evidence) healthcare services are key.

Simple strategies can precipitate and maintain positive outcomes.

Some organisations estimate 100-150 million homeless children living in the streets around the world with at least 250,000 children dying every week from diseases and malnutrition.

Please see UN comments relating to homeless children on relevant web pages.

https://www.un.org/press/en/2020/soc4884.doc.htm

We have joined a Hot Cross Bun Run this year, for Easter – drop a few sealed hot cross buns off with someone in need. Join us.

#belong #enthusiastic #simplesolutions #education #fun #enjoyment #UN #poverty #homeless #children #animals #change #sustainable #debt #developing #hotcrossbun

Priorities for Children and Families

One of the largest informal settlements in the country with approximately 40 000 children under the age of five.

We asked children what their greatest wish was today, and they said “to go to the #beach , but without the masks”.

Children are children in every corner of the world.

We asked 17 year olds what their greatest wish was, they reported “to have our soccer field back, they are taking it away, and it keeps us on the straight and narrow, we have a team we belong to, it is home, it is nice, it is good”.

Simple strategies change children’s lives.

Most children and families, in various countries including the UK, countries in Europe, India, Sri Lanka, Thailand, Cambodia, Malaysia, Vietnam, New Zealand, South Africa and countries in Europe report that the most important items for their family are:

1. physical safety

2. freedom (many explain that this means “education for children”), then

3. health

4. mental health

5. peace

6. joy, then

7. victory with goals (such as “learning to swim”)

Many include beauty, animals, loved ones and friends.

We have been asked to provide a text, book, manual or summary of principles to precipitate and maintain these items for children and for adults, based on our clinical training and experience assisting children and families, from all walks of life, with these goals for the last 20 plus years.

Simple items are often the most effective.

Please email us at admin@mentalhealthbus.co.uk if you would like a copy. This is likely to take us a while though, but if there is a sufficient need, we will oblige.

#joy #peace #safety #health #mentalhealth #victory #success #simple #soccer #book #principles #maintain

Relax – enjoy – experience normalcy – learn

Children and families report that they need ideas of places, or a place, to safely relax – enjoy – experience normalcy – learn – evidence-based protective factors to improve health and mental health for themselves and their children.

They want places where evidence-based (good clinical evidence) strategies are followed such as

– alcohol gel, along with wash rooms with soap and water available

– social distancing facilitated and maintained on for example safari or a game drive with animals

– food hygiene where food is covered and children are supervised

– practical education is prioritised for example cover your mouth and nose if you cough or sneeze

– staff and customers are calm and positive

We will provide thoughts on local options. We have liaised with travel agencies and organisations offering these services to families and children.

1. Houtbay has a bird park, a small zoo, where children walk amongst monkeys, which most families enjoy. This is an excellent environment to teach children about animals and social behaviour. All safety regulations are followed, from reports and firsthand experience during our brief visit.

2. Sailing in the Waterfront on the Victoria is advised. This is an excellent environment to teach children about the sea, seals and dolphins. All safety regulations are followed, from reports and firsthand experience during our brief visit.

3. Imhoff farm offers lessons on horse riding (very limited instructions for beginners, please ask for more information if you need to – a slow walk through vineyards, valleys and on the beach is available, this remains a high risk sport), 4×4 skills and preparing for challenging terrain and breakdowns, animal farms for children, goats, fish markets and restaurants. Wonderful opportunities for families to relax together and for children to learn about animals. All safety regulations are followed, from reports and firsthand experience during our brief visit.

4. De Meye – a wine farm close to Stellenbosch – offers a wonderful meal next to vines under trees with dogs at your feet. We can absolutely recommend their food and the environment for safe relaxation and enjoyment. Very informal. Lovely people. All safety regulations are followed, from reports and firsthand experience during our visit.

5. Klein Joostenberg – a wine farm close to Stellenbosch – offers a beautiful meal within a ‘kraal’, outside, on the grass or a ‘stoep’ or porch, with dogs at your feet. Lovely staff and friendly people. Very informal. All safety regulations are followed, from reports and firsthand experience during our visit.

We have been asked about ideas or a place that offers safe, normative activities for children and families, to relax, enjoy and learn together, to recover, restore health or mental health and to maintain or promote health or mental health, for several months.

Many want to “blow off steam”, “fill my tank”, “get my bounce back”, “feel like a person again, “get some perspective”, “tick some bucket list boxes”, “make up for lost time” or “enjoy life again”.

We are now working on developing a service in Europe for children and families to recover – relax – laugh – learn (practical skills like survival in the woods or fishing or swimming or snorkelling or boating or cooking food outdoors or working with animals) – we plan for at least half of the service to be pro bono services.

This service will aim to meet the needs of very fortunate children, every day children and also children who have experienced serious trauma.

#safari #game #animals #SouthAfrica #Africa #learn #relax #enjoy #families #children #normalcy #calm #positive #developing #services #Europe #recover #laugh #fishing #snorkelling #boating #cooking #Houtbay #birdpark #zoo #waterfront #sailboat #Imhoff #horseriding #beach #winefarm #vineyard #vines #DeMeye #KleinJoostenberg #Stellenbosch

Normalcy and Good Clinical Evidence in Cape Town, South Africa

A small team arrived in #CapeTown #SouthAfrica.

We have been asked to provide information on #experiences of #normalcy and the following of #goodevidence.

Normalcy is an evidence-based protective factor for children and adults. Protective factors reduce morbidity and mortality from a general health, mental health and social risk point of view. These factors are important in healthy child development (language, cognitive, physical, social and emotional development), children’s well-being, children’s general safety, mental health and general health.

Activities on offer in Cape Town, South Africa, offering normalcy in the context of the pandemic, that do not increase risk, if engaged in safely, with evidence-based risk reducing initiatives.

Normalcy:

1. Sailing – there are whales, dolphins, seals and penguins in the bays

2. Horse riding – in vineyards, valleys, mountains or on the beach

3. Hiking

4. Exploring mountains by 4×4 or mountain biking

5. Volunteering with animals or visiting animal parks – many safari experiences in the area now offer private drives to facilitate social distancing.

6. Surfing or kite surfing

7. Tours in vineyards – private tours to facilitate social distancing

8. Live music performances outdoors (or art performances)

9. Restaurants, cafes, pubs, shops – most facilitating social distancing and ventilation

10. Swimming or snorkelling

Cape Town offers lessons on developing or increasing skills in all activities above in safe ways that do not increase risk.

Many refer to the CCHH rules of evidence-based risk reducing initiatives (good clinical evidence):

1. Close – keep a safe distance at restaurants, cafes, pubs or during sport or exercise.

2. Cover – cover your mouth when cough or sneeze – avoid those who don’t, and cover food.

3. Hands – keep hands clean before touching food or face.

4. Home – stay home if you have symptoms or are sick or have been in recent confirmed contact with a positive case.

Good Clinical Evidence:

1. Temperature and symptom screens are available at nearly every shop, restaurant, cafe or pub. Screens were offered at airports and hotels.

2. Alcohol gel is available on nearly every restaurant table.

3. Many restaurants eg #Wimpy have facilitated screens to ensure social distancing.

4. Outdoor events such as music shows are on offer to facilitate social distancing.

5. People engage in protective and normative initiatives and activities – eg many children and adults are spending time with loved ones in nature – in safe ways – ensuring their hands are clean before eating and keeping a safe distance. Most individuals appear very calm and positive – “we do the basics, we look after ourselves, do what relaxes us and makes us happy, and we believe we will be fine, then we are fine”, as reported by a father of five children.

Unfortunately masks are mandatory for every individual in every context. Except for this item, South Africa is following good clinical evidence.

“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” World Health Organisation, Dec 2020.  More details available at https://apps.who.int/iris/rest/bitstreams/1319378/retrieve.  

“There is limited evidence on the effectiveness of medical face masks for the prevention of COVID-19 in the community.” ECDC, European Centre for Disease Prevention and Control https://www.ecdc.europa.eu/sites/default/files/documents/covid-19-face-masks-community-first-update.pdf

We will provide more details in the next days or weeks.

#safari #4×4 #mountainbiking #hiking #horseriding #surfing #kitesurfing #sailing #mountains #livemusic #artperformances #whales #dolphins #seals #penguins

Evidence-based risk reducing initiatives for children in schools

Evidence-based risk reducing initiatives for children in schools:

Schools and education play an important protective role for all children, including the most vulnerable, in terms of cognitive, language, social, emotional and physical development, mental health, physical health, social risk and well-being.  Please see statements relating to evidence-based protective factors and normative activities.

Systemic risk and protective factors in the context of #covid19 must however be assessed, identified, considered, weighed and managed by professionals with experience in this context (experience in respiratory infections, children’s health, children’s social, emotional, language, cognitive and physical development, including children’s neurodevelopment, children’s mental health and social risk).

Doctors with training and experience in neurodevelopment, especially in the context of respiratory infections, will likely have concerns regarding schools opening without additional and effective (based ONLY on GOOD clinical evidence) risk reducing initiatives, that do not increase risk for children in other ways.  

Most adults who work with children present with frequently increased incidence of upper respiratory infections (colds or flu).  Children also visit grandparents and elderly relatives, and engage within the general community unsupervised or supervised.  This impacts on risk for communities.  

Normal neurodevelopmental stages of children indicate that children (without learning, neurodevelopmental and mental health problems) are often significantly more physically playful, fidgety, impulsive, inattentive and forgetful than adults.  Consider research where authority figures inform children that they cannot touch an object; that it would very likely result in imminent death.  Children proceed to touching and playing with the object within minutes.  This is normal behaviour for most children without mental health, neurodevelopmental or learning problems.  Research indicates that adults (mostly with fully developed frontal lobes and neurological systems) touch their faces more or less 16-23 times per hour, often without registering this behaviour.  In Europe and the UK, we observe most adults #touching their #faces underneath their #masks with #unwashed #hands on a daily basis, masks hanging on #ears or #chins, or adults dropping masks on wet floors and wearing it again – this increases risk and harm relating to general health significantly.  We can provide many photographs from many countries. Children’s behaviour in this context will likely not be safer or more #responsible, the contrary will be likely. 

Mental health problems, learning problems or neurodevelopmental disorders such as #ASD or #ADHD, often increase these features, relating to physical playfulness, fidgeting, impulsivity, inattentiveness and forgetfulness, markedly for children or adults.  

In the UK more or less 2.5% of children present with #learning disabilities, as reported by MENCAP.  Learning problems are more prevalent, 14.9% of school aged children have special educational needs, as reported by GOV. UK.  Many children with learning problems have not been identified.  More or less 30% of children with developmental delay, present with associated mental health problems or concerns. 

Prevalence of neurodevelopmental disorders, such as ADHD, in children is more or less 3-4% in England and Wales.  It must be noted that children in this category are often most vulnerable for co-morbid mental health morbidity, often presenting with more than one co-morbid mental health diagnosis or concern, which are not always easy to identify; this is one of the reasons we recommend that children are assessed, diagnosed and treated or managed by Child Psychiatrists with training, CCTs, in Child Psychiatry, and that children with #ADHD or #ASD remain within generic #CAMHS teams, rather than be referred to separate neurodevelopmental, ADHD or ASD teams.  Children also often wait months or years on ADHD waiting lists, whilst presenting with serious co-morbid concerns such as #depression and #suicidal ideation, which lead to markedly increased risk.  Co-morbidities of ADHD include depression (15%), anxiety disorders (25%), learning disabilities (15-40%), language impairment (15-75%), Oppositional Defiant Disorder (35-50%) and Conduct Disorder (25%).  More than 50% of children with ADHD meet criteria for 2 co-morbid conditions.  

The WHO reports that more or less 20% of adolescents may experience a mental health problem in any given year.  GOV.UK reports that more or less 12.5% of 5-19 year olds had at least one mental health disorder and that more or less 5% met criteria for 2 or more mental health disorders (survey 2017, published 2019).  The Children’s Society reports that more or less 10% of children and young people aged 5-16 years have a clinically diagnosable mental health problem, yet 70% of children and adolescents with mental health problems have not had appropriate interventions at a sufficiently early age. This is one of the reasons we recommend that children referred to CAHMS are seen by a medical doctor / Child Psychiatrists within 2 weeks of referral.

It might be relevant to add in this context, considering recent research published by the Lancet, that longstanding research indicates that all or most physical health problems or disorders can increase mental health morbidity by up to 50%, neurological injury can increase prevalence by up to 500%, and neurological injury associated with epilepsy can increase prevalence by up to 1000%.

Biological risks in schools will affect risk in communities.  Risk reducing initiatives, based ONLY on GOOD clinical evidence, have been employed to reduce risk and harm from a bio-psycho-social point of view for children attending schools in many nations – we will provide examples.  

Evidence-based risk reducing initiatives for children in schools:

1. Children now rotate through schools in some countries to keep the numbers down per classroom (if a large number of children in a small classroom) and at the school in general, for instance in corridors, to facilitate social distancing and reduce risk.  

2. We have observed that social distancing is possible in almost all contexts in the public.

3. Good ventilation is facilitated, even if it has to be through open windows and doors.

4. Some classes are taught in gym class or outside if weather permits.

5. Clear instructions are given to staff and pupils to remain at home if a raised temperature, symptoms or recent confirmed contact (some include a recent traveller at their homes).

6. Temperature screens and symptom or health questionnaires are in place for every student, staff member and teacher to complete every morning at home before attending schools on interactive apps or on paper format. Many countries still identify individuals with symptoms by paper questionnaires and old fashioned temperature screens, this is equally effective.

7. It is our clinical opinion as Consultant Child Psychiatrists with more or less 15 years training and more than 20 years clinical experience that indiscriminate mandatory mask wearing will likely increase risk markedly from a general health, mental health, child development and social risk point of view for children (and adults).

There is no good clinical evidence that supports the wearing of face masks in the community for healthy individuals, there is however significant evidence indicating increased risk.

The WHO and ECDC agree that there is no good clinical evidence to support face masks for healthy individuals in the community:

“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”  World Health Organisation https://apps.who.int/iris/rest/bitstreams/1319378/retrieve

“There is limited evidence on the effectiveness of medical face masks for the prevention of COVID-19 in the community.” ECDC, European Centre for Disease Prevention and Control https://www.ecdc.europa.eu/sites/default/files/documents/covid-19-face-masks-community-first-update.pdf

In our opinion it is not clinically indicated and it is not based on good clinical evidence to ask all children to wear face masks in schools.

Children at high risk for severe COVID-19 and children who have symptoms need to follow different protocols.

8. It is our clinical opinion that face masks should never be ‘normalised’ for children or adults, considering the lack of good clinical evidence to support face masks in the community for healthy individuals, and the evidence that risk is increased for many. We have written extensively on this topic, normalcy (and evidence-based protective factors), liaising with appropriate parties.

9. It is our clinical opinion that absolutely no #clinical #tests (side-room or special #investigations) should be completed on children unless there are clinical #indications based on good clinical #research.

Children are very sensitive to various mental health problems including different anxiety disorders at different ages, which can cause long term, sometimes life long, debilitating symptoms, distress and impairment. Medical #tests provide a very strong #message to a #child, often of ‘sick’ or ‘patient’, which often causes emotions such as fear, panic, frustration, anger or low mood, and negative beliefs regarding germs, sickness, health, death and safety – this affects behaviours, general health, mental health and social risk.

Most professionals who work with children with mental health problems have seen children referred with little or no #skin on their hands due to excessive, repetitive and longstanding #handwashing eg due to #OCD or #germ #phobias , or children with serious #wounds due to #selfharm (we have often had to refer children to plastic surgery). Children may also present with wounds inside of their mouths due to regular biting, secondary to high levels of anxiety or stress – adults, parents or carers, are sometimes not aware that children engage in these behaviours. These are often complex matters with complex predisposing, precipitating and maintaining factors, and it is essential that clinical experts in this domain be consulted.

It is our clinical opinion that indiscriminate mandatory mask wearing initiatives, along with other initiatives associated with deprivation of liberty, not based on clinical indications and good clinical evidence, such as ongoing and repetitive quarantine, curfews, stay at home and lockdown, will likely markedly affect children’s social, language, cognitive, emotional and physical development, along with mental health, general health and social risk in negative ways.

Children’s development often (not always) experiences ‘catch up’ when they are removed from abusive or neglectful environments, however, we have to ask whether it is ethical to expose children to initiatives associated with risk, when there is no good clinical evidence to support these initiatives. We have to first do no harm, as per the oath most medical doctors took after their initial 6 years of training.

Increased risk in terms of mental health, general health and social concerns, such as violence, however, can be associated with significant long term consequences. It is also important to note that mental health affects general health and social risk; any one of these factors, including child development, affects the other factors. Immediate, short term, long term risk is therefore increased.

Ethical and medico-legal questions have to be asked and answered in these contexts, considering that this is a health (or medical) crisis and medical (or clinical) decisions are (or should be) made based on medical (clinical) evidence and patient specific clinical indications to protect children and adults in the community, preventing increased risk and harm.

10. Education is key – regarding good hand or food #hygiene and #healthy #food and life style – but this has to be executed in a #fun and ‘ #normalising ‘ manner – children should not experience increased anxiety, anger, frustration or sadness by these ‘ #lessons ‘, the opposite should be relevant – children should be #distracted, #relax, #enjoy themselves and feel #empowered by these #narratives and #activities, by #learning new #skills and developing exciting dreams for tomorrow. This is essential.

It is very important to focus on age appropriate topics for children, considering their developmental age, not chronological age – and to execute the lessons or education in an age appropriate manner.

We receive too many statements from children age 3 to 13, that are not appropriate for children relating to the pandemic. Many children do not have the tools, due to their normal developmental age, to manage these concerns. Let children be children and let them deal with children’s issues, until it is their time to gradually start taking different roles, and eventually lead. We often refer to children taking adult roles as ‘young carers’ – this is not in the best interest of a child’s development, mental health and general health.

#Creative evidence-based options to reduce risk are always available in every domain and context, however, it is essential that risk factors and protective factors are assessed, identified, acknowledged, understood and managed appropriately, by professionals with experience in this domain, with regular review.  

The importance of #eduction for the general public is relevant in this and every context.  It is our opinion, based on observation in more or less 20 countries since the pandemic was reported, that this has not been achieve in many nations regarding the basic evidence-based (good clinical evidence) risk reducing and protective factors in the context of respiratory infections.

We have shared observations and concerns with relevant authorities since March 2020. Many authorities, health ministries, public health departments as well as international and national organisations safeguarding children are working together to ensure that good clinical evidence is followed to prevent increased risk and harm for children and adults. We thank everyone for their responses and efforts to work in collaboration to achieve clinical goals.

We offer pro bono training and presentations relating to this topic to staff supporting vulnerable children such as teachers, youth offending teams, Social Care or the Police, twice a year. Please contact us at admin@cinaps.co.uk for details of upcoming training events.

For more comments on protecting children, please see comments on:

An Achievable, Sustainable New Normal

https://mentalhealthbus.wordpress.com/2021/02/28/an-achievable-sustainable-new-normal/

Our General Recommendations to Maintain Good Health

https://mentalhealthbus.wordpress.com/2021/02/28/our-recommendations-to-remain-healthy-during-travel-and-outreach-work/

Healthy Enjoyable Food Options

https://mentalhealthbus.wordpress.com/2020/12/11/food-for-thought/

Simple Initiatives to Support the Immune System

https://mentalhealthbus.wordpress.com/2020/11/27/simple-initiatives-can-support-the-immune-system-for-children-and-adults/

https://mentalhealthbus.wordpress.com/2020/11/18/the-immune-system/

The Importance of Normalcy for Children and Adults

https://mentalhealthbus.wordpress.com/2020/11/18/normalcy/

Simple Initiatives Can Positively Impact on Mental State

https://mentalhealthbus.wordpress.com/2020/11/27/simple-initiatives-can-positively-impact-on-mental-state/

#adhd #asd #neurodevelopment #learning #schools #mentalhealth #disabilities #childrensdevelopment #masks #facemasks #playful #fidget #hyperactive #impulsive #forgetful #inattentive #risk #depression #comorbidities #mentalillness #ventilation #safety #health #neurological #socialdistancing #education #teachers #pupils #college

 

Fear Can Put Us in Chains

Fear can put us in chains:

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

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

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

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

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

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

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

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

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

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

Quotations:

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

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

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

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

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

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

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

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

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

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

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

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

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

#Ignorance is the parent of fear. #HermanMelville

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

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

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

An Achievable, Sustainable, New Normal

An Achievable, Sustainable, New Normal:

In efforts to prepare volunteers for outreach work, and to prepare for service development projects, we remain up to date with local bio-psycho-social risk and protective factors as well as local procedures and policies relating to emergency and general medicine, including infectious diseases and tropical diseases, with relevant management or preventative options, such as vaccines, in various countries.

Questions are asked about a ‘new normal’ on a daily basis in many countries. Many are concerned that they will have to wear face masks for the next 1-5 years, when there is no good clinical evidence to support the wearing of face masks for healthy individuals in the community, as the World Health Organisation and the ECDC agree. Many have raised concerns regarding increased risk and harm due to indiscriminate mandatory face mask initiatives. Many are concerned that regular #travel (without face masks or quarantine) will not resume within the next 2 or more years; many elderly patients report “we need our cruises” and “we want to get back to travelling, but not with face masks”.

We have been asked for our thoughts regarding a ‘new normal’.

In our opinion it is important that we focus on longstanding, well-established, evidence-based strategies (only good clinical evidence) to reduce #risk of #infection or #disease (morbidity and mortality) and to protect (evidence-based protective factors – based only on good clinical evidence). This is likely the first step in #creating #positive and #lasting #change for children and adults – high and low risk individuals.

1. TOOLS – Give all individuals #tools to practice good #hygiene – this relates to alcohol gel on tables, wash rooms with running water and soap, and allow #homeless people access to tools too (more than 50% returning #veterans who risked their lives for the nation’s #freedom , needing and wanting access to #water and #soap , in some states and nations – please know that currently more or less 40,056 veterans are homeless on any given night (see link) – many are informed that they are not allowed to use outside showers, even at night or early in the morning when no one is around). http://nchv.org/index.php/news/media/background_and_statistics/

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

Water quality, which affects children, adults and communities, is relevant. Please see previous comments relating to Bangkok, Thailand and the river – this is relevant in many nations. #Sewerage drains leaking eg into beaches or rivers need to be addressed as a matter of urgency in every country – these concerns precipitate and maintain many different infectious diseases. Numerous infectious diseases including coronavirus can be found in urine/faeces.

Let’s start with the basics, with simple measures, let’s get it right, before we make it more complicated and introduce measures not based on good clinical evidence. What affects one of us, affects all of us – this is relevant in most contexts, but especially with infectious diseases and general health, if a global health perspective is employed.

2. BE AT HOME IF YOU ARE SICK – Be at home and stay at home, if you feel sick, have symptoms or have been in recent contact with a confirmed case – and contact health services for advice. Too many individuals attend #work or #flights or #travel when they are not well. Employers should support employees in this systemic approach. We often offer emergency services during flights and most often the person felt unwell whilst still at home. Individuals report on a daily basis that they travel or leave their homes when they know they have a cold or flu, even during this pandemic, eg “I knew I was getting sick, I felt awful, but I took the flight and thought I will get better on the beach” and “I went for a quick breakfast with my wife although I was sick with the flu, but I thought it would make me feel better”. We observe individuals on a near daily basis who have a cold or flu (raised temperature, clearly sweating but experiencing cold, coughing etc), mostly at restaurants or airports.

3. COVER YOUR NOSE AND MOUTH IF YOU COUGH OR SNEEZE – Cover your nose and mouth if you cough or sneeze whether you wear a mask or not, and no spitting. These behaviours reduce risk. Some nations now offer fines for non compliance.

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

5. FOOD – Food hygiene – cover food at buffets, do not touch items unless you are taking those items with you and supervise children at all times.

6. VENTILATION – Ventilation – open windows and doors to facilitate ventilation or improve ventilation in any way appropriate – this is especially relevant for #restaurants or cafes, #schools , #hospital waiting rooms and #GP practices, and any area where large groups of individuals gather eg during #transit or travel.

7. SPACE – Positive Space – create and maintain space inside and outside, in shade, with seating where individuals can rest and relax in an enjoyable quiet atmosphere. Theme parks such as #DisneyWorld can be wonderful places for #children to #enjoy, #develop and #learn, (we have liaised with numerous children in need or at risk who report their lives have changed with messages from Disney, such as “anything is possible” or “let your conscience be your guide”), however, when there are limited seating options, groups gather in small areas to rest in the same shade to keep an eye on the same seats hoping they would be available. This is also relevant for cruise liners – particularly when doing emergency drills, preparing passengers, when passengers stand in close proximity, often in hot weather.

#Airports and #airplanes are relevant here. Boarding and disembarking are often associated with chaos and several lines, up to 5 lines to board one flight, streamlining with planning and preparation is possible. Airplanes where seats are very small, passengers sit close together and passengers recline onto other passengers’ laps with no healthy or positive space is of particular concern, and avoidable. Many airlines now stop individuals from reclining, which offers more personal and positive space. We have observed, firsthand, that these positive changes are possible in airports and flight in Asia – social distancing and ventilation were facilitated, passengers were asked not to wear face masks unless they presented with clinical indications, with good clinical outcomes.

Small changes can have significant effects on health, mental health and social risk.

8. NUMBERS – Limit numbers to avoid #chaos and #crowding. It is the #culture to encourage and be proud of long #lines and #crowds – it provides messages of popularity, demand and ‘not to be missed’, however, these same factors lead to increased risk in terms of health, mental health and safety. We usually aim to avoid these contexts, by choosing quiet times or alternative options. This is especially relevant for contexts such as cruise liners and theme parks. Individuals sometimes report that they wait in 3-4 lines before entering a theme park, and then wait for approximately 5-7 hours in lines for coffee, food, entertainment or rides – this increases risk, not only during a pandemic. Most individuals report that they “cannot wait for #Disney to reopen” or “I can’t wait to get on a cruise again”, reporting benefits relating to mental health and general health, however, small changes can inspire great health benefits.

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

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

10. EVIDENCE – A commitment to follow only good clinical evidence during clinical or medical emergencies, urgent medical matters and routine medical matters – to weigh evidence-based risk and protective factors, and to first do no harm, ensuring that health and mental health related statistics (morbidity and mortality), as well as child protection statistics, improve, not worsen. A commitment to transparency and collaborative work within nations and amongst nations during clinical or medical emergencies – a global health plan for global health emergencies. These are the #strategies #doctors employ every day during #health #crises to ensure #good #clinical #outcomes (or the best chance of good clinical outcomes) – it only makes sense that these strategies be employed on a larger scale, a #global scale, as part of a global health plan, to protect nations.

Medical doctors engaging in clinical work (who work with patients) usually do not use strategies based on inconsistent or weak evidence – they focus on strategies (recommendations or management plans or treatment) based on good clinical evidence only – before they return to the drawing board (if good outcomes are not achieved) and reconsider their risk assessment, clinical impression and management plan, asking themselves if they have missed anything, liaising with colleagues, and then if the answer is ‘no’, they possibly consider more creative options.

We have been asked whether face masks should be part of a new normal. We would strongly advised that face masks not be #normalised in any way. Face masks have a specific clinical indication where they are likely to be of benefit for certain individuals. We have liaised with the relevant Health Commissions and Health Ministries regarding these concerns, including relating to children in the context of child development and schools.

Based on our experience travelling through different countries, meeting with individuals from various cultural backgrounds, ranging from the most vulnerable to the most fortunate, it is our opinion that these 10 items would improve morbidity and mortality statistics for every child and every adult markedly, in the context of the pandemic, future pandemics and general health risks.

Many countries in Asia reported that they were prepared for the pandemic, based on previous experiences, and that they believe it is likely that repeat occurrences will be relevant. Statistics support their approaches. It is unfortunate that many now report pressure from countries with less experience in infectious diseases to comply with initiatives not based on good clinical evidence.

Let’s learn from our neighbours and follow good evidence to reduce risk and to protect.

#NewNormal #education #children #space #medical #doctors #psychiatrists #travel #health #mentalhealth #volunteer #socialrisk #flight #cruiseline #cruise #themepark #entertainment #symptoms #achievable #sustainable

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

CURRENT EVIDENCE REGARDING FACE MASKS December 2020 and January 2021

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

Indiscriminate Mandatory Face Mask Initiatives:  Evidence and Recommendations

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Conclusion

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

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

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

#evidence #recommendations #healthy #travel #children #schools #smoking #drinks #Cambridge #UK #ChildPsychiatrist #Mentalhealth #Health #International #ServiceDevelopment #OutreachWork

Liberty linked to Peace

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

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

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

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

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

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

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

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

#liberty #children #development #safety #wellbeing #evidence #ProtectiveFactor #peace #identity #doctor #medicine #medical #psychiatrist #free #freedom

#Cambridge #UK #ChildPsychiatrist #Mentalhealth #Health #International #ServiceDevelopment #OutreachWork

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

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

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

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

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

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

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

What can you do now?

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

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

For today – think about your thoughts.

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

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

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

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

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

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

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

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

Nothing is worth more than this day. #Goethe

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

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

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

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

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

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

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

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

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

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

Master your thoughts to master your life. A #Lincoln

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

How do I start to do this?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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